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151 Cards in this Set
- Front
- Back
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- stimulates lactation
- tonically suppressed by dopamine (pituitary likes to make it even without being told) - stimulated by phenothiazenes & TRH - Suppressed by dopamine agonists |
Prolactin
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- Dopamine agonist used to suppress prolactin secreting tumors
- More effective & better tolerance than Bromocriptine SE: - nausea, lightheadedness, orthostatic hypotension, fatigue, psychoses CI: - pregnancy |
Cabergoline
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- Dopamine agonist used to suppress prolactin secreting tumors
SE: - nausea, lightheadedness, orthostatic hypotension, fatigue, psychoses - can cause hot red feet CI: - pregnancy |
Bromocriptine
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- causes release of GH
- inhibited by somatostatin |
Growth Hormone Releasing Hormone
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-synthetic GHRH (before GH)
- not as effective as GH therapy - used diagnostically |
Semorelin
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- targets bone, liver, fat, & muscle
- causes release of IGF-1 (mediates its anabolic effects) - Bone: longitudinal growth & increased mineral density - skeletal muscle: increased mass & glucose utilization - Fat: increase lipolysis & decrease glucose utilization - lIver gluconeogenesis |
GH
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- GH agonist
- used in growth failure due to GH deficiency (chronic renal disease; turner's syndrome) - injected every morning SE: - fluid retention & edema - musculoskeletal pain & stiffness - Throws off sugar balance CI: - Diabetes - Hypothyroidism |
Somatropin & Somatrem
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- IGF1 replacement (after GH)
- not as effective as GH therapy Indications: - IGF1 deletion/mutation - GH receptor mutation - GH antibodies SE: - hypoglycemia (m/c) |
Mecasermin
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- inhibits secretion of pituitary & gastrointestinal hormones
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Somatostatin
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- Somatostatin analog
- just like octreotide but long acting (take it once a month) |
Lanreotide
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- Somatostatin analog
- inhibits secretion of pituitary & gastrointestinal hormones - used to tx GH excess (acromegaly) - can reduce tumor size/growth - Used to tx excessive diarrhea - injected 3x daily SE: - GI effects - Gallstones - Cardiac problems CI: - gall bladder disease - Diabetes - Cardiac disease - Thyroid problems |
Octreotide
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- GH receptor antagonist
- used in GH excess syndromes such as acromegaly - return to normal IGF1 levels in 97% of patients SE: - growth of a GH secreting tumor (lack of negative feedback) - reversible hepatotoxicity CI: - hepatic disease |
Pegvisomant
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- FSH & LH
- control female cycle SE: - ovarian enlargement - ovarian hyperstimulation syndrome - multiple births - Gynecomastia - head ache, depression, edema CI: - sex steroid dependent neoplasia - precocious puberty |
Gonadotropins
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- Gonadotropin releasing horomne
- used to tx infertility - short acting |
Gonadorelin
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- causes release of gonadotropins (FSH & LH)
- pulsatile release - pulse frequency determines which one - tonic release leads to suppressed gonadotropin release |
Gonadotropin Releasing hormone
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- long acting Gonadotropin releasing hormone
- Continuous admin suppresses LH & FSG release after an initial stiumlation Used to shut down the HPG axis for: - infertility ART - Prostate or breast cancer - delay precocious puberty SE: - Menopausal symptoms - Ovarian cysts - Testicular atrophy |
Leuprolide, Goserelin, Nafarelin
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- Gonadotropin Releasing Hormone Antagonist
- suppress LH (lower dose) & FSF (higher dose) - no initial surge of gonadotropins to shut it down - Indicated for assisted reproductive techniques & endometriosis |
Cetrorelix & Ganirelix
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- FSH & LH mixture but used as FSH
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Menotropins
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- recombinant FSH
- expensive |
Follitropin
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- has a similar structure & binds to LH receptor
- longer half life than LH |
HcG
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- Non steroidal estrogen
- contraception |
Diethylstibesterol
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- regulated by FSH & LH
- produced by fetal/placental unit in pregnant women - acts on nuclear receptors - metabolized in liver Functions: - endometrial growth - closes epiphyses at end of puberty - bone maintenance - synthesis of clotting proteins & increase of platelet adhesives - raises HDL & lowers LDL Uses: - Primary hypogonadism - HRT - oral contraception SE: - Migraines - gall bladder disease - thromboemboislm from accelerated blood clotting CI: - estrogen dependent neoplasm - thromboembolic disorder - smoking - liver disease - pregnancy |
