Pharm Final Exam Review PDF

EXAM-I Overview:------Local effect: at site; Systemic: Through blood>target tissue Pure Food and Drug Act: No adulterants, Food, Drug, and Cosmetic Act: Undergo testing/Deemed safe, Durham-Humphrey Amendment: OTCvs.Prescribed (refill needs prescription), Kefauver-Harris Amendment: Proof of effective...

EXAM-I Overview:------Local effect: at site; Systemic: Through blood>target tissue Pure Food and Drug Act: No adulterants, Food, Drug, and Cosmetic Act: Undergo testing/Deemed safe, Durham-Humphrey Amendment: OTCvs.Prescribed (refill needs prescription), Kefauver-Harris Amendment: Proof of effectiveness (test older drugs), Comprehensive Drug Abuse Prevention and Control Act: DEA/locked up, inventory, & disposal (nurses)//SCH-I: Non-medical,SCH-II: High abuse/no refill,SCH-III: Abuse,SCH-IV: Some abuse,SCH-V: have controlled substance>record keeping, NIH Revitalization Act: include women/minorities, FDA Modernization Act: Experimental access; Drug development: Phase I: Healthy volunteers>toxicity, Phase II: Diseased subjects>compare, Phase III: Double blind,Phase IV: Marketed; Beers Criteria: Poor outcomes older adults Absorption: admin.>bloodstream; Enteral=GI,Parenteral=the rest; Bioavailability: portion reaching circulation (PO=never 100%>First Pass) Distribution: systemic>target cells; BBB: Lipid soluble only; Protein Binding: Bound=non-active Metabolism: Excretion (Liver) CYP-P450; Enzyme Induction [Stimulates metabolism], Enzyme Inhibition [Inhibits metabolism] Excretion: Elimination (Kidney) Toxicity-(Therapeutic Range)-MEC , Steady State: 4-5 Half lives, Pharmacodynamics: effect on body normal systems, Agonist=stimulates, Antagonist=inhibits, Up-Regulation: Inhibition>more receptors, Down-Regulation: Stimulation>less receptors, Additive: similar actions (better), different actions (even better) , Pharmacogenomic Variations: age, sex, ethnicity, genetic. , Cardiology/hepatic/renal disorders: affect all Pharmacokinetics Pregnancy Categories: A-no risk,B-no risk in animals,C-risk in animals (benefit vs. Risk), D-Risk in babies,, X-unacceptable Rights: drug,dose,patient,assessment,route,time,Reason,to refuse,documentation,patient education,evaluation Order needs: Date,Time,Drug,Dose,Route,Frequency,Signature Anti-Microbial-----Colonization: Does not necessarily cause injury or elicit an immune response, Superinfection: depletion of normal flora Community-Acquired Infections (46hrs Bacteriostatic: “INHIBITS GROWTH”; C&S: before 1st dose Beta-Lactam: inhibits cell wall, need “ring”, Clavulanic acid protects ring… “cillin”: Bactericidal, ruptures cell wall, Hypersensitivity risk, BBW: DO NOT ADMINISTER IV PCN G, 1st dose, monitor 30min, QSEN: don’t double dose (clavulanate.) “Cef” “ceph”: bactericidal, broad-spectrum, QSEN: 60min before surgeries, superinfection risk. “Micin” “mycin”: bactericidal (ribosomes,) for serious systemic infection, prolonged QT interval, hypersensitivity risk, BBW: NEPHROTOXICITY & OTOTOXICITY, 2-3 liters of water/day, peak: highest levels (.5-1hr post admin., Trough: before dose.) “Floxacin”: bactericidal (DNA), 1st line anthrax, Adverse:PHOTOSENSITIVITY, BBW: tendinitis and tendon rupture, peripheral neuropathy, CNS/CV effects, prolong QT interval, BBW: Myasthenia gravis – may exacerbate muscle weakness. “Cycline”: bacteriostatic (protein synthesis), Lyme disease/animal bites/STIs, H. Pilori, Adverse:PHOTOSENSITIVITY, take with water for GI irritation, can tread Anthrax, Not for hypersensitive, renal failure, pregnant, excreted in stool (black