Pharm 1 Semester Finale Test

Front 1

Inhaled Corticosteroids
Examples: Beclomethasone HFA, Budesonide (plmicort), aerobid, Flovent, Fluticasone,

Back 1

Use: Long term Control. Most effective treatment
ADR: Xerostomia, Hoarseness, Tongue/mouth irritation. High doses are linked to HPA suppression with systemic use also.
To reduce effects: spacer/rinsing mouth, lowest dose, use with long-acting beta 2 agonists, watch growth in children.

Front 2

Oral Glucocorticoids
DTC: Prednisone

Back 2

Use: Most severe Asthma. Use highest dosage of inhaled before using these. Don’t go higher than 60mg/day.
ADR: Everyting. Watch for Cohrn’s disease. Atrophy, thinning of the skin, osteoporosis, cataracts, GI problems, HTN, Mood swings, increased sugar

Front 3

Step 1
Mild Intermittent

Back 3

Symptoms: symptoms less than 2 times a week, Asymptomatic and normal PEF between exacerbations. Exacerbations brief (from a few hours to a few days); intensity may vary
Nighttime Symptoms: twice a month
Lung Function: FEV/PEF > 80% predicated, PEF variability >20%

Front 4

Step 2
Mild Persistent

Back 4

Symptoms: symptoms greater than twice a week but less than every day. Exacerbations effect activity
Nighttime Symptoms: twice a month
Lung Functions: FEV/PEF > 80%, PEF >30

Front 5

Step 3
Moderate Persistent

Back 5

Symptoms: Daily symptoms, daily use of inhaled short-acting beta2 agonist. Exacerbations affect ADL. Exacerbations greater than twice a week; may last days
Night Symptoms: >once a week
Lung Functions: FEV/PEF> 60 to <80% predicted, PEF variability >30

Front 6

Step 4
Severe Persistent

Back 6

Symptoms: continual symptoms, limited physical activity, frequent exacerbations
Nighttime Symptoms: Frequent
Lung Function: FEV/PEF >60% predicted, PEF >30%
PEF: maximal flow (or speed) achieved durin the maximally forced expiration initiated at full inspiration. Measured in L per minute. 71-100% good, 50-70% moderate, less than 50% oh shit.

Front 7

Step 1 Mild intermittent
treatment

Back 7

No daily medication.

Front 8

Step 2 Mild Persistent treatment

Back 8

Low dose inhaled corticosteroids
(alternative is cromolyn, leukotriene modifier, nedocromil, or SR Theophylline

Front 9

Step 3 moderate treatment

Back 9

Low to Medium inhaled corticosteroids, and long-acting inhaled beta 2 agonists.
(Alternative increased corticosteroids only or add leukotriene modifier/theophylinne)
(If having many severe exacerbuations, increase corticosteroids to medium, and add long-acting beta 2 agonists, Alternative to this is add leukotriene modifier/theophylinne instead

Front 10

Step 4 Severe Persistent treatment

Back 10

High Dose Corticosteroids, Long acting inhaled beta 2 agonists
(add corticosteroids up to 60mg a day)

Front 11

Anticholinergics
IE Atrovent

Back 11

Actoins: dilates bronchioles
(also decrease secretions)

Front 12

Methylaxthine (xanthine) derviatives
Drugs: aminophylline, theophylline, caffeine

Back 12

Action: stimulates the CNS/respiration, dilates coronary/pulmonary vessels

Theophylline levels of 10-20 ug/ml
Side effects: GI disturbanes, nerousness, irritability, cardiac dysrhythmias, tachycardia, palpitations, hyperglycemia. Interacts with Beta-blockers

Front 13

Leukotriene Receptor Antiagonists/Inhibitors
Drugs: zafirlukast 9Acclate), zileuton (zyflo)

Back 13

Action: reduces inflammoatory process and decrease bronchoconstriction

Front 14

Cromolyn (intal)

Back 14

Inhibits mast cell degranulation, inflammatory, and inhibition of il-4 induced IgE synthesis
ADR: safest of all drugs just cause cough/bronchospasm

Front 15

Alpha 1 Proteinsase Inhibtor
IE Prolastin

Back 15

Given IV weekly. For use in the genetic deficiency of alpha 1 antitrypsin which leads to emphysema.
ADR: tachycardia, chest pain, drowsiness, nausea.

