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198 Cards in this Set
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Acetylcholinesterase inhibitors (-stigmine)
• Rivastigmine |
Acetylcholinesterase inhibitors (-stigmine) Use for Alzheimer’s and dementia. Reversible acetylcholinesterase inhibitor that causes an increase in concentrations of acetylcholine, which in turn enhances cholinergic neurotransmission
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ACHase inhibitor used for Alz/Dementia |
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Cholinergic Antagonist • Atropine |
In the eye, induces mydriasis by blocking contraction of the circular pupillary sphincter muscle, which is normally stimulated by acetylcholine release, thereby allowing the radial pupillary dilator muscle to contract and dilate the pupil.
induces cycloplegia by paralyzing the ciliary muscles, whose action inhibits accommodation to allow accurate refraction in children, helps to relieve pain associated with iridocyclitis, and treats ciliary block (malignant) glaucoma. Lasts much longer. Anticholinergic, muscarinic |
contracts |
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Cholinergic Antagonists
• Tolterodine |
detrol anti muscarinic - symptomatic tx for urinary incontinence. tx.
detrusor overactivity in adults, use with pelvic floor therapy. Acts on M2/M3 subtypes of antimuscarinic receptors. Fewer SE than oxybutinine. Targets M3 receptor found in bladder. SE: dry mouth/upset stomach, HA constipation dry eyes insomnia. |
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Cholinergic Antagonists
• Dicyclomine |
GI
antispasmodic. Uses: IBS, smooth muscle relaxer, |
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Alpha 1 agonist
• Epinephrine |
Direct acting, vasoconstrictor, bronchial dilator, local anesthetics,
OVERDOSE – MI or stroke, CAUTION in hyperthyroid pts, pts on thyroid hormone or cocaine |
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Alpha 1 agonists
• Phenylephrine |
a-adrenergic agonist, Direct acting, vasoconstrictor, used as a decongestant
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Alpha 2 agonist
• Clonidine |
Direct acting, decreases sympathetic outflow, used in hypertension,
causes dry mouth, sedation and sexual dysfunction, postural hypotension (first dose effect) |
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Alpha 1 antagonist
Tamsulosin |
used for BPH-
Blocks alpha1a adrenergic receptor in smooth muscle of prostate, decreasing bladder neck and urethral resistance. a-adrenergic blocker, used for BPH, improves urination, SE: dizziness/fainting/avoid taking overheated/hot weather, hx prostate cancer, CI pregnancy, viagara/any dilator. |
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Beta 2 agonist • Albuterol |
bronchodilator fast onset
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Beta 1 antagonist
• Atenolol, Propranolol |
antihypertensives. Can't quit cold turkey d/t rebound hypertension.
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Anesthetics /sedatives
Local • Cocaine |
Class 2, local anesthetic blocks Na+ channel, releases catecholamines, alertness, arousal, improved performance, sense of confidence and well being, euphoria at higher doses, binges common,
OD: cardiac, pregnancy problems, involuntary motor activity, irritability, violence, sexual disorders, anxiety WDL – dysphoria, depression, sleepiness, fatigue, craving, bradycardia |
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Benzodiazepines (-zolam/-zepam)- • Diazepam |
tx anxiety long acting, many uses
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Benzodiazepines • Alprazolam (Xanax) |
anxiety intermediate acting, tx panic disorder
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Non-Benzo sedatives
• Zolpidem |
short term hypnotic
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Alpha 1 agonists Pseudoephredrine |
mixed acting, releases norepi, cardiac stimulant (increases bp, bronchodilator, CNS stimulant) |
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Non-Benzo sedatives • Diphenhydramine |
antihistamine (Benadryl). Anticholinergic nonselective H1 histamine receptor.
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Non-Benzo sedatives: • Melatonin |
Hormone produced by pineal gland; regulates sleep cycle.
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Barbituate:
• Phenobarbital |
long acting, used in head trauma and seizures. CI porphyrias (OD can be fatal - whole class of barbituates CI in lactation and pregnancy D).
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Muscle Relaxant
• Methocarbamol (SOMA) |
CNS depression, short term painful muscle spasms. SE dizziness (lesser profile)
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• Carisopradol |
Muscle relaxant: painful muscle spasms, Pregnancy C, C/I in porphyrias, Lv/Ki disease and lactation. SE drowsiness/excess urination
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• Cyclobenzaprine |
Muscle relaxant: blocks a-motor neurons. brand names Amrix, Flexeril and Fexmid, is a muscle relaxer medication used to relieve skeletal muscle spasms and associated pain in acute musculoskeletal conditions. used off-label for fibromyalgia treatment. CI w/ TCAs also EtoH and depressants. Don't use within 14 days of MAOI or SSRI, increases risk of serotonin syndrome.
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Ketamine
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Anesthetics: Produces dissociative anesthesia, Blocks NMDA receptor, Overdose may lead to panic attacks and aggressive behavior; rarely seizures, increased ICP, and cardiac arrest. Very similar in chemical makeup to PCP (phencyclidine), but it is shorter acting and less toxic.
CI HTN and acute alcohol and drug intoxication and severe mental illness because it can worsen. |
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Aspirin
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Medications used to treat pain, headaches irreversible Cox 2 inhibitor Salicylate, anti-pyretic, stimulates respiration,
CI: Contra in children and mixing with piroxicam and other NSAIDS ***increases risk of REYE’S SYNDROME (Stage 1 – continuous vomiting, brain dysfunction. Stage 2 – Irritability, aggression, confusion, delirium, coma)*** permanently removes platelets, OVERDOSE- 10-30gm fatal, headache, ringing ears, mental confusion, hyperventilation, convulsions, coma, petechial hemorrhage, Aspirin is Nephrotoxic. TREAT with charcoal and vit K |
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• Acetaminophen |
Medications used to treat pain, headaches. decreases Substance P.
APAP (Acetyl Para Amino Phenol) - reversible Cox 3 inhibitor, anti-inflammatory, headaches, low anti-inflammatory activity (treats osteoarthritis), analgesic, antipyretic, high toxic potential. OVERDOSE- skin rash, severe hepatotoxicity, TREAT with N-acetylcysteine/Mucomyst, INTERACTS with alcohol Acetominophen is hepatotoxic. *** 4 gram rule *** |
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• Ibuprofen |
NSAID. nonselective COX2
Proprionic acid, anti-inflammatory, migraines, does not permanently remove platelets like aspirin. |
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• Naproxen |
Proprionic acid (NSAID- COX2 nonselective). preferred in CVD. Anti-inflammatory. Migraines, does not permanently remove platelets like aspirin.
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Celecoxib (Celebrex)
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NSAID selective Cox 2 inhibitor, fewer side effects.
