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97 Cards in this Set
- Front
- Back
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REVIEW:
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3 Drugs that undergo 1st order elimination:
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ALL drugs EXCEPT:
*EPA Ethanol Phenytoin Asparin (high dose) |
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What question is answered by Phase II drug development?
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Does it work?
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How do we calculate Therapeutic Index?
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*TILE
TI = LD50 / ED50 |
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What are the Phase II elimination reactions?
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*GAS
Glucoronidation Acetylation Sulfonation |
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What direction does a noncompetitive antagonist shift the potency curve (right, left, up, or down)?
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"It doesn't: potency (Km) is not affected (the drug is just as potent as before, but some receptors are turned off)
However, efficacy (Vmax) is decreased and therefore the EFFICACY curve is shifted downward |
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What are all of the NRTI's, their 3-letter acronyms, and SE's?
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All NRTI's: Lactic acidosis
Ziduvidine (AZT/ZDV) --Aplastic anemia --Megaloblastic anemia Didanosine (DDI) --Drug-induced pancreatitis Zalcytobine (DDC): --SJS --Peripheral neuropathy Lamuvidine (3TC) --only lactic acidosis Stavudine (D4T) --Peripheral neuropathy Abacavir (ABC) --Hypersensitivity syndrome |
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What is the MOA of AMG's?
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Inhibits initiation complex causing inhibition of mRNA
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What is the MOA of Tetracyclines?
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Inhibition of tRNA charging by preventing attachement of amino acyl tRNA
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What is the MOA of Macrolides?
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"Blocking translocation from the A --> P site by binding the 23s subunit of the 50s ribosome
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What is the MOA of Chloramphenicol?
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"Inhibits Peptidyltransferase, the enzyme responsible for transferring nucleotides from A --> P site
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What is the MOA of Clindamycin?
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Inhibits peptide bond formation b/w nucleotides at the P site
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What are the "general categories" of MOA for all the anti-fungal drugs & which drugs fall under each category?
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Inhibit DNA Synthesis
--Griseolfulvin --Flucytosine Inhibits Membrane Synthesis **CAT --Caspofungin --""Azoles"" --Terbinifine Destroys Fungal Membranes --Amphotericin B --Nystatin |
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DAY 5:
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What does "Neuroleptic" mean?
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TYPICAL Antipsychotics = 1st Gen Antipsychotics
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What are the Neuroleptics?
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Fluphenazine
Thioridazine Haloperidol Chlorpromazine Promazine |
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What is the MOA of the Neuroleptics?
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Inhibition of D2 receptors
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What is the c/u for Neuroleptics?
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Psychosis
Schizophrenia |
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What are the 2 main SE's of the Neuroleptics?
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Extra Pyramidal Symptoms (EPS) Sx's
Neuroleptic Malignant Syndrome |
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What are 4 features of Extra Pyramidal Symptoms and the timeline involved for each feature?
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4 Hrs: Dystonia (sustained muscle contractions causing twisting and repetitive
movements or abnormal postures) 4 Days: Akinesia (inability to initiate movement due to difficulty selecting and/or activating the movement pathway) 4 Wks: Akathisia (unpleasant sensations of ""inner"" restlessness that manifests itself with an inability to sit still or remain motionless) 4 Mos: Tardive Dyskinesia (disorder resulting in involuntary, repetitive body movements having a slow or belated onset) |
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What is the tx for Dystonia?
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Diphenhydramine
Benztropine Trihexyphenidyl |
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What are 3 features of Neuroleptic Malignant Syndrome?
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Autonomic Instability
Hyperthermia Muscle Rigidity |
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"
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What are 3 features of Serotonin Syndrome?
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CV Collapse
Hyperparexia Muscle Rigidity |
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Compare & Constrast Neuroleptic Malignant Syndrome (NMS) with Serotonin Syndrome (SS).
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Neuroleptic Malignant Syndrome Serotonin Syndrome
Autonomic Instability CV Collapse HYPERTHERMIA HYPERPYREXIA Muscle rigidity Muslce rigidity |
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What is the difference between Hyperthermia and Hyperpyrexia?
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Hyperthermia: body temperature rises above its ""set point""
Hyperpyrexia: the body's temperature regulation mechanism sets the body temperature above the normal ""set point"" and then generates heat to achieve this increased temperature |
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What is the Tx for Neuroleptic Syndrome?
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Dantrolene (tx sx's) AND Dopamine Agonist (neuroleptic reversal)
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What are the DA Agonists?
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*CPR LAB
Carbamylcholine Pramipexole Ropinerole Levadopa/Carbidopa Amantidine Bromocriptine |
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What is the toxicity of Fluphenazine?
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Hyperthermia due to disruption of the thermo-regulatory center
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What is the toxicity of Thioridazine?
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Pigmented Retinopathy
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What is the MOA of Dantrolene?
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Inhibition of Ca2+ release by blocking Rhanidodine receptors at the cytoplasmic reticulum
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What are the Atypical Anti-Psychotics?
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*Its ""ATIPical"" for OLd CLOZets to ""Risper"" QUiETly
(they usually squeak loudly!) ATIPamezole OLanzapine CLOZapine RISPERidone QUETiapine Ziprasidone |
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What is the MOA of the Atypical Anti-Psychotics?
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Block 5-HT-2 & D2 receptors
Olanzapine also blocks D4 receptors |
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"
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What is the c/u for Atypical Anti-Psychotics?
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Psychosis
Schizophrenia |
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What is/are an additional(s) c/u(s) for Olanzapine?
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*DOA
Depression OCD Anxiety (& Tourettes) |
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What is the tx for Tourette's?
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"Olanzapine
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What is the tx for OCD?
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1. Paroxetine
2. Chlormipramine (& Olanzapine) |
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"
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What is the MOA of Chlormipramine?
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Block the reuptake of NE & 5-HT (TCA's)
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What is the MOA of Lithium?
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Inhibition of Phosphoinositol Cascade
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What is an alternative MOA of Lithium?
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ADH receptor antagonist
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What is the c/u for Lithium?
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Mood Stabilizer
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What are the "mood stabilizer" drugs?
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Lithium
Valproic Acid Carbamazepine |
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What is the toxicity of Lithium?
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*LMNOP
L = Lithium M = Muscle rigidity = tremors N = Nephrogenic Diabetes Insipidus O = HyOthyroidism P = Pregnancy = Ebstein's Anomaly or Total Anomalous Pulmonary Venous Return (TAPVR) P = Psoriasis Exacerbation (added day 9) |
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What are the SSRI's?
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Sertaline
Fluoxetine Citalopram Paroxetine |
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What is the c/u of SSRI's?
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*P-LOAD
Premature Ejactulation Long-term tx of Panic Attacks OCD (Paroxetine) Anxiety Depression (MC drug used) |
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What are the TCA's?
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*CANDID (PASS Program uses DD CAIN)
Clomipramine Amitriptyline Nortriptyline Desipramine Imipramine Doxepin |
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What is the MOA of the TCA's?
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Block the reuptake of NE & 5-HT
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Which TCA is LEAST sedating?
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Desipramine
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Which TCA has the most anti-cholinergic SE's?
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Amitriptyline
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Which TCA has the LEAST anti-cholinergic SE's?
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Nortriptyline
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What is the tx for enuresis (bedwetting)?
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DOC = Desmopressin (similar to ADH --> H2O Retention)
TCA = Imipramine |
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What is the DOC for bedwetting in a pt < 5 y/o?
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NONE! It is expected at 5 years of age!
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What is the toxicity of TCA's?
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*The 4 C's
Cardiotoxicity Confusion Convulsion Coma |
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What type of Cardiotoxicity develops with TCA toxicity?
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Torsades De Pointes
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What is Torsades De Pointes?
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Ventricular Tachycardia associated with Prolonged QT Syndrome
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What is the tx for Desipramine toxicity?
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Na+ Bicarbonate (Tx for toxicity of all TCA's)
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What are some (3) Heterocyclic Anti-Depressants
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What is the MOA of TCA's?
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Block the reuptake of NE & 5-HT
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What is the MOA of Maprotiline?
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Block the reuptake of NE
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What is the MOA of Trazodone?
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Block the reuptake of 5-HT
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What is the MOA of Venlafaxine?
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Block the reuptake of NE, 5-HT, & DA
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What is the DOC for generalized anxiety?
