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195 Cards in this Set
- Front
- Back
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Prevention of Type 2 Diabetes
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Glucose intolerance precedes the development of diabetes
screening tests can identify persons at high risk |
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Insulin
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Typical production by non-diabetic adult is .2-.5 U/kg/day
Aprrox 50:50 split between basal and pranidal (in response to meals) 50% cleared through liver so [portal venous]> [systemic] |
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Formulation of Insulin
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Short Acting
Intermediate Acting (complexed with protamine) Long-acting (crystal suspensions with Zn) |
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Site of Insulin Injection
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Abdomen> buttock> ant thigh> dorsal arm
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Depth of Insulin Injection
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Intramuscular > subcutaneous
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Absorption from these sites compared to IV administration
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Gives systemic levels > portal vein
Slow in onset (30 - 120 min for peak levels) Slow in offset (up to 6hrs)- risk of post-prandial hypoglycemia |
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Sulphonylureas (1st gen)
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Chlorpropamide
Tolbutamide (Obsolete) |
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Sulphonylureas (2nd gen)
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Glibenclamide
Gliclazide |
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Actions of Sulphonylureas
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Acutely release Insulin by depolarizing B-Islet cells
Effect not sustained chronically Significant extapancreatic effects (upregulation of Insulin receptors) |
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How much more potent are second generation sulphonylureas than first generation?
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about 100x
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Side effects of Sulphonylureas
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Hypoglycemia
Hyponatraemiea (potentiate ADH action) |
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Biguandes (metformin) effect on insulin release?
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Do not cause hypoglycemia even in overdose
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Biguandes (metformin) action?
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appears to have post-receptor effect on insulin action
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Biguandes (metformin) used in conjuction with?
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Sulphonylureas
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Rare problem associated with Biguandes (metformin)
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Lactic Acidosis (<1 in 10000 patient-years)
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Biguandes (metformin) avoided if? (contraindications)
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Significant hepatic/renal impairment
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Thiazolidinediones (-glitazones) effect on insulin?
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dos not effect insulin function in normal tissues
effective in various insulin-resistant states |
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Do Thiazolidinedione (-glitazones) cause hypoglycemia? why or why not?
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do not cause hypoglycemia because it doesnt affect insulin function in normal tissues
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How do cyclooxygenase's (Cox Enzymes) work?
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Cyclooxygenase converts arachidonic acid (AA) into various prostaglandins (PGs)
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What forms of Cox Enzymes are there?
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Cox-1, Cox-2, Cox-3
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Cox-1 inhibited by?
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Asprin, advil, aleve, voltaren, daypro, and others
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Cox-2 inhibited by?
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cox-1 inhibitors, vioxx, and celebrex
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Cox-3 inhibited by?
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Cox-1, 2 inhibitors, and tylenol
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NSAID function and effects?
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block the activity of COX's
decrease pain, inflammation, and fever prevent clot formation (heart attack/stroke prevention) Possible prevention of cancer via COX-2 alteration |
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Aspirin
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Many Trade Names
Most widely used NSAID for analgesic and anti-inflammatory effects Used for antipyretic an danticoagulant effects |
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Diclofenac
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Voltaren
More potent that naproxen and several other NSAIDs |
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Diflunisal
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Dolobid
Has potency 3-4 times greater than aspirin For analgesic and anti-inflammatory, not for antipyretic activity |
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Etodolac
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Lodine
Analgesic/Anti-inflammatory fewer side effects than most NSAIDs may have gastric sparing properties |
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Ibuprofin
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Motrin, many others
first nonaspirin NSAID, fewer GI side effects |
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Ketoprofen
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Orudis, Oruvail, others
similar to aspirin relatively short half life (1-2hrs) |
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Ketorolac
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Toradol
Administered orally or by intramuscular injection |
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Nabumetone
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Relafen
Analgesic/anti-inflammatory |
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Naproxen
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Anaprox, Naprsyn, others
similar to ibuprofen |
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Oxaprozin
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Daypro
analgesic and anti inflammatory fewer side effects than other NSAIDs |
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Piroxicam
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Feldene
Long half-life (45 hrs) better tolerated than aspirin |
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Asprin dosage
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Analgesia- 325-650 mg every 4 hr
Anti-inflammation- 3.6-5.4 g/d in divided doses |
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Ibuprofen dosage
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Analgesia- 200-400 mg every 4-6 hr as needed
anti-inflammation 600-800 mg q 4-6 h |
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Ketoprofen dosage
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Analgesia- 25-50 mg every 4-6 hr
anti-inflammation- 150-300 mg/d in 3-4 divided doses |
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Naproxen (Naprosyn) dosage
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Analgesia- 500 mg initially, 250 mg every 6-8 hr
Anti-inflammation- 250, 375, 500 mg BID |
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Naproxen Sodium
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Analgesia- 440-660 mg initially, 220 mg q 6-h hrs
Anti-inflammation- 440 mg BID |
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Complication of Chronic NSAID use
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Liver and Kidney damage
Gastric Ulcers NSAID rebound effect |
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Why does chronic NSAID use cause liver and kidney damage?
