Nd Boards 2011 Drugs And Nutrients

Front 1

Glyburide

Back 1

Class: Sulfonylurea
Ind: DM II
MOA: Stimulates beta cells to produce insulin
Side fx: hypogly, CV risk
C/I: not for pts w/ sulfa allergies, IDDM, hypoglycemia, PG B

Front 2

Nitroglycerin

Back 2

-Class: Nitrate Vasodilator
-Ind: Acute/Chronic angina, acute MI, CHF, Hypertensive crisis (IV), Raynaud's (topically)
-MOA: Converted to NO in smooth muscle (powerful vasodilator), relaxation IMMEDIATE to 30 minutes
-Side Fx: Hypotension, HA, tolerance, reactive tachycardia and increased O2 consumption via cardiac sinus stimulation, d/c of blurred vision or dry mouth, overdose mb lethal, Pregnancy C
-C/I: severe anemia, gluacoma, head trauma, hypotension (IV), hypertrophic cardiomyopathy
-Interactions: with ethanol causes severe hypoTN/ CV collapse, potentiated by asprin, xs hypotension with Ca-channel blockers and sildenafil (viagra), NAC helps reduce tolerance
-Pearls: give to pt seated, C/I w/ other vasodilators

Front 3

Metformin

Back 3

Class: Biguanides (only one approved in US)
IND: DM II, insulin resistance
MOA: reduce gluconeo, increase glucose uptake in skel muscle
Side FX: N/V, metallic taste, lower b12/folate, increase fertility

Front 4

Rosiglitazone

Back 4

Class: Thiazolidediones
IND: DM II, PCOS
MOA: decrease gluconeo, increase uptake (sim metformin, actos)
Side fx: edema, worsening CHF
caution in pts with CHF, liver dz; PG B

Front 5

Atorvastin

Back 5

-CLASS: Statin
-MOA: HMG-CoA Reductase inhibitor
-IND: high total chole, hi LDL, lo HDL, sxs of CAD
-SIDE FX: Muscle soreness (mb dt low CoQ10); PREGNANCY X
-PEARLS: inhibits coQ10 production (supp!); not for pts w/ LIVER DZ,

Front 6

Lovastatin

Back 6

-Class: statin/ HMG-CoA reductase inhibitor
-IND: hypercholesterolemia, hyperlipidemias, atherosclerosis
-MOA: inhibits synth of cholesterol, lowers LDL levels, possibly anti-inflammatory
-Adverse fx: inhibits CoQ10 formation, elevated liver enzymes, pruritis, myalgia, HA, hep, myositis, cataracts, insomnia, peptic ulceration, carcinogenic in animals, photosensitivity
-C/I: liver or kidney dz, cataracts, PUD, lactation, secondary hyperlipidemia, PG X!!
-Interactions: CoQ10 decreases cardio and myotoxicity, synergistic with niacin, interferes with rifampin, increases OCP levels, potentiates digoxin and warfarin
-Monitoring: liver enzymes (before, then 6 wk, 12 wk after), slit lamp exams, CPK levels with myalgia
-Rx: PO at night

Front 7

Niacin

Back 7

-Indications: Hyperchole, hyperlipidemia, dyslipidemia, atherosclerosis
-AXN: Inhibits VLDL production
-Adverse FX: flushing and itching, nausea, hypergly, hyperuricemia, high hcy
-InterAXNs: synergistic with Lovastatin, use other B's to prevent high hcy
-C/I: DM, gout, PUD
-Rx: 1-4 g qd po
Pearl: niacinamide is not effective in lowering blood lipids

Front 8

Carvedilol

Back 8

-Ind: mild to severe HF, left vent dysfxn
-AXN: Beta and alpha adrenergic blocking (non-selective)
-Adverse FX: hypoTN, dizziness, fatigue, hypergly, wt gain, diarrhea, weakness, bradycardia
-C/I: bronchial asthma, AV block, sick sinus syndrome, bradycardia, cardiogenic shock, hepatic impariment, PG C
-InterAXNs: inhibited by antifungals, NSAIDS, sulfonamides, clonidine, cimetidine potentiate

Front 9

Digoxin

Back 9

-IND: CHF, atrial fib/flutter
-AXNs: cardiac glycoside, inhib Na/K-ATPase; increases contractility and decreases HR, makes beat more efficient
-Aderse FX: anorexia, fatigue, N/V, visual changes, bradycardia, arrhythmias, OD can be lethal and T.I. narrow
-C/I: hypoK, hyper/hypocalcemia, hypoMg, vent arrhythmias, kidney failure, PG C
-InterAXNs: "Lots" can cause weird EKGs,
Monitor serum levels of drug, electrolytes, renal fxn and EKG
Dose according to metabolism

Front 10

Amidarone

Back 10

IND: serious vent arrhythmias, chemical cardioversion of a-fib; NOT a first-line antiarrhythmic dt toxicity
AXNs: sodium chan blocker
Adverse RXNs: used cautiously with elderly, surgical pts, hypoTN, neurlogical adverse events, N/V, CHF, arrhythmias, fever, fatigue, photosensitivity, involuntary movements, muscle weakness
C/I: serious sinus-node dysfxn, second or third-egree av block, bradycardia causing syncope, PG/bf
InterAXNs: long half-life, serious interaxns
Monitor: thyroid levels, HR, ECG, lethargy, edema, PFTs
Rx: Oral (hospital -- most likely)

Front 11

Lisinopril

Back 11

ACE inhibitor
IND: HTN, edema, hypervolemia, CHF, chronic renal failure, diabetic nephropathy
AXNs: ACE inhibition which prevents conversion of angio I to angio II (a vasoconstrictor), decreases aldosterone production
Adverse FX: dry cough, rash, fever, dizziness, HA, loss of taste/ metallic taste, neutropenia, proteinuria and nephrotic synd, severe hypoTN
C/I: bone marrow suppression, renal AA stenosis, hyperkalemia, PG D
InterAXNs: antacids, NSAIDs, capsaicin exacerbates cough, increases digoxin and lithium levels, ^ risk hyperkalemia with K-sparing diuretics
Monitor: UA for proteinuria
RX: oral, away from food

