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80 Cards in this Set
- Front
- Back
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3 types of respiratory anti-inflammatory drugs
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1. glucocorticoids (e.g., fluticasone)
2. antileukotriene drugs (e.g., montelukast) 3. mast cell stabilizers (cryomolyn sodium) |
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3 categories of bronchodilators
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1. selective beta-2 agonists (e.g., albuterol)
2. anticholinergics (e.g., ipratropium, tiotropium) 3. methylxanthine drugs (e.g., theophylline) |
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3 broad categories of respiratory drugs
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antiinflammatory drugs
bronchodilators IgE antibodies |
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what are the possible acute side effects of steroid therapy?
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hyperglycemia, electrolyte disturbances, hypertension, weight gain, fluid retention, GI irritation/ulceration, bleeding, CNS
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what are the possible chronic effects of steroid therapy?
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immunosuppression
Adrenal suppression Growth suppression Osteoporosis (give Ca + Vit D) Proximal muscle weakness Ocular toxicities can induce diabetes! |
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what are the 2 selective Beta-2 andrenoceptor agonists to know?
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albuterol (rapid-acting, rescue)
salmetrol (long-acting, controller) |
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what are the 2 anticholinergic bronchodilators to know?
describe give MOA |
Ipratropium (Atrovent) - rescue medicine for asthma.
blockade of acetylcholine at muscarinic receptors Tiotropium (Spiriva) - same MOA as above. COPD med. |
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what's the thing to remember about smokers and theophylline?
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they'll need a higher dose because smoking induces CYP1A2 enzymes, which break down theophylline.
careful if someone quits smoking though, without changing dose --> toxicity |
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what is the IgE antibody for allergic asthma and how does it work?
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Omalizumab (Xolair) - SQ injection q 2-4 wks.
this complexes with free IgE is plasma. controller med. can work for other allergies as well. super expensive. |
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how do you treat mild, intermittent asthma?
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no daily meds required.
short-acting selective Beta-2 agonist for attacks. |
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how do you treat mild, persistent asthma?
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low dose of inhaled corticosteroid with NEB or MDI.
alternative: cromolyn sodium, antileukotriene drugs, SR theophylline. |
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how do you treat severe, persistent asthma
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medium dose of inhaled corticosteroid + long-acting beta-2 agonist.
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drugs associated with depression
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Reserpine
Methyldopa Propranolol High dose oral contraceptives Benzodiazepines Corticosteroids Alcohol Opioids |
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contraindications for MAOIs
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Liver disease
Pheochromocytoma (adrenal tumor) Congestive heart failure Concomitant use with other sympathomimetic drugs (like a decongestant like sudafed**) |
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what are the traditional anticholinergic side effects?
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Dry mouth, constipation, urinary retention, blurred vision, confusion
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describe serotonin syndrome
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Vague constellation of symptoms:
Autonomic instability Tachycardia, labile blood pressure, hyperthermia CNS Agitation, hallucinations, coma Neuromuscular Weakness, hyperreflexia, incoordination GI Nausea, vomiting, diarrhea |
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3 anxiety and pharmacologic targets
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Adrenergic modification (somatic symptoms of anxiety disorders)
GABA (inhibitory NT) Serotonin |
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what is the prototype alpha-1 blocker?
MOA? |
prazosin (minipress)
smooth muscle relaxation, peripheral vasodilation. |
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what is the prototype alpha-2 agonist?
mech? |
clonidine
suppresses CNS release of NE tablets, IV, patch |
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what are the prototype selective Beta-1 blockers?
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metroprolol (Lopressor)
atenolol |
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what's a new alpha-1 blocker that's selective for bladder without affecting blood pressure?
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flomax
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indications for alpha-1 blockers
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HTN, bladder flow difficulty
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indications for beta-blockers
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post MI, HF, HTN, anxiety
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adverse effects of beta-blockers?
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Bronchospasm*** (e.g., propanolol)
Hypoglycemia Bradyarrhythmia Incr trig/decr HDL (but not if ISA) Fatigue/depression Sexual dysfunction |
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what are the prototype benzodiazepine-like drugs?