Estrogen
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- Synthetic estrogen
- used in oral contraceptives |
Estradiol & Mestranol
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- Selective estrogen receptor modulator
- agonist in uterus & bone (prevents loss) - Antagonist in breast - DOC: Breast Ca SE: - hot flashes - increased risk of uterine cancer |
Tamoxifen
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- Not a SERM but a full blown estrogen receptor antagonist
SE: - menopausal symptoms |
Fulvestrant
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- Selective estrogen receptor modulator
- antagonist in breast & uterus - agonist in liver & bone - used to prevent postmenopausal osteoporosis SE: - hot flashes |
Raloxifene
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- Selective estrogen receptor modulator
- DOC for infertility with intact HPG axis - antagonizes negative feedback of estrogen in hypothalamus SE: - multiple pregnancies |
Clomiphene
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- aromatase inhibitors
- used in breast cancer tx in postmenopausal women & in advanced breast cancer after tamoxifen failure SE: - hot flashes |
Anastrozole & Letrozole
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- Combination oral contraceptive
- inhibits ovulation - decreases implantation - mimics normal hormonal cycle to minimize side effects - reduces risk for ovarian & endometrial cancer SE: - wt gain - cardiovascular problems - clotting - mild HTN - migraine - MI/stroke - teratogenesis - fertility suppresed after stopping drug for 3+ months CI: - thrombembolic phenomena - estrogen dependent neoplasms - liver disease - P450 inducers & ABX can both reduce effectiveness |
Drosperenone/Estradiol (YAZ)
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- Gonane progestin
Uses: - oral contraceptives - endometrial hyperplasia prevention in HRT SE: - bone loss - reduced HDL - risk of breast cancer |
Norgestrel
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- regulated by LH
- produced by corpus luteum - acts on nuclear receptor - converts endometrium of uterus to a secretory state & maintains pregnancy |
Progesterone
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- varied levels of androgenic activity
- can even be antiandrogenic - not orally active Uses: - oral contraceptives - endometrial hyperplasia prevention in HRT SE: - bone loss - reduced HDL - risk of breast cancer |
Progestins
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- Estrane progestin
Uses: - oral contraceptives - endometrial hyperplasia prevention in HRT SE: - bone loss - reduced HDL - risk of breast cancer |
Norethindrone
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- Pregnane projestin
- antagonizes the mineralcorticoid receptor Uses: - oral contraceptives - endometrial hyperplasia prevention in HRT SE: - bone loss - reduced HDL - risk of breast cancer |
Medroxyprogesterone
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- Progesterone receptor antagonist (glucocorticoid too)
Uses: - pregnancy termination w/ PGs - prevent implantation (day after pill) - induction of labor following fetal death CI: - pregnancy or breast feeding |
Mifepristone
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- weak progestin & androgen
- suppresses ovarian function Uses: - to tx endometriosis |
Danazol
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- secreted by testes or ovaries
- Rate limiting step in synthesis is going from cholesterol to pregnenolone - converted by 5alpha reductase to dihydrotestosterone (most potent form) in target tissues - virilizing effects (spermatogenesis) - Anabolic effects - puberty Uses: - testicular deficiency in men - female hypopituitarism in women - nephrosis - debilitated patients w/ negative Nitrogen balance SE: - decreased spermatogenesis in men - masculinization in women - pseudohermaphroditism of fetus - acne (oily skin) - decreased HDL - physiological changes (aggression, libido, depression, psychosis) CI: - pregnancy, children - androgen dependent neoplasms - aplastic anemia |
Androgens
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- suppress androgen function
Uses: - hirsuitism in women - severe cystic acne in women - prostate cancer in men |
Antiandrogen
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- androgen receptor antagonist
- used in prostate cancer - has been used topically for hirsutism & baldness |
Flutamide
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- Aldosterone antagonist K sparing diuretic
- mineral corticoid antagonist - partially blocks androgen receptor (used in hirsutism & PMS in women) - MOA: competitive inhibitor of aldosterone - oral admin - ↑ survival in CHF - most effective tx of hyperaldosteronism SE: - gynecomastia - impotence - caution with ACE inhibitors & ARBs (acidosis) |
Spironolactone
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- antigungal that also inhibits androgen synthesisi
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Ketoconazole