Front 12

Clonidine

Back 12

IND: HTN w/ w/o diuretics / cardiac glycoside/ ACE inhibitors / calcium agonists; BPH
AXNs: alpha adrenergic agonist
Adverse FX: caution with renal impairment, hypoTN with syncope in first dose, dizziness, HA, orthostatic hypoTN, fatigue, somnolence, vertigo, diarrhea, abdominal pn, drowsiness, tachycardia
C/I: prostate CA must be ruled out before using for BPH, PG C
InterAXNs: increased fx with beta-blockers, diuretics, ACE inhibitors, Ca-channel blockers; decreased fx with NSAIDS; avoid saw palmetto concurrently

Front 13

Atenolol

Back 13

Beta blocker
IND: HTN, angina pectoris, post-MI
AXNs: blocks response to beta-adrenergic stimulation
Adverse FX: bradycardia, hypoTN, chest pn, dizziness, fatigue, insomnia, constipation alopecia
C/I: brady, sinus node dysfxn, heart block (beyond first deg.), cardiogenic shock, edema, PG D
InterAXNs: potentiates any drug that slows AV node conduction (digoxin, verapamil, diltiazem, clonidine), can mask tachy dt other causes; fx decreased with aluminum salts, barbiturates, NSAIDS, penicillins
Monitoring: BP, pulses, fluid intake/output, wt, respiration, circulation
Rx: oral (iv in pts with renal insufficiency)

Front 14

Diltiazem and Verapamil

Back 14

Ca-Channel blockers
IND: HTN, hypertensive crisis, angina (oral); injection: a-fib or flutter, PSVT
AXNs: ca-channel antagonist that reduces calcium influx = vasodilation; can increase HR
Adverse FX: edema, HA, AV block, dizziness, gout, rash, hypoTN, brady
C/I: sick sinus syndrome, heart block, hypoTN, acute MI, pulmonary congestion, PG C
InterAXNs: synergistic toxicity with beta blockers, increases toxicity of several drugs, inpredictable interaxn with lithium, ca, vit D and others
Monitor: liver enzymes, BP, EKG
RX: oral, rebound HTN occurs with rapid withdraw

Front 15

Furosemide

Back 15

Diuretic - loop, potassium wasting
IND: HTN, edema (pulmonary, CHF, nephrotic synd, ascites)
AXNs: loop diruetic (inhibits Na and Cl reabs in PCT and DCT and loop of henle
Adverse FX: hypokalemia, hyperuricemia, hypergly, dehydration, hypovolemia with circulatory collapse, thromboembolism, tinnitus, hearing loss
C/I: anuria, sufonylurea allergy, severe electrolyte imbal, hepatic cirrhosis, SEL, DM, PG C
InterAXNs: potentiates digoxin and lithium (toxicity), synergistic toxicity with ototoxics (aminoglycosides, cisplatin, salicylates) and anticoagulants, phenytoin and NSAIDS interfere with this rx
Monitor: wt, intake/output of fluids, BP, serum electrolytes, uric acid, glucose, renal function, hearing

Front 16

Penicillin G

Back 16

CLASS: Beta Lactam ABX
MOA: Inhibit cell wall formation; bacteriocidal
IND: GM (+) bx; strep throat; pneumococcal pneumonia
SIDE FX, ETC: Hypersensitivity rxn to pen

Pens = m/c cz RX RXN

Front 17

Hydrocholorthiazide (HCTZ)

Back 17

Diuretic - potassium wasting
IND: HTN (not preeclampsia), edema (CHF, ascites, estrogen or steroid-induced, nephrotic syndrome), urolithiasis prevention, osteoporosis, DI
AXNs: thiazide diuretic - acts in distal tubules and ascending loop of henle to increase NaCl excretion, wastes potassium and decreases hypercalciuria
Advers FX: hyperTG, dyslipidemia, electrolyte imbalance (hypokalemia, hypoMg), decrease glucose tolerance, impaired renal fxn, photosensitization
C/I: anuria, electrolyte imbal, sulfonamide intolerance, hepatic problems, SLE, DM, PG B
InterAXNs: supp minerals, hyperCa with Ca supplementation, interferes with anticoagulants, prolongs leukopenia dt chemo, potentiates digoxin and lithium toxicity, interferes with oral hypoglycemics, anticholinergics increase abs, NSAIDS decrease fx
Monitor: BP, electrolytes, renal fxn, wt, BUN, creatinine

Front 18

Amoxacillin / Amoxil

Back 18

CLASS: Beta Lactam ABX
MOA: prevents cell wall formation; bacteriocidal
IND: UTI, ENT infxns
SIDE FX, ETC: ^ resistance

Front 19

Spironolactone

Back 19

Diuretic - potassium-sparing
IND: Edema, HTN, primary hyperaldosteronism, hypokalemia, hirsuitism, cirrhosis with edema or ascites, severe CHF along with ACE inhibitors
AXNs: thiazide diuretic, acts on aldosterone receptors (antagonist) in DCT, increases NaCl and water excretion - potassium sparing
Adverse FX: avoid using with K supplements/ hyperkalemia (can be fatal), edema, CNS disorders, drowsiness, lethargy, HA, mental confusion, ataxia, fatigue, gynecomastia, anorexia, nausea, cramping, diarrhea, gastric bleeding
C/I: acute renal insufficiency, anuria, hyperkalemia, renal impairment,PG D
InterAXNs: avoid using with other potassium-sparing diruetics, angiotensin-receptor antagonists, cotrimoxazole, ace inhibitors; effects of digoxin mb reduced
Monitor: BP, electrolytes, renal fxn, input and output ratios, daily wt

Front 20

Amoxacillin and Clavalanate / Augementin

Back 20

CLASS: Beta Lactam ABX
MOA: prevents cell wall formation; bacteriocidal
IND: UTI, ENT infxns; good for BETA LACTAMASE PRODUCERS
SIDE FX, ETC: GI upset

CLAVALANATE DOSE IS *SAME* IN EVERY AUGMENTIN PILL

Front 21

Compare Diuretic Drugs and give a prototype of each:
Loop vs
Thiazide vs
Potassium Sparing

Back 21

Loop : Furosemide : Decrease Na and Cl reabsorption : Mild strength

Thiazide : HCTZ : Increases NaCl excretion : Medium strength

K-Sparing : Spironolactone : Aldosterone antagonist : Strong!

