Pharm 3 medications

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Pharm 3 medications
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pharm 3 meds
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  1. What are the medications used for diabetes prevention?
    • Metformin (Glucophage): should be the only drug considered for prevention due to cost, side effects, and lack of persistent effect seen with other drugs
    • Acarbose (Precose)
    • Orlistat (Xenical)
    • Rosiglitazone (Avandia)
  2. Drug of choice for type 1 diabetes.
    Insulin
  3. Non-insulin injectable for type 1 DM (controls post prandial hyperglycemia).
    Pramlintide (Amylin)
  4. Bolus insulin (controls post-prandial hyperglycemia), rapid acting.
    • Lispro (Humalog)
    • Aspart (Novolog)
    • Glulisine (Apidra)
  5. Bolus insulin (controls post-prandial hyperglycemia), short acting insulin.
    Regular (Humulin R, Novolin R)
  6. Basal insulin (controls fasting hyperglycemia), intermediate acting.
    NPH (Humulin N, Novolin N)
  7. Basal insulin (controls fasting hyperglycemia), long acting.
    • Glargine (Lantus)
    • Detemir (Levemir)
  8. What are insulin combinations of NPH-Regular?
    • Humulin 70/30
    • Novolin 70/30
  9. What are insulin combinations of insulin analogs?
    • Humalog Mix: 75/25 (neutral protamine lispro/lispro)
    • Humalog Mix: 50/50 (neutral protamine lispro/lispro)
    • Novolog Mix: 70/30 (aspart protamine suspension/aspart)
  10. Highly concentrated form of human regular insulin, used in pts with severe insulin resistance (require doses >200U/day), dose determined by adding up the total daily dose of U100 insulins and dividing by 5.
    U-500 insulin
  11. What are the drug therapies available for type 2 DM?
    • Human insulin & insulin analogs: various
    • Insulin secretagogues: sulfonylureas, metglitanides (repaglinide, nateglinide)
    • Biguanide: metformin
    • A-Glucosidase inhibitors: acarbose, miglitol
    • Thiazolidinediones: pioglitazone, rosiglitazone
    • Amylin analogue: pramlintide
    • GLP-1 agonist: exantide, liraglutide
    • DPP-4 inhibitor: sitagliptin, saxagliptin
    • Bile acid sequestrants: colesevelam
    • Dopamine agonist: bromocriptine
  12. What types of medication help increase insulin secretion?
    • Insulin
    • Insulin secretagogues
    • GLP-1 agonist
    • DPP-4 inhibitors
  13. What types of medication help decrease insulin resistance?
    • Biguanides
    • Thiazolidinediones
    • Dopamine agonist
  14. What types of medication are considered as miscellaneous treatment options for type 2 DM?
    • α-glucosidase inhibitor
    • amylin analogue
    • bile acid sequestrants
  15. Binds to a specific sulfonylurea receptor (SUR) on the pancreatic β cell leading to enhancement of insulin secretion (2d phase).
    Sulfonylureas
  16. What are the 1st generation sulfonylureas?
    • Acetohexamide (Dymelor)
    • Chlorpropamide (Diabenese): highest hypoglycemic potential, SIADH/hyponatremia, disulfirm-type reaction
    • Tolazamide (Tolinase)
    • Tolbutamide (Orinase): shortest acting, disulfirm-type reaction
  17. What are the 2nd generation sulfonylureas?
    • Glipizide (Glucotrol)
    • Glipizide XL (Glucotral XL)
    • Glyburide (Diapeta; Micronase)
    • Glyburide mirconized (Glynase)
    • Glimepiride (Amaryl)
  18. Stimulate insulin secretion from the β cells of the pancreas.
    Non-sulfonylurea secretagogues
  19. What are the non-sulfonylurea secretagogues?
    • Nateglinide (Starlix)
    • Repaglinide (Prandin)
  20. Decreases hepatic glucose production and increases insulin sensitivity of hepatic and peripheral (muscle) tissues.
    Biguanide (CI if Scr >1.4 in females, >1.5 in males)
  21. What are the immediate release biguanides?
    • Metformin (Glucophage)
    • Metformin (Riomet)
  22. What are the extended release biguanides?
    • Metformin XR (Glucophage XR)
    • Metformin ER (Fortamet ER)
    • Metformin (Glumetza)
  23. Competitively inhibit α-glucosidase enzymes (maltase, isomaltase, sucrase, glucoamylase) in the small intestine delaying the breakdown of sucrose and complex carbs to glucose and other monosaccharides; net effect is a reduction in the post-prandial blood glucose increase.
