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Pharm Test 4
Herbs, geriatrics, prenatal/peds, prescription
72
Pharmacology
Undergraduate 4
11/10/2011

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Term
Echinacea (Echinacea pupurea)
USES?
Definition
-Immune Modulation (controversial)
-*Anti Inflammatory
Term
Feverfew (Tanacetum parthenium)
USES?
Definition
-Migraine Headache (most often migraine prophylaxis)
-Rheumatoid Arthritis (Anti-inflammatory)
Term
Echinacea (Echinacea pupurea)
S/E (w/ IV and oral use)?
Definition
IV- flu like sx's
Oral- unpleasant taste, GI upset, CNS effects (HA, dizziness), allergic rxn (rare)
Term
Feverfew (Tanacetum parthenium)
Most common S/E's?
Definition
mouth ulcers & GI upset
Term
Garlic (Allium sativum)has effects on what general systems/processes of dz? (there is 4)
Definition
-Cardiovascular effects
-Endocrine effects
-Anti-microbial effects
-Antineoplastic effects
Term
Garlic (Allium sativum)
S/E's?
Definition
nausea, hypotension, allergy,bleeding, breath odor, contact dermatitis
Term
Garlic (Allium sativum) should be used cautiously in pts receiving ________ medications
Definition
anticlotting
Term
What is Ginseng used for?
Definition
to improve physical and mental performance
Term
Ginseng adverse effects?
Definition
vaginal bleeding and mastalgia (secondary to weak estrogenic properties), CNS stimulation (insomnia, nervousness), HTN
Term
ST. John's Wort (hypericum perforatum) USES?
Definition
-antidepressant
-antiviral
-anticarcinogenic
Term
ST. John's Wort (hypericum perforatum) S/E's?
Definition
photosensitization
hypomania
Term
Saw Palmetto (Serenoa repens/Sabal serrulata) USE?
Definition
Benign Prostatic Hyperplasia (BPH)
Term
Saw Palmetto (Serenoa repens/Sabal serrulata) S/E's?
Definition
HTN, HA, decreased libido, impotence,GI upset, abd pain, back pain, urinary retention
Term
Exogenous Dehydroepiandrosterone (DHEA)supplementation is advocated for/used for what (5)?
Definition
-age related d/o's
-weight loss
-reduced heart dz risk
-cancer prevention
-immune system enchancement
Term
Dehydroepiandrosterone (DHEA) S/E's?
Definition
-BPH and cancer
-other cancers: breast
-endocrine: DHEA conversion to testosterone favored in post menopausal women & conversion favors estrogen in men
Term
Melatonin USES?
Definition
-induce sleep
-jet lag (OTC sleep aid)
Term
Melatonin is contraindicated or should be used cautiously in what pts?
Definition
Women who are pregnant, attempting to conceive, or nursing
(suppresses LH surge and decreases prolactin release)
Term
Melatonin S/E's?
Definition
drowsiness, tachycardia, dysthymia, HA, sporadic cases of movement d/o's and psychoses
Term
You want to avoid Echinacea in what patients?
Definition
avoid in pts w/...
-Immune deficiency d/o's (ex. AIDS, CA)
-Autoimune d/o (RA, MS)
-TB
-Immunosuppression
Term
Name the Drug Law
-required manufactures to provide the FDA w/evidence of drug safety in the form of a New Drug Application before distributing the agent
-introduced the principle of separating drugs into prescription and nonprescription (OTC) categories
Definition
Federal Food, Drug, and Cosmetic Act of 1938
Term
Name the Drug Law
-An amendment to the Federal Good, Drug, and Cosmetic Act of 1938
-prohibited the dispensing & refilling of certain kinds of drugs (systemic antibiotics, cortisosteroids & other agents whose unsupervised use may not be safe) except on the prescription of a licensed practitioner
Definition
Durham-Humphrey Law/Amendment of 1951
Term
Name the Drug Law
-An amendment to the Federal Good, Drug, and Cosmetic Act of 1938
-required manufacturers of new drugs to proceed along set standards of animal and human pharmacological and toxicologic testing; data from each step to be reviewed by FDA
Definition
Kefauver-Harris Ammendment of 1962
Term
Name the Drug Law
-regulates control of the distribution depressant and stimulant drugs(opiods, barbs, amphetamines) and other classes of drugs designated as possessing abuse potential by the DEA
Definition
Controlled Substance Act
Term
A drug with high abuse potential, no current accepted medical use, may lead to severe dependence, ex. LSD, heroin