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zolpidem (ambien)
zaleplon (sonata) |
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what is the prototype barbirturate?
effects? |
phenobarbitol
enhances GABA activity + more widespread CNS depression. |
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what are the prototype high-potency benzodiazepines?
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alprazolam (Xanax)
lorazepam (Ativan) |
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what are 2 prototype benzodiazepines?
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diazepam (Valium) - low/med potency
midazolam (Versed) - used for procedures, v. titratable, short-acting. |
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what's our most potent endogenous vasoconstrictor?
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angiotensin II
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what is the prototype ACE inhibitor?
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lisinopril
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what happens to bradykinin when we give an ACE inhibitor?
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it builds up, which can be irritating.
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what is the prototype angiotensin receptor blocker (ARB)?
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losartan
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adverse effects of ACE inhibitors
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Headache, dizziness, hypotension
(Acute renal failure - not so bad for kidneys, actually) risk for Hyperkalemia (antialdosterone effects) Cough Rash, angioedema Teratogenic |
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compelling indications for ACE inhibitors?
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HF, diabetic nephropathy
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what's the SE of ACE inhibitors that often causes d/c?
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dry, non-productive cough
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the most sodium is reabsorbed in which part of the nephron?
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the proximal tubule
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what is the prototype loop diuretic?
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furosemide (Lasix)
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what are osmotic diuretics used for?
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acutely change fluid status (cerebral hemmorhage, post-trauma)
not BP. works on proximal tubule. |
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carbonic anhydrase diuretics indications?
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glaucoma and seizure disorders
not BP |
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MOA loop diuretics
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Inhibit sodium & chloride reabsorption, mostly in Loop of Henle
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main indication for loop diuretics
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HF to manage fluid overload.
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which are the primary anti-HTN drugs?
where do they work in the nephron? |
thiazide and thiazide like drugs.
they work in the distal tubule, inhibit Na and Cl reabsorption. |
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what is the prototype for thiazide drugs?
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HCTZ (hydrochlorothiazide)
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what are potassium-sparing diuretics used for?
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Produce no change in fluid, no change in BP. Used for promoting reabsorption of potassium, usu. in combination with other diuretics that put people at risk for hypokalemia.
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adverse effects of thiazide drugs?
so what groups are thiazides risky for? |
Hypotension
Hypokalemia Hyperglycemia Hyperuricemia Hypercalcemia Sulfonamide allergy diabetics and gout |
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what diuretic can you use if you have a sulfonamide allergy?
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ethacrynic acid
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what is the second prototype thiazide drug?
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chlorthaladone
this is the drug often used in studies. |
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what is the dose range for hydrochlorothiazide (HCTZ)?
when should you think about adding a second drug rather than increasing dose? |
Typical oral dose: 12.5 - 50 mg once daily
if you have a pt. at 25 or 50 mg, it's time to think about adding a drug with a different mechanism. |
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what is a healthy side effect of HCTZ?
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hypercalcemia.
good for bone density. |
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what is the prototype potassium-sparing diuretic?
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triamterene
usu. used in combo with other diuretics. |
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what is nitroprusside used for?
how is it administered? |
hypertensive crisis. used in the hospital (very strong agent) parenterally.
direct-acting vasodilator |
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what are hydralazine and minoxidil used for?
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HTN. orally administered multiple times per day.
not used so often. 3rd or 4th line agents. |
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what are adverse effects of hydralazine and monoxidil?
(direct acting vasodilators) |
Headache, dizziness, hypotension
Although less than non-specific vasodilators Reflex tachycardia Myocardial ischemia (coronary “steal”) Avoid IV use in pts with underlying CAD Fluid retention |
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what's the MOA for direct-acting vasodilators?
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Relax smooth muscle cells that surround blood vessels
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what's a "unique effect" of hydralazine?
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lupus-like syndrome
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what's a "unique effect" of minoxidil?
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hirsutism. this is why it's used for hair growth in rogaine.
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what is nitroprusside metabolized to?
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cyanide. this can lead to toxicity/lactic acidosis.
