Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm Test - 4 > Test 4 > Flashcards

Test 4 Flashcards

1
Q

What Types of medications may worsening HF symptoms?

A
  1. NSAIDs
  2. Chemotherapy medications
  3. TZDs
  4. CCBs
  5. Saxagliptin
  6. Alpha Blockers
  7. Itraconazole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is Stage A HF treated?

A

Fix underlying issues

Ex:

HTN
Lipids
Weight
DM
Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is stage B HF treated (Class 1)?

A
  1. ACEi / ARB (in patients with reduced EF)
  2. Beta-Blockers
  3. Statins (h/o of MI)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is stage B HF treated (Class III)?

A

Non-dihydropyridine CCBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is Stage C HF with a reduced EF treated?

A
  1. ACEi / ARB
  2. Beta-Blockers
  3. Aldosterone Agonist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Sacubitril/Valsartan (Entresto) is a ___________ receptor blocker/neprilysin inhibitor.

A

Angiotensin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Sacubitril is a __________ inhibitor

What does it promote?

A

Neprilysin

Natrieuresis
Vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a major contraindication in the use of Entresto?

A

Angioedema (related to ACEi / ARB use)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some ADRs of Entresto?

A 
Hypotension 
Hyperkalemia
Cough
Dizziness
Renal Failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Ivabradine is a _____ channel inhibitor. (used in HF patients with an EF <35%)

T/F: This will lower heart rate with inotropic effects

A

HCN

False (It has NO inotropic effects)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What ADRs are associated with Ivabradine?

A

Bradycardia
HTN
Afib
Luminous Phenomena (Visual Brightness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What class of medication is recommended in HF patients with fluid retention?

A

Diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What should be monitored in a patient taking diuretics?

What should you do to the dosing if the patient notices increased edema or SOB?

A

Monitor the patient’s dry weigh and daily weights

If they notice increased edema or SOB, increase the dose and symptoms should improve in 3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What “type” of medication is used to treat…..

Hypokalemia

A

K+ Supplements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T/F: K+ supplements have NO effect on BP

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When are contraindications to K+ supplement use?

A

Renal Impairment
Gastroparesis
GI Transit Issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are ADRs of K+ supplements?

A 
Hyperkalemia
Nausea
Vomiting
Diarrhea
Flatulence
Abdominal Pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What drug is used for hyperkalemia treatment?

A

Kayexalate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If a patient has has a bowel ________, then use of kayexalate is contraindicated.

A

Resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some ADRs of Kayexalate?

A 
Hypokalemia
Gastric Irritation
Nausea
Vomting
Anorexia
Constipation
Electrolyte Imbalance

BEZOARS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is used to treat Stage C HF (Class 2a)

A

Digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Digoxin inhibits the function of ___-__-_____ and regulates _____ overactivation

Do Digoxin have a positive or negative chronotropic effect?

Inotropic?

A

Na-K-ATPase

SNS

Negative

Positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

T/F: Digoxin is renally eliminated

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What two classes of ABx does Digoxin interact with?

A

Tetracyclines

Macrolides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are some ADRs of Digoxin

A 
Bradycardia
Hypotension
Arrhythmia
N/V/D, Anorexia
Blurred/Yellow vision
Headache
Dizziness
Gynecomastia (prolonged use)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Toxic doses of Digoxin cn be found in _________ (Hint: It a plant)

A

Oleander

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the Sx of an acute digoxin OD?

A 
Sinus Bradycardia
Hypotension
Hyperkalemia
Vomiting 
3rd Degree AV block
Vtach/Fib
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the Sx of an chronic digoxin OD?

A 
Sinus Bradycardia
Hypotension
Vision Changes
Afib
Hypokalemia/Magnesiumia
Weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What two medications treat a digoxin OD?

A

Digibind

DigiFab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the first line treatment for hyperkalemia?

Bradycardia?

Vtach?

A

Hyperkalemia:

  1. Furosemide
  2. Kayexalate
  3. Sodium Bicarb

Bradycardia:
1. Atropine

Vtach:

  1. Lidocaine
  2. Phenytoin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

T/F: Statins are recommended in Stage C HF treatment

A

False

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What classes of drugs should be avoided in Stage C HF treatment?

A

NSAIDs
Many Antiarrhythmics
CCBs (except amlodipine)
TZDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

________ is a endogenous catecholamine, used to treat acute decompensated HF and shock.

A

Dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What ADR is associated with Dopamine

A

Arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Dobutamine is a ____ agonist used to treat acute decompensated HF.

A

B1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the ADRs associated with Dobutamine?

A

Tachycardia
SVT
Tachyarrhythmia
HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

_________ is a PDE3 Inhibitor (Phosphodiesterase) which promotes vasodilation and smooth muscle relaxation to be used in acute decompensated HF patients.

A

Milrinone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

If milronone is given to a hypotensive patient with acute decompensated HF, would you expect the BP to improve?

A

Not likely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What ADRs are associated with Milronone?

A

Arrhythmia
Hypotension
Rare Thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What should you check prior to giving Milronone?

Think: Thrombocytopenia

A

Platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Other than Dopamine, Dobutamine, or Milronone, what medications should be continued in ADHF management?

What medications should be started?

What medications could be added to relieve dyspnea and hypotension?

A

Continue…..

  1. ACEi / ARB
  2. Beta-blockers

Start….

  1. IV Loop Diuretics
  2. Low Dose IV Dopamine

Relieve….

  1. IV NTG
  2. Nitroprusside
  3. Nesiritide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

T/F: Nitrates are prodrugs of NO

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Are nitrates vasodilators or vasoconstrictors?

A

Vasodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Nitrates are direct venous and arterial vasodilators.

Which do they have a greater effect on?

A

Veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

T/F: Nitrates have a large first pass effect

A

Ture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Do nitrates have long or short half lives?

A

Short (1-2 mins)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What ADRs are associated with Nitrates?

What is a unique ADR that effects the blood?

A

Headache
Dizziness
N/V
Hypotension

Methemoglobinemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What drugs/medications/substances interact with nitrates?

A

Alcohol
CCBs
PDE-5s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

You need a __ hr nitrate free interval to decrease nitrate tolerance

A

12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

This form of nitrate can be taken sublingual, buccal, as a spray, or in ointment form.

It typically relieves pain within 3 minutes.

A

Nitrogylcerin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the maximum number of NTG tablets you should take?

What should you do if you reach this number and the pain is not relieved?

A

3

Call 911

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

___________ is a peripheral arterial vasodilator commonly used in eclampsia, in combination to treat HTN, and in combination with a nitrate to treat angina

A

Hydralazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What ADRs are associated with hydralazine?

