Adv Pharm 1

Front 1

Bupropion SR (Zyban) MOA

Back 1

blocks the reuptake of dopamine

Front 2

Bupropion SR (Zyban) also marketed under Wellbutrin

Back 2

can be used in combination with NRT. First choice for depressed smokers. Well tolerated in pt with cardiovascular disease. May delay wgt gain. Caution in pts with seizure disorder. Therapy should start 1-2 weeks before quit date

Front 3

Varenicline (Chantix) MOA

Back 3

Selective for nicotine receptors. Acts as partial agonist at nicotine receptors. Prevents full agonist activity of nicotine at the receptors.

Front 4

Varenicline (Chantex) Warning

Back 4

Serious neuropsychiatric symptoms have occurred- changes in behavior, agitation, depressed mood, and suicidal ideation

Front 5

Which orally administrated drug blocks leukotriene receptors?

Back 5

Montelukast (Singular)

Front 6

Which drug inhibits the degradation of cAMP?

Back 6

Theophylline (Theo-Dur)

Front 7

BW is a 20 year old woman who recently joined a fitness
club to lose weight; she has never exercised before. She
comes to the clinic today because ne onset cough and
has some trouble breathing in her new aerobics class
that she attends twice weekly; however, it does not limit
her activity. Which one of the following medications
would be best for BW’s intermittent asthma?

Back 7

Albuterol MDI 1 or 2 puffs 4 times/day as needed prior to exercise

Front 8

Your recommendation has slightly improved her
symptoms. However, she has now begun having
increasing symptoms at night and using her albuterol
inhaler 1-3 nights per week. Which one of the following is
the preferred treatment?

Back 8

Fluticasone 110 mcg/puff 1 puff 2 times/day

Front 9

RF is a 75 year old man who presents to the emergency department
with shortness of breath at rest. He is having trouble with
conversation. He used 20 puffs of his albuterol MDI at home with no
resolution of symptoms. His FEV1 is checked, and it is 38% of
predicted which indicates severe COPD. Which one of the following
is the best initial therapy for RF in the emergency department, in
addition to oxygen?

Back 9

Inhaled albuterol by nebulizer every 20 minutes for 1 hour plus IV corticosteroids.

Front 10

Insulin secretion

Back 10

basally in small amounts between meals and overnight. Boluses in response to food. In general 50% of insulin is secreted by the pancreas as basal and 50% as bolus.

Front 11

Basal Insulin Secretion

Back 11

small amounts of insulin are released by the pancrease every 24 hours. Adults secrete about 1 unit of insulin per hours regardless of food intake

Front 12

Bolus Insulin

Back 12

also called premeal, mealtime, prandial or nutritional insulin. Used to limit postprandial hyperglycemia by stimulating glucose uptake by peripheral tissue. In response to food, larger amounts of insulin are secreted.

Front 13

DM

Back 13

syndrome that dev when insulin secretion or activity are not sufficient to maintain normal blood glucose levels

Front 14

Type 1 DM

Back 14

results from B cell destruction; absolute lack of insulin

Front 15

Type 2 DM

Back 15

results from progressive insulin secretory defect and insulin resistance; relative lack of insulin

Front 16

Gestational DM

Back 16

onset or discovery of glucose intolerance during pregnancy

Front 17

Secondary causes

Back 17

Pancreatic disease; cystic fibrosis; endocrinopathies; drugs and chemicals

Front 18

Medication-induced Hyperglycemia

Back 18

Thiazide diuretics; Protease inhibitors; Atypical antipsychotics; Glucocorticoids;Calcineurin inhibiors; Nicotinic acid; Oral Contraceptives; Phenytoin

Front 19

Insulin

Back 19

Therapy of choice for pts with Type 1 DM. Used in Type 2 DM for those who cannot control their condition with diet, exercise and oral medications

Front 20

Rapid acting insulin preparations

Back 20

Insulin lispro (Humalog)
Insulin aspart (NovoLog)
Insulin glulisine (Aventis)

Front 21

Rapid acting insulin onset, peak and duration

Back 21

Onset: 15-30 minutes
Peak: 1-2 hours
Duration: 3-4 hours

Front 22

When do you administer rapid acting insulin?

