pharm II exam 3

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pharm II exam 3
2013-10-17 21:09:20
pharm II exam

pharm II exam 3
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  1. what are the gastric stimulants that activates the proton pump
    • acetylcholine
    • histamine
    • gastrin
  2. what are the gastric protective substances that diminishes proton pump action
    prostaglandins E2 and I2
  3. what are the commonly used ways to control excess gastric acid secretions
    • antacids
    • H2 receptor antagonists
    • proton pump inhibitors
  4. what are the less common methods in controlling excess gastric acid secretion
    • mucosal protective agents
    • prostaglandins
    • antimuscarinic agents
  5. what are the treatments for GERD
    • antacids
    • H2 antagonists
    • PPI
  6. what is the treatment for phase I GERD
    • lifestyle changes, OTC
    • mild: lifestyle changes, antacids, OTC H2 antagonists
  7. what is the treatment for phase II GERD
    standard/high dose anti-secretory Rx

    Mod/Severe: acid suppressive tx; maintenance therapy
  8. what is the treatment for phase III GERD
    surgical intervention
  9. these medications have an MOA that are weak bases that neutralize gastric acids
  10. which antacid may cause constipation
    aluminum hydroxide (amphojel)
  11. which antacid may be used as antacid or laxative (diarrhea)
    magnesium hydroxide (Milk of Magnesia)
  12. which antacids have a less acid neutralizing capability compared to the other agents
    calcium carbonate (Tums)
  13. which antacid needs to be avoided for long term and excessive use due to systemic alkalosis
    sodium bicarb
  14. which antacid relieves flatulence with a defoaming action (the gas bubbles combine and are more easily freed)
  15. aluminum hydroxide and magnesium trisilicate contain which acid that creates a foamy layer above the stomach contents (reduces reflux)
    alginic acid
  16. what are your H2 receptor antagonists
    • cimetidine (Tagamet)
    • ranitidine (zantac)
    • famotidine (Pepcid)
    • nizatidine (axid)
  17. these medications competitively block the binding of histamine to H2 receptors whereby inhibiting gastric acid secretion induced by histamine
    H2 antagonists
  18. which class of medications are indicated for peptic ulcers, ZOLLINGER-ELLISON syndrome, acute stress ulcers, and GERD
    H2 antagonists
  19. which H2 antagonist can act as an antiandrogen causing gynecomastia, galactorrhea, and reduced sperm count
    cimetidine (Tagamet)
  20. which H2 antagonist does not cause endocrine side effects, does not inhibit the P450 system and requires BID dosing for most indications
    ranitidine (zantac)
  21. what are you proton pump inhibitors
    • omeprazole (Prilosec)- BCF
    • esomeprazole (nexium)- BCF
    • rabeprazole (aciphex)
    • lansoprazole (prevacid)
    • pantoprazole (protonix)
    • dexlansoprazole (dexilant)
  22. which gastric medication class binds to the H+/K+ ATPase enzyme system (proton pump) of the cells suppressing secretion of hydrogen ions (acid)
  23. which medication class is indicated for PUD, erosive esophagitis, zollinger-ellison syndrome, GERD, stress ulcer prophylaxis
  24. what are the adverse reactions associated with the proton pump inhibitors
    • GI discomfort, N/V/D, HA and dizziness
    • C DIFF infx association during acid suppression
  25. what are the drug/drug interactions associated with proton pump inhibitors
    P450 inhibition varies slightly with each agent. ALL PPIs can decrease the absorption of ketoconazole or itraconazole
  26. how are proton pump inhibitors to be taken
    recommended to take in the morning 15 min to 20 min before breakfast to maximize efficacy
  27. what are the drug /drug interactions associated with omeprazole (prilosec)
    • clopedigrel (decreased effectiveness of Plavix)
    • potential to inhibit the metabolism of warfarin, diazepam and phenytoin
  28. which proton pump inhibitor is available in granules (used for PEG? tubes)
    lansoprazole (prevacid)
  29. which gastric medications decrease gastrointestinal motility (antispasmodic) and inhibit gastric acid secretion
    anti-muscarinic agents
  30. this class of medication is indicated as an adjunct agent to H2 blockers or PPIs, high doses are required to heal peptic ulcers
    anti-muscarinic agents
  31. what are the adverse reactions of anti-muscarinic agents
    • anticholinergic side effects
    • dry mouth, urinary retention, mydriasis
  32. what are the cautions/warnings associated with anti-muscarinic agents
    glaucoma, GI obstructive disease, and heat prostration in high temps
  33. what is the name of your anti-muscarinic agents
    hyoscyamine (levsin)
  34. which medications MOA is that it is a synthetic, oral prostaglandin E1 analog that has both antisecretory and mucosal protective properties
    misoprostol (cytotec)
  35. which medication is used for the prevention of NSAID induced gastric ulcers
    misoprostol (cytotec)
  36. which mucosal protective medication causes diarrhea, abd pain and is a category X due to causing uterine contractions and may cause a miscarriage
    misoprostol (cytotec)
  37. which mucosal protective medication has a MOA the covers the ulcer site and protects it against acid, also stimulates prostaglandin release
    sucralfate (Carafate)
  38. how is sucralfate (Carafate) dosed
    take before meals and hs- requires acidic

