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Pharmacology > Week 6-7 > Flashcards

Week 6-7 Flashcards

1
Q

Who is at risk for toxicity from methylxanthines (theophylline) and why?

A

patients with impaired liver functions, older adultsdue to hepatic impairment

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2
Q

What are the symptoms and frequency of symptoms associated with intermittent asthma?

A

daytime symptoms < 2x per week
nighttime symtoms < 2x per month
this should only be treated with a SABA as needed

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3
Q

What are the symptoms and frequency of symptoms associated with mild persistent asthma?

A

daytime symptoms > 2x per week but < daily
nighttime symtoms 3-4x per month
this should only be treated with a SABA as needed

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4
Q

What are the symptoms and frequency of symptoms associated with moderate persistent asthma?

A

daytime symptoms < daily
nighttime symtoms > 1x per week but < nightly
this should be treated with low dose ICS plus an ICS as needed or low dose ICS/LABA plus SABA as needed

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5
Q

What are the symptoms and frequency of symptoms associated with severe persistent asthma?

A

daytime symptoms several times per day
nighttime symptoms often nightly
this should be treated with medium/high dose maintenance ICS-LABA with low dose ICS reliever or medium/high dose maintenance ICS-LABA with SABA as needed

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6
Q

What are examples of SABAs?

A

albuterol, levalbuterol, salbutamol, terbutaline

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7
Q

What are examples of LABAs?

A

formoterol, salmeterol, oldalterol, indacaterol, isoproterenol

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8
Q

What are examples of SAMAs?

A

ipratropium

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9
Q

What are examples of LAMAs?

A

tiotropium, aclidinium, umeclidinium, revefenacin, glycopyrrolate

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10
Q

What are examples of ICSs?

A

fluticasone, budesonide, beclomethasone, mometasone, flunisolide

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11
Q

When would roflumilast be indicated for a COPD patient?

A

roflumilast is a phosphodiesterase-4 inhibitor (PDE) that is not a first-line drug treatment and is reserved for severe cases of COPD with a primary component of chronic bronchitis

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12
Q

What patient education is needed for nicotine gum?

A

don’t eat for 15 minutes before or during, chew slowly and intermittently for abut 30 minutes, gradually withdrawal and discontinue after 3 months

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13
Q

What patient education is needed for nicotine nasal spray?

A

it can be addictive

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14
Q

What are contraindications for wellbutrin (bupropion)?

A

use caution in seizures, cocaine use, alcohol withdrawal, and anorexia, do not use concurrently with MAOIs

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15
Q

What is the recommended length of treatment with wellbutrin (bupropion)?

A

12 weeks?

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16
Q

What constitutes multidrug-resistant TB?

A

multidrug-resistant (MDR TB) is caused by bacteria that are resistant to both isoniazid and rifampin, two potent TB drugs.

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17
Q

What constitutes extensively drug-resistant TB?

A

extensively drug-resistant (XDR TB) is caused by resistance to isoniazid, rifampin, any fluoroquinolone, and at least one of three second-line medications.

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18
Q

What should be included for the treatment of TB in a pregnant person?

A

rifabutin is deemed the safest drug for TB during pregnancy, but the CDC reports that the benefit justifies the risk for isoniazid, rifampin, and pyrazinamide.
*ethambutol has caused teratogenesis in animal studies

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19
Q

Is ethambutol safe in pregnancy?

A

ethambutol has caused teratogenesis in animal studies

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20
Q

What TB meds are safe during breastfeeding?


A

Isoniazid and rifampin

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21
Q

What drug can be used to prevent TB in people who have been exposed?


A

Isoniazid

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22
Q

What are examples of decongestants?

A

beclomethasone, budesonide, fluticasone, triamcliolone

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23
Q

Which cough/cold drug class has no significant drug interactions?

A

expectorants

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24
Q

What are the components of the 5As model for tobacco use and dependence?

A

Ask (screen all patients)
Advise tobacco users to quit
Assess willingness to quit
Assist with quitting (offer medication and provide or refer to counseling)
Arrange follow-up contacts, beginning within the first week after the quit date

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25
Q

After how many months should nicotine gum be discontinued?

A

after 3 months without smoking
use beyond 6 months is not recommended

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26
Q

How long is treatment with nicotine lozenges?

A

12 weeks

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27
Q

How long is treatment with nicotine patches?

A

8-12 weeks

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28
Q

What are common adverse effects of bupropion (wellbutrin)?

