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178 Cards in this Set
- Front
- Back
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What is the potential harm of acyclovir to a nursing child?
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None
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What is the potential harm of metronidazole to a nursing child?
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Unknown effect on infant but is a known in vitro teratogen-->breast feeding must be stopped when mother is taking it
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What is the potential harm of cholamphenicol to a nursing child?
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may cuase idiosyncratic bone marrow suppression
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What is the potential harm of fluroquinolones to a nursing child?
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May affect cartilage development in infant
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What is the potential harm of nitrofurantoin or sulfur drugs to a nursing child?
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may cause hemolysis in G6PD baby
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DOC for Actinomyces israelii
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Penicillin G
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What is the MOA of isoniazid?
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It is a mycolic acid synthesis inhibitor
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MOA of fluoroquinolones
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blocks DNA gyrase
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What recombinant cytokine has been implicated in the treatment of MS?
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Beta-interferon
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MOA and use somatropin
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-Growth hormone analog
-Use: GH deficiency, cachexia |
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MOA and use octreotide
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-somatostatin analog, suppresses secretion of substances such as serotonin
-serotonin syndrome, acromegaly, gigantism, thyrotropinoma |
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MOA and use phentolamine
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-non-selective alpha blocker
-pheochromocytoma |
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MOA and use leuprolide
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-GnRH analog
-prostate cancer |
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MOA and use hydroxyurea
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-interferes with DNA synthesis by inhibiting ribonucleotide reductase
-anti-cancer agent |
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What is fomepizole?
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Antidote to methanol or ethylene glycol (antifreeze) poisoning
-->Ethanol can also be used, but has more side effects |
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What are the short acting insulins?
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Regular insulin, insulin lispro, insulin aspart, and insulin glulisine
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What are the intermediate acting insulins?
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Lente, NPH, Humulin 70/30
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What are the long acting insulins?
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ultralente, insulin glargine, insulin determir
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What is the HBA1C to be considered diabetic?
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Greater than or equal to 6.5%
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What medicines are in the biguanide class?
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Metformin
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MOA of Metformin
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Work to inhibit the absorption of glucose from the gut, to decrease glucose output by the liver, and to increase glucose uptake in adipose tissue and skeletal muscle
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Who should avoid Metformin?
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-Those who abuse alcohol
-Severe CHFers -Liver failure patients -Kidney failure patients |
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Name the Alpha-glucosidase inhibitors.
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Acarbose, Miglitol
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What is a major ADR of the alpha-glucoidase inhibitors?
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Flatulence
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MOA of glitazones
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Sensitize the skeletal muscle and fat tissue to insulin by increasing the number of insulin receptors and glucose transporters.
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ADRs of the glitazones.
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-Weight gain, edema, new onset heart failures, and exacerbation of pre-existing heart failure.
-hepatotoxic=monitor LFTs -Rosiglitazone not to be used with nitrates or insulin |
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MOA of Meglitinides and Sulfonyureas.
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Work to promote insulin release from Beta-islet cells
-Sulfonyureas have decreased effect after long-term treatment |
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What are the first generation sulfonyureas?
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Tolbutamide, Chlorpropamide, Tolazamide
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What are the second generation sulfonyureas?
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Glimepiride, Glyburide, Glipizide
-->Up to 200 times more potent than first generation agents |
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What are ADRs/contraindications to sulfonureas?
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-disulfiram-like reaction
-water retention -Should not be used in elderly, renal, or kidney patients |
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Major ADR of metformin
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lactic acidosis
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Major ADR of meglitinides
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hypoglycemia
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Major ADR of Pramlinitide
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hypoglycemia and nausea
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What are the two classes of incretin system agonists?
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DPP-4 inhibitors and GLP-1 analogues
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What are the DPP-4 inhibitors?
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sitagliptan and saxagliptan
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What are the GLP-1 analogues?
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Exenatide, liraglutide
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What is the general MOA of incretins?
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They are hormones that are released by the GI cells after a meal to enhanse insulin secretion
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What incretin has an increased risk for pancreatitis?
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Exenatide-->more seriously and sitagliptan
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What incretin is associated with increased rates of medullary cell carcinoma of the thyroid?
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Liraglutide
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What is DOC and what is first line therapy for hypertriglyceridemia?
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-DOC: fibric acid agents: clofibrate (not used often, gemfibrozil, fenofibrate
-First line therapy: Diet modification |
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ADRs of Fibric acid agents.
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Formation of gallstones, cardiac dysrhythmias, increase in malignancies, and a risk for myopathy and rhabdomyolysis
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Contraindications to bile acid sequestrants
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Hypertriglyceridemia-->it raises tryglycerides
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ADRs of HMG-CoA reductase inhibitors
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hepatotxicity
myopathy that can progress to rhabdomyolysis |
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What does stimulation of the ACh and gastrin receptors on the stomach cause an influx of?
