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Pharm II Exam 2

Terms in this set (120)

inducers
increase metabolism
inhibitors
decrease metabolism; toxicity
CRAP GPS
what is the acronym for inducers?
carbamazepine
rifampine
alcohol
phenytoin
grisofulvin
phenobarbital
sulfonylureas
inducers (CRAP GPS)
VICKS FACE All OVER GQ
acronym for inhibitor drugs
valporate
isoniazid
cimetidine
ketoconazole
sulfonamides
flucanozole
alcohol
chloramepenicol
erythromycin
amiodarone
omeprazole
vitamin E
ritonavir
grapefruit juice
quinidine
inhibitor drugs (VICKS FACE All OVER GQ)
acetaminophen
CYP 1A2 Subtype
ETOH
CYP-2E1 subtype
warfarin/coumadin
CYP-2C9
cardiovascular drugs
CYP-2D6
cimetidine (weak)
amiodarone (moderate)
keocinazole (strong)
CYP-3A4 subtype
Fluconazole will decrease the metabolism of the omeprazole.
A patient is taking Omeprazole (a substrate of the CYP-enzymes) and the physician adds fluconazole (an inhibitor for the same CYP-enzyme) for a fungal infection, what will occur between these 2 medications?
Alcohol is an inducer to the CYP-40 enzyme inducer, therefore will increase the metabolism of the Grisofulvin. An increased dose may be needed, or the patient should limit or cease drinking alcohol while taking this medication.
A patient who drinks alcohol on a regular basis is taking Grisofluvin (CYP-enzyme). What interaction will occur?
medulla
where is the vomit center?
antacids, diphenhydramine
OTC tx for N/V
dramamine
Motion Sickness Medication
scopolamine (transdermal)
ondansetron (zofran)
promethazine (phenergan)
prescribed meds to tx N/V
anticholinergics
benadryl, scopolamine, & dramamine are what?
30-60 mins
what is the ideal timing for antiemetics?
Anticholinergic drugs
can be drying
cause hypotension if given too fast IV
most commonly used for motion sickness (give BEFORE travel)
N/V
benzodiazepines (lorazepam) can be used to treat... ?
N/V (schedule 2 drugs)
cannabinoids can be used to treat what?
N/V (should only be used short term)
corticosteroids can be used to treat what?
facial flushing
insomnia
GI problems
S/E of corticosteroids
cannibanoids
primarily given prior to chemo
neurokinin
antiemetic primarily used prior to chemo
penothiazine
antiemetic that can cause some EPS and TD (can also be constipating and drying)
decadron
antiemetic used for brain tumors/increased ICP
diphenoxylate with atropine (lamotil)
antidiarrheal that can cause CNS depression (schedule V)
loperamide (imodium)
antidiarrheal that can be obtained OTC @ low dose & Rx @ high dose
diarrhea caused by infection w/ toxin producing organisms or poisoning
when should you not give antidiarrheal medications?
fiber, increase water intake, increase activity
how do you treat constipation
cathartics (used for GI prep)
magnesium hydroxide (MoM)
lactulose
polyethelene glycol (miralax)
fleets enema
what are the types of osmotic (saline) constipation meds?
bisacodyl
stimulant medication for constipation
bisacodyl
irritate mucose and promote peristalsis (dumb & dumber)
opioid antagonists
constipation meds that dont cross BBB (can have pain relief)
alvimpoan (entereg)
opioid antagonist
surfactant stool softener
constipation med that doesnt make you go, but makes it easier to go
docusate (colace)
surfactant stool softener med
psyllium (metamucil)
bulk-forming constipation med that has fiber
senna
castor oil
herbal constipation medications
linaclotide (linzess)
lubiprostone (amittiza)
drugs used to treat IBS-Const (decreases bloating and constipation by increasing H2O in gut)
Loperamide
initial therapy for IBS-Diarrhea
sulfasalazine
first line of defense to tx IBD (inflammatory bowel disease)
Sulfasalazine
-cant give if sulfa drug allergy
-may impair male fertility while taking
-can be hepatoxic
-dont give if dehydrated
-can cause HYPOglycemia
corticosteroids
second line of defense for IBD
immunosuppressants (methotrexate)
3rd line of defense for IBD
NSAIDS
what is the most common cause of peptic ulcer disease outside of H. pylori?
Helicobacter pylori
-Primary cause of peptic ulcers
-Gram-negative bacillus linked with the development of peptic ulcers
combination therapy
what drug regimen is needed to tx H. pylori?
amoxicillin or metronidazole, omeprazole or lansoprazole, and clarithromycin
what drugs should be chosen to tx h. pylori?
