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191 Cards in this Set
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Digoxin
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inhibit Na/K/ATPase,positive inotrope. Increase actin/myosin interaction,increase Ca,increase contractility. **increased K->decrease Dig effects,increased Ca->increase arrythmias
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Milrinone
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Phosphodiesterase inhibitor, increase cAMP&cGMP, increase Ca into cell, increase Ca from SR. Positive inotrope, vasodilator. **liver enzyme changes
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Inamrione
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Phosphodiesterase inhibitor, increase cAMP&cGMP, increase Ca into cell, increase Ca from SR. Positive inotrope, vasodilator. **liver enzyme changes
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Dobutamine
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Beta-stimulant, B1-B2-high dose-A1, positive inotrope, increase CO (2.5-15mcg/kg/min)
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Dopamine
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Beta-stimulant, D, B1, high dose-A1. Dilate remal arteries, increase UO, inotrope/chronotrope(1-2mcg/kg/min-low, 3-10 med, >10mcg high)
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Nesiritide
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B-naturetic peptide, decrease venous and arteriolar tone, increase cGMP in smooth muscle, diuresis
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Acetalzolamide
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carbonic anhydrase inhibitor (decreased dehydration of carbonic acid, concentrates urine, decreased water reabsorption). Increase HCO3 in urine (acidosis). USE:glaucoma, met alkalosis, seizures(increase acidity in brain). ***not long term, body overcomes decreased carbonic anhydrase, renal stones, increased NH3 in liver failure
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Furosemide
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Loop diuretic, inhibit NaCl reabsorption in thick ascending loop of Henle (inhibit Na/K/2Cl), decrease Mg/Ca, NaCl reabsorption, increase K excretion, increase renal blood flow, induce renal prostaglandins ***NSAIDS decrease diuretic and prostaglandin action, Sulfanomide
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Bumetodine
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Loop diuretic, inhibit NaCl reabsorption in thick ascending loop of Henle (inhibit Na/K/2Cl), decrease Mg/Ca, NaCl reabsorption, increase K excretion, increase renal blood flow, induce renal prostaglandins ***NSAIDS decrease diuretic and prostaglandin action, Sulfanomide
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Ethacrynic Acid
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Loop diuretic, inhibit NaCl reabsorption in thick ascending loop of Henle (inhibit Na/K/2Cl), decrease Mg/Ca, NaCl reabsorption, increase K excretion, increase renal blood flow, induce renal prostaglandins ***NSAIDS decrease diuretic and prostaglandin action, Sulfanomide ***high ototoxicity***
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Torsemide
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Loop diuretic, inhibit NaCl reabsorption in thick ascending loop of Henle (inhibit Na/K/2Cl), decrease Mg/Ca, NaCl reabsorption, increase K excretion, increase renal blood flow, induce renal prostaglandins ***NSAIDS decrease diuretic and prostaglandin action, Sulfanomide
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Hydrochlorothiazide
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Thiazide diuretic, inhibit NaCl transport in distal tubules, decrease carbonic anhydrase. Enhance Ca reabsorption. ***elevates cholesterol and uric acid. ***NSAIDS decrease action (dependant on prostaglandins), Sulfanomide
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Chlorothiazide
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Thiazide diuretic, inhibit NaCl transport in distal tubules, decrease carbonic anhydrase. Enhance Ca reabsorption. ***elevates cholesterol and uric acid. ***NSAIDS decrease action (dependant on prostaglandins), Sulfanomide
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Metolazone
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Thiazide diuretic, inhibit NaCl transport in distal tubules, decrease carbonic anhydrase. Enhance Ca reabsorption. ***elevates cholesterol and uric acid. ***NSAIDS decrease action (dependant on prostaglandins), Sulfanomide
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Spironlactone
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K sparing diuretic. Decrease aldosterone at collecting tubule and late distal tubule, decrease Na influx in luminal membrane. Use:long term diuretic. ***K suppliments cause elevated [K], hypercalcemic met acidosis, kidney stones
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Triamteriene
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K sparing diuretic. Decrease aldosterone at collecting tubule and late distal tubule, decrease Na influx in luminal membrane. Use:long term diuretic. ***K suppliments cause elevated [K], hypercalcemic met acidosis, kidney stones
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Eperenone
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K sparing diuretic. Decrease aldosterone at collecting tubule and late distal tubule, decrease Na influx in luminal membrane. Use:long term diuretic. ***K suppliments cause elevated [K], hypercalcemic met acidosis, kidney stones