    α-glucosidase inhibitors
  24. What are the α-glucosidase inhibitors?
    • Acarbose (Precose): eliminated in bile, don't use if Scr 2 mg/dL
    • Miglitol (Glyset): eliminated renally, don't use if Scre >2 mg/dL
  25. Binds the peroxisome proliferator activator receptor-Υ (PPAR-Υ) enhancing insulin sensitivity at skeletal muscle, liver, and fat cells.
    Thiazolidinediones (TZDs)
  26. What are the thazolidinediones?
    • Pioglitazone (Actos): also partial agonist at PPAR-α, simiar to fibric acid derivatives
    • Rosiglitazone (Avandia)
  27. Neurohormone co-secreted from the β cells with insulin, very low or absent in type 1 DM and lower than normal in type 2 DM.
    Amylin
  28. What is a synthetic analog of amylin?
    Pramlintide (Symlin): do not mix with other insulins, skip dose if meal is skipped, causes wt reduction
  29. Suppresses inappropriate high postprandial glucagon secretion, increases satiety (may cause wt loss), slows gastric emptying therefore improving the rate of glucose appearance in the plasma.
    Amylin analogue
  30. What are the two incretin hormones?
    • Glucose-dependent insulinotropic polypeptide (GIP)
    • Glucagon-like peptide-1 (GLP-1)
  31. Enhances insulin secretion in a glucose-dependent manner, suppresses glucagon secretion, slows gastric emptying, and reduces food intake (increases satiety); stimulates β cell proliferation, preservation, and function in animals.
    Glucagon-like peptide 1 (GLP-1) agonist (incretin-based therapy)
  32. What are the incretin mimetics (GLP 1 agonists)?
    • Exenatide (Byetta)
    • Exenatide ER (Bydureon)
    • Liraglutide (Victoza)
  33. Prolongs the t1/2 of endogenous GLP-1 and GIP resulting in enhanced insulin secretion and glucagon suppression; no effect on gastric emptying and satiety.
    Dipeptidyl Peptidase-4 (DPP-4) inhibitors (incretin based therapy)
  34. What are the DPP-4 inhibitors (incretin based therapy)?
    • Sitagliptin (Januvia)
    • Saxagliptin (Onolyza)
    • Linagliptin (Trajenta)
  35. Bile acid sequestrant.
    Colesevelam (Welchol)
  36. Dopamine agonist.
    Bromocriptine (cycloset)
  37. What are the combination products used to treat type 2 DM?
    • Glipizide/metformin (metaqlip)
    • Glyburide/metformin (glucovance)
    • Repaglinide/metformin (prandimet)
    • Pioglitazone/metformin (actoplus met)
    • Pioglitazone/glimeperide (duetact)
    • Rosiglitazone/metformin (avandamet)
    • Rosiglitazone/alimeperide (avandaryl)
    • Sitagliptin/metformin (janumet/janumet XR)
    • Sitagliptin/simvastatin (juvisync)
    • Linagliptin/metformin
  38. What is the drug of choice for gestational diabetes mellitus treatment?
    Insulin (Reg and NPH)
  39. What drugs demonstrate the therapeutic benefits of reducing major acute coronary events, CHD mortality, coronary procedures, stroke and total mortality, and are the most potent LDL lowering agents?
    HMG-CoA reductase inhibitors (statins)
  40. Inhibits the first committed enzymatic step of sterol synthesis by blocking hydroxymethylglutaryl coenzyme A reductase.
    HMG-CoA reductase inhibitors (statins)
  41. What is the place in therapy for Statins (HMG-CoA reductase inhibitors)?
    Used to treat elevated LDL and/or VLDL by depleting intracellular supplies of cholesterol, causing up regulating of cellular LDL receptors that bind circulating LDL in the blood.
