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101 Cards in this Set
- Front
- Back
Morphine OD
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don't give O2. could contribute to respiratory failure
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Dextromethorphan
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opioid. cough suppression, pain.
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Loperamide
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opioid. diarrhea.
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Diphenoxylate
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opioid. diarrhea.
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Methadone
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opioid. maintetaince for addicts. => acute pulmonary edema?
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Opioid Toxicity
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1) CNS depression 2) seizure 3) miosis (pin point pupil) 4) respiratory depression 5) constipation
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Opioid Withdrawl
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1) Flu-like sx 2) mydriasis 3) piloerection "cold turkey" 4) yawn
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Treat opioid toxicity
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naloxone (short acting), naltrexone
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NSAIDS mech, func + names
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inh COX 1 and 2. 1) analgesic 2) anti-pyretic 3) anti-inflammatory Ibuprophen, indomethacin, naproxen, ketorolac
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NSAIDS tox
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1) Gi bleed, ulcers 2) Renal tox 3) aplastic anemia 3) hemolysis in G6PD def
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Indomethacin
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dec prostaglandin synth => close PDA
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Ketorolac
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NSAID. short term use only.
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Cox-2 selective inhibitors
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spare COX1 => Gi protection. Use: osteoarthritis + rheumatoid arthritis. Tox: 1) less GI ulcer/bleed 2) renal tox 3) aplastic anemia 4) hemolysis in G6PD
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Acetominophen
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reversibly inh CNS COX. 1) analgesic 2) anti-pyretic. No anti-inflammatory (so not an NSAID).
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Acetominophen toxicity
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hepatic necrosis. depletes glutathione. tx: n-acetyle cysteine (also mucolytic)
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Acute Gout tx
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colchicine (mt depolymerization => dec PMN chemotaxis. but GI tox) or indomethacin (NSAID, more common)
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Chronic gout tx
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Allopurinol first (inh xathine oxidase; also tumor lysis-associated urate nephropathy). Then probenecid (inh urate reabs; inh PCN sec). fyi: high dose ASA ~ probenecidm, but lose dose ASA dec urate secretion.
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Etanercept
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soluble TNF-alpha R. use: ankylosing spondylitis, psoriasis, RA
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Adalimumab
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humanized mAb vs. TNF-alpha. Use: ankylosing spondilitis, RA, psoriasis
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Infliximab
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mAb vs. TNF-alpha. Use: IBD, RA, akylosing spondylitis
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cyclosporin
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bind cyclophilin => inh calcineurin => dec NFAT => IL2. Use: transplant, autoimmune. Tox: viral infections, lymphoma, nephrotoxic (prevent with mannitol)
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Tacrolimus/FK506
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bind FKBP => inh calcineurin => dec NFAT => IL2 and other cytokines. Use: transplant. Tox: nephrotoxicity, peripheral neuropathy, htn, pleural effusion, hyperglycemia.
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Azathioprine
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antimetabolite (derivative of 6MP). inh nuc acid synthesis. metabolized by xanthine oxidase (allopurinol inc tox). Use: renal tplant, autoimmune (GNitis, hemolytic anemia). Tox: Bone marrow suppression.
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Sirolimus/rapamycin
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bind mTOR => inh protein synthesis => G1 arrest. Use: drug eluting stents. Tox: hyperlipidemia, thrombocytopenia, leukopenia. Not nephrotoxicity.
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Daclizumab
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mAb vs. IL2
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Aldesleukin
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IL2. RCC, metastatic melanoma.
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IFN-alpha
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viruses (HBV, HCV, Kaposi's sarcoma), leukemia, malignant malanoma
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IFN-beta
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multiple sclerosis
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IFN-gamma
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chronic granulomatous dz
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Oprelvekin
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IL-11. Thrombocytopenia.
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Thrombopoietin
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Thrombocytopenia
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Epoetin
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Erythropoietin. Anemia, esp renal failure.
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Filgrastim
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Fil-GRA-STIM. G-CSF. Bone marrow recovery
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Sargramostim
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sar-GRA-MO-stim. GM-CSF> Bone marrow recovery
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Mannitol
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osmotic diuretic. Use: Increased intracrcanial/intraocular pressure, shock, drug OD. Tox: pulmonary edema, dehydration. Contraindications: anuria, CHF
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Acetazolamide
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sulfa carbonic anhydrase inhbitor; dec HCO3 abs @ PT. Use: met acidosis, glaucoma, urinary alkalinization (ASA tox, gout), altitude sickness (resp alkalosis). Tox: hyperchloremic acidosis, neuropathy, NH3 toxicity, sulfa
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Which diuretics are sulfa drugs
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"about HAF": hydrochlorothiazide, acetazolamide, furosemide (torsemide, bumetinide)
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Furosemide
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sulfonamide loop diurectic; inh NaK2Cl. Lumen more neg => inc Ca2+, Mg2+ excretion. Use: Edema (CHF, cirrhosis, nephrotic syn, pulmonary edema), htn, hypercalcemia. Tox: OH DANG! Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa)/Alkalosis, Nephritis (interstitial), Gout (dec urate secretion because lum neg?)
