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NR565 - Advanced Pharmacology > Week 6 - Peer Support > Flashcards

Week 6 - Peer Support Flashcards

1
Q

What are the components of the 5 A’s model for treating Tobacco use and dependence?

A

Ask (screen all patients for tobacco use).
Advise tobacco users to quit.
Assess willingness to make a quit attempt.
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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2
Q

When educating our patients, how should we advise them to chew Nicotine gum?

A

Patients should be advised to chew the gum slowly and intermittently for approximately 30 minutes. Rapid chewing can release too much nicotine at one time, resulting in effects similar to those of excessive smoking (e.g., nausea, throat irritation, hiccups). . Because foods and beverages can reduce nicotine absorption, patients should not eat or drink while chewing or for 15 minutes before chewing

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3
Q

After how many months should we discontinue the nicotine gum?

A

After 3 months without cigarettes, patients should discontinue nicotine use. Withdrawal should be done gradually. Use of nicotine gum beyond 6 months is not recommended.

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4
Q

What are the common side effects of Nicotine gum?

A

The most common adverse effects are mouth and throat soreness, jaw muscle ache, eructation (belching), and hiccups.

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5
Q

How do we dose Nicotine Lozenges?

A

First cigarette 30 min or more after waking: 2 mg
First cigarette within 30 min of waking: 4 mg
No more than 5 lozenges every 6 h or 20 daily

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6
Q

What are the most common adverse effects of Nicotine Lozenges?

A

Mouth irritation, dyspepsia, nausea, and hiccups

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7
Q

How should we advise our patients to apply Nicotine patches?

A

Nicotine patches are applied once a day to clean, dry, nonhairy skin of the upper body or upper arm. The site should be changed daily and not reused for at least 1 week. NicoDerm CQ patches are left in place for 24 hours and then immediately replaced with a fresh one

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8
Q

How is most of the Nicotine absorbed with Nicotine inhalers use?

A

Most of the nicotine is absorbed through theoral mucosa—not in the lungs.

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9
Q

What are the common side effects of Nicotine inhalers?

A

The most frequent are dyspepsia, coughing, throat irritation, oral burning, and rhinitis. The inhaler should not be used by patients with asthma.

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10
Q

What type of medication is Bupropion (Zyban)?

A

Antidepressant

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11
Q

What are the common adverse effects of Bupropion?

A

Dry mouth, Insomnia, Weight loss

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12
Q

What drugs should be avoided with Bupropion?

A

MAOIs
Wellbutrin

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13
Q

Which patients should we be cautious of when considering Bupropion?

A

Use with caution in patients with history of seizure, anorexia nervosa (may cause weight loss), cocaine use (has stimulant effect), and alcohol withdrawal.

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14
Q

What is the black box warning for Bupropion?

A

Bupropion can cause seriousneuropsychiatric effects,including mood changes, erratic behavior, and suicidality.

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15
Q

What is the name of the medication that is most effective for smoking cessation?

A

Varenicline (Chantix, Champix)

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16
Q

What is the most common side effect of Varenicline?

A

The most common side effect is nausea.

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17
Q

What type of patients should we avoid prescribing Varenicline?

A

Patients with stable cardiovascular disease.

Risk for cardiovascular events (e.g., angina pectoris, peripheral edema, hypertension, nonfatal myocardial infarction)

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18
Q

Who is banned from using Varenicline?

A

Use of varenicline by truck drivers, bus drivers, airplane pilots, and air traffic controllers is banned.

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19
Q

Prescribing steps for treating Asthma

A

Always a SABA+

  1. Low-dose IGC
  2. Low-dose IGC plus LABA OR Medium-dose IGC
  3. Medium-dose IGC plus LABA
  4. High-dose IGC plus LABA AND Consider omalizumab for patients with allergies
  5. High-dose IGC plus LABA plus Oral glucocorticoids AND Consider omalizumab for patients with allergies
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20
Q

Prescribing steps for treating COPD

A

Always a SABA+

  1. LAMAorLABA
  2. LAMA
  3. LAMA or LAMA/LABA or IGC/LABA
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21
Q

What are two classes of Asthma and COPD agents?

A

Anti-inflammatory agents (glucocorticoids) and bronchodilators (beta2 agonists).

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22
Q

What is the most effective drug for long-term control of airway inflammation?

