NR565 Advanced Pharm: Final Study Guide - Vocabulary Flashcards

Vocabulary-style flashcards covering key concepts, mechanisms, indications, contraindications, and management principles from the NR565 Advanced Pharm lecture notes.

A1c target in diabetes

A1c goal: <7.0% to reduce risk of complications.

Premeal plasma glucose target

Target: 70-130 mg/dL before meals.

Postprandial glucose target

Peak post-meal plasma glucose: <180 mg/dL.

Diabetic nephropathy prevention

Prevention includes tight glycemic control, blood pressure management (ACE inhibitors/ARBs), regular monitoring for albuminuria, lifestyle modifications, and avoiding nephrotoxins.

ACE inhibitors/ARBs in nephropathy

Used to protect kidney function by achieving BP targets (often <130/80 mm Hg) in diabetes.

Albuminuria monitoring

Routine screening for protein in urine to detect early kidney changes.

Nephrotoxins to avoid

Limit nephrotoxic drugs (e.g., NSAIDs) and excessive alcohol/smoking.

First- vs second-generation sulfonylureas

Second-generation are more potent with lower required doses and fewer drug interactions; largely replaced first-generation in practice.

Dipeptidyl peptidase-4 (DPP-4) inhibitors MOA

Enhances incretin hormones by inhibiting DPP-4, increasing glucose-dependent insulin release and suppressing postprandial glucagon.

Sitagliptin MOA

Sitagliptin inhibits DPP-4, preserving incretin hormones to improve glucose control.

GLP-1 receptor agonists MOA

Activates GLP-1 receptors: slows gastric emptying, suppresses glucagon, promotes insulin release in a glucose-dependent manner, and can reduce appetite.

Incretin mimetics

Injectable meds that mimic incretin hormones to enhance insulin secretion, suppress glucagon, slow gastric emptying, and promote satiety.

Incretin mimetics in pregnancy

Generally not recommended due to insufficient safety data; insulin is preferred during pregnancy.

Meglitinides vs sulfonylureas

Meglitinides (e.g., repaglinide) are taken before meals with shorter action; sulfonylureas have longer action; both can cause hypoglycemia.

Metformin MOA

Inhibits hepatic glucose production, modestly reduces gut glucose absorption, and improves insulin sensitivity; low risk of hypoglycemia.

Metformin in pregnancy

Metformin is used in pregnancy but insulin is preferred because it does not cross the placenta in significant amounts.

Metformin side effects

GI disturbances (nausea, diarrhea), decreased appetite; possible B12/folate deficiency; risk of metabolic acidosis in impairment.

Pioglitazone (TZD) adverse effects

Weight gain, edema, HF risk, bone fractures; long-term potential bladder cancer risk.

Pioglitazone MOA

PPAR-γ activation increases insulin sensitivity and glucose uptake.

Repaglinide MOA

Meglitinide that stimulates rapid, short-duration insulin release before meals.

DPP-4 inhibitors adverse effects

Generally well tolerated; rare pancreatitis (including hemorrhagic/necrotizing) per post-marketing reports.

SGLT-2 inhibitors MOA

Block SGLT-2 in kidneys, increasing urinary glucose excretion and lowering blood glucose.

SGLT-2 inhibitors adverse effects

Common: UTIs, genital infections, dehydration, and hypotension; rare DKA.

SGLT-2 inhibitors therapeutic goal

Improve glycemic control with cardiovascular and renal benefits, esp. in HF or CKD.

Sitagliptin side effects

Upper respiratory infections, headaches, GI issues; pancreatitis risk.

Sulfonylurea MOA

Stimulate pancreatic insulin release by closing ATP-sensitive K+ channels; risk of hypoglycemia; caution in organ dysfunction.

Sulfonylurea pregnancy contraindication

Contraindicated during pregnancy and breastfeeding.

Sulfonylurea side effects

Hypoglycemia, weight gain, GI disturbances.

Thiazolidinediones (TZDs) adverse effects

Weight gain, edema, HF risk; liver toxicity; potential bladder cancer risk.

Methimazole MOA

Blocks thyroid hormone synthesis by inhibiting iodide oxidation and coupling via peroxidase.

Methimazole time to euthyroid

May take 3–12 weeks to achieve euthyroid state.

