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NU 560 Pharmacotherapeutics > Unit 2 > Flashcards

Unit 2 Flashcards

1
Q

goals of AED therapy (4)

A

reduce # of seizures
limit ADRs
return to normal ADL(ex driving)
improve quality of life

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2
Q

First-line monotherapy treatment for seizures (gen tonic-clonic, focal, or TBI)

A

Hydantoins: Phenytoin and Fosphenytoin

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3
Q

Class of seizures not to use hydantoins

A

gen myoclonic or absence
they can exacerbate symptoms

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4
Q

Phenytoin/Fosphenytoin therapeutic serum concentration

A

10-20mcg/ml

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5
Q

Phenytoin/Fosphenytoin contraindications

A

heart block, sinus bradycardia

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6
Q

Carbamazepine (tegretol) class

A

anticonvulsant

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7
Q

Carbamazepine (tegretol) is used for what seizure types?

A

focal onset (1st line) and generalized tonic-clonic

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8
Q

Carbamazepine (tegretol) therapeutic range

A

4-12mg/L

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9
Q

goals of care for status epilepticus (3)

A
  1. control SE within 60min (ASAP)
  2. use of benzo + AED
  3. supportive measures (airway mgmt, IV access, hemodynamic monitoring, ID underlying cause)
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10
Q

considerations for febrile seizures in peds (2)

A

-educated parents on the importance of fever control
-do not need AEDs

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11
Q

geriatric considerations related to seizures/meds

A

-risk of drug toxicity due to
decreased drug clearance and metabolism

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12
Q

considerations for women with a seizure disorder

A

-most AEDs are preg category C or D
-discuss pregnancy status and desires in women of childbearing age

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13
Q

patient education for seizures (6)

A
  1. avoid sleep deprivation (can lower seizure threshold)
  2. excess alcohol (can lower threshold)
  3. avoid heavy machinery or working from heights (risk of self harm if seizure occurs)
  4. never swim alone
  5. most sports are ok
  6. driving
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14
Q

T/F: PA providers are mandated reporters of seizures

A

true–> must report to DOT who will further assess the situation and see if the patient can continue to drive

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15
Q

3 serious side effects of macrolide antibiotics used for CAP

A
  1. QTC prolongation
  2. LFT abnormalities
  3. GI upset
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16
Q

sinusitis treatment (6)

A

intranasal steroids
augmentin
clindamycin
cephalosporins
doxycycline
fluoroquinolones

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17
Q

first line treatment for sinusitis

A

amoxicillin/augmentin after 7 days unless severe

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18
Q

when to use augmentin for sinusitis

A

if pt at high risk for infection from amoxicillin resistant pathogen

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19
Q

antibiotic to prescribe for sinusitis in a patient with PCN allergy

A

doxycycline
moxi/levofloxacin
clindamycin

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20
Q

considerations when using antihistamines

A

caution in elderly- confusion, constipation, dizziness, dry mouth, urinary retention, sedation
on beers list

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21
Q

considerations when using 2nd gen antihistamines (2)

A

ineffective for cough and may induce dryness causing worsening congestion
caution in renal and hepatic impairment

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22
Q

2 first gen antihistamines

A

benadryl
chlorpheniramine

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23
Q

considerations when using 1st gen antihistamines

A

drowsiness/sedation
contraindicated in breastfeeding

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24
Q

considerations for benadryl (5)

A

caution in:
asthma
CV disease
Increased IOP
BPH
thyroid dysfunction

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25
Q

considerations for chlorpheriniamine (4)

A

caution in:
narrow-angle glaucoma
bladder neck obstruction
BPH
avoid in newborns (SIDS)

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26
Q

3 2nd gen antihistamines

A

fexofenadine (allegra)
loratadine (claritin)
cetirizine (zyrtec)

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27
Q

2 intranasal antihistamines

A

azelastine
olopatadine

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28
Q

MOA of nasal decongestants

A

sympathomimetic agents that stimulate alpha and beta receptors causing vasoconstriction