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- inhibit 5alpha reductase (no DHT)
- used in BPH & male pattern baldness - SE: - reduces serum prostate specific antigen so can mask detection of prostate carcinoma CI: - pregnancy teratogens |
Finasteride & Dutasteride
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- promotes entry of glucose into skmm, heart, fat & leukocytes
- not requried for glucose transport into breain, liver & RBCs - inhibits catabolic processes - decreases gluconeogenesis - increases glycogen synthesis - metabolized by liver & kidney SE: - hypoglycemia (tachycardia, confusion, vertigo, sweating; S&S disappear after repeated events) - allergic rxn |
Insulin
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- insulin that is ok to use IV
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Rapid acting & short acting insulins
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- 2nd generation sulfonylurea (more potent)
- worst hypoglycemia effects of the 2nd generations - 24 hour effect |
Glyburide
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- 1st generation sulfonylurea
- disulfiram like effect - causes worst hypoglycemia |
Chlorpropamide
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- 2nd generation sulfonylurea (more potent)
- least hypoglycemia of 2nd gens |
Glipizide
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- Stimulate insulin release form pancreatic beta cells indirectly potentiate action of insulin on target tissues
SE: - hypoglycemia - wt gain CI - allergies to sulfa drugs |
Sulfonylureas
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- 2nd generation sulfonylurea (more potent)
- once a day dosing - little hypoglycemic effect |
Glimepiride
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- 1st generation sulfonurea
- rapid absorption - least hypoglycemia of 1st gen meds - safest in elderly |
Tolbutamide
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- Meglitinides
- Rapid short action that mimics insulin - less hypoglycemia than sulfonylureas - not much effect on wt - MOA: receptors on K channels on beta cells stimulated to increase insulin release - they aren not sulfa based so can be used in sulfa allergy - rapid action SE: - hypoglycemia - GI symptoms CI: - never use in combo w/ sulfonylureas |
Repaglinide & Nateglinide
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- Doesn't release insulin
- insulin like action in muscle & fat (glucose uptake) - decreases glucose absorption from GI - decreases glucagon & gluconeogenesis - glucose not lowered in normal subjects just in diabetics - doesn't increase body wt - decreases macrovascular events - safe for use in children > 10 yrs old - DOC: DM2 SE: - lactic acidosis (rare but lethal) - one of the top 5 diarrhea drugs |
Metformin
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- Thiazolidinedione
- lower insulin resistance - potential for reducing development of type 2 DM via prophylactic use - no GI symptoms SE: - Edema w/ increased risk of heart failure in CHF patients (prone to it) CI: - hepatic disease - CHF |
Pioglitazone
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- thiazolidinedione
- black label warning - virtually off the market |
Rosigltazone
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- alpha glucosidase inhbitors
- reduce glucose absorption - no significant effects on wt SE: - flatulence CI: - hepatic disease - renal impairment - GI disease |
Acarbose & Miglitol
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- synthetic version of GLP1 from gila monster saliva
- resistant to enzymatic degradation by DPPIV - single daily SC injection - half life is about 12-13 hours - potential increased Beta cell number & function - wt loss CI: - thyroid cancer black box warning |
Liraglutide
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- synthetic version of GLP1 from gila monster saliva
- resistant to enzymatic degradation by DPPIV - Morning & evening SC injections 60 min before 2 main meals - eliminated by kidney - potential increased Beta cell number & function - wt loss |
Exenatide
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- Dipeptidyl peptidase IV inhibitor
- potentiates effects of incretin hormones - has no significant effect on wt - administered orally - no GI symptoms |
Saxagliptine
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- Dipeptidyl peptidase IV inhibitor
- potentiates effects of incretin hormones - has no significant effect on wt - administered orally - no GI symptoms SE: - acute pancreatitis as well as pancreatic cancer possible |
Stiagliptin
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- Amylin like peptide
- adjunct to insulin therapy in type 1 & 2 - synthetic analog of amylin - regulates postprandial glucose by decreasing gastric emptying, suppression postprandial glucagon secretion & centrally mediated modulation of appetite to decrease caloric intake - causes wt loss - SC injection 3x per day with meal bolus of insulin |
Pramlintide
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- dopamine agonist
- leads to enhanced suppression of hepatic glucose production - reduces cardiovascular end point problems CI: - pregnant & nursing women |
Bromocriptine in tx of diabetes
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- Hormone produced pancreatic alpha cells