Front 16

Xolair
(for use in moderate to severe patients with allergic asthma)

Back 16

Action: binds with IgE
Given SubQ every 2 to 4 weeks by at Physican’s office
Cost: 10,000 to 30,000 a year.

Front 17

Typical pneumonia

Back 17

Fever, chills, yellow/green sputum, pleuritic chest pain, lobar consolidation on chest x-rays
Cause: typical Strep Pneumoniae (given PCN For this)

Front 18

Atypical Pneumonia

Back 18

gradual onset of cough. No/scant sputum, low-grade fever. Myalgia, arthralgias. Lack of Consolidation on x-raysatypical, Mycopasma pneumonia (given Macrolide such as azithromycin, clarithromycin, erythromycin)

Front 19

Treatment

Back 19

Ask about if they have used any antimicrobials in the last 3 months (then use a diferent drug)
If they have got this give Fluoroquinolone (moxifloxacin, levofloxacin) or beta-lactam (cefuroxime or high dose amoxcillinan plus a macrolide aka macrolide)
Treat for 5 days. Should become afebrile in 48-72 hours. Stop therapy if no temp, increase in baseline HR, RR less tan 24, 02 stats greater tan 90, and non change in mental status

Front 20

IF patient has clinical findings of pneumonia has
No Cardiac/Pulmonary issues/histry

Back 20

Give a Macrolide (arzithromycin, clarithromycin, erthroymcin, or doxycline).

Front 21

If history of cardiopulmonary disease

Back 21

Give Beta-lactum plus macrolide or doxycline (if antipneumoccal fluroquinolone which should be used normal)
If no improvement use a broader spectrum antibiotics

Front 22

Symptoms of Pulmonary TB

Back 22

cough with productive purulent secretions with blood streaks. May include malaise, fatigue, night sweats.

Front 23

Symptoms of extrapulmonary TB

Back 23

vague and difficult to define. For Lymphatic TB unilateral, painless cervical Lymphadenopathy.

Front 24

With Prego women ONLY ONLY ONLY give

Back 24

INH (insoniazied)
RIF (rifampin)
EMB (ethambutol)
Add pyridoxine (vitamin b6) 25mg/day to prevent INH peripherial neuropathy.
All these drugs cross placenta but don’t turn babies into freaks. They can breastfeed.

Front 25

ADR of the TB drugs:

Back 25

INH-watch for peripheral neuropathy so given d6 (pyridoxine) to prevent)
EMB- watch vision
RIF-red-colored urine, sweet, tears. Hinders hepatic enzymes (like birth control) so use other methods

Front 26

Treatment For adults/kids

Back 26

INH, RIF, EMB, and PZA for 2 months (stop PZA after 2 months)
1. Give there is a Cavitation on CXR or Postive AFB smear at 2 months keep patient on INH/RIF
a. If after two months after that negative stop antibotics at 6 months, and if still positive stay on till 9 months
2. No cavitation on CXR and Negative AFB Smear at 2months. Give INH/RIF for 6 months if HIV patient. If non HIV give INH/RPT (RPT=rifapentine) for 6 months up to 9 months.

Front 27

Osteoporosis Proccess

Back 27

Osteoclast breaks down the bone to resoprtion, which leads to reverseal, that osteoblasts (builds up the bone)

Front 28

What enchances Bone Resorption

Back 28

Low Serum Calcium, Parathyoroid Hormone, and Cortiocsteroids.

Front 29

Prevents it (bone resorption)

Back 29

Strontium, Vit D, Ipriflavvone, Disphosphonates, Raloxifene, Calcitononin

Front 30

Osteoblast-Bone Formation what enchanges it

Back 30

Calcium,Vit K, strontium, Ipriflavone, Genestein.

Front 31

Bisphosphonates: alendronate, risedronate, lbandronate

Back 31

ADR: acute phase response, upper GI (stay up), rash, iritis, renal problems, Jaw Osteonecrosis

Front 32

Zoledronic Acid

Back 32

Reclass given once a year IV

Front 33

Pancreatic enzymesTrypsinogen (protein digestion),
Chymotrypsin (protein digestion)
Amylse (carbonhydrate digestion)
Lipase (fat digestion)

Back 33

Drug interactions: Don’t given with Calcium/Mag antacids. Also oral iron may work as wel. Alkaline food break down the ezyymes to fast in the stomach acid instead of Lower GI.

