Pharm Exam III
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- Allergic Rhinitis Therapies
-
-antihistamines
-nasal anti-inflammatories
-decongestants
-anticholinergic agents
-leukotriene modifiers
-immunotherapy - 2nd generation antihistamines
-
-acrivastine
-cetirizine
-desloratadine
-fexofenadine
-loratatdine - Mast cell stabilizer
- -cromolyn sodium
- intranasal corticosteroids
-
-bedomethasone dipropionate
-budesonide
-flunisolide
-fluticasone
-triamcinolone acetonide
-mometasone - Anticholinergic agents
- -ipratropium
- Tx for allergic conjunctivitis
-
-naphazoline hydrochloride
-keterolac
-cromolyn sodium - Early phase response of allergic rhinitis
-
-histamine
-serotonin
-prostaglandin leukotrienes
-tryptase
-kinins - Lab eval of allergic rhinitis pt
-
-eosinophils in nasal smear
-RAST testing - When treating allergic rhinitis, what class of drugs has the greatest effect on the greatest number of sxs?
- -corticosteroids
- Antihistamine side effects
-
-sedation
-anticholinergic effects (dry eye, urinary retention, tachycardia, constipation)
-cardiac (prolonged QT, torsades) - Anticholinergic agent side effects
-
-h/a
-epistaxis
-pharyngitis
-nasal dryness
-nausea - How to Tx intermittent allergic rhinitis sxs:
-
oral antihistamine (decongestant if necessary)
-intolerance: corticosteroid - How to Tx moderate allergic rhinitis sxs:
- intranasal corticosteroid + antihistamine
- How to Tx moderate persistent allergic rhinitis sxs:
- -corticosteroid + antihistamine-decongestant
- How to Tx severe allergic rhinitis sxs:
-
-prenisone
-corticosteroids + antihistamine-decongestant - T/F: You should administer Abx when treating allergic rhinitis.
- False
- Why is budesonide better than citirizine?
- -budesonide prevents relapse and can be used periodically to control sxs
- How might you tx a STEMI?
-
-O2
-can use apsirin, heparin, BB, nitro, ACEI, or lipid lowering - Mx of Fibrinolytic therapy
- -catalyze the cleavage of plasminogen to generate plasmin which breaks to fibrin
- What criteria must you meet to use fibrinolytic therapy?
-
-sxs of ischemia
-ST elevation or BBB
-start 12 hrs of onset of sxs
-<75 yo - Absolute contraindications of fibrinolytic agents
-
-hemorrhagic stroke
-any stroke w/in a year
-tumor
-active internal bleeding
-possible aortic dissection - Relative contraindications of fibrinolytic agents
-
-uncontrolled HTN
-CVA
-use of anticoagulants
-bleeding diathesis
-trauma
(more than one of these: becomes absolute) - Fibrinolytic agents
-
-streptokinase
-alteplase (tPA)
-reteplase (rPA)
-tenecteplase (TNK-tPA) - Mx of aspirin
- -prevent synthesis of thromboxane A2, so platelet aggregation is inhibited
- When monitoring unfractionated heparin, check:
-
-aPTT
-platelets
-Hb/Hct - Mx of nitrates
- -dilates peripheral and coronary vasculature by inc cGMP and dec MVO2
- What is the long term benefit of nitrates?
- -there is none, nitrates treat sxs only
- Mx of BB
-
-block the effects of catecholamines on beta receptors
-this dec HR and contractility - What are the long term benefits of BB?
-
-reduce morbitity
-prevent arrhythmias - When do you use CCB?
- -only when BB are contraindicated
- When do you use ACEI?
-
-ST elevation in > 2 ant leads
-ejection fraction < 40%
-sxs of CHF - What are the long term benefits of ACEI?
-
-decrease morbitity
-prevent neurohormonal remodeling - How do you monitor ACEI?
-
-SCr
-K
-BP
-S/S of angioedema - When is long term use of warfarin indicated?
-
-pt unable to take daily aspirin
-LV thrombus
-AFib post MI
-wall motion abn - What type of antiplatelet therapy do you use in NSTEMI?
-
-aspirin
-clopidogrel
-GIIbIIIa receptor blockers - Mx of Thienopyridines (clopidogrel and ticlopidine)
- -inhibits ADP-induces platelet aggregation
- What anticoagulation therapy would you use for tx in NSTEMI?
