Pcm Test 1 Ch. 7, 15, 11, 3

Front 1

Mechanism of Action for PDE-5 Inhibitors (Viagra, Levitra, Cialis)

Back 1

inhibits cGMP-specific PDE-5 enzyme that degrades cGMP in the corpus cavernosum. They enhance the effect of nitric oxide (NO) by inhibiting PDE-5 thereby increasing conc of cGMP which leads to relaxation of smooth muscle and flow of blood to the penis.

Front 2

When should a man take a PDE-5 Inhibitor?

Back 2

1 hour before intercourse

Front 3

What is the caution for pilots taking Viagra, Levitra, or Cialis?

Back 3

Alters blue-green colors, do not use 1 to 2 days before flying

Front 4

Patients taking these two class of medications should avoid taking PDE-5 inhibitors

Back 4

Nitrates: isordil (isosorbide dinitrate), Nitro S.L, ISMO, Imdur, nitrolingual spray, nitro-dur, amyl Nitrite, etc

Alpha-1 blockers

Front 5

What are some drug interactions with PDE-5 inhibitors?

Back 5

hepatically metabolized by CYP3A4: cimetidine (OTC Tagamet HB), erythromycin, grapefurit juice INHIBIT CYP3A4=increase PDE-5 inhibitor levels=priapism!!

Front 6

Which PDE-5 Inhibitors should be taken on an empty stomach because fatty foods decrease absorption?

Back 6

Viagra (Sildenafil)
Levitra (Vardenafil)

Front 7

Which PDE-5 Inhibitor can be taken with food and is longer acting (36-48 hour duration)

Back 7

Cialis (Tadalafil)

Front 8

The ED drug Viagra may also be used for? What is the other brand name of sildenafil citrate?

Back 8

Pulmonary Hypertension, 25 mg TID
Revatio 20 mg q8h

Front 9

This causes local vasodilation and has no effect on the heart. Vasodilates SMM in vascular bed, induces erection

Back 9

MUSE - Medicated Urethra System for Erection

Front 10

Which formulation has the least dry mouth of the anticholinergic group?

Back 10

Oxytrol (3.9 mg oxybutynin) Transdermal Patch

Front 11

Mechanism of Action of Ditropan (Oxybutynin)

Back 11

Antispasmodic for bladder instability. Antimuscarinic (Atropine-like) actions on smooth muscle of the bladder. It inhibits the involuntary detrusor muscle contractions caused by muscle instability. This decreases urgency by delaying the initial desire to void.

Front 12

This drug for overactive bladder is selective for bladder (possibly less dry mouth)

Back 12

Detrol LA (Tolterodine) - 2 and 4 mg ER capsules, 1 and 2 mg tablets, possible less dry mouth than PO Ditropan

Front 13

This drug is similar to Detrol LA (tolterodine), they both have the same active metabolite

Back 13

Toviaz (fesoterodine) - 4mg and 8 mg QD

Front 14

What is the active isomer of atropine?

Back 14

Levsin (L-hyoscyamine) - anticholinergic for urinary tract and GI antispasmodic, also used as a sputum and saliva drying agent for terminally ill (hospice patients)

Front 15

Mechanism of Action for BPH - 5 Alpha reductase inhibitors

Back 15

Inhibit 5-alpha reductase, reduces formation of active form of testosterone (DHT). For symptomatic BPH in men with enlarged prostate to improve symptoms, reduce the risk of acute urinary retention, and reduce the risk of the need for BPH-related surgery.

Front 16

Prostate Specific Antigen is reduced by ___%. This happens when prostate volume decreases. When testing PSA lab #, ______ it to calculate prostate cancer risk.

