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101 Cards in this Set

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  • Back
Morphine OD
don't give O2. could contribute to respiratory failure
opioid. cough suppression, pain.
opioid. diarrhea.
opioid. diarrhea.
opioid. maintetaince for addicts. => acute pulmonary edema?
Opioid Toxicity
1) CNS depression 2) seizure 3) miosis (pin point pupil) 4) respiratory depression 5) constipation
Opioid Withdrawl
1) Flu-like sx 2) mydriasis 3) piloerection "cold turkey" 4) yawn
Treat opioid toxicity
naloxone (short acting), naltrexone
NSAIDS mech, func + names
inh COX 1 and 2. 1) analgesic 2) anti-pyretic 3) anti-inflammatory Ibuprophen, indomethacin, naproxen, ketorolac
1) Gi bleed, ulcers 2) Renal tox 3) aplastic anemia 3) hemolysis in G6PD def
dec prostaglandin synth => close PDA
NSAID. short term use only.
Cox-2 selective inhibitors
spare COX1 => Gi protection. Use: osteoarthritis + rheumatoid arthritis. Tox: 1) less GI ulcer/bleed 2) renal tox 3) aplastic anemia 4) hemolysis in G6PD
reversibly inh CNS COX. 1) analgesic 2) anti-pyretic. No anti-inflammatory (so not an NSAID).
Acetominophen toxicity
hepatic necrosis. depletes glutathione. tx: n-acetyle cysteine (also mucolytic)
Acute Gout tx
colchicine (mt depolymerization => dec PMN chemotaxis. but GI tox) or indomethacin (NSAID, more common)
Chronic gout tx
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.
soluble TNF-alpha R. use: ankylosing spondylitis, psoriasis, RA
humanized mAb vs. TNF-alpha. Use: ankylosing spondilitis, RA, psoriasis
mAb vs. TNF-alpha. Use: IBD, RA, akylosing spondylitis
bind cyclophilin => inh calcineurin => dec NFAT => IL2. Use: transplant, autoimmune. Tox: viral infections, lymphoma, nephrotoxic (prevent with mannitol)
bind FKBP => inh calcineurin => dec NFAT => IL2 and other cytokines. Use: transplant. Tox: nephrotoxicity, peripheral neuropathy, htn, pleural effusion, hyperglycemia.
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.
bind mTOR => inh protein synthesis => G1 arrest. Use: drug eluting stents. Tox: hyperlipidemia, thrombocytopenia, leukopenia. Not nephrotoxicity.
mAb vs. IL2
IL2. RCC, metastatic melanoma.
viruses (HBV, HCV, Kaposi's sarcoma), leukemia, malignant malanoma
multiple sclerosis
chronic granulomatous dz
IL-11. Thrombocytopenia.
Erythropoietin. Anemia, esp renal failure.
Fil-GRA-STIM. G-CSF. Bone marrow recovery
sar-GRA-MO-stim. GM-CSF> Bone marrow recovery
osmotic diuretic. Use: Increased intracrcanial/intraocular pressure, shock, drug OD. Tox: pulmonary edema, dehydration. Contraindications: anuria, CHF
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
Which diuretics are sulfa drugs
"about HAF": hydrochlorothiazide, acetazolamide, furosemide (torsemide, bumetinide)
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?)
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
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
Ethacrynic acid
NON sulfa loop diurectic. Use: Edema (CHF, cirrhosis, nephrotic syndrome, pulmonary), htn, hypercalcemia. Tox: ototoxicity, hypokalemia, dehydration, alkalosis, nephritis (intersitial)
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
aldo R compet antag in CCT. K sparing diuretic. Use: hyperaldosteronism, hypokalemia, CHF. Tox: hyperkalemia, gynecomastia
aldo R compet antag (specific). K sparing diuretic. Use: hyperaldosteronism, hypokalemia, CHF. Tox: hyperkalemia.
block ENaC. K sparing diuretic. Use: hypokalemia, CHF. Tox: hyperkalemia.
block ENaC. K sparing diuretic. Use: hypokalemia. Tox: Hyperkalemia.
