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247 Cards in this Set
- Front
- Back
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True/False:
Aluminum salt type antacids cause diarrhea. |
False - Cause constipation
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What medication binds or alters intestinal gas?
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Simethicone
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What drug class blocks histamine at the receptors of acid producing parietal cells?
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H2 blockers
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What is the MOA of stimulants and examples of medications?
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- Increases peristalsis via intestinal nerve stimulation.
ex: castor oil, senna, cascara |
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What action can decrease the effectiveness of h2 blockers and why?
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Smoking. Increases gastric acid production.
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Examples of H1 antihistamines and indications for use?
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Benadryl, pheniramine
Used for nasal allergies, seasonal/perennial allergic rhinitis, allergic reactions |
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Benadryl is an example of a traditional or peripherally acting anti- histamine?
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Traditional
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What are anti-histamines contraindicated for use for?
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acute asthma and lower respiratory disease
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Pancreatic dornase is under what drug class?
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Proteolytic enzymes
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What way do direct stimating expectorants act?
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secretory glands are stimulated directly to increase their production of respiratory tract fluids.
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What is the MOA of PPI?
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Irreversibly bind to the H+/K+ atpase enzyme = achlorhydria
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What drug class causes achlorhydria?
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PPIs
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What is the first line treatment of PUD/Gerd?
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PPIs
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PPIs can increase the serum levels of what medications?
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diazepam, phenytoin, and cause increase chance for bleeding with warfarin
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What is the MOA of antacids?
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Promote gastric mucosal defense mechanisms.
Secrete mucus, bicarb, and prostaglandins. |
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True/False:
Antacids do not prevent the over production of acid. |
True
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What is a drug effect of antacids?
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Reduction of pain associated with acid related disorders.
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This type of antacid causes diarrhea.
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Magnesium salts
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In what group of patients should you not prescribe a magnesium salt antacid to?
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Renal failure pts - the failing kidneys cannot excrete magnesium, resulting in hypermagnesemia.
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Kidney stones are a adverse effect for this drug if used for long term.
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Antacids - calcium salts
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What is an example of a calcium salt antacid?
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tums
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True/false: Sodium bicarb are highly soluble.
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True
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True/false: sodium bicarb may cause metabolic acidosis?
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False - may cause metabolic alkalosis.
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The sodium content in sodium bicarb antacids can pose a problem to which group of patients?
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Patients with HF, HTN, renal insufficiency.
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What is it called when there is a chemical binding or inactivation of another drug that can happen when taken with antacids?
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chelation
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When pts are prescribed calcium containing antacids, what 2 side effects should they report?
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constipation, acid rebound
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Cimemetidine, famotidine, and ranitidine are all examples of which kind of drug class?
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H2 antagonists
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H2 antagonists cause achlorhydria?
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False - PPIs
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What drug class causes decreased production of HcL?
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H2 Antagonists.
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Iansoprazole, omeprazole, rabeprazole, pantoprazole, and esomeprazole are all examples of medications found in what drug class?
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PPIs
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PPIs are given for long term treatment of active duodenal and benign gastric ulcers.
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False - given for short term treatment
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What drug class can be given for treatment of H.pylori induced ulcers?
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PPIs.
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What teaching should be done to a pt taking omeprazole (prilosec)?
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emphasize that treatment will be short term.
should be taken before meals. capsule should be swallowed whole. |
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What specific PPI can be taken with antacids?
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Omeprazole (prilosec)
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Sucralfate is an example of what kind of agent?
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Cytoprotective agent?
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Cytoprotective agents can be used for what conditions?
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stress ulcers, erosions, pud
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What is the MoA of sucralfate?
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Attracted to and binds to the base of ulcers and erosions forming a protective barrier over these areas.
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Sucralfate protects the ulcers and erosions from what?
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Pepsin, which normally breaks down proteins, making ulcers worse.
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True/false:
You may administer carafate with other meds? |
False - do not administer with other medications
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What cytoprotective agent can be used in chronic renal failture pts?
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Sucralfate, bc it binds with phosphate and can reduce phosphate level in this population
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What is an example of a synthetic prostaglandin analog used in GI?
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Misoprostol (cytotec)
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Protecting gastric mucosa from injury by enhancing local production of mucus or bicarb, promoting cell regeneration, and helping to maintain mucosal blood flow is the MOA of which medication?