A 
Headache
Nausea
Sweating
Anorexia
Reflex Tachycardia
Lupus like reaction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

___________ is a vasodilator used to treat HTN but also has the unique effect of hair growth.

It works to open K+ channels.

A

Minoxidil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What ADRs are associated with Minoxidil?

A 
Salt/Fluid Retention
Increased HR
Palpitations
Angina
Edema
Hirsutism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

_______________ is a vasodilator used in a hypertensive emergency and acts on the peripheral arterioles.

A

Diazoxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What ADRs are associated with Diazoxide?

A 
Transient hyperglycemia
hypotension
N/V
Weakness
dizziness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

___________ _____________ is a vasodilator that activate guanylyl cyclase to dilate arterioles and veins.

It is used for short term management of ADHF

A

Sodium Nitroprusside

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

In what condition is sodium nitroprusside contraindicated?

A

Cerebral edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

_____________ is a form of recombinant human BNP and used largely for ADHF.

A

Nesiritide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

In what conditions is use of Nesiritide contraindicated?

A

Cardiogenic Shock

Hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What ADRs are associated with Nesiritide?

A 
Headache
Hypotension
Nausea
Back Pain
Worsening renal failure (Monitor sCR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What are the Class 1a Anti-arrhythmics

A

Quinidine
Procainamide
Disopyramide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What medication is a Class 1b anti-arrhythmic?

A

Lidocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What medications are Class 1c anti-arrhythmics?

A

Flecainide

Propafenone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What medications are Class 2 anti-arrhythmics?

A

(Beta-blockers)

Propanolol
Metoprolol
Esmolol
Timolol
Atenolol
Carvedilol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What medications are Class 3 anti-arrhythmics?

A 
Sotalol
Ibutilide
Dofetilide (Tikosyn) 
Amiodarone
Dronedarone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What medications are class 4 anti-arrhythmics?

A

Verapamil

Diltiazem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Quinidine blocks ___ and ____ channels as well as slows conduction through the heart and _______ the QRS

A

Na+
K+

Prolongs QRS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Quinidine can prolong the QT interval putting a patient at risk for what arrhythmia?

A

Torsades

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Other than Torsades, what ADRs are associated qith Quinidine?

A 
Syncope
Asystole in patients with sick sinus syndrome
Hypotension
Cinchonism
Hypersensitivity 
N/V/D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Quinidine ________ the plasma level of digoxin

A

Increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

________________ is a class 1a anti-arrhythmic which acts similarly to Quininide but is more effective.

A

Procainamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Procainamide is more effective with _____________ (atrial/ventricular) arrhythmias

A

Ventricular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What ADRs are associated with Procainamide?

A 
QT Prolongation (Torsades) 
Syncope
Lupus Erythematous Syndrome
N/V?D
Hypotension (Rapid Administration)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Disopyramide is more effective with _____________ (atrial/ventricular) arrhythmias

A

Ventricular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Disopyramide is metobilzed by CYP3A4 so it should be used with caution in CYP3A4 inhibitors like ______ or ________.

A

Verapamil

Diltiazem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What ADRs are associated with Disopyramide?

A

QT-Prolongation (Torsades)

CHF Sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

In patients with ______, disopyramide should be avoided.

A

CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Lidocaine is more effective with _____________ (atrial/ventricular) arrhythmias

A

Ventricular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

T/F: Lidocaine blocks both inactive and active Na+ channels

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Lidocaine is the first line drug of choice in treatment of ventricular arrhythmias due to _____

A

AMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What ADRs are associated with Lidocaine?

A 
Neurological Effects (parasthesias, tremor, convulsions) 
Hypotension (CHF)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Flecainamide is used in _____________ arrhythmias and can supress PVCs

A

Supraventricular

Namely Afib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

This class 1c anti-arrhythmic is used to _________ sinus rhythm in patients with supraventricular arrhythmia

A

Propafenone (Rythmol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What ADRs are associated with Propafenone?

A

Metallic Taste

Constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What are three uses of Sotalol?

A
  1. Life-threatening ventricular arrhythmias
  2. Maintain sinus rhythm in atrial fibrillation
  3. Pediatric arrhythmia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What ADRs are associated with Sotalol

A

Torsades

LV Depression in CHF patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Ibutilide (Corvert) is used for acute cardioversion of ______ _______ or _______ _______ to NSR.

A

Atrial Flutter

Atrial Fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Dofetilide (Tikosyn), used to treat Afib, is initiated in the ________ due to ADRs of……..

A

Hospital

Prolonged QT
Bradycardia
Hypokalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

An IV loading dose of Amiodarone might cause what?

TWO Things

A

AV Block

Bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Amiodarone is a CYP3A4 substrate so…..

Durgs like Cimetidine (a CYP3A4 inhibitor would ___________ levels of amiodarone

Durgs like Rifampin (a CYP3A4 inducer would ___________ levels of amiodarone

A

Increase

Decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What should happen to a patient’s Warfarin dose is amiodarone is given?

A

It should be cut in half

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What are THREE uses for amiodarone?

A
  1. Recurrent and refractory arrhythmias
  2. WPW associated arrhythmias
  3. Maintain NSR in Afib patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What ADRs are associated with amiodarone?

A 
Bradycardia, Heart Block
Pulmonary Toxicity
Abnormal LFTs
Gray-Blue skin
Photodermitis 
Corneal Microdeposits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What are uses for CCBs in terms of anti-arrhytmics?

A

Supraventricular Arrhythmia

Reduce Ventricular rate in Afib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

__________ is a nucleoside made naturally in the body with a half life of 10 seconds and is a supressor of calcium dependent action potentials

A

Adenosine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

When treating SVT with adenosine doses should be given at __ mg followed by ___ mg if necessary

A

6 mg followed by 12 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Adenosine is contraindicated in patients with ______ or ________.

A

Asthma

Bronchospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Adenosine is contraindicated in patients with a __ _______.

A

AV Block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What ADRs are associated with Adenosine

A 
Bronchospasm
CP
SOB
Flushing
AV Block
Hypotension
Afib
Headache
Nausea
Palpitations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What are THREE uses for Mg2++

A
  1. Torsades
  2. Sinus Tachycardia
  3. Digitalis induce arrhythmia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What class of anti-arrhythmics is used in patients with structurally sound hearts?

A

Class 1c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Most of the anti-arrhythmics should be avoided in patients with CHF and CAD, except which two?

A

Amiodarone
Dofetilide (Tikosyn)

(In CAD only Sotalol can also be used)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What anticoagulant works to inhibits vitamin K reductase and inhibits clotting factor production in the liver?

What clotting factors does it inhibits?