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29
Q

4 contraindications of nasal decongestants

A

narrow-angle glaucoma
uncontrolled HTN
CAD
recent use of MAOIs

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30
Q

8 SE of nasal decongestants

A

HTN
Tachycardia
palpitations
insomnia
tremors
urinary retention (caution with BPH)
GI upset
dizziness

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31
Q

2 topical nasal decongestants

A

oxymetazoline
phenylephrine

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32
Q

education with topical nasal decongestants

A

no more than 2-3 days d/t rhinititis medicamentosa (rebound congestion)

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33
Q

education with oral decongestant x2

A

don’t crush or chew
give at least 2 hrs before bed

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34
Q

patho of acute bronchitis

A

infection of the bronchial tree

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35
Q

cause of acute bronchitis

A

90% viruses
10% bacterial

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36
Q

hallmark sign on acute bronchitis

A

moist productive cough

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37
Q

treatment of acute bronchitis

A

antitussives
expectorants
antibiotics
antivirals

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38
Q

antitussive drugs

A

benzonatate
dextromethorphan
cough meds with codeine or hydrocodone for severe cough

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39
Q

expectorant drug

A

guaifenesin

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40
Q

when to use antibiotics for acute bronchitis (4)

A

hx of COPD
high fever
cough over 4-6 days
65 y/o + with comorbidity (CAD, DM)

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41
Q

when to use antivirals for acute bronchitis

A

flu A or B+

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42
Q

which antibiotic for acute bronchitis from H influenzae

A

amox. or augmentin

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43
Q

which antibiotic for acute bronchitis from m catarrhalis

A

augmentin

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44
Q

which antibiotic for acute bronchitis from m pneumoniae

A

macrolide

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45
Q

which antibiotic for acute bronchitis from b pertussis

A

macrolide

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46
Q

treatment of CAP in patients without comorbidities

A

Amoxicillin 1 g TID OR
Doxycycline 100mg BID OR
azithromycin OR
clarithromycin 500mg BID

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47
Q

treatment of CAP in patients WITH comorbidities

A

amox + macrolide
cephalosporin + marcolide OR doxy
fluroquinolone monotherapy

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48
Q

3 considerations when prescribing tamiflu

A

within 48 hours onset
can be used for prophylaxis for up to 6 weeks during community outbreak
dosage adjustment with reduced kidney function (not recommended in ESRD)

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49
Q

theophylline adverse events (6)

A

Tachyarrhythmias
restlessness
insomnia
N/V
GERD
seizures

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50
Q

indication for leukotriene modifiers

A

allergies and asthma

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51
Q

3 drugs that are leukotriene modifiers

A

montelukast
zafirlukast
zileuton

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52
Q

age for montelukast

A

2+

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53
Q

age for zafirlukast

A

7+

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54
Q

age for zileuton

A

12+

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55
Q

montelukast SE

A

BLACK BOX serious behavior and mood changes

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56
Q

zafirlukast SE

A

pharyngitis, headache, rhinitis, gastritis

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57
Q

zafirlukast considerations

A

metabolized by CYP450
rare liver failure
monitor LFTs q2-3 months

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58
Q

zileuton considerations

A

metabolized by CYP450
monitor LFTs before, monthly for 3 months, then q2-3 months

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59
Q

zileuton SE

A

dyspepsia
abd pain
nausea

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60
Q

SAMA mechanism of action

A

short acting muscarinic antagonist
blocks acetylcholine at muscarinic receptors, decreasing cAMP which relaxes airway smooth muscle and increases bronchial ciliary activity, therefore decreasing mucous secretions

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61
Q

GOLD group D

A
  1. daily LABA/LAMA
  2. daily ICS/LABA
  3. daily ICS/LABA/LAMA, (can add) theophylline, phosphodiesterase 4 inhibitor, macrolide abx, OR ICS/LAMA/LABA/roflumilast
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62
Q