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Misoprostal (cytotec)
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What is the indication of use for misoprostal?
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Prevention of NSAID induced gastric ulcers
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Activated charcoal, bismuth subsalicylate are examples of what drug class of antidiarrheals?
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Absorbents
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Absorbents bind to what?
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the causative bacteria or toxin, which is then eliminated through the stool.
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To which population should bismuth subsalicylate never be given to and why?
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Children <16 y/o or teens with chicken pox due to risk of reye's syndrome
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What class of anti diarrheals has an adverse effect of increased bleeding time?
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Absorbents
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In what way to anticholinergics treat diarrhea?
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Decrease intestinal muscle tone and peristalsis = slowing the movement of fecal matter through GI tract.
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Belladonna, alkaloids (donnatal), and atropine are examples of which drug class and what are they used for?
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Anti cholinergics. Antidiarreal
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Urinary retention, hesitancy can be seen in what drug class?
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Anti cholinergics
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To which group of pts shoud anticholinergics not be prescribed to?
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Pts with recent hx of glaucoma, urinary retention, BPH, recent bladder surgery, cardiac problems.
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A pt with myasthenia gravis should never be prescribed which type of drug class?
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Anticholinergics.
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Dark stools is a side effect of which anti diarrheal?
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Absorbents
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A pt presents to you c/o dark stools after having taken pepto bismol for diarrhea. What should you do?
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Make sure there is no internal bleeding, check bleeding times as pepto bismol can increase these.
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Opiates can be used as an antidiarrheal, why?
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Decrease bowel motility and relieve rectal spasms.
Decrease transit time through the bowel, allowing more time for water and electrolytes to be absorbed. |
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Imodium is an example of what drug class?
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Opiates
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If a pt has been taking imodium long term, what should as their arnp monitor?
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LFTs.
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Drowsiness, sedation, dizziness, lethargy, brady, hypotension are all side effects of which type of anti diarrheal?
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Opiates
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L.acidophilus is an example of what kind of drug class and what is it used for?
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Intestinal floral modifier and used as antidiarrheal
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What is the MOA of intestinal flora modifiers?
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Supplies missing bacteria to the GI tract, suppressing the growht of the diarrhea-causing bacteria.
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Antacids can increase the effects of anticholinergic antidiarrheal agents.
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False - decreases effects
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Absorbents increase the absorption of many agents, including digoxin, clindamycin, quinidine, and hypoglycemic agents
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False - decreases absorption
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In which group of pts should absorbents be used carefully?
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Geriatric
decreased bleeding time clotting disorders recent bowel surgery confuson |
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What teaching should you provide for pts taking antidiarrheals?
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Take meds exactly as prescribes and to be aware of their fluid intake and dietary changes.
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What assessment data should you gather on pt taking antidiarrheals?
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Assess fluid volume status, I&O, and mucous membranes before, during, and after initation of treatment.
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Is constipation a symptom or a disease?
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symptom
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What type of laxative distends bowel to initate reflex bowel activity and absorbs water to increase bulk?
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Bulk forming agents
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Metamucil, citrucel, and fibercon are examples of what kind of laxative?
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Bulk forming agents
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What are the indications of use for bulk forming agents?
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actue and chronic constipation
IBS Diverticulosis |
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What kind of laxative can be used for softening of fecal impaction, and facilitation of BMs in anorectal conditions?
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Emollients
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A pt presents to you c/o constipation. What is your first intervention?
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Encourage healthy high fiber diet and increase fluid intake
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What can happen if laxatives are used for long term?
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Decrease bowel tone and may lead to dependency
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When prescribing a bulk forming agent, what should you teach the pt?
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To take with at least 240 ml water.
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What is an adverse effect of all laxatives?
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Electrolyte imbalances
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What are 2 side effects of bulk forming laxatives?
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impaction and fluid overload
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What are examples of saline laxative?
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Magnesium sulfate, mag hydroxide, mag citrate, fleets enema
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Saline laxatives do what to the osmotic pressure within the intestinal tract?
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They increase osmotic pressure, thus causing more water to enter the intestines
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What is the result of increasing osmotic pressure in intestinal tract, as seen with saline laxatives?
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Bowel distention, increased peristalsis, and evacuation
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For the removal of helminths and helminths, this type of laxative should be prescribed.