tarry,) used in motherhood or Fe anemia, may stain teeth, take on empty stomach. Take 2-4hrs BEFORE/AFTER MEALS. BBW: anaphylaxis w/ iron dextran QSEN: have tools ready in case. IM=Z-track method. Hyperkalemia: REMEMBER “CRIK”, Calcium gluconate: protects heart, Remove: K, Insulin+Glucose: push K into cell (restore glucose,) Restrict: K. Anticipate acidosis & watch for peaked T-wave. QSEN: No sodium polystyrene sulfonate in sorbitol>intestinal necrosis risk. Hypokalemia: use KCL, Contraindicated in “SHUP” Severe renal impaired, Hyperkalemia (no shit?), Untreated Addisons, Potassium sparing diuretics. Check K levels (toxic,) IV DILUTED & SLOWLY 10mEq/hr. *end of hypokalemia* Magnesium: MG=BM, antidote is calcium gluconate Nutritional products: Enteral is preferred, complication is aspiration. CVC (subclavian/jugular)/PICC Peripheral TO CENTRAL. Anorexiants: Phentermine: ups SNS, contraindicated in up’d SNS, habit/tolerance forming. Lipase inhibitors: blocks 30% of fat, contraindicated in malabsorption, need vitamins. Ozempic: slows GI emptying & ups saity, BBW: thyroid cancer/Pancriatitis. PUD: My Belly’s Basic Protection (mucus, Bicarbonate, Blood flow, Prostaglandins.) Antacid: Localized action, Neutralizes HCL, shake before giving, Al one=constipation/Mg one=diarrhea, 1hr before or after meals. H2RA: Cimetidine: block H2>decreased acids, QSEN: enzyme inhibitor>increases drug serum levels. PPIs: “Prazole”: 1st line but pricey$$$, irreversibly binds to acid enzyme (prevents pumping”, may affect B12 absorption. QSEN: pharmacogenomic effects. *NOTE: all critically ill patients will get PPI or H2RA.* Prostaglandin: inhibits gastric acid secretion, Adverse: diarrhea in 10%-40% of patients, BBW: birth defects. Bismuth Subsalicylate: Pepto: avoid in Aspirin allergy. Antiemetics: Phenothiazine: “azine”: blocks CTZ, Adverse: EPS, remember EXANSEDOR acronym (Extrapyramidal symptoms, anticholinergic, Sedation, Orthostatic Hypotension. BBW: increased death risk in dementia. Antihistamines: DO NOT give hydroxyzine IV, administer deep IM. Serotonin Receptor Antagonist 5-HT3: Ondansetron , N/V for surgery, Adverse: transient increase in LFT, more than 16mg increased risk of QT prolongation. Substance P: blocks substance P, Chemotherapy N/V, oral contraceptives futile for 28 days., Corticosteroids: post op nausea, Scopolamine: Motion sickness Laxatives: Metamucil: non-digestible, bulk-forming, causes flatulence/bloating, may be long-term, take with water!!!, Fleets enema (lubricant laxative): mineral oil, Surfactant laxatives: Docustate “Do Cushion Stool”, decreases surface tension. , Cathartics: strongest/most abused. Stimulant Cathartics: Ducolax: used for bowel prep, QSEN: not for >1 week., Saline laxatives: Ups osmotic pressure in lumen, short term, prep for endoscopic treatment., Chronulac: “Chron-ic L-iver” (liver damage) *i didn’t even study diarrheals ngl* EXAM-II (PT-I)-----IV Fluids: Crystalloids: for hydration/fluid replacement. Isotonic: equal concentration (cell size=same) ie. 0.9NS/Lactated Ringers/D5W (D5W turns hypotonic *no neuro patients.) These are 1st line for dehydration. Also fluid loss/sepsis. Adverse: Fluid overload CKS & HF Hypertonic: More solutes (cell shrinks) ie. 3%NaCL or 5%. Treats hyponatremia. Hypotonic: Less solutes (cell swell) 0.45% NaCL or 0.3%. No ICP patients… must replace intracellular fluid before extracellular.) Colloids: Volume expanders, big molecules (Hetastart, albumin, Dextran,) increase colloidal osmotic (oncotic) pressure. Can cause overload & maybe hypersensitivity. PSNS: Cholinergic (acetylcholine) SNS: Adrenergic (norepinephrine) Block PSNS: limited use (smooth muscle in GI,GU,Eye) *warfare* Mushrooms can cause toxicity. Cholinergic drugs: Stimulate PSNS (mimic Ach) or inhibit Ach enzyme. Agonist will low-HR,vasodilate,constrictbronchioles,juices flowing,Miosis; Antagonist=opposite (Mydriasis.) Indications: Alzheimer's>need Ach, Glaucoma>Miosis, MG>need Ach, Urine retention>will pee. Contraindications: Asthma>constricts, PUD/Obstruction/GI surgery>too much action, Cardiac>lowers HR, Pregnancy>see cardio (passes placenta,) Urinary obstruction>UTI. ATROPINE=ANTIDOTE, Medical alert bracelet for MG. Anticholinergic: Atropine is Ach antidote “trop”: Indications: PUD/Gastritis/Diverticulitis>Relaxes GI (may cause constipation though,) Eye surgery/exam>mydriasis (blurred vision,) neuromuscular blocking>paralysis for surgery, Parkinsons>reduces salivation, tremors, spasticity, Pulmonary (COPD/Bronchitis)>bronchodilation, Surgery>dries mouth, SYMPTOMATIC BRADYCARDIA>INCREASES HR, Urinary incontinence>retention. SYMPTOMATIC BRADYCARDIA: 0.5-1mg IV ATROPINE Cant see, spit, pee,. Contraindications: Glaucoma>increases pressure, Intestinal obstruction> low motility may worsen, MG>you’ll literally kill them, Tachycardia>increases HR, Urinary obstruction>more retention. Give 30min before meals in GI issues, sugarless gum/candy for cottonmouth. A1=vAscular, vasoconstriction, A2:vAscular (“2”=“on “”2nd”” thought, don’t constrict”, B1: ups HR,AV conduction,contractility (B1=“1 heart”), B2: bronchodilation (“we need “”2”” breathe”) Adrenergic Drugs: For emergent Allergic,Respiratory,cardiac disorder. Indications: ANAPHYLACSIS>dilates lungs & vasoconstriction (ups BP), BRONCHOCONSTRICTION>dilates, CARDIAC SUPPORT (ARREST/HYPOTENSION/SHOCK:) Vasoconstriction & ups BP. Eye surgery/exam>mydriasis, Local anesthetic>local vasoconstriction, Nasal>Vasoconstricts, prevent uterine contractions> relax muscles. Contraindications (RELATIVE:) Cardio (CAD,HTN,Dysrhythmia:) constrict worsens, Cerebro>same, 2nd stage labor>slows it, Hyperthyroid>increased metabolic, Narrow-angle Glaucoma>ups pressure. Stomach destroys Epinephrine.*** Pseudoephedrine: OTC, ADDICTIVE. Phenylephrine: selective A1, OTC, tolerance issues (contraindicated in cardiac disease.) Hypotension & Shock: issue is low perfusion, metabolic acidosis, treat underlying issue first. Need MAP over 70. Dobutamine: Stimulates B1, UPs BP***, +inotropic, “DOButrex = CO Better” L.E.N.D. the BP A HELPING HAND (Levophed, Epinephrine, Neosynephrine, Dobutamine)************ Adverse: dysrhythmia, HTN, Low renal perfusion (vasoconstriction,) same for liver, ischemia (same,) EXTRAVASATION> STOP DRUG & ELEVATE QSEN: use diluted phentolamine. Vitals per 5-15 min, Titration: “Start low - Go slow.” Antiadrenergic: (Selective) “Zosin”: block A1:dilates & lowers BP, “FLomax=Max Flo”, used in HTN/BPH, administer at bedtime for orthostatic hypotension, may cause reflex tachycardia due to baroreceptors. A2 agonist ( technically antiadrenergic because A2 stops A1): inhibits norepinephrine>lowers BP, crosses BBB, “Clonodine (Catapress)= C2 = B2”, used in HTN, Adverse: rebound HTN, drowsy, Reflex tachycardia. Non-selective A blockers: Regitine, relaxes smooth muscle vessels (vasodilation) & cause tachycardia. Controls BP in Pheochromocytoma (tumor that secretes SNS stimulants,) helps with extravasation. Selective/Non-Selective Beta Blockers: “Olol”: *i’ll put what they do the same, then what’s different* MOA:Decrease HR,AV conduction,contractility (B1 