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Calcium
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What does calcium activate in the stomach in order to pump H+ ions into the stomach lumen?
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Activates protein kinase to stimulate the proton pump
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What are the side effects of Cimetidine?
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Anti-androgenic-->gynecomastia, galactorrhea, decreased sperm count
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What does misoprostol do?
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-analog of PGE2, works to decrease HCL secretion
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ADRs of PPIs
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-Increased gastric carcinoids from decreased HCl state in stomach and increased gastrin state
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What is the antimuscarinic agent that acts only on M1 receptors and is usually reserved just for Zollinger-Ellison patients?
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Pirenzepine
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What does sucralfate do?
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Provides mucosal protection because it binds to positively charged groups in proteins of normal and necrotic mucosa.
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Uses of sucalfate
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Protection or prevention of duodenal ulcers
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What does stimulation of D1 receptors cause?
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Renal and mesenteric vasodilation
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What does stimulation of D2 receptors cause?
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Decreased NE release
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What non-selective alpha blocker can be used in the diagnosis of pheo?
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Phetolamine
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What is the MOA of prazosin and terazosin in BPH? What kind of drug are they?
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-they decrease the tone of the porstatic urethral smooth muscle
-they are alpha-1 blockers |
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What kind of drug is clonidine?
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Central alpha-2 agonist-->results in decreased sympathetic flow
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Which beta blockers must be used in asthmatics?
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-BEAM drugs-->they are B1 selective
-B2 activity causes bronchoconstriction |
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Uses of Terbutaline
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-B-2 agonist used in asthma and to decrease premature contractions
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MOA of reserpine
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-prevents NE and dopamine from getting packaged into vesicles, thus they remain in the cell cytoplasm and are degraded to MAO, never having effect
-used for hypertension and psychosis |
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MOA of Guanethidine
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-prevents NE and dopamine from getting packaged, as well as blocks release of any prepackaged NE, thus these substances cannot have their extra-cellular effect
-used for hypertension |
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List the cholinesterase inhibitors
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physostigmine
neostigmine Edrophonium Organophosphates |
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Uses of cholinesterase inhibitors.
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myasthenia gravis
Organophosphates-->closed angle glaucoma |
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What is the antidote to organophosphates?
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atropine or pralidoxime (2-PAM)
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MOA and uses of Bethanechol
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-stimulation of muscarinic receptors
-used for atonic bladders to increase tonicity |
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Uses for pilocarpine and carbachol
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-Cause miosis via stimulation of M receptors
-used for acute angle glaucoma |
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What class of durgs are atropine and scopolamine?
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Anti-muscarinics
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What are the antinicotinic drugs used for?
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Produce complete muscle relaxation and are primarily used during surgery
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What are the two non-depolarizing antinicotinic muscle blockers?
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Tubocurarine and Pancuronium
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What is the depolarizing antinicotinic blocker?
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Succinylcholine
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MOA of Tubocurarine
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prevents ACh binding
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MOA of Succinylcholine
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Acts like ACh and binds at ACh receptors, persisting and causing flaccid paralysis
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Where are M1 receptors located?
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ANS ganglia, brain, gastric parietal, vacular smooth muscle
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Where are M2 receptors located?
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heart
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Where are M3 receptors located?
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glands and bronchial smooth muscle
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Where are M4 and M5 receptors located?
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CNS
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Which cholinergic and adrenergic receptors work via stimulation of phospholipase C?
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M1, M3, M5 and Alpha 1
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Which cholinergic and adrenergic receptors work via stimulation of adenylate cyclase?
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Beta
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Which cholinergic and adrenergic receptors work via inhibition of adenylate cyclase?
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M2, M4, Alpha 2
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Progesterone side effects
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Hirsutism
Weight gain Depression Acne |
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Estrogen Side effects
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Skin pigmentation
Breathrough bleeding Breat tenderness N, V hypertension |
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List the major estrogens
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diethylstilbestrol
estrone mestranol ethinyl estradiol |
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List the major progesterones.
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hydroxyprogesterone
norethindrone norgestrel |
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What is the unique effect of the Kappa receptor affect by opiods?
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Sedation/dysphoria
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Where are there opiod receptors?
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-limbic system
-periphery -receptors in CNS other than limbic system-->spinal cord, brainstem, medial thalamus |
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Why is heroin easily able to cross the BBB?
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Because it is acetylated
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What are the levo and dextro forms of propoxyphene used for respectively?
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-levo: antitussive
dextro: analgesic for mild to moderate pain |
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List the TCA drugs.
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amitriptyline,
clomipramine, despipramine, imipramine, doxepin, maprotiline-->rarely used, not in kids nortriptyline protriptyline trimipramine |
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What substances do TCAs block?