A

Warfarin (Coumadin)

Factors II, VII, IX, X

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

T/F: Warfarin is metabolized by CYP450 so it DOES NOT interact with everything

A

False

It does interact with everything

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

The anticoagulant effect of Warfarin is measured by what lab value?

What is the normal lab value?

A

INR (2-3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What are the indications for Warfarin use?

A
  1. ACS following ASA
  2. DVT (Second Line)
  3. Afib (First Line)
  4. Valvular Disease (First line in mechanical valves)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What medications should be avoided in Warfarin use?

A
  1. NSAIDs
  2. Other antiplatelets
  3. Some ABx (Ceohalosporins, Bactrim, Flagyl, FQs, Amox, Doxy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What are the signs and symptoms of a Warfarin toxicity?

How is it treated?

A

Bruising
Bleeding (everywhere)

Tx:

Transfusion
Vitamin K1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What should be considered prior to starting anticoagulants such as Warfarin?

A

The patient’s bleeding risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

If the INR is elevated (>4) what should you do to the Warfarin dose?

A

Lower or skip dose

If severely elevated may need to miss several doses to get the INR back in range

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Other than bleeding and bruising, what additional ADRs are associated with Warfarin use?

A 
Hypersensitivity
Vasculitis
Elevated LFTs
N/V/D, Flatulence
Rash, Dermititis
Chills
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

______ ___ syndrome is associated with Warfrin use and is caused by small atherothrombi.

A

Purple Toe Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

______ _____ occurs with Warfarin use in the setting of protein C deficiency and is most common in middle age women being treated for DVT.

A

Skin Necrosis (WISN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What anticoagulant is derived from pig mast cells and works by accelerating the binding of antithrombin III to thrombin.

A

Heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What are the indications for Heparin use?

A
  1. DVT / PE prophylaxis
  2. Anticoagulant for PCI
  3. STEMI / NSTEMI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

_______ is a low molecular weight Heparin which targets Factor Xa

A

Enoxaparin (Lovenox)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

T/F: Heparin does not cross the placenta

A

True (Preferred in pregnancy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Heparin is often used as a ____ ________ to Warfarin use?

What does this help prevent?

A

Bridging therapy

prevents the pro-coagulant effect of initial Warfarin therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

How is a Heparin OD treated?

A

Replace blood loss
Observation
Antidote (Protamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What is the name of the Heparin antidote and how does it work?

A

Protamine

Binds and inactivates Heparin (onset in 30-60 minutes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Is anaphaylaxis seen with Protamine?

If yes, watch drugs should you have on hand?

A

Yes

Epinephrin
Diphenhydramine
H2 Blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Other than bleeding, what ADRs are associated with Heparin use?

A

Elevated LFTs
Osteoporosis
Heparin Induced thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

HIT can be seen within ____ to ___ days after heparin therapy is started.

A

2 to 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

In type 1 HIT how fast does the platelet count fall?

Type 2?

Which is more serious?

A

Type 1: 2-3 days

Type 2: 4-10 days (More serious)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

T/F: White Clot syndrome is associated with Type 1 HIT

A

False (Type 2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

How is HIT treated?

A
  1. Stop Heparin
  2. Document Heparin allergy
  3. Use alternative anticoagulant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

__________ ___________ was the first direct oral anticoagulant which prevents the conversion of fibrinogen to fibrin.

A

Dafigatran etexilate (Pradaxa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What are the indications for dabigatran etexilate use?

When is it contraindicatied?

A

Indication:
Reduce CVA risk in nonvalvular Afib

Contraindication:
Mechanical valves
renal failure
liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

T/F: Rifampin, Amiodarone, and Verapamil all interact with Pradaxa and should be avoid

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

What ADRs are associated with Dabigatran Etexilate?

A 
N/V/D
Fatigue
Edema
Dizziness
Headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

How is Pradazxa toxicity treated?

What is the name of the reversal agent?

A

Diuresis and hemodialysis FFP

Idarucizumab (Praxbind)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

When Warfarin and Pradaxa are compared in regards to Afib treat……

Praxada _____ more strokes when compared to warfarin but had a _______ risk of major GI bleeding

A

prevents

higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

What are the TWO Factor Xa inhibitors?

A

Rivaroxaban (Xarelto)

Apixaban (Eliquis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

What are the indications for Rivaroxaban (Xarelto) use?

A
  1. Reduce CVA risk in patients with Afib
  2. DVT prophylaxis/Tx
  3. PE Prophylaxis/Tx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

T/F: Rivaroxaban is metabolized by P-glycoprotein, which is similar to CYP3A4

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

What ADRs are associated with Rivaroxaban?

A
  1. Bleeding
  2. Increased CVA risk after discontinuing in Afib patients
  3. Spinal/Epidural hematoma
  4. Abdominal pain
  5. Dyspepsia
  6. Fatigue
  7. Back Pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

What are the indications for Apixaban (eliquis) use?

A

Reduce CVA risk in nonvalvular Afib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

T/F: Apixaban (Eliquis) is NOT a substrate of CYP3A4

A

False

It is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Is there a specific antidote for Apixaban (Eliquis)

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Which anticoagulant should be used in patients with renal failure?

prosthetic heart valves?

decreased ischemic stroke risk?

A

Warfarin

Warfarin

Dabigatran

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

T/F: Anticoagulants can often be continued through minor dental procedures, skin surgeries, or cataract surgery

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Should anticoagulants be continued through invasive surgery?

When should they be restarted?

A

No

Restart 12-24 hours post-op

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

______ is an antiplatelet drug that inhibits COX1 and TXA2

A

Aspirin (ASA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

What are indications for ASA use?

A
  1. Pain Relief
  2. Fever Reducer
  3. Inflammatory treatment
  4. Secondary TIA prevention
  5. Post-MI or CAD patients
  6. Primary Prevention of ischemic cardiac events
  7. Kawasaki’s disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

What ADRs are associated with ASA use?

A

GI Bleed
Abdominal pain, N/V
Decreased Renal Function

148
Q

_____ _______ commonly occurs when ASA is given to children with influenza or chicken pox.

Sx include….

Vomiting
Somnolence
Diarrhea
Tachypnea
Irritabilty
A

Reye’s Syndrome

149
Q

What composes the “ASA Triad”?

A

Asthma
Nasal Polyps
ASA Sensitivity

This can result in a life-threatening asthma attack

150
Q

What dose of ASA is given in “MONA Therapy” in AMI?

A

325 mg

151
Q

___________ works to inhibit DP receptor binding and ADP activation in the G protein complex to block platelet activation and aggregation irreversibly.

A

Clopidogrel (Plavix)

152
Q

What are the indications for Clopidogrel (Plavix) use?