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Amiloxide
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K sparing diuretic. Decrease aldosterone at collecting tubule and late distal tubule, decrease Na influx in luminal membrane. Use:long term diuretic. ***K suppliments cause elevated [K], hypercalcemic met acidosis, kidney stones
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Mannitol
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Osmotic diuretic. Concentrates urine, prevents water reabsorption. Decrease Na reabsorption. Use: to decrease ICP, remove toxins (hemolysis, contrast)
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Quinidine Class I anti-arrythmic (Ia, III)
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blocks activated Na channels, blocks K channels. Decrease pacemaker rate/excitability/contraction, alpha-blocker, lengthen QT (prolong AP), anti-muscarinic (can increase afib rate).*give w/ ca-blocker/b-blocker to prevent increased HR. ***Torsades, wide QRS, asystole
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Procainamide Class I anti-arrythmic (Ia, III)
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more effective Na blocker. Less effective at decreasing pacemaker rate, less anti-muscarine, lengthen QT, decrease PVR (ganglion blocking) *2nd line therapy for afib, V-arrythmias. ***Cause lupus erythematous
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Lidocaine Class I anti-arrythmic (Ib)
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Blocks Na channels (activated and inactivated), supress abnormal cardiac activity, shorten AP, prolong diastole. Does not work with normally polarized tissue (afib/flutter) ***tremors, slurred speech, nausea
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Disopyrammide
Mexiletine Flecainide Propafenone Moriazine |
Class I anti arrythmics
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Propranolol
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Beta Blocker Class II. Anti-arrythmic effect not known. Decreases ventricular ectopic depolarization (not as good as Na blocker)
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Esmolol
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Beta blocker Class II. Short acting IV beta blocker
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Sotalol
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Beta blocker Class II and Class III. Non-selective B1 and B2. Prolong QT, ***torsades at high doses
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Amiodarone
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Class III Anti-arrythmic. Na blocker (inactivated channels). Prolong QT, weak Ca blocker, inhibit abnormal automaticity, decrease PVR (Ca and alpha blocker) ***may precipitate heart failure, pulm fibrosis, many drug interactions
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Verapamil
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Class IV anti-arrythmic, Ca-channel blocking, non-dihydropyradine. Non-selective L-type Ca channels (vessels and heart), don't give with b-blocker-too much cardiac blockade). Decreases insulin release, decrease chemo resistance
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Diltiazem
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Class IV anti-arrythmic, Ca-channel blocking, non-dihydropyradine. Non-selective L-type Ca channels (vessels and heart), don't give with b-blocker-too much cardiac blockade).
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Bepridil
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Class IV anti-arrythmic, Ca-channel blocker (non-dihydropyradine), blocks Ca and Na channels
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Adenosine
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enhance K conductance, inhibit cAMP, Ca influx. Inhibits AV conduction, increase refractory period
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Magnesium
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influence Na/K/ATPase, Na channels, K channels. Use: Dig induced arrythmias, torsades, with/without hypomagnesemia
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Potassium
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stabalize membrane potential
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epinephrine
Sympathomimietic |
alpha 1, 2 beta 1, 2
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ephedrine
Sympathomimetic |
alpha, weak beta
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Isoproteranol
Sympathomimetic |
Beta 1, 2. Potent bronchodilator
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Terbutaline
Sympathomimetic |
Beta 2, only beta 2 selective available in IV
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Albuterol
Sympathomimetic |
Beta 2
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Metaproterenal
Sympathomimetic |
Beta 2
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Salmeterol/formeterol
Sympathomimetic |
Beta 2, long lasting (12 hours), ***Not for acute attacks
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Theophyllin
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Methylzanthines. Inhibit phosphodiesterase ->smooth muscle relaxation, anti-inflammatory. Effects: CNS,heart (inotrope/chronotrope), kidneys, increase gastric enzymes, reverse fatigue of diaphragm in COPD ***Monitor levels (cigarettes, charcole cooked foods), narrow theraputic window (seizures, tremors)
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Aminