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PHARM 2
From Quiz 1- Test 1
94
Medical
Graduate
04/12/2012

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Term
what vitamins can be toxic because they build up in the body while other vitamins are water soluble and not stored?
Definition
A D E K
Term
macrominerals (5)
Definition
Mg
Na
K
Cl
S
Term
microminerals (11)
Definition
Fe Zn I Se Mn Mo F Cu Cr Co B
Term
ultratrace elements (6)
Definition
aresenic
aluminum
tin
nickel
vanadium
silicon
Term
what is bad in regards to drug disposition with vitamins?
Definition
may can N/V, diarrhea
Term
example of absorption w/vitamins
Definition
Alendronate (fosamax)
negligible if taken with food and reduced by 60% if taken with coffee or orange juice
Term
distribution of vitamins: inadequate protein intake as Warfarin is ____ and phenytoin is ____ protein bound. low albumin level in especially elderly may cause excessing bleeding and toxic levels of phenytoin.
Definition
99.9%
90%
Term
foods can both inhibit and enhance the METABOLISM of drugs by altering the ______ _____. example?
Definition
enzyme system
- diet high in protein/low in carbs can increase the hepatic metabolism of theophylline
- grapefruits can inhibit the intestinal metabolism of CCB and can last up to 72 hours
Term
what can alter reabsorption of drugs from the renal tubule by altering the pH?
Definition
food and nutrients (milk, most fruits, and juices)
Term
loop diuretics (Furosemide or Bumetanide) ___ the excretion of potassium but also _____ Mg, Na, Cl, and Ca
Definition
increase
increase
Term
high dose of diuretics and low sodium diets can lead to ____ especially in older pts and lead to mental confusion
Definition
hyponatremia
Term
thiazide diuretics ____ the excretion of K & Mg but ____ Ca
Definition
increase
decrease
Term
K sparing diuretics (Spironalactone or Triameterene) ___ excretion of Na, Cl, and Ca. what can happen with this>
Definition
increase
blood levels of K can rise to dangerous levels if they take K supplements or suffer from renal insufficiency
Term
ACE inhibitors (Enalapril or Fosinopril) ____ K. so use of an ACE & K sparing diuretic ____ the danger of hyperkalemia
Definition
decrease
increase
Term
long term corticosteroids (prednisone) can __ Na excretion that leads to water and Na retention so what is recommended?
Definition
decrease
Ca and vit D recommended
Term
drugs that alter taste or smell of food (2)
Definition
docusate Na
Phenteramine
Term
sympathomimetics tx for obesity
Definition
phentermine (alters taste/smell of food!)
Term
are vitamins an energy source?
Definition
no
Term
what are catalysts in the body?
Definition
vitamins
Term
____ are inorganic (dont have carbon) are are "catalysts catalysts"
Definition
minerals
Term
at what are are men considered at risk for osteoporosis?
Definition
80
Term
_____ is needed by all women of reproductive age. recommended 400 micrograms/day
Definition
folic acid
Term
bone lose increases ____ years post menopause
Definition
5-10
Term
at what age does Ca decrease and we need supplementation?
Definition
16
Term
do antioxidants confer health benefits?
Definition
no
Term
what has a possible increased mortality with a very high dose?
Definition
beta keratin
vit A, E
Term
where do you need exposure to UV lights for vit D?
Definition
alaska
Term
what vitamin do you not have to worry about toxicity with?
Definition
vitamin k
Term
increasing vitamin ___ is bad and increases morbidity
Definition
E
Term
what vitamins are inversely proportional?
Definition
Na and K
Ca and Phosphorus
Term
older than ___ yo with poor Ca absorption are at ____ risk for type 2 osteoporosis
Definition
75
Ca
HIGH!!!
Term
women ____ or older and postmenopausal or have been on ___ for a long time are at increased risk for osteoporosis
Definition
65
HRT (hormone replacement therapy)
Term
patients with RA are at increased risk for what
Definition
osteoporosis
Term
what is currently the 1st line tx for osteoporosis? examples? when should they take it?
Definition
Bisphosphonates
alendronate (Fosamax)
risedronate (actonel)
ilbandronate (boniva)
- taken on an EMPTY stomach and pt must sit for 1/2 hour
Term
what is the only selective estrogen receptor modulator (SERM) that is used to tx OA? what does it do?
Definition
Raloxifene (evista)
reduces resorption of bone and decreases overall bone turnover
Term
alert that __, ___, ___ containing medicine (antacids) may interfere with absorption of bisphosphonates so avoid for 2 hours (tx for OA)
Definition
Ca
Al
Mg
Term
most people with gout have reduced _____ clearance
Definition
uric acid
Term
causes of gout?
Definition
pruine metabolism abnormalities : (PRPP, HGPRT)
Term
what is gouty arthritis?
Definition
- When uric acid reaches high levels in the blood it crystalizes and forms insoluble precipitates.
- These crystals can aggregate in the joints and cause inflammation.
Term
what is tophi? what does it look like?
Definition
deposits of monosodium urate crystals
white nodules
Term
____ are 1000x more prevalent in pts with gout
Definition
renal stones
Term
acute tx for gout?
chronic?
Definition
Cochicine
Allopurinol (aloprim, zyolprim)
Term
___ for gout prevents proliferation and migration of leucocytes and STOPS INFLAMMATION (stops the pain)
Definition
Colchicine
Term
what replaced Colchicine bc of GI upsets? what is commonly used?
Definition
NSAIDs
Indomethacin
Term
Colchicine has been pulled off the market in its generic form. the brand ___ is the only colchicine available now so increased cost. what are the adverse effects?
Definition
Cocrys
***diarrhea, abdominal cramps, nausea, vomiting
Rarely: bone marrow suppression, neuropathy and myopathy
Term
uricosuric agents ______ and _______ effect ion exchangers in the renal tubules to inhibit reabsorption of uric acid by the kidneys
Definition
Probenecid, Sulfinpyrazone
Term
cautions with uricosuric agents? how can we prevent this?
Definition
- Excess uric acid secretion may predispose patients to stone formation
- Maintain fluids and high urine output
Alkalinize urine [>6.0] to enhance solubility of uric acid
Term
secretion of other weak acids (penicillin) may be inhibited by what agents?
Definition
Uricosuric
- Probenecid was originally developed to prolong penicillin blood levels
Term
what is the 1st new gout drug in 40 years? its potent and selective inhibitor of xanthine oxidase
Definition
Febuxostat (Uloric)
Term
what drug for gout is used prophylactically like allopurinol?
Definition
Febuxostat
Term
1st line tx for gout?
Definition
NSAIDs -- Indomethacin MC
- or Naproxen (Aleve) -- prescription strength of 500 mg
Term
gout management strategies
Definition
1. reduce uric acid levels -- nhibit uric acid production by xanthine oxidase (allopurinol, febuxostat)
Promote uric acid excretion by kidneys (uricosurics - probenacid)
2. Stop inflammatory cascade
NSAIDS (naproxen, indomethacin, NOT aspirin)
Colchicine - antimicrotubular agent that prevents proliferation and migration of leucocytes
Corticosteroids
Term
Currently believed that RA is triggered by a combination of _______
Definition
genetic, environmental, hormonal, and reproductive factors
Term
RA peak onset
Definition
20-40 years
Term
80% of people with RA are positive for ______
Definition
rheumatoid factor
Term
comparison of OA and RA:
- duration of pain
- joint location
- labs
Definition
- OA: <30 mins, RA: >30 mins
- OA: DIP, PIP, hips (may be asymmetrical), RA: PIP, MCP, wrist, elbow, MTP (symmetrical)
- OA: no change in ESR, RA: inc ESR
Term
A patient has RA if at least 4 of these criteria are satisfied.
Criteria 1-4 must have been present for at least 6 weeks
Definition
morning stiffness
arthritis of 3+ joints
arthritis of hands
symmetric arthritis
rheumatoid nodules
serum rheumatoid factors
radiographic changes
Term
examples of NSAIDs for RA
Definition
Celebrex
ASA
- short onset of action
Term
NSAIDs examples for RA
Definition
Examples: Aspirin, Celebrex (COX-2 Inhibitor), Naproxen, Ibuprofen (tolerate, cost, frequency)
Voltaren Gel (diclofenac topical) – can be rubbed on hands or other affected joint
Term
what is most often selected as initial therapy for RA due to ability to induce a long-term response
Definition
Methotrexate (MTX)
Term
Adverse effects of low-dose MTX in patients with RA are related to what?
so what is typically added to this therapy?
Definition
folate antagonism and/or folate deficiency
- folic acid
**birth control must be used!!
Term
what RA tx has a side effect of liver toxicity and the patients must used effective contraception (X)
Definition
Leflunomide (Arava®)
Term
Useful in early RA or in patients *who have failed other DMARDs (disease Modifying Antirheumatic Drugs)
Definition
Etanercept (Enbrel®)
Term
what RA tx must be used in combo with MTX?