A

insomnia, dry mouth, weight loss

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29
Q

What drugs should be avoided with bupropion (wellbutrin)?

A

MAOIs

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30
Q

What is the black box warning for bupropion (wellbutrin)?

A

neuropsychiatric effects including suicidal ideation

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31
Q

What is the most effective drug for smoking cessation?

A

Varenicline (chantix), decrease use after 7-12 weeks

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32
Q

In what patients should varenicline be avoided?

A

CVD, agnina, HTN, MIs

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33
Q

What is the black box warning for omalizumab and reslizumab for asthma?

A

anaphylaxis

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34
Q

What are mast cell stabilizers (cromolyn and nedocromil) used for?


A

mast cell stabilizers (cromolyn and nedocromil) are used as an alternative therapy for exercise-induced asthma

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35
Q

What is the black box warning for leyukotrine receptor antagonists?

A

neuropsychiatric effects such as agitation, aggression, insomnia, depression, anxiety, and suicidal ideation

36
Q

For what conditions are anticholinergics (ipratropium) contraindicated?

A

acute narrow-angle glaucoma or an enlarged prostate

37
Q

What education is needed with theophylline?


A

Don’t use caffeine because it can intensify the adverse effects of theophylline on the heart and CNS and can decrease theophylline metabolism.
Don’t smoke tobacco or marijuana cause it can increase clearance to 50% in adults and 80% in older adults so it is important to inquire regarding smoking habits to optimize dosing. If smoking is discontinued during therapy, it will be important to decrease the dosage of methylxanthines to avoid toxicity.

38
Q

For what conditions are methylxanthines (theophylline) contraindicated?

A

dysrhythmias, liver dysfunction (increased risk for toxicity), peptic ulcer disease (can exacerbate the condition), or seizure disorders (can exacerbate seizures)

39
Q

What drug-drug interactions can occur with theophylline?

A

Drugs that can induce metabolization of theophylline include phenobarbital, phenytoin, rifampin so the dosage of theophylline may need to be increased when taken concurrently.
Drugs that can inhibit metabolization of theophylline include cimetidine, fluoroquinolone antibiotics so theophylline should be used in reduced dosages when taken concurrently.

40
Q

How is theophylline toxicity managed?

A

Theophylline overdose can cause severe dysrhythmias, convulsions, and death from cardiorespiratory collapse. Manage toxicity by discontinuing theophylline, administering activated charcoal (to decrease theophylline absorption) plus a cathartic (to accelerate fecal excretion). Preferred drugs to control ventricular dysrhythmias (most common dysrhythmia to occur) and seizures are IV lidocaine (amiodarone is an alternative) and IV benzodiazepines (e.g., diazepam)

41
Q

What is roflumilast?

A

Roflumilast is a PDE4 inhibitor which works by inactivating cAMP

42
Q

What are adverse effects of roflumilast?

A

nausea, vomiting, diarrhea, reduced appetite, weight loss, headache, back pain, insomnia

43
Q

What are contraindications for antihistamines?

A

impaired liver or kidney functions
antihistamines

44
Q

Dextromethorphan should be used cuatiously in what condition?

A

hyperthyroidism, hypertension, MAOI use within 2 weeks, advanced cardiac disease, glaucoma

45
Q

What are common adverse effects from TB meds?

A

hepatotoxicity and optic neuritis

46
Q

What baseline monitoring is needed before starting isoniazid, pyrazinamide, rifampin, and other rifamycins?

A

LFTs, CBC, renal function, chest radiograph

47
Q

What is the most common adverse effect from isoniazid?

A

peripheral neuropathy so patients should take vitamin B6

48
Q

What is the black box warning for isoniazid?

A

hepatitis

49
Q

What special education is needed for women of child-bearing age on rifampin?


A

Oral contraceptives may not be effective so nonhormonal birth control is needed

50
Q

What is a special consideration for patients with HIV and TB?

A

rifampin can accelerate metabolism of protease inhibitors

51
Q

What is a potential adverse effect of ethambutol?

A

optic neuritis

52
Q

What are examples of H2 receptor agonists?

A

famotidine, cimetidine, nizatidine, ranitidine

53
Q

What H2 receptor antagonists are most likely to interact due to CYP450 enzyme system?

A

cimetidine is a weak CYP450 inhibitor

54
Q

What vitamin and/or mineral deficiencies are associated with PPIs?

A

low magnesium, calcium, B12, folic acid

55
Q

What medications used to treat GERD should be avoided in older adults and why?