Front 22

Cephalexin / Keflex

Back 22

CLASS: Cephalosporin
MOA: inhibit cell wall formation
IND: ENT infns, surgical prophylaxis
SIDE FX, ETC: GI upset, yeast overgrowth

Alternative for Pen-sensitive but mb sensitive to both pen and this one

Front 23

Cardisoprodol

Back 23

IND: Muscle relaxant, muscle spasm, myalgia, acute painful MS conditions w/ limited mobility
AXN: blocks neuron transmission in spinal cord
Adverse FX: sleepiness, drowsiness, vertigo, lack of concentration, insomnia, agitation, dependence (rare), mild withdrawl, danger with ETOH or psychoactive drugs
C/I: acute intermittent porphyria, liver dz, kd dz, lactation, PG C
InterAXN: CYP2C19, some rx ay increase fx, ETOH, CNS depressants [ may increase toxicity]
Monitor: assess pain relief, avoid xs drowsiness
Rx: often with asprin or codeine

Front 24

Erythromycin / Rythromycin

Back 24

CLASS: Macrolide ABX
MOA: Inhibit BX protein synth; bacteriostatic; travels via leukocytes (!)
IND: Resp infxns, atypicals CT, RCKETTSIA, MYCOPLASMA, MYCOBX

Good choice for Pen-allergic pts
SIDE FX, ETC: GI UPSET

Front 25

Cyclobenzaprine

Back 25

IND: skeletal muscle spasm (NOT dt CND dz)
AXN: anti-spasmodic via CNS (not spinal cord), similar to TCAs, anticholinergic, sedative
Adverse FX: spaciness, drowsiness, anticholinergic fx (dry mouth/eyes, constipation), PG B
C/I: arrhythmia, acute MI, CHF, hyperthyroid, glaucoma, urinary retention
InterAXNs: NOT TO BE USED WITH MAOIs, antagonist of reserpine, safe with asprin, mb synergistic with other anticholinergics
Monitoring: no longer than 2-3 week use, watch liver enzymes if concern

Front 26

Azithromycin / Zithromax "Z-Pack"

Back 26

CLASS: Macrolide ABX
MOA: Inhibit BX protein synth
IND: ENT infxns, atypicals, CT, RICKETTSIA, MYCOPLASMA, MYCOBX
SIDE FX, ETC: Less GI upset than other macrolides

LONG HALF-LIFE (68 hrs)

Front 27

Acyclovir

Back 27

IND: HSV infection (labialis, genitalis), to prevent herpes outbreaks, vericella and zoster, EBV infxn, CMV
AXN: inhibits viral replication, non-curative
Adverse FX: HA, D, N, delierum, tremor, HTN, renal dysfxn
C/I: PG C
Interactions: increases toxicity of AZT
Monitoring: BUN, UA, serum creatinine, liver enzymes, CBC

Front 28

Tetracycline / Sumycin

Back 28

CLASS: Tetracyclines
MOA: Inhibits BX protein synth
IND: Cystic acnea, rosacea, CT, RICKETTSIA
SIDE FX, ETC: GI upset, photosensitivity

BINDS W/ CA2+; goes to BONES AND TEETH; NOT FOR < 15yo; TAKE AWAY FROM CA2+ supps and CA2+ rich foods

Front 29

Terbinafine

Back 29

IND: tinea pedis, cruris, corporis, onychomycosis
AXNS: antifungal inhibits replication in certain fungus and candida albicans
Adverse FX: changes in ocular lense or retina, pancyopenia, neutropenia, steves-johnson syndrome, hepatic failure, HA, dizziness, vertigo, rash, pruritis, alopecia
C/I: liver or renal dz, PG B
Monitoring: CBC, Liver fxn tests

Front 30

General side fx and interactions of ABX

Back 30

Adverse fx: dysbiosis (N,V, D, malabs, psudomembranous colitis), reduce vit K production (hemorrhage), resistant microbes

General interAXNs: interferes with digoxin, glycosides and estrogens that are normally activated by gut flora; can potentiate warfarin (decreasing vit K production)

Front 31

Ciprofloxacin / Ciproxin

Back 31

CLASS: Quinolone ABX, -floxacins
MOA: Inhibits BX DNA synth
IND: Chlamydia, Mycoplasma, mycobaterium, Gm + and - 's
SIDE FX, ETC: Ca2+ binding (teeth and bone fx), increased risk TENDON INJURY; prolongs caffeine half-life

C/I pregnancy, nursing mothers, kids (can injure cartilage)
was ANTHRAX PROPHYLAXIS

Front 32

Penicillin
Similar drugs: amoxicillin, augmentin (amox + clavulanate)

Back 32

Class: Beta-Lactams
IND: gram +, gram -, spirochetes
AXNS: inhibits cell wall synthesis, bactericidal, Clavulanic acid inhibits bx use of beta-lactamase to decrease resistance
Adverse fx: generals, allergy common
C/I: PG B, allergy, kidney toxicity

Front 33

Metronidazole / Flagyl

Back 33

CLASS: Imidazole ABX
MOA: Disrupts BX DNA synth
IND: giardia, trichamoniasis, amebiasis, rosacea, anerobes, crohn's dz, H pylori
SIDE FX, ETC: GI upset, metallic mouth taste, AWAY from ETOH