A
  1. Unstable angina / NSTEMI (Reduce CVA/MI risk deaths)
  2. STEMI (reduce re-infarct)
  3. Recent MI / CVA
  4. PAD
153
Q

T/F: Clopidogrel has a increased effectiveness in poor etabolizers

A

False

It has a diminished effect

154
Q

Other than bleeding, what ADR is associated with Clopidogrel?

A

TTP

155
Q

This anti-platelet drug is a prodrug which inhibits ADP-dependent platelet aggregation and activation

A

Prasugrel (Effient)

156
Q

T/F: Prasugrel (Effient) is converted to an active metabolite by CYP3A4

A

True

157
Q

Other than active bleeding, what is a contraindication of Prasugrel (Effient) use?

A

Previous TIA / CVA

158
Q

This anti-platelet drug is a direct acting, REVERSIBLE P2Y12 inhibitor which has a greater effect on platelet inhibition.

A

Ticagrelor (Brilinta)

159
Q

T/F: Ticagrelor is metabolized by CYP 3A4

A

True

160
Q

This anti-platelet drug also acts as a vasodilator and is also indicated for caudication treatment

A

Cilostazol (Pletal)

161
Q

In what cardiac disease if Cilostazol use contraindicated?

A

Heart Failure

162
Q

Why should Cilostazol be avoided in the elderly?

A

Increased syncope risk

163
Q

What ADRs are associated with Cilostazol?

A

Headache
Diarrhea
Abnormal Stools
Rhinitis

164
Q

What are the recommendations for anti-platelet therapy following PCI treatment for STEMI?

A
  1. ASA (81 mg following PCI)
  2. Plavix
  3. Effient
  4. Brilinta
165
Q

What is the antifibrinolytic drug we learned about?

What are the agents?

A

Tissue Plasminogen Activators (t-PA)

Alteplase
Reteplase
Tenecteplase

166
Q

Where does t-PA bind to fibrin

A

binds to fibrin via lysine binding sites

167
Q

What are the indications of tPA use?

A
  1. STEMI (within 12 hrs of onset, w/o PCI access)
  2. Acute CVA (Within first 4.5 hours)
  3. PE
168
Q

What are contraindications of tPA use?

A
  1. Intracranial hemorrhage/malignancy/Surgery
  2. Aortic Dissection
  3. Active bleeding
  4. Uncontrolled HTN
169
Q

Other than bleeding, what ADRs are associated with tPA?

A

Hypersensitivity
Hypotension
Cerebral Edema

170
Q

What is the name of the fibrinolytic antidotes? `

A

Aminocaproic acid
Tranexamic Acid
Lysine anolog

171
Q

What is improtant to remember in assessing a patient’s stool patterns for constipation or diarrhea?

A

Everyone has their own “normal”

172
Q

What classes of medications commonly have constipation as an ADR?

A 
Opiods
Anticholinergics
Antidepressants
Antacids
Iron
Verapamil
173
Q

What is first line for constipation treatment?

What can this be combined with to improve bowel movements?

A

Soluble fiber (20-25g daily - slow increase)

Increased fluids
Increased exercise

174
Q

What are the bulk-forming laxatives

A 
Psyllium (Metamucil) 
ethylcellulose (Citrucel) 
Calcium polycarbophil (Fibercon) 
Fiber inulin (Metamucil clear) 
Wheat Dextrin (Benefiber) 
Malt Soup Extract (Maltsupex Liquid)
175
Q

How do the bulk forming laxative work?

A

Dissolve or sell in intestinal fluid to distend colon and promote peristalsis

176
Q

Are bulking agents a good option for the elderly or post-partum women?

A

Yes

In general this is a good choice in patients who need to avoid straining

177
Q

What ADRs are associated with bulk-forming laxative?

A

Bloating
Flatulence
Cramping

178
Q

Should bulk-forming laxatives be avoided in with DM?

Megacolon?

Fecal Impaction?

A

Yes

179
Q

What are the emollient laxatives (“stool softners”)?

A 
Docusate Sodium (Colace) 
Docusate Calcium (Kaopectate)
180
Q

How do emollient laxatives work?

A

Increase wetting of intestinal fluid to create a soft mass

181
Q

Are emollient laxatives a good choice for colostomy patients?

A

Yes

182
Q

What are common ADRs of emollient laxative use?

A

Diarrhea

Abdominal Cramping

183
Q

T/F: Mineral Oil is a Emolient laxative

A

True

184
Q

Why should you not take Mineral Oil at bed time?

What is this

A

To avoid lipid pneumonia

PNA caused by ingestion or inhalation of mineral oil

Sx include….

Hemoptysis
Cough
Dyspnea

185
Q

What are the saline laxatives?

A 
Magnesium Citrate (Citroma)
Magnesium Hydroxide (Phillip's Milk) 
Magnesium Sulfate (Epsom Salt)
Magnesium Oxide (Mag-Ox)
Sodium Phosphate (Fleet Phospho-Soda)
186
Q

How do Saline Laxatives work?

A

Increases SI intestinal pressure and stimulates intestinal motility

187
Q

Are Saline laxatives a good choice for patients who need complete bowel evacuation?

A

Yes

188
Q

Are saline laxatives contraindicated in patients with and ileostomy, colostomy, or renal impairment?

A

Yes

189
Q

What ADRs are associated with saline laxatives?

A

N/V/D
Cramping
Dehydration

190
Q

Saline laxatives should be taken on an ________ stomach.

A

Empty

191
Q

What are the TWO hyperosmotic laxitives?

A
  1. Glycerin (Fleet Suppository

2. Polyethylene glycol (Miralax / Dulcolax)

192
Q

How do hyperosmotic laxatives works?

A

Create an osmotic effect in combination with an irritating effect to cause a BM

193
Q

Are hyperosmotic laxatives more useful for chronic or occasional laxatives?

A

Occasional

194
Q

What are the most common ADRs associated with hyperosmotic laxatives

A 
Rectal irritation 
Bloating
Cramping
Flatulence
Diarrhea
195
Q

This non-digestible sugar is a prescription only “anti-constipaiton” medication

A

Lactulose

196
Q

Lactulose is useful in treating constipation in the elderly as well as in _______-induced constipation

A

opioid-induced

197
Q

What ADRs are associated with Lactulose?

A 
Diarrhea
Flatulence
Nausea
Abdominal Discomfort 
Bloating
198
Q

Lactulose can also be given to treat _________ ___________

A

Hepatic Encephalopathy

199
Q

What are the sugar alcohols that are used to treat constipation

A

Sorbitol
Mannitol
Xylitol

200
Q

Sugar alcohols may effect ______ levels in diabetes

A

glucose

201
Q

What are the stimulant laxatives used to treat constipation?

