Pharmacology Final Exam Review: Key Concepts and Medications, Study Guides, Projects, Research of Pharmacology

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MN 553 Pharmacology final exam review

1. regulations: all states have title protection for NPs

• the board of nursing regulates practice -5 states have joint oversight with medical board
• scope of practice is determined by NP license

2. investigational new drug (IND): •required before an investigational drug or bio

product can be administered to a human

• the IND app is a compilation of all known information about the compound
• it also includes a description of the clinical research plan for the product
• specific protocol for phase I study

3. phases of clinical study: •phase I clinical eval is the 1st testing of a new

compound in subjects for the purpose of establishing the tolerance of healthy human subjects

• phase II clinical eval is controlled studies performed on pts having the target disease or disorder to determine a compound's potential usefulness and short term risks
• phase III trials are controlled and uncontrolled clinical trials of a drug's safety and efficacy in hospital and outpt settings
• phase III trials verify that the acceptable risk/benefit ratio seen in II persists under conditions of anticipated usage in groups of pts large enough to identify statistically and clinically significant responses

4. clinical judgment in prescribing: •is there clear indication for drug?

• what drugs are effective for the disease?
• what are the goals of therapy?
• monitoring to see if drug is meeting goals

• duplications in med pts is taking
• otc vs prescription
• cost
• sources of info

5. the process of prescribing: •identify the pts problem

• specify the therapeutic objective
• collab with the pt
• choose the treatment
• edu the pt
• mt for effectiveness
• individualize drug choice

6. special population: pregnancy: •avoid ACEI, consider BB

• bulk laxative

7. special population: nursing moms: avoid ACEI, consider BB

8. special population: pediatric: •best pharmaceuticals for children act (BPCA)

• authorizes research to promote efficacy and safety

9. special population: older adults: •beers criteria

-looks at potential risk -does not look at effectiveness

10. pediatric distribution: •newborns and infants have higher percentage of water

• BBB is incomplete and permeable in newborn
• infants younger than 6 mths of age have decreased plasma proteins available for drug binding
• in infants dosing needs to be decreased if metabolized by kidneys

11. older adults: •take more meds than any other age group

• PD and PK are altered

• ADRs common
• risk increase with number of drugs used
• decreased protein impacts absorption

12. medication metabolisms: •some meds need a loading dose

13. first pass: occurs when metabolized by the liver

14. peak levels: important to have this to achieve desired effect

15. half-life: •ibuprofen ~2 hours

• SSRI~ 22 hours

16. antacids: clinical use and dosing: •GERD

-antacids are OTC and often used first before care -may be given 30-60 min until symptoms subside -maintenance after meals and bedtimes -H2RAs receptor antagonists or PPIs are first line therapy -ranitidine followed by PPI

17. drugs used for GERD: •H2 receptor antagonists

• PPIs
• antaci ds Prokinetics
• cytoprotective agents

18. PPIs ADRs: •osteoporosis

• risk of C diff
• kidney disease
• mt for -IDA -b -Ca

19. PUD: treatment of H. pylori: •all regimens include a PPI plus antibiotics to treat

H. py

• triple therapy: PPI plus -clarithromycin: 500mg 2x daily, or metronidazole: 500mg 2x daily -amoxicillin:1gm 2x daily tx: 10-14 days

20. Impetigo (bacterial skin infection): •topical treatment with mupirocin or reta-

pamulin, or OTC bacitracin or combo of bacitracin and poly B sulfate

• oral tx for worsening or more than 5 lesions -cephalexin, amox/clav, dicloxacillin, or clindamycin

21. furuncle (bacterial skin infection): •MRSA: SMZ/TMP or doxy

• cephalexin/doxy

22. Cellulitis (bacterial skin infection): •consider IMIV ceftriaxone followed by oral

cephalexin/doxy

23. tinea corporis (ringworm) and tinea cruris: •commonly caused by microspo- rum

canis, T. tonsurans, or epidermophyton floccosum

• classic presentation: an annular lesion with raised borders and a clear center tx: topical antifungals

24. tinea pedis (athlete's foot): •caused by dermatophytes E. floccosum, T rubrum,

T mentagrophytes, and C albicans tx: topical antifungals (azoles) -for 4 wks

25. tinea corporis (body): •topical azoles

• naftifine
• ciclopirox olamine

26. tinea cruris (groin): •topical azoles

27. contact dermatitis: •topical corticosteroids

• oral corticosteroids -may need 2-3 wks of therapy
• wet dressings or baths -aluminum acetate solution (burrow's, domeboro) is an astringent wet dressing applied for 30 min 4 times/day -baths contain colloidal oatmeal solids (aveeno) or oils (alpha keri bath oil, lubriderm bath oil)