Front 34

Cephalexin

Back 34

Class: Cephalosporins
IND: gram +, gram -
AXNs: same as pen - inhibits cell wall synthesis, bactericidal
Adverse fx: generals
C/I: PG B, allergy to pen (cross-rxn)

Front 35

Vancomycin / Vancocin

Back 35

CLASS: Glycopeptide ABX
MOA: Blocks BX cell wall formation
IND: PSUDOMEMBRANOUS COLITIS; MRSA (our last line of defense)
SIDE FX, ETC: "red man/ red neck syndrome" - Stevens Johnson-like sxs

M/C IV admin

PO only for psudomembranous colitis

Front 36

Doxycycline
Similar drugs: tetracycline, minocycline

Back 36

Class: Tetracyclines
IND: gram +, gram -, spicrochetes, rickettsiae
AXN: inhibits protein synthesis, bacteriostatic
Adverse fx: generals, black tongue, yellowing of teeth, photosensitivity, psudotumor cerebri (tetracycline only)

C/I: may active SLE, PG D, caution with renal or liver failure

Front 37

Mupirocin / Bactroban

Back 37

CLASS: topical antibacterial
MOA: Blocks BX cell wall formation
IND: Skin MRSA - carriers intranasally, impetigo topically
SIDE FX, ETC: only topical; NOT for closed infxns
C/I for use with open wounds d/t absorption of PEG
Expect improvement in 5 days

Front 38

Azithromycin

Back 38

Class: Macrolides
IND: gm -, gm +, spirochetes, Chalmydia!
AXN: protein synthesis inhibitor, bacteriostatic

Front 39

Neomycin

Back 39

CLASS: Aminoglycoside ABX
MOA: Inhibits BX protein synth
IND: Gm - / +
SIDE FX, ETC: topical abx

Front 40

Silver Nitrate (topical)

Back 40

IND: prevention of congenital gonorrhea in eyes, on severe burns to prevent infxn
Axns: anti-microbial
Adverse fx: staining, blue discoloration of skin
C/I: none known
Interaxns: none known
Monitoring: methemoglobin levels if prolonged use

Front 41

USP Thyroid - Dessicated - Armour Thyroid

Back 41

IND: Hypothyroid, for weight loss, post thyroidectomy
AXNS: replacement of everything thyroid secretes (T3, T4, DIT, MIT)
Adverse FX: xs amounts can cz hyperthyroid sxs, worsen osteoporosis and DM (long-term)
C/I: acute MI, thyrotoxicosis w/o hypothyroid, uncompensated addisons; PG A
Interaxns: agents that increase TBG (estrogens, etC) may interfere
Rx: 1 grain = 65 mg = 0.1 mg levothyroxine (T4) = 25 mcg liothyronine (T3)

Front 42

Levothyroxine (T4)

Back 42

IND: hypothyroid
AXNS: replaces T4 which is largest source of T3 by conversion
Adverse Fx: xs can cz hyperthyroid, worsen osteoporosis and DM
C/I: acute MI, PG A, untx addison's
Rx: 1 grain = 60 mg = 0.05 mg levothyroxine = 15 mcg liothyronine

Front 43

Liothyronine (T3)

Back 43

IND: Hypothyroid
Axns: replaces T3 - very rapid acting b/c no conversion needed
Adverse fx: hyperthyroid, osteoporosis, DM
C/I: acute MI, untx addison's, PG A
Rx: 1 grain = 60 mg = 0.05 mg levo = 15 mcg liothyronine

Front 44

4 Different types of Short-Acting Insulin

Back 44

used with meals; essential for IDDM
-Regular - for regular injection and also in pump; 30-45 min before meal, peaks 1-2 hr after injection
-Lispro - Quick uptake after injection
-Aspart - quick uptake after injection
-Inhaled - no more than 10 min before eating - respiratory problems
5-10 units per use

Front 45

3 Different types of Long-acting insulin

Back 45

NPH - may run out before 24 hr
Glargine - 0.15 U/kg once daily
Detemir - 0.1-0.2 U/kg once daily; very slowly absorbed after injection

used all day long to maintain baseline levels

Front 46

Pseudoephedrine,
Oxymetazoline (nasal spray)

Back 46

IND: allergic rhinitis, nasal congestion
AXNs: adrenergic agonists - sympathomimetics
Urinary incontinence, wt loss, asthma
Adverse FX: htn, CNS overstim, tachy, rebound rhinorrhea, local irritation
C/I: HTN, hyperthyroid, DM, urinary retention, glaucoma, insomnia

Front 47

Dihenhydramine

Back 47

HI blocker - sedating/ First generation
IND: Allergic rhinitis, allergic skin d/o, insomnia, motion sickness, Parkinson's, urticaria
FX: H-1 receptor antagonist crosses BBB
Adverse FX: drowsiness, may shorten menstrual cycle, anticholinergic fx (dry eyes, mouth, constip, blurry vision), tolerance
C/I: BPH, acute glaucoma, PUD, bronchial asthma, pneumonia, seizures, chicken pox, elderly, not with MAOIs, may worsen cold

Can cause dementia-like sxs in elderly

Front 48

Loratadine

Back 48

Second gen antihistamines
IND: Allergic rhinitis, conjunctivitis, allergic skin conditions
AXNs: selective H1 receptor antagonist that doesn't cross BBB
Adverse FX: minimal drowsiness and anticholinergic fx, PG B
C/I: acute asthma attack, lower resp dz
Interaxns: MAOIs
Monitor for drowsiness, judgement, coordination issues

Front 49

Chloroquine

Back 49

IND: suppression of phrophylaxis of malaria, extra-intestinal amebiasis
Adverse FX: heart problems, hypoTN, HA, visual changes, vomiting...
C/I: PG D