SCHEDULE ___ of Controlled substance Act?
Definition
Schedule I
Term
Abuse potential < Schedule I & II, accepted medical use, mod to low dependence liability relative to drugs of Schedule II, ex. glutethimide

SCHEDULE ___ of Controlled substance Act?
Definition
Schedule III
Term
A drug with high abuse potential, accepted medical use, may lead to severe dependence, ex. amphetamine, methadone, morphine

SCHEDULE ___ of Controlled substance Act?
Definition
Schedule II
Term
A drug with low abuse potential, accepted med use, limited dependence liability, ex.phenobarbital, diazepam

SCHEDULE ___ of Controlled substance Act?
Definition
Schedule IV
Term
Less abuse and dependence than Schedule IV, accepted med use, may be sold w/o a prescription, ex. cough preparations containing codeine or similar opiate derivatives

SCHEDULE ___ of Controlled substance Act?
Definition
Schedule V
Term
WHAT COMPONENT OF THE PRESCRIPTION DOES THIS BELONG?
directions to the patient
Definition
Transcription/Signature"Sig"
Term
What is included in the Inscription component of the prescription?
Definition
name of drug, unit dosage/strength or amt of drug
Ex. Amoxicillin 125mg/mL suspension
Term
In compliance with the Control Substance Act of 1970 what must appear on any prescription for a controlled or scheduled drug
Definition
DEA registration number
Term
WHAT COMPONENT OF THE PRESCRIPTION DOES THIS BELONG?
directions to the pharmacist
-quantity and dosage form of drug to be dispersed
-# of authorized refills
Definition
Subscription ("Disp)
Term
What is included in the Superscript component of the prescription?
Definition
patient and provider demographics, the symbol which means “Take Thou”(Rx)
Term
MOA of Sucralfate
Definition
(in an acid environment)crosslinking to produce viscous sticky polymer that adheres to epithelial cells of ulcer craters & inhibits hydrolysis of mucosal proteins by pepsin
Term
Contraindication of Sucralfate
Definition
Renal failure
-risk for Aluminum overload
Term
Misopristol MOA
Definition
inhibits HCL secretion (PGE2) and increases bicarb and mucous secretion (PGI2)via activation of EP3 receptors on parietal & epithelial cells
Term
Misopristol S/E's & Contraindications
Definition
-diarrhea, cramps, abd pain
-pregnancy(incr uterine contractions)
Term
What administration instructions would you give a patient you prescribed Sucralfate for?
Definition
Take on an empty stomach 1 hr BEFORE meals & AVOID antacids
(b/c drug activated by stomach acid)
Term
Which class of drugs inhibits H+/K+ ATPase pump and used for GERD, duodenal/gastric ulcers, & H.pylori infxn
Definition
Protein Pump Inhibitors
Term
FETAL THERAPY: Match drug w/ use
_______=Stimulates lung maturation
_______=induces liver enzymes close to term reducing incidence of jaundice
_______=stimulate production of surfactant
_______=tx fetal arrythmias
Definition
Corticosteroids=Stimulates lung maturation
Phenobarbital=induces liver enzymes close to term reducing incidence of jaundice
Betamethasone=stimulate production of surfactant
Antiarrythmic=tx fetal arrythmias
Term
TERATOGENICITY
What is the drug teratogenic effect?
Carbamazepine-->
Diethylstilbestrol-->
Lithium-->
Thalidomide-->
Definition
Carbamazepine-->Neural tube defects
Diethylstilbestrol-->vaginal adenosis, vaginal adenocarcinoma
Lithium-->Ebstein's anomaly
Thalidomide-->Phocomelia
Term
Name the 4 Teratogenic Mechanisms?
Definition
1. Effect on Maternal tissue (ex. cocaine->abortion)
2.Diminish delivery of O2 and nutrients (ex. cocaine->vasoconstriction)
3. Alterations during differentiation (ex. excess Vit A-> bone dysfxn, liver damage; excess niacin->ocular dysfsn)
4. Vitamin or Mineral deficiencies (ex. folic acid def->neural tube defect)
Term
Diseases during pregnancy that require treatment
Definition
Diabetes, Arrhythmias, Depression, Psychosis,Cancer, Chronic conditions (epilepsy)
Term
6 Factors affecting Drug Transfer to the Fetus
Definition
1. Physiochemical properties
2. Amount of Drug Reaching Fetus
3. Exposure Rate
4. Duration of Exposure
5. Tissue Distribution
6. Stage of Development
Term
The duration of exposure of the fetus to a drug can be increased if the fetus takes in the drug eliminates it into the amniotic fluid and takes in the drug again repeating that cycle...WHAT IS THAT CALLED?
Definition
Redistribution
Term
When is the fetus LEAST vulnerable to teratogens? MOST?
Definition
1st 2 weeks; 1st trimester
Term
If a teratogen disrupts the development of an organ/body part early there will most likely be _______ defects; later _______ defects
Definition
morphological; physiological
Term
DRUG AFFINITY FOR SPECIFIC TISSUES
Tetracycline->
Quinine->
Corticosteroids->
Phenytoin->
Warfarin->
Definition
Tetracycline-> teeth, liver
Quinine-> retina
Corticosteroids-> Adrenal gland
Phenytoin-> Adrenal gland
Warfarin->face, bone deformations
Term
What are the physiochemical properties of drugs that affect transfer to the fetus?
Definition
Lipid solubility
Degree of Ionization
Protein Binding
Molecular Size
Placental Metabolism
Placental Transport
Term
Name 3 factors that INCREASE placental transfer of drugs; DECREASE
Definition
INCREASE:
Lipid Solubility
Nonionized state
High maternal-fetal gradient
Increased fetal acidity
Molecular weight <600
Low protein binding
Increased placental blood flow
Larger surface area