K sparing diuretics
Aldosterone R antagonists (spironolactone, eplereone) + ENaC blockers (triamterene, amiloride) + Ace inhibitors (captopril, enalopril, lisinopril)
Ace inhibitors
Captopril, enalapril, lisinopril. inh ACE => red ATII => red aldo. also inc bradykinin (vasoD). Use: htn, CHF, *DIABETIC RENAL DZ*
Ace inhibitor tox
CAPTOPRIL: Cough, Angioedema, Proteinuria, Taste ∆s, hypOtension, Pregnancy (fetal renal damage), Rash, Inc renin/kalemia, Lower angiotensin II. Also: hyperkalemia.
diuretics in DM patients
ACE inhibitor (or ARB)
tx for nephrogenic diabetes insipidus
tx for hypercalciuria
to for hypercalcemia
loop diuretic (furosemide, bumetidine, torsemide, ethacrynic acid)
Diuretics: inc urine NaCl
all: loop diuretic, thiazide, carbonic anhydrase inhibitors, k-sparing
Diuretics: inc urine K
loop diuretics, thiazide, carbonic anhydrase
Diuretics that cause alkalosis
loop diuretics, thiazide
diuretics that cause acidosis
carbonic anhydrase inhibitors, K-sparing
HCT toxicities
"hyperGLUC": hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia. + Hypokalemia (+ Alkalosis) + sulfa
Loop diuretic tox
OH DANG: ototoxicity, hypokalemia, dehydration, allergy (sulfa)/alkalosis, nephritis (interstial), Gout
Clonidine tox
sedation, dry mouth, severe rebound htn
Methyldopa tox
sedation, *positive coombs test*
Hexamethonium tox
orthostatic hypotn, blurred vision, constipation, sexual dysfunction… research animals only!
Reserpine tox
sedation, depression, nasal stuffiness, diarrhea
Guanethidine tox
orthostatic hypotension, sexual dysfunction, diarrhea
Prazosin tox
1st dose orthostatic hypotension
ß blockers tox
impotenence, asthma, cardiovascular (bradycardia, CHF, AV block), CNS (sedation, sleep ∆s)
Hydralazine tox
*SLE-like snydrome* (HIPP, antihistone Abs), reflex tachycardia (use ß blockers), salt retention (use diuretic)
Minoxidil tox
*hypertrichosis*, angina, pericardial effusion, reflex tachycardia (use ß blocker), salt retension (use diuretic)
Nifedipine tox
verapamil tox
flushing, constipation
Nitroprusside tox
cyanide toxicity
Ace inhibitors tox
CAPTOPRIL: cough, angioedema, proteinuria, taste ∆s, hypOtension, preg: fetal renal damage, rash, increased kalemia/renin, lower at2
fetal renal toxicity, hyperkalemia
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)
Calcium channel blockers
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.
Nitroglycerine, isosorbide dinitrate
release NO => GC => cGMP. V>A => dec preload. Use: angina, pulm edema, erection. Tox: h/a, hypotension, tachycardia; Monday Morning Headache in industrial exposure.
Nitrates affect on: EDV, BP, contractility, HR, Ejection time, MVO2
dec EDV, dec BP, inc contractility (reflex), inc HR (reflex), dec ET (less blood). dec MVO2
ß blockers affect on: EDV, BP, contractility, HR, Ejection time, MVO2
Inc EDV (HR down, venoconstrict), dec BP, dec contractility, dec HR, inc ET (inc preload). dec MVO2
Cardiac glycosides
Digoxen. t1/2=3days. inh NaK ATPase => inc intracell Ca+ => inc contractility. Also, slow AV node conduction. Use: 1) CHF 2) AFib.
Digoxen toxicity
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
Class I antiarrhythmics
block Na channels. slow phase 4 + inc threshold => slow SA node
Class IA antiarrhythmics
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.
Class IA antiarrhythmics tox
Tox: inc QT => TDP. q=> tinitus, thrombocytopenia ("cinchonism"). p=> SLE (HIPP, anti-histone)
Class IB antiarrhthmics
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
Class IC antiarrhythmics
large Na+ block. no ∆AP duration. Use: Vfib to Vtac. intractable SVT. Tox: arrhythmias, esp post MI.
Class II anti-arrhythmics
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.
Class III antiarrhythmics
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)
Class IV antiarrhythmics
Ca2+ block => slow phase 0 + 3 at AV => dec conduction v + dec refractory period. Tox: flushing
Open K => dec resting potential => dec AV rate. AV nodal arrhythmias, convert PSVT. Tox: bronchoconstriction
inhibit ectopic pacemaker, esp digitoxin tox
torsades de pointes, digitoxin tox
class 1a
class 1a and 3
class 1a
class 1a
class 1b
class 1b
class 1b
class 1c
class 1c
class 1c