  42. What pregnancy category are HMG-CoA reductase inhibitors (statins)?
    Cat X (do not use!)
  43. What are the HMG-CoA reductase inhibitors (statins)?
    • Simvastatin (Zocor)
    • Atorvastatin (Lipitor)
    • Fluvastatin (Lescol)
    • Lovastatin (Mevacor)
    • Pravastatin (Pravachol)
    • Rosuvastatin (Crestor)
  44. What are the most efficacious statins currently on the market?
    • Atorvastatin (Lipitor)
    • Rosuvastatin (Crestor)
  45. Which statins do not require adjustment for renal insufficiency?
    • Atorvastatin (Lipitor)
    • Fluvastatin (Lescol)
  46. What is the only statin that is not highly protein bound?
    Pravastatin (Pravachol)
  47. Which statin has shown adverse affects of SEVERE myopathy or rhabdomyolysis?
    Lovastatin (Mevacor)
  48. Concurrent administration of HMG-CoA reductase inhibitors and what other drug increases the risk of severe myopathy or rhabdomyolysis and liver toxicity?
    Nicotinic Acid (Niacin)
  49. Anion exchange resins that bind negatively charged bile acids and bile salts in the small intestine for excretion leading to more cholesterol being converted into bile acids.
    Bile acid sequestrants/binding agents
  50. What are the bile acid sequestrants?
    • Colestipol (Colestid)
    • Cholestyramine (Questran)
    • Colesevelam (Welchol)
  51. Which bile acid sequestrant is the newest on the market and is more potent so patients take smaller doses, and has fewer GI side effects?
    Welchol
  52. Demonstrated therapeutic benefits of which drugs reduce major coronary events, reduce CHD mortality, and is used in combination with statins or niacin in elevated LDL and VLDL?
    Bile sequestrants
  53. What class of antihyperlipidemic drug is the only approved agent in pregnancy?
    Bile acid sequestrants
  54. Reduces the hepatic synthesis of VLDL by inhibiting lipolysis.
    Nicotinic Acid (Niacin)
  55. What are the major actions of niacin?
    • Decreases LDL
    • Decreases TG
    • Increases HDL (best)
  56. What is a disadvantage to using niacin?
    Difficult to get patients to a therapeutic dose.
  57. Stimulates lipoprotein lipase activity which hastens the removal of chylomicrons and VLDL from the plasma, subsequently decreasing TG.
    Fibric Acids
  58. Demonstrated therapeutic benefits of what drugs reduce progression of coronary lesions, and reduce major coronary events?
    Fibric Acids
  59. What are the fibric acids?
    • Gemfibrozil (Lopid)
    • Fenofibrate (Tricor; Antara; Lofibra)
  60. Inhibits absorption of cholesterol at the brush border of the small intestine, via the sterol transporter.
    Selective cholesterol absorption inhibitors
  61. What are the selective cholesterol absorption inhibitors?
    Ezetimibe (Zetia)
  62. What antihyperlipidemic drug is approved for children 10-18 years old?
    Ezetimibe (Zetia)
  63. What are the approved medications for the treatment of hypertriglyceridemia?
    • Niacin
    • Fibrates
    • Statins (Atorvastatin is the only one approved)
  64. What are other drugs used to treat hyperlipidemia that are not in ATP III?
    • Psyllium (Metamucil)
    • Fish Oils (Lovaza)
  65. Decreases the formation or the action of chemical signals that promote platelet aggregation, used for occlusive cardiovascular diseases, vascular grafts and as adjuncts to MI thrombolytic therapy.
    Platelet aggregation inhibitors
  66. What are the platelet aggregation inhibitors?
    • Aspirin
    • Clopidogrel (Plavix)
    • Abciximab (ReoPro)
    • Eptifibatide (Integrilin)
    • Tirofiban (Aggrastat)
  67. Irreversibly blocks TXA2 synthesis from arachidonic acid in platelets by inhibiting COX (cyclooxygenase). Also inhibits prostacyclin activity in endothelial cells (not as sensitive).
    Aspirin
  68. What drug reduces the risk of a second heart attack and was recently shown to reduce the chance of a first heart attack in high risk patients?