-avoid tobacco and alcohol
-weight loss
-avoid hot, spicy, and greasy foods
-Avoid NSAIDS
non-pharm measures to tx GERD
antacids
anti-ulcer medication
-neutralize hydrochoric acid - act fast! (10 - 15 min), but only last 2 hrs
-reduce pepsin activity
Sodium Bicarbonate (alka-seltzer)
- systemic anti-ulcer medication
-too many s/e
calcium carbonate (tums)
-systemic anti-ulcer med
-most effective
-may cause acid rebound
-may result in hypercalcemia
lifestyle changes & pharmacotherapy
what is the best treatment for PUD & GERD
histamine 2 blockers
Block H2 receptors of parietal cells in the stomach, reducing acid secretion and concentration
ranitidine (zantac)
H2 blocker
-rapidly absorbed (1-3 hours)
-ulcer healing in 4 weeks
HA, dizzy, anemia, constipation, decreased libido, impotence
s/e of H2 blockers
Proton Pump Inhibitors
suppresses gastric acid secretion (end in azole)
lansoprazole
omeprazole
pantoprazole (PPI)
onset: 2 hrs
peak: 1.5-3 hrs
may increase liver enzymes (AST/ALT)
pepsin inhibitor
covers ulcers and protects it from acid and pepsin
sucralfate (carafate)
pepsin inhibitor medication that is non-absorbable & the dose = 1gm QID before meals & bedtime
steatorrhea
what will happen if stools dont have enough pancreatic enzymes?
pancrelipase
pancreatic enzymes taken right before or with meals
GI disturbances
increase uric acid levels at high doses
S/e of pancreatic enzymes
islets of langerhans
clusters of cells
alpha cells
glucagon
beta cells
insulin
insulin
-acts as a bridge that carries glucose into cell
-tells liver to store glucose as glycogen
-inhibits breakdown of glycogen into glucose
-inhibits gluconeogenesis
Gluconeogenesis
release of fatty acids from liver --> production of glucose from fats/proteins
novolog
humalog
apidra
types of rapid insulins
5-15 mins
onset of rapid insulins
1-2 hours
peak time for rapid insulin
humulin R
novolin R
types of short (regular) insulins
30-60 mins
onset of short (regular) insulins
2-4 hours
peak of short (regular) insulins
NPH
humulin N
novolin N
relion N
types of intermediate insulins
2-4 hours
onset of intermediate insulins
4-8 hours
peak of intermediate insulins
10-18 hours
intermediate insulins last __ hours?
glargine (lantus)
levemir (detemir)
tresiba
types of long acting insulins
tresiba
insulin that has no peak and lasts 42 hours
1 hour
onset of long acting insulins
minimal lasts 24 hours
glargine and levemir duration times
first clear, then cloudy
how do you draw up insulins?
diabetes insipidus
can happen after a stroke or head trauma (pituitary issues)
high urine output (clear large volumes w/ low gravity)
clinical findings of DI
DDAPP (desmopressin)
what is the treatment for DI?
DDAPP
-treats DI
-given IV or intranasal
-andtidiuretic hormone (stop pee)
-can be given for hemophilia A or nocturnal uresis
Hyponatremia
Desmopressin can cause what as a side effect?
Hyperthyroidism
graves disease = hypo or hyper thyroidism?
bulging eyes (exophthalmos)
what is a tell tell sign of graves disease?
symptoms of graves disease
-insomnia
-wt loss
-increased HR
-flushing
addisons or secondary adrenal insufficiency
what can happen with long term steroid use?
taper dose
how do you discontinue corticosteroids?
increase dose
if ill or stressed, what should you do with dose of corticosteroids?
2 weeks
how long before you worry about secondary adrenal insufficiency while on steroids?
-hump on neck
-moon face
-wt gain
-increased BS
-insomnia
-agitation
-bone demineralization
S/E of corticosteroids
PTU (methimazole)
drug preferred for hyperthyroidism in pregnancy and breast feeding
synthroid
drug used for hypothyroidism
-take same time everyday
-take without food
-dont change brands
what should you do if you're taking synthroid?
lowers K+ levels
what happens to your K+ levels when on hydrocortisone?
give K+ supplementation
what should you do if patient is on hydrocortisone and lasix?
erythropoietin
secreted by kidneys with decreased perfusion
-stimulates stem cells to produce erythrocytes
Exogenous erythropoietin
epoetin alfa
-given SQ
-increased risk for DVT, strokes, MI
-exogenous erythropoietin
epoetin alfa
uncontrolled HTN
contraindication for epoetin alfa
Thrombopoietin
Stimulated by liver to produce megakaryocytes in the bone marrow.....they shed packets that enter the bloodstream and become platelets
Oprelvekin (Neumega)
given to STIMULATE production of thrombopoietin and megakaryocytes
7 days
how long do platelet counts remain elevated after giving last dose of oprelvekin
SQ
how is oprelvekin given?
fluid retention
S/E of oprelvekin
-blood loss
-erythrocyte destruction
-decreased erythrocyte production
what are the causes of anemias?
iron deficient anemia
low Hgb
low Hct
low RBCs
low MCV
low MCHC
high RDW
low ferritin
high TIBC
low transferrin saturation
ferrous sulfate
treatment for iron deficient anemia
nausea, heartburn, constipation, diarrhea, dark stools, hypotension
s/e of ferrous sulfate
pernicious anemia
normal or low Hgb
normal or low Hct
low RBC
elevated MCV
normal MCHC
elevated RDW
low Vit B12
low folate
cyanocobalamin (nascobal)
treatment for pernicious anemia
hypokalemia
can cause sodium retention (use with caution in cardiac patients)
side effects of cyanocobalamin (nascobal)
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