blocker is better at first three),renin activity. Non-selective blocking B2 causes bronchoconstriction.; Indications: CAD/Angina/HTN. Selective: HF,MI. Non-Selective: Migrane,stage fright.; Adverse: Bradycardia, low CO, Hypotension. Caution in Diabetes: masks tachycardia. Non-selective B2 block has hypoglycemia risk.; BBW: never stop abruptly (angina, cardio-ischemia, MI, dysrhythmias.; Hold if HR ACE (enzyme) turns Angio-1 into Angio-2 (this is a vasoconstrictor)>Angioplasty-2 ups Aldosterone release (thus Na & H2O retention)>ups BP. ACE inhibitors: Ramipril: “Prils”: block Angio-2 receptors, used in HTN,HF, Diabetic Nephropathy,MI. Angioedema, cough, 1st dose phenomenon hypotension, hyperkalemia (due to lower aldosterone,) Pregnancy Cat-X. *avoid K salt subs. In Ace* ARBS: stop the enzyme that makes Angiogenesis-2. *same as “prils” (except their MOA) but less shitty. Calcium channel blockers: dilate peripheral/coronary arteries, -inotropic & slow HR/AV conduction. *same listing style as Beta blockers; ill note similarities, then differences “dipine vs. (starts with) Ca* Affect vascular smooth muscle (Ca moreso arteriole/heart,) lower BP, ups coronary perfusion. “Di-pine= Di-lates arteries.” Ca=lower HR,AV conduction,contractility. Used in Angina,HTN (Dipine for Renaud's & Ca for atrial dysrhythmias. Adverse: (due to dilation) hypotension, flushing, HA, Peripheral edema. Dipine causes reflex tachycardia & Ca causes AV block,bradycardia,constipation. Heart Failure: ACE & ARBs: dilation lowers preload/afterload & Aldosterone suppression also lowers preload. ARNIs: “Sartan”: ups Natriuretic peptide and has an ARB (which reduces Na) to block RAAS. Used in HF where ejection fraction is 70 if maxed out on Beta blockers. Adverse: bradycardia, hypotension, A-Fib, Phosphene (perception of lights/brightness.) Not for HR5min. 20mg/min dose if IV. ADVERSE: “OHHHHHHHH” Ototoxic, Hypo-volemia,tension,kalemia,natremia. Potassium sparring: Lower Na reabsorption & K excretion in distal tubule, used in HTN,HF,Low K (from loops,) ADVERSE: Hyperkalemia, low voice/small balls, gynecomastia, menstrual irregularities. BBW: tumors in rats. QSEN: avoid K supplements/Na substitutes. Osmotic Diuretics: up Osmotic pressure>pulls water into vascular>lowers Na/H2O retention. Used in ICP, AKI, can have low GFR. IV only. Coagulation disorders: Anti-coagulants (prevent new/worsening of existing,) Antiplatelets (stop from forming,) Thrombolytics (dissolve them) *BLEEDING RISK* Anticoagulant: Heparin (aPTT 1.5-2.5x baseline) *Antidote: Protamine Sulfate*, prevents fibrinogen>fibrin. Must be parenteral, IV=immediate,Sub-Q=20- 30min. GOOD FOR RAPID NEED. Normal aPTT=25-35. QSEN: HIGH ALERT MED. Contraindications: C.R.I.B.S. (GI ulceration, recent surgery, Intracranial bleeds, blood dyscrasias, severe HTN. Warfarin (PT.INR of 2-3) *A: Vit-K*, Vitamin-K antagonist (prevents clotting factor synthesis, 99% bound, *HEPARIN/WARFARIN CAN BE GIVEN TOGETHER* Preg Cat-X. MANY DRUG_DRUG INTERACTIONS. NEED VITAMIN K SUPPLIMENTS. Direct Thrombin inhibitor (N/A) *A:Praxbind*, Xa inhibitors (N/A) *A:Andexxa* Xa inhibitors: “Xaban” (“you’re BANNED, Xa!”) Antiplatelets: Aspirin: Thromboxane A2 inhibitor, irreversibly binds to platelet for its lifetime (7-10 days,) hold that long for surgery unless cardiac diseased or has stent (outweighs risk.) Adenosine Diphosphate Receptor Antagonist: inhibits aggregation for platelet lifespan, used in ACS, Ischemic brain attack, TIA. Similar to aspirin. Some people are “poor metabolizers.” Glycoprotein IIb/IIIa