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258 Cards in this Set

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Carbonic anhydrase inhibitor*
Acetazolamide
Diuretic used for mountain sickness and glaucoma*
Acetazolamide
SE of acetazolamide
Paresthesias, alkalization of the urine
(which may ppt. Ca salts), hypokalemia,
acidosis, and encephalopathy in patients
with hepatic impairment
MOA of Loop Diuretics
Inhibits Na+/K+/2Cl- cotransport
Site of action of loop diuretics *
Thick ascending limb
SE of loop (furosemide) diuretics*
Hyperuricemia, hypokalemia and ototoxicity
Aminoglycosides used with loop diuretics potentiate what adverse effect?
Ototoxicity
Loops lose and thiazide diuretics retain *
Calcium
MOA of thiazide diuretics
Inhibit Na+/Cl- cotransport
Site of action of thiazide diuretics *
Work at early distal convoluted tubule
Class of drugs that may cause cross-sensitivity with thiazide diuretics.
Sulfonamides
SE of thiazide (HCTZ) diuretics*
Hyperuricemia, hypokalemia and hyperglycemia
Potassium sparing diuretics inhibit *
Na+/K+ exchange
Diuretic used to treat primary aldosteronism *
Spironolactone
SE of spironolactone*
Gynecomastia hyperkalemia, and impotence
Osmotic diuretic used to treat increased intracranial pressure*
Mannitol
Inhibit angiotensin-converting enzyme (ACE) *
ACE inhibitors
Captopril and enalapril (-OPRIL ending) are *
ACE inhibitors
SE of ACE inhibitors *
Dry cough, hyperkalemia
ACE inhibitors are contraindicated in *
pregnancy and with K+
Losartan and valsartan block *
Angiotensin receptor
Angiotensin receptor blockers do NOT cause *
Dry cough
Agents that block L-type calcium channel
Calcium channel blockers
CCB contraindicated in CHF *
Verapamil
CCB with predominate effect on arteriole dilation
Nifedipine
SE of CCB *
Constipation, edema, and headache
Agents that reduce heart rate, contractility, and O2 demand*
Beta-blockers
B-blockers that are more cardioselective
Beta-1 selective blockers
Cardioselective Beta 1-blockers *
Atenolol, acebutolol, and metoprolol
Beta-blockers should be used cautiously in
Asthma (bronchospastic effects), diabetes (block signs of hypoglycemia)and peripheral vascular disease
Non-selective Beta-blocker also used for migraine prophylaxis
Propranolol
SE of beta blockers*
Bradycardia, SEXUAL DYSFUNCTION, decrease in HDL, and increase in Triglycerols (TG)
Alpha 1-selective blockers*
Prazosin, terazosin and doxazosin (-AZOSIN ending)
Non-selective Alpha1blockers use to treat pheochromocytoma
Phenoxybenzamine
For rebound HTN from rapid clonidine withdrawal
Phentolamine
A1a-selective blocker with no effects on HTN used for BPH*
Tamsulosin (Flomax)
SE of alpha blockers*
Orthostatic hypotension (especially with first dose) and reflex tachycardia
Presynaptic Alpha 2 agonist used in HTN, and acts centrally
Clonidine, and methyldopa
SE of methyldopa
Positive Coomb's test, depression
Methyldopa is contraindicated in*
Geriatrics due to its CNS (depression) effects
SE of clonidine
Rebound HTN, sedation, dry mouth
Direct vasodilator of arteriolar smooth muscle
Hydralazine
SE of hydralazine *
Lupus-like syndrome
Arterial vasodilator that works by opening K+ channels
Minoxidil
SE of minoxidil
Hypertrichosis
IV Drug used Hypertensive Crisis
Nitroprusside
Nitroprusside vasodilates
Arteries and veins
Toxicity caused by nitroprusside and treatment
Cyanide toxicity treated with sodium thiosulfate
MOA of Cardiac glycosides (eg. digoxin)
Indirectly increase intracellular calcium and cardiac contractility by inhibiting Na+/K+ ATPase
Digoxin is used in
Atrial fibrillation and CHF
Digoxin toxicity can be precipitated by
Hypokalemia
Antidote for digoxin toxicity
Digibind
Phosphodiesterase inhibitors that increase mortality and have been found to have NO beneficial effects
Amrinone and milrinone
SE of amrinone
Thrombocytopenia
Beta 1 agonists used in acute CHF
Dobutamine and dopamine
Diuretics work in CHF by
Reducing preload
Beta blockers work in CHF by
Reducing progression of heart failure (never use in acute heart failure)
Peptide drug used to treat CHF
Nesiritide (BNP)
MOA of nesiritide
Increasing sodium excretion and decreases arterial and venous tone
SE of nesiritide
Excessive hypotension and kidney failure
Agent used in CHF that is a selective alpha and nonselective beta blocker
Carvedilol
Agent used in acutely decompensated CHF resembling natriuretic peptide
Nesiritide (Natrecor)
Nonselective alpha-blocking drug, long acting and irreversible, and used to treat pheochromocytoma. Blocks 5-HT, so occasionaly used for carcinoid tumor. Blocks H1 and used in mastocytosis
Phenoxybenzamine
Nonselective alpha-blocking drug, short acting and reversible, used for rebound HTN from rapid clonidine withdrawal, and Raynaud's phenomena
Phentolamine
Selective Alpha 1 blocker used for hypertension, BPH, may cause first dose orthostatic hypotension *
Prazosin, terazosin, doxazosin
Selective Alpha-1A blocker, used for BPH, but with little effect on HTN
Tamsulosin
Selective Alpha 2 blocker used for impotence (controversial effectiveness)
Yohimbine
What do alpha cells in the pancreas produce?