BLACK BOX WARNING – RISKS OF CV EVENTS. Tx: RA, OA, joint pain specifically CI – renal failure, hypertension treatment, poorly controlled asthma, ulcers, blood clots, $$$$ |
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Capsaicin: |
Topical pain relievers: Capsaicin causes transient increased pain at application site (substance P release) → Stinging/burning/tingling sensation of skin. Transient receptor potential vanilloid-1 (TRPV1) agonist; topical application causes initial TRPV1 stimulation that may cause transient pain, followed by pain relief by reduction in TRPV1-expressing nociceptive nerve endings.
Apply Menthol as Local anesthesia. inhibits substance P, CI open wounds, irritated red skin, you want them to leave it on for 10 minutes and then rub it off. Must dilute it. Eventually pain will decrease. |
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Methylsalicylate
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Topical pain relievers - (quicker acting and milder): winter green oil/ menthol- Anti-inflammatory, analgesia, local anesthesia
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• Oxycodone- |
Schedule 2. Is not combined with acetominophen. Used for more severe pain t restless leg syndrome, has less nausea and vomiting than morphine. Major SE constipation and itching. CI Renal/Respiratory disease.
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**create new card Opiates . •Morphine-(Oral aka MS Contin)-
Schedule 2. chronic and severe pain, absorbed from GI tract. |
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Opiates • Codeine- |
Class 2, anti-tussive, small amount converts to morphine, treats mild pain in combination with APAP
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Ergotamine
• Sumatriptan |
Preg category C, drug of choice for severe migraines, slower onset triptans have the benefit of fewer side effects (increased BP and symptoms of angina).
CAUTION in diabetics with food ulcers and vascular problems, CI – SC and IM preparations (use IV instead), pts with ischemic heart, vascular, or bowel disease, or uncontrolled hypertension, within 24 hours of an ergotamine or ergot type medication, concurrent use or w/i 2 weeks of MAOI therapy, w/i 24 hours of another 5-HT agonist. Do not combine with other triptans. |
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Neuropathic pain/Tx seizures
TCA • Amitryptiline- |
also used for depression at a higher dose, blocks norepi and serotonin uptake, used for MAJOR depression, neuropathic pain, anxiety, enuresis,
LOW THERAPEUTIC INDEX , decreases seizure threshold, sedating, increases appetite, sexual dysfunction, serotonin syndrome, pro-arrhythmic, suicidal ideations CI MAOI/SSRI |
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Antidepressants/
Neuropathic pain SNRI • Buproprion SR (Zyban) |
- treats neuropathic pain, only used for those trying to quit smoking ~
Zyban marketed for smoking - Welbutrin for depression. Can induce nightmares or suicide. Lowers seizure threshold. CAUTION when given with anti-psychotics. |
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Neuropathic pain
• Trazodone - |
First SSRI, treats neuropathic pain, anti depressant, serotonin agonist. Used for insomnia/depression. Less side effects - Doesn't affect sexual dysfunciton much as regular SSRIs.
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Smoking cessation • Nicotine Patch |
Nicotine patch is nicotinic agonist. (various types of products) - Preg category D, antidepressant.
OD – nausea, vomiting, diarrhea, stomach pain, head ache, dizziness, sensory alteration, confusion, sweating, palpitations, chest pain, seizures and death, Wdl – irritability, impatience, hostility, anxiety, restlessness, dysphoria, depression, difficulty concentrating, bradycardia, increased appetite, smoking is the best way to absorb nicotine, INTERACTS with caffeine, clozapine, haloperidol, TCAs, Warfarin. As smoker quits must adjust doses of other medications (IE – caffeine overdose in a person who quits) |
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Medications used to control seizures: • Carbamazepine- |
IMINOSTILBENES (sedating). Tx: trigeminal neuralgia, monitor blood levels (can also be toxic), also used to treat seizures
(TONIC CLONIC and PARTIAL seizures), Tx: bipolar disorders. CAUTION with hepatic impairment, USED IN CHILDREN, BLACK BOX WARNING – APLASTIC ANEMIA, AGRANULOCYTOSIS, STEVEN JOHNSON SYNDROME, adjust dose with erythromycin, lower dose when added to Valproate |
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Gabapentin
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Medications used to control seizures: treats neuralgia, also used to treat seizure disorders (generalized tonic clonic, simple or complex, or partial seizures), GABA agonist, an orphan drug used on ALS, MONITOR renal function. Can cause peripheral edema.
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MAOI
• Phenelzine |
Tx: MDD or treatment resistant depression. Suicide inhibitors, adverse effects (hypotension, sexual dysfunction, HTN crisis with tyramine foods).
INTERACTS with TYRAMINE (hard aged cheese, red wine, cured meats, smoked fish), sympathomimetics, antidepressants, meridine, methylphenidate, levodopa, sibutramine.
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SSRI
Fluoxetine |
Depression, OCD, bulimia, PMDD (premenstrual dysphoric disorder), panic disorder/migraines, .
2 week weaning off period. Drug holiday- don't take depression meds on weekend. |
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• Buspirone (Buspar) |
Chronic Anxiety --Non-Benzo
not sedating, chronic GAD, can be used in elderly and pregnancy, takes 3-4 weeks for efficacy, |
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Chronic Anxiety --Non-Benzo
• Hydroxyzine - |
H1-receptor antagonist with low to moderate antihistaminic properties; inhibits respiratory, vascular, and GI smooth-muscle constriction. Moderate to high anticholinergic and antiemetic properties. First generation antihistamine. Very sedative.
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• Risperdone |
Acute anxiety: Benzos CI glaucoma, withdrawal anxiety insomnia muscle tension seizures, ataxia blurred vision, fatigue, caution liver compromised patients overdose at a
Medications used to treat bipolar disorders |
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Medications used to treat bipolar disorders
• Lithium |
Lithium (Bipolar) – Adenylate cyclase inhibitor, phosphlipase C inhibitor, displaces Na+ from nerves, thought to increase 5HT release, may block dopamine receptor sensitivity and increase GABA activity, 95% eliminated though kidney, 80% reabsorbed, Na competes with Li for reabsorption in the proximal and distal renal tubules
Monitoring: renal function, serum levels, daily intake of fluids and Na, drug and herb interaction,. If suspect toxicity take to hospital!!! Toxicities: predisposed by: dehydration, decreased Na levels, infection w/ fever, drugs that reduce clearance, MILD (1.2-1.5): nausea, memory difficulty, hand tremor (of intent), muscle weakness and fatigue, headache, MODERATE (1.5-3): confusion, lethargy, dysarthria, nystagmus, vomiting, increased reflexes, coarse tremors, SEVERE (>3): choleoathetosis, seizures, irreversible, brain damage, respiratory complications, coma, and death. Contraindications: Prego Cat-D, not established in children, renal disease or impairment, CD, who are receiving neuroleptics, elderly. Interaction: not metabolized in liver, increase serum Li: fluoxetine, loop and thiazide diuretics, NSAIDS, ACE inhibitors, decrease serum Li: acetazolamide, osmotic diuretics (urea and mannitol), verapamil, theophyline, increase Li toxicity independent of serum level: diltiazem, haloperidol, carbamazepine, methyldopa. |
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Medications used in the treatment of Parkinson’s disease, dementia, ALS and Huntington’s disease
• Amantadine- |
***Dopamine reuptake inhibitor. use for a year then need levodopa, enhances dopamine release from, and inhibits re-uptake into presynaptic storage vesicles, may inhibit NMDA receptor,
C/I epilepsy and liver/kidney disease SE you anticholinergic side effect... |
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Medications used in the treatment of Parkinson’s disease, dementia, ALS and Huntington’s disease • Pramipexole |
Medications used in the treatment of Parkinson’s disease, dementia, ALS and Huntington’s disease
– (1st gen) Dopamine agonist ***USES: Restless leg and parkinson’s |
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Medications used in the treatment of Parkinson’s disease, dementia, ALS and Huntington’s disease
• Bromocriptine- |
Medications used in the treatment of Parkinson’s disease, dementia, ALS and Huntington’s disease
Use first: (2nd gen) *** Dopamine agonist. USES: Parkinson’s – readily cross the blood brain barrier and act directly on striatal post-synaptic dopamine receptors, longer duration than levodopa. |
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• Levodopa, carbidopa- aka Sinemet- |
Last resort: Medications used in the treatment of Parkinson’s disease, dementia, ALS and Huntington’s disease
good control of symptoms for 5 yrs, levodopa crosses the blood brain barrier and is converted to dopamine (Carbidopa does not - inhibits peripheral conversion of L-dopa), |
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Donepezil -
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Cholinesterase inhibitors (***Uses: dementia***) – slow progression of symptoms, MONITOR for interactions. Inducers of donepezil metabolism-rifampin, Phenobarbital, carbamazepine, phenytoin, anticholinergics, acetylcholinesterase inhibitors. |
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Controlled substances
• Heroin- |
Class 1, sedation, rapid tolerance and frequent OD, convert to morphine after passing the blood brain barrier.
Controlled substances Withdrawal – craving opiates, restlessness, irritability, dysphoria, insomnia, anxiety, pain sensitivity, nausea, cramps, muscle aches, increased BP, tachycardia, fever, mydriasis. |
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Controlled substances • Cannabis- |
Controlled substances
contains 10 times more THC than marijuana MARIJUANA – |
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Controlled substances
• MDMA (ecstasy)- |
Controlled substances Class 1, stimulant and psychedelic, tachycardia, dry mouth, muscle aches, hallucinations, agitation, panic attacks, hyperthermia.
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Caffeine -
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(adenosine antagonist) increases norepi, forming rapid tolerance/dependence,
OVERDOSE- nausea, vomiting, anxiety, cardiac arrhythmias, seizures, delirium, Withdrawal – starts a couple hours after missed dose, headache nausea, fatigue, sedation. |
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Controlled substances • Cocaine |
- Class 2, local anesthetic, releases catecholamines, alertness, arousal, improved performance, sense of confidence and well being, euphoria at higher doses, binges common.
OD– cardiac, pregnancy problems, involuntary motor activity, irritability, violence, sexual disorders, anxiety. Withdrawal: dysphoria, depression, sleepiness, fatigue, craving, bradycardia. |
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Controlled substances • Dextroamphetamines == |
stereoisomer of an amphetamine tx: ADHD, narcolepsy, “military go pill" (BBW for abuse and dependence) |
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Controlled substances • Methylphenidate - |
aka ritalin
catecholamine/dopamine reuptake inhibitor. |
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Controlled substances • Naltrexone |
- treatment for alcoholism
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Sedative antag: keeps people awake Modafinil: |
use for sleep apnea and narcolepsy, e.g. shift workers who need to stay up. Unknown; not sympathomimetic; may increase dopamine levels in the brain by binding to the dopamine transporter and inhibiting dopamine reuptake
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Thyroid
• *Thyroid H are lipid soluble→take other lipid soluble Rx 2hrs apart from thyroid meds • HYPO Tx: o Levothyroxine (T4): |
Take 1qd, T1/2 6-7 days, best absorbed on empty stomach, cannot change Rx to glandular/dessicated.
Caution: Still chance of putting patient on thyrotoxicosis |
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Thyroid
• HYPER Tx: o Propylthiouracil (PTU): |
Long-term, prego preferred, Tx thyroid storm. Caution w/Lv Dz dt hepatotoxicity. S/E lupus-like syndrome (recall procainamide too). Inhibits conversion peripherally T4→T3 by effecting enzyme.
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Diabetes/ Insulins • Regular: |
30-60min onset with meals, if acutely sick and on regular, ^ dose 1-2 units and test for ketones in urine to monitor ketoacidosis while immune compromised→gets glucose to tissues
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Insulin secretogogues/Sulfonureas: • Glyburide: |
STOP AFTER 10-15 yrs!!!! Change to metformin instead☺ CI w/elderly and ETOH→disulfram rxn!
T2DM only. Wears out the beta cells long-term. CI in Ki failure. Has mild diuretic effect. Give with meal. |
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Insulin sensitizers: DM2 only.
• Metformin: |
Insulin sensitizers: DM2 only. Decreases effectiveness of OCPs→unintended pregnancy Ki elimination via OCTs →^^risk lactic acidosis aka metabolic acidosis dt dysfxn OCTs dt failing Kidney. |
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Insulin sensitizers: DM2 only. Decrease OCPs→unintended prego • Rosiglitazone: |
More potent dt ^affinity for insulin receptors. BBW: HF esp w/CHF dt ^ water absorption. ^TG, LDL, Total cholesterol. (Avandia) - anti diabetic drug.
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Medications approved for treatment of obesity • Phenterimine: |
“fanatic F” want FAST weight loss. Mech→sympathomimetic anoretic aka anorexic.
S/E: ^^^pulmonary HTN caution: valve Dz, dependency. Short tem only. PREGO C. diet pill, SE: Heart issues, agitation/restlessness. Don’t use with other amphetamines. CI: cardiac, pregnancy, SSRI’s, TCAs. Works on hypothalamic portion of brain. C/I: serious depression. |
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Antihistamines:
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ALL OTC: 1st generation: dose BID→sedation. 2nd generation: dose QD→less sedating. DO NOT XBBB. |
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Antihistamines: • Diphenhydramine: |
Antihistamines: Tx allergies/allergic rhinitis. Anti-H1 antihistamine. 1st generation. crosses BBB. S/E: sedating, fatigue, dry mouth, respiratory passages, disuria, constipation w/ chronic use.
