Upgrade to remove ads
Intro to Pharm Exam 2
Terms in this set (91)
timing of medication exposure
What is teratogenicity based on?
heparin and insulin
Exceptions to medications crossing in mother's milk to infants
agents that act to irreversibly alter growth, structure, or function of the developing embryo or fetus
- environmental factors
Examples of teratogens
- gestational age
- route of administration
- absorption of medicine
- maternal serum levels/clearance
- placental transfer
Exposure of medications in pregnant women depends on what?
weeks 1 to 2 of the first trimester
critical exposure phase in pregnancy
9 weeks to birth
What medicines should you watch for during the fetal period?
A mild tranquilizer that, taken early in pregnancy, can produce a variety of malformations of the limbs, eyes, ears, and heart.
2-3% or 20-30 per 1000 live births
Incidence of major malformations
- ACE inhibitors
- oral contraceptives
Some teratogenic medicines
increased risk of congenital malformations
What is diabetes associated with in pregnancy?
How much more likely are infants to develop teratogenic effects of the CNS and CV system is that are exposed to ACE inhibitors?
week 2-3 and lasts to week 8-12
When does nausea and vomiting usually begin in pregnancy and how long does it last?
- steroids for hyperemesis gravidarum
Management of nausea and vomiting in pregnancy
Are there teratogenic issues with medications for asthma?
- 30% will worsen
- 30% will experience greater control
- 30% remain same
Asthma in pregnancy
- increase in 40%
- decrease in 10%
- no change in 50%
Epilepsy in pregnancy
maintain current regimen
What is in the best interest of a pregnant mother with epilepsy and baby?
What may lower fetal Vitamin K clotting factors and cause bleeding in baby?
type 2 diabetes
What does gestational diabetes increase your chance of being diagnosed with in the future?
- diet and exercise
- insulin when needed
Treatment of diabetes in pregnancy
diastolic BP goes down 10 mmHg and returns to normal over time
What happens with blood pressure in normal pregnancy?
hypertension during pregnancy
20-24 weeks; gone by day 40 postpartum
When does preeclampsia usually appear and disappear?
Which depression medication should pregnant women stay away from?
- maternal plasma concentration
- milk to plasma ratio
- protein binding
- volume of milk consumed
Properties that matter with breastfeeding and medication exposure
Which medication should not be used in pregnant women for treatment of migraines but can be used if all other treatments for epilepsy has failed?
lower IQ scores and autism
What did valproate do to children whose mother's took the medication while pregnant?
For EACH pregnancy between 27-36 weeks
When should a pregnant woman receive a Tdap?
No, does not produce high enough maternal antibodies to protect the baby postpartum
Is vaccinating women before pregnancy with a Tdap not sufficient enough?
Three types of drug interactions
What percentage of adverse effects are related to drug interactions? What does this go up to with the use of 5 durgs?
- critical care patients
- patients undergoing surgery
- CV disease
Who's at risk for drug interactions?
Not all drug interactions are between prescription medications (OTC/herbal)
Principle #1 of drug interactions
Are all drug interactions detrimental?
Three types of drug-drug interactions
based on one drug altering the absorption, distribution, excretion or metabolism of another drug
ones that result in a decrease in the total amount absorbed
Which types of interactions are the most clinically significant?
Drugs with narrow therapeutic windows
What types of drugs produce clinically significant interactions?
Warfarin and AIDs drugs
Always look up drug interactions for which drugs?
commit to memory some of the drugs that are inducers and which are inhibitors of enzymes
What can you do to aid in the prediction of a drug interaction?
interpatient and intrapatient variation with metabolism interactions
What occurs making the prediction of the extent of the interaction difficult?
- antagonistic effects
- synergistic effects
What type of effects can pharmacodynamic interactions have?
occurs when 2 drugs are mixed resulting in a physical or chemical incompatibility
- reduced rate or extent of absorption
- increased rate or extent of absorption
- chemical/pharmacologic effects
Three mechanisms drug-food interactions can occur
to reduce side effects
Why are some drugs taken with food?
Drugs that do better when taken with food
1 hour before meals or 2 hours after meals
What is considered an empty stomach?