Glucagon
What do beta cells in the pancreas produce?
Insulin
Where are beta cells found in the pancreas?
Islets of Langerhans
What do delta cells in the pancreas produce?
Somatostatin
Product of proinsulin cleavage used to assess insulin abuse
* C-peptide
Exogenous insulin contains *
Little C-peptide
Endogenous insulin contains
Normal C-peptide
Very rapid acting insulin, having fastest onset and shortest duration of action
Lispro (Humalog), aspart, glulisine
Rapid acting, crystalline zinc insulin used to reverse acute hyperglycemia
Regular (Humulin R)
Long acting insulin *
Ultralente (humulin U)
Ultra long acting insulin, has over a day duration of action
Glargine (Lantus), detemir
Major SE of insulin
Hypoglycemia
Important in synthesis of glucose to glycogen in the liver
GLUT 2
Important in muscle and adipose tissue for glucose transport across muscles and TG storage by lipoprotein lipase activation
GLUT 4
Examples of alpha-glucosidase inhibitors (AGI)
Acarbose, miglitol
MOA of AGI's (alpha-glucosidase inhibitors)
Act on intestine, delay digestion and absorption of glucose formed from digestion of starch and disacchrides
SE of AGI's (alpha-glucosidase inhibitors)
Flatulence (do not use beano to tx), diarrhea, abdominal cramps
Alpha-glucosidase inhibitor associated with elevation of LFT's
Acarbose
Amino acid derivative, active as an insulin secretagogue *
Nateglinide
MOA of nateglinide
Insulin secretagogue - closes ATP sensitive K+ channel
Biguanide
Metformin
Drugs available in combination with metformin
Glyburide, glipizide, and rosiglitazone
MOA of metformin
Decreases hepatic glucose production and intestinal glucose absorption; increase insulin sensitivity
Vascular effects of metformin
Decreased micro and macro vascular disease
Most important potential SE of metformin
Lactic acidosis
Incidence of hyoglycemia with metformin
None
Meglitinide class of drugs
Repaglinide
MOA of repaglinide
Insulin release from pancreas; faster and shorter acting than sulfonylurea
First generation sulfonylurea
Chlorpropamide, tolbutamide, tolazamide, etc.
Second generation sulfonylurea
Glyburide, glipizide, glimepiride, etc.