Front 34

Figure 21-2 Hypothalamus –pituitary-growth hormone axis
When there is a decrease in glucose causes a

Back 34

Stimulation This on the Hypothalamus to
Secretes growth hormone releasing hormone which acts on the
Anterior pituitary to secrete growth hormone

Front 35

Growth hormone

Back 35

Increased protein synthesis ,increased lipolysis, increased cell growth, retention of sodium potassium, phosphorus.
There is a neg feedback because all of this creates more glucose than inhibitions first.

Front 36

Levothyroxine (t4) (Synthroid)
ADR

Back 36

ADR: tachycardia, angina, tremors

Front 37

Levothyroxine (t4) (Synthroid)

Back 37

Dose: calculated by Ideal Body weight. Adults 1.6mcg/kg/day, Elderly 1 mcg/kg/day. Children 4 mcg/kg/day
In Pregnancy increased dose by 33-50%
If Giving IV/IM give 50% of dose

Front 38

Levothyroxine (t4) (Synthroid)

Back 38

TSH lab in 6 to 8 weeks
If TSH is high
-dose is too low, drug interactions, and adherence
TSH too low
-exessive use, dose too igh
TSH
If Great than 4 increase by 12.5-25 mcg/day
If less than 0.5 decrease 12.5 to 25mcg/day.
After stable watch q 6 months, and yearly.

Front 39

Liothyronine (Cyomel

Back 39

works faster but not as long. Very expensive

Front 40

Liotrix

Back 40

has both t3 and t4

Front 41

Propylthiouracil (PTU)/methimazole (Tapazole)(

Back 41

Action: Inhibits thyroid hormone synthesis
ADR: agranulocytosis (within two months), neonatal hypothyroidism (breast milk/placenta)

Front 42

Lugol’s solution (strong iodine solution)

Back 42

Actions: suppresses thyroid function in preparation for thyroidectomy.
ADR: brassy taste, burning sensation, frontal headache, salivation

Front 43

Radioactive Iodine 131

Back 43

-kills the thyroid

Front 44

Treatment of Hyperthyroidism

Back 44

Use Beta blockers (propranolol/nadolol for symptoms)

Front 45

Somatropin (humatrope)

Back 45

Use: growth failure with chronic renal insufficiency, growth failure, truner’s syndrome, and somatropin deficiency. MUST MUST watch to make sure growth is appropriate

Front 46

Octreotide (Sandostatin)

Back 46

Use: suppresses growth hormone release. Can cause GI and Gallstones issues. Expensive.

Front 47

Somatrem (Protropin)

Back 47

Use: growth hormone for dwarfism. Can cause hyperglycemia, hypothyroidism, antibody to GH, and interactions with glucocorticoids

Front 48

Desmopressin

Back 48

Use: diabetes insipidus, abdominal distention, nocturnal bedetting
ADR: water intoxication, vasoconstriction
Drug Interaction: lithium (big one), epinephrine, demeclomycin, heparin
Action: enhances reabsorption f water in the kidney by increasing cellular permeability of the collecting ducts.

Front 49

Diagnostic Criteria for DM

Back 49

Fasting Plasma levels < or = 126 mg/dl
Random blood glucose > or = 20 mg/dl with symptoms
75g oral glucose test- 2 hour blood glucose > or = 200 mg/dl
Hemoglobin a1c> or = 6.5%

Front 50

Treatment goals for DM

Back 50

A1c= <7%
Fasting Glucose 70-130 mg/dl
BP of 130/80
Lipids dld<100 mg/dl (<70 mg/dl if CV history)
Triglycerides <150 mg/dl

Front 51

Biguanides
Examples: Glucophage

Back 51

Action: decrease liver from releasing too much glucose, decrease peripheral resistance, decrease lipids
Take with a meal
ADR: GI upset, titrate the dose upwards after 1-2 weeks, Rare lactic acidosis (don’t not us if SCR > 1.4), metallic taste. Watch for b-12 low levels due to interactions
Other Side effects: Avoid in Renal Insufficiency, CHF, Lactic acidosis, d/c 2-3 days before IV dye, and 2 days post, can cause weight loss/positive effective lipids

Front 52

Thiazolidinediones (TZD)Examples: rosiglitazone (Avandia), rioglitazone (Actos).