Back 16

50%, double it

Front 17

This 5-alpha reductase inhibitor inhibits two forms of the 5-a reductase (Type 1 and Type 2). Advantage is that results are seen in __ weeks

Back 17

Avodart (Dutaseride), results seen in a few weeks (1 month)

Front 18

BPH products - alpha-1 Blockers MOA

Back 18

Inhibits alpha-1A receptor (urinary tract) - relatively more specific for smooth muscle in lower urinary tract than in blood vessels, but dizziness is still a ADR

Front 19

Should NOT take alpha agonists (Sudafed) or anticholinergics (Benadryl) with this medication

Back 19

Alpha-1 Blockers for BPH: Flomax (Tamsulosin), Uroxatral (Alfuzosin), Cardura XL (Doxazosin)

Front 20

Associated with Retrograde Ejaculation (occurs when semen enters the bladder instead of emerging through the penis during orgasm. Although you still reach sexual climax, you may ejaculate very little or no semen. This is called a dry orgasm. Retrograde ejaculation isn't harmful, but it can cause male infertility)

Back 20

Alpha-1 Blockers for BPH: Flomax (Tamsulosin), Uroxatral (Alfuzosin), Cardura XL (Doxazosin)

Front 21

Floppy Iris Syndrome is a complication of ________ and is a major concern with cataract surgery

Back 21

Mainly associated with Flomax (Tamsulosin) which is a selective alpha blocker that works by relaxing the bladder and prostatic smooth muscle. As such, it also relaxes the iris dilator muscle by binding to its postsynaptic nerve endings.

Front 22

These have a synergistic effect for BPH

Back 22

5 alpha-reductase inhibitors and alpha-1 blockers

Front 23

Causes urine color to change to reddish-orange

Back 23

Pyridium (Phenazopyridine) 100, 200 mg Py-RED-ium

Front 24

Converted to Formaldehyde at urine pH less then or equal to 5.5. Nearly all bacteria are sensitive to formaldehyde if critical conc is reached. Use cranberry juice, Vitamin C to lower urine pH because amount of formaldehyde is directly proportional to pH of environment

Back 24

Hiprex (Methenamine Hippurate) - 1 gram tabs
Mandelamine (Methenamine Mandelate) - 0.5, 1 gram tabs, 0.5 gram/5mL susp

Front 25

Sulfa interaction - acidic urine increases possibility of precipitating sulfonamides in urine

Back 25

Hiprex (Methenamine Hippurate) - 1 gram tabs
Mandelamine (Methenamine Mandelate) - 0.5, 1 gram tabs, 0.5 gram/5mL susp

Front 26

Do not give to patient with ASA allergy or COPD/Asthma because of FD&C Yellow Dye #5 (tartrazine)

Back 26

Hiprex (brand only) (Methenamine Hippurate)

Front 27

Forms a reactive metabolite - inactivates bacterial ribosomal proteins and damages bacterial DNA

Back 27

Macrodantin, Macrobid (Nitrofurantoin) - antimicrobial for UTI infections only, commonly used when resistance to sulfonamides or quinolones occurs

Front 28

Renally eliminated - if it accumulates = lung and liver toxicity
Contraindicated in patients with anuria, oliguria, significantly impaired renal function (CrCL<60mL/min) or increases SCr

Back 28

Macrodantin, Macrobid (Nitrofurantoin)

Front 29

Pulmonary function should be monitored!!

Back 29

Macrodantin, Macrobid (Nitrofurantoin)

Front 30

Works only in Gut and Kidneys - ihibits DNA gyrase

Back 30

Noroxin (Norfloxacin) 400 mg q12h (quinolone antimicrobial) - use UTI, intestinal infections, traveler's diarrhea, NO SYSTEMIC INFECTIONS

Front 31

May discolor urine - blue marker lets pts know they are taking medicine

Back 31

Methylene Blue in Methenamine combinations (hyoscyamine, methenamine, methylene blue, phenyl salicylate, benzoic acid)

Front 32

The main therapeutic agent in Methenamine combinations

Back 32

Hyosyamine (aniticholinergic)

Front 33

Calculate BMI

Back 33

lbs x 703/ht in inches^2

Front 34

Some uses for Benadryl

Back 34

allergy, sleep, anti-tussive, extrapyramidal symptoms

Front 35

Should not use this in any patients with a perforated tympanic membrane

Back 35

Cortisporin Otic Suspension (USE Cortisporin Solution)

Front 36

What are the ingredients in Tussionex?

Back 36

10 mg Hydrocodone with 8 mg chlorpheniramine per tsp

Front 37

What is the normal dosing regimen of Tussionex suspension?

Back 37

1tsp q12h, 1tsp TID (q8h) for Cancer patients

Front 38

Can Tussionex be phoned in to a pharmacy? (It is a C-III)

Back 38

Yes

Front 39

Why is there an anticholinergic agent in Hycodan cough syrup?