- increases blood glucose levels by mobilizing hepatic glycogen when available - potent inotropic & chronotropic effects on heart (used in beta blocker overdose) - produces profound relaxation of intestine (used in radiology) - onset of action is gradual |
Glucagon
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- K channel regulator
- its actually a thiazide - Activates ATP sensitive K channels - Vasodilator & Hyperglycemic - Used in patients with insulinoma SE: - Hyperglycemia (ketoacidosis or non ketotic hyperosmolar coma) - Sodium & water retention - Hyperuricemia (because its a thiazide) - excessive hair growth (most frequently in children) |
Diazoxide
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- Ocytoxic drug
- DOC to induce labor at term if indicated (IV) - used for prevention of hemorrhage (IM injection) - used for stimulation of milk let down (nasal) SE: - Water intoxication w/ convulsions - Uterine rupture (large dose) - allergy/anaphylaxis - Sinus bradycardia of fetus CI: - placenta previa - uterine scar from previous C section - cervical scarring - unegnaged head |
Oxytocin
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- Synthetic Prostaglandin
- used for expulsion of uterine contents & cervical ripening prior to term delivery - gel to cervix for ripening, supposatory in vagina for abortion SE: - one of the 5 diarrhea drugs (black box) - GI disturbances CI: - don't use for abortions in patients w/ acute cardiac, pulmonary, renal or hepatic disease; in patients w/ asthma, HTN, anemia, jaundice or epilepsy |
Dinoprostone
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- prostaglandin derivative
- used to induce abortion between 13th-20th week (2nd trimester) - used to tx postpartum bleeding due to uterine atony (3rd line after massage, oxytocin & ergots) SE: - Vomiting & diarrhea CI: - acute cardiac, pulmonary, renal or hepatic disease - Asthma, HTN, anemia, jaundice or epilepsy |
Carboprost
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- Ergot alkaloid
- Oxytocic drug - used after completion of labor & deliver of placenta - causes contraction of uterus through 5HT & alpha receptors SE: - angina, MI, HTN (contacts all smooth muscles) CI: - never to induce labor - obliterative vascular or coronary artery disease |
Ergonovine maleate
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- Tocolytic
- relaxes the uterus by unkown mechanism - considere 1st line drug - can prevent convulsion in pre-eclampsia & tx eclampsia - administered IV slowly (must be at hospital) SE: - flushing, hypotension - depressed deep tendon reflexes |
Magnesium sulfate
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- tocolytic
- historically used in rural areas - direct relaxing effect on myometrium & inhibition of oxytocin release |
Ethanol as a uterine relaxant
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- tocolytic
- L-type Ca blocker - oral - Becoming 1st line agent |
Nifedipine as uterine relaxant
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- uterine relaxants
- goal to prevent premature labor - delivery can happen before 37th week if fetal lungs developed via corticosteroids |
Tocolytics
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- Tocalytic
- also a non specific reversible COX inhibitor - reduces PG synthesis SE: - partial closure of the fetal ductus areriosus |
Indomethacin as uterine relaxant
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- tocolytic
- emergency use only in case of uterine rupture |
Nitroglycerin as a tocolytic
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- given prophylacticially from the 16th-37th week of pregnancy to prevent early delivery
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Progesterone as a tocolytic
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- 90% are plasma bound Corticobinding globulins & aslbumin (only free ones have actions)
- work on nuclear receptors - increase glucose, FFAs & AAs in circ - antagonizes insulin (catabolic) - redistribution of body fat (from extremeties to center) - increase vascular responsiveness to sympathetic stimulation - some Na & H2O retention - increase CO - Decrease Ca in bone - immunosuppressive - blocks all steps in inflammation - suppresion of wound healing - CNS effects: mood elevation, insomnia, restlessness, anxiety, depression, psychosis |
Glucocorticoids
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- replacement glucocorticoid in adrenal insufficiency
- has weak antiinflammatory effects - must be converted to hydrocortisone in liver in order to be active |
Cortisone
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- replacement glucocorticoid in adrenal insufficiency
- has weak antiinflammatory effects - cortisone must be converted to this in the liver in order to be active |
Hydrocortizone
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- Mineral corticoid replacement steroid
- Given as needed (decreased aldosterone signs & symptoms) in adrenocortical insufficiency - given in combination w/ glucocorticoid - has both gluco & mineral corticoid effects but mineral are stronger - similar to aldosterone |
Fludrocortisone
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- Anti-inflammatory corticosteroid
