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140 Cards in this Set

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Allergic Rhinitis Therapies
-antihistamines
-nasal anti-inflammatories
-decongestants
-anticholinergic agents
-leukotriene modifiers
-immunotherapy
2nd generation antihistamines
-acrivastine
-cetirizine
-desloratadine
-fexofenadine
-loratatdine
Mast cell stabilizer
-cromolyn sodium
intranasal corticosteroids
-bedomethasone dipropionate
-budesonide
-flunisolide
-fluticasone
-triamcinolone acetonide
-mometasone
Anticholinergic agents
-ipratropium
Tx for allergic conjunctivitis
-naphazoline hydrochloride
-keterolac
-cromolyn sodium
Early phase response of allergic rhinitis
-histamine
-serotonin
-prostaglandin leukotrienes
-tryptase
-kinins
Lab eval of allergic rhinitis pt
-eosinophils in nasal smear
-RAST testing
When treating allergic rhinitis, what class of drugs has the greatest effect on the greatest number of sxs?
-corticosteroids
Antihistamine side effects
-sedation
-anticholinergic effects (dry eye, urinary retention, tachycardia, constipation)
-cardiac (prolonged QT, torsades)
Anticholinergic agent side effects
-h/a
-epistaxis
-pharyngitis
-nasal dryness
-nausea
How to Tx intermittent allergic rhinitis sxs:
oral antihistamine (decongestant if necessary)
-intolerance: corticosteroid
How to Tx moderate allergic rhinitis sxs:
intranasal corticosteroid + antihistamine
How to Tx moderate persistent allergic rhinitis sxs:
-corticosteroid + antihistamine-decongestant
How to Tx severe allergic rhinitis sxs:
-prenisone
-corticosteroids + antihistamine-decongestant
T/F: You should administer Abx when treating allergic rhinitis.
False
Why is budesonide better than citirizine?
-budesonide prevents relapse and can be used periodically to control sxs
How might you tx a STEMI?
-O2
-can use apsirin, heparin, BB, nitro, ACEI, or lipid lowering
Mx of Fibrinolytic therapy
-catalyze the cleavage of plasminogen to generate plasmin which breaks to fibrin
What criteria must you meet to use fibrinolytic therapy?
-sxs of ischemia
-ST elevation or BBB
-start 12 hrs of onset of sxs
-<75 yo
Absolute contraindications of fibrinolytic agents
-hemorrhagic stroke
-any stroke w/in a year
-tumor
-active internal bleeding
-possible aortic dissection
Relative contraindications of fibrinolytic agents
-uncontrolled HTN
-CVA
-use of anticoagulants
-bleeding diathesis
-trauma
(more than one of these: becomes absolute)
Fibrinolytic agents
-streptokinase
-alteplase (tPA)
-reteplase (rPA)
-tenecteplase (TNK-tPA)
Mx of aspirin
-prevent synthesis of thromboxane A2, so platelet aggregation is inhibited
When monitoring unfractionated heparin, check:
-aPTT
-platelets
-Hb/Hct
Mx of nitrates
-dilates peripheral and coronary vasculature by inc cGMP and dec MVO2
What is the long term benefit of nitrates?
-there is none, nitrates treat sxs only
Mx of BB
-block the effects of catecholamines on beta receptors
-this dec HR and contractility
What are the long term benefits of BB?
-reduce morbitity
-prevent arrhythmias
When do you use CCB?
-only when BB are contraindicated
When do you use ACEI?
-ST elevation in > 2 ant leads
-ejection fraction < 40%
-sxs of CHF
What are the long term benefits of ACEI?
-decrease morbitity
-prevent neurohormonal remodeling
How do you monitor ACEI?
-SCr
-K
-BP
-S/S of angioedema
When is long term use of warfarin indicated?
-pt unable to take daily aspirin
-LV thrombus
-AFib post MI
-wall motion abn
What type of antiplatelet therapy do you use in NSTEMI?
-aspirin
-clopidogrel
-GIIbIIIa receptor blockers
Mx of Thienopyridines (clopidogrel and ticlopidine)
-inhibits ADP-induces platelet aggregation
What anticoagulation therapy would you use for tx in NSTEMI?