Back 22

Administered immediately before a meal.

Front 23

What does rapid acting insulin and short acting insulin look like?

Back 23

Clear

Front 24

What insulin can be administered IV

Back 24

rapid acting insulin and short acting insulin

Front 25

Short acting insulin preparations

Back 25

Regular Novolin R
Regular Humulin R

Front 26

Short acting insulin onset, peak and duration

Back 26

Onset: 30 minutes
Peak: 2-3 hours
Duration: 4-6 hours

Front 27

When do you administer short acting insulin?

Back 27

30-45 minutes before meals.

Front 28

Intermediate acting insulin preparations

Back 28

NPH Humulin N
NPH Novolin N

Front 29

Intermediate acting insulin onset, peak and duration

Back 29

Onset: 2-4 hours
Peak: 4-8 hours
Duration: 8-12 hours

Front 30

When is intermediate acting insulin administer

Back 30

once or twice daily

Front 31

What is the appearance of intermediate acting insulin

Back 31

cloudy

Front 32

Long acting insulin preparations

Back 32

Insulin glargine (Lantus)
Insulin detemir (Levemir)

Front 33

Long acting insulin Glargine onset, peak, duration, appearance

Back 33

Onset: 4-5 hours
Peak: none
Duration: 22-24 hours
Appearance: Clear

Front 34

Long acting insulin Detemir onset, peak, duration, appearance

Back 34

Onset: 2 hours
Peak: 3-9 hours
Duration: 14-24 hours
Appearance: Clear

Front 35

Rapid/Short acting insulin

Back 35

covers meal intake and used for elevated glucose.

Front 36

Intermediate/Long Acting Insulin

Back 36

Used for basal insulin needs; not intended to cover meals

Front 37

Duration of action of insulin is prolonged in patients with

Back 37

hepatic and renal failure

Front 38

Combination Product Novolin or Humulin 70/30

Back 38

70% NPH and 30% regular insulin

Front 39

Combination Product NovoLog 70/30

Back 39

70% aspart protamine suspension and 30% aspart

Front 40

Combination Humalog 50/50 and 75/25

Back 40

50 or 75% protamine lispro and 50 or 25% lispro

Front 41

Advantages of combination products

Back 41

fewer injections per day; less calculation by the patient

Front 42

Disadvantages of combination products

Back 42

Dose adjustments alter both insulin

Front 43

Dosing pearls of insulin

Back 43

in general 1 unit of insulin will lower BG by 50-100 mg/dL. Wait 24 hours before adjusting the dose.

Front 44

Storage of insulin

Back 44

room temperature for 28 days

Front 45

Never use

Back 45

cloudy/discolored regular insulin

Front 46

Adverse effects of insulin

Back 46

hypoglycemia: signs of autonomic hyperactivity - sympathetic: fast HR (tachycardia), palpitations, sweating, and tremulousness. Parasympathetic: nausea and hunger. May progress to convulsions and coma if left untreated.

Front 47

Sulfonylureas MOA

Back 47

increase secretion of preformed insulin from B-cells of the pancreas by closing K+ channels. Secondary effects: increases insulin receptor sensitivity and decreases hepatic glucose output.

Front 48

Sulfonylureas therapeutic use

Back 48

Type 2 DM

Front 49

Second generation of Sulfonylureas

Back 49

Glyburide (DiaBeta, Micronase, Glynase PresTab) - duration 12-24 hours; active metabolite inactive; elimination 50% hepatic/50% renal.
Glipizide (Glucotrol, Glucotrol XL) - duration 12-16 hours; active metabolite inactive; 90% hepatic elimination.
Glimepiride (Amaryl) - duration 24 hours; active metabolite weakly active; elimination 100% hepatic

Front 50

Sulfonylureas metabolism

Back 50

hepatically metabolized - used with caution and at reduced doses in pts with hepatic impairment.