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Antihistamines:
• Loratadine: |
2nd gen. anticholinergic effects (less sedating than 1st).
Greatly reduced sedation→ OK to operate heavy equipment. |
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Antihistamines:
• Cyproheptadine: |
Is a first-generation antihistamine with additional anticholinergic, antiserotonergic, and local anesthetic properties. *more effective in preventing histamine response than in reversing it; may be useful in patients with syndromes sustained by histamine-producing tumors. Moderate anticholinergic activity with low sedative effect. May have anti-5HT2 effects. May have some calcium-channel blocking activity. Sold under the brand name Periactin or Peritol. Moderate SSRI syndrome. |
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Cardiovascular medications
DIURETICS: • Furosemide: |
Cardiovascular medicationsDIURETICS:
Loop diuretic, profound→rapid acting. Inhibits Na/K/Cl symporter in thick ascending loop of Henle. NOT DOC for HTN. Uses: edema in CHF. S/E: ototoxicity→deafness, hypo-electrolytes!!!! (hypokalemia). |
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Cardiovascular medications • Hydrochlorothiazide: |
DOC in HTN. Inhibits Na/Cl symporter in distal tubule. SE: hypokalemia/hyponatremia, dec glucose tolerance, ^LDL/TG. NSAIDS decrease efficacy because they constrict the afferent tubules in kidneys,
increases uric acid (causing gout), rash, phototsensitivity. |
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Cardiovascular medications • Spironolactone: |
Aldosterone sparing. K sparing,
NOT monotherapy→use w/Loop. Given b/c hydrochlorathizadize.→hypokalema→. (Spironolactone corrects that issue.) |
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• Desmopressin: |
Cardio Medication. Uses: Hypotension, bedwetting and diabetes insipidis, hemophilia. desmopressin increases water permeability in renal tubular cells, which in turn decreases urine volume and increases urine osmolality. Also produces dose-related increase in von Willebrand factor VIII and t-PA levels; this shortens activated partial thromboplastin time (aPTT), as well as bleeding time. In blood pressure, synthetic replacement for vasporessin hypothalamus. |
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SYMPATHOLYTICS:
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SE: postural hypotension, bradycardia, fatigue, exercise intoleranc
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SYMPATHOLYTICS: • Propranolol: |
B-Blocker, non-specific B1/2 antagonist.
Nonspecific→starts with N→Z. Specific starts with A→N. B2 antagonist->asthma. DO NOT GIVE TO ATHLETE! |
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SYMPATHOLYTICS: • Atenolol: |
Starts with M→cardio-selective B1. DO NOT GIVE TO ATHLETE!
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SYMPATHOLYTICS:
• Carvedilol: |
Not a drug of choice for HTN- use other B-blockers first. Nonselective beta-adrenergic and alpha1-adrenergic blocking agent with
no specific activity for use in congestive heart failure and hypertension |
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SYMPATHOLYTICS: • Clonidine: |
alpha2 agonist→central→auto-regulates to decrease sympathetic tone. Last-line Tx for HTN.
^^^S/E: sedation, low E, xerostomia, dec libido, gynecomastia. DO NOT GIVE TO ATHLETE! |
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CCBs: (Calcium Channel blockers) -Amlodipine: |
Use for HTN.
Inhibits transmembrane influx of extracellular calcium ions across membranes of myocardial cells and vascular smooth muscle cells without changing serum calcium concentrations; this inhibits cardiac and vascular smooth muscle contraction, thereby dilating main coronary and systemic arteries. Increases myocardial oxygen delivery in patients with vasospastic angina. |
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ACE/ARBs • Lisinopril, Captopril, enalapril,… (ends with pril): |
ACE-I. DOC forPt w/ HTN & DM. Don’t give if poor Ki function.
ACEI→XS prostaglandins and bradykinin→inflammation→cough and angio-edema esp in F→ switch to ARB. S/E: hyperkalemia, photosensitivity. NSAIDS dec effectiveness |
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ACE/ARBs • Valsartan, Losartan:ARB |
(end in SARTAN). fewer S/E than ACEI. ARB decrease angioedema whereas ACEI increase bradykinin. Tx aneurysms seen in Marfan’s.
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• Digoxin: |
Cardiac glycoside, Tx HF not HTN.^^strength of contraction/(+) ionotrope.
(-)chronotrope→Ca2+maintained in muscle tissue longer →not in SR→ longer to recover before next AP and more Ca2+ released so stronger contraction. LOW therapeutic index. S/E: yellowing of vision. Mechanism: .inhibits Na/K ATPase→slowing down fluid loss. Influences |
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Vasodilators: • Nitroglycerin:. |
Tx angina. Converts to NO→ Vasodilation→relieves pain. S/E: HA/ orthostatic HTN.
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Vasodilators: • Sildenafil: |
Viagra. Phosphodiesterase-5 inhibitor→keeps cGMP from being degraded→causing vasodilation. S/E: HA, flushing, visual alteration→blindness, hypotensive.
CI w/nitrates→DEATH, do not take after angina or post-MI. Prego B. Take 15-20min prior to intercourse. Vasodilator - phosphodiesterase inhibitor - causing increased erections. SE: priapism. Causes H/A. heartburn diarrhea, flushing, nosebleeds, C/I Nitro. |
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Vasodilators:
• Pentoxifylline: |
Use for intermittent claudication- Improves blood flow by decreasing blood viscosity and increasing red blood cell (RBC) flexibility. May increase tissues oxygenation through enhanced blood flow.
Tx intermittent claudication d/t peripheral artery disease. Peyrone’s disease. Sarcoidosis, peripheral neuropathy, endometriosis. Raises - cAMP, raises pKa -> Competitive nonselective phosphodiesterase inhibitor. Modulates inflammation: Inhibits TNF/leukotriene synthesis (decreases blood viscosity). |
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ANTI-HYPERLIPIDEMIAS:
Atorvastatin |
Anything ending with –statin: DOC ^^LDL -> Dec LDL 18-60%!!! CI Prego X, Lv Dz.
SE: N, dizziness, fatigue. Caution ALS Sx might be revealed→CI in those Pts. Monitor LFT, CPK. Replace bile acid resins for Tx. |
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• Gemfibrazole: |
Fibric acid derivative, Tx TG>500!!!! Don't combine with statins because increases risk of rhabdo -only do one or the other.