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-Block reuptake of NE and serotonin
-also block muscarinic, alpha, and histamine receptors |
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What is a non-depression use for TCAs?
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Enuresis-->due to their anticholinergic effects
-->Atropine is used for this reason as well |
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What are the side-effects of TCAs?
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-Anticholinergic: xerostomia, constipation, urinary retention, aggravation of glaucoma, blurred vision, risk of seizures.
-Others: reflex tachy, orthostatic hypotension (alpha blocking effects) |
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What are the indications for SSRIs?
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depression
bulimia nervosa OCD anorexia nervosa panic disorder diabetes-related neuropathic pain PMS |
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Side effects of SSRIs
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loss of libido
delayed ejaculation weight gain anorgasmia |
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List the SSRIs
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citalopram
escitalopram fluoxetine paroxetine sertraline fluvoxamine |
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List the SNRIs.
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Desvenlofaxine
Duloxetine Venlafaxine |
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List the MOAIs.
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Phenelzine
Isocarboxazid Tranylcypromine Selegiline-->MAOI diet only required higher dosing |
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What are the side effects of Venlafaxine?
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Headache, weight loss, loss of libido, and increased blood pressure
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MOA of Venlafaxine and Duloxetine
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inhibit the reuptake of NE and serotonin
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MOA of MAOI
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Inactivate MAO (monoamine oxidase) allowing transmitters to escape degradation and to leak into the synaptic cleft
-Increased amounts of NE and serotonin become available. |
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MOA of lithium
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interferes with the normal function of Na+ ions to produce numerous changes in neurotransmitter activity in the brain
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Side effects of lithium
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Muscle tremor, ataxia,acquired diabetes insipidus, twitching, seizures.
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What congenital defect can lithium cause?
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Ebsteins anomaly of the heart
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What congenital anomalies do carbamazepine and valproic acid cause?
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neural tube defects
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What diseases can lamotrigine be used to treat?
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seizure disorder and bipoolar disorder
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What are the ADRs of lamotrigine?
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Steven-Johnsons, drug-drug interactions
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What is the MOA of lamotrigine?
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inhibits voltage-gated NA+ channels, prolonging the relative refractory period
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What diseases can topiramte treat?
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bipolar disorder, seizure disorder, migraines
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What are the ADRs of topiramte?
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headache, paresthesias, increased risk for URIs, weight loss, renal stones, temporary or permanent blindness
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MOA of topiramate
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works to enhance GABA-activated chloride channels, allowing chloride entry into neurons and subsequent inhibition of neuronal activity.
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MOA of valproic acid
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Increases the concentration of GABA in brain
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Side effects of Valproic acid
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thrombocytopenia, GI problems, risk for fatal hepatic failure, risk for fatal pancreatitis
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What channels does carbamazepine work one?
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voltage gated Na+ channels
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ADRs of carbamazepine
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Stevens-Johnson, migraines, arrythmias, bone marrow suppression
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DOC for trigeminal neuralgia
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Carbamazepine
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Uses of gabapentin
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Seizure disorder and neuropathic pain
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MOA of methylxanthines
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-calcium influx and decreased histamine release by inhibiting phosphodiesterase and blocking adenosine receptors-->increased cAMP
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What are the effects of nicotine at low doses?
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Stimulator-->increases BP, causes euphoria, arousal, relaxation, and improves attention, learning, and problem-solving skills
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MOA of cocaine
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Reuptake inhibitor of NE, serotonin, and dopamine
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What drug is the only local anesthetic that causes vasoconstriction?
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cocaine
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Are amphetamines more or less addictive than cocaine? Why?
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less addictive because euphoria lasts longer
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MOA of amphetamines
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Release intracellular stores of catecholamines as well as block MAO.
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MOA of buspirone
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Primarily stimulation 5-HT1 receptors
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ADRs of Benzos
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dorwsiness, confusion, ataxia (at high dose
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MOA of Benzos
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enhanced binding of GABA receptor by GABA resulting in stimulation of Cl entry and inhibition of the neuron
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Use of diazepam
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Anxiolytic and muscle relaxant
DOC for status epilepticus |
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Use of Chlordiazepoxide
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acute treatment of alcohol withdrawal
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Use of lorazepam and alprazolam
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anxiety disorder
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Triazolam ADR
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rapidly eliminated=severe withdrawal symptoms
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Use of Temazepam and flurazepam
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sleep disorders
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MOA of barbiturates
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Act to interfere with the Na/K transport system of cell membranes, increasing GABA action and enhancing chloride entry into neurons
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In what type of patients are barbiturates contraindicated?