Front 51

Sulfonylureas excretion

Back 51

renal excretion - glyburide may accumulate in pts with CrCl <30 ml/min

Front 52

Most common adverse effect of Sulfonylureas

Back 52

hypoglycemia

Front 53

Adverse effects of Sulfonylureas

Back 53

dermatologic reactions: rash, photosensitivity, hypersensitivity. GI disturbances: N/V, abnormal liver function tests. Wgt gain.

Front 54

Meglitinides MOA

Back 54

same as sulfonylureas. Structurally related to sulfonylureas (no sulfa moiety)

Front 55

Meglitinides Available Agents

Back 55

Repaglinide (Prandin)
Nateglinide (Starlix)

Front 56

Meglitinides onset of action, peak, duration, metabolized

Back 56

Onset of action: 15 minutes
Peak response: 60-90 minutes
Duration of action: <4 hours
Metabolized through CYP 34A

Front 57

Potential advantages of Meglitinides

Back 57

rapid onset and short duration of action; may be used in pts with renal insufficiency; may be useful in pts who skip meals.

Front 58

Adverse Effects of Meglitinides

Back 58

Hypoglycemia and Wgt gain.

Front 59

Biguanides MOA

Back 59

decrease hepatic glucose output; secondary effects: increases peripheral glucose uptake and utilization.

Front 60

Biguanide available agents

Back 60

Metformin (Glucophage).

Front 61

Adverse effects of Biguanides

Back 61

GI upset; Lactic acidosis.

Front 62

Contraindicaitons for Biguanides

Back 62

-Renal impairment
Males creatinine > 1.5 mg/dL
Females creatinine > 1.4 mg/dL
-Hepatic impairment
May decrease the ability to eliminate lactic acid
-Hypoxic states, acute or chronic alcohol abuse, elderly, CHF (on drug therapy)

Front 63

Biguanides caution

Back 63

iodinated contrast materials, stop at least day prior to receiving contrast

Front 64

Advantages of Biguanides

Back 64

no hypoglycemia when used as monotherapy; wgt loss; decreases triglycerides

Front 65

α-Glucosidase Inhibitors

Back 65

Acarbose (Precose) and Miglitol (Glyset)

Front 66

α-Glucosidase Inhibitors MOA

Back 66

Potent competitive inhibitor of brush border alpha-glucosidases necessary for the breakdown of complex carbohydrates

Front 67

Thiazolidinediones

Back 67

Rosiglitazone (Avandia) and pioglitazone (Actos)

Front 68

Thiazolidinediones MOA

Back 68

binds to the nuclear steroid hormone receptor and promotes glucose uptake into skeletal and muscle/adipose tissue --> decreases insulin resistance; increases insulin sensitivity; no effect on insulin secretion.

Front 69

Name the adverse effects of Thiazolidinediones

Back 69

Hepatotoxicity and edema; Fracture risk; bladder cancer

Front 70

What is something to observe in patients for when on Thiazolidinediones

Back 70

after initiation and after dose increase, observe carefully for s & s of HF.

Front 71

What patients is initiation of Thiazolidinediones are contraindicated

Back 71

NYHA Class III or IV HF

Front 72

Thiazolidinediones may cause or exacerbate

Back 72

CHF in some pts

Front 73

Oral Combination Products

Back 73

Pioglitazone + metformin (Actoplus Met)
" Rosiglitazone + metformin (Avandamet)
" Rosiglitazone + glimepiride (Avandaryl)
" Pioglitazone + glimepiride (Duetact)
" Glyburide + metformin (Glucovance)
" Glipizide + metformin (Metaglip)

Front 74

Incretin Mimetics

Back 74

incretins are gi hormones released in response to glucose

Front 75

GLP-1 stimulates insulin release; delay of gastric emptying; suppression of postprandil glucagon release. What rapidly degrades GLP-1

Back 75

DPP-4, so do not see the effects long lasting

Front 76

GLP-1 Agonists

Back 76

Exenatide (Byetta)
Liraglutide (Vicotza)