- must be converted in liver to active form - most commonly perscribed oral glucocorticoid |
Prednisone
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- most commonly prescribed glucocorticoid for inhaled & intranasal use
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Fluticasone
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- preferred glucocorticoid for cerebral edema (CNS penetration)
- used when endogenous cortisol levels have to be measured (doesn't cross react) |
Dexamethasone
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- Anti-inflammatory corticosteroid
- virtually no mineral with high glucocorticoid activity - most newer glucocorticoid drugs are like this |
Methylprednisolone
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- Mineralcorticoid receptor antagonist
- used in primary hyperaldosteronism, hirsutism, ascites associated w/ cirrhosis - eplerenone could also be used |
Spironolactone
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- corticosteroid synthesis inhibitors
- inhibits all steroid synthesis - used in cushings, breast & prostate cancer SE: - corticosteroids mus be given concomitantly because it causes adrenal insufficiency |
Amino glutethimide
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- antagonist of progesterone receptors & at higher doses glucocorticoid receptors
- used in inoperable cushing's patients that haven't responded to other tx SE: - abdominal pain - amenorrhea - fatigue - GI upset |
Mifeprostone
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- antifungal agent
- inhibits all steroid synthesis - used with cushings before surgery or radiation (most effective inhibitor of steroid biosynthesis in patients with cushings disease) |
Ketoconazole
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- only corticosteroid inhibitor that can be given to pregnant women
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Metyrapone
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- Corticosteroid synthesis inhibitor
- Adrenocrticolytic (causes adrenocortical atrophy) - used in primary adrenal carcinoma - can sometimes produce remission of cushing's disease |
Mitotane
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- beta blocker used to tx hyperthyroidism
- decreases many of the signs & symptoms of hyperthyroidism CI: - asthma |
Propanolol in hyperthyroidism tx
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- thyroid hormone replacement drug
- drug of choice for hypothyroidism - drug levels must be carefully titrated to individual TSH levels & signs & symp |
Levothyroxine sodium
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- Replacement thyroid hormone drug
- T3 - used for initial therapy but not maintenance - side effects similar to hyperthyroidism |
Liothyronine sodium
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- Thyroid synthesis inhibitor
- Circulating Tx/T4 lasts a week or so - used in conjunction w/ other tx - DOC: graves disease; Hyperthyroid SE: - black box warning: severe liver injury & acute liver failure - itching & skin rash (m/c) - Granulocytopenia & agranulocytosis - goiter (may need to add t4 to reduce TSH levels) |
Propylthiouracil
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- Thyroid synthesis inhibitor
- taken int gland specifically - small amounts used as diagnostic tool - large amounts destroy gland - used in elderly patients & those w/ heart disease cause they can't have surgery |
Radioactive iodine
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- Thyroid synthesis inhibitors
- decreases synthesis & release of T3/4 - short term effect (6-8 weeks) - used to decrease vascularity & thyroid content of gland - used for 7-10 days before surgery to decrease likelihood of thyroid storm - can use in radioactive emergencies |
Iodide
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- Can't prevent or tx osteoporosis alone but given together to help
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Ca & Vitamin D together
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- used in osteoporosis tx
- increases circulating Ca by stimulating osteoclast activity via RANKL - works in conjunction w/ PTH |
Vitamin D
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- Hormone used in osteoporosis tx
- decreases circulating Ca by inhibiting osteoclasts to decrease resorption - stimulated by estrogen - antagonizes PTH - Nasal spray or injection - used to tx osteoporosis & paget's disease SE: - can have allergic rxns cause we use salmon version of it - Rhinitis/sinusitis w/ nasal spray - nausea & vomiting w/ injection |
Calcitonin
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- Hormone used in osteoporosis tx
- recombinant PTH that when given intermittently produces bone growth instead of resorption - used to tx osteoporosis & hypoparathyroidism SE: - hyper calcemia & calciuria - dizziness, leg cramps CI: - osteosarcoma (black label warning) - paget's disease |
Teriparatide
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- Rank ligand inhibitor
- antibody against RANKL - DENsity - OSteo - hUman - Monoclonal AntiBody - used in severe osteoporosis in postmenopausal women - increase bone mass & strength in both cortical & trabecular bone SE: - osteonecrosis of the jaw CI: - Hypocalcemia |
Denosumab
