Pharmacology Exam 3

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Pharmacology Exam 3
2014-03-31 18:48:45
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  1. Thyroid medication
    Levothyroxine (Synthroid)


    • MOA: Binds at receptors
    • Uses: reverses the symptoms of hypothyroidism
  2. Parathyroid medication
    Aledronate (Fosamax)

    Fosamax-Fossils as in bones

    • Use: treatment of exess parathyroid hormone or hypercalcium. Treatment of osteoporosis
    • MOA: slows normal and abnormal bone resorption 


    Adverse: esophagitis, bone pain
  3. Special instructions for aledronate (fosamax)
    • Must be upright for 30 min to an hour after taking pill
    • Must drink at least 8 oz of water
    • Must wait 2 hours to take calcium supplement
    • Most wait to eat or drink anything for 30 min
    • Must only take with water
  4. Adrenal medication

    MOA: enter target cells and bind to cytoplasmic receptors and exert anti-inflammatory and immunosuppressive effects. Blocks arachidonic acid which decreases release of prostaglandin and leukotriene formation. Impairs phagocyte movement into tissues. Blocks production of antibodies.

    •  Many adverse effects
    • Used in multiple systems
  5. If attempting to get off prednisone, it is necessary to
  6. Best time to take prednisone?
    8-9 am
  7. Types of Antihypertensives
    • ACE inhibitors
    • Calcium channel Blockers
    • Beta 1 blocker
    • Angiotensin receptor blocker
  8. ACE inhibitor medication

    (Put a cap on high bp)


    • MOA: blocks conversion of angiotensin I to
    • angiotensin II in the lungs.  So less
    • angiotensin II to bind to receptors in blood vessels- result is less
    • vasoconstriction.  Less angiotensin II
    • also means less aldosterone release from the adrenal glands.  Result in lowered BP and  less sodium retention and less fluid
    • retention.  

    Adverse: most common is cough, angiodema, chests pain, angina, GI irretation, renal compromise, photosensitivity, pancytopenia
  9. Primary contributor to heart disease
  10. what does Chronotropic mean?
    affects rate
  11. what does Inotropic mean?
    affects contractility
  12. Primary or essential hypertension
    90% of all cases

    • Theory:  abnormal sodium excretion result in renal retention of sodium and water with expansion of plasma and ECF volume.  This leads to both more sodium and water in arterial walls and increase cardiac output.  
  13. Secondary hypertension
    Some other problem in the body thats causing elevated bp
  14. White coat hypertension
    elevated bp only in the doctors office
  15. Calcium channel blockers


    • MOA: decrease movement of calcium into cardiac and arterial
    • muscle cells. Results in vasodilation
    • and decreased PVR. So lower BP, decrease
    • workload and decrease oxygen consumption. 

    Contraindications: heart block, impairment that can be worsened due to altered conduction, renal or hepatic dysfunction

    Adverse: constipation, peripheral edema
  16. Beta 1 blocker
    • Atenolol 
    • (Attention, gets the hearts attention to slow down and reduce high bp)

    MOA: blcok beta adrenergic receptors in the heart and juxtaglomerular apparatus of the nephron resulting in decreased heart rate, contractility, and excitability, and lowered bp

    Adverse: bradycardia, may increase serum triglycerides and lower HDL, and may increase glucose intolerance 

    Can't use non selective beta blocker in people with asthma or COPD
  17. Angiotensin II receptor blocker

    (Losartan- LOW arrtery- lower pressure in arteries)

    MOA- bind to angiotensin II receptors in blood vessels to prevent vasoconstriction and to receptors in adrenal cortex- prevent aldosterone release

    Adverse:  HA, dizzy, syncope, weakness, diarrhea, and pain, N/V, URI, cough, rash

  18. Cardiotonic medication

    (used for congestive heart failure- you will DIE without it)

    • MOA:  increases intracellular calcium levels in the myocardial cells during depolarization  resulting in increased contractility which leads to increased cardiac output, renal blood flow and urine production.   Calcium inactivates troponin thus increasing the formation of actomyosin bridges which enhances contraction) positive inotrope, negative chronotrope