13 LABA serious SE

A

paradoxical bronchospasm
asthma exac
laryngospasm
hypersensitivity
anaphylaxis
HTN
HoTN
angina
cardiac arrest
arrhythmia
hypokalemia
hyperglycemia
BLACK BOX : asthma related death

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63
Q

namenda MOA

A

NaMenDA
blocks activation and overstimulation of NMDA receptor during glutamate abundance which inhibits neuronal degeneration that would otherwise result

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64
Q

Goal of drug therapy for AD

A

maintain and maximize the patient’s functional ability, quality of life, and independence for as long as possible while minimizing adverse events and cost

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65
Q

Med classes to control noncognitive symptoms in AD

A

Antipsychotics
benzos
antidepressants

66
Q

antipsychotics used for AD

A

haldol
risperidone
olanzapine

67
Q

Black box warning for antipsychotics

A

increased risk of death associated with increased risk of stroke

68
Q

how to use benzos for AD

A

start low and use sparingly
short acting (ativan and xanax) preferred
use as needed for anxiety/episodic agitation

69
Q

how/why antidepressants for AD

A

high incidence of depression
improved QoL
SSRIs preferred (zoloft/lexapro)

70
Q

treatment recommendations for mild AD disease

A

cholinesterase inhibitors

71
Q

3 cholinesterase inhibitors

A

donepezil
rivastigmine
galantamine

72
Q

treatment recommendations for moderate to severe AD disease

A

NMDA receptor antagonist
trial second CI may be warrated

73
Q

NMDA receptor antagonist drug

A

Namenda

74
Q

cogentin contraindication

A

narrow angle glaucoma

75
Q

cogentin special consideration

A

avoid with potassium (increase ulcer)
glucagon (increase GI adverse effects)
anticholinergics (increase effects)

76
Q

common treatments for the treatment of motor symptoms in PD mild potency

A

anticholinergics
amantadine
MAOIs

77
Q

2 examples of anticholinergics for PD

A

cogentin
artane

78
Q

common treatments for the treatment of motor symptoms in PD high potency

A

Dopamine agonists (levodopa)
COMTIs

79
Q

COMTI 2 drugs

A

Comtan
Tasmar

80
Q

3 MAOIs for PD

A

selegiline
rasagiline
safinamide

81
Q

4 dopamine agonists

A

Mirapex
Requip
Neupro
Apokyn

82
Q

MOA levodopa

A

dopamine precursor
crosses BBB
converted via decarboxylation (L-DOPA decarboxylase) to dopamine
stored in presynaptic neurons until stimulated for release

83
Q

carbidopa MOA

A

limits peripheral breakdown of levodopa and allows for 4x more levodopa to cross BBB
reduces N/V caused by circulating dopamine

84
Q

amantadine MOA

A

inhibition on NMDA receptors
potentiates dopaminergic responses to reduce PD symptoms
binds/blocks NMDA receptors and increases release of dopamine

85
Q

treatment of PD depression

A

mirapex
effexor

86
Q

treatment of PD psychosis

A

clozaril
seroquel

87
Q

medications to NOT prescribe for PD psychosis

A

zyprexa, risperdal, abilify
can worsen motor deterioration

88
Q

treatment of PD dementia

A

exelon
aricept

89
Q

treatment of PD insomnia

A

neupro

90
Q

treatment of PD HoTN (4)

A

Florinef
midodrine
indomethacin
droxidopa

91
Q

treatment of PD drooling

A

SL atropine
robinul
botox

92
Q

carbamazepine black box warning

A

SJS, TEN, aplastic anemia, agranulocytosis

93
Q

carbmazepine consideration (6)

A

screen for HLA-B*1502 allele
increased risk of derm reactions
Pregnancy category D
can lead to hyponatremia in elderly
inducer of several CYP pathways
B/l CBC and follow up labs

94
Q

Serious carbamazepine SE

A

blood dyscrasias
SIADH
cardiac conduction abnormalitis
DRESS (drug reaction with eosinophillia and systemic symptoms)