Front 50

TMP-SMX
Trimethoprim/ sulfamethoxazole

Back 50

Combination of trimethoprim and sulfamethoxazole
IND: gm -, malaria, gonorrhea, h. flu, legionnaire's, enterobacteria, p. jiroveci
Axns: analog of folate and PABA

Adverse fx: folate deficiency, photosensitivity, allergic rxn
C/i: porphyria, liver and kidney dz, G6PD def PG C

Front 51

Doxorubicin / Adrimycin

Back 51

IND: chemotherapeutic drug - almost every type of cancer
Axn: type of abx
Adverse fx: CHF, alopecia, NV, ulcerations, necrosis of colon, anorexia, diarrhea, esophagitis
C/I: CHF, arrythmias, previous tx with this rx

administration via IV

Front 52

5-Fluorouracil

Back 52

IND: Many different cancers (including breast, colon); topically for actinic karatoses, bcc (superficial types)
Axns: blocks dna synthesis
Adverse fx: dermatitis, NVD, heartburn, anorexia, GI ulceration...
C/I: poor nutritional state, depressed bone marrow function, thrombocytopenia, recent major surgery, PG

RX: IV or topical

Front 53

Cyclosporine

Back 53

IND: prophylaxis of organ rejection in organ transplant (kidney, liver, heart)
Axns: immunosuppressant
Adverse fx: nephro/hepatotoxicity
C/I: abnormal renal fxn, PUVA/UVB tx concurrently, psoriasis, RA

Front 54

Methotrexate

Back 54

IND: trophoblastic neoplasms, leukemias, psoriasis, RA, lots of cancers (breast, neck, lung), bone cancers and sarcomas, gastric cancer
Adverse fx: tissue necrosis, GI toxicity
C/I: women of childbearing age unless warranted, severe liver/kidney impairment, AIDS

Front 55

Vinblastine

Back 55

From madagasgar periwinkle
IND: HL and NHL, cancers (testicular, lung, neck, brest, renal, kaposi's)
Axn: stops cell division
Adverse fx: aloepcia, D, rash
C/I: severe bone marrow suppression, bx infxn

Front 56

Paclitaxel/ Taxol

Back 56

From Yew tree
IND: cancers (lung, ovary, neck, Kaposi's)
Axns: microtubule interruption
Adverse fx: anaphylaxis, NV, alopecia, neuropathies, easy bleeding, bone marrow suppression, severe infxn

Front 57

Clopidogrel

Back 57

IND: Atherosclerosis, MI, stroke, peripheral AA dz, prevention of thrombotic complications
Axn: Prevents fibrinogen binding, reduces PLT adhesion and agg
Adverse FX: bleeding, hemorrhage, abd pn, bomiting, gastritis, chest pn
C/I: PUD, intracranial hemorrhage, coagulation d/o
Interaxn: lots
monitor for signs of bleeding

Front 58

Heparin

Back 58

glycoprotein
IND: thromboembolic d/o
AXNs: potentiates action of antithrombin II and inactivates thrombin - prevents production of fibrin and clots!
Adverse fx: hemorrhage, chest pn, vasospasm, hemorrhagic shock, fever, HA...
C/I uncontrolled bleeding except from DIC, severe thrombocytopenia

Monitor: PLT, aPTT, hgb, hct

rx: IV

Front 59

Vitamin K

Back 59

IND: blood clotting d/o dt vit k def, hemorrhagic dz of newborn (vit k def), osteoporosis, NV of PG, fx, calcium oxalate kid stones, CA

axns: required for biological activation of vit k-dep clotting factors (VII, IX, X)

Adverse fx: hemolytic anemia, jaunice
C/I: not to be used with warfarin

Front 60

Warfarin

Back 60

Vit K analog (antagonist)
IND: venous thrombosis, hypercoag state, a fib, artificial heart valves
Axns: anticoag by inhibiting formation of vit k dependent clotting factors
Adverse fx: hemorrhage, OD can be lethal
Interaxns: highly protein bound - decrease in carrier proteins = increase in activity
abx can decrease vit k therefore increasing axn
rx: PO only

Front 61

Prochlorperazine

Back 61

IND: NV, psychosis, anxiety
Axns: antiemetic, antipsychotic, domaminergic receptor antagonist

adverse fx: allergic rxn, irreversible tardive dyskinesia, drug-induced parkinsonism, confusion, heart problems, skin disocoloration...

C/I: severe CNS depression, coma, bone marrow suppression, young children

Interactions: MANY

Front 62

Promethazine

Back 62

IND: motion sickness, sedative, post-op pain, allergic conditions, anaphylaxis

Axns: blocks postsynaptic dopaminergic receptors in brain

Adverse fx: bradycardia, hypertn, confusion, xerostomia, urinary retention, incoordination, blurred vision

C/I: CNS depression, coma

Front 63

Benzocaine

Back 63

IND: pain, pruritis
Axns: inhibits nn conduction
Adverse fx: none topically
C/I: large wounds or burns, xs use on mucous membranes (can produce methemoglobinemia) PG C

Front 64

Lidocaine/ xylocaine

Back 64

IND: minor surgery procedures, ventricular fib, PVCs
FX: local anethetic, stops depol of neurons - usually blocks sharp pains not the pressure/vibration nn fibers

adverse: hypotn, seizure

RX: SubQ 1-5 cc in area of work; MAX DOSE 30cc
Epi added to increase duration of effect via vasoconstriction (not for use in nose, ear, penis, fingers/toes)

Front 65

Cocaine

Back 65

IND: topical EENT anesthetic

FX: local anesthetic, block sharp pains not pressure/vibration

Adverse fx: dependency

Front 66

Capsaicin

Back 66

IND: osteo or rheumatoid arthritis, myalgia, postherpetic neuralgia, diabetic neuralgia - nerve pain, pruritic psoriasis, phantom limb pain, cluster HA