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ANEMIA Epoetin/ Erythropoietin (darbopoietin-alpha): |
associated w/anemias caused by chemo Tx, Ki Dz, elderly, sickle-cell anemia, thalessemias. (Normocytic normochromic)
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Arrythmias
Amiodarone: |
Class III, #1 selling Rx of anti—arrhythmic.
DOC CHF who need anti-arrhythmic agents or Pt who failed other Tx. T(1/2)=20-47 days→feel like crap for a long time! Sun exposure→BLUE SPOTS. Nitroglycerine: see above. |
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Anti-platelet
ASA (aspirin): |
NSAID, irreversible COX inhibitor. 1st line Tx TIA/CVA
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Clopidogrel (Plavix): |
fancy form of ASA. Inhibits platelets (reversible) → prevents aggregation. Used for stroke prevention. 2nd-line Tx TIA/CVA. Low risk of neutropenia.
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Anti-Coagulants Warfarin: |
PT INR (1-2 is Normal, 2-3 is therapeutic range on warfarin), Vit K antagonist affects 1-9-7-2. Prego X. Antidote=Vit K.
CI inferior vena cava filter replacement. Statin indicated →pravastatin ONLY. 1st line: Tx cardiogenic stroke. 3rd line: arteriogenic stroke. Caution: unsteady gate~ predisposes Pt to fall and bleed out. |
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Topical corticosteroids - Isotretinoin- |
specifically for Type 4 CYSTIC acne, Oral. SE: depression, sunburn, drying of skin, Caution w/ Etoh, CI pregnancy/sexually active/liver issues. (version of super high dose vitamin A)
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Topical Antibiotics: • Antibiotics topical- |
Apply to entire face to Decrease SE. START w/ TOPICAL to reduce acne and then you can start oral.
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Type 2 acne
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Papules 10-25 lesions & mild scarring: Tetracyclines, erythromycin, clindamycin.
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Antibiotics:
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oral ( ^SE)
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Triple antibiotic ointment-
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triple antibiotic (bacitracin, neomycin, polymyxin B) topical; SE: promotes MRSA. G+/-
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• Mupirocin: |
Bactericidal; inhibits protein synthesis in susceptible bacteria by reversibly binding to bacterial isoleucine-tRNA ligase (isoleucyl-tRNA synthetase) -> the enzyme that catalyzes the formation of isoleucyl-tRNA from isoleucine and tRNA.
Antibiotic - mono oxy carbolic acid class. **Bacteriostatic at low concentrations. **Bacteriocidal at high concentrations. Topical. Tx: MRSA, furuncles, impetigo. |
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• Silver nitrate: |
Used in wound cauterization- Antiseptic that denatures proteins, acts on surface of bacteria causing substantial changes in cell wall and membrane.
AntiOxidant/styptic/antimicrobial, used to prevent bleeding and cutaneous warts. SE: nosebleeds, stain skin brown/black. Used in 2nd/3rd degree burns. Used for toenail removal. |
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• Estrogens: |
Estrone=E1, # circulating E in blood (strongest post-menopause).
Estradiole=E2 (strongest form), high first pass metabolism→fast elimination. Estriole=E3. Think WOMEN’S ISSUES. proliferation of endometrial lining. Causes hyper-secretion of cholesterol. Effects Lv metabolism lipids. S/E: GI Sx N/V, ^^risk breast Ca, blood clots, H/A, PMS. NOT USED AS MONOTHERAPY must be combo for OCP. |
add new card: HRT• *Creams, IM, sublingual,patch. All lipid soluble CAUTION TRANSFER TO FAMILY/FRIENDS with cream• *CI Hx thromboembolism |
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HRT • CEE (conjugated equine estrogen): |
source of E3
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HRT • Progesterone: |
used to prevent endometrial proliferation and Cancer which are stim by Estrogens. S/E: mood changes, weight gain, bloating, acne, hirsuitism, as a monotherapy ^ risk breast Ca.
If a lot of acne, breakthrough bleeding, etc. side effects (THINK excess ANDROGENS.) Can be used as monotherapy for OCB. |
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Selective Estrogen R modulators SERMS: S/E hot flashes, clots. • Raloxifene: |
Selective Estrogen R modulators SERMS: S/E hot flashes, clots. If Family Hx breast Ca and menopause Sx USE THIS ONE!! |
new card: • medroxyprogesterone acetate == used for abnormal uterine bleeding, inhibits secretion of pituitary gonadotropins which inhibits follicular maturation and ovulation. Prevents endometrial changes with estrogen replacement therapy. SE thromboembolism, stroke, CI breast cancer. |
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Selective Estrogen R modulators SERMS: • Finasteride: |
Selective Estrogen R modulators SERMS: |
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Selective Estrogen R modulators SERMS: • Testosterone: |
hypogonadism in Men, dec libido in women and perimenopause in Females.
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Selective Estrogen R modulators SERMS: • DHEA: |
no negative feedback→fewer SE. makes Testosterone in (in F)→Estradiole (in M) note makes both in post-menopause. No Prego or lactation. Monitor for BPH by checking PSA levels.
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Selective Estrogen R modulators SERMS: • Anastrozole: |
non-steroidal aromatase inhibitor→dec estrogen production in Lv, fat, muscle, skin, breast. Tx breast Ca. SE bone pain, vaginal bleeding, insomnia, hot flashes.
Can be first line Tx for hormone therapy. Try first until post-menopause→then give Raloxifine. |
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Selective Estrogen R modulators SERMS: • Androstenedione: |
Precursor of estrone and testosterone
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OCP’s • Ethinyl estradiol /norelgestromin |
– Estrogen monotherapy SE: nausea. Fluid ret, breast tenderness, leucorrhea, h/a, htn
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IUD (Levonorgestrel aka Mirena)- |
IUD. Progestins w/ varying activities of estrogen, progesterone, and androgens. So consider changing if pt experiences XS progestin, est, or androgen effects:
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OCP’s• Norgestimate (oral progestin) == same but different delivery system. |
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Birth control: • Medroxyprogesterone acetate |
– Depovera (injection) – ok for breast feeding, SE: wt gain > 100lbs, bone loss (so not for perimenopause), breast tenderness, CI: smokers, FHx of Cardiac Dz
(give this if they don't want OCP.) |
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OCP’s • Misoprostal: |
MOA: ^PGE1 → acts on parietal cells to inhibit acid secretion & Stim uterine contractions - Emergency contraceptives: Abortifacient
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Osteroporosis • Alendronate: |
A bisphosponate- decreasing osteoclast activity thereby reducing bone resorption and turnover. After 5-7 yrs increases risk of fractures! |
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Osteroporosis • Raloxifene: |
SERMS. S/E: clots, hot flashes, leg cramps. Inhibits bone resorption in femur and vertebra and not the hips.