MOA of both generations
Insulin release from pancreas by modifying K+ channels
Common SE of sulfonylureas, repaglinide, and nateglinide
Hypoglycemia
Sulfonylurea NOT recommended for elderly because of very long half life
Chlorpropamide
Thiazolidinediones
Pioglitazone, Rosiglitazone, Troglitazone (withdrawn/d from market)
Reason troglitazone was withdrawn from market
Hepatic toxicity
MOA of thiazolindinediones
Stimulate PPAR-gamma receptor to regulate CHO and lipid metabolism
SE of Thiazolindinediones
Edema, mild anemia; interaction with drugs that undergo CYP3A4 metabolism
Hyperglycemic agent that increases cAMP and results in glycogenolysis, gluconeogenesis, reverses hypoglycemia, also used to reverse severe betablocker overdose and smooth muscle relaxation
Glucagon
MOA of quinolones
** Inhibit DNA gyrase
MOA of penicillin
Block cell wall synthesis by inhibiting peptidoglycan cross-linkage
Drug used for MRSA
* Vancomycin
Vancomycin MOA
** Blocks cell wall synthesis by sequestration
Genetic basis of low level resistance found with vancomycin
Point mutation
Meningitis prophylaxis for persons in contact with patients
*Ciprofloxacin or Rifampin (for children less than 4 yrs old)
Technique used to diagnose perianal itching, and the drug used to treat it
*Scotch tape technique and mebendazole
Two toxicities of aminoglycosides
nephro and ototoxicity
DOC for Legionnaires' disease
Moxifloxacin
MOA of sulfonamides
*Inhibit dihydropteroate synthase
Penicillins active against penicillinase secreting bacteria
Methicillin, nafcillin, and dicloxacillin
Cheap wide spectrum antibiotic DOC for otitis media ***
Amoxicillin
Class of antibiotics that have 10% cross sensitivity with penicillins
Cephalosporins
PCN active against pseudomonas
ceftazidime, imipenem, piperacillin and ticarcillin
Antibiotic causing red-man syndrome, and prevention
Vancomycin, infusion at a slow rate and antihistamines
Drug causes teeth discoloration
Tetracycline
MOA of tetracycline
Decreases protein synthesis by inhibiting 30S ribosome
Drug that causes gray baby syndrome and aplastic anemia
Chloramphenicol
Drug notorious for causing pseudomembranous colitis
Clindamycin
DOC for tx of pseudomembranous colitis (mild) **
Metronidazole
Treatment of severe/relapsing pseudomembranous colitis
ORAL vancomycin
Anemia caused by trimethoprim *
Megaloblastic anemia
Reason fluoroquinolones are contraindicated in children and pregnancy
Cartilage damage
DOC for giardia, bacterial vaginosis, and trichomonas *
Metronidazole
Treatment for TB patients (think RIPE) *
Rifampin, Isoniazid, Pyrazinamide, Ethambutol
Metronidazole SE if given with alcohol
Disulfiram-like reaction
Common side effect of Rifampin *
Red urine discoloration
MOA of nystatin
Bind ergosterol in fungal cell membrane
Neurotoxicity with isoniazid (INH) prevented by
Administration of Vit. B6 (pyridoxine)
Toxicity of amphotericin
Nephrotoxicity
SE seen only in men with administration of ketoconazole
Gynecomastia
Topical DOC in impetigo
Topical mupirocin (Bactroban)
DOC for influenza A
* Oseltamivir
DOC for RSV *
Ribavirin
DOC for CMV retinitis
Ganciclovir
SE for ganciclovir
Neutro, leuko and thrombocytopenia
Anti-viral agents associated with Stephen Johnson syndrome
Nevirapine, amprenavir
HIV antiviral class known to have severe drug interactions by causing inhibition of metabolism *
Protease inhibitors
Antivirals that are teratogens
Delavirdine, efavirenz, and ribavirin
Antivirals associated with neutropenia
Ganciclovir, zidovudine, saquinavir, and interferon
HIV med used to prevent perinatal transmission
Nevirapine
Drug used for African sleeping sickness
Suramin
Drug used in Chagas disease
Nifurtimox
Cephalosporins able to cross the BBB
Ceftazidime, Ceftriaxone or Cefotaxime
Oral 3rd generation cephalosporins NOT able to cross the BBB
Cefixime
Drug used for N. gonorrhea in females *
Ceftriaxone
Cephalosporin causes kernicterus in neonates
Ceftriaxone or cefuroxime
SE of INH
Peripheral neuritis and hepatitis
Aminoglycoside that is least ototoxic
Streptomycin
Drug used in exoerythrocytic cycle of malaria
Primaquine
Oral antibiotic of choice for moderate inflammatory acne
Minocycline
Drug of choice for leprosy
Dapsone, rifampin and clofazimine combination
DOC for herpes and its MOA*
Acyclovir; phosphorylation, incorporation into viral DNA, and chain termination