Back 39

homatropine is in Hycodan to discourage Abuse (anti-ACh)

Front 40

What is an advantage of Claritin over Benadryl?

Back 40

Non-sedating, no significant anti-ACh

Front 41

How does Clarinex differ from Claritin?

Back 41

clarinex is the active metabolite (desloratadine) of Claritin (loratadine)

Front 42

What are the ingredients and mg strengths of Claritin D products?

Back 42

loratadine/pseudoephedrine 12 hr = 5/120mg, 24hr = 10/240mg

Front 43

What are the names of the non-sedating antihistamines?

Back 43

Claritin, Alavert, Clarinex, Allegra

Front 44

What makes Periactin such a unique antihistamine?

Back 44

used for anorgasmia due to SSRIs (street drug)

Front 45

Why should a person with Parkinson’s disease not use Phenergan

Back 45

Slight DA blockade

Front 46

What is the active metabolite of Atarax?

Back 46

cetirizine (zyrtec)

Front 47

What is the most common use of oral hydroxyzine products?

Back 47

anxiety and potentiate narcotics

Front 48

What is an advantage of Zyrtec over other Rx antihistamines?

Back 48

long duration of action, non-sedating, pregnancy category B

Front 49

What is the relationship of Xyzal to Zyrtec?

Back 49

active isomer of Zyrtec (levocetirizine)

Front 50

When should a person take vitamins when using Xenical?

Back 50

take fat soluble vitamins at bedtime or 2 hours apart

Front 51

What is a good strategy for starting a person on Xenical?

Back 51

take only with meals containing 30% fat, start with one daily with the fattiest meal and then add the second and third for the second and third daily meals on the following weeks to have less problems with fecal incontinence.

Front 52

Name some products that contain Chlorhexidine?

Back 52

Hibiclens, Hibistat, Peridex

Front 53

What is the important counseling for a person who uses Peridex?

Back 53

swish after brushing and flossing, do not swallow

Front 54

What warning should be given to patients who take antibiotics & oral contraceptives?

Back 54

while on antibiotics you should use some other form of contraceptive such as a condom because they tend to make oral contraceptives not as effective

Front 55

How does Sudafed work?

Back 55

sympathomimetic, alpha adrenergic agonist, vasoconstricts the blood vessels allowing less fluid to get to nose, decreased mucous production, decreased inflammation

Front 56

Which receptors in the lower urinary tract are stimulated by the action of Sudafed, resulting in risk of urinary obstruction?

Back 56

Alpha 1 adrenergic receptors

Front 57

Sudafed is converted to which illegal substance?

Back 57

methamphetamine

Front 58

Why is there a risk of Sudafed raising blood pressure?

Back 58

Increased NE action on alpha-1 receptors in vasculature

Front 59

What is contained in Sudafed PE?

Back 59

phenylephrine

Front 60

What is the mechanism of action of the antibiotic effect of Bactroban?

Back 60

binds to bacterial enzyme, inhibits tRNA, bacterial protein & RNA synthesis

Front 61

Why is there an intranasal formulation of Bactroban?

Back 61

eradication of nasal colonization with MRSA

Front 62

How should Lotrisone be applied?

Back 62

dot method

Front 63

What are the two classes of drug contained in Lotrisone?

Back 63

Bethamethasone Dipropionate 0.05% with clotrimazole 1% (Corticosteroid with antifungal)

Front 64

What are the three classes of drugs in Midrin?

Back 64

Isometheptene Mucate 65 mg sympathomimetic, dichloralphenazone 100mg mild sedative, APAP analgesic

Front 65

The patient takes Darvocet-N 100 and OTC Tylenol. Why is there a potential problem when a person also takes Midrin (count the mg in each)?

Back 65

Midrin has 325 mg APAP, Darvocet N100 has 650 mg APAP, OTC Tylenol has 500 mg per tablet do not exceed 1000mg in a dose or 4000 mg a day.

Front 66

Which product for migraine contains an NSAID plus a triptan?

Back 66

treximet 85 mg sumatriptan and 500 mg naproxen sodium

Front 67

How does Silvadene work?

Back 67

antimicrobial cream, silver damages cell wall

Front 68

Why should a person who takes Tessalon be cautioned not to chew the capsules?