95
Q

Hydantoin drugs (2)

A

phenytoin
fosphenytoin

96
Q

Serious SE for hydantoins (6)

A

dose dependent:
lateral nystagmus
lateral gaze
ataxia
lethargy
decreased mentation
arrhythmia

97
Q

Acute treatment of status epilepticus and dose

A

ativan 4mg IV
valium 5-10mg IV (max dose 30mg)
q3-5 mins if seizure continues

98
Q

5 prophylactic treatments for cluster headaches

A

verapamil
lithium
melatonin
warfarin
galcanezumab

99
Q

when to treat tension-type headaches

A

more than 2/week requiring analgesic meds, initiate prophylactic treatment

100
Q

first line ppx treatment for tension-type headaches

A

amitriptyline

101
Q

amitriptyline drug class

A

tricyclic antidepressant

102
Q

second line ppx treatment for tension-type headaches

A

Effexor
Remeron

103
Q

effexor drug class

A

SNRI

104
Q

remeron drug class

A

atypical antidepressant

105
Q

treatment for HTN and/or essential tremor PLUS migraine first line

A

beta-blockers
propranolol
lopressor
timolol

106
Q

treatment for HTN PLUS migraine second line

A

CCB
verapamil

107
Q

treatment of anxiety/depression and/or postmenopausal hot flashes PLUS migraine

A

SNRI
effexor

108
Q

treatment of migraine ppx with daily medication regimen adherence issues

A

CGRP receptor antagonists
-mab

109
Q

second line treatment for migraine ppx

A

CGRP receptor antagonists
-mab

110
Q

8 second line treatment for migraines

A

triptans
ditans
CGRP receptor antagonists
Ergot derivatives
barbiturates
opioids
steroids
antiemetics

111
Q

CGRP receptor antagonists for migraine treatment

A

-pant

112
Q

ergot derivatives (2)

A

ergotamine
dihydroergotamine

113
Q

triptans education (2)

A

should not be used for more than 9days/month
should not be used w/in 24 hours of vasoconstricting drugs

114
Q

who to avoid triptans in (4)

A

patients with basilar, hemiplegic, and retinal migraines
CAD
CeVD
severe PVD

115
Q

triptans contraindications (2)

A

cocomitant use with ergotamines and dihydroergotamine
pregnancy

116
Q

when are ergot derivatives used

A

long standing migraines in patient who have had multiple relapses with triptans

117
Q

medication overuse headache diagnosis

A

treating more than 2 headaches with OTC analgesic per week can lead to development of chronic daily headache

118
Q

risk factors for medication overuse headaches (10)

A

obesity
caffeine overuse
alcohol consumption
TMJ
Female
genetics
socioexonomic status
head/neck injury
age
life events

119
Q

treatment of medication overuse headache (4)

A

withhold all OTC analgesics for 1-2 weeks
identify triggers
lifestyle modifications
poss. prophylactic agent

120
Q

important education on bisphosphonate therapy

A

AM dose on empty stomach
must be taken with 8oz of water and must be upright for 30-60 min

121
Q

why do you have to upright for 30-60 mins after taking bisphosphonate

A

increase absorption and decrease esophagitis

122
Q

first line treatment for acute gout

A

colchicine and NSAID
oral corticosteroid and colchicine
IA steroid +NSAID or colchicine or PO steroid

123
Q

3 nsaids for acute gout

A

naproxen
indomethacin
sulindac

124
Q

consideration for colchicine for acute gout

A

must be given within 24-48 hours

125
Q

second line treatment of acute gout

A

switching to alternative 1st line
do not mix steroids and NSAIDs

126
Q

RA bridging treatment

A

NSAIDs or steroids in an acute episode until DMARDs (methotrexate/plaquenil) is therapeutic

127
Q

4 common SE of steroids

A

cataracts
glaucoma
glucose intolerance
cutaneous atrophy

128
Q

what to check when prescribing steroids for RA

A

LFT and CBC before treatment
patient at risk for fibrosis, leukopenia, thrombocytopenia