A

Inhaled glucocorticoids

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23
Q

What is the most common adverse effect of inhaled glucocorticoids and how should we educate our patients to prevent it?

A

Oropharyngeal candidiasisanddysphonia (hoarseness, speaking difficulty).

To minimize these effects, patients should rinse the mouth with water and gargle after each administration. Using a spacer device can help too.

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24
Q

What can result from long-term high-dose use of glucocorticoids?

A

someadrenal suppression (after how many months should we check for this? 6)and Long-term use of inhaled glucocorticoids may promotebone loss.Fortunately, the amount of loss is much lower than the amount caused by oral glucocorticoids. To minimize bone loss, patients should:
(1) use the lowest dose that controls symptoms, (2) ensure adequate intake of calcium and vitamin D
(3) participate in weight-bearing exercise.

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25
Q

What is the concern with long-term use of glucocorticoids in children?

A

There has been concern that prolonged therapy might increase the risk forcataractsandglaucoma.

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26
Q

Should we advise our patients to take Inhaled glucocorticoids first or short-acting B2 agonist first?

A

Delivery of glucocorticoids to the airways can be enhanced by inhaling a SABA 5 minutes before inhaling the glucocorticoid.

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27
Q

What are potential adverse effects of oral glucocorticoids?

A

Potential adverse effects includeadrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease,and, in young patients,growth suppression.

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28
Q

What are the names of the Inhaled glucocorticoids?

A
  1. Beclomethasone dipropionate (QVAR),
  2. Budesonide; pulmicort
  3. Ciclesonide
  4. Flunisolide
  5. Fluticasone propionate; flovent
  6. Mometasone furoate
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29
Q

What is the contraindication for inhaled glucocorticoids?

A

Inhaled glucocorticoids are contraindicated for patients with persistently positive sputum cultures for Candida albicans.

30
Q

What is the MOA of leukotrienes?

A

Compounds that promote smooth muscle constriction, blood vessel permeability, and inflammatory responses through direct action as well as through recruitment of eosinophils and other inflammatory cells. these drugs can decrease bronchoconstriction and inflammatory responses such as edema and mucus secretion.

31
Q

What are the names of the three leukotrienes available?

A
  • zileuton
  • zafirlukast
  • montelukast
32
Q

Are leukotrienes first or second line therapy?

A

current guidelines recommend using these agents as second-line therapy when an inhaled glucocorticoid cannot be used

33
Q

What are the serious potential adverse effects that leukotrienes can cause?

A

LTRAs can cause adverse neuropsychiatric effects, including depression, suicidal thinking, and suicidal behavior.

34
Q

What monitoring is required with Zileuton?

A

increased plasma levels of alanine aminotransferase (ALT) activity. A few patients have developed symptomatic hepatitis, which reversed after drug withdrawal. To reduce the risk for serious liver injury, ALT activity should be monitored. The recommended schedule is once a month for 3 months, then every 2 to 3 months for the remainder of the first year, and periodically there after

35
Q

What is the most common adverse effects of Zafirlukast?

A

headache and gastrointestinal (GI) disturbances, both of which are infrequent.

Arthralgia and myalgia may also occur.

36
Q

Concurrent use of what medication should be avoided with LTRA due to risk for toxic blood levels?

A

Concurrent use can raise serum theophylline to toxic levels and warfarin.

37
Q

What are the three approved indications of Montelukast?

A

(1) prophylaxis and maintenance therapy of asthma in patients at least 1 year old
(2) prevention of exercise-induced bronchospasm (EIB) in patients at least 15 years old
(3) relief of allergic rhinitis

38
Q

Is cromolyn used for quick-relief or prophylaxis?

A

It is used for prophylaxis—not quick relief—in patients with mild to moderate asthma. effective for prophylaxis of seasonal allergic attacks and for acute allergy prophylaxis immediately before allergen exposure (e.g., before mowing the lawn). Cromolyn can prevent bronchospasm in patients at risk for EIB.

39
Q

What is the MOA of cromolyn?

A

Cromolyn suppresses inflammation; it does not cause bronchodilation.

40
Q

What is the black box warning for Omalizumab and Reslizumab?

A

Omalizumab (Anti-IgE Antibody) and Reslizumab (Interleukin-5 Receptor Antagonist) carries a risk for anaphylaxis that may occur at any time during the course of treatment.