DECREASE:
Incr diffusion distance
High molecular charge
High molecular weight
Highly protein bound
Drug alterd or bound by placental enzymes
Decr maternal blood flow
drugs highly metabolized by mother
Term
REMEMBER CHILDREN ARE NOT LITTLE ADULTS!
What are 2 of 4 reasons children are very susceptible to drug toxicity?
Definition
-Prone to hypersensitivity
-Immature kidney & liver
-Relative insufficiency of drug binding proteins
-Immature BBB
Term
4 factors that create difficultly in dispensing medications to children
Definition
-measuring errors
-spitting
-spills
-polytherapy
Term
Out of the drugs affecting mobility in the elderly which do NOT cause sedation?
Definition
-Beta-adrenergic blockers
-Antihypertensives
Term
Out of the drugs affecting mobility in the elderly which drug class causes cardiac arrhythmias and tremors?
Definition
Tricyclic antidepressants (TCA'S)
Term
AGE RELATED CHANGES IN ORGAN BLOOD FLOW RATES
With/As a fxn of age there is a _____ in blood flow rate to what areas of the body?
Definition
DECREASE; brain, heart, liver, kidney, tissue
Term
Name 4 physiologic fxns that decline with age
Definition
-Heart: conduction velocity, cardiac index
-Lung: vital capacity, max breathing capacity
-Kidney: standard GFR, standard renal plasma, standard renal plasma flow
-Misc: basal metabolic rate, standard cell water
Term
Geriatric Barriers of Compliance (5)
Definition
1. Regimen complexity
2. Miscommunication
3. unresolved pt concerns
4. Physical disabilities
5. Chronic Dz
Term
What is the preferred Tx for rapid relief of Dyspnea in asthmatics?
Definition
Short acting beta-agonist (ex. albuterol)
Term
At VERY high doses which class of asthmatic drugs can cause these adverse effects?
Seizures, Toxic encephalopathy, hyperthermia, brain damage
Definition
Methylxanthines
Term
Which asthmatic drugs...
•Inhibit immediate allergic response to antigen but DOES NOT relieve response once initiated