    * do not administer with agents that increase gastric pH
  39. which medication stimulates motility of the upper GI track without effecting secretions; dopamine antagonist
    metoclopramide (reglan)
  40. which medication is indicated for GER, N/V from chemotherapy, diabetic gastroparesis
    metoclopramide (reglan)
  41. which medication can cause CNS side effects, can cause drowsiness and restlessness, can cause drug induced Parkinsonism and tardive dyskinesis
    metoclopramide (reglan)
  42. how long should H pylori treatment last
    10-14 days

    *continue antisecretory agent for ~4 weeks for duodenal and 8 weeks for gastric ulcers
  43. what are the two popular H pylori treatment options
    clarithromycin 500 mg BID, Amoxicillin 1 gm BID, and a PPI BDI

    bismuth subsalicylate 2 tabs QID, tetracycline 500mg QID, metronidazole 250mg QID, and PPI BID

    * continue PPI or H2 antagonist therapy for 4-8 weeks after eradication therapy
  44. what is the #1 drug for H. pylori treatment (both PPI based triple therapy and bismuth based quadruple therapy)
    • PPI once or twice daily
    • PPI or H2 antagonist once or twice daily
  45. what is the failure rate of triple therapy for the eradication of H pylori, due to clarithromycin resistance
  46. what are the mechanisms of mucosal injury with NSAID induced ulcers
    • direct or topical irritation of gastric epithelium
    • systemic inhibition of mucosal prostaglandin synthesis
  47. this is a rate- limiting enzyme in the conversions of arachidonic acid to prostaglandins and is inhibited by NSAIDS
    cyclooxygenase (COX)
  48. this produces protective prostaglandins that regulate physiologic processes such as GI mucosal integrity, platelet homeostasis and renal function
  49. this is induced by inflammatory stimuli, such as cytokines and prostaglandins involved in inflammation
  50. what are your anti-emetic 5HT3 antagonists
    • ondansetron (Zofran)
    • granisetron (kytril)
    • dolasetron (anzemet)
  51. what is the place in therapy for 5HT3 antagonists
    • antiemetic for CA therapy
    • N/V following surgery
  52. this class of medication improves the response rates of serotonin-receptor antagonists by 15-30% and its place in therapy is for the use in chemotherapy-induced emesis with serotonin blockers
    corticosteroids (usually dexamethasone)
  53. what are your dopamine antagonists that are used as anti-emetics
    • phenothiazines (prochlorperazine (Compazine); promethazine (Phenergan))
    • metoclopramide (reglan)
  54. which dopamine antagonist used as an anti-emetic, is the effective first line oral, injectable and rectal anti-emetics for inpt and outpt use
    phenothiazines (Compazine or Phenergan)
  55. this drugs MOA is it blocks dopamine receptors in chemoreceptor trigger zone and cause sedation
    phenothiazines (Compazine or Phenergan)
  56. what are the side effects of phenothiazines
    • HoTN
    • restlessness
    • extrapyramidal SE
    • drowsiness
  57. this phenothiazine is indicated for the treatment of nausea and vomiting only
    prochlorperazine (Compazine)
  58. this phenothiazine is indicated for the treatment of nausea, vomiting and motion sickness
    promethazine (Phenergan)
  59. this dopamine antagonist is indicated for nausea and vomiting in addition to being a GI stimulant
    metoclopramide (reglan)
  60. this dopamine antagonist blocks dopamine receptors in the CTZ (chemoreceptor trigger zone) of the CNS, it enhances the response to ACh of tissue in the upper GI tract causing enhanced motility and accelerated gastric emptying without stimulating gastric, biliary, or pancreatic secretions
    metoclopramide (reglan)
  61. what are the adverse reactions to metoclopramide (reglan)
    • drowsiness
    • agitation
    • confusion
    • possible extrapyramidal symptoms
  62. this class of medication works to prevent vomiting due to motion sickness
  63. what are the different antihistamines used for motion sickness
    • meclizine (antivert)
    • dimenhydrinate (Dramamine)
    • diphenhydramine (Benadryl)
  64. which anticholinergic is used to treat motion sickness
    scopolamine transdermal
  65. which anti-emetic drug augments the antiemetic activity of the 5HT3 receptor antagonists and corticosteroids
    aprepitant (emend)
  66. this antiemetic was approved for the treatment of anorexia associated with weight loss in AIDS pts and also approved for nausea associated with chemotherapy
    THC; dronabinol (marinol)
  67. which benzodiazepine antiemetics can be used in anticipatory N/V