A 
Sennosides (Senoket) 
Bisacodyl (Dulcolax) 
Castor Oil
Aloe
Cascara Sagrada
202
Q

How do stimulant laxatives work?

A

Increase peristalic activity of intestines via irritation.

Irritation also stimulates water accumulation and intestinal motility.

203
Q

When should stimulant laxatives be used?

A
  1. Colostomies
  2. Opioid use
  3. Bowel evacuation prior to GI procedures
204
Q

Castor oil should be avoided in ________.

A

Pregnancy

205
Q

___________ + _______ is the best combination to treat opioid induced constipation

A

stimulant + Emollient

Senokot-S or Perdiem Granules

206
Q

_______ are great to use in children

A

Probiotics

207
Q

What are TWO non-pharmacological ways to manage constipation in children?

A
  1. Establish a regular toileting routine

2. Consider a change in diet

208
Q

What medications are recommended in children to treat constipation?

What should be AVOIDED?

A
  1. Docusate or MOM
  2. Glycerin suppositories (2-6 y.o.)

Avoid…

Mineral Oil
Castor Oil
Magnesium Sulfate

209
Q

What is the most common age group effected by constipation?

A

Elderly

210
Q

______-________ laxatives are the first line choice in elderly with constipation?

What should be avoided?

A

Bulk-forming laxatives

Avoid….

Saline Laxatives
Mineral Oil

211
Q

What anti-constipation medications should be avoided in pregnancy?

A

Mineral oil
Caster Oil
Saline Laxatives

212
Q

This intestinal secretagogue is a prostaglandin E derivative that actives CIC-2 to increase fluid secretion to aid in the passage of stools.

A

Lubiprostone (Amitiza)

213
Q

What are the indications for Lubiprostone?

A
  1. Chronic Idiopathic Constipation

2. Constipation in IBS

214
Q

What ADRs are associated with Lubiprostone?

A

Nausea (take with food to reduce)
Diarrhea
Dyspnea

215
Q

This intestinal secretagogue is a guanylate cyclase agonist that increases Cl- channel activity which increases fluid secretion and intestinal motility.

A

Linaclotide (Linzess)

216
Q

What are the indications for Linaclotide use?

A
  1. Idiopathic chronic constipation

2. Constipation in IBS

217
Q

What are the contraindications for Linaclotide use?

A
  1. Pediatrics

2. Mechanical Bowel Obstruction

218
Q

What ADRs are associated with Linaclotide use?

A 
Diarrhea
Abdominal Pain
Headache
Flatulence
Gastroenteritis
Bloating
GERD
Vomiting
Fatigue
219
Q

__________ is the newest medication for idiopathic chronic constipation, which is a guanylate cyclase-C agonist structurally identical to uroguanylin that increases fluid movement into the intestinal lumen

A

Plecanatide (Trulance)

220
Q

T/F: Plecanatide is contraindicated in kids under 12 y.o

A

False

Contraindicated in kids under 6 yo.

221
Q

What is the most common ADR associated with Plecanatide?

Most severe?

A

Diarrhea

Dehydration

222
Q

In what age group is diarrhea more common?

A

Children less than 5 y.o.

223
Q

What types of medications are associated with diarrhea?

THERES A LOT

A
  1. Antibiotics
  2. Metformin
  3. SSRIs
  4. Mg2+ containing antacids
  5. Colchicine
  6. Corticosteroids
  7. Digoxin
  8. Diuretics
  9. Laxatives
  10. Chemotherapy
  11. Propanolol
  12. Quinidine
224
Q

What is a common, more serious, result of diarrhea, especially in children?

How can this be treated non-pharmocologically?

If you have diarrhea should you continue eating?

A

Fluid lose and electrolyte imbalance

FLUID REPLACEMENT:
Pedialyte in children
Soup in adults

YES! (Small meals, avoid fats/spices, limit dairy)

225
Q

What are the anti-motility agents used in diarrhea treatment?

A
  1. Loperamide (Imodium)
  2. Diphenoxylate/Atropine (Lomotil)
  3. Morphine
  4. Difenoxin/Atropine (Motofen)
226
Q

What anti-motility drug is the treatment of choice in most cases of diarrhea treatment?

A

Loperamide (Imodium)

227
Q

How does Loperamide work?

A

Opioid agonist

Slows intestinal motility
Allows for absorption

228
Q

When should Loperamide be avoided?

A

Avoid in bloody diarrhea or inflammatory processes

229
Q

T/F: The FDA warns that Loperamide has an abuse potiential (especially in opioid withdrawal treatment) and has been linked to cardiac events like torsades, ventricular arrhythmias, or SCD

A

True

230
Q

What common ADRs are associated with Loperamide?

A 
Dizziness
Constipation
Abdominal Pain
 Dry Mouth
Sedation
231
Q

Should loperamide be avoided in children under 6 y.o.?

In C. Diff patients?

A

YES

232
Q

Diphenoxylate works to ________ GI transit time and is used in combination with atropine which is a ___________ that inhibits smooth muscle tone in the GI tract decreasing ________

A

Lengthens

Anti-cholinergic

Peristalsis

233
Q

Should Diphenoxylate/Atropine (Lomotil) be used in children under 2 y.o.?

A

No

234
Q

What ADRs are associated with Diphenoxylate/Atropine?

A
  1. Sedation
  2. Dizziness/Headache
  3. Abdominal Pain
  4. N/V
  5. Anaphylaxis
  6. Toxic Megacolon in UC patients
235
Q

T/F: Alcohol will interact with Diphenoxylate/Atropine

A

True

236
Q

Difenoxin is an _________ metabolite of Diphenoxylate with a similar MOA and ADRs

A

Active

237
Q

What are the anti-secretory agents used to treat diarrhea

A

Bismuth Subsalicylates (Pepto Bismol)
Lactase Enzymes
Probiotics
Octreotide

238
Q

How does Bismuth Subsalicylate (Pepto) work?

A

Reacts with hydrochloric acid in the stomach to form bismuth oxychloride and salicylic acid

Increases stool consistency
Decrease N/V/D

239
Q

Why should Bismuth Subsalicylates be avoid in children under 12 y.o?

What could an overdose cause?

A

Reye’s Syndrome risk in children

OD can result in neurotoxicity

240
Q

Should Bismuth Subsalicylates be used in pregnancy?