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Bumetanide
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sulfonamide loop diurectic; inh NaK2Cl. Lumen more neg => inc Ca2+, Mg2+ excretion. Use: Edema (CHF, cirrhosis, nephrotic syn, pulmonary edema), htn, hypercalcemia. Tox: OH DANG! Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa)/Alkalosis, Nephritis, Gout
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Torsemide
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sulfonamide loop diurectic; inh NaK2Cl. Lumen more neg => inc Ca2+, Mg2+ excretion. Use: Edema (CHF, cirrhosis, nephrotic syn, pulmonary edema), htn, hypercalcemia. Tox: OH DANG! Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa)/Alkalosis, Nephritis, Gout
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Ethacrynic acid
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NON sulfa loop diurectic. Use: Edema (CHF, cirrhosis, nephrotic syndrome, pulmonary), htn, hypercalcemia. Tox: ototoxicity, hypokalemia, dehydration, alkalosis, nephritis (intersitial)
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Hydrochlorothiazide
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sulfa thiazide diuretic. inh NaCl symporter in early distal tubule. Inc calcium absorption. Use: htn, CHF, idiopathic hypercalciuria, *NEPHROGENIC DIABETES INSIPIDUS* (desmopressin for central). Tox "hyperGLUC": hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia. + hypoK, metabolic alkalosis
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Spironolactone
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aldo R compet antag in CCT. K sparing diuretic. Use: hyperaldosteronism, hypokalemia, CHF. Tox: hyperkalemia, gynecomastia
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Eplereone
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aldo R compet antag (specific). K sparing diuretic. Use: hyperaldosteronism, hypokalemia, CHF. Tox: hyperkalemia.
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Triamterene
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block ENaC. K sparing diuretic. Use: hypokalemia, CHF. Tox: hyperkalemia.
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Alimoride
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block ENaC. K sparing diuretic. Use: hypokalemia. Tox: Hyperkalemia.
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K sparing diuretics
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Aldosterone R antagonists (spironolactone, eplereone) + ENaC blockers (triamterene, amiloride) + Ace inhibitors (captopril, enalopril, lisinopril)
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Ace inhibitors
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Captopril, enalapril, lisinopril. inh ACE => red ATII => red aldo. also inc bradykinin (vasoD). Use: htn, CHF, *DIABETIC RENAL DZ*
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Ace inhibitor tox
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CAPTOPRIL: Cough, Angioedema, Proteinuria, Taste ∆s, hypOtension, Pregnancy (fetal renal damage), Rash, Inc renin/kalemia, Lower angiotensin II. Also: hyperkalemia.
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diuretics in DM patients
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ACE inhibitor (or ARB)
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tx for nephrogenic diabetes insipidus
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hydrochlorothiazide
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tx for hypercalciuria
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hydrochlorothiazide
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to for hypercalcemia
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loop diuretic (furosemide, bumetidine, torsemide, ethacrynic acid)
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Diuretics: inc urine NaCl
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all: loop diuretic, thiazide, carbonic anhydrase inhibitors, k-sparing
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Diuretics: inc urine K
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loop diuretics, thiazide, carbonic anhydrase
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Diuretics that cause alkalosis
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loop diuretics, thiazide
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diuretics that cause acidosis
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carbonic anhydrase inhibitors, K-sparing
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HCT toxicities
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"hyperGLUC": hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia. + Hypokalemia (+ Alkalosis) + sulfa
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Loop diuretic tox
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OH DANG: ototoxicity, hypokalemia, dehydration, allergy (sulfa)/alkalosis, nephritis (interstial), Gout
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Clonidine tox
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sedation, dry mouth, severe rebound htn
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Methyldopa tox
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sedation, *positive coombs test*
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Hexamethonium tox
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orthostatic hypotn, blurred vision, constipation, sexual dysfunction… research animals only!