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Saline laxative
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If a pt with renal insufficiency takes a saline laxative, what is a potential adverse effect?
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Magnesium toxicity
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Stimulants can be used for what conditions?
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Acute constipation, diagnostic/surgical preps
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What 3 types of laxatives can be used for diagnostic/surgical preps?
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Hyperosmotic, Saline, and stimulants
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Scopolamine is a medication used for what?
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Nausea/vomiting
motion sickness |
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What drug class binds to and blocks acetylcholine receptors in the inner ear labrynth, blocks transmission of nauseating stimuli to CTZ, and blocks transmission of nauseating stimuli from the reticular formation to the VC.
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Anticholinergic agents
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Benadryl, antivert, and promethazine (phenergan) are H2 antagonists.
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False - H1
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Serotonin blockers have what type of approach?
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3 fold - blocks serotonin receptrs in the GI tract, CTZ, and VC
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These meds can be used for n/v in pts receiving chemo.
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Serotonin blockers and tetrahydrocannabinoids
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Dolasetron(anzamet), granisetron (kytril), and ondansetron (zofran) are examples of what drug class?
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serotonin blockers
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For a pt who is having n/v post op, what anti emetic can you consider prescribing?
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Zofran (serotonin blocker)
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For a pt infected with AIDS and experiencing anorexia, what can you prescribe?
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Dronabinol (marinol)
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THC is the major psychoactive substance in what?
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Marijuana
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What is the MOA of THC?
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Inhibitory effects on reticular formation, thalamus, and cerebral cortex
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Rantidine inhibits what?
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Histamine at the receptors of the acid producting parietal cells
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Cimetidine should be used with caution in this group of pts.
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Pts who are confused, disoriented, or elderly
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What is the most effective med to treat motion sickness over a long period of time?
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Scopolamine
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5-HT3 antagonists are effective for motion sickness?
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False
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What is the time frame of PPI administration to obtain maximal inhibition of acid secretion?
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3-4 days
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Can H2 receptor antagonists cross the BB and the placenta?
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Yes, and is secreted in breastmilk.
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What dermatoligic med can be used alone, or in combo with neomycin, polymixin B, or both?
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Bacitracin
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Bacitracin is indicated for use against what pathogens?
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Gram +
Strep and Staph Neisseriae, tetanus, diptheria. |
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5-HT3 antagonists are effective for motion sickness?
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False
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What is the time frame of PPI administration to obtain maximal inhibition of acid secretion?
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3-4 days
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Can H2 receptor antagonists cross the BB and the placenta?
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Yes, and is secreted in breastmilk.
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What dermatoligic med can be used alone, or in combo with neomycin, polymixin B, or both?
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Bacitracin
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Bacitracin is indicated for use against what pathogens?
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Gram +
Strep and Staph Neisseriae, tetanus, diptheria. |
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What can be given to a preop pt to eliminate the intranasal carriage of MRSA?
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Mupirocin
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What type of toxicity can be seen with increased absorption of polymyxin B?
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Nephro/neuro
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Polymyxin B is effective against what pathogens?
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Gram -
Klebsiella, ecoli, pseudomonas |
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Polymyxin B is effective against serratia and proteus
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False - resistant
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Neomycin and gentamycin are under what drug class?
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Aminoglycosides
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What is the MOA of azoles?
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Fungistatic --> inhibition of ergosterol synthesis --> cell membrane become more permeable and leak cell contents --> inhibits cell growth and replicatiom
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A pt presents with vulvovaginal candidiasis. What can you consider prescribing?
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Miconazole, clotrimazole
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Gynecomastia, increased liver enzymes and hepatitis are adverse reactions of what oral antifungal agent?
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Ketoconazole
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What can be prescribed for pt with candida albicans?
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Amphotericin B or Nystatin
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Nystatin swish and spit oral can be used for what condition?
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Oral candididiasis
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What is unique regarding triazoles among azoles?
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It cross the blood brain barrier and has good CSF penetration
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Examples of triazole meds are?
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Ketoconazole, fluconazole, voriconazole, posoconazole
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What are some adverse effects seen in pts using triazoles?
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Hepatotoxcity
exfolliative dermatitis |
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Indications for triazole use specifically are?
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Oropharyngeal/esophageal candidiasis
single dose tx of vulvovaginal candidiasis |
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Triazoles should not be taken with food?