•Inhibit mediator release from bronchial mast cells
Definition
Cromolyns
Term
The most important muscarinic cholingergic receptor anticholingergics work on is...
Definition
M3 (mediating smooth muscle
contraction and mucous gland secretion in airway)
but works on M1-4
Term
Name 4 Adverse effects of corticosteroids used for asthma
Definition
Hypothalamic–pituitary–adrenal axis suppression
Bone resorption
Carbohydrate and lipid metabolism
Cataracts
Skin thinning
Purpura
Dysphonia
Candidiasis
Growth retardation
Term
WHO AM I?
•Does NOT directly relax smooth muscle
•Little effect on acute constriction, and doesn’t affect mast cells
•Induced apoptosis in inflammatory cells (eosinophils and TH2 lymphocytes)
•Reduce the # of inflammatory cells in airways and damage to epithelium
Definition
Corticosteroids
Term
TYPE A or TYPE B ADRxn?
-exaggeration of drugs normal pharmacological action @ therapeutic doses
-predictable
-dose dependent
-high Incidence & morbidity
-low mortality
-tx: adujust dose
Definition
TYPE A
Term
Describe TYPE B ADRxn
-predictability
-dose-dependence
-morbidity
-mortality
-tx
Definition
-predictability= (-)
-dose-dependence= (-)
-morbidity= (low)
-mortality= (high)
-tx= (STOP)
Term
FREQUENCY CLASSIFICATION
> If a drug causes a rash in 13% of pts that ADR is ________
>If 1 in a 1000/5 cases in 3 yrs get the rash it is _____
>If 5% of pts get the rash it is ____
>If less than 1% but >1:100(0.1%) than it is _________
Definition
> If a drug causes a rash in 13% of pts that ADR is *COMMON
>If 1 in a 1000/5 cases in 3 yrs get the rash it is *VERY RARE
>If 5% of pts get the rash it is *OCCASIONAL
>If less than 1% but >1:1000 than it is *RARE
Term
NAME THE DRUG INTERACTION TYPE
Ex. Phenergan(R), an antihistamine, when given with a painkilling narcotic such as Demerol(R) intensifies its effect, there by cutting down on the amount of the narcotic needed.
Definition
Potentiation
-increased effect of a toxic agent acting simultaneously w/ a nontoxic one
-a+b=A
Term
NAME THE DRUG INTERACTION TYPE
Ex. taking a dose of alcohol and a dose of a barbiturate (2 depressantss) causing a coma
1+1=5
Definition
Synergism
-both are depressants and alone may not cause a coma but together more likely because more depression
- combined effect of 2 chemicals > sum of effect of each agent alone
Term
NAME THE DRUG INTERACTION TYPE
EX. barbiturate and a tranquilizer given together before surgery to relax the patient
1+1=2
Definition
Additive
-combined effect of 2 chemical =sum of the effect of each individual agent when given alone
Term
Give 2 of the 4 subtypes of Antagonistic drug reactions
Definition
-functional or physiological antagonism
-chemicl antagonism or inactivation
-Dispositional antagonism
-antagonism at the receptor
Term
PharmacoKINETIC or PharmacoDYNAMIC?
Drug effects the absorption, distribution, metabolism, and excretion of another drug
Definition
PharmacoKINETIC
Term
What is the general criteria for establishing that an adverse effect is caused by a drug the pt is taking?
Definition
1. Is the chronology from admin of drug and onset of untoward event/rxn appropriate?
2. Is the rxn a known pharmacologic effect or adverse effect of the drug?
3. Can the pts illness or non pharmacologic therapy account for the rxn?
4. What happens when the drug is discontinued (dechallenged)?
5. What happens when the patient resumes taking the drug, either accidental or intentionally (rechallenge)?
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