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Buspirone
Benzodiazapines |
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What is the indication for Benzodiazepines over Buspirone?
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Generalized anxiety in a pt with a hx of Etoh addiction
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What Heterocyclic is used for generalized anxiety?
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Venlafaxine
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What are 2 anti-depressants used to tx a pt w/sleep disturbances?
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Trazodone
Mirtazapine |
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What is the DOC for a pt w/depression & sexual dysfunction?
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Bupropion
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What are the indications for Bupropion?
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Smoking Cessation
Depression (DOC if pt also has sexual dysfunction) |
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When is Bupropion contraindicated & why?
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Bulemia hx (bulemia causes electrolyte imbalance = incr'd risk of seizures)
Epileptic pt's Bupropion lowers the seizure threshhold |
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What is the MOA of Mirtazapine?
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a2-antagonist
5-HT-2 & 5-HT-3 antagonist |
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What other drugs are a2-antagonists?
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Mirtazapine
Yohimbine |
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What is the toxicity of Mirtazapine?
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*1 causes 2 causes 3 causes 4
1. Incr'd appetite 2. wt gain 3. Incr'd Cholesterol 4. Sedation |
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What is the MOA of Tranylcypromine?
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Non-selective MAO-I
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What drugs are Non-selective MAO-I's?
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Tranylcypromine
Phenelzine |
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What is the c/u for the Non-selective MAO-I's?
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Atypical Depression
Anxiety Hypochondriasis (Non-selective MAO-I's = Tranylcypromine & Phenelzine) |
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What is "Atypical Depression"?
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Depression with mood disorders and/or wt gain
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With which drugs are MAO-I's contraindicated?
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SSRI's
Meperidine |
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When taken with what, MAO-I's cause hypertensive crisis?
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"Foods with tyramine (e.g. cheese & wine)
B1-agonists (B1 --> Gs --> Incr'd cAMP --> Incr'd SS outflow --> Incr'd NE) |
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EXPECTATIONS FOR DAY 6 (using First Aid as a guide):
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What are the SE's of HTZ's?
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*Hyper-GLUC:
HyperGlycemia HyperLipidemia HyperUricemia HyperCalcemia |
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What are the SE's of Loop Diuretics?
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*POH-DANG (""POH"" for Hy-POH-kalemia):
Pancreatitis (drug-induced) Ototoxicity HyPOHkalemia Dehydration Allergies (Sulfa) Nephritis (interstitial) Gout |
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What is the toxicity of Clonadine?
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Severe rebound HTN
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What is the toxicity of Methyldopa?
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Positive Coomb's Test
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What is the toxicity of Hexamethonium?
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Sympatholytic
Severe orthostatic Hypotension Sexual Dysfunction Parasympatholytic Constipation Blurred Vision |
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What is the toxicity of Reserpine?
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Depression
Diarrhea |
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What is the toxicity of Guanethidine?
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Sexual Dysfunction
Diarrhea |
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What is the toxicity of Prazosin?
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1st-dose Orthostatic Hypotension
Priapism |
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What is the toxicity of B-Blockers?
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Impotence
Exacerbates asthma Masks hypoglycemia in DM Cardiovascular efffects (bradycardia, AV block, CHF) CNS effects (sedation, sleep alteration) |
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What is the toxicity of Hydralazine?
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*SARS
Salt retention Angina Reflex tachycardia SLE-like sx's |
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What is the toxicity of Minoxidil (Rogaine)?
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*SHARP
Salt retention Hypertrichosis (too much hair) Angina Reflex tachycardia Pericardial effusion |
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What is the toxicity of Verapamil?
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Verapamil = Ca2+ Channel Blocker
Constipation |
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What is the toxicity of Nitroprusside?
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Cyanide poisoning
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What is the toxicity of Ace Inhibitors?
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*CHAPTOPRIL where ""H"" = Hyperkalemia
C = Cough H = Hyperkalemia A = Angioedema P = Proteinuria T = Taste change O = HypOtension P = Pregnancy problems (fetal renal ?) R = Rash I = Incr'd renin L = Lowers Ang II |
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What is the toxicity of Diuretics?
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Anti-hypertensive SE's
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