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inhibition of PGs that promote blood flow and function in liver and kidney
hepatic toxicity from chronic metabolism of NSAID |
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Reyes syndrome
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a condition that can be triggered when a child takes asprin after an acute viral or bacterial illness
high fever, encephalopathy, fatty liver |
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who shouldn't take asprin?
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children (and some teenagers) who have fevers
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what should be taken instead of asprin in cases of reyes syndrome?
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tylenol or ibuprofen
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why shouldnt they take asprin in cases of reye's syndrome?
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asprin irreversibly inhibits COX
Other NSAIDs and coxibs are reversible |
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Other complications with NSAIDs
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1% population is hypersentive to NSAIDS causing bronchospasm, rhinitis, urticaria, shock
NSAIDs may delay fracture healing by 1 or more weeks Should not be used in patients with acute bleeding/swelling (causes inhibition of COX-1, not allowing platelet aggregation and vasoconstriction) |
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Thromboxane function (TX's)
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blood clot remodeling in acute injuries
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how are cox-1 and thromboxanes related?
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inhibition of COX-1 may lead to increase edema in acute injuries
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COX-2 Pharmaceutical Hypothesis
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COX-2 specific inhibitors (coxibs) will reduce pain, fever, and inflammation without causing gastrointestinal or renal injury
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Acetaminophen (Paracetamol) function
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Analgesic
Anti-pyretic not anti-inflammatory |
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How does acetaminophen (paracetamol) work?
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inhibits COX-3
nociception and pyresis in the brain |
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Dosing for acetaminophen (paracetamol)
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regular- 325-1000 mg q 4-6 hrs
8 hr 625-1250 mg q 8 hours max daily dose- 4000 mg |
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Concern with taking acetaminophen (paracetamol)?
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liver toxicity
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Corticosteroid
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steroid hormones produced by adrenal cortex
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Glucocorticoids
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Metabolism, anti infammation, immune modulation
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Beclomethasone
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Beclovent, vancerilill,, others
Topicak, inhalation, nasal |
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Cortisone
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Cortone
systemic |
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Dexamethasone
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Decadron, Dexasone, others
Systemic, Topical, ophthalmic, otic, nasal |
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Ruocinolone
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Fluorsyn, Synatar, others
Topical |
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Ruticason
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Cultivate, Flonase
Topical, Nasal |
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Hydrocortisone
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Cortef, Dermcort, hydrocortone, many others
sysetmic, topical, ophtlamic |
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Methylprednisolone
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Medrol, others
systemic |
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Prednisone
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Delatsone, Meticorten, others
systemic |
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Triamcinolone
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azmacort, artiscort, nasacort, others
systemic, topical inhalation nasal |
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Osteoarthritis
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Most common type of arthritis
Characterized by the progressive loss of joint cartilage and overgrowth of subchondral bone |
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Hyaluronan
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GAG that helps to hydrate and lubricate the joint
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Glucosamine and Chondroitin
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precursor molecules for many of the more complicated molecules that make up articular cartilage and synovial fluid
glucosamine- 1500 mg/day chondroitin- 1000 mg/day Methylsulfonylmethane (MSM)- 1000-4000 mg/day |
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Rheumatoid Arthritis
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Autoimmune disorder characterized by sever inflammation of they synovium
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What is RA caused by?