    Aspirin
  69. Non-competitive platelet ADP antagonist, inhibits platelet aggregation by selectively and irreversibly blocking ADP binding.
    Clopidogrel (Plavix)
  70. Most providers reserve what drug for use in patients who have a contraindication to aspirin?
    Clopidogrel (Plavix)
  71. Fragment of a monoclonal antibody that causes stearic hindrance near the active GP IIb/IIIa binding site, preventing fibrinogen from binding to platelets.
    Abciximab (ReoPro)
  72. What are similar agents to Abciximab that reversibly inhibit the binding of fibrinogen to the glycoprotein (GP) IIb/IIIa receptor? Are these agents monoclonal antibodies?
    • Eptifibatide (Integrilin), Tirofiban (Aggrastat)
    • No (less immunogenic)
  73. What are the natural inhibitors of coagulation found in the blood?
    • Protein C (destroys factors Va and VIIIa)
    • Protein S (cofactor to Protein C)
    • Antithrombin III (inactivates IIa, VIIa, IXa, Xa)
  74. Binds to antithrombin III and speeds its ability to inhibit thrombin, acts within minutes not hours and days, and is given parenterally because it does not cross membranes.
    Heparin (unfractionated heparin-UFH)
  75. Developed by depolymerization of UFH into products that are smaller molecular weight entities. Advantages include improved bioavailability, predictable dose-response, longer t1/2 and fewer monitoring requirements. Has a lower affinity for antithrombin but maintains effect on factor Xa therefore does not affect aPTT.
    Low molecular weight heparins (LMWH)
  76. What are the low molecular weight heparins?
    • Enoxaparin (Lovenox)
    • Dalteparin (Fragmin)
    • Ardeparin (Normiflo)
    • Tinzaparin (Innohep)
  77. What anticoagulant is safe for use in pregnancy because it does not cross the placenta?
    Low molecular weight heparins (LMWH)
  78. Heparin antagonist (antidote), used when heparin reversal is indicated, administered VERY SLOWLY via IVP over 10 mins.
    Protamine Sulfate (will not completely reverse LMWH)
  79. Inhibits vitamin K epoxide reductase which reduces available vitamin K needed by the Vit K dependent clotting factors (II, VII, IX, X).
    Warfarin (Coumadin)
  80. Is warfarin safe to use in pregnancy?
    NO
  81. Reversal agent for Coumadin (warfarin antidote), fat soluble vitamin, route and dose based on INR and bleeding symptoms.
    Phytonadione (Vit K)
  82. What are the phytonadione (vit k) products?
    • Mephyton (phytonadione) tablets
    • Aquamephyton (phytonadione) injection
  83. What are the anticoagulant agents that directly inhibit thrombin (don't need cofactor) derived from leeches?
    • Lepirudin (Refludan): irreversible thrombin inhibition
    • Argatroban (Acova): reversible thrombin inhibitor
    • Bivalirudin (Angiomax): reversible, indicated for unstable angina with percutaneous transluminal coronary angioplasty
  84. What are the anticoagulants that are pentasaccharides?
    Fondaparinux (Arixtra)
  85. Specific factor Xa inhibitor (ATIII-mediated), no cross reactivity w/ heparin antibodies, approved for prophylaxis of DVT in pts undergoing surgery (hip/knee), also used for tx of PE and acute DVT.
    Fondaparinux (Arixtra)=pentasaccharide
  86. Dissolves clots by activating conversion of plasminogen to plasmin that hydrolyzes fibrin, greatest benefit if given within the first 3 hours and some benefit after 12 hours, indicated for treating AMI, acute ischemic stroke, acute PE, restoration of CV catheter flow and massive DVT.
    Thrombolytics
  87. What are the representative agents for thrombolytic enzymes?
    • Streptokinase (Streptase): avoid in pts who have used it before or who had recent strep infection (not available in US)
    • Urokinase (Abbokinase)
  88. What are the representative agents for tissue plasminogen activators (thrombolytics)?
    • Alteplase (Activase): complicated IV regimen
    • Reteplase (Retevase): two bolus dose
    • Tenecteplase (TNKase): one bolus dose
  89. Miscellaneous anticoagulant that improves blood flow by decreasing blood viscosity and improving erythrocyte flexibility, indicated to treat intermittent claudication.