Axns: deletes substance P from NN leads to decreased pn/itching

Adverse fx: pain and burning w/ application, burning in eyes or mucous membranes

CI: wounds or burns

rx: topical, wash hands throughouly

Front 67

Methyl Salicylate

Back 67

IND: counter-irritatant for rheumatic conditions, painful muscles or joints

Axns: salicylates absorbed into epidermis and dermis; masks sxs of pain with heat or cold

Adverse fx: local irritation, erythema, rash, dequamation, pruritis, skin disocoloration; salicylate xs

C/I: asprin, NSAIDS, absorb toxicity by using only a little

Do not apply heat over

Front 68

Arrange these opioids from strongest to least strong: oxycodone, fentanyl, codeine, hydrocodone, methadone

Back 68

fentanyl -> methadone -> oxycodone -> hydrocodone -> codeine

Front 69

Opioid analgesics general ind/ axn/ c/i

Back 69

Axns: opioid receptor agonist to inhibit pain transmission; cough suppression, decreases diarrhea, decrease release of substance P

Adverse fx: euphoria, dysphoria with xs, sedation, miosis, cough suppression, highly addictive, allergic rxn common, respiratory depression, NV, constipation

OD antidote is naloxone/ narcan

C/I: renal or liver failure, respiratory weakness, bladder obstruction, hypovolemia-- can cause hypotn

Front 70

Fentanyl

Back 70

schedule III opioid

IND: sedation, pain, preop, breakthrough cancer pain (lollypop)

80x analgesia of morphine

adverse fx: muscular rigidity, bradycardia, hypotn, drowsiness, nv, bronchospasm, addiction

rx: transdermal patches (do not use heat with these), lollypop, IM, IV

Front 71

Methadone

Back 71

IND: severe pain, detox/ tx for narcotic addiction
Axns: binds to opiate receptors

Adverse fx: general to opioids

rx: oral, injection

Front 72

Oxycodone

Back 72

schedule II opioid

IND: pain, cough

Axns: opioid

C/I: general to opioids

Front 73

Hydrocodone

Back 73

schedule III opioid
m/c found with aspirin as vicodin
IND: pain, cough

axns: opioid

adverse fx: general to opioids

Front 74

Codeine

Back 74

schedule III opioid

IND: severe HA, severe dysmenorrhea, cough

axns: opioid - weak opioid agonist; 10% of dose is metabolized to morphine

side fx: mild general to opioids

Front 75

Acetaminophen/ Paracetamol

Back 75

IND: mild pain, acute MS pain, OA, RA, fever

Axns: inhibits PG synthesis, analgesic, anti-pyretic, NOT anti-inflammatory, does NOT fx PLT aggregation

adverse fx: overdose can be lethal hepatotoxicity (antidote: charcoal, nAC)

C/I: liver dz, alcoholism

Hepatotoxicity w/ ingestion of great than 4 g per day

Front 76

Aspirin

Back 76

IND: minor pain, fever, inflammation, prevent MI and stroke

Axns: inhibits COX 1 and 2 to prevent PG synthesis, inhibitis PLT aggregation, hypolycemic

Adverse fx: GI irritation, bleeding, increased gut permeability, cartilage synthesis, asprin toxicity (tinnitus, decreased hearing, vertigo); allergic reaction

C/I: chicken pox and children with viral infxns (due to risk of reye's syndrome); PUD, bleeding d/o, IDA, surgery, salicylate allergy, liver and kidney insufficiency, PG D

not for pain of gout - uricosuric

Rx: best forms Mg salicylate or cu salicylate

Front 77

Ibuprofen

Back 77

IND: mild pain relief, inflammation, fever

Axns: inhibit peripheral COX 1 and 2, anti-inflammatory, antipyretic, inhibits kidney vasodilation

adverse fx: dyspepsia, ulcers, IDA, increases intenstinal permeability, nephrotoxicity

C/I: PUD, IDA, renal dz, hepatic failure, PG B

do not combine with aspirin

Front 78

Hydroxychloroquine

Back 78

IND: RA, SLE, malaria

Axns: inhibits neuts and eos chemotaxis, impairs ag/ab rxns

adverse fx: cardiomyopathy, irritibility, alopeica, wt loss, ha, drowsiness

CI: retinal or visual changes from 4 aminoquinolones

interaxns: avoid ETOH

monitor vision changes

Front 79

Methotrexate

Back 79

IND: severe RA, severe pnuemoconiosus, prevent organ transplant rejection, cancer

Axns; folic acid analog inhibits folic acid dependent mechanisms -- cytotoxic

adverse fx: elevates serum liver enzymes, GI upset - high doses can cause ulcers, diarrhea, bone marrow suppression, long-term toxicity, renal damage, neurological damage

CI: renal failure, liver failure, alcohoilsm, immune def,

Low dose used for RA 1 dose/week; high dose in cancers

Front 80

Alendronate

Back 80

Bishphosphate derivative

IND: osteoporosis in postmenopause, males, pagent's dz of bone

Axns: acts on osteoclasts to inhibit bone resorption

Adverse fx: esophagitis, esophageal ulcers, HA, transient hypocalcemia, GI distress/abd pn, acid reflux, N

CI: hypocalcemia, esophageal abnormalities, inability to stand or sit upright for 30 minutes

monitor bmd

rx: take PO with full glass of water in morning 30 minutes before food seated upright or standing; also take calcium and vitamin D

Front 81

Raloxifene

Back 81

IND: prevent and tx osteoporosis in postmenopause

Axns: SERM - acts like estrogen to prevent bone loss w/o causing as many adverse fx as estrogen

adverse fx: thromboembolism, hot flashes, arthralgia, chest pain, migraine, rahs, peripheral edema, UTI

CI: active thromboembolism, pg, premenopausal

Interaxns: ETOH

Front 82

Allopurinol

Back 82

IND: prevention of gout attacks, hyperuricosuria during chemo, prevention of urolithiasis - calcium oxalate or uric acid stones