    • Slows
    • Strengthens
    • Stimulates

    Results in decreased myocardial workload and relief of CHF

    • Adverse effects: Fatigue, bradycardia, anorexia, nausea, vomitting, arrithmias 
  19. digitilizing dose
    loading dose
  20. Digoxin toxicity
    • abdominal pain, anorexia, N/V, visual disturbances (more common in adults), disrythmias (more common in children)

    Risk of toxicity increases with low potassium 

  21. Digoxin antidote
  22. Digoxin as a _______ theraputic index
  23. Before giving a dose of digoxin, you must
    check apical pulse for one minute, and in an adult you would hold the medication if the pulse rate is below 60
  24. Preload
    amount of blood returned to hear and then pumped out
  25. Afterload
    resistance that the heart has to pump against
  26. Congestive heart failure
    heart fails to meet the metabolic demands of the body

    • causes:
    • damage to heart muscle
    • worlkoad excessive for prolonged period
    • abnormal heart structure
  27. Signs and symptoms of CHF
    • Respiratory symptoms:

    • Fine crackles on inspiration and expiration
    •             Increased Respirations
    • Peripheral edema
    • Pitting edema
    • Engorgement of the liver
    • Extra heart sounds
    • Arythmias
    • Falling urinary output
    • Weak
    • Tired
    • Anxious
    • Weight
  28. Lowe lipids medication
    atrovastatin (Lipitor)

    • MOA:  these drugs inhibit the action of hydroxymethylglurtaryl coenzyme A reductase.  This compound must be present to produce cholesterol in the cell. 

    Kinetics: absorbed GI, first pass metabolism, excreted in feces and urine peak effect in 2-4 weeks.  Drugs cross the placenta and cause skeletal malformations.

    • Adverse:  can cause liver toxicity so must monitor enzymes.  GI- N/V/gas/constipation.  Rhabdomyolysis- destruction of muscle tissues with myoglobin release and can result in kidney failure (increased risk with EES, cyclosporine, gemfibrozil, antifungals, niacin).  Rate is 1 per 11 million prescriptions. Muscle cramping, weakness    
  29. pregnancy category of Lipitor
  30. Grape fruit juice alters the way _______ is metabolized and creates toxicity
    Lipitor (atorvastatin)
  31. Cholesterol
    function is to maintain cell membrane, formation of steroid hormones. Made by body if not enough taken in ( can be made by every cell)
  32. LDL
    • cholesterol, triglyceride, and lipid package carried by protein.  When broken down for use creates remnants that are then to be returned to liver.  
  33. HDL
    • loosely packed lipids that are used for energy and for clean up of remnants.  genetic
  34. ________ regulates early step in synthesis of cholesterol
    • Hydroxymethylglutaryl coenzyme A reductase (HmgCOA)
  35. Statins POSSIBLY decrease
    • risk of Alzheimers
    • incidence of macular degeneration
    • incidence of glaucoma
    • number of lesions in MS
    • number of joint swelling in RA
    • incidence of prostate cancer
  36. This drug class is used in individuals with elevated triglycerides. More risk of rhabdomyolysis if given with statins
  37. This drug class is often given to increase a low HDL. It can be difficult to take due to flushing sensation, headache, and liver toxicity
    Niacin or Nicotinic acid (vitamin B3)
  38. Alternative therapies for High cholestorole
    • 1.  omega 3 fatty acids (fish oils)- 2gm supplement decreases heart rate variability and risk for MI
    • 2.  walnuts- labeled as agent that may reduce the risk of heart disease
    • 3.  olive oil- use seems to reduce risk of CVD
    • 4.  Plant sterols and stanols- found in products like Take Control and Benecol.  Reduce LDL- approx 11%.  Need 2 gms per day- 2tbsp.  SE- GI/ flatulence/ diarrhea/ constipation.  MOA:  decreased cholesterol absorption, and increase fecal elimination (42 trials)
    • 5.  Policosonal- extract from sugarcane wax- 23.7% reduction in lipids (5-40 mg per day).  Decrease cholesterol synthesis with decrease in TC, HDL, triglycerides.  May have somnolence, nervousness, dizziness.  Can inhibit platelet aggregation (equivalent to taking 100 mg ASA daily).  About $20.
    • 6.  Red yeast supplements- seem to have a similar action as statins, but issues with purity and safety.
  39. Antianginal medicine

    MOA: direct action on smooth muscle to cause vessel dilation and lower BP due to drop in systemic pressure.  Decreases both preload and afterload. 