Back 52

Work: improve insulin sensitivity
Take once a day with or without a meal (not first line therapy)
ADR: Fluid retention, hepatotoxicity, weight gain, anemia, peripheral edema. CV Risk do not given CHF (esp late cases), Osteoporosis, and do not give to pregnancy, children, or impaired hepatic function. Don’t give Avandia in ischemic heart disease.

Front 53

Sulfonylureas
Examples: amarly (glimepiride), DiaBeta, Glynase, Micronase (Glyburide), Glucotorl Glipizide) Diabinese (chlorpropamide)

Back 53

Action: increase insulin release from panc.
How to take: one to two days before breakfast/dinner
(may work better with very overweight people, and with FPG <200 mg/dl)
ADR: hypoglycemia (carefully with old people, renal insufficiency, or advance liver disease), GI upset, skin rash/itching, weight gain, hemolytic anemia, cholestasis, beta cell burnout.

Front 54

Alpha-Gluosidase Inhibitors
Examples: precise (Acarbose), Glyset (miglitol)

Back 54

Action: slows carb digestion of carbs
Take 3x a day with meals
ADR: may cause flatulence, bloating, diarrhea (can be minimized by slow-dosage titration), Can cause hypoglycemia if given with other agents. Have to take IV glucagon, parenteral glucose, or glucagon, elevated Transaminase Levels

Front 55

Meglitinides
Repaglinide (Prandin)
Nateglinide (starlix)

Back 55

Action: increase insulin response to food keeping blood glucose from rising too high after meals
Take 30 minutes before meal. Skip if missed.
Side Effects: Hypoglycemia

Front 56

DPP-IV Inhibitors
Examples: saxagliptin (onglyza), Januvia (sitagliptin)

Back 56

Action: increase insulin release when blood sugar is high after meals. Also reduces the amount of sugar made by the liver after meals.
Take only daily without regard to meals, and reduce dose with renal impairment
ADR: hypoglycemia, headache/stuffy nose.

Front 57

Glp1 Agonist
Examples Exenatide (byetta) comes from gila monster lizard

Back 57

Action: enchances glucosedepent insulin secretion, and reduces hepatic glucose production. Decreases appetite and slows gastric emptying.
Take twice daily, 60 minute before a meal. If taking oral medication take one hour before byetta
ADR: n/v, diarrhea, hypoglycemia, decreased appetite + weight reduction, used as an add onto metformin, sulfonylurea

Front 58

Liraglutide (Victoza)
GLP 1 agonist. Donce daily.

Back 58

ADR: n/v/dir, headache, dizziness. Pancreatitis, Thyroid cell hyperplasia

Front 59

Amylin Analog
(injection)
Examples: pramlintide (Symlin)

Back 59

Action: suppresses inappropriately high postprandial glucagon secretion, reduces food intake and slows gastric empfying.
(take right before meals with food greater than 250 calories)
ADR: weight loss, hypoglycemia, n/v
This is an add on to inuslin

Front 60

Rapid Acting Insulin:
Insulin lispro (Humalog), insulin aspart (Novolog), Inuslin gluisine (apidra)

Back 60

Onset: 15 minutes
Peaks: 1-2 hours
Duration: 3 to 5 hours

Front 61

Short-Acting Insulins
Humlin-R, Novolin-R

Back 61

Onset: 30 minutes
Peak: 3 to 5 hours
Duration: 6 to 8 hours.

Front 62

Intermediate-Acting Insulin
NPH: Novolin N, Humulin N

Back 62

Onset: 2 to 4 hours
Peak: 4 to 6 hours
Duration: 14 to 18 hours

Front 63

Very Long Acting Insulins
insulin glargine (Lantus)

Back 63

Onset: 4-5 hours
Duration: 24 hours
Administered once daily at bed time

Front 64

Very Long-acting, insulin detemir (Levemir)

Back 64

-Onset 2 hours, Duration 14 to 24 hours, Injected once or twice daily (Am and pm)
Can’t mix together.

Front 65

Insulin Dosing

Back 65

0.6-0.8 units/kg/day
Insulin Dosing
Only adjust one at a time, determine dosage adjustment needed (1-2 units= 30-50 mg/dl). Never change insulin by more than 5 units or 5-20% of total daily dose.