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Repeat? |
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Respiratory • Albuterol: |
short acting B2 agonist. Reliever therapy. DOC for acute. Don’t use >q 4-6hrs. ORAL dose is NOT preferred dt ^SE.
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Add: Salmeterol == generallyused with inhaled corticosteroids. U: asthma, COPD, cysticfibrosis A: long-acting b-2 receptor agonist. |
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• leukotriene modifiers Respiratory • Montelukast |
(met b Lv, DOC <1yr)
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Respiratory • Tiotropium bromide (Spiriva): |
used for COPD- Long-acting antimuscarinic agent, often referred to as anticholinergic. Inhibits M3-receptors at smooth muscle, leading to bronchodilation.
Anticholinergic bronchodilator; powder inhaler for COPD, wheezing SOB, Bronchitis. Do not use of acute exacerbations. Anti muscarinic effects. CI: Acute angle glaucoma, allergies. Assoc with increased mortality with people with COPD. |
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Digestive Mucosal protectant
• Misoprostol- |
Prostaglandin E2 analog – mucus lining protectant (decreasing histamines/gastric acid), taken w/ NSAID use → SE: nausea & diarrhea.
CI: in prego → causes uterine contractions |
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Digestive • sucralfate- |
Al- hydroxide & sulfated sucrose.
MOA: Stim PG release -> create a barrier so impairs diffusion of HCl,& requires an acidic pH to be activated. Trx: duodenal ulcers only! |
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Laxatives: • bisacodyl |
– stimulant laxative (Senna)- stim muscle contraction and dec H2O & electrolyte abs SE: painful muscle contractions. Works in 6 hrs
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Laxatives: • docusate – |
surfactant → emulsifying and wetting and acts spec on small intestine
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Laxatives: • Sodium Phosphates Enema |
- used for treating constipation and cleansing bowel in certain medical procedures. Saline laxative - often softens stools and cause BM. CI: bowel blockage, bowel problems, CHF/kidney failure/hypophosphatemia. interacts: ACE/NSAIDS/ARBs.
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Anti-Diarrhea • loperamide |
– tx: diarrhea, e.g. AIDS assoc.
MOA: inhibits gastric acid secretion -> dec sm contraction. (more effective than Bismuth! ) |
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Anti-Diarrhea • Bismuth (pepto bismol) |
good for mild traveler's diarrhea,
Good for diarrhea caused by Abx, inhibits pepsin, ^mucus secretion. |
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Anti-Diarrhea • Esomeprazole, omeprazole – |
PPI - (Esomeprazole = prodrug)_, CYP 450 inhibit, pumps H+ out of the cell against the gradient. Inhibits basal and gastric acid secretion. Binds irreversibly and used to trx GERD,PUD. They will get REBOUND acid when you take them off of it.
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Anti-Diarrhea • metoclopramide: |
Pro kinetic Drug Uses: GERD, diarrhea, constipation. MOA: acts as a dopamine antagonist ^ motility (SE: movement disorders).
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Anti-Diarrhea • prochlorperazine: |
Antiemetic- dopamine antagonist→ so inhibits emetic reaction ( SE: movement disorders)
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continue here |
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Anti H2 Ranitidine (5-10x more potent w/ min side effects) ==- |
Anti H2 – MOA: inhibits secretion of pepsin and Intrinsic Factor. Crosses placenta & breast milk. Drug interactions! So take antacid 2-4 hrs before or after other drugs! SE: h/a, dizziness, nausea |
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Sulfasalazine |
Anti H2Aminosalycilates: Trx IBD –> SE: N/V, HA, alopecia, folate/malabs issues, HS rash, hepatitis
(used for Ulcerative Colitis) –Sulfa Abx + ASA – use locally in a suppository |
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• Latanoprost (Latisse) == |
Ophthalmology Open angle glaucoma – PG analog used for glaucoma and may grow eye lashes. May ^ iris pigmentation. ophthalmic solution - reduces interocular pressure -prostaglandin analog via prostaglandin F2a. Ester pro drug. |
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Ophthalmology • rivastostigmine |
anticholinesterase promotes Ach –Used in Alz/Dementia - unlikely to be used w/ glaucoma. Use as last resort. SE: follicular hypertrophy of palpebral conjunctiva.
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Toxicology / Chelators • EDTA |
– IM/IV injection – monitor urine output to prevent renal toxicity. because it Chelates Pb
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Toxicology / Chelators • Penicillamine |
-IM injection – cuprimine/Cu/Hg chelator, used in Wilson’s dz - binds copper and eliminates it in urine.
Used in cystinuria (inherited disease). SE: bad. Bone marrow suppression, anorexia, nephro-/hepato-toxic, Myasthenia gravis |
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Toxicology / Chelators • DMSA- |
Pb chelator > Hg and Ar.
Pulls Pb from soft tissue NOT bone. (vs. EDTA pulls lead from Bone.) Urinary excretion. |
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Toxicology / Chelators • DMPS – |
inorganic Hg chelator > Pb and Ar.
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Toxicology / Chelators • DeFEroxamine – |
Fe chelator for acute iron poisoning – hemochromatosis, Also chelates aluminum via urinary excretion.
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Antibiotics: 1. Beta-lactams |
– Cell wall synthesis inhibitors → bactericidal
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• Penicillins |
(1st gen) Anaphylaxis SE is common, cell wall synthesis inhibitor, kidney excretion. Uses: strep infxn (pharyngitis DOC) and IM for gonorrhea. Gram+ only. Considered among safest, if allergic → erythromycin which is C/I in pregnancy. But pts can be desensitized if they are preg.
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do final section with penicillins |
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Antibiotics: • Penicillin VK (5th generation K+ based)- |
Inhibits the biosynthesis of cell wall mucopeptide; bactericidal against sensitive organisms when adequate concentrations are reached, and it is most effective during the stage of active multiplication (of bacteria); inadequate concentrations may produce only bacteriostatic effects.
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Antibiotics: • Amoxicillin- |
(3rd gen) bactericidal, β-lactam antibiotic, extended spectrum (Gr-/+)
Uses: H. influenza, strep, dental prophylaxis, gonorrhea, H-pylori, endocarditis (prophylaxis), anthrax SE: Common: N, V, fatigue, diarrhea, non allergic rash, candidiasis. SE:less common: allergic rxn, pseudomembranious colitis, thrombocytopenia, leukopenia, anemia, superinfections, seizures, eosinophilia, elevated liver enzymes. CI: Mono, penicillin allerg. Also ↓effectiveness of OCP. Bromelain increases absorbtion. |
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Cephalosporins Cephalexin |
a. 1st gen - Cell wall synthesis inhibitor. Tx: URI, first line for cellulitis. Broad spectrum.