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overproduction of inflammatory cytokine (TNF-alpha)
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DMARDs
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Disease-modifying antirheumatic drugs designed to reverse or halt the progression of RA
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Gold Drugs for RA
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Auranofin (Ridaura)- Oral
Intramuscular- Aurothioglucose (Solganal) |
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Leflunomide (Arava)
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inhibits synthesis of RNA precursors in lymphocytes
effective in reducing pain and joint erosions |
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Methotrexate (Rheumatrex)
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most effective DMARD
limits lymphocyte proliferation |
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TNF-alpha inhibitors
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Entancercept (Enbrel)
Infliximab (Remicade) Adalimumab (Humira) |
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Alpha-1 Receptor acts on?
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vascular smooth muscle: vasoconstriction
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Agonist use alpha-1 receptor?
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Hypotension, Nasal congestion, Paroxysmal supraventricular tachycardia
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Antagonist use alpha-1 receptor?
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Hypertension
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Alpha-2 receptor acts on?
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CNS synapses (inhibitory)
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Alpha-2 receptor Agonist Use
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Hypertension
Spasticity |
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Alpha-2 receptor antagonist use
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No significant clinical use
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Beta-1 Receptor primary receptor location response when stimulated?
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Heart: increased heart rate and force of contraction
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Agonist use Beta-1 receptor?
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cardiac decompensation
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Antagonist Use
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Hypertension
Arrhythmia Angina pectoris heart failure prevention of reinfarction |
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Beta-2 receptor primary receptor location response when stimulated
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bronchioles- bronchodilation
uterus- relaxation |
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Beta-2 receptor agonist use
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prevent bronchospasm, premature labor
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Beta-2 receptor antagonist use
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no significant clinical use
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alpha 1 adrenergic receptor activation causes
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smooth muscle contraction and vasoconstriction
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Acute hypotension characterized by?
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shock, general anesthesis
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treatment of hypotension?
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Mephenteraine (Wyamine) and Methoxamine (Vasoxyl)
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Treatment for blood shot eyes
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tetrahyrozoline (Visine)
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Nasal congestion/bloody nose (epistaxis) treatment
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phenylephrine (neo-synephrine)
oxymetazoline (afrin) pseudoephedrine (sudafed) |
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Mixed alpha/beta agonists do what
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activate both alpha and beta agonists
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mixed alpha/beta agonists
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Amphetamine, epinephrin, norepinephrine
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alpha adrenergic receptor antagonists
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primarily used to cause peripheral vasodilation
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alpha adrenergic receptor antagonists
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Prazosin (minipress)
Terazosin (Hytrin) Doxazosin (Cardura) |
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Beta adrenergic receptor antagonists are used?
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to decrease heart rate and cardiac contractility
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Atenol
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Trade Name- Tenormin
Selectivity- Beta-1 Primary Indications- Angina pectoris, hypertension, prevent reinfarction |
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Carteolel
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Cartrol
Nonselective Hypertension |
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Propranolol
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Inderal
Nonselective Angina pectoris, arrhythmias, hypertension, prevent reinfarction, prevent vascular headache |
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Timolol
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Blocadren
Nonselective Hypertension, prevent reinfarction, prevent vascular headache |
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ACE inhibitors (angiotensin converting enzyme) do what?
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block the conversion of angiotensin 1 to angiotensin II
use dto treat mild-moderate hpyertension |
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ACE inhibitors
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Captopril (Capoten)
Lisonopril (Prinivil) |
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Angiotension II receptor inhibitors
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Losartan (Cozaar)
Valsartan (Diovan) |
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Clacium channel blockers used to?
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block the entry of Ca2+ into vascular smooth muscle cells
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effects of ca2+ blockers?