Anti-bacterials that cause hemolysis in G6PD-deficient patients *
Sulfonamides
MOA of erythromycin
Inhibition of protein synthesis at the 50s subunit of ribosome
Antibiotic frequently used for chronic UTI prophylaxis *
sulfamethoxazole/ trimethoprim
Lactams that can be used in PCN allergic patients
Aztreonam/carbapenems
SE of imipenem
Seizures
Anti-viral with a dose limiting toxicity of pancreatitis
Didanosine
Constant proportion of cell population killed rather than a constant number
Log-kill hypothesis
Treatment with cancer chemotherapy at high doses every 3-4 weeks, too toxic to be used continuously
Pulse therapy
Toxic effect of anticancer drug can be lessened by rescue agents
Rescue therapy
Drug used concurrently with toxic anticancer agents to reduce renal precipitation of urates
Allopurinol
Pyrimidine analog that causes "Thymine-less death" given with leucovorin rescue
5-flouracil (5-FU)
Drug used in cancer therapy causes Cushing-like symptoms
Prednisone
Side effect of Mitomycin
SEVERE myelosuppression
MOA of cisplatin
Alkylating agent
Common toxicities of cisplatin
Nephro and ototoxicity
Analog of hypoxanthine, needs HGPRTase for activation
6-mercaptopurine (6-MP)
Interaction with this drug requires dose reduction of 6-MP
** Allopurinol
May protect against doxorubicin toxicity by scavenging free radicals
* Dexrazoxane
Blows DNA (breaks DNA strands), limiting SE is pulmonary fibrosis
* Bleomycin
Bleomycin+vinblastine+etoposide+cisplatin produce almost a 100% response when all agents are used for this neoplasm
Testicular cancer
ABVD regimen used for HD, but appears less likely to cause sterility and secondary malignancies than MOPP
Adriamycin (doxorubicin) +bleomycin, vinblastine +dacarbazine
Regimen used for non-Hodgkin's lymphoma
CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) plus rituximab
Regimen used for breast cancer
CMF (cyclophosphamide, methotrexate, and fluorouracil) and tamoxifen if ER+
Alkylating agent, vesicant that causes tissue damage with extravasation
Mechlorethamine
Anticancer drug also used in RA, produces acrolein in urine that leads to hemorrhagic cystitis
Cyclophosphamide
Prevention of cyclophosphamide induced hemorrhagic cystitis
Hydration and mercaptoethanesulfonate (MESNA)
Microtubule inhibitor that causes peripheral neuropathy, foot drop (eg. ataxia), and "pins and needles" sensation
Vincristine
Interact with microtubules (but unlike vinca which prevent disassembly of tubules), it stabilizes tubulin and cells remain frozen in metaphase
**Paclitaxel (taxol)
Toxicities include nephrotoxicity and ototoxicity, leading to a severe interaction with aminoglycosides
Cisplatin
Agent similar to cisplatin, less nephrotoxic, but greater myelosuppression
Carboplatin
Converts asparagine to aspartate and ammonia, denies cancer cells of essential AA (asparagine)
L-asparaginase
Used for hairy cell leukemia ; it stimulates NK cells
Interferon alpha
Anti-androgen used for prostate cancer
Flutamide (Eulexin)
Anti-estrogen used for estrogen receptor + breast cancer
** Tamoxifen
Aromatase inhibitor used in breast cancer
Letrozole, anastrozole
Newer estrogen receptor antagonist used in advanced breast cancer
Toremifene (Fareston)
Some cell cycle specific anti-cancer drugs
Bleomycin, vinca alkaloids, antimetabolites (eg., 5-FU, 6-MP, methotrexate, etoposide)
Some cell cycle non-specific drugs
Alkylating agents (eg., mechlorethamine, cyclophosphamide), antibiotics (doxorubicin, daunorubicin), cisplatin, nitrosourea
Anti-emetics used in association with anti-cancer drugs that are 5-HT3 (serotonin receptor subtype ) antagonists
*Odansetron, granisetron
Nitrosoureas with high lipophilicity, used for brain tumors
Carmustine (BCNU) and lomustine (CCNU)
Produces disulfiram-like reaction with ethanol
Procarbazine
3 zones of adrenal cortex and their products
Glomerulosa (mineralocorticoids), fasciculata (glucocorticoid=GC), and reticularis (adrenal androgens)
Pneumonic for 3 zones of adrenal cortex
GFR
Used for Addison's disease , Congenital Adrenal Hyperplasia (CAH) , inflammation, allergies, and asthma (as a local inhalation)
Glucocorticoids
Short acting glucocorticoids
Cortisone and hydrocortisone (equivalent to cortisol)
Intermediate acting glucocorticoids