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False - absorption and bioavailability not affected by food for gastric pH.
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When considering prescribing sporonox, what data should you obtain prior?
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Obtain culture prior to tx.
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If a pt is taking propulsid or halcion, what medication should never be prescribed?
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Sporonox
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For a pt with hepatitis taking sporonox, what lab values should be monitored?
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LFTs.
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There is an increased absorption of sporonox in an HIV pt.
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False - decreased
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In regards to absorption of sporonox, is it increased or decreased with decreased gastric acidity.
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Decreased
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Ater d/c, there is no longer drug in the body.
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False - therapeutic concentrations may persist in fingernails and toenails for up to 6 mos post d/c
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When considering prescribing sporonox, what data should you obtain prior?
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Obtain culture prior to tx.
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What type of antifungal as the following MOA: Inhbits fungal cell mitosis, binds keratin, and inhibits fungal invasion?
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Griseofulvin
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If a pt is taking propulsid or halcion, what medication should never be prescribed?
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Sporonox
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What medication would you not prescribe for a pt who presents with candida?
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Griseofulvin
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For a pt with hepatitis taking sporonox, what lab values should be monitored?
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LFTs.
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There is an increased absorption of sporonox in an HIV pt.
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False - decreased
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Griseofulvin is effective against what?
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Dermatophytes
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In regards to absorption of sporonox, is it increased or decreased with decreased gastric acidity.
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Decreased
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Terbinafine (Lamisil) is under what drug class and what is its MOA?
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Allylamine
Inhibits squalene epoxidase, therefore inhibiting egesterol synthesis |
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Ater d/c, there is no longer drug in the body.
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False - therapeutic concentrations may persist in fingernails and toenails for up to 6 mos post d/c
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What type of antifungal as the following MOA: Inhbits fungal cell mitosis, binds keratin, and inhibits fungal invasion?
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Griseofulvin
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What medication would you not prescribe for a pt who presents with candida?
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Griseofulvin
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Griseofulvin is effective against what?
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Dermatophytes
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Terbinafine (Lamisil) is under what drug class and what is its MOA?
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Allylamine
Inhibits squalene epoxidase, therefore inhibiting egesterol synthesis |
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What lab tests should be orderered prior to initation of lamisil?
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LFTS
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What lab tests should be orderered prior to initation of lamisil?
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LFTS
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What is a dermatologic side effect of terbinafine?
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SJS
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What is a dermatologic side effect of terbinafine?
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SJS
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Terbinafine can be used with significant renal impairment.
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False - contraindicated
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Terbinafine can be used with significant renal impairment.
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False - contraindicated
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Tinea pedis, tinea cruris, tinea corporis and onycyosis can be treated with?
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Terbinafine
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Tinea pedis, tinea cruris, tinea corporis and onycyosis can be treated with?
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Terbinafine
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A pt presents with genital warts. What treatment regiment can be prescribed?
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Imiquimod (aldara)
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A pt presents with genital warts. What treatment regiment can be prescribed?
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Imiquimod (aldara)
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What pt teaching should be given to pt being prescribed aldara?
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Requires frequent application.
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What pt teaching should be given to pt being prescribed aldara?
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Requires frequent application.
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What drug class stimulates mononuclear cells to release interferon alpha, therefore stimulating production of interleukins and TNF?
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Anti viral immunomodulators
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What drug class stimulates mononuclear cells to release interferon alpha, therefore stimulating production of interleukins and TNF?
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Anti viral immunomodulators
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What is an example of a anti viral immunomodulator?
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Imiquimod (aldara)
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What is an example of a anti viral immunomodulator?
|
Imiquimod (aldara)
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Tacrolimus and pimecrolimus are used for what condition?
|
Atopic dermatitis
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Tacrolimus and pimecrolimus are used for what condition?
|
Atopic dermatitis
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Meds are inhibit T-lymphocyte activity and prevent release of proinflammatory substances fall under what drug class?
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Macrolide immunosuppressants (immunomodulators)
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Meds are inhibit T-lymphocyte activity and prevent release of proinflammatory substances fall under what drug class?
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Macrolide immunosuppressants (immunomodulators)
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Tacrolimus is indicated for long duration.
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False - short to intermediate
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What medication can be prescribed for scabies?
|
Permethrin
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What is the MOA of permethrin?