Axns: xanthine oxidase inhibitor preventing uric acid formation

adverse fx: GI irritation, allergic rxn, vasculitis, blood dyscrasia, hypatotoxicity,

CI: liver, renal failure

Front 83

Colchicine

Back 83

from autumn crocus

ind: acute gout, herniated discs, primary amyloidosis, primary biliary cirrhosis, behcet's disease, AI dz

axns: selective inhibition of microtubule assembly in leukocytes reduces migration and phagocytosis

advers fx: GI iritaion, NV, dirrhea, B12 malabsorption

CI: renal or liver failure, caution in elderly

Front 84

Corticosteroid drugs (betamethasone, hydrocortisone, prednisone, prenisolone, triamcinolone)

Back 84

IND: allergy, asthma, atopic derm, inflammatory d/o, urtiaria topical, AI dz, adrenal insufficiency, ... lots of dz

axns: suppresses PMNs, decreases cap perm
inhibits PL A2 and arachadonic acid release
inhibits cartilage synthesis
stimulates gluconeo - catabolic fx on skin, bone, muscle
renal sodiuum and water retention, potassium wasting

Adverse fx: aggression, insomnia, edema, increased appetite, acne, wt gain, thinnning skin and bones, PUD, cushing's dz

CI: systemic fungal or other severe infections...

interaxns: may

do not d/c suddenly, administor before 8am to reduce risk of adrenal suppression

Front 85

Order these corticosteroids from strongest to least strong:
prednisone, hydrocortisone, betamethasone, triamcinolone

Back 85

betamethasone -> triamcinolone -> predisone -> Hydrocortisone

Front 86

Tamoxifen

Back 86

IND: palliative or adjunctive tx for breast CA, reduce incidence of breast CA in high risk women; est pos breast CA

Axns: estrogen receptor antagonist

Adverse fx: meno type sxs - hot flashes, decreased libido, tumor flare, bone pain, vaginal bleeding and d/c

Front 87

Anastrozole

Back 87

IND: estrogen receptor positive breast CA; any syndrome with xs testosterone aromatiziation to estrogen (BPH, prostate CA)

axns: aromatase inhibitor

Adverse fx: HTN, thrombophlebitis, edema, HA, visual disturbances
PG D

Front 88

ACS colorectal cancer screening recommendations

Back 88

Starting at age 50
Yearly: FOBT
Every 5 years: flexible sigmoidoscopy
Every 10 years or pos FOCBT or flexible sigmoid.
: colonoscopy

Earlier than 50 YO if:
fhx cancer or polyps or genetic polyposis
first degree relatives with cancer or polyps
IBD

Front 89

Iron RDA men, women (menstruating, lactating), pregnant women, post-meno women

Back 89

Adult male: 10 mg
Menstruating or lactating woman: 15 mg
Post meno woman: 10 mg
Pg woman: 30 mg

Front 90

Sumatriptan

Back 90

IND: migraine w/ or w/o aura

Axns: selective serotonin agonist= vasoconstriction

Adverse fx: coronary AA spasm, transient ischemia, MI, v-tach, vision changes, tingling sensation, weakness, tightness in chest...

C/I: ischemic heart dz, agina, TIA

Front 91

Levodopa-Carbidopa

Back 91

IND: Parkinson's dz, Parkinsonianism, herpes zoster pn, restless legs synd

Axn: inhibits dopamine carboxylase to decrease catab of endogenous dopa and then replacing dopa

Adverse fx: anorexia, NV, depresion, mood changes, hallucinations, loss of fx

C/I: MAOIs psychosis

possibly interacts with pyridoxine

must increase dose over time = more side fx

Front 92

Carbamazepine

Back 92

IND: seizure (all types), trigeminal neuralgia, neuralgia, bipolar d/o, schizophrenia, restless legs synd, ETOH/cocaine withdrawal
Axns: decreases neuron excitability in CNS

Adverse: increased seizure frquency, edema, aplastic anemia

C/I: MAOIs

Interaxns: interferes w/ most seizure meds

Front 93

Gabapentin

Back 93

IND: anticonvulsant

Axns: unknown - related to GABA but does not fx gaba receptors

Adverse fx: avoid quick withdrawal, possible staticus epilepticus

Front 94

Phenytoin

Back 94

IND: seizures, trigeminal neuralgia

Axns: decreases excitability of neurons, helps with wound healing (increases fibroblast activity)

Adverse fx: hyperplastic gums, hirsuitism, impaired intellectual development, sluggish, hyperglycemia, megaloblastic anemia (folic acid low), lymphadenopathy

CI: arrhythmias, may worsen absence seizures

Interaxns: may decrease effectiveness of OCPs

Must supp folate, vit D, vit K

Narrow T.I.

Front 95

Melatonin

Back 95

IND: insomnia, jet lag, cancer at high doses, SAD

Axns: regulatory molecule of diurnal rhythms, interacts with melatonin receptors, antioxidant, antineoplastic

Adverse fx: N, morning drowiness, HA

CI: daytime use

possible serotonin syndrome if used with SSRIs

Front 96

Zolpidem

Back 96

IND: short-term tx insomnia

Axns: similar axns to benzodiazepines but different - hypnotic fx

Adverse fx: caution in depression, use of ETOH can potentiate, palpitation, HA, drowsiness, coma, rash, confusion

CI: longterm use without evaluation of insomnia

limit use 7-10 days

Front 97

Bisacodyl

Back 97

IND: short-term tx atonic constipation - synthetic cathartic laxative

Axns: promote colonic motility

Adverse fx: NV, cramping, obstipation, chronic use can induce atonic constipation and pseudomelanosis coli (dark-stools), diarrhea, abuse potential

CI: use no longer than 10 days in a row, GI obstruction, spastic constipation, eating d/o, acute intestinal inflammation/pain

