Pharmacology Exam II Study Guide

Mechanism of Action (MOA)

Know the drug's target and pathway.

Use

Indications and rationale behind drug choice.

Monitoring

Labs

vital signs

therapeutic levels.

Red Flags

Contraindications

black box warnings

unique adverse effects.

Special Populations

Pregnant

renal/hepatic impaired

pediatrics

elderly.

what herbs/supplements have Interactions we need to keep in mind

ephedra, ginseng, licorice, grapefruit, and MAOIs.

what is the MOA of ACE Inhibitors

↓ Ang II which causes Vasodilation

what conditions is the use of ACE inhibitors indicated for

HTN

HF

diabetic neuropathy

what do ACE inhibitors monitor and why

K+ and Cr

renal function

what are the adverse events associated with ACE inhibitors

cough

hyperkalemia

angioedema

what population should avoid ACE inhibitors

pregnant

what is the MOA of ARBs

Block Ang II receptor

what are the uses of ARBS

ACE inhibitor alternative

what do ARBs monitor

K+

renal function

what are the adverse events associated with ARBs

hyperkalemia

who should avoid taking ARBS

pregnant

what do loop diuretics (furosemide) do

Lose Na+

lose K+

lose Ca2+

collective loss causes ototoxicity

what does thiazide (HCTZ) do

lose Na+

lose K+

retain Ca2+

what do K sparing diuretics (spironolactone) have an increased risk of

hyperkalemia

gynecomastia

what do diuretics monitor

electrolytes

uric acid leading to gout

what is the MOA of calcium Channel Blockers

↓ Ca2+ influx causing vasodilation

what are the uses of calcium channel blockers

hypertension

angina

arrhythmia

non-DHP

what are the adverse effects of calcium channel blockers

edema

constipation (verapamil)

bradycardia

what herb/supplement should be avoided if taking calcium channel blockers

grapefruit

if a person if taking calcium channel blockers what should be monitored

BP

ECG

what is the MOA of beta blockers

decrease HR and contractility

what are the uses of beta blockers

hypertension

post-MI

HF

what are the adverse events associated with beta blocker use

bradycardia

fatigue

masks

hypoglycemia

what conditions do we need to exercise caution with when our pt is on beta blockers

asthma

COPD

what do we need to monitor for pt on beta blockers

HR

glucose

what is the MOA of cardiac glycosides

Inhibits Na/K ATPase →

increases/stimulates Ca2+ →

increases/stimulates contractility

what are the uses of cardiac glycosides

heart failure

atrial fibrillation

what toxicity signs are assocaited with cardia glycosides

visual halos

arrhythmia

what do we need to monitor if our pt is on cardiac glycoside

digoxin level

K+

renal function

what is the MOA of phosphodiesterase Inhibitors

increased cAMP causes increased Ca2+ which also causes increased contractility

what do we need to monitor when taking phosphodiester inhibitors

K+

renal function

what are the adverse effects associated with phosphodiesterase inhibitors

arrythmias

what are phosphodiesterase inhibitors used for

acute heart failure

what is the MOA of Direct Vasodilators

Arterial dilation

what are direct vasodilators used for

severe hypertension

heart failure

especially in black patients w/ nitrates

what are the adverse effects of direct vasodilators

reflex tachycardia

lupus like syndrome

what do direct vasodilators monitor

ANA

BP

what are examples of 1st gen H1 Antihistamines

diphenhydramine

Benadryl

what are some characteristics of first gen H1 antihistamines

sedating

anticholinergic

what is the MOA of 1st gen H1 antihistamines

H1 receptor inverse agonist

reverse effects of histamine

what are examples of 2nd gen H1 antihistamines

loratadine, claritin or alavert

are 2nd gen H1 antihistamines sedating or non-sedating

non-sedating

what is the MOA of 2nd gen H1 antihistamines

bind to and block H1 histamine receptors

located outside brain and spinal cord

what are the uses of 2nd gen H1 antihistamines

allergies

what are the adverse effects of 2nd gen H1 antihistamines

dry mouth

sedation

should loratadine/diphenhydramine be used as primary treatment for Severe Allergic Reactions (Anaphylaxis)

no

what is the first line of defense for a severe allergic reaction

epi pen for severe anaphylaxis

what are the uses of Intranasal Corticosteroids

Allergic rhinitis

what are the adverse effects of intranasal corticosteroids

epistaxis nasal irritation

what is the MOA of decongestants

Alpha agonist causing vasoconstriction

what medications should be avoided when taking decongestants

MAOI’s

what are the adverse effects of decongestants

hypertension

rebound congestion

what is the MOA of antitussives

Suppress cough reflex

who should avoid taking antitussives

<12 year olds

what are the adverse effects associated with antitussives

codeine causing sedation and constipation

what are examples of expectorants/mucolytics

guaifenesin

acetylcysteine

Expectorants/Mucolytics

Guaifenesin: Thins mucus

what does acetylcysteine do

break mucus

tylenol antidote

when should we advise someone to take expectorants/mucolytics

when they need to increase fluids

what is the MOA of anticholinergics

Block M3 → bronchodilation

what are the uses of anticholinergics

COPD

asthma adjunct

what are the adverse effects of anticholinergics

dry mouth

what conditions should be avoided with anticholinergics

BPH

glaucoma

what is the MOA of Inhaled Corticosteroids

decrease airway inflammation

what is the use of inhaled corticosteroids

asthma prophylaxis

what advice should we give a patient taking inhaled corticosteroids

rinse mouth to prevent thrush

what is the use of leukotriene Modifiers

Asthma

allergic rhinitis

what are the adverse effects of leukotriene modifiers

mood changes

what do we need to monitor if a person is on leukotriene modifiers

LFT

what is the MOA of methylxanthines

PDE inhibition → bronchodilation

what kind of therapeutic index are methylxanthines

narrow

what do we need to monitor if a person is on methylxanthines

drug levels

what are potential adverse effects of methylxanthines

nausea

seizures

arrhythmia

Pregnancy Red Flags

ACEI

ARB

warfarin

statins

Renal insufficiency Red Flags

Adjust dosing for digoxin

aminoglycosides

lithium

monitor K+

Cr.

Pediatrics Red Flags

Avoid aspirin (Reye's)

codeine (<12).

what does a person taking ephedra have an increased risk of

increased heart rate

what does someone taking ginseng have the increased risk of

bleeding

what does someone taking licorice have an increased risk of

K+ loss

Grapefruit juice Red Flags

Avoid with CCBs, statins, some psych meds.