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what is the prototype dihydropyridine calcium channel blocker?
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amlodipine (Norvasc)
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what is the prototype non-dihydropyridine calcium channel blocker?
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verapamil
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MOA non-dihydopyridine calcium channel blockers?
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MOA non-dihydropyridine: suppress AV node conduction. Reduce HR and contractility.
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MOA dihydropyridine calcium channel blockers?
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MOA dihydropyridine: Block L type calcium channels on sm muscle of arteries. Produce arterial vasodilation.
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adverse effects of Ca channel blockers?
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Dizziness, headache, hypotension
Bradycardia, heart block Peripheral edema Gingival hyperplasia (overgrowth of gum tissue) Gastroesophageal reflux Constipation More with verapamil Drug interactions More with non-DHPs |
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how long does an insulin vial last when it's taken out of the fridge?
how about pens? |
vial - 30 days
pens - about 2 weeks. |
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who was the Nobel for insulin given to?
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Banting & McCleod
(should have gone to Charles Best too. And not McCleod) |
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goals of diabetes therapy:
preprandial BG? postprandial BG? A1C after 2-3 months? |
Pre-prandial glucose:
Approximately 70-130 mg/dL Post-prandial glucose: Less than 180 mg/dL A1c: Less than 7% after 2-3 months |
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how do you improve microvascular and macrovascular outcomes for diabetics?
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intensive control of diabetes.
but it does take far longer for the macrovascular risk reduction to become evident (like 10 years) |
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what sort of drug would be good for a type II DM who is developing hypoglycemia in between meals?
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a non-sulfonylurea secretogogue. because it is rapid-acting and quickly cleared. less likely to cause hypoglycemia between meals.
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Why do we give insulin injections in the abdomen?
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there's a more constant rate of absorption there compared with other sites.
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what is our prototype rapid-acting insulin?
what is its onset? what is its peak? |
Humalog (Lispro)
onset: < 30 min peak: 30 - 90 min |
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what are the onset and peak of regular insulin?
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short acting (regular) insulin
onset: approx. 30 min. peak: 2-3 hrs |
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what is our prototype intermediate-acting insulin?
onset? peak? |
NPH. also considered "basal"
onset: 1-2 hrs peak: 4-10 hrs |
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what's our prototype long-acting insulin?
onset? peak? |
Glargine (Lantus).
Onset: 2-6 hrs Peak: minimal |
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what are the 6 categories of non-insulin diabetes therapies?
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1. sulfonylureas
2. non-sulfonylurea secretagogues 3. alpha-glucosidase inhibitors 4. biguanides 5. Thiazolidinediones (TZDs) 6. Incretin modulators SAINT B |
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what is the prototype for sulfonylureas?
what do these do? associated side effects? |
glipizide (Glucotrol)
these promote more release of insulin from pancreas. SE: wt gain, hypoglycemia, dermatologic rxns |
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What are the prototypes for non-sulfonylurea secretagogues?
why are they especially useful? |
Replaglinide, Nateglinide
good because of rapid absorption and clearance. can dose around mealtimes. |
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what is our prototype alpha-glucosidase inhibitor?
how does it work? side effects? |
Acarbose
blocks action of the enzyme that breaks down complex carbs to simple sugars. keeps postprandial blood sugar down. GI side effects |
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what is our prototype for the Biguanides?
what are the 3 MOAs? Important adverse effect? |
Metformin (glucophage)
1. reduces hepatic glucose production 2. reduces glucose absorption 3. improves insulin receptor sensitivity important adverse effect: risk of lactic acidosis |
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What is our prototype TZD?
what does it do? what population should we not use it with? |
Piaglitazone (Actos)
improves tissue response to insulin. not to be used in patients with advanced HF because of fluid retention side effect. |
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What are the two types of Incretin Modulators that we studied?
how do they work? |
1. GLP analogs (Byetta).
a. slows down gastric emptying b. tells pancreas to release more insulin c. suppresses glucagon 2. Dipeptidyl Peptidase IV inhibitors - block enzymes that degrade GLP. |
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what does glp-1 stand for?
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glucagon-like peptide 1.
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