Interfere with lots of RX b/c of decreased absorption dt decreased transit time

Rx: oral, bedtime, enema

Front 98

Docusate

Back 98

IND: atonic constipation, hemorrhoids or anal fissures assoc with constipation

Axns: emollient laxative - stool softener

minimal adverse fx
c/i :diarrhea, obstruction, longterm use

takes 24+ hrs to work

Front 99

Magnesium

Back 99

short-term tx of constipation

C/i: colostomy, ileostomy, GI obstruction, fecal impaction, renal failure, appendicitis

Front 100

Loperamide

Back 100

IND: acute diarrhea

MOA: cholinergic muscarinic antagonist - binds gut opioid receptors

Adverse fx: constipation, NV

CI: acute UC, pseudomembranous colitis, enterotoxin-producing bx diarrhea, dehydration, electrolyte imbalances

C/I: use longer than 10 days

oral OTC

Front 101

Guidelines for prescribing ABX for h. pylori

Back 101

Always use at least 2 diff abx
One luminal abx:
tetracycline, penicillin, amoxicillin, ampicillin, bismuth

at least one systemic abx diff from luminal abx:
Penicillin, amoxicillin, apicillin, metronidazole or tinidazole, erythromycin or clarithromycin, cipro, ofloxacin, or norfloxacin, tetracycline, bismuth

Most also add acid-blocking drug
Adjunct probx

Front 102

Ranitidine
sim: cimetidine

Back 102

H2 blocker
IND: sxs relief for reflux esophagitis, PUD, dyspepsia, Z-E syndrome

Axns: Histamine-2 antagonist preventing HCL formation in stomach

adverse fx: HA, fatigue, poor mineral abs, imapred B12 abs, gastroenteritis and candiiasis, confusion and psychosis

C/I: elderly - increases confusion, gastric cancer, renal failure, lactation

interacts with many drugs

Front 103

Esomeprazole
sim: Omeprazole

Back 103

PPI
IND: erosive esophagitis, PUD, GERD
axns: blocks proton pump creation of HCL in stomach, more potent than H2 blockers - basically cause achlorhydria

adverse fx: infxns, dysbiosis, malabsorption, gastritis (atrophic)

c/i renal and hepatic impairment

Front 104

Sulfasalazine

Back 104

Non-narcotic analgesic
IND: UC, crohn's dz, RA
Axns: conjugated salicylate analog and a sulfa abx; anti-inflammatory

adverse fx: hypersensitivity, folate def, photosensitivity, NVD, oligospermia

C/I: renal, liver problems, abd NVPn with toxicity

adverse fx: hypersensitivity, folate def, ha, NV

Front 105

Amantadine

Back 105

IND: preventino of influenza A, very early influenza A infection, Early parkinson's or extrapyeramidal drug fx, adjunct to levodopa

Axns: inhibits viral RNA transcription, augments dopaminergic fx

advers fx: influenza resistance, dry mouth, blurred vision, confusion

CI: epilepsy, liver or kidney dz, psychosis

Front 106

Cromolyn Sodium

Back 106

Ind: prevention of asthma attacks esp in kids, allergic rhinitis, allergic conjunctivitis, food allergies, mastocystosis

Axns: mast-cell stabilizer!!

Adverse fx: unpleasant tastes, useless during acute events, rare allergic pneumonitis

C/I: liver or renal failure, no drug interaxns

oral, inhaler, nose drops, eye drops

Front 107

Beclomethasone

Back 107

Ind: asthma, seasonal or perennial rhinitis, prevents nasal polyps before surgery

Axns: inhaled corticosteroid; slows PMN migration

adverse fx: corticosteroid side fx - slows growth, suppresses immune system, adrenal problems

Front 108

Fluticasone

Back 108

IND: prophylactic tx asthma, mgmt of allergic rhintis, topical inflammation relief

Axns: corticosteroid, POTENT vasoconstrictor and anti-inflammatory

Adverse fx: corticosteroids

C/I: not for acute asthma attacks

oral inhalation

Front 109

Albuterol / Salbutamol

Back 109

Ind: acute bronchospasm

MOA: increases cAMP levels = bronchodilation

Adverse fx: htn, tremor, arrhythmia, dry mouth, altered taste, nervousness, agitation, fatigue

CI: CV Dz, hyperthyroid, DM, angina, during labor

Front 110

Epinephrine/ Adrenalin

Back 110

IND: Anaphylaxis, acute bronchospasm, v-fib, v-tach, glaucoma, vasoconstriction in minor surgery

Axns: Alpha and beta adrenergic agonist

Adverse fx: tachycardic fx, v-fib, angina, hypertenson

CI: arrythmias, athero of coronary artery, CM, hyperthyroid, epilepsy

IM, IV, endotracheal, inhaled

Front 111

Monteleukast

Back 111

IND: prophylaxis and chronic tx of asthma

Axns: LT receptor antagonist

Adverse fx: eosinophilia, HA, dizziness, rash, dyspepsia, cough, flu-like sxs, allergy to med

CI: acute bronchospasms

Oral, take in evening

Front 112

Isotretinoin

Back 112

IND: severe nodular acne

Axns: synthetic retinoid; reduces sebum production

Adverse fx: palpitations, tachycard, edema, fatigue

C/I: PG X!!!!!!!!!!!! use birth control while taking this drug, avoid use with ETOH

Front 113

Fluconazole

Back 113

IND: antifungal for local and systemic candidiasis, cryptococcal meningitis - ENTERS CNS

Axns :inhibits cell wall synth and fungal metab

Adverse fx: GI irritation, rash, liver impairment, HA

CI: liver and renal impairment

Front 114

Nystatin

Back 114

Ind: Vaginal candidiasis, thrush, intestinal candidiasis

Axns: pokes holes in fungal wall by binding ergosterol

Adverse fx: N, GI irritation - not systemically absorbed

CI: allergy, PG B or C (swish vs swallow)