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Cephalosporins Cefdinir: |
Third-generation cephalosporin; inhibits mucopeptide synthesis in bacterial cell wall; typically bactericidal, depending on organism susceptibility, dose, and serum or tissue concentrations.
Fewer side effects. Mostly G- bacteria. |
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Protein Synthesis Inhibitors → Bacteriostatic c. Macrolides – |
Protein Synthesis Inhibitors → Bacteriostatic
often used in penicillin allergy. Inhibitor of CYP 450 – Otoxicity! |
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i. azithromycin– |
Protein synthesis inhibitor, macrolide.
SE: prolonged QT/cardiac arrythmias, ototoxicity, jaundice. Drug-drug interaction w/ warfarin, digoxin, corticosteroids. C/I: pregnancy, kidney failure. |
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d. Clindamycin – |
Protein synthesis inhibitor (bacteriostatic). BBW: can cause pseudomembranous colitis (C. Diff.)
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a. doxycycline – |
Tetracyclines–30S Protein Synthesis Inhibitors CI dairy→Bacteriostatic.
SE: tooth modeling in kids, photosensitivity (avoid in UV light), liver and renal toxicity, C/I Pregnancy. |
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a. Sulfamethoxazole, trimethoprim |
– antimetabolite, folic acid inhibitors. Crystallization in urine #1 for UTIs.
SE: Steals Fe+ → hemolytic anemia. CI: Not to use in newborns! Bc: liver isn’t mature enough. |
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a. Ciprofloxacin- |
4. Nucleic Acid Synthesis inhibitors (DNA) → bacteriocidal
Quinolones (-floxacins) DNA gyrase inhibitors, cause DNA supercoils til they break – SE: Achilles tendon rupture! Seizures, hallucinations, C/I w/ NSAIDS, P, and prepuberty kids |
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a. Nitofurantoin –
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urinary antiseptic.
SE: N/V, chills, fever, and BBW – lung toxicity if prolonged use or preexisting lung issues. |
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a. Phenazopyridine |
(not an Abx, but a urinary anesthetic)~ bright orange urine!
Used to diagnose prostatitis empirically. |
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1. Antivirals a. Amantadine: |
NMDA receptor antagonist. Influenza A only (also used for parkinson's). Prevents viral uncoating.
SE: GI, CNS, antimuscarinic, renal toxic |
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a. Oseltamavir (Tamiflu) – |
Influenza A & B.
SE: CNS, GI, Vertigo. |
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a. Acyclovir- |
Uses: HSV. Poorly absorbed.
SE: N/V/D myalgia. Monitor Liver Function. |
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a. Valcyclovir – |
Uses: HSV, prodrug to acyclovir: absorbed better.
SE: H/A. N/abd pain, dysmenorrhea, depression. Monitor Liver Function. |
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a. Adefovir- |
4. Nucleic Acid Synthesis inhibitors (DNA) → bacteriocidal.
Uses: HepB. SE: HA, rash, GI, Increased LFT’s. |
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a. Nystatin – |
6. Antifungals. yeast only/ not abs well – stays in the gut.
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a. Fluconazole (Diflucan) |
7. Antifungals.newest,
Broad spectrum, Well absorbed, renal excretion – chronic use in HIV for coccidiomycosis. SE: N, V, dry skin, rash, hepatotox, HA, alopecia |
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8. Antifungals a. Metronidazole- |
Uses: DOC for giardia, nosocomial diarrhea, C.Diff, H.Pylori.
C/I-Prego- 1st trimester. CI Disulfram, do not drink w EtOH (N/V/lightheadedness) SE: HA, nausea, dysgeusia, neurotoxicity. |
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a. Terbinafine: |
9. Topical antifungal (athlete's foot, use for onchomycosis- Inhibits squalene epoxidase,
reduces cell membrane ergosterol synthesis, causes inhibition of fungal cell-wall synthesis and subsequently, fungal cell death. |
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a. Hydroxychloroquine - |
10. Antimalarial
inhibits neutrophils & chemostaxis of eosinophils, and decreases the complement cascade. USES: RA, SLE (by decreasing complement cascade), Malaria. SE: irreversible retinal damage, nausea, and anemia. BBW: Ocular dz, CI: w/ children, G6PD. So monitor w/eye exams and CBC. |
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a. Mebendazole- |
11. Antihelminths
good for kids (becuase it is not absorbed). good for tx worms. Used for ascariasis and enterobiasis (tapeworms, hookworms, etc. ) Inhibits and destroys microtubules in parasitic worms. Caution: hi doses - toxic epidermal necrolysis. |
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a. Permethrins: |
12. Antiparasitic topical creme.
Tx: scabies, mites, pediculosis-(lice). Like natural pyrethrins, permethrin acts as a neurotoxin by depolarizing nerve cell membranes of parasites, leading to their death. The drug disrupts Na+ channel current by which membrane repolarization is regulated. neurotoxin, SE: hyper excitability tremors, seizure, death, only neurotoxic if ingested. First line tx: Scabies. |
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• Ritonavir. |
13. Protease inhibitors- binds to active site of HIV protease.
Don't give it with antiarrythmics. CI Liver Dz, Hep B, Heart Dz. WORST SE: GI, Paresthesias, endocrine, *buffalo hump/cortisol inc*, hyperglycemia, fat maldistribution, lactic acidosis, hyperlipidemia |
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• Zidovudine |
NRTI (nucleoside reverse transcriptase inhibitor)
tx: HIV SE: GI, malaise, HA, peripheral neuropathy, anemia |
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Glucocorticoids
• Prednisone, hydrocortisone: |
Withdrawal sx: N, V, Anorexia, HA, joint pn, fever, lethargy, myalgia, hypoTN, weight loss
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Glucocorticoids • Dexamethasone: |
Potent glucocorticoid with minimal to no mineralocorticoid activity.
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes (PMNs) and reducing capillary permeability; stabilizes cells/lysosomal membranes, increases surfactant synthesis, increases serum vitamin A concentration, and inhibits prostaglandin and proinflammatory cytokines; suppresses lymphocyte proliferation through direct cytolysis, inhibits mitosis, breaks down granulocyte aggregates, and improves pulmonary microcirculation. steroid, ACTH challenge test |
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• Cyclosporin |
Calcineurin inhibitors (Immune suppressant.)
CI: red wine, CY3A4 inhibitors. Used in organ transplant, severe RA after methotrexate, and severe psoriasis. - SE: renal dysfxn, tremor, hirsutism, HTN, diabetogenic, N/V, infxn. Numerous D-D interactions: including methotrexate. |
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Antimetabolic agent
• Methotrexate |
-Folate antagonist/inhibitor. Renal metabolism.