    Pentoxifylline (Trental)
  90. Miscellaneous anticoagulant that inhibits phosphodiesterase activity and suppress degradation of cyclic adenosine monophosphate (cAMP) resulting in an increase in cAMP in platelets and blood vessels. Reversibly inhibits platelet aggregation induced by ADP, collagen, arachidonic acid, epinephrine, thromboxane A2, platelet activating factor, and shear stress, also causes vasodilation.
    Cilostazol (Pletal)- indicated for intermittent claudication
  91. What are the thyroid replacement medications used to treat hypothyroidism?
    • Desiccated thyroid (animal source)
    • Levothyroxine/T4 (Synthroid, others)
    • Liothyronine/T3 (Cytomel)
    • Liotrix/T4:T3, 4:1 (Thyrolar)
  92. What are the thioamides used to treat hyperthyroidism (thyrotoxicosis)?
    • Methimazole (Tapazole)
    • Propylthiouracil (PTU): safe for pregnancy (esp 1st trimester), nursing and thyroid storm
  93. Inhibits thyroid perioxidase, thus blocking organification and coupling (inhibits thyroid synthesis).
    Thioamides
  94. Which thioamide inhibits the peripheral conversion of T4 to T3?
    Propylthioruracil (PTU)
  95. Large doses (>6 mg/day) inhibits thyroid perioxidase, resulting in decreased iodide organification (Wolff-Chaikoff block), coupling (MIT+DIT, etc) and hormone release. Reduces the thyroid gland's vascularity (increasing firmness) and size prior to thyroidectomy.
    Iodides
  96. What are the iodide agents used to treat hyperthyroidism (thyrotoxicosis)?
    • Potassium iodide 5% and elemental iodine 5% (Lugol's solution)
    • Saturated solution of potassium iodide (SSSKI)
    • Iodinated contrast agents (Telepaque, Oragrafin)
  97. Rapidly accumulates in the thyroid and emits beta and gamma radiation (t1/2 about 5-8 days) therby destroying thyroid tissue, full effects seen after 2-6 months.
    Radioactive iodine (131I)
  98. Used as an adjunct to block the B1 and B2 receptors in order to control hyperthyroid manifestations such as tremor, tachycardia, hypertension and atrial fibrillation during thyroiditis or thyroid storm.
    Beta blockers
  99. What are the beta blockers used to treat hyperthyroidism (thyrotoxicosis)?
    • Propranolol (Inderal): may decrease T3 lvls by inhibiting peripheral conversion of T4 to T3
    • Nadolol (Corgard)
    • Metoprolol (Lopressor): B1 specific
    • Esmolol (Brevibloc)
  100. What drugs can be used to control tachycardia in patients with hyperthyroidism who cannot use B-blockers (ie, asthma)?
    • Verapamil (Calan) CCB
    • Diltiazem (Calan) CCB
  101. What is the treatment of hoice for myexedema coma?
    Levothyroxine IV
  102. What drugs are used to treat thyroid storm?
    • Propronolol or esmolol IV: control CV symptoms (Diltiazem if B-blockers contraindicated)
    • PTU: prevents synthesis of thyroid hormones
    • SSKI: given AFTER PTU, prevent release of thyroid hormones
    • Hydrocortisone: protects pt against shock and blocks peripheral conversion of T4 to T3
  103. What hormone is approved for use in diagnostic evaluation of the ability of the pituitary to secrete GH? What is the product name?
    • Growth hormone releasing hormone (GHRH)
    • Sermorelin (Geref) for injection (withdraw in 2002)
  104. What are the approved uses for growth hormone inhibiting hormone (GHIH)? What is the hormone?
    • Tx of acromegaly, control of sx in pts with metastatic carcinoid and vasoactive intestinal peptide secreting tumors (VIPomas).
    • Somatostatin: inhibits release of GH, glucagon, insulin, gastrin
  105. What are the endogenous and exogenous somatostatin (GHIH) products used to treat acromegaly and VIPomas?
    • Endo: somatostatin
    • Exo: Lanreotide (somatulin) for acromegaly only; Octreotide (Sandostatin, Sandostatin LAR) 45x more potent than somatostatin at inhibiting GH release
  106. Diagnostic agent used to differentiate between pituitary (Cushing's DISEASE) and ectopic production of ACTH. What is the product name?