-LMWH or UFH (but LMWH prefered)
T/F: Thrombolytics have no role in the mgmt of NSTEMI
True
Mx of ACEI
-inhibit conversion of Ang I to Ang II
-inhibit the breakdown of bradykinin
Absolute contraindications of ACEI
-angioedema
-renal artery stenosis
Side effects of ACEI
-cough
-inc'd SCr
-hyperkalemia
-hypotn
When would you use ARBs
-when there is intolerance to ACEI
Mx of ARBs
-blockade of Ang II
Long term benefits of ARBs
-dec mortality
-dec hospitalizations
Contraindications to ARBs
-renal artery stenosis
-angioedema
Side effects of ARBs
-hyperkalemia
-inc SCr
-hypotn
contraindications of BB
-reactive airway disease
-bradycardia
-AV block w/o pacemaker
-decompensated HF
-HR <50
-sys BP <90
Side effects of BB
-bradycardia
-fluid retention (worsens HF)
-hypotn
-fatigue
-bronchospasm
-masks hypoglycemia
Aldosterone Antagonists
-spironolactone
-eplerenone
CI for Aldosterone antagonists
-SCr >2.5
-serum K > 5
Side effects of aldosterone antagonists
-hyperkalemia
-gynecomastia (less with eplerenone)
Mx of diuretics
-inc excretion of fluid and Na
-dec fluid retention
Long term benefits of diuretics
-none, only sxs relief
Side effects of diuretics
-electrolyte abn
-hypotn
-azotemia
Long term benefits of digoxin
-improve sxs
side effects of digoxin
-GI sxs
-arrhythmias
-neurologic
Do CCB have a role in HF?
no
ACEI agents
-captopril
-enalapril
-lisinopril
-ramipril
-quinapril
ARB agents
-losartan
-valsartan
-candesartan
Thiazide diuretic agents
-hydrochlorothiazide
-chlorothiazide
-metalazone
Loop diuretic agents
-furosemide
-bumetanide
-rosemide
Optimal level of LDL
<100
Very high level of LDL
>190
optimal level of TC
<200
high level of TC
>240
Mx of HMG-CoA reductase inhibitors
-inhibition of HMG-CoA reductase to mevalonate causing a dec in biosynthesis of cholesterol (or an inc in the LDL receptor activity)
What do statins do?
-dec LDL
-dec TG
-inc HDL
Side effects of statins
-myalgias
-myopathy
-rhabdomyolysis
-inc in liver enzymes
absolute CI to statins
-liver disease
relative CI to statins
-niacin, fibrates (inc in myopathy)
Statin agents
-lovastatin
-simvastatin
-fluvastatin
-pravastatin
-atorvastatin
-rosuvastatin
-cerivastatin
Which statin is the most potent? the least?
most: rosuvastatin
least: fluvastatin
Mx of Bile acid resins
-interrupts recycling through enterohepatic recirculation
-hepatic cells convert more cholesterol to bile acid (or inc the synthesis of LDL receptors)
What do bile acid resins do?
-dec LDL
-inc HDL
-may inc TG
side effects of bile acid resins
-GI distress
-dec absorption of other drugs
Absolute CI to bile acid resins
-dysbetalipoproteinemia-expialadocious
-raised TG >400
relative CI to bile acid resins
-TG >200
Bile acid resin agents
-cholestyramine
-colestipol
-colesevelam
Mx of Niacin
-dec hepatic production of VLDL (which dec LDL production)
What does niacin do?
-dec LDL
-dec TG
-inc HDL
Side effects of niacin
-flushing/itching
-hyperglycemia
-hyperuricemia
-UGI distress
-heptotoxicity
Niacin agents
-crystalline IR niacin
-niacin SR
-niacin ER
Mx of Fibric acid derivatives
-dec TG by inc lipoprotein lipase activity
What do fibric acids do?
-dec TG
-inc HDL %
-dec LDL (w/NL TG)
-may inc LDL (w/ high TG)
Side effects of fibric acids
-GI sxs
-gallstones
-myopathy
absolute CI of fibric acids
-renal or hepatic disease
Fibric acid agents
-gemfibrozil
-fenofibrate
Mx Cholesterol absorption inhibitor
-impair absorption of cholesterol at the brush border of the intestine
What do cholesterol absorption inhibitors do?