Prednisone, methylprednisolone, prednisolone, and triamcinolone
Long acting glucocorticoids
Betamethasone and dexamethasone
Mineralocorticoids
Fludrocortisone and deoxycorticosterone
Some side effects of corticosteroids*
Osteopenia, impaired wound healing, inc. risk of infection, inc. appetite, HTN, edema, PUD, euphoria, psychosis, stria, thinning of skin
Period of time of therapy after which GC therapy will need to be tapered
5-7 days
Used for Cushing's syndrome (increased corticosteroid)
Dexamethasone suppression test
Inhibits conversion of cholesterol to pregnenolone therefore inhibiting corticosteroid synthesis
Aminoglutethimide
Antifungal agent used for inhibition of all gonadal and adrenal steroids
Ketoconazole
Antiprogestin used as potent antagonist of GC receptor
Mifepristone
Diuretic used to antagonize aldosterone receptors *
Spironolactone
Common SE of spironolactone **
Gynecomastia and hyperkalemia
MOA of NSAIDS
inhibit prostaglandin synthesis by inhibiting cyclo-oxygenase (cox)
Difference between aspirin and other NSAIDS
Aspirin irreversibly inhibits cyclooxygenase
Four main actions of NSAIDS
Anti-inflammatory, analgesia, antipyretic and antiplatelet activity
Agent used for closure of patent ductus arteriosus*
Indomethacin
Aspirin is contraindicated in children with viral infection
Potential for development of Reye's syndrome
SE of salicylates
Tinnitus, GI bleeding
NSAID also available as an ophthalmic preparation
Diclofenac, ketoralac
NSAID available orally, IM and ophthalmically
Ketoralac
NSAID that is used for acute condition, such as preop anesthesia and has limited duration (<5 days) of use due to nephrotoxicity
Ketoralac
Newer NSAID that selectively inhibits COX-2
Celecoxib
COX 2 inhibitors may have reduced risk of
Gastric ulcers and GI Bleeding
COX 2 inhibitors should be used cautiously in pts with
Pre-existing cardiac or renal disease
Acetaminophen only has *
Antipyretic and analgesic activity
SE of acetaminophen
Hepatotoxicity
Antidote for acetaminophen toxicity *
N-acetylcysteine
DMARDs are slow acting drugs for *
Rheumatic disease
Initial DMARD of choice for patients with RA
Methotrexate
Drug ofter used in combination with TNF - alpha inhitors for RA
Methotrexate
Causes bone marrow suppression
Methotrexate
SE of penicillamine
Aplastic anemia and renal toxicity
Interferes with activity of T-lymphocytes
Hydroxychloroquine
Anti-malarial drug used in rheumatoid arthritis (RA)
Hydroxychloroquine
SE of hydroxychloroquine
Retinal destruction and dermatitis
MOA of Leflunomide (newer agent)
Inhibiting dihydroorotate dehydrogenase which leads to decreased pyrimidine synthesis, decreased T cell proliferation and decreased antibody production by B cells
Proteins that prevent action of tumor necrosis factor alpha (TNF-alpha)
Adalimumab, infliximab and etanercept
Anti-rheumatic agent also used for ulcerative colitis
Sulfasalazine
Anti-rheumatic agent also used for Chron's disease
Infliximab
NSAID used in gout *
Indomethacin
NSAID contraindicated in gout
Aspirin
MOA of colchicine (used in acute gout)
Selective inhibitor of microtubule assembly
SE of colchicine
Kidney and liver toxicity, diarrhea
Agent used to treat chronic gout by increasing uric acid secretion and excretion
Probenecid and sulfinpyrazone
Allopurinol treats chronic gout by decreasing uric acid production by inhibiting*
Xanthine oxidase
Available bisphosphonates
Alendronate, etidronate, risedronate,
pamidronate, tiludronate, and zoledronic
acid
MOA of Bisphosphonates
Inhibits osteoclast bone resorption
Names of three bisphosphonates available IV
Pamidronate, zoledronate, ibandronate
Uses of bisphosphonates
Osteoporosis, Paget's disease, and
osteolytic bone lesions, and
hypercalcemia from malignancy
Major SE of bisphosphonates
Chemical esophagitis
Bisphosphonates that cannot be used on continuous basis because it caused osteomalacia
Etidronate
Used for prevention of postmenopausal osteoporosis in women
Estrogen (HRT-Hormone replacement therapy)
Increase bone density, also being tested for breast CA prophylaxis **
Raloxifene (SERM-selective estrogenreceptor modulator)
Used intranasally and decreases bone resorption *
Calcitonin (salmon prep)
Used especially in postmenopausal women, dosage should be 1500 mg
Calcium
Vitamin given with calcium to ensure proper absorption
Vitamin D