41
Q

Is Omalizumab approved for children?

A

Omalizumab was recently approved for children as young as 6 years. Benralizumab, dupilumab, and mepolizumab are approved for children age 12 years and older.

42
Q

What is the classification of medication that is considered first-line drug for Asthma?

A

Beta 2 agonist

43
Q

How are short acting Beta 2 agonist (SABA) usually prescribed?

A

Short-acting inhaled β2 agonists are used as needed (PRN) for prophylaxis of exercise-induced bronchospasm and to relieve ongoing asthma attacks and chronic obstructive pulmonary disease exacerbations. Oral and inhaled long-acting β2 agonists are used for maintenance therapy.

44
Q

What is the MOA of Beta 2 agonists?

A

By activating β2receptors in smooth muscle of the lung, these drugs promotebronchodilationand thus relieve bronchospasm.

45
Q

What MUST Long acting beta agonists be prescribed with?

A

LABAs are not first-line therapy, and they must always becombined with a glucocorticoid.In fact, their usealonein asthma iscontraindicatedbecause LABA monotherapy has been associated with increased incidence of asthma-associated death

46
Q

When are SABAs contraindicated?

A

β2agonists arecontraindicatedfor patients with tachydysrhythmias or tachycardia associated with digitalis toxicity. cautionin patients with diabetes, hyperthyroidism, organic heart disease, hypertension, or angina pectoris.

47
Q

What are the potential systemic adverse effects of SABAs?

A

Systemic effects—tachycardia, angina, and tremor—can occur but are usually minimal. cautionin patients with diabetes, hyperthyroidism, organic heart disease, hypertension, or angina pectoris.

48
Q

What patient education should we provide when prescribing SABAs?

A
  • Using a spacer with a one-way valve may improve results.
  • assess peak expiratory flow daily and compare with personal best
  • keep a record of these assessments along with symptom frequency and symptom intensity, nighttime awakenings, effect on normal activity, and short-acting β2agonist (SABA) use.
    Inform patients who are using metered-dose inhalers or dry-powder inhalers that,
  • when two inhalations are needed with metered dose or dry powder inhalers an interval of at least 1 minute should elapse between inhalations.
  • report chest pain associated with changes in heart rate or rhythm. This could indicate cardiac stress secondary to adrenergic effects.
  • Do not exceed recommended dosages
  • If worsening symptoms require more frequent use of a SABA, the provider should be notified.
49
Q

What is the generic name for the most commonly prescribed SABA?

A

-terol

ex. albuterol

50
Q

What baseline data is needed before prescribing a SABA?

A

Forced expiratory volume in 1 second (FEV1), frequency and severity of attacks. Attempt to identify trigger factors.

51
Q

What patient education should we provide when prescribing Theophylline?

A

Warn patients that, if a dose is missed, the following dose should not be doubled. Instruct patients to swallow enteric-coated and sustained-release formulations intact, without crushing or chewing. Warn patients against consuming caffeine-containing beverages (e.g., coffee, many soft drinks) and other sources of caffeine. Explain that caffeine can intensify adverse effects while decreasing theophylline breakdown. Instruct patients to call the clinic if they start to develop symptoms of nausea, vomiting, abdominal discomfort, diarrhea, insomnia, restlessness, or palpitations, because these may signify theophylline toxicity.
Warn patients that smoking tobacco or marijuana can increase theophylline clearance, resulting in ineffective dosing

52
Q

What medication is an atropine derivative administered by inhalation to relieve bronchospasm?

A

Ipratropium

53
Q

What is the Long-acting muscarinic antagonist approved for?

A

maintenance therapy of bronchospasm associated with COPD

54
Q

What is the most common side effect Ipratropium and what can we advise our patients to do to help with side effect?

A

dry mouth which is generally mild and diminishes over time.
Patients can suck on sugarless hard candy for relief, but should we warned that high intake of candy containing sorbitol and xylitol can cause diarrhea.

55
Q

Why are two or more drugs needed for the treatment of TB?

A

Antituberculosis regimens must always contain two or more drugs to which the infecting organism is sensitive. Because treatment is prolonged, there is a high risk that drug-resistant bacilli will emerge

56
Q

Which four drugs are first-line treatment for TB?