Back 68

could cause anesthesia of the mouth and choking

Front 69

How do the triptan drugs work?

Back 69

5HT1b/1d agonists, constrict intracranial blood vessels that become dilated during a migraine, inhibit release of inflammatory neuropeptides from trigeminal pain pathways

Front 70

Which triptan is the longest acting one?

Back 70

Frova 2.5 mg (FOREVER)

Front 71

Which one has the lowest ORAL bioavailability?

Back 71

Sumatriptan (Imitrex)

Front 72

Which one is available in SC, Nasal, and Oral formulations?

Back 72

Sumatriptan (Imitrex)

Front 73

Why would a triptan product not be safe for a person with uncontrolled HTN or CHF?

Back 73

constrict intracranial blood vessels that become dilated during a migraine

Front 74

Name the product that is used for smoking cessation that works by blocks re-uptake of DA and NE in the brain?

Back 74

Zyban (Bupropion)

Front 75

Describe the mechanism of action of Chantix?

Back 75

Nicotinic Acetylcholine receptor agonist at α4 β2 neuronal receptor. It stimulates, but at a significantly lower level than nicotine. Blocks the ability of nicotine to activate the receptor and to stimulate central nervous mesolimbic dopamine system

Front 76

What is the most appropriate alternative to Zyban?

Back 76

Rx and OTC Nicotine replacement therapy

Front 77

Has a Black Box Warning (BBW) of Fatal Respiratory Depression in pediatrics < 2 years old

Back 77

Phenergan (Promethazine)

Front 78

Hydroxyzine Pamoate

Back 78

vistaril (capsules)

Front 79

Hydroxyzine HCL

Back 79

Atarax (tablets)

Front 80

1st rx must be written for a 30 day supply only

Back 80

Ionamin (phentermine) and Meridia (sibutramine)

Front 81

What are some potential adverse effects to caution patients about while taking oral contraceptive?

Back 81

ACHES - Abdominal pain: gallbladder disease, pancreatitis
Chest Pain: Pulmonary embolus, MI
Headaches: Stroke, HTN, migraine
Eye Problems: Stroke, HTN, vascular problems
Severe leg pain: DVT

Front 82

Can have a blue skin discoloration

Back 82

Silvadene Cream (SSD) (Silver Sulfadiazine) 1%

Front 83

These 2 NSAIDs are used IV to treat patent ductus arteriosus (PDA)

Back 83

indomethacin (Indocin) and Ibuprofen (Neoprofen)

Front 84

This NSAID is a prodrug, converted to an active metabolite, then to an inactive metabolite in the kidneys

Back 84

Clinoril (Sulindac)

Front 85

This long-acting NSAID is related to ibuprofen and is in OTC Aleve

Back 85

Naproxen Sodium (220 mg Na salt)

Front 86

This warning is in the “black box warning” for NSAIDs

Back 86

increased risk of serious CV thrombotic events, MI, stroke, which can be fatal. increased risk of serious GI adverse reactions including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal.

Front 87

This is the only COX-2 selective drug

Back 87

Celecoxib (Celebrex) 50, 100, 200, 400 mg capsules

Front 88

This is the # of days of total therapy allowable for Toradol

Back 88

5 day limit

Front 89

This NSAID is a ketone, not an acid. It is metabolized to a naproxen-related drug

Back 89

Nabumetone (Relafen) 500, 750 mg tablets

Front 90

This muscle relaxant is related to an antihistamine and works by depressing the CNS

Back 90

Cyclobenzaprine (Flexeril)

Front 91

This muscle relaxant is related to meprobamate, a controlled drug

Back 91

Carisoprodol (Soma) - 350 mg tablets (250 mg brand only)

Front 92

This muscle relaxant inhibits presynaptic motor neurons, reducing spasm

Back 92

Tizanidine (Zanaflex) 2, 4 mg tablets 2, 4, 6 mg capsules

Front 93

This muscle relaxant is a GABA agonist

Back 93

Baclofen (Lioresal) 10, 20 mg tablets

Front 94

This is the NSAID in Advil

Back 94

Ibuprofen

Front 95

This is the food counseling for all patients who take NSAIDs

Back 95

Take with food or milk

Front 96

This organ is at high risk with the long-term use of APAP

Back 96

liver

Front 97

This product contains an NSAID plus a prostaglandin, to protect the GI mucosa

Back 97

Arthrotec (voltaren plus misoprostol) 50/200, 75/200

Front 98

This muscle relaxant is related to an antidepressant, Elavil

Back 98

Cyclbenzaprine (Flexeril)