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Inhibits sodium influx in parasites, causing delayed repolarization, paralysis and death.
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What is pt teaching when prescribing permethrin?
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Apply and leave on for 8-14 hours
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What medication stimulates the nervous system of parasites, causing seizure and death?
|
Lindane
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Lindane can be prescribed for what conditions?
|
Pediculosis capitis or pubis
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In what population should you use caution with prescribing lindane?
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children and pregnant women
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What is pt teaching for lindane lotion?
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Leave solution on x 4 mins
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Neurotoxicity and hepatotoxicity is an adverse effect of which ectoparasiticide?
|
Lindane
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Hydroquinone, monobenzone, and mequinol increase pigmentation of skin.
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False - reduce pigmentation of skin
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Monobenzone causes reversible or irreversible pigmentation?
|
Irreversible pigmenation
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What is the MOA of depigmenting agents?
|
Inhibit tyrosine, therefore inhibit synthesis of melanin
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What can be used for repigmentation, vitiligo?
|
Trioxsalen and methoxsalen
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An Acid from vitamin A
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Retnoic acid
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In what population should all acne preparations be used with caution?
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Women of childbearing age
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How does retnoic acid work to treat acne?
|
Decreased cohesion of epithelial cells and increased epidermal cell turnover, causes skin to peel
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What is used only for severe cystic acne?
|
Isotretinoin
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What anti acne medicaiton inhibits sebaceous gland size and function?
|
Isotretinoin
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Isotretinoin is not teratogenic.
|
False
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What is a frequent adverse effect of isotretinoin?
|
Lipid abnormalities
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Benzoyl peroxide is an example of what?
|
Acne preparation
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What medication can bleach fabric?
|
Benzoyl peroxide
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What acne preparation releases free-radical oxygen, oxidizes bacterial proteins, inhibiting anaerobic growth
|
Benzoyl peroxide
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What anti psoriatic agent can be used also for acne?
|
Tazarotene
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What type of antipsoriatic agent is an anti-inflammatory?
|
Tazarotene
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What is the MOA of tazarotene?
|
Modulates differentiation and proliferation of epithelial tissue
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What antipsoriatic is a Vitamin D analog?
|
Calcipotriene
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Topical corticosteroids have what MOA?
|
Decrease inflammation by decreasing capillary permeability.
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For a pt with nonintact skin, what effect could you see with topical steroid use?
|
Increased absorption
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What parts of the body could you have increased absorption?
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Forehead, scrotum, vulvar skin, axilla, groin, face, scalp
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Atopic eczema, allergic contact dermatitis, lichen simplex, primary irritant dermatitis, psoriasis of the face, and varicose eczema have a good response to what treatment?
|
Topical corticosteroids
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What are the adverse effects of corticosteroids?
|
Suppression of pituitary- adrenal axis, growth retardation in children, immunosupression, acne
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What at what percentage does salicylic acid destroy tissue?
|
>6%
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What side effects of an allergy to salicylic acid can be seen?
|
Urticaria, anaphylaxis, and erythema multiforme
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For which med do you terminate once you see necrosis at site of treatment?
|
Fluorouracil
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How does minoxidil work?
|
Vasodilation, relaxing arterioral smooth muscle and increasing blood floow.
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Minoxidil is more effective for what condition?
|
Vertex balding
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For a pt taking finasteride for hair loss, what adverse effects can you counsel about?
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decreased libido, ejaculation disorders, ED
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What can happen to a male fetus if the mother handles finasteride?
|
Hypospadiasis
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What selective estrogen receptor modulator is an agonist in the uterus?
|
Tamoxifen
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What are the indications of use for tamoxifen?
|
Prevent or treat Breast CA in premenopausal women, and breast ca treatment in postmenopausal women
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What is the Moa of a selective estrogen receptor modulator?
|
Blocks estradiol binding to the ER
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What is the effect of tamoxifen on the bone?
|
Prevents reabsorption, inhibits osteoclasts
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What is the effect of tamoxifen on the serum?
|
decreases total cholesterol and LDL, doesn't increase HDL
|
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With tamoxifen, you can see a increase in what cancer?
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Endometrial (2 fold)
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Evista is a uterus agonist.
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False - antagonist, with decrease risk of endometrial ca
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If a pt taking evista presents to your office c/o leg cramps, what should be your intervention?