129
Q

treatment for fibromyalgia (5)

A

SNRIs
SSRIs
TCAs
CBT
Exercise

130
Q

TCA suffix

A

-ine
-mine
-line

131
Q

3 examples of SNRIs

A

cymbalta
savella
effexor

132
Q

3 examples of SSRIs

A

prozac
zoloft
lexapro

133
Q

4 cons of using coal tar for psoriasis

A

odor
staining
photosensitivity
folliculitis

134
Q

education for patients using coal tar for psoriasis

A

use sunscreen

135
Q

when to treat herpes zoster (4)

A

of rash has been present for fewer than 72 hours
new lesions are still developing
patient older than 50
immunocompromised

136
Q

3 treatments for herpes zoster

A

acyclovir 800mg 5x/day
famiciclovir 500mg TID
valacyclovir 1g TID

137
Q

terbinafine (lamisil) PO for toenail fungus contraindications

A

chronic or acute hepatic disease

138
Q

first line treatment of impetigo

A

oral abx
broad spectrum PCN (augmentin) or first gen cephalosporin (cephalexin)

139
Q

first line treatment of impetigo with PCN allergy

A

clindamycin
topical bactroban

140
Q

lotrimin cream considerations (2)

A

keep away from eyes
no occlusive dressing (may cause irritation)

141
Q

lotrimin contraindication

A

pregnancy/lactation

142
Q

contraindications for prescribing systemic corticosteroids for contact dermatitis (2)

A

systemic mycoses (systemic fungal infection)
patients receiving a vaccine

143
Q

cautions for prescribing systemic corticosteroids for contact dermatitis (7)

A

TB
hypothyroid
cirrhosis
renal insufficiency
HTN
osteoporosis
DM

144
Q

SE of systemic steroids for contact dermatitis

A

avoid prolonged use
skin irritation
pruritus
burning
skin atrophy

145
Q

max treatment duration systemic steroids

A

children 1 week
adults 2 weeks

146
Q

treatment of dermatitis on the face and intertriginous areas (4)

A

low potency steroids d/t thin skin
alcometasone
fllucinolone
hydrocortisone
triamcinolone

147
Q

what to order before prescribing accutane

A

CBC
Chem panel
fasting lipids
and obtained 1 month after initiation

148
Q

Considerations when ordering accutane (5)

A

2 forms of BC
pregnancy should be avoided for 1 month after d/c’d
only 30 days can be ordered at a time
patient must have finished growing before taking
patients must be registered in SMART program

149
Q

black box warning accutane

A

aggressive/violent behavior
SI

150
Q

first line treatment for acne (7)

A

topicals:
tretnoin
differin
tazorac

comedolytics:
benzoyl peroxide
azelex
clindamycin
erythromycin

151
Q

role of oral contraceptives in acne treatment

A

decreases testosterone production

152
Q

Treatment of MRSA superficial bacterial infection (6)

A

vanc
dapto
-vancins
-zolids
tigecycline
bactroban in nostrils

153
Q

treatment of community acquired MRSA (4)

A

Bactrim
minocycline
clinda
linezolid

154
Q

7 factors that influence absorption rates

A

amount of agent
surface area of application
length of application time
frequency
broken skin/erosions
choice of vehicle (liquids/powders)
stratum corneum thickness

155
Q

topical vehicle preferred for hairy areas

A

creams
hydrophilic
easy to apply and wash off

156
Q

vehicle that produces the greatest local effects

A

ointments

157
Q

vehicle that allows medication spread easily over large area

A

gel

158
Q

first line treatment of rosacea

A

flagyl
sodium fulfacetamide
azelaic acid

159
Q

second line treatment of rosacea

A

add oral abx
tetracycline
dozy
erythromycin (when tetra contraindicated)
bactrim

160
Q

third line treatment of rosacea

A

oral isotretinoin
dermatologist referral

NU 560 Pharmacotherapeutics (5 decks)

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