Front 99

This is a once-a-day NSAID that is related to Feldene

Back 99

Meloxicam (Mobic) 7.5 mg, 15 mg related to Feldene (Piroxicam) 10, 20 mg

Front 100

This is the rate-limiting substance in the arachidonic acid cascade

Back 100

phospholipase

Front 101

This NSAID is composed of two salicylic acid structures fused together

Back 101

Salsalate (Disalcid)

Front 102

This is what would happen to a person’s GI if he takes Rx Motrin plus OTC Advil

Back 102

stomach ulceration, irritation

Front 103

This is the mg amount that is maximum for normal adults for both ASA and APAP

Back 103

4000 mg

Front 104

This is the blood substance that is responsible for the initial clotting plug in an injury

Back 104

platelets

Front 105

This is what would happen if a hypertensive patient takes high-dose NSAIDs

Back 105

Can cause elevated BP in the elderly hypertensive patient

Front 106

This class of medications should be avoided by an ASA-allergic patient

Back 106

NSAIDs

Front 107

This is the mg amount of ASA in Norgesic

Back 107

385 mg (Orphenadrine 25 mg, ASA 385 mg, caffeine 30 mg)

Front 108

This propionic acid derivative is dosed QD and is available in a 600-mg tablet

Back 108

Oxaprozin (Daypro) 600 mg caplets 1200 mg QD MAX=1800mg QD

Front 109

When thinking about NSAIDs, this ADR should be the first one to come to mind

Back 109

GI effects use PPI when taking long term

Front 110

Name the Non-selective Cox inhibitors, carboxylic acids, Proprionic Acid Drugs

Back 110

Ibuprofen (advil/motrin)
Naproxen (Aleve, Naprosyn Naprelan, Anaprox)
Oxaprozin (Daypro)

Front 111

Name the Salicylic Acid of the Carboxylic Acids in the Non-Selective Cox Inhibitors

Back 111

Salsalate (Disalcid)

Front 112

Name the Acetic Acids of the Carboxylic Acids in the Non-Selective Cox Inhibitors

Back 112

Indomethacin (Indocin), Ketorolac (Toradol), Diclofenac (Voltaren, Cataflam), Sulindac (Clinoril)

Front 113

Name the Pyranocarboxylic Acid of the Carboxylic Acids in the Non-Selective Cox Inhibitors

Back 113

Etodolac (Lodine)

Front 114

Name the Oxicams of the Enolic Acids in the Non-Selective Cox Inhibitors

Back 114

Piroxicam (Feldene) and Nabumetone (Relafen)

Front 115

What are some longer acting NSAIDs?

Back 115

Daypro, Mobic (meloxicam), Feldene (Piroxicam), and long-acting Voltaren (Diclofenac)

Front 116

Which one is available in a topically applied product for use on a specific area, such as wrist or knee?

Back 116

Diclofenac (Voltaren)

Front 117

Threee products with structural similarity and have similar actions

Back 117

Soma, Flexeril, Norflex

Front 118

Both of these have strong anticholinergic effects as well as CNS depression

Back 118

Norflex and Benadryl

Front 119

Both of these are CNS depressants with high potential for addiction

Back 119

Soma and Meprobamate

Front 120

It inhibits the enzyme (Xanthine Oxidase) which is involved in the production of uric acid. Therefore it inhibits the formation of uric acid in patients with hyperuricemia. Not a uricosuric drug

Back 120

Allopurinol (Zyloprim)

Front 121

When allopurinol is also used with Imuran or Purinethol the dose of ___ must be reduced to __ or __ of the original dose - not the dose of allopurinol

Back 121

the immunosuppressive (Imuran or Purinethol) to 1/3 or 1/4 of the original dose

Front 122

Interferes with Uric Acid Synthesis

Back 122

Allopurinol

Front 123

Increases Uric Acid excretion

Back 123

Probenecid or sulfinpyrazone

Front 124

Inhibits Leukocyte entry into the affected joint

Back 124

colchicine