A

No

241
Q

T/F: Bismuth Subsalicylates does NOT interact with Warfarin, tetracyclines, or ciprofloxacin

A

False

It does

242
Q

_______ is a anti-secretory agent that is used in patients with diarrhea due to lactose intolerance

A

Lactase (Lactaid)

243
Q

________ is an opioid receptor agonist used to treat IBS related diarrhea in adults.

A

Eluxadoline (Viberzi)

244
Q

In what conditions is Eluxadoline contradindicated

A

Hepatitis
Pancreatitis
Alcohol Abuse

245
Q

This anti-secretory agent is a somastatin analog used to treat diarrhea associated with a VIP tumor or acromegaly

A

Octreotide

246
Q

_________ __ is commonly used to treat rectal hemorrhoids

A

Preparation H ointment

247
Q

What are the anticholinergic medications (antispasmodics) which work to increae motility to decrease abdominal pain

Are these typically used short-term, PRN, or long-term?

A

Dicyclomine (Bentyl)
Hyoscyamine (Levsin)
Methscopolamine

Short-term or PRN

248
Q

__________ is a antimuscarnic (anticholinergic) that relaxes smooth muscle spasm in the GI tract

A

Dicyclomine (Bentyl)

249
Q

Is dicyclomine (Bentyl) contraindicated in GI obstruction, Reflux, and Glaucoma?

A

Yes

250
Q

What ADRs are associated with Dicyclomine (Bentyl)?

A
  1. Dry mouth, N/V, constipation
  2. CNS effects
  3. Blurred vision, diplopia
  4. Urinary Hesitancy/retention
  5. Tachycardia
  6. Dyspnea, apnea
  7. Lactation Suppression
251
Q

What class of anti-arrhythmics does Dicyclomine (Bentyl) interact with?

A

Class 1

252
Q

_________ is a 5-HT3 receptor agonist that prevents serotonin binding that blocks abdominal pain signals and reduces GI secretion

A

Alostetron (Lotronex)

253
Q

What are the indications for Alostetron (Lotronex) use?

A
  1. Severe IBS associated diarrhea that has not responded to typically treatment
254
Q

What are contraindications of Alostetron (Lotronex) use?

A
  1. Constipation

2. Severe hepatic/bowel disorders

255
Q

T/F: Alosetron is metabolized by CYP3A4

A

True

256
Q

What ADR is associated with Alostetron (Lotronex) use?

What should you do?

What can it progress to?

A
  1. Constipation

d/c immediately b/c it can progress to Toxic Megacolon or obstruction

257
Q

_________ is similar to Dicyclomine, but is not FDA approved

A

Hyoscyamine (Levsin)

258
Q

________ ___ is a supplement that works similar to antispasmodics to slow peristalsis and relax GI smooth muscle

A

Peppermint Oil

259
Q

What ADRs are associated with Peppermint Oil?

A
  1. Dyspepsis
  2. N/V
  3. Hypersensitivity
260
Q

T/F: Peppermint Oil is a mild P450 inducer

A

False

Inhibitor

261
Q

______ are typically used to treat IBS.

What are examples of these?

A

Salicylates

Mesalamine
sulfasalazine
olsalazine
balsalazide

262
Q

_______ is a salicylate and is the drug of choice for UC treatment

A

Sulfasalzine (Azulfidine)

263
Q

What ADRs are associated with Sulfasalzine (Azulfidine) use?

A
  1. Nausea, Diarrhea, Abdominal Pain
  2. Photosensitiity
  3. Reversible oligospermia
  4. Hepatotoxicity
  5. Rare renal toxicity
  6. Rare serious rash (Stevens-Johnson)
  7. Rare blood dyscrasias
  8. Rare goiter, hypoglycemia, diuresis
264
Q

_____________ is a salicylate that is believed to have anti-inflammator effects and is indicated for the treatment of UC

A

Mesalamine

265
Q

What is the most concerning ADR associated with Mesalamine?

A

Mesalamine-induced acute intolerance syndrome

(Cramping, bloody diarrhea, fever, headache, rash)

Discontinue the drug if you see this

266
Q

___________________ is a corticosteroid used in the management of moderate to severe IBD and mild to moderate Crohn’s Disease

A

Budesonide (Entocort)

267
Q

________ is the most effective corticosteroid in the use of moderate to severe Crohn’s Disease or IBD not responding to mesalamine

A

Prednisone

268
Q

What should be monitored when giving corticosteroids?

A
  1. Adrenal Insufficiency
  2. BMD
  3. Eye Exam
  4. Hyperglycemia
  5. Infection
269
Q

What are the two purine antimetabolites which act as immunosuppressants?

What are their indications?

A

Azathioprine (AZA) which is used in transplant rejection and RA

6-mercaptopurine (6-MP) which is used in Leukemia

270
Q

Are purine anti-metabolites indicated in pregnancy?

A

No

271
Q

What ADRs are associated with purine antimetabolites?

A
  1. Increased risk of lymphoma/malignancies
  2. Bone marrow suppression (Monitor CBC)
  3. N/V
  4. Hepatotoxicity
  5. Rash, Fever, Arthralgia
272
Q

What are the TWO Tnf-alpha inhibitors

A

Infliximab (Remicade)

Golimumab (Simponi)

273
Q

What are the indications for Tnf-alpha inhibitor use

A
  1. Crohn’s
  2. UC
  3. RA
274
Q

How do Tnf-alpha inhibitors work?

A

Block tumor necrosis factor alpha

275
Q

In what condition are Tnf-alpha inhibitors contraindicated

A

CHF

276
Q

What types of medications relax the LES?

A

NItrates
CCBs
Beta-blockers
Anticholinergics

277
Q

What foods/drinks worsen GERD Sx?

A 
Alcohol
Carbonated Drinks
Chocolate
Coffee
Fatty Foods
Peppermint
Spicy Food
Tomato Products
278
Q

What are FOUR examples of antacids?

A

Aluminumon Hydroxide
Magnesium Hydroxide
Calcium Carbonate
Sodium Bicarbonate

279
Q

How do antacids work?

A

They neutralize stomach acids as weak bases

280
Q

What ADRs are associated with Sodium Bicarbonate?

Calcium Carbonate?

Magnesium hydroxide?

Aluminum Hydroxide?

A
  1. Gastric Distension
  2. Eructation
  3. Fluid retention
  4. Metabolic Alkalosis in higher doses
  5. Eructation
  6. Metabolic Alkalosis
  7. Diarrhea
  8. Constipation
281
Q

What are the FOUR H2 receptor blockers?

Histamine receptor antagonists

A
  1. Ranitidine (Zantac)
  2. Famotidine (Pepcid)
  3. Nizatadine (Axid)
  4. Cimetidine (Tagamet)
282
Q

How do H2 receptor blockers work?

A

Competitively inhibit parietal H2 receptors for great potency and longer duration of action than antacids

283
Q

What are the indications for H2RAs use?