28. ophthalmic anti-infectives: •conjunctivitis-otitis syndrome

-children younger than age 6 years -h.flu the causative organism in the majority of 73% of pts with conjunctivitis-otitis syndrome syndrome tx: high dose amox/clav or amox

29. asthma tx: •initial tx

-bronchodilators: SABA

• step up -ICS -LABA -leukotriene antagonist -salmeterol must have + an inhaled corticosteroids
• acute exacerbation -IV corticosteroids -mag sulfate o

30. mild persistent asthma: •treat with low dose inhaled corticosteroid med daily

-low dose inhaled corticosteroids are the mainstay for pts of all ages

• use of beta agonists as needed; if using more than 2 days per week, step up

31. nicotinic receptor partial agonists: •varenicline

• highly selective to the alpha 4 beta 2 and mod selective to the 5-HT3 receptor
• started a week before quit date
• dosing 0.5mg orally daily for the first 3 days -then 0.5mg 2x daily on days 4- -on day 8, increased to 1.0 mg 2x daily
• therapy cont. for 12 weeks

32. Varenicline (Chantix): •smoking cessation

• ADRs -nausea neuropsychiatric symptoms: changes in behavior, agitation, depressed mood, suici- dal ideation, and suicidal behavior, "vivid dreams"
• preg cat C: do not use
• adults only

33. nicotine replacement: •patches: mt for skin irritation

• Gum: "park" in buccal space
• lozenges: mt for irritation

34. gout med considerations: •allopurinol causes hypersensitivity rash (higher in

blacks and hispanics)

• check renal fx
• colchicine results in myopathy, weakness, neuropathy and malabsorption of b

35. osteoporosis: •bisphosphonates

-no longer used for preventative therapy! -1st line therapy for postmenopausal women -1st line therapy for men older than age 70 years with osteoporosis

-if given iv need to mt/assess renal fx

36. biguanides: •metformin (glucophage)

-decreases glucose prod in liver -increases insulin sensitivity -does not stimulate insulin release for beta cells -inhibits platelet aggregation and reduces blood viscosity

• pt may lose weight: not labeled use, mostly wt neutral

37. hypothyroidism: •the exam is important... lab values tend to be diagnostic

• ideal 0.3- 3
• low t4 (0.7-1.8)
• high TSH (>4)/ can go as high as 10
• this is consistent with "primary hypothyroidism"
• when you have a low T4 and normal TSH this Is consistent with "central hypothy- roidism"
• pituitary (secondary hypothyroidism)
• hypothalamic (tertiary)

38. erectile dysfunction drugs: •PDE5 inhibitors

-sildenafil citrate (viagra). tadalafil, vardenafil

• contraindications -in pts using nitrates because of risk of severe, even fatal hypotension -alpha blockers have additive hypotension effect -MI in recent 6 mths

39. MMR vaccine: •2 doses 99% effective in providing immunity for measles (88%

for mumps)

• contraindications: neomycin allergy, pregnancy, immunosuppression, febrile illness -ok to give those with egg allergy -may be given to breastfeeding women

• ADRs: fever 7-12 days after vaccination
• don't give with blood productions: consider why??

40. UTIs: •drug therapy

-spectrum of activity: need gram-neg coverage -empirical tx with nitrofurantoin -not recommended for use in febrile infants and children

• alt or 2nd line therapy with cephalosporins (cefpodoxime, cefixime).
• when is 3 day ok? female w/ no risk fx

41. beta lactams: PCNs: •used for gram neg urinary and GI pathogens: E. coli,

proteus mirabilis, salmonella, some shigella, Enterococcus faecalis; active against the common gram neg resp pathogens moraxella catarrhalis and (hae flu type B)

• combo with beta lactamase inhibitors to broaden their spectrum: clav, sulbactam, tazobactam
• cross sensitivity and resistance with PCN and cephalosporin

42. beta-;actams: cephalosporins: •PD: structurally and chemically similar to

PCNs -inhibit mucopeptide synthesis in the bacterial cell wall

• 1st gen -used for skin and soft tissue infections -primarily active against gram pos bacteria, s. aureus and s. epi
• 2nd gen: active against same as 2st gen, plus klebsiella, proteus, E. coli

43. macrolides: •drug of choice for community acquired pneumonia (mycoplasma)

• chlamydia
• pertussis
• h.py infections (clarithromycin
• chronic bronchitis

44. adult community-acquired pneumonia: tx: •healthy adults, no risk fx

-macrolide (level I evidence) (azithromycin and clarithromycin, erythromycin) -doxycycline, if allergic -treatment for a min of 5 days

45. antimicrobials: •tetracycline: no antacids

• minocycline: mt for HA
• tb tx: Folic acid supplement
• azithromycin: prolonged QT
• fluoroquinolones: no longer 1st line UTI