    Uses: angina- treatment (short acting like SL) or prevention (longer acting) 

    Contraindications: CANNOT TAKE WITH VIAGRA

    Adverse: headache, dizziness, hypotention, tachycardia 

  40. pain with activity
    stable angina
  41. pain at rest
    unstable angina
  42. Antianginals can reduce pain by 2 mechanisms
    • dilate blood vessels
    • decreases afterload, which decreases workload, which decreases pain
  43. Special instruction for administrating Nitroglycerin
    • Take 1 tablet, put it under your tongue
    • Wait five minutes
    • If pain persists, take another tablet
    • Wait five minutes
    • If pain persists, take third tablet call 911

    • Keep it with you, in original packaging (dark brown glass bottle)
    • Should burn under tongue
    • Only good 6 months
  44. Anticoagulant meications
    • Heparin
    • Warfarin
  45. Warfarin
    MOA: interferes with hepatic synthesis of vitamin K

    Kinetics: good GI absorption, metabolized in liver, excreted in urine and feces; onset of action 3 days

    Uses: atrial fibrulation, DVT

    Contraindications: not for use during pregnancy or lactation
  46. Warfarin Antidote
    Vitamin k
  47. Heparin
    MOA: prevents the inhibitory effect of antithrombin on factor Xa and thrombin 

    Kinetics: IV or SQ with almost immediate onset, excreted in urine, does not cross placenta or is not in breast milk 

    Uses: prevent and treat venous thrombosis, pulmonary emboli, atrial fibrulation
  48. Heparin antidote
    Protamine sulfate
  49. Enoxaparin (Lovenox)
    • MOA: inhibit thrombus and clot formation by blocking Xa and IIa
    • Use: post operative to prevent clots and emboli for which an individual is at decreased risk due to surgery and/or prolonged bedrest
    • Fewer side effects due to specificity
  50. Antiplatelet drug

    MOA: Aspirin inhibits platelet adhesion and aggregation 

    Use: patient with increased risk of CVD, prevent second heart attack, reduce risk for stroke, maybe prevents colon cancer 

    Adverse effects: bleeding and bruising, HA, dizzy, weakness, nausea and GI irritation from medication, rash
  51. Contraindications and adverse effects for Anticoagulants
    • Contraindications: 
      • Increased bleeding tendencies, recent trauma, GI ulcers, recent surgeries
      • Pregnancy
      • Lactation (can use heparin)
      • Caution with CHF, diarrhea, fever (the later two affect Vit. K levels and plasminogen activation)
    • Adverse Effects:
      • Bleeding
      • Nausea, upset stomach
      • Hepatic dysfunction
      • Warfarin- BMD, alopecia, dermatitis, erectile problems
  52. RBC's last how many days
  53. Iron
    • In erythropoesis- forming hemoglobin rings to carry 02
    • Types of Anemia- iron deficiency anemia 
    • How to give- usually orally
    • Instructions- GI upset most common. Best taken empty stomach or with vitamin C source to increase absorption. Stains teeth
  54. Folic acid
    • In erythropoesis- supporting structure of RBC
    • Type of anemia- megaloblastic anemia (large immature RBC)
    • How to give: usually orally 1 mg/?
    • Instructions- found in green/ leafy veggies, eggs, milk, liver
  55. B12
    • in erythropoesis- supporting structure of RBC
    • Type of anemia- macrocyticanemia, perncesus anemia
    • How to give- IM daily for 5-10 days; then monthly
    • Instructions- important in health of myelin sheath as well as RBCs
  56. What is the mechanism of action of epoetin alfa
    acts like natural erythropoieten to stimulate bone marrow to produce RBC's
  57. Iron is
  58. Rescue drug

    MOA: selective beta 2 agonist 

    Can cause increased beta 1 agonist- increased heart rate, ect 

    Kinetics: routs can be inhaled, injected SQ or IV, less common po, liver metabolism, urinary excretion. Cross placenta and enter breast milk. 