A
  1. Gastric and duodenal ulcers
  2. Short-term treatment of uncomplicated GERD
  3. Stress ulcer prophylaxis
  4. Hypersecretory conditions
284
Q

What ADRs are associated with Famotidine (Pepcid) and Nizatadine (Axid)?

A

Headache
Dizziness
Diarrhea
Constipation

285
Q

T/F: Ranitidine will interact with Warfarin, Ketoconazole, Glipizide (Increase levels), Procainamide (increases levels)

A

True

286
Q

T/F: Cimetidine is a P45o inducer

A

False

It is an inhibitor

287
Q

What ADRs are associated with Cimetidine?

A 
Diarrhea
Dizziness
Headache
Gynecomastia (Long term) 
Bradycardia
Tachycardia
Agranulocytosis
288
Q

How do Proton Pump Inhibitors work?

A

Ireversibly block proton pumps on parietal cells which is the terminal step in HCL production.

289
Q

T/F: Proton Pump Inhibitors are prodrugs

A

True

290
Q

What are the indications for proton pump inhibitor use?

A

GERD
Gastric and duodenal Ulcers
Hypersecretory conditions

291
Q

What ADRs are associated with PPIs?

A
  1. Nausea, Diarrhea, Flatulence
  2. Myopathy, Arthralgia
  3. Decreased B12 absorption
  4. Increased C. diff (Elderly, ABx use)
  5. Increased Fx risk (max use 14 days up to 3x yearly)
  6. Increased PNA (S. Pneumo)
292
Q

What are the FIVE PPIs?

A
  1. Omeprazole (Prilosec)
  2. Esomeprazole (Nexium)
  3. Lansoprazole (Prevaicd)
  4. Pantoprazole (Protonix)
  5. Rabeprazole (AcipHex)
293
Q

T/F: Omeprazole and Esomeprazole interact with Clopidogrel and warfarin

A

True

294
Q

PPIs should be a course of __ weeks, starting ____ daily and moving to __ if partial response.

_______ can be added as maintenance or in combination with PPIs at bedtime.

A

8 weeks

once daily

BID

H2RAs

295
Q

At what age can antacids be used without physician recommendation?

H2RAs?

PPIs?

A

> 2y.o.

> 12 y.o.

> 18 y.o.

296
Q

What is the first line for treatment for ulcers?

A

PPI, Amoxicillin, Clarithromycin

Metronidazole can be used as an alternative to clarithromycin

297
Q

What are the THREE cytoprotective Agents?

A

Bismuth Subsalicylate (Pepto Bismol)
Sucralfate (Carafate)
Misoprostol (Cytotec)

298
Q

If Bismuth Subsalicylates are used for H. ptlori treatment what should it be used in combination with?

A

Tetracycline

Metronidazole

299
Q

T/F: Black tongue is a common side effect of Bismuth Subsalicylate

A

True

300
Q

How does Sucralfate (Carafate) work?

A

Creates a “gooey” gel that adheres to the ulcer and inhibits pepsin activity

301
Q

What are the indications for Sulcralfate (Carafate) use?

A

Short-term treatment of duodenal ulcers

302
Q

What is a contraindication for Sucralfate use?

A

Renal Disease

303
Q

What ADRs are associated with Sucralfate (Carafate)?

A
  1. Constipation
  2. Diarrhea
  3. Dry mouth
  4. N/V
  5. Flatuence
304
Q

____________________ is a prostoglandin E1 analog that binds to EP3 receptors on parietal cells to suppress acid production and stimulates the production of mucus and bicarb.

A

Misoprostol (Cytotec)

305
Q

How is Misoprostol (Cytotec) used?

A

To prevent NSAID induced ulcers

commonly packaged with diclofenac

306
Q

Misoprostol (Cytotec) is pregnancy category __.

A

X

It increases uterine contractility and can lead to miscarraige

307
Q

What non-pharmacologic treatments would you recommend for gastroporesis?

A
  1. Diet: Small Frequent Meals
  2. Discontinue meds causing slower gastric transit
  3. Antiemetics
  4. Prokinetic Agents
308
Q

Patients with gastroporesis should be on a ____ ________ diet and avoid ____ ____ or _____ foods.

A

Low residue

High fiber
Raw

309
Q

What are the THREE prokinetic agents?

A

Metoclopramide (Reglan)
Erythromycin
Domperidone

310
Q

What are the indications for Metoclopramide (Reglan) use?

A
  1. DM Gastroporesis

2. Symptomatic GERD

311
Q

How does Metoclopramide (Reglan) work?

A

Central and Peripheral D2 receptor antagonist
Acitivates serotonin receptors to release acetylcholine
Accelerates gastric emptying

312
Q

In what conditions is Mectoclopramide (Reglan) contraindicated?

A
  1. Intestinal Obstruction/Hemorrhage/Perforation
  2. Epilepsy
  3. Phenochromocytoma
313
Q

What are the ADRs associated with Metoclopramide (Reglan)?

A 
Headache
N/V
Fatigue
Somnolence
Sleep Disturbances
Agitation
Akathisia
314
Q

Is Metoclopramide (Reglan) associated with hyperprolactinemia

A

Yes

315
Q

What is the most severe side effect of Metoclopramide (Reglan)?

A

Tardive Dyskinesia

Uncontrolled movements
Irreversible

Common when used for > 3 months, women, elderly

Also can see…..

Dystonia
Depression
Suicide
Parkinsonian Tremors
Neuroleptic Malignant Syndrome 
HTN
Edema
316
Q

_________ is a D2 receptor antagonist with similar effects as Metocloparmide but DOES NOT cross the BBB

A

Domperidone

317
Q

T/F: Domperidone is associated with a prolonged QT, cardiac arrest, and SCD and is no longer approved by the FDA in the US

A

True

318
Q

How does erythromycin work as a prokinetic drug?

A

It works on motilin receptors in the stomach and duodenum.

319
Q

What are the indications for erythromycin use as a prokinetic?

A
  1. Diabetic Gastroporesis
  2. Idiopathic Gastroporesis
  3. Post-surgical gastroporesis
320
Q

What are common ADRs associated with Erthromycin?

A
  1. N/V/D
  2. Abdominal Pain
  3. Anorexia
  4. Prolonged QT
  5. Liver abnormalities
  6. C. diff
321
Q

What are the phenothiazines antiemetics?

A

Promethazine (Phenergan)
Prochlorperazine (Compazine)
Trimethobenzamide (tigan)

322
Q

Promethazine (Phenergan) is a ______________ which blocks ___ receptors.

A

Antihistamine

H1

323
Q

What are the indications for Promethazine (Phenergan)?

A
  1. Nausea and vomiting
  2. Allergic and vasomotor rhinitis
  3. Urticaria
  4. Anaphylaxis
  5. Motion Sickness
324
Q

Should you use Phenergan in children under 2 y.o.?