A

PPIs as they have many medication interactions and they can result in mineral deficiencies and osteoporosis and fractures

56
Q

Which cytoprotective agents would be used to treat GERD in pregnancy?

A

sucralfate

57
Q

How should h. Pylori be treated?

A

First line therapy is standard dose PPI, 500mg clarithromycin BID, and 1000mg amoxicillin BID for 10-14 days then continue the PPI for 8-12 weeks
— PPI plus clarithromycin or metrondiazole and amoxicillin
— PPI plus levofloxacin and amoxicillin
— PPI and bismuth subsalicylate plus metronidazole and tetracycline

58
Q

What is the black box warning associated with metronidazole?

A

cancer was found in some animals during testing with metronidazole

59
Q

What patient teaching is necessary for metronidazole?

A

do not drink alcohol or take while pregnant

60
Q

What antibiotics used for the treatment of H. pylori are contraindicated in pregnant women?

A

metrondiazole and tetracyclines

61
Q

What antibiotics used for the treatment of H. pylori are contraindicated in children?

A

tetracyclines

62
Q

What drugs can interact with PPIs?

A

antifungals, protease inhibitors, clopidogrel (omeprazole is a CYP inhibitor which decreases metabolization of the prodrug clopidogrel into its active form)

63
Q

How is does aprepitant interact with drugs metabolized by CYP450 enzymes?


A

aprepitant is a CYP405 inhibitor

64
Q

What is the only approved GI indication for misoprostol?

A

ulcer prevention with NSAID use

65
Q

What are common adverse effects of misoprostol?

A

diarrhea, cramping, abdominal pain

66
Q

What is the black box warning for misoprostol?

A

premature birth, stillbirth, abortion, uterine rupture

67
Q

What are the common adverse effects of antacids?


A

constipation or diarrhea

68
Q

What are potential drug interactions with antacids and how can they be prevented?


A

ranitidine, cimetidine, sucralfate; administer them one hour apart

69
Q

What corticosteroids are used for chemotherapy induced nausea and vomiting?

A

solumedrol and decadron

70
Q

What is the black box warning for phenergen?

A

respiratory depression

71
Q

What medications are used to treat IBS?


A

hycosamine, dicyclomine, psyllium, loperamide, tricyclic antidepressants

72
Q

What is the black box warning for alosetron?


A

ischemic colitis secondary to decreased blood flow

73
Q

What are contraindications for alosetron?

A

constipation, bowel obstruction, chrons disease, diverticulitis

74
Q

How is alosetron interact with drugs metabolized by CYP450 enzymes?

A

alosetron is a CYP450 substrate

75
Q

What are adverse effects of H2RAs?

A

pneumonia, CNS effects such as confusion, hallucination, CNS depression, or CNS excitation (especially in older adults with renal or hepatic impairment)
gynecomastia, reduced libido, impotence with cimetidine

76
Q

What drug-drug interactions can occur with cimetidine?


A

Cimetidine is CYP450 inhibitor and can lead to toxic levels of warfarin, phenytoin, theophylline, and lidocaine

77
Q

What are the two forms of IBD?


A

ulcerative colitis — circumferential and starts in the rectum and ascends through the colon
chrons disease — can affect the entire GI tract but is most common in the terminal ileum and is seen in a skipping cobblestone pattern

78
Q

What is the black box warning for metocolopramide (reglan)?

A

tardive dyskinesia

79
Q

What is the class and mechanism of action for metoclopramide (reglan)?

A

reglan is a dopamine antagonist that acts by suppressing nausea through the blockade of dopamine receptors in the chemoreceptor trigger zone

80
Q

What are contraindications to metocolopramide (reglan)?

A

GI obstruction, GI perforation, GI bleed

81
Q

What is the first line therapy for nausea in pregnancy?


A

doxylamine and pyridoxine (vitamin B6)
alternatives include prochlorperazine, metoclopramide, and ondansetron

82
Q

What antiemetic should be avoided in elderly patients?

A

benzos, scopolamine, and metoclopramide

83
Q

What antihistamines are used for nausea?

A

diphenhydramine, meclizine, cyclizine

84
Q

How is severe traveler’s diarrhea treated?


A

fluoroquinolone such as ciprofloxacin, azithromycin is preferred for children and pregnant women

85
Q

What medications are used to treat IBS?

A

antispasmodics — hyoscyamine and dicyclomine
bulk-forming agents — psyllium and polycarbophil)
antidiarrheals — loperamide
tricyclic antidepressants — TCAs

Pharmacology (5 decks)

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