    lorazepam (Ativan) or alprazolam (Xanax)
  68. which benzodiazepine antiemetic is used for pre-treatment in parkinsons patiens and used for post-op N/V and for nausea associated with gastroenteritis
    trimethobenzamide (tigan)
  69. which class of medications are used to treat severe diarrhea
  70. what is the antibiotic therapy for travelers diarrhea
    fluoroquinolones or Zithromax or rifampin
  71. how is antibiotic associated diarrhea treated
    • metronidazole (flagyl)
    • oral vancomycin
  72. this medication should be considered first line anti-diarreal for acute diarrhea
    loperamide (Imodium)
  73. this anti-diarrheal will cause opioid activity at high doses so atropine is included to discourage abuse, is contraindicated in acute diarrhea
    diphenoxylate (lomotil)
  74. this medication prevents travelers diarrhea by anti-inflammatory and anti-bacterial action, has antisecretory, antimicrobial, antacid, and possibly anti-inflammatory properties
    bismuth subsalicylate (Pepto-Bismol)
  75. what are your bulking agents used in constipation
    • metamucil
    • fibercon
    • citrucel
    • bran powder
  76. which constipation meds have a prophylactic use in pts who should not strain and for pts on opioid therapy
    stool softners (Colace, Surfak)
  77. this stool softener may cause lipoid pneumonia if aspirated
    mineral oil
  78. this class of medications have a place in therapy for acute constipation and in older patients to prevent chronic constipation and fecal impaction
    osmotic/saline laxatives
  79. what are your osmotic and saline laxative agents
    • MOM
    • magnesium citrate
    • magnesium sulfate
  80. this osmotic/saline laxative should be used first due to it being the cheapest but is CI in pts with renal insufficiency
    magnesium sulfate
  81. what are the adverse effects of osmotic/saline laxatives
    • severe flatus
    • cramps
  82. which medication can be used for chronic use in constipation
  83. what are the short term treatments of constipation
    • bisacodyl (dulcolax)
    • senna (senokot, exlax)
    • cascara (natures remedy)
    • Castrol oil (causes severe cramping and diarrhea)
  84. which constipation medications induce bowel movements/diarrhea to cleanse the bowel usually within 4 hours
    • Polyethylene (GoLye, GoLYTELY)
    • sodium phosphate (fleets)
  85. this medication is used for acute constipation and for use prior to a medical procedure
    fleets enema
  86. what are the adverse effects associated with fleets enemas
    • hyperphosphatemia
    • hypocalcemia
    • hypernatremia
    • hypokalemia
  87. how is constipation predominant IBS treated
    lubiprostone (amitiza)
  88. this IBS treatment has a MOA that works on the chloride channel activator in the small intestines
    lubiprostone (amitiza)
  89. how is diarrhea predominant IBS treated
    aloesetron (5HT3 serotonin antagonist)
  90. this class of medications inhibit peripheral mu opioid receptors without impacting analgesic effects within the CNS
    mu-opioid receptor antagonists
  91. this mu-opioid is approved for the tx of opioid induced constipation in pts receiving palliative care for advanced illness who have had inadequate response to other agents
    methylnaltrexone (relistor)
  92. this mu-opioid is approved for short term used to shorten the period of postoperative ileus in hospitalized pts who have undergone small or large bowel resection
    alvimopan (entereg)
  93. these agents have an MOA that act primarily on the brain (CNS) and perhaps spinal reflexes to relax skeletal muscle by unknown mechanism
  94. what are your anti-spasmodic agents
    • cyclobenzaprine (flexeril) *BCF
    • methocarbamol (robaxin) *BCF
    • metaxalone (skelaxin)
    • orphenadrine (norflex)
    • carisoprodol (soma)
    • tizanidine (zanaflex) *both anti-spasmodic and antispasticity
    • diazepam (valium) * both anti-spasmodic and antispasticity
  95. what are the adverse effects of cyclobenzaprine (flexeril)
    • drowsiness
    • anti-muscarinic effects (dry mouth, urinary retention, increased IOP)
  96. what are the CI associated with cyclobenzaprine (flexeril)
    CI in pts with MI, cardiac conduction defects, and pts receiving MAOI
  97. what are the clinical uses of cyclobenzaprine (flexeril)
    acute local muscle spasms; use as adjunctive tx with PT
  98. this anti-spasmodic can lower seizure threshold, especially if used in combination with tramadol
    cyclobenzaprine (flexeril)
  99. this drugs clinical use is to treat acute local muscle spasm with PT; is approved to treat muscle spasticity associated with tetanus (toxin) poisoning