- -LMWH or UFH (but LMWH prefered)
- T/F: Thrombolytics have no role in the mgmt of NSTEMI
- True
- Mx of ACEI
-
-inhibit conversion of Ang I to Ang II
-inhibit the breakdown of bradykinin - Absolute contraindications of ACEI
-
-angioedema
-renal artery stenosis - Side effects of ACEI
-
-cough
-inc'd SCr
-hyperkalemia
-hypotn - When would you use ARBs
- -when there is intolerance to ACEI
- Mx of ARBs
- -blockade of Ang II
- Long term benefits of ARBs
-
-dec mortality
-dec hospitalizations - Contraindications to ARBs
-
-renal artery stenosis
-angioedema - Side effects of ARBs
-
-hyperkalemia
-inc SCr
-hypotn - contraindications of BB
-
-reactive airway disease
-bradycardia
-AV block w/o pacemaker
-decompensated HF
-HR <50
-sys BP <90 - Side effects of BB
-
-bradycardia
-fluid retention (worsens HF)
-hypotn
-fatigue
-bronchospasm
-masks hypoglycemia - Aldosterone Antagonists
-
-spironolactone
-eplerenone - CI for Aldosterone antagonists
-
-SCr >2.5
-serum K > 5 - Side effects of aldosterone antagonists
-
-hyperkalemia
-gynecomastia (less with eplerenone) - Mx of diuretics
-
-inc excretion of fluid and Na
-dec fluid retention - Long term benefits of diuretics
- -none, only sxs relief
- Side effects of diuretics
-
-electrolyte abn
-hypotn
-azotemia - Long term benefits of digoxin
- -improve sxs
- side effects of digoxin
-
-GI sxs
-arrhythmias
-neurologic - Do CCB have a role in HF?
- no
- ACEI agents
-
-captopril
-enalapril
-lisinopril
-ramipril
-quinapril - ARB agents
-
-losartan
-valsartan
-candesartan - Thiazide diuretic agents
-
-hydrochlorothiazide
-chlorothiazide
-metalazone - Loop diuretic agents
-
-furosemide
-bumetanide
-rosemide - Optimal level of LDL
- <100
- Very high level of LDL
- >190
- optimal level of TC
- <200
- high level of TC
- >240
- Mx of HMG-CoA reductase inhibitors
- -inhibition of HMG-CoA reductase to mevalonate causing a dec in biosynthesis of cholesterol (or an inc in the LDL receptor activity)
- What do statins do?
-
-dec LDL
-dec TG
-inc HDL - Side effects of statins
-
-myalgias
-myopathy
-rhabdomyolysis
-inc in liver enzymes - absolute CI to statins
- -liver disease
- relative CI to statins
- -niacin, fibrates (inc in myopathy)
- Statin agents
-
-lovastatin
-simvastatin
-fluvastatin
-pravastatin
-atorvastatin
-rosuvastatin
-cerivastatin - Which statin is the most potent? the least?
-
most: rosuvastatin
least: fluvastatin - Mx of Bile acid resins
-
-interrupts recycling through enterohepatic recirculation
-hepatic cells convert more cholesterol to bile acid (or inc the synthesis of LDL receptors) - What do bile acid resins do?
-
-dec LDL
-inc HDL
-may inc TG - side effects of bile acid resins
-
-GI distress
-dec absorption of other drugs - Absolute CI to bile acid resins
-
-dysbetalipoproteinemia-expialadocious
-raised TG >400 - relative CI to bile acid resins
- -TG >200
- Bile acid resin agents
-
-cholestyramine
-colestipol
-colesevelam - Mx of Niacin
- -dec hepatic production of VLDL (which dec LDL production)
- What does niacin do?
-
-dec LDL
-dec TG
-inc HDL - Side effects of niacin
-
-flushing/itching
-hyperglycemia
-hyperuricemia
-UGI distress
-heptotoxicity - Niacin agents
-
-crystalline IR niacin
-niacin SR
-niacin ER - Mx of Fibric acid derivatives
- -dec TG by inc lipoprotein lipase activity
- What do fibric acids do?
-
-dec TG
-inc HDL %
-dec LDL (w/NL TG)
-may inc LDL (w/ high TG) - Side effects of fibric acids
-
-GI sxs
-gallstones
-myopathy - absolute CI of fibric acids
- -renal or hepatic disease
- Fibric acid agents
-
-gemfibrozil
-fenofibrate - Mx Cholesterol absorption inhibitor
- -impair absorption of cholesterol at the brush border of the intestine
- What do cholesterol absorption inhibitors do?