    Adverse: shaky, anxious, arrhythmias 

    • Salmeterol- long acting 
    • Albuterol- short acting
  59. Antitussives

    MOA: act at your cough center at the medulla of the brain

    Contraindications: need to cough to maintain airway or remove secretions

    Adverse: drowsiness, dryness, respiratory depression

    Not for use during pregnancy or lactation due to CNS depressant effects

    Dont really work in children. Above the age of one, honey works better than dextromethorphan in children
  60. Decongestants

    MOA: causes local vasoconstriction

    Use: allergies, viral inflammation

    Kinetics: can be oral or topical with increased systemic effects with oral use. Delayed response to topical. 

    Contraindicaions- increased smpathetic activity could be harmful (thyroid, CV, diabetic, glaucoma, prostate)

    Adverse: shouldnt take if have high bp, causes irritability and wakefulness in children, not recommended for infants and young children, urinary retention, arrhythmias 
  61. Rebound congestion
    after topical in about 3 days

  62. How to use nasal steroids
    aim applicator at side of nose, can cause holes in nasal septum cartilage
  63. Antihistamines
    diphenhydramine (Benadryl)

    MOA: block the release of histamine 1 receptors

    Use: allergies

    • 1st generation (diphenhydramine)- greater anticholinergic effect so more sleepiness
    • 2nd generation (Claratin) (Zyrtec) (Allegra)- less anticholinergic effects

    Kinetics: contraindicated during pregnancy and lactation

    Adverse: drowsiness, headache and can cause GI upset, arrhythmias, dysuria
  64. Expectorant medicaiton
    guaifenesin (Musinex)

    MOA: liquidizes secretions by decreasing surface tension of secretions

    Take with a lot of liquid. 1 tablet- 8 oz of water 

    Use: chronic obstructive conditions, pneumonia

    Adverse: N/V/, anorexia, HA, dizziness
  65. Mucolytics

    MOA: splits bonds in mucus that hold mucus together- decrease tenacity and viscosity of secretions (acetylcysteine) or breaks down mucus in respiratory tract by cleaving DNA strands (dornase alfa)

    Use: chronic respiratory problems (children), antidote for Tylenol overdose

    Kinetics: given by neubulizer

    • Adverse: N/V, bronchospasm, rhinorrhea, stomatitis 
  66. Overdose of dextromethrophan
    temperature, dry mouth, dry skin, bluured vision, hallucinations, delusions, nausea, headache
  67. Inhaled steroids
    • MOA:  decrease effectiveness of inflammatory cells which reduces swelling and increases B receptor stimulation which may result in smooth muscle relaxation in the airways and inhibit bronchoconstriction
    • Use: 
    • Kinetics:  well absorbed from respiratory tract, metabolized liver, excreted urine, cross placenta and enter breast milk
    • Contraindications: 
    • Adverse:  sore mouths, mouth fungus, adrenal suppression (very high doses)
  68. Leukotriene Receptor Antagonists
    • MOA:  antagonize receptors for the production of D4 and E4 components of SRSA- results in blocking neutrophil and eosinophil migration and aggregation, leukocyte adhesion, increased capillary permeability, smooth muscle contraction
    • Use:  helps prevent inflammation, edema, mucus secretion
    • Kinetics:  rapid GI absorption, metabolized in liver by P450 system, cross placenta, enter breast milk- fetal toxicity in animal studies
    • Adverse:  myalgia, nausea, HA, dizzy, elevated liver enzyme (some require monitoring of liver enzymes)
    • Interactions:  theophylline, propranolol, warfarin (increase toxicity)
  69. Anticholinergic
    Ipaptropium (atrovent)

    • MOA:  block vagal nerve effect of bronchoconstriction (ACH receptors blocked at vagal medicated receptor sites) result in bronchodilation
    • Uses:  maintenance of COPD
    • Kinetics:  onset 15min with inhalation, peak 1-2 hours,  duration of 3-4 hours.  Not systemically absorbed. 
    • Cautions:  if have narrow angle glaucoma, prostatic hypertrophy,
    • Adverse:  think anticholinergic, dry mouth, increased heart rate, difficulty urinating
    • 4-8 puffs 4 times/ day
  70. Xanthines (caffeine and tehophylline)