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lead to vasodilation, decreased heart rate, and cardiac contractility
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Ca2+ blockers
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Verapamil (Calan)
Diltiazem (Cardizem) |
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Minoxidil
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(Lontiten, Rogain)
Not commonly used for hypertension, comonly used for allopecia |
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Hydralizine
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(Apresoline)
used to treat hypertensive emergencies and preeclampsia |
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Diazoxide
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(Hyperstat)
Used to treat hypertensive emergencies and preeclampsia |
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Atorvastatin
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(Lipitor)
decrease cholesterol |
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Simvastatin
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(Zocor)
decrease cholesterol |
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Pravastatin
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(Pravachol)
decrease cholesterol |
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enoxeparin
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(Lovenox)
low molecular weight heparins inhibit synthesis and function of clotting factors |
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Warfarin
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(Coumadin)
inhibit synthesis and function of clotting factors |
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Aspirin use as anticoagulant
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inhibit platelet aggregation and platelet-induced clotting
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Clopidogret
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(Plavix)
inhibit platelet aggregation and platelet-induced clotting |
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Biofilms are?
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(slime) collections of various microorganisms in a community
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Biofilm matrix provides?
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protection, anchoring and nutrition for residnet
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Triclosan works by and is used for?
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inhibits bacterial fatty acid synthesis
antiseptic |
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is triclosan more effective than standard soap in destroying bacteria?
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no, but may have residual, long term benefits
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Ethanal or isopropyl alcohol (60-70%) is used as and is effective against?
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hand sanitizer
fairly effective against bacteria |
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Hydrogen peroxide works by?
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forming hydroxyl radicals which are potent membrane disruptors
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Povidone-iodine works by and is effective against?
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(Betadine)
Iodinates fatty acids and is fairly effective against most microorganisms |
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Chlorhexidine gluconate works by and is used for?
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(hibiclens) disrupts bacterial membranes and is used as antiseptic scrub
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B-lactam antibiotics
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inhibit organziation of polysaccharide layers of cell wall
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penicillins
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first and most widely used antibiotics
penicillin (narrow) Amoxicillin (broad) Ampicillin (broad) |
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cephalosporins
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used for patients that have penicillin allergies or if penicillin is poorly tolerated or ineffective
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Cephalexin
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(Keflex) 1st generation cephalosporin for gram-broad and gram +cocci
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Cefaclor
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(Ceclor) 2nd generation cephalosprin
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Ceftriaxone
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(rocephin) 3rd generation (best of all cephalosporins)
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Cefepime
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(Maxipime) 4th generation
broad spectrum for both gram + and gram - |
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Bacitracin
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Topical formulation for broad spectrum
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Vancomycin
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antibiotic of last resort administered via PICC line
treatment of methicillin-resistant staphylococcus aureus |
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Biofilms are?
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(slime) collections of various microorganisms in a community
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Biofilm matrix provides?
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protection, anchoring and nutrition for residnet
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Triclosan works by and is used for?
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inhibits bacterial fatty acid synthesis
antiseptic |
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is triclosan more effective than standard soap in destroying bacteria?
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no, but may have residual, long term benefits
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Ethanal or isopropyl alcohol (60-70%) is used as and is effective against?
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hand sanitizer
fairly effective against bacteria |
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Hydrogen peroxide works by?
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forming hydroxyl radicals which are potent membrane disruptors
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Povidone-iodine works by and is effective against?
|
(Betadine)
Iodinates fatty acids and is fairly effective against most microorganisms |
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Chlorhexidine gluconate works by and is used for?