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Patients with acute intermittent poryphyria
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Use of phenobarbital
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long term seizure disorder control
status epilepticus eclampsia DOC for febrile seizures in kids |
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Use of thiopental
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anesthesia
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Who is antihistamine use contraindicated in?
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patients with: BPH, bladder obstruction, narrow angle glaucome
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Name the first generation antihistamines (sedation qualities).
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Cetrizine
Chlorpheniramine Clemastine Diphenhydramine Hydroxyzine Promethazine |
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Name the second generation antihistamines (non-sedating)
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Descloratadine
loratadine Fexofenadine |
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What is MAC?
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Concentration of anesthetic gas (inhaled) needed to eliminate movement in a patient challeneged by a standard skin incision.
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What does a low MAC indicate?
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High potency
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What is the induction agent of choice for shock patients and those with acute bronchospasm?
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Ketamine
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What are the local anesthesia agents?
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Procaine, bupivacaine, tetracaine, lidocaine
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N-acetylcysteine is the treatment for what kind of overdose?
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Acetaminophen OD
There is no antidote for aspirin. Be sure to distinguish between these two!!! |
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MOA of triptans.
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-Act as agonists at the serotonin 1b/1d receptor to cause vasocontriction and relieve migraines.
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MOA of Ergotamine
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5-HT2 serotonin agonist to cause vasoconstriction
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MOA of and use of cyproheptadine
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-blocks 5HT2 receptors
-prevention of migraine and cluster headaches |
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MOA of and use of -setrons
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-5-HT3 antagonists
-anti-emetics |
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MOA and use of metoclopramide
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-5HT4 agonist
-minimized gastroparesis and vomiting |
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MOA of buspirone
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-5HT1 agonist
-anxiolytic |
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Tx for CML
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Imatinib
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What are the uses for cyclophosphamide?
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-Non-Hodgkins lymphoma
-autoimmune renal diseases - |
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What anti-cancer drug used to treat Non-Hodgkin's lymphoma has been associated with the development of transitional cell carcinoma of the bladder?
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Cyclophosphamide
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MOA of fibrates
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-Upregulate lipoprotein lipases
-this then promotes breakdown of VLDL - |
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MOA of ezetimibe
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-Prevents the absorption of cholesterol from the GI tract
-decreases LDL |
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What is the use of zolpidem and zaleplon?
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Short-term treatment of insomnia
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Which drugs CANT histamines be taken with?
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MAO inhibitors
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Which drugs, when used in combination with drugs like macrolide antibiotics, ketoconazole, and itraconazole, can predispose one to arrythmias?
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2nd generation antihistamines
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What inhaled anesthetic is hepatotoxic for adults but not kids?
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Halothane
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What inhaled anesthetic is contraindicated in patients with kidney failure?
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Enflurane
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DOC for induction of general anesthesia
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propofol
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MOA of propofol
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Stimulation of GABA receptors to cause CNS depression
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MOA of ketamine
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works to block the NMDA receptor-->CNS depression
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List the first generation antipsychotics.
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Chlorpromazine
fluphenazine haloperidol droperidol loxapine molindone perphenazine thioridazine thiothixene trifluoperazine |
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Which first generation, typical antipsychotic carries a risk for producing QT prolongation, torsade de pointe or sudden death?
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Thioridazine
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What are the second generation, atypical antipsychotics?
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aripiprazole
clozapine olanzapine paliperidone quetiapine risperidone ziprasidone |
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What are the general ADRs of the atypical antipsychotics?
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Weight gain, hyperlipidemia, hyperglycemia, diabetes mellitus
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Describe neuroleptic malignant syndrome.
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-can occur with use of any antipsychotic
-more likely to occur in first two weeks with rapid or large increases in dose -muscle rigidity, high fever, autonomic instability, elevated CPK -treated with dantrolene |
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Drugs used for tonic-clonic seizures.
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Phenytoin, carbamazepine, phenobarbital
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DOC for petit mal seizure
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Ethosuximide
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DOC for febrile seizures
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phenobarbital
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What seizure drugs can cause blood dyscrasias?
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Carbamazepine and Ethosuxamide
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Hepatotoxic anti-epileptics.
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Valproic acid and Carbamazepine
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DOC for post-herpetic neuralgia
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Gabapentin
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MOA of -Azoles
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Ergosterole synthesis inhibitors
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DOC for BPH
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5-alpha reductase inhibitors
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Which are the macrolide antibiotics?
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erythromycin, azithromycin, and clarithromycin
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MOA of fluoroquinolones
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inhibits DNA gyrase
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Which antibiotic is a transcription inhibitor?
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Rifampin
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Describe HELLP.
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hemolysis
elevated liver enzymes low platelets |
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Describe placenta previa.
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implantation of the placenta either partially or completely over the internal cervical os
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MOA of ethosuximide
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Blocks calcium channels in the thalamus
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