    Not on the review, may not be necessary
    • MOA:  direct action on smooth muscle of respiratory tract and blood vessels (may influence calcium movement within the cell).  Causes relaxation with increased vital capacity.  May also inhibit release of SRSA (slow reacting substances of anaphylaxis) and histamine, which cause swelling of bronchioles and narrowing. 
    • Bronchodilation
    • Theophylline- third line
    •             Can cause fatal cardiac arrhythmias
    •             Seziures
    •             Tachycardia
    •             Overdose- nausea and vomiting
    • Use:  increase breathing
    • Kinetics:  rapid GI absorption, cross placenta, and enter breast mil,
    • Contraindications: pregnancy, renal and hepatic disease, CAD, alcoholism, hyperthyroidism
    • Adverse: 
    • Interactions: multiple with other drugs due to liver metabolism, smoking increases metabolism
  71. major cause of PUD
    helicobacter pylori
  72. Gastroesophageal reflux disease results from a problem at _______ and can be made worse by
    LES- lower esophageal sphincter

    • Fat
    • Alcohol
    • Chocolate
    • Caffeine
    • Eat large amount
    • Smoke
    • Abdominal obesity
  73. Antacids
    Sodium Bicarbonate lest potent 

    Moa: neutralizes HCL acid in stomach

    • Uses:  occasional heartburn,  symptomatic relief of GI hyperacidity, minimization of uric acid crystalluria, adjunctive treatment of severe diarrhea

    • Contraindications:  electrolyte imbalances, GI obstruction
    • Adverse:  constipation, electrolyte disturbances, absorbs other nutrients in GI tract, can impact other medications
    • Rebound acidity- continuous alkaline environment causes stimulation of gastrin which increases acidity.  
  74. H2 blocker
    Cimetidine (tagamet) medium potency 

    MOA: block H2 receptors located on the parietal cells of the stomach 

    • Uses: treatment of duodenal and gastric ulcers, hypersecretory conditions, prophylaxis of stress induced ulcers, treatment of GERD, relief of heartburn
    • Contraindications:  hepatic or renal dysfunction, pregnancy
    • Adverse:  diarrhea or constipation, dizziness, HA, somnolence, confusion, hallucination, arrhythmias, hypotension,
  75. Proton pump inhibitor medication
    omeprazole (prilosec) most potent 

    • MOA:  inhibits the hydrogen-potassium adenosine triphosphatase enzyme system (HKATPase)  of the gastric parietal cells so decreases production of HCL (lowers acid level in stomach)
    • Uses:  peptic ulcer disease, prevent ulcerations for NSAIDs
    • Adverse:  CNS (dizzy, loss of strength, vertigo, insomnia, dreaming) GI ( dry mouth, vomiting, abdominal pain, diarrhea). Excellent safety profile even with long term use in high doses, affects calcium absorption, decrease magnesium levels
    • Administration:  should be given before a meal
  76. Omeprazole can prevent frequent heartburn but...
    takes days to relieve symptoms so H2 blockers better for sporadic or acute treatment
  77. Chemical stimulants
    stimulate nerve plexus in intestinal wall to increase movement of contents. Harshest category
  78. Bulk stimulants:
    increase bulk of stool by drawing water into lumen of the bowel 

    Psyllium (metamucil)
  79. Lubricating laxatives
    help retain fat and water in lumen of bowel, makes stool softer and easier to evacuate
  80. Adverse effects of laxatives
    • volume and electrolyte depletion from stronger forms, cramping, loss of fat soluble vitamin absorption, cathartic dependence (not as big of an issue as once thought)
  81. it is best to take laxatives 30 minutes or longer after other meds because
    they can impact absorption of medications
  82. Anti- diarrheal agent
    loperamide (imodium) over the counter

    • MOA: directly acts on the muscles of the GI tract to slow peristalsis 
    • Adverse: constipation, discomfort, N/V, dry mouth
  83. Irritable Bowel Syndrome
    • More common in females
    •             People tend to alternate between constipation and diarrheal
    •             Could be genetic, could be serotonin levels
    •             Treatment: Bulk laxatives, anticholinergic drugs, 
  84. Anti-emetics

    MOA: act on chemoreceptor trigger zone and vegas nerve

    Use: prevent vomiting related to chemo therapy, post op patients

    Really expensive
  85. Which antiemetic drug has a black box label
  86. Finigrin most commonly used for
    stomach bug, post op
  87. Reglan most commonly used in
    increased GI movement in diabetics iwth neuropathy
  88. Meclizine (antivert) most offten used in
    sea sickness patches/meds, motion sickness