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- Bisphosphonate
-FDA approved - Oral |
Alendronate & Risedronate
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- substitutes for PO4 in Ca binding
- they are incorporated into the bone & inhibit bone resorption - DOC for post menopausal osteoporosis - must be taken on empty stomach SE: - oral have GI symptoms - IV have renal toxicity if given too fast - osteonecrosis of the jaw |
Bisphosphonates
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- bisphosphonate
- off label use - slow IV (once every 3 months) |
Pamidronate
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- Bisphosphonate
- off label use - oral |
Etidronate
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- Ca receptor inhibitor
- calcimimetic drug - blocks PTH release from parathyroid gland - used to tx 2ndry hyperparthyroidism in chronic kidney disease & parathyroid carcinoma |
Cinacalcet
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- Inorganic bases that neutralize acid
- Magnesium causes diarrhea - aluminum causes constipation - used to relieve heart burn - many drug interactions |
Antacids
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- Antacid
- Poorly absorbed - diarrhea - Mg accumulates if poor renal function |
Magnesium hydroxide
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- antacid
- Fast acting - belch - not useful for ulcer |
Sodium Bicarbonate
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- Antacid
- Milk alkali syndrome if too much Ca - Not for peptic ulcer |
Calcium carbonate
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- H2 receptor blocker
- DOC: peptic ulcer SE: - anti testosterone effect - gynecomastia, loss of libido, impotence |
Cimetidine
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- Works on H2 receptors on parietal cells
- Decrease GI acid formation by blocking receptors - Nocturnal acid reduced best |
H2 Antagonists "tidines"
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- Proton pump inhibitor
- DOC: GERD - May inhibit P450s |
Omeprazole
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- Administered as prodrugs
- activated in parietal cell - irreversible block of acid formation Uses: - heal duodenal ulcer (4 wk) - Gastric ulcer (8 wk) - GERD (omeprazole is DOC) - Zollinger Ellison syndrome SE: - osteoporosis (decrease Ca absorption) - skin rash, bacterial overgrowth |
Proton pump inhibitors "prazoles"
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- Cytoprotective agent
- polymerizes to provide protective barrier cells in ulcer base - causes constipation (contains Al) |
Sucralfate
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- peptobismol
- Absorbs water - absorbs pathogens - used for travellers diarrhea - Black tongue, mouth & stool - Salicylate: antiinflammatory CI - pts allergic to aspirin - children (Reye's) - asthmatics |
Bismuth Salicylate
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- Cytoprotective agents
- PG E1 analogue - Prevent or reduce NSAID induced damage SE: - diarrhea, nausea, headache, dizzy CI: - Pregnancy (will cause abortion) |
Misoprostol
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- Macrolide ABX used as kinetic agent in diabetic gastroparesis
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Erythromycine
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- Muscarinc agonist used as prokinetic agent in GI
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Bethanechol
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- Prokinetic agent (GI)
- D2 antagonist: increases ACH release - Reduces Gastroesophageal refulx - antiemetic - GI cramping - High doses cause parkinson's symptoms |
Metoclopramide
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- 3 drugs used in tx of irritable bowel syndrome
- Muscarinic antagonist, antispasmodic & TCA for pain |
Glycopyrrolate, dicyclomine, Amytriptiline
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- Antinausea agents
- Serotonin antagonists - few side effects - very effective for nausea & vomiting |
"setrons"
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- 5HT antagonist used for carcinoid & serotonin syndrome
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Cyproheptidine
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- Cannabinoid used for antinausea
- stimulates appetitie - used in chemo induced nausea/vomiting |
Dronabinol
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- Phenothiazines used as antinausea/antiemetics
- Block DA, muscarinic, Histamine receptors - highly sedating - used postop, gastroenterities, chemo, etc |
Prochlorperazine & Promethazine
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- Lubricant/softner (poop)
- emuslifies, softens BMs |
Docusate
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- Laxative
- Bloating & flatulence common - take w/ plenty of water - can alter absorption of drugs |
Bulk forming laxitives (Fiber & psyllium)
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- Osmotic laxative
- prep for colonoscopy |
Polyethylene glycol
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- ocasional use is safe but overuse or chronic use can lead to adverse effects