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R/o dvt, side effect of evista
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What is clomid used for?
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Treat infertility
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What are the side effects of clomid?
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Ovarian enlargement, multiple births
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For the treatment of tamoxifen-resistant metastatic breast ca in post menopausal women, what drug would you consider?
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Fulvestrant (faslodex)
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What drug class is now considered the first line treatment for breast ca?
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Aromatase inhibitors
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Anastroze (armidex), letrozole (femara) are all examples of steroidal competetive aromatase inhibitors?
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False - nonsteroidal
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What is the main adverse effect of progestin?
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Edema
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What effect do synthetic progestins have on LH?
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Suppresses LH surge --> blocks ovulation
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What effect do synthetic progestins have on the endometrium?
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Cause atrophy
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What anti progestin is used as abortifacent in early pregnancy?
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Mifepristone (mifeprex)
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What is the main mechanism of oral contraceptives?
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To suppress gonadotropin secretion, thereby inhibiting ovulation
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What effect does estrogen have on FSH?
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suppresses FSH --> no development of dominant follicle
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What action can increase the risk of blood clots when taking OC?
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Smoking
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When prescribing an progestin only oc, what side effect should you caution your pt about?
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Since progestins may not block ovulation, there is a higher risk of ectopic pregnancy
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Meds such as amoxicillin, amipicillin, protease inhibitors can increase the effectiveness of OCs?
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False - decrease the effectiveness
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What does the acronym ACHES stand for?
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A - Abdominal pain
C - Chest pain H - Headache E - Eye problems S - Severe leg pain |
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What emergency contraceptive is progestin only?
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Plan B
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How does Plan B work to prevent pregnancy?
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Prevents implantation, thickens cervical mucus,
prevents ovulation, preventing sperm penetration |
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What pt teaching can be given regarding the ortho evra patch?
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Efficacy may be compromised as weight increases, apply to abdomen, upper torso or upper outer arm. beginning of menses. Replace qweek x 3 weeks.
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When does fertility return after a pt stops taking Lunelle?
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1 month
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Which population may the subdermal progestin implant be less effective in?
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overweight patients
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When considering postmenopausal hormone therapy, what differentiates tx options b/t premarin and prempro?
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Prempro is for women with intact uterus
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What are the indications for post menopausal hormone therapy?
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vasomotor symptoms, post-menopausal atrophic vaginitis, reduce osteoperosis risk
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Which weak progestational, adrogenic, glucocorticoid medication is used to treat endometriosis, and fibrocystic disease of the breast?
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Danazol
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What does Danazol do to the ovaries?
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Suppresses ovarian function
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What is treated by the anabolic effects of androgens?
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Severe burns, speeds up recovery from surgery or chronic debilitationg disease
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What do the adrogenic effects of androgens treat?
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Hypogonadism due to leydig cell dysfunction or to failure of the hypothalamic pituitary system
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As far as growth, what do androgens treat?
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with other hormones for skeletal growth in prepubertal boys with pituitary dwarfism
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What conditions are antiandrogens used to treat?
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Advanced prostatatic CA
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What drug class is responsible for interfering with androgen synthesis and blocking androgenic receptors?
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Antiandrogens
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Finasteride and Ketocanazole are examples of what drug class in reproductive medicine?
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Antiandrogens
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What is ketoconazole used for in reproductive medicine?
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Advanced prostate CA
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What antiandrogen inhibits 5 alpha reductase thus decreasing formation of DHT = decrease prostate size?
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Finasteride (Proscar)
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Finasteride is indicated for what conditions?
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BPH, male pattern hair loss
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What medication is a competitive inhibitor of androgens?
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Cyproterone acetate
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Cyproterone acetate is used for what conditions?
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Treatment of hirsutism in women, and used to decrease excessive sexual drive in men
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What is ketoconazole used for in reproductive medicine?
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Advanced prostate CA
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|
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What antiandrogen inhibits 5 alpha reductase thus decreasing formation of DHT = decrease prostate size?
|
Finasteride (Proscar)
|
|
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Finasteride is indicated for what conditions?
|
BPH, male pattern hair loss
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|
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What medication is a competitive inhibitor of androgens?
|
Cyproterone acetate
|
|
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Cyproterone acetate is used for what conditions?
|
Treatment of hirsutism in women, and used to decrease excessive sexual drive in men
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