receptor antagonist: super aspirin, IV following ACS or PCI (stent placement.) Thrombolytic agents: break down fibrin to dissolve clots. For MI, IBA, acute PE. Absolute contraindications: Active bleeding (other than menses), History of intracranial hemorrhage/neoplasms, Ischemic stroke q12hr. Terbutaline: Sub-Q for pre-term labor, Preg cat-C. Anticholinergics: “Trop”: Blocks Ach (inhibiting bronchoconstriction, synergistic with B2 adrenergic. Nebulizer=acute,inhaler=long-term managment,B2 AGONIST AND ANTICHOLINERGIC CAN BE USED TOGETHER. Adverse: anticholinergic effects (caution in narrow-angle glaucoma/BPH. Xanthines: 2nd line, 1st if normal meds don’t work. Oral for prevention/maintenance (sustained release common.) Similar to caffeine. Narrow range: 5- 15mcg/mL. Adverse: SNS activation. NOT FOR ACUTE. Lavage or charcoal in toxicity. Corticosteroids: “sone””lone””solone”: suppress inflammatory process & inflamm. Mediator response in persistent asthma alone or in combination. In acute: IV/PO multiple doses (lowest dose possible.) Chronic: daily inhalation, NEVER PRN. Inhaled Glucocorticoids: 1st line DAILY**** for asthma, NOT PRN, Adverse:hoarsness,candida. Leukotriene Modifiers: “lu””leu”: prevents Leukotrienes binding, can be used with cortico or B2 agonists, NEVER PRN. Adverse: “H.I.N.D.: HA, Infection, Nausea, Diarrhea.” BBW: Suicidal ideation. Mast cell stabilizers: Stabilize mast cells, prophylaxis before attack (allergic to grass=take 30-60min before cutting.) Immunosuppressant Monoclonal Antibody: “Mab” “Mab=Mad Scientist” ***ANAPHYLAXIS*** & MALIGNANCIES. Have tools ready for anaphylaxis. Independant review (in a nutshell): Antihistamines: 1st gen=CNS Depression, 2nd=doesn't. The rest is cake, but nothing really stands out. Antineoplastic:-------Solid organ: carcinoma (epithelial,) sarcoma (connective.) Hematologic: leukemia, Lymphoma. Main types of drugs: cytotoxic: (kill cells,) combinations help. Avoid contact with these meds. cytotoxic-biologic, hormone inhibitors also used. *only adverse effects need study…* Cytoxan: “Cy=cystitis (bladder. Bloody urine.) Cisplatin: “cis=piss=kidney damage” & peripheral neuropathy. Bleomycin: “ble=blebs (pulmonary toxicity.) Adriamycin: “Rocky, “ARDIANNNN” *beats chest*=cardiac toxicity” & also turns secretions red “red devil” think of how daredevils dad was a boxer. Vincristine: “Chris Rock=gets on nerves=peripheral neuropathy.” alemtazumab: “mad scientist” ANAPHYLAXIS (have tools ready=epinephrine & pre-med w/ antihistamines. Tamoxifen: “save the ta-tas (breasts.) Aromatase inhibitors: “think perfume=estrogen” (breast cancer.) Anti-androgens/LH-releasing hormones: “think male hormones=prostate cancer.” Cytoprotectants: Anemia: use erythropoietin. Neutropenia: “nadir”=lowest count, avoid infection risks. Anorexia: eat anything , stimulate appetite “C.A.M.P.=corticosteroids, Atarax,Megace,Periactin.” Hand-foot syndrome: take Tylenol. Tumor lysis: treat electrolyte/metabolic disturbances. Hematopoiesis & immune --------*review indipendant study if you’re rusty on patho* Vaccines: dead vs. attenuated (weakened.) Toxoids: tetanus (need boosters.) Passive immunity: thing breastmilk IgG (BBW: thrombosis risk.) *this section is basically just a PSA. Hematopoietic/immunostimulant drugs: Mimic cytokines & stimulate proliferation in bone marrow. Hematopoietics: Procrit: (basically erythropoietin) used for hgb12 (never medicate over hgb12. QSEN Fe supplements needed. Colony stimulating factors: “neu”: stimulate neutrophil production in marrow suppression/transplant