Uses: - maintaining soft stools - empty bowel for diagnostic or surgical procedure - Get rid of pathogens/toxins - tx constipation CI: - undiagnosied abdominal pain - appendicitis - intestinal obstruction |
Laxatives
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- Mucosal agent laxative
- stimulates peristalsis - enhances secretion & inhibits absorption of H2O |
Senna
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- osmotic laxative
- stimulates GI tract |
Mg hydroxide
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- osmotic diuretic
- used in cirrhosis & liver disease to decrease NH3 - Causes flatulence |
Lactulose
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- Anticonstipate
- PG E1 analogue - activates Cl channels in luminal cells to increase fluid secretion - softer stool & better motility |
Lubiprostone
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- Opiod Mu receptor antagonist
- used as an anticonstipate - useful for post operative constipation due to opiods - should not be used if opiods used for > 7 days preoperatively - For short term hospital use only |
Alvimopan & Methylnaltrexone
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- Gas-X
- coats gas, dissipates - decreases bloating, flatulence |
Simethicone
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- Somatostatin analogue
- used to tx diarrhea caused by GI tumors - decrases release of 5HT, gstrin, CCK - Decreases GI motility |
Octreotide
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- Anti inflammatory activated by bacteria in GI tract
- used in inflammatory bowel disease SE: - allergic rxns possible (salicylates) CI: - Avoid in children (Reye's) |
Sulfsalazine
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- First generation H1 antagonist antihistamine
- sedating - used for motion sickness |
Diphenhydramine
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- first generation H1 antagonist antihistamine
- motion sickness (Dramamine) |
Dimenhydrinate
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- antihistamines
- Enter brain - frequently very sedating (tolerance develops w/ long term use) - used to tx Motion sickness (prophylacitc use before you get sick) - block muscarinic recptors - competitive antagonists - used to dry up secretions - anticholinergic effect (dry mouth) SE: - decreased seizure threshold - similar to atropine poisoning |
First generation H1 antagonists (sedating)
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- First generation H1 antagonist antihistamine
- Sedating |
Hydroxyzine
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- antihistamine
- don't enter brain well - sedation less common - doesnt' have anticholinergic effects - not useful for mition sickness Uses: - allargies - itching SE: - decreased seizure threshold - arrhythmias - sinus tachycardia |
2nd generation H1 antagonist
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- 2nd generation H1 blocker antihistamine
- may also inhibit histamine release - ok in patients w/liver disease |
Cetirizine (Zyrtec)
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- long acting B2 agonist used in asthma tx
- used for prevention & prophylaxis - effects take 20-30 min - Should always be combined w/ steroid |
Salmeterol
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- selective B2 agonists used to tx asthma
- acts immediately - can stop attack in progress - usually inhaled - effects last 4-6 hours |
Albuterol
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- Muscarinic antagonist used to tx asthma
- useful for patients intolerant of B2 agonists - used in COPD - combined with albuterol |
Ipratropium
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- phosphodiesterase inhibitor used in asthma tx
- relaxes smmm, stimulates CNS & heart SE: - CNS: nervousness, insomnia, anxiety, tremor - Cardiac: tachycardia, arrhythmias - Muscles: decreases diaphragm fatigue, increases contraction - weak diuretic - seizures on overdose |
Theophylline
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- inhaled steroids becoming first line of tx
- decrease inflammation - reduce bronchial reactivity - improve response to Beta agonists - few SE because not absorbed systematically (local effects in just lung) - spacer increases delivery to lung SE: - candidasis, thrush - hoarseness |
Corticosteroids
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- Leukotriene inhibitor
- inhibit 5 lipoxygenase - may decrease aspirin sensitive asthma |
Zileuton
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- no effect on attack in progress
- may allow decreased steroid use - few side effects |
Leukotriene inhibitors "Lukasts"
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- Leukotriene receptor antagonist
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Pranlukast
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- inhibits release of histamine from mast cells
- not a bronchodilator - used as prevention - non toxic but tastes bad - DOC: for asthma in kids |
Cromolyn
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- Monoclonal antibody to IgE's receptor
- lowers IgE in circulation - used to tx moderate to severe allergic asthma SE: - rash - injection site reactions - small decrease in platelets |
Omalizumab
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