-SE: N/V/D, elevated liver enzymes. -Tx: RA drug of choice, AI, Cancer/Chemo. -Hepatotoxic/pulmonary toxic. -Pregnancy X |
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• Interferons - |
Immunostimulants
Anti-viral; SEs: fever, ha, rash, flu-like sx, alpha-interferon can cause cv probs |
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• A2b interferon |
tumors, e. coli, hep B/C, kaposi's sarcoma, renal cell carcinoma, esophageal and colon cell cancer, malignant melanoma
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• Gamma interferon |
tx: activates phagocytes → granulomatous infxns
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B1a interferon |
→ tx: antiviral, MS,
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• *doxorubicin |
Cancer/ Chemo drugs
–inhibits DNA synthesis. USES: solid tumors and leukemia. SE: BBB Cardiac toxic. Immunosuppression, GI upset, alopecia. CI: cardiac disorders, breastfeeding, and Prgy D. |
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Cancer/ Chemo drugs
• *Methrotrexate- |
folate antagonist. USES: Autoimmune dz, (RA and psoriasis). CI: Abortifacient, CI Pregnancy
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• *Vinblastine – |
Cancer/ Chemo drugs
mitosis inhibitor – arrest cells at metaphase. USES: hodgkins, NH lymphoma, testicular Ca, Lu Ca. SE: peripheral neuropathy, alopecia, HTN, rash. CI: severe bone marrow depression and Pregnancy D. |
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• *Paclitaxel – |
Cancer/ Chemo drugs
microtubule inhibitor → inhibits cell division. USES: nonsmall cell Lung Ca, metastatic carcinoma of breast/ovary, Kaposi sarcoma. SE: BBW-Severe anaphylaxis, immunosuppression, GI upset. CI: hypersensitivity to castor oil. Prgy cat D |
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• 5-Fluorouracil |
Cancer/ Chemo drugs
– anti-metabolite → Dec DNA synthesis by blocking methylation of deoxyuridic acid. SE: immunosuppression, GI upset, low therapeutic index. CI: myelosuppression, breastfeeding, poor nutritional stats, surgery w/in 1 mos. Preg D. |
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• Colchicine- |
tx: Rheumatology
affects tubules and early stages of attack gout. SE N/V/diarrheal pain. Inhibits formation of uric acid crystals. Prevent acute flares. Binds tubulin, used as an anti-cancer treatment. Inhibits: microtubule polymerization by binding to tubulin. Essential for mitosis. “mitotic poison” or spindle poison. |
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• Adalimumab - |
Rheumatology
Monoclonal antibody (Ab) against TNF-a. Blocks interaction of human tumor necrosis factor (TNF)–alpha with receptors and modulates biological responses induced or regulated by TNF. |
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• Dextromethorphan: |
Tx: Cough/Cold
Coughs- Acts on cough center in medulla; decreases sensitivity of cough receptors and interrupts cough impulse transmission. C/I with MAOI → serotonin syndrome! Antitussive |
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Cough/Cold • Guaifenesin: |
Cough- Reduces viscosity of secretions by increasing amount of respiratory tract fluid and irritates gastric mucosa. Mucolytic expectorant.
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• Fluticasone: |
use for Rhinitis.
Potent anti-inflammatory corticosteroid with vasoconstrictive properties. Available in 2 salt forms, fluticasone propionate (Flonase) and fluticasone furoate (Veramyst). Corticosteroid which decreases nasal mucosal eosinophils and basophils. |
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Cough/Cold • Momentasone: |
Cough/Cold
Nasal inhalation. use for asthma-Corticosteroid with potent anti-inflammatory properties; exerts effects on various cells, including mast cells and eosinophils; also exerts effects on inflammatory mediators (eg, histamine, eicosanoids, leukotrienes, cytokines). synthetic glucocorticosteroid tx penile phimosis, allergic rhinitis, antiinflammatory, antipuritic, vasoconstrictive properties. in Creme- used for psoriasis. |
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Cough/Cold • Oxymetazoline (Afrin) |
for nasal decongestion- Alpha-adrenergic agonist; stimulates alpha-adrenergic receptors and produces vasoconstriction in the arterioles of the nasal mucosa. nasal spray, a1-a2 agonist, topical decongestant.
SE rebound vasocongestion due to a-2 receptors |
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Medications used to control seizures• Phenytoin- |
(5, 7, bipolar) – Drug class - HYDATOIN, Blocks voltage sensitive sodium channels, sedating, used to treat neuropathic pain, trigeminal neuralgia, also treats seizures (primary and secondary generalized tonic clonic, simple and complex partial seizures), used in electroshock therapy to prevent seizures and some cardiac arrhythmias, |
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Hydrocodone |
Mild to moderate pain, side effects dizziness N/V/drowsiness/constipation/euphoria. Combine with acetominophen to make vicodin. |
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Naloxone |
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D5W |
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Sterile Water |
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Lactated Ringers |
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Sodium Chloride |
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Hepatitis B Vaccine |
Used at Birth, 3 doses: 6, 10, 14 weeks, serum/recombinant vaccine. If Chronic form or after birth: dose 2-5 months. SE: Fever, HA, pain, fatigue, tenderness warmth at injection site achiness and arthralgias. CI: acute febrile illness. |
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Hep A Vaccine: |
Virus: not chronic; fecal-oral, 28 day incubation period, Vaccine: cell cultured virus, need 2 doses, recommended for third world travelers. |
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HIB Vaccine: |
Conjugate vaccine, dose 4 times: at 2 months, 4 months, 6 months, and 12-15 months. CI in children < 6 weeks old, might reduce response to subsequent doses. |
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DTaP Vaccine |
SE: Encephalopathy within 7 days of adminsitration. Administration: 5 times. If child Guillan-Barre, you want to adminsiter the DTaP 6 weeks after. Dosing schedule: 5 doses: 2 months, 4 months, 6 months, 15-18 months, 4-6 years old |
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MMR Vaccine |
2 doses, 1 at 12-15 months, 1 at 4-6 years (unless outbreak). CI: immunocompromised, steroids, pregnancy, erythromycin, and Hx of convulsions or cerebral injury. Measles: Sx: highest outbreak in college students, rash/feverMumps: orchitis, 21 day incubation periodRubella: German measles - caution: congenital rubella syndrome |
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Polio Vaccine |
replicates in Gut, live attenuated you get boosters at 2 months, 4 months, 6-18 months, and 4-6 years. We use Killed virus.
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All Killed vaccines |
Rabies
Influenza Polio Always (hep a) |
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