-
-dec LDL
-dec TC
-dec TG
-inc HDL - side effects of cholesterol absorption inhibitors
-
-hypersensitivity rxn
-myopathy - absolute CI to cholesterol absorption inhibitors
- -active liver disease
- What drugs might be used for a drug induced exercise stress test?
-
-dobutamine
-dipyridamole
-adenosine - Nitrate agents
-
-nitroglycerin
-isosorbide dinitrate
-isosorbide mononitrate - Side effects of nitrates
-
-h/a
-hypotn
-syncope
-dizziness
-tachycardia
-flushing - Drug interactions with nitrates
- -viagra: drop BP big time
- Selective BB agents
-
-atenolol
-metoprolol
-acebutalol
-betaxolol
-bisprolol - Nonselective BB agents
-
-nadolol
-propranolol
-timolol
-pindolol - Mx of CCB
- -dec MVO2 (vasodilates) which dec contractility and dec HR
- Side effects of CCB
- -constipation, peripheral edema
- -CI to CCB
-
-AV block w/o pacemaker
-bardycardia
-sys HF
-use of BB - DHP CCB agents
-
-nifedipine
-amlodipine
-felodipine
-nicardipine - NDHP CCB agents
-
-verapamil
-diltiazem - TX of HTN in caucasians
- -BB and ACEI
- TX of HTN in AA
- -diuretics and CCB
- TX of HTN in the elderly
-
-lower initial and maintenance doses
-longer intervals between dose adjustments - Side effects of Thiazide diuretics
-
-dec K
-dec Mg
-inc Ca
-hyperuricemia
-glucose effects
-hyperlipidemia - -Side effects of loop diuretics
- -like thiazide except dec Ca
- side effects of K-sparing diuretics
-
-inc K
-gynecomastia by spironolactone - Drug interactions with diuretics
-
-ACEI: fall in BP, renal insufficiency
(w/ specifically K sparing and ACEI: inc hyperkalemia) - Drug interactions with BB
-
-decongestants: raise BP
-CCB: sig bradycardia, AV block
-NSAIDS: blunt the antiHTN effects of BB
-thyroid hormones: antagonisitic
-Digoxin: inc bradycardia - Mx of alpha 1 BB
- -work like BB but also blocks peripheral a1 receptors (reduces vascular resistence)
- Side effects of a1 BB
-
-sycnope, orhtostasis
-h/a
-dizziness - Drug interactions with ACEI/ARBs
-
-NSAIDS: inhibit the antiHTN effects of ACEI
-K sparing: inc risk for hyperkalemia
-lithium: inc risk for toxicity - Mx of a2 inhibitors
-
-stimulate a2 in the brain to dec symp activity to periphery
-suppresses plasma renin - a2 inhibitor agents
-
-clonidine
-methyldopa
-guanfacine
-guanabenz - Mx of direct vasodilators
-
-inc the relaxing factor, dec PVR
-Na and water retention - side effects of direct vasodilators
-
-lupus like
-hypotn
-relfex tachycardia
-edema - tx of tinea corporis, cruris, pedis, versicolor
- -spectazole
- tinea capitis
- -nizoral shampoo
- tinea unguium
-
-sporonox
-lamisil - oral candidiasis
- -diflucan
- cutaneous cadidiasis
- -spectazole
- vulvar/vaginal cadidiasis
-
-gyne-lotrimin
-diflucan - pruritis
-
-benadryl
-zonalon - dry skin
-
-aveeno
-lac-hydrin - atopic derm (eczema)
-
-aclovate
-elidel
-protopic - seborrheic derm
-
-selsun lotion on the scalp
-aclovate, on the face
-nizoral if uncontrolled - acne vulgaris
-
-clindagel
-tetracycline - acne rosacea
-
-metrogel
-clindagel - impetigo
- -bactroban
- allergic contact derm
-
-clamine lotion
-kenalog lotion in Sarna - Miliaria (heat rash)
- -triamcinolone in Sarna
- Urticaria/ Angioedema
-
-atarax
-zyrtec - warts
-
-freeze w/ liquid nitrogen
-aldara
-duofilm - scabies
- -elimite
- pediculosis
- -nix
- psoriasis
-
-limited: enbrel, dovonex
-general: soriatane, rheumatrex - Varicella
-
-Benadryl
-calamine
-acetaminophen - Herpes
-
-face: abreva, valtrex
-genital: valtrex
-zoster: prednisone - Herpetic Neuralgia
-
-zostrix
-elavil
-neurontin