    methocarbamol (robaxin)
  100. what are the adverse effects of methocarbamol (robaxin)
    • drowsiness
    • urine discoloration (brown)
  101. which antispasmodic is not administered IV to pts with renal impairment
    methocarbamol (robaxin)
  102. this antispasmodic is used in the treatment of acute muscle spasms associated with musculoskeletal conditions
    metaxalone (skelaxin)
  103. this antispasmodic is categorized as an anticholinergic and skeletal muscle relaxant
    orphenadrine (norflex)
  104. this is a centrally acting alpha 2 agonist that is used for the treatment of muscle spasticity
    tizanidine (zanaflex)
  105. this class of medications act directly on the muscle fibers altering the influx of calcium and the release of substance P
  106. what are your anti-spasticity medications
    • baclofen (lioresal)
    • tizanidine (zanaflex)
    • gabapentin (Neurontin)
    • tiagabine (gabtril)
    • dantrolene sodium (dantrium)
    • denervating relaxant (botulinum toxin A)
  107. this anti-spasticity is the DOC for multiple sclerosis
    baclofen (lioresal)
  108. this is the drug of choice for malignant hyperthermia
    dantrolene sodium (dantrium)
  109. this anti-spasticity MOA reduces skeletal muscle strength by interfering with excitation-contraction coupling in the muscle fibers
    dantrolene sodium (dantrium)
  110. which anti-spasticity had adverse effects of muscle weakness, sedation, and occasional hepatitis
    dantrolene sodium (dantrium)
  111. this anti-spasticity (denervating relaxants) has an MOA that temporarily blocks the nerve receptors on the muscle causing a temporary reduction in muscle activity
    botulinum toxin A
  112. this drug is used in the treatment of cervical dystonias; dynamic muscle contractures in cerebral palsy, blepharospasm, and bladder dysfunction
    botulinum toxin a
  113. what are your nonopioids
    • NSAIDS
    • salicylates
    • acetaminophen (APAP)
  114. what are your opioids used in pain management
    • phenanthrenes (morphine-like)
    • phenylpiperidines (meperidine-like)
    • diphenylheptanes (methadone-like)
  115. this class of medications MOA is reversible inhibition of COX 1&2 enzymes resulting in decreased prostaglandin formation
  116. what are the effects of NSAIDS
    • analgesia
    • anti-inflammatory
    • antipyretic
    • antiplatelet
  117. what type of pts may have a hypersensitivity to NSAIDS
    • pts with:
    • asthma
    • nasal polyps
    • chronic urticaria
  118. what is the drug interaction between NSAIDS and low dose ASA
    increased GI bleeding
  119. what is the drug interaction between NSAIDS and ACE-inhibitors
    reduce anti-HTN effects
  120. what is the drug interaction between NSAIDS and warfarin
    increased drug levels and risk of bleeding
  121. this NSAID is an irreversible COX 1&2 inhibitor
  122. what are the adverse effects of mild salicylate toxicity
    • N/V
    • hyperventilation
    • H/A
    • confusion
    • tinnitus
  123. what is the treatment for severe salicylate toxicity
    • IV fluids
    • activated charcoal dialysis
    • monitor acid-base and electrolyte balance
  124. what is the most commonly used NSAID in the US
  125. this NSAID appears to have the smallest cardiovascular risk of OTCs
  126. this NSAID appears to have the highest cardiovascular risk, has a sulf component so don't give to pts with a sulfa allergy, is recommended for use in osteoarthritis and RA
    celecoxib (Celebrex)
  127. what is the only nonacid NSAID, it preferentially inhibits COX-2 over COX-1
    meloxicam (Mobic)
  128. this NSAID is a potent nonselective COX inhibitorand is the 1st NSAID that showed accelerate closure of PDA
    indomethacin (Indocin)
  129. which NSAID may effect the tumor necrosis factor and is associated with unique neurologic symptoms (cogwheel rigidity, tremor, and myoclonus)
    flurbiprofen (Ansaid)
  130. which ophthalmic NSAID is used for the inhibition of intraoperative miosis starting at 2 hours before surgery
    flurbiprofen (ocufen)
  131. this ophthalmic NSAID is used in postoperative inflammation following cataract extraction
    diclofenac (voltaren)
  132. this ophthalmic NSAID is used in the relief of ocular itching caused by seasonal allergic conjunctivitis and post operative inflammation
    ketorolac (acular)
  133. this medications MOA inhibits the synthesis of prostaglandins in the CNS (COX inhibition) and blocks pain impulses in the periphery
  134. what increases bowel motility to speed up elimination of toxic substances