A

Four drugs—isoniazid, rifampin, pyrazinamide, and ethambutol—are first-line drugs for TB treatment

57
Q

How long should the four drugs TB drugs be prescribed for?

A

The intensive phase, which lasts 8 weeks, consists of four drugs:isoniazid, rifampin, pyrazinamide,andethambutol.The continuation phase, which lasts 18 weeks, consists of two drugs—isoniazidandrifampin

58
Q

For the continuation phase of treatment for TB which medications are prescribed and for how long?

A

Isoniazid, Rifampin and 18 weeks

59
Q

What is the major adverse effects of the four drug regimen for TB treatment?

A

Hepatotoxicity and optic neuritis (ethambutol)

60
Q

What baseline data should we gather before starting Isoniazid, Pyrazinamide, Rifampin and Other Rifamycins?

A
  • chest radiograph (and other imaging as appropriate if there is extrapulmonary TB),
  • liver function (AST, ALT, bilirubin, alkaline phosphate), - complete a clinical assessment.
61
Q

What patient education should we provide when prescribing first-line medication regimen for TB?

A

encourage patients to take their medication exactly as prescribed and to continue treatment until the infection has resolved.
inform patients to be alert to the occurrence of jaundice, anorexia, malaise, fatigue, and nausea and instruct them to report any of these symptoms if they develop. Urge patients who drink alcohol to minimize or eliminate alcohol consumption so as to avoid increasing the risk for liver damage. Also, instruct patients to avoid acetaminophen and other drugs that can cause liver damage.
Inform patients taking isoniazid about symptoms of tingling, numbness, burning, or pain in the hands or feet that can signal onset of peripheral neuropathy and instruct them to report such symptoms if they occur. Explain the importance of taking vitamin B6, if prescribed, to prevent this.
Inform patients taking rifampin that it may impart a harmless red-orange color to urine, sweat, saliva, and tears. Warn patients that soft contact lenses may undergo permanent staining. Advise them to consult their eye care specialist about continued use of the lenses.
When rifampin is being prescribed, advise women taking oral contraceptives to use a nonhormonal form of birth control.
Advise patients taking pyrazinamide who develop polyarthralgias to take an NSAID (e.g., aspirin, ibuprofen) to relieve pain.
Instruct patients taking ethambutol to report any alteration in vision such as blurring of vision or reduced color discrimination.

62
Q

What medication is usually a problem for patients being treated for TB and HIV?

A

TB infection and those used for HIV infection are a common problem, especially for patients takingrifampin.can accelerate the metabolism of most protease inhibitors and most nonnucleoside reverse transcriptase inhibitors (NNRTIs) prescribed to treat HIV, and this can decrease the effects of the latter.

63
Q

What is the recommended treatment for latent Tuberculosis?

A

isoniazid alone, rifampin alone, or isoniazid plus rifapentine

64
Q

What is a potential adverse effect of Ethambutol?

A

Optic neuritis

65
Q

What is the MOA of Isoniazid?

A

Isoniazid suppresses bacterial growth by inhibiting the synthesis of mycolic acid, a component of the mycobacterial cell wall.

66
Q

What is the black box warning for Isoniazid?

A

Isoniazid therapy may cause severe hepatitis.

67
Q

What is the most common dose-related adverse effect of Isoniazid?

A

Dose-related peripheral neuropathy is the most common adverse event.

68
Q

We should use caution when prescribing Isoniazid to what patients?

A

Use withcautionin patients with high alcohol intake, patients with diabetes, patients with vitamin B6deficiency, patients older than 50 years, and patients who are taking phenytoin, rifampin, rifabutin, rifapentine, or pyrazinamide.

69
Q

What can be given prophylactically to peripheral neuropathy caused by Isoniazid?

A

Prophylactic use of pyridoxine at 25 to 50 mg/day can decrease the risk of acquiring peripheral neuropathy. Preventive supplementation is especially important for at-risk people with diabetes or with high alcohol intake.

70
Q

What is the MOA of Rifampin?

A

Rifampin inhibits bacterial DNA-dependent RNA polymerase and thereby suppresses RNA synthesis and, consequently, protein synthesis. The results are bactericidal.

71
Q

How does Rifampin effect the urine, sweat, saliva, and tears?

A

Rifampin frequently imparts a red-orange color to urine, sweat, saliva, and tears.

NR565 - Advanced Pharmacology (13 decks)

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