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(hibiclens) disrupts bacterial membranes and is used as antiseptic scrub
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B-lactam antibiotics
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inhibit organziation of polysaccharide layers of cell wall
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penicillins
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first and most widely used antibiotics
penicillin (narrow) Amoxicillin (broad) Ampicillin (broad) |
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Cephalosporins
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used for patients that have penicillin allergies or if penicillin is poorly tolerated or ineffective
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Generation 1 cephs
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Cephalexin (Keflex)
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Generation 2 cephs
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Cefaclor (Ceclor)
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Generation 3 cephs
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Cetriaxone (Rocephin)
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Generation 4 cephs
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Cefepime (maximpime)
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Bacitracin
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Broad spectrum topical for both gram positive and negative
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Vancomycin
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antibioticof las resort for life threatening infections
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Aminoglycosides
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irreversibly bind to bacetrial ribosomes
Gentamycin, Kanamcin (kantrax) neomycin, streptomycin |
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Macrolides
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inhibit tRNA interaction with ribosomes
erythromycin, azithromycin (zithromax) |
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Tetracyclines
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inhibit translation or peptide bond formation in the ribosome
Doxycycline, Tetracycline |
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Cephalosporins
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used for patients that have penicillin allergies or if penicillin is poorly tolerated or ineffective
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Generation 1 cephs
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Cephalexin (Keflex)
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Generation 2 cephs
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Cefaclor (Ceclor)
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Generation 3 cephs
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Cetriaxone (Rocephin)
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Generation 4 cephs
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Cefepime (maximpime)
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Bacitracin
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Broad spectrum topical for both gram positive and negative
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Vancomycin
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antibioticof las resort for life threatening infections
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Aminoglycosides
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irreversibly bind to bacetrial ribosomes
Gentamycin, Kanamcin (kantrax) neomycin, streptomycin |
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Macrolides
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inhibit tRNA interaction with ribosomes
erythromycin, azithromycin (zithromax) |
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Tetracyclines
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inhibit translation or peptide bond formation in the ribosome
Doxycycline, Tetracycline |
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Clindamycin
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(Cleocin)
inhibit tRNA interaction with ribosomes |
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Fluroquinolones
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Ciprofloxacin (Cipro), Levofloxacin (Levaquin)
inhibt bacterial DNA/RNA synthesis or function |
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Sulfonamides
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Sulfadiazine (Silvadene)
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Rifampin
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(Rifadin)
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Mupirocin
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(Bactroban)
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Imiquimod
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(Aldara)
topical cream that promotes activation of immune system (HPV) |
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Acyclovir
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(Zovirax) topical or oral for herpes simplex
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Valacyclover
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(Valtrex)
pro form of acyclovier, oral can also be used for herpes zoster infection |
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Docosanol
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(Abreva)
topical for herpes labialis |
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Ganciclover
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(Cytovene)
viral DNA polymerase inhibitor |
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Valgancyclovir
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(Valcyte)
prodrug of ganciclovir |
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Penciclovir
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(Denavir)
herpes zoster and simplex, viral DNA polymerase inhibitor |
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Famciclover
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(Famvir)
prodrug of penciclovir |
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Oseltamivir
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(Tamiflu)
influencza A and B |
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Zanamivir
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(Relenza)
influenza a and b inhibit viral budding/shedding from host cells |
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Amantadine
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(Symmetrel)
influenza A inhibit the release of viral RNA from the capsid |
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Rimantadine
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(flumadine)
influenza A inhibit the release of viral RNA from the capsid |
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Nucleoside revers transcriptase inhibitors
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blocks viral (and non-viral) DNA synthesis
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Azidothymidine (AZT)
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Retrovir, Zidovudine
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Non-nucleoside revers transcriptase inhibitors
|
efavirenz (sustiva)
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Protease Inhibitors (PI)
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Atanzavir (Reyataz)
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HIV Integrase Inhibitors
|
Raltegravir (Isentress)
Block the HIV integrase enzyme |
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HIV Entry inhibitors
|
Enfuvirtide (Fuzeon)
|
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Permethrin
|
topical anti lice and scabies
|
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Ivermectin
|
(stromectol)
oral anti lice and scabies |
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Tolnaftate
|
(tinactin)
topical anti fungal |
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Ketoconzazole
|
(Nizoral
topical anti fungal |
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Miconazole
|
(monistat)
topical or oral anti fungal |
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Lamisil
|
Terbinafine
topical or oral antifungal |
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Praziquantel
|
(biltricide) increase Ca2+ permeatbility anti worm
|
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Niclosamide
|
(Niclocide)
anti worm |