-dec LDL
-dec TC
-dec TG
-inc HDL
side effects of cholesterol absorption inhibitors
-hypersensitivity rxn
-myopathy
absolute CI to cholesterol absorption inhibitors
-active liver disease
What drugs might be used for a drug induced exercise stress test?
-dobutamine
-dipyridamole
-adenosine
Nitrate agents
-nitroglycerin
-isosorbide dinitrate
-isosorbide mononitrate
Side effects of nitrates
-h/a
-hypotn
-syncope
-dizziness
-tachycardia
-flushing
Drug interactions with nitrates
-viagra: drop BP big time
Selective BB agents
-atenolol
-metoprolol
-acebutalol
-betaxolol
-bisprolol
Nonselective BB agents
-nadolol
-propranolol
-timolol
-pindolol
Mx of CCB
-dec MVO2 (vasodilates) which dec contractility and dec HR
Side effects of CCB
-constipation, peripheral edema
-CI to CCB
-AV block w/o pacemaker
-bardycardia
-sys HF
-use of BB
DHP CCB agents
-nifedipine
-amlodipine
-felodipine
-nicardipine
NDHP CCB agents
-verapamil
-diltiazem
TX of HTN in caucasians
-BB and ACEI
TX of HTN in AA
-diuretics and CCB
TX of HTN in the elderly
-lower initial and maintenance doses
-longer intervals between dose adjustments
Side effects of Thiazide diuretics
-dec K
-dec Mg
-inc Ca
-hyperuricemia
-glucose effects
-hyperlipidemia
-Side effects of loop diuretics
-like thiazide except dec Ca
side effects of K-sparing diuretics
-inc K
-gynecomastia by spironolactone
Drug interactions with diuretics
-ACEI: fall in BP, renal insufficiency
(w/ specifically K sparing and ACEI: inc hyperkalemia)
Drug interactions with BB
-decongestants: raise BP
-CCB: sig bradycardia, AV block
-NSAIDS: blunt the antiHTN effects of BB
-thyroid hormones: antagonisitic
-Digoxin: inc bradycardia
Mx of alpha 1 BB
-work like BB but also blocks peripheral a1 receptors (reduces vascular resistence)
Side effects of a1 BB
-sycnope, orhtostasis
-h/a
-dizziness
Drug interactions with ACEI/ARBs
-NSAIDS: inhibit the antiHTN effects of ACEI
-K sparing: inc risk for hyperkalemia
-lithium: inc risk for toxicity
Mx of a2 inhibitors
-stimulate a2 in the brain to dec symp activity to periphery
-suppresses plasma renin
a2 inhibitor agents
-clonidine
-methyldopa
-guanfacine
-guanabenz
Mx of direct vasodilators
-inc the relaxing factor, dec PVR
-Na and water retention
side effects of direct vasodilators
-lupus like
-hypotn
-relfex tachycardia
-edema
tx of tinea corporis, cruris, pedis, versicolor
-spectazole
tinea capitis
-nizoral shampoo
tinea unguium
-sporonox
-lamisil
oral candidiasis
-diflucan
cutaneous cadidiasis
-spectazole
vulvar/vaginal cadidiasis
-gyne-lotrimin
-diflucan
pruritis
-benadryl
-zonalon
dry skin
-aveeno
-lac-hydrin
atopic derm (eczema)
-aclovate
-elidel
-protopic
seborrheic derm
-selsun lotion on the scalp
-aclovate, on the face
-nizoral if uncontrolled
acne vulgaris
-clindagel
-tetracycline
acne rosacea
-metrogel
-clindagel
impetigo
-bactroban
allergic contact derm
-clamine lotion
-kenalog lotion in Sarna
Miliaria (heat rash)
-triamcinolone in Sarna
Urticaria/ Angioedema
-atarax
-zyrtec
warts
-freeze w/ liquid nitrogen
-aldara
-duofilm
scabies
-elimite
pediculosis
-nix
psoriasis
-limited: enbrel, dovonex
-general: soriatane, rheumatrex
Varicella
-Benadryl
-calamine
-acetaminophen
Herpes
-face: abreva, valtrex
-genital: valtrex
-zoster: prednisone
Herpetic Neuralgia
-zostrix
-elavil
-neurontin