Levothyroxine administration

Oral, daily on an empty stomach (morning, 30–60 min before eating); IV in myxedema coma; IV dose ~50% of oral dose.

Levothyroxine interactions (summary)

Absorption reduced by H2 blockers, PPIs, sucralfate, cholestyramine, colestipol, aluminum antacids, calcium, iron, magnesium; separate by 4 hours; several drugs can increase metabolism (e.g., phenytoin, rifampin). Warfarin effects may be enhanced; catecholamines risk increased.

Levothyroxine adverse effects

Rare with appropriate dosing; overdose may cause tachycardia, angina, tremor; chronic overdosage may cause bone loss and AF.

Levothyroxine monitoring

Check TSH 6–8 weeks after initiation/dose changes; then at least yearly once stabilized.

Hypothyroidism treatment in pregnancy

Early diagnosis and treatment; fetal development depends on timely maternal therapy.

Hyperthyroidism treatment in pregnancy

Iodine-131 contraindicated; methimazole avoided in the first trimester.

Thyroid Storm symptoms

Profound hyperthermia, tachycardia, restlessness, tremor; may progress to coma, hypotension, heart failure.

Ipratropium MOA

Anticholinergic bronchodilator; inhibits muscarinic receptors to cause bronchodilation and reduce mucus.

Monoclonal antibodies for asthma (omalizumab)

Targeted therapy that binds IgE to reduce inflammation and exacerbations.

Bronchodilators (general)

Medications that relax bronchial smooth muscle; include short-acting and long-acting beta-agonists; often used with inhaled corticosteroids.

Methylxanthines (theophylline) MOA

PDE inhibition increases cAMP leading to bronchodilation; less commonly used due to side effects.

Leukotriene receptor antagonists MOA

Block leukotriene receptors to reduce inflammation and bronchoconstriction (e.g., montelukast).

Glucocorticoids for asthma (inhaled)

Inhaled anti-inflammatory steroids that reduce airway inflammation and prevent exacerbations.

Systemic glucocorticoids for asthma

Used for severe exacerbations or when inhaled steroids are insufficient; more side effects.

Oral leukotriene receptor antagonists use

Add-on therapy for asthma; useful for exercise-induced bronchoconstriction.

Leukotriene antagonists & CYP450

Can interact with CYP450 enzymes; monitor when coadministered.

Leukotriene antagonists administration timing

Take at least one hour before meals or two hours after; should be scheduled, not PRN.

Beclomethasone

Inhaled glucocorticoid for asthma; regular use essential for control.

PDE-4 inhibitors MOA (roflumilast)

Inhibits PDE-4 to raise cAMP, reducing inflammation; reserved for severe COPD.

COPD management goals

Reduce symptoms, improve health, increase exercise tolerance; reduce risks and mortality.

Tiotropium (LAMA) MOA

Long-acting muscarinic antagonist that relaxes airway smooth muscle.

Adverse effects of LAMAs

Dry mouth, constipation, urinary retention.

Aminoglycosides adverse effects

Ototoxicity and nephrotoxicity; black box warnings; monitor hearing and renal function.

Ethambutol adverse effects

Optic neuritis; allergic reactions; GI upset; hyperuricemia; peripheral neuropathy.

XDR-TB treatment considerations

Prolonged treatment (≥24 months); use second/third-line agents; more toxic and less effective.

Isoniazid MOA

Inhibits synthesis of mycolic acids in Mycobacterium tuberculosis cell wall.

Isoniazid drug interactions

Interacts with antiepileptics and warfarin; dose adjustments may be needed.

TB treatment regimen (initial phase)

Typically isoniazid, rifampin, ethambutol, and pyrazinamide followed by INH and rifampin.

Pyrazinamide indication

Used in combination therapy for active TB, especially in the initial phase.

Rifampin adverse effects

Hepatotoxicity; orange discoloration of bodily fluids; GI upset; requires LFT monitoring.

Rifampin MOA

Inhibits bacterial RNA synthesis by binding to bacterial RNA polymerase.

TB/HIV coinfection considerations

2–20% of HIV patients have TB; requires aggressive, longer therapy; frequent drug interactions.

Proton pump inhibitors (PPIs) MOA

Irreversibly inhibit the H+/K+ ATPase in gastric parietal cells to reduce acid production.

PPIs discontinuation considerations

Taper to avoid rebound acid hypersecretion; stopping can cause GI symptoms.

PPI adverse effects

Headache, GI disturbances; higher risk of infections and potential nutrient malabsorption with long-term use.

H. pylori triple therapy

Two antibiotics plus a PPI or bismuth compound for 10–14 days to eradicate H. pylori.

NSAID-induced ulcer prophylaxis

PPI or misoprostol to protect gastric mucosa in high-risk patients.

PPI alternatives

H2 antagonists, antacids, sucralfate, lifestyle changes.

Laxatives in pregnancy – safety focus

Bulk-forming and osmotic laxatives are safer; stimulant laxatives used cautiously.

Osmotic laxatives contraindications

Severe renal impairment, intestinal obstruction, bowel perforation, GI conditions worsened by pressure.

Lubiprostone indications

Treatment of chronic idiopathic constipation, IBS-C, and opioid-induced constipation unresponsive to other treatments.

Laxative patient education

Dosing, fiber/hydration, potential side effects, risk of dependency, when to seek care.

Laxative abuse causes

Body image issues/eating disorders, misconceptions about bowel function, psychological stress.

Opioids for diarrhea MOA

Mu-opioid receptor agonist in the gut slows motility, increasing transit time and reducing fecal water.

Glucocorticoids for IBD

Used to reduce inflammation and manage flares; immunosuppressive effects; short-term use preferred to minimize toxicity.

Immunosuppressants for IBD

Azathioprine, mercaptopurine; suppress immune response for long-term remission maintenance.

Infliximab in IBD

Monoclonal antibody against TNF-α; reduces inflammation and induces remission in moderate-severe IBD.

Long-term IBD therapy approach

Combination of anti-inflammatory agents, immunosuppressants, and biologics to maintain remission.

Sulfasalazine indication

Mild–moderate ulcerative colitis; maintenance therapy for Crohn's disease.

Alosetron MOA

5-HT3 receptor antagonist; reduces gut motility and increases fluid absorption for IBS-D.

Alosetron contraindications

Ischemic colitis history, chronic constipation, severe hepatic impairment.

IBS therapeutic goal

Relieve symptoms, improve quality of life, minimize flares through diet, meds, and lifestyle.

Dimenhydrinate use

Antihistamine used to prevent and treat nausea, vomiting, and dizziness from motion sickness.

Benzodiazepine indications

Anxiety, sedation, and adjunctive treatment for nausea/vomiting in chemotherapy.

Cannabinoids indications

Indicated for chemotherapy-induced nausea and vomiting.

Cannabinoids cautions

Dizziness, sedation, impaired cognition; caution with substance use disorders or psychiatric issues.

Serotonin receptor antagonists

Ondansetron; prevent nausea/vomiting by blocking 5-HT3 receptors in GI tract and CNS.

Black cohosh indications

Used for menopausal symptoms (hot flashes, mood changes, etc.).

Coenzyme Q-10 benefits

Antioxidant; used in heart failure, statin-induced myopathy, and mitochondrial disorders.

Cranberry juice use in UTIs

Used to prevent UTIs and reduce urine odor; effective for recurrent UTIs in older women.

Supplement interactions (general)

Cranberry with warfarin; garlic with bleeding risk; St. John’s Wort induces CYP3A4; interactions vary.

Echinacea adverse effects & cautions

Allergic reactions; may oppose immunosuppressants; avoid in autoimmune conditions.

St. John’s Wort indications

Oral therapy for mild to moderate depression.

St. John’s Wort side effects

Allergic skin reactions, CNS effects, GI upset, phototoxicity.

Valerian contraindications

Avoid in pregnancy and breastfeeding.

Valerian interactions

Potentiates CNS depressants and alcohol/benzodiazepines; use with caution.

Blood flow distribution impact on distribution

During distribution, tissues are delivered via blood flow; abscesses/tumors can have reduced perfusion.

Blood-Brain Barrier (BBB) impact

BBB tight junctions limit passage; only lipid-soluble or transporter-assisted drugs cross.

First-pass effect

Liver metabolism reduces oral drug bioavailability; high first-pass requires higher oral doses or alternative routes.