for SEVERE NEUTROPINIA. may cause angiogenesis, bone pain expected DO NOT STOP. QSEN: admin 24hrs of cytotoxic to avoid growth. QSEN: monitor neutrophils. IV/Sub-Q only. Interferons: antineoplastic & interferes with viral replication in Hep-b/c, HPV, some cancers. Adverse: depression, anemias, suicidal ideation. Can also treat Multi. Sclerosis. Interleukins: Neumega” inhibit metastatic tumor growth, not used if organ transplanted or serious cardio/pulmonary disease. HIGHLY TOXIC. Corticosteroids: suppress immune, many adverse effects. Cytotoxic: suppress B/T lymphocytes. Used in organ transplant, autoimmune,cancer. TERATOGENIC. Antiproliferative: Suppress only T lymphocytes. BBW: Nephrotoxicity & HTN. Antibody preparations: “mab” “mad scientist:” obtained from animals , monoclonal=1/polyclonal=many. Used in allografts, unrelieved allergic asthma, pregnancy blood mismatch issues (Rh +/-.) Cytokine inhibitors: inhibit cytokines to promote tissue repair in RA, psoriasis,chron’s. Allograft patients need lifelong treatment. Endocrine Pt-I *only doing thyroid. Thyroid: T3 &T4, T3 more potent, T4 turns to T3. Hypothyroidism: Levothyroxine: once daily dosing (long 1/2 life.) Not for weight loss, may cause hyperthyroidism. Take alone 30-60min before breakfast. *lifelong treatment* teach to take pule>need5 DAYS. DONT USE ASA IN CHILDREN (RISE SYNDROME) OR IN IMPAIRED RENAL FUNCTION, also contraindicated in PUD/GI bleed. Low doses fir MI/brain attack. Salucylate toxicity=LIFE THREATENING (Acidosis, CNS depression, tinnitus is early symptom.) COX-2 Inhibitors: Celebrex: focus more in inflammation & less GI action “Celebr-ex.” Adverse: GI upset. Tylenol: reduces fever/pain but not inflammation. Don’t use in liver impairment. Can cause necrosis** Antidote=Acetylcysteine “think of Sistine Chapel=only God can save you!.” Gout: upped Uric acid, 1st line=NSAIDS, IV/PO options if ineffective. Increase fluid intake 2-3quarts/day. Acute Pain: Selective Serotonin 5-HT Receptor Agonist: “Triptans”: abort HA. Don't use in Angina, MI,HTN. Ergot Preparations: relieves migraine by constricting blood vessels (also not for CAD,HTN. DO NOT USE TRIPTAN WITHIN @$HRS OF ERGOT (VASOCONSTRICTION)*** Seizures: Phenytoin: IV>dilute with NS as 50mg/min***. Serum lvls. =5-20mg/dL. Adverse: GINGIVAL HYPERPLASIA, CNS depression,rash. Preg Cat-X. Fosphenytoin can be given with D5 & NS (faster admin 150mg/min) & converts to phenytoin in blood. Use mono-therapy w/ reduced dose in pregnancy. Parkinsons: balance dopamine & Ach. Levodopa: “-Dopa” is a cornerstone in treatment (ONLY DRUG IN PD THAT REPLACED DOPAMINE,) Carbidopa helps get more Levodopa in system. Adverse, head bobbing, grimacing,ticks. Anticholinergic: lower Ach to lower tremors,rigidity. Contraindicated when Ach needed. Skeletal relaxants: Treat localized spasm. Adverse is CNS depression. CNS stimulants: lower fatigue, cause euphoria , up alertness/wakefulness. Contraindicated in drug abuse history. Adverse involves SNS stimulation. Take early to avoid sleep disturbances. Alzheimer's: Aricept: prevent enzymatic Acetylcholine breakdown. ONLY SLOWS PROGRESSION. Cholinergic Crisis “ch-O-linergic=O-verdose”; Myasthenic Crisis “my-A-sthenic=need -A- *ach*” (possibly fatal.) Tensilon test: must be mechanically ventilated prior to test, give Tensilon, it is Myasthenic crisis if symptoms improve…Cholinergic crisis if worsen. So, you either increase tensilon or give Atropine. *and then there's weed… pretty straight forward* *I haven’t touched Psych chapter* GL on the exam!!!!!!!!!!!!!!!