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Reserpine tox
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sedation, depression, nasal stuffiness, diarrhea
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Guanethidine tox
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orthostatic hypotension, sexual dysfunction, diarrhea
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Prazosin tox
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1st dose orthostatic hypotension
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ß blockers tox
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impotenence, asthma, cardiovascular (bradycardia, CHF, AV block), CNS (sedation, sleep ∆s)
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Hydralazine tox
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*SLE-like snydrome* (HIPP, antihistone Abs), reflex tachycardia (use ß blockers), salt retention (use diuretic)
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Minoxidil tox
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*hypertrichosis*, angina, pericardial effusion, reflex tachycardia (use ß blocker), salt retension (use diuretic)
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Nifedipine tox
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flushing
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verapamil tox
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flushing, constipation
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Nitroprusside tox
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cyanide toxicity
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Ace inhibitors tox
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CAPTOPRIL: cough, angioedema, proteinuria, taste ∆s, hypOtension, preg: fetal renal damage, rash, increased kalemia/renin, lower at2
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ARB
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fetal renal toxicity, hyperkalemia
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Hydralazine
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inc cGMP => smooth muscle relaxation. Vasodilate a>v => dec afterload. Use: htn, CHF. Tox: SLE-like syndrome (HIPP, anti-histone), reflex tachycardia (use ß), fluid retention (use diuretic)
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Calcium channel blockers
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block V-dep L-type Ca2+ channels in cardiac (dec contractility) and smooth muscle (vasoD). "vasculature needs dilation" [heart] verapamil - diltiazem - nifedipine [vasc]. Use: angina, arrhythmia, htn. Tox: cardiac depression, pulmonary edema, flushing. Nifedipine ~ nitrates.
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Nitroglycerine, isosorbide dinitrate
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release NO => GC => cGMP. V>A => dec preload. Use: angina, pulm edema, erection. Tox: h/a, hypotension, tachycardia; Monday Morning Headache in industrial exposure.
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Nitrates affect on: EDV, BP, contractility, HR, Ejection time, MVO2
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dec EDV, dec BP, inc contractility (reflex), inc HR (reflex), dec ET (less blood). dec MVO2
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ß blockers affect on: EDV, BP, contractility, HR, Ejection time, MVO2
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Inc EDV (HR down, venoconstrict), dec BP, dec contractility, dec HR, inc ET (inc preload). dec MVO2
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Cardiac glycosides
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Digoxen. t1/2=3days. inh NaK ATPase => inc intracell Ca+ => inc contractility. Also, slow AV node conduction. Use: 1) CHF 2) AFib.
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Digoxen toxicity
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Tox: yellow blurry vision, arrhythmia. Worse by: RF, hypoK (P-NaK), quinidine (dec clearance, tissue binding sites). Tx: slowly fix K, lidocaine, pace, anti-dig Fab
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Class I antiarrhythmics
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block Na channels. slow phase 4 + inc threshold => slow SA node
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Class IA antiarrhythmics
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moderate block Na and K chan. 1) slow phase 0 => dec conduction v. 2) slow phase 4 => delayed repolarization. result: dec reentry. Drugs: Queen Amy Proclaims Diso's Pyramid. Quinidine, Amioderone, Procainamide, Disopyramide. Use: atrial and ventricular.
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Class IA antiarrhythmics tox
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Tox: inc QT => TDP. q=> tinitus, thrombocytopenia ("cinchonism"). p=> SLE (HIPP, anti-histone)
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Class IB antiarrhthmics
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small Na+ block (also slow Na+). dec AP duration. Toc to the Li-ing Mexi-can B. Lidocaine, Tocainide, Mexiletine. USE DEPENDENT. Use: post MI, dig-tox b/c inc resting potential => inc firing. Tox: anesthetic
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Class IC antiarrhythmics
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large Na+ block. no ∆AP duration. Use: Vfib to Vtac. intractable SVT. Tox: arrhythmias, esp post MI.
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Class II anti-arrhythmics
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ß blockers. inc cAMP => slow phase 4 + 3 => dec rate + inc refractory time. Tox: impotence, cardio (bradycardia, AV block, CHF), sedation, mask hypoglycemia, exacerabte asthma.
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Class III antiarrhythmics
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K+ block => inc plateau = inc repolarization time => inc refractory period. "year 3: ib sot bre + ami" Ibutyilide, sotalol, bretylium, amioderone. Tox: torsades de pointes. Amioderone: corneal deposits, photosensitivity, pulmonary fiborsis, hepatotoxicity, hypo/hyperthyroidism (check PFTS, LFTS, TFTs)
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Class IV antiarrhythmics
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Ca2+ block => slow phase 0 + 3 at AV => dec conduction v + dec refractory period. Tox: flushing
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Adenosine
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Open K => dec resting potential => dec AV rate. AV nodal arrhythmias, convert PSVT. Tox: bronchoconstriction
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K
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inhibit ectopic pacemaker, esp digitoxin tox
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Mg2+
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torsades de pointes, digitoxin tox
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Quinidine
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class 1a
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Amioderone
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class 1a and 3
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Procainamide
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class 1a
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Disopyramide
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class 1a
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Tocainide
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class 1b
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Lidocaine
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class 1b
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Mexiletine
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class 1b
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Flecainide
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class 1c
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encainide
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class 1c
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propafenone
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class 1c
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