    • Corticotropin releasing hormone (CRH)
    • Corticorelin (Acthrel)
  107. What are the gonadotropin releasing hormone (GnRH) products used to treat certain cancers, reproductive issues, and can be used as diagnostic agents?
    • Gonadorelin (Factrel, injection)
    • Goserelin (Zoladex, monthly implant/Zoladex LA Q3 month implant)
    • Leuprolide (Lupron, Eligard, Viadur)
    • Nafarelin (Synarel)
    • Triporelin (Telstar Depot)
  108. Which GnRH is used as a diagnostic agent?
    Gonadorelin (Factrel)
  109. Which GnRH is used to tx primary hypothalamic amenorrhea?
    Gonadorelin (Factrel, pulse doses stimulate FSH and LH release)
  110. Which GnRH is used to treat breast cancer?
    Goserelin (Zoladex), continuous doses=medical castration
  111. Which GnRH is used to treat prostate cancer?
    Goserelin (Zoladex), continuous dose
  112. Which GnRH are used to treat endometriosis?
    • Goserelin (Zoladex)
    • Leuprolide (Lupron)
    • Nafarelin (Synarel)

    **continuous dose x 6 months only**
  113. Which GnRH is used to treat central precocious puberty (before 8 in girls, before 9 in boys)?
    Nafarelin (Synarel), continuous dose
  114. What products are used to treat hyperprolactinemia, prolactin-secreting adenomas, and acromegaly?
    • Bromocriptine (Parlodel), daily dosing
    • Cabergolin (Dostinex), twice weekly
    • **dopamine agonists**
  115. Used to treat growth failure and prader-willi syndrome in children, and HIV pts with wasting, and short bowel syndrome (SBS) in adults.
    Growth Hormone (GH)
  116. What are the growth hormone products used to treat children and adults with deficiencies or other related issues?
    Somatotropin (Genotropin, Humatrope, Norditropin-ECF, Nutropin, Omnitrope, Saizen, Serostim, Tev-Tropin, Zorbtive)
  117. Used to treat acromegaly resistant to or unable to tolerate other therapies. Most effective agent at normalizing IGF-1 serum concentrations.
    • Growth hormone antagonist
    • Product: Pegvisomant (Somavert)
  118. Diagnostic agent for detecting blood levels of thyroglobulin to exclude the diagnosis of residual or recurrent thyroid cancer following a thyroidectomy.
    • Thyroid stimulating hormone (thyrotropin)
    • Product: Thyrotropin alfa (Thyrogen)
  119. Diagnostic agent used to differentiate between primary adrenal insufficiency and secondary adrenal insufficiency caused by inadequate ACTH secretion.
    • Adrenocorticotropic hormone (ACTH)
    • Product: Cosyntropin (Cortrosyn)
  120. Approved for use in ovulation induction, including infertile females with LH deficiency, and spermatogenesis induction.
    • FSH/LH
    • Products: Follitropin alfa (rFSH), Follitropin beta (rFSH), Urofollitropin (uFSH)-purified from urine of post-menopausal women, Lutropin alfa (Luveris)
  121. Approved for use during labor to stimulate uterine contraction, and post partum to stimulate lactation and control post-partum bleeding.
    • Oxytocin
    • Product: Oxytocin (Pitocin) for injection
  122. What product is a dopamine antagonist also used (off label) to stimulate lactation besides oxytocin?
    Metoclopramide (Reglan)
  123. Acts on renal collecting ducts to conserve water, and is used in the diagnosis and treatment of diabetes insipidus.
    • Vasopressin
    • Product: vasopressin (pitressin)
    • **PRESSOR is used in the ACLS algorithm for VF/pulseless VT**
  124. Used as an injection to treat central DI, and control bleeding associated with hemophilia A and von Willebrand's disease.
    • Desmopressin (DDAVP)
    • Products: desmopressin (DDAVP for inj, nasal, tab), desmopressin (Stimate nasal)

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