- most AIDs drugs
Drugs that should be taken on an empty stomach
MAOI, linezolid or warfarin
It is important to instruct patients about proper foods in the diet when taking which drugs?
blocks the metabolism of tyramine, increasing norepinephrine
What happens when taking MAOI's?
- overripe foods
- bean pods
- aged cheese
- fermented meats
- red wine
Foods containing tyramine
Vitamin K rich foods
What types of foods should you watch when taking warfarin?
True/False: Discontinue all unnecessary drugs
What food causes a drug interaction that produces hypotension?
inhibits the CYP3A4 enzyme in the intestinal wall
How do grapefruits produce a drug interaction?
Is daily ingestion or intermittent ingestion more important in consuming grapefruit products?
- know patient's medications
- encourage one pharmacy
- take meds with a full glass of water
- do not take meds with milk, metamucil, antacids
Drug interaction tips
How do we know what we know?
- empirical evidence
What do we use to know what we know?
Disease oriented evidence
What does DOEs stand for?
pharmacology, pathophysiology, etiology
Examples of DOEs
Patient oriented evidence
What does POEMs stand for?
morbidity, mortality, quality of life, final outcomes of disease
Examples of POEMs
change in your practice
What should POEMs result in?
fails to account for underlying susceptibility of the patient entering the trial
Fundamental flaw of RRR
takes into account the internal incidence of the condition being treated or prevented
Advantage of absolute risk reduction
RRR = control - treatment / control
Equation for RRR
ARR = control - treatment
Equation for ARR
NNT/NNH = 1/ARR
Equation for NNT/NNH
Number needed to harm
term for assessing side effects/harm of treatments
- an understanding of research
- application of evidence based medicine
- allocation of resources
- thinking outside the boxy
What does the medical decision making model require?
- finding the best evidence possible
- critical analysis
- patient application
Goals of evidence based medicine
- Annals of Internal Medicine
- Archives of Internal Medicine
- British Medical Journal
- Obstetrics and Gynecology
- Arthritis and Rheumatology
- America Journal of OB/GYN
- Journal of the American College of Cardiology
Which journals accounted for 50% of POEMs?
Are POEMs easy to find?
reading 98% of the original research published each month
By focusing on POEMs and journals that publish them, what can clinicians avoid?
- Cochrane Collaboration
- Clinical Evidence
- Agency for Healthcare Research and Quality Evidence Reports
- National Guideline Clearinghouse
- USPSTF Evidence Reports
Top 5 websites to find POEMs
- Essential Evidence
- ACP Journal Club
- Journal Watch
Subscription based awareness services
The BEST EBM site
- are the results valid?
- what were the results?
- will the results help me?
3 questions to ask for randomized controlled trials
- is the study a randomized controlled trial?
- were all groups properly randomized?
- were all the patients accounted for?
- were patients blinded to treatment?
- are the groups similar?
- allocation concealment?
Questions to ask yourself regarding if the results are valid?
- is the article from a peer-reviewed journal?
- will this info have a direct impact on the health of patients, and is it something they would care about?
- will this info require me to change my current practice?
- is the problem addressed one that is common to my practice?
Questions concerning relevance
- gather outcomes
- determine statistical significance
- assess data based on absolute differences
- calculate NNT and NNH
Things to do to get the results
you are 95% certain that the results were NOT due to chance
What does it mean if a p-value is set at <0.05?
NO, just more precise
Does a lower p-value mean the treatment and outcome or more significant?
Should you calculate the NNT and NNG if the p-value is not significant?
(validity x relevance) / work
highly relevant and valid info and can be obtained with minimal effort
What does the best source of information provide?
THIS SET IS OFTEN IN FOLDERS WITH...
Lecture 1 - Pharm
Lecture 2 - Pharm
Lecture 3 - Pharm
Lecture 4 - Pharm
YOU MIGHT ALSO LIKE...
PHARM chapter 9
Ch 9 older adult Geropharmacology
NSG 313 - Pharmacotherapeutics - Week 5 (Ch8-11)
OTHER SETS BY THIS CREATOR
Pharmacology Test 2
Unit II Anatomy
Pharmacology Test 1
Unit 1 Anatomy
OTHER QUIZLET SETS
Children's Advocacy Centers and Multidisciplinary…
Unit 5 Legislative Branch
Chapter 12 Human A&P