46. TB: •active TB

-follow with monthly sputum -goal is to complete tx

• LTBI

-important to treat -3,4,6 month

47. syphilis: •screen high risk pts and all preg women

• increasing incidence
• parenteral pen G is the drug of choice -if pt is penicillin allergic, treat with 14 days of doxycycline or tetracycline

48. gonorrhea: •often co infection with chlamydia, tx for both

• screen
• ceftriaxone 500mg IM one time is drug of choice -may use cefixime 400mg PO one time
• gonorrhea is resistance to fluoroquinolones
• treat partners
• repeat screening of women 3-6 mths after treatment

49. chlamydia: •all sexually active women younger than 25yrs should be screened

annually

• all women with new or multiple sex partners need to be screened
• tx: azithromycin 1g PO one time or doxycycline 100mg 2x daily for 7 days

50. UTI pharmacodynamics: •wide range of antibiotics treat UTIs

-TMP/smz, nitrofurantoin, fluoroquinolones, cephalosporins, and penicillins

• cranberry: may exert a bacteriostatic effect by inhibiting the adherence of organisms to bladder mucosa
• urinary analgesic: phenazopyridine
• 3 day regimen appropriate for young healthy female

51. treatment: heart failure: •stage A

-aceis are drug of choice -ARBs are considered but more $

-eval for thyroid dysfunction

• stage B -ACEI in all pts, ARB for those who cannot tolerate an ACEI -BBs in most
• stage c -ACEI and BBs (nonselective) in all pts -diuretics, digoxin -spironolactone
• stage D -sacubitril/valsartan (entresto) in lieu of ACE or ARB -inotropes: dobutamine -ventricular assist device, transplantation, hospice

52. ACEIs use: •not as effective in blacks

-when combined with a diuretic, race not an issue

• however, 3-4x greater risk of angioedema in blacks and asians
• ADRs: dry cough, (bradykinin-mediated), hypotension, loss of taste, angioedema, blood dyscrasias, teratogenicity, hyperkalemia, acute renal failure, cholestatic jaun- dice, pancreatitis, rash

53. beta adrenergic blockers: •more effective in black and older pts

• BB my not be abruptly withdrawn, because it will increase beta receptor sensitivity
• no longer 1st line HTN drug choice
• impacts vasc smooth musc tone

54. hyperlipidemia: •atherosclerosis major cause of CAD

• based on cardiac risk fx
• lipoproteins: all contain triglys, phospholipids, and cholesterol -LDL

-HDL

-Very LDL (VLDL) -triglys

• statins with 1st degree relatives with severe myalgia would be considered a con- traindication

55. diuretics: •loop diuretics: potential for cross sensitivity with sulfa

-furosemide, bumetanide, torsemide

• k+ sparing: often used in combo with thiazide to reverse low K+ effect -triamterene -spironolactone -eplerenone (inspra)
• eplerenone: next gen aldosterone agent k+ sparing, selective aldosterone blocker

56. antiplatelet drugs: •clopidogrel

-PPIs -CYP2C19 inhibitors

• clinical use and dosing -aspirin -MI prevention: 75-162mg daily

57. vitamin b12 clinical use: •pernicious anemia

-initial dose 1,000mcg/day IM or SC for 7 days, then 100 to 1,000mcg IM per week for a month

• maintenance -1,000mcg IM monthly -500mcg intranasal cyanocobalamin weekly -1000 mcg orally daily

58. beta blockers: •post MI antidysrhythmics

• migraine prophylaxis

• arrhythmias
• adjustment in those with renal impairment

59. SSRIs: •PD: all have selective inhibitory effects on presynaptic serotonin reup-

take

• PK -slow absorption, half life: 26 hours, has extensive 1st pass metabolism -fluoxetine half life 1-3 days and 1st metabolite 4-16 days! -liver metabolism may involve CYP2C19 and CYP2D

60. herbal therapy: •ginseng: potentiates insulin

• melatonin do not give with -benzos -narcs -antidepressants do not give with
• st johns wort: SSRI/SRNI

61. clusteral HA: rational drug selection: •O2 100% for 15-30 min

• ergotamine derivatives -suppositories or intranasal or IM DHE
• intranasal lidocaine -admin
• sumatriptan

62. acute pain: •less than 6 months duration

• acute somatic: arises from connective tissue, muscle, bone, and skin
• scute visceral: pain In the internal organs and abd
• referred pain: pain that is present in the area distant from its point of origin

63. opioids: •morphine: prototype

-all opioids rated against morphine

• combo products: vicodin, percocet, percocet, percodan, tylenol with codeine

• PD: bind to opioids receptors in the CNS PK: vary
• ADRs: CNS sedation, constipation, euphoria

64. opioid receptors: •mu

• kappa
• delta
• sigma

65. common adverse reaction/risk: •nsaids

-GI bleed -kidney damage

• opioids -constipation -resp depression -hypotension
• ASA -tinnitus -bleeding