Definition
Infliximab (Remicade®)
Term
dosing rule in regards to Anakinra (tx for RA)
Definition
Reduce dose(100 mg QOD in severe impairment)
Term
what should you start with for RA tx in mild disease?
Definition
Start with NSAIDS or glucocorticoids in mild disease then use as adjunctive therapy
Term
what should you start asap with RA tx?
Definition
Get DMARD on board ASAP (within 3 months of diagnosis)
Term
what is the last alternative for RA tx?
Definition
surgery
Term
what is the most common joint disease and is "wear and tear"
Definition
OA
more common in athletes
Term
0-90% of people (male and female) have evidence of _______ by the time they reach age 65
Definition
osteoarthritis
Term
in OA, when does inflammation occur?
Definition
secondary to joint damage!
leads to erosion of articular cartilage
Term
is OA systemic? what is involved?
Definition
NO
only 1 or a few joints
Term
what is the oral 1st line tx for OA? topical?
Definition

tylenol

capsaicin, arnica

Term
prescription oral agents for OA
topical?
Definition
NSAIDs - ibuprofen max 3.2 g/day
- opiate analgesics (Lortab, Percocet)
Topical - diclofenac in DMSO
Term
what is the njection of hyaluronate into joint to help lubricate it for OA called?
Definition
Viscosupplementation
Term
OP pathophys?
Definition
Imbalance in osteoblast and osteoclast activity
Term
modifiable RF for OP?
Definition
Low calcium/Vitamin D intake
Sedentary Lifestyle
Low body weight (< 125 lbs)
Alcohol excess
Cigarette smoking
Caffeine (increases calcium excretion)
Term
nonmodifiable RF for OP?
Definition
Sex
Race (Caucasian, Asians at higher risk)
Advanced age
History of 1st degree relative, low trauma fracture, or osteoporosis
Early menopause (< 45 YO)
Small thin frame
Term
Potentially Modifiable Risk Factors for OP?
Definition
Impaired vision despite correction
Dementia
Poor health/frailty
Frequent falls
Low physical activity
Term
OP is a ____ onset. fx with ___ trauma
Definition
gradual
minimal
Term
Physical activity is associated with ______ reduced risk of hip fracture compared with sedentary lifestyle for OP
Definition
20-40%
Term
Only 500-600mg of calcium can be absorbed at one time
in regards to OP tx. what is a good example of a Ca medication (2)?
Definition
1. Calcium citrate (Citracal®) –can take without meals. Does NOT require acidic environment to promote absorption –recommended for pts on chronic acid suppression therapy (H2 antagonists & PPIs)
2. Calcium carbonate – best taken with meals
Cheaper!!
Term
best form of vit D tx for OP?
Definition
D3 (Cholecalciferol) is best absorbed oral form
Term
example of a SERM for OP?
Definition
Raloxifene (Evista®)
Bones = Estrogen Agonist
Breast = Estrogen Antagonist
- Raloxifene increases bone mineral density and reduces vertebral fracture rates 40-49% in postmenopausal women with or without prior fracture
Term
most commonly used tx for OP?
Definition
bisphosphonates
- 1st line: Alendronate sodium (Fosamax)
- Ibandronate sodium - Boniva - 2nd line
Term
how to bisphosphonates work for OP?
Definition
Decrease bone resorption by causing osteoclast apoptosis and decreased function
Term
whats the best bisphosphonate to use for OP?
Definition
Alendronate sodium (Fosamax®)
70 mg/wk
Term
whats a good bisphosphonate for OP thats useful in patients unable to take oral formulation
Definition
Ibandronate sodium (Boniva) injection (2nd line)
(This is brand only and expensive –most patients switch over to fosamax ($3))
Term
whats an OP tx that is an inhibitor of bone resorption (inhibits osteoclasts) and is a last line therapy (tx only). how is it used?
Definition
Calcitonin
nasal spray bc inactivated by gastric fluid
Term
what is an OP tx that has an increased risk for osteosarcoma?
Definition
Recombinant Parathyroid - Teriparatide use is limited to 2 years
- only used in postmenopausal osteoporosis with high risk for fracture
Term
what is the only approved for tx of postmenopausal osteoporosis in women with high risk of fracture
Definition
Denosumab (Prolia)
Term
what is a cause of OP in men?
Definition
Hypogonadism
*Low levels of testosterone
Lack aromotase
Term
glucocorticoids can induce ___
Definition
OP
Term
tx for acute attack of gout?
Definition
NSAID’s *Naproxen (Naprosyn) and *Indomethacin (Indocin)
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