A

No (Fatal respiratory Depression)

325
Q

What warnings are associated with Promethazine (Phenergan) use?

A

Neuroleptic malignant syndrome
CNS depression
Bone marrow depression

326
Q

What is neuroleptic malignant syndrome?

A

Potentially fatal adverse reaction to medications

Sx.....
Fever
Sweating
Unstable BP
Stupor
Muscular Rigidity 
Tachycardia

Presents withing the 1st week of use

327
Q

What is a treatment option for refractory gastroporesis?

A

Botox injections (paralyzes pyloric valve)

328
Q

_______ is a pancreatic enzyme that is used to treat cystic fibrosis, chronic pancreatitis, and following a pancreatectomy

A

Pancrelipase (Creon)

329
Q

What ADRs are associated with Pancrelipase (Creon)?

A

Colonopathy
Hyperuricemia
Allergy

330
Q

What types of foods should patients avoid in celiac disease?

A 
Wheat
Barley
Rye
Spelt
Triticale
Kamut
Einkorn
Some oats
331
Q

This weight loss medication is a reversible gastric and pancreatic lipase inhibitor that mimics systemic absorption.

Diet must be < 30% fat

A

Orlistat (Alli)

332
Q

Orlistat may be taken ___ times a day with meals

A

3x

333
Q

T/F: Orlistat is NOT a good choice for patients who do not feel hungry or have an increased risk for cardiovascular disease

A

False

It is

334
Q

What are the indications for Orlistat use?

A

Obesity Management
Weight Loss
Weight Maintenance

335
Q

What are the contraindications to Orlistat use?

A 
Pregnancy
Chronic Malabsorption syndrome
Cholestasis 
Hx of CaO kidney stones
Hx of anorexia/Bulimia
336
Q

What ADRs are associated with Orlistat?

A
  1. Diarrhea
  2. Steatorrhea
  3. Oily Spotting, Stools
  4. Flatulence
  5. Fecal Urgency
337
Q

What are the SERIOUS ADRs associated with Orlistat?

A
  1. Hypersensitivity
  2. Angioedema
  3. Vitamin Deficiencies
  4. Hepatotoxicity
  5. Lower GI Bleed
338
Q

Orlistat will _____ ____ when it interacts with arfarin and ______ vitamin K absorption

A

Increase INR

Decrease

339
Q

This is a weight loss medication is a serotonin receptor agonist which is thought to decrease food intake.

A

Lorcaserin (Belviq)

340
Q

What things should be monitored when a patient is using Lorcaserin (Belviq)

A

Monitor for depression or SI

Monitor blood glucose

341
Q

T/F: Priapism is not associated with Lorcaserin (Belviq)

A

False

It is

342
Q

T/F: Lorcaserin with interact with serotonin drugs

A

True

343
Q

What ADRs are associated with Lorcaserin (Belviq)?

A 
Headache
Dizziness
Fatigue
Nausea
Dry mouth
Constipation
Cough 
Bradycardia
hyperprolactinemia
344
Q

______/______ is an opioid antagonist in combination with an antidepressant that is used for weight loss in obesity and in the overweight with comorbidities

A

Naltrexone/Bupropion (Contrave)

345
Q

What are the contraindications to Naltrexone/Bupropion (Contrave) use?

A

Uncontrolled HTN
Sz
Chronic Opioid use

346
Q

What are the warning associated with Naltrexone/Bupropion (Contrave)?

A 
SI
SZ
HTN
Tachycardia
Liver dysfunction
347
Q

What ADRs are associated with Naltrexone/Bupropion (Contrave) use?

A 
N/V/D 
Constipation
HA
Dizziness
Insomina
Dry Mouth
348
Q

What THREE drugs are approved for short term use in weight loss?

A

Phentermine
Diethylpropion
Phendimetrazine

349
Q

___________ is a sympathomimetic similar to amphetamines that stimulates CNS activity promoting catecholamine release thus decreasing hunger

A

Phentermine

350
Q

Patients with a history of what should not take Phentermine?

A

Heart Disease

351
Q

What SERIOUS ADRs are associated with Phentermine?

A 
Dependency
Psychosis
Tachycardia
HTN
Pulmonary HTN
Valvular Heart Disease
352
Q

_______ is a antiseizure medication that is used off-label as monotherapy for weight loss

A

Qsymia

353
Q

In what THREE conditions is Qsymia contraindicated

A
  1. Pregnancy
  2. Glaucoma
  3. Hyperthyroidism
354
Q

T/F: Qsymia interacts with OCP and EtOH

A

True

355
Q

_______ is a short-term option (<12 weeks of use) for weight lose that is a sympathomimetics that stimulates catecholamine release decreasing hunger

A

Diethylpropion (Tenuate)

356
Q

What are the contraindications of Diethylpropion (Tenuate) use?

A 
Pulmonary HTN
Severe HTN
Agitiation
Heart Murmurs
Valvular disease
CAD
Arteriosclerosis
357
Q

What are the common ADRs of Diethylpropion (Tenuate) use?

A 
Dry Mouth
Diarrhea/Constipation
Restlessness/Anxiety
Headache
HTN
Palpitation/Arrhythmias
358
Q

_____ is another short term weight lose drug similar to Diethylpropion/

A

Phendimetrazine (Bontril)

359
Q

What ADRs are associated with Phendimetrazine (Bontril) use?

A 
Palpitations                                   
Tachycardia
Restlessness
Hypertension
Insomnia
Agitation
Dizziness
Headache
Flushing
Sweating
Tolerance
Diarrhea/constipation
360
Q

What shou;ld be evaluated prior to starting Phendimetrazine?

A

Cardiology baseline functions

EKG
BP
CV Exam
Echocardiogram should be considered

361
Q

What THREE drugs are used off-label for weight loss?

A

Desvenlafaxine (Pristiq)
Spironolactone
Pindolol

362
Q

________ is a recently approved drug for binge-eating disorder and is a prodrug of dextroamphetamine.

A

Lisdexamfetamine (Vyvanse)

363
Q

What are the serious warnings associated with Lisdexamfetamine (Vyvanse)?

A
  1. Serious CV events
  2. HTN
  3. Tachycardia
  4. Peripheral Vasculopathy
  5. Psychotic/Mania
364
Q

What are the common ADRs of Lisdexamfetamine (Vyvanse) use?

A
  1. Dry Mouth
  2. Insomnia
  3. Decreased appetite
  4. Increased HR
  5. Constipation
  6. Feeling jittery
  7. Anxiety
365
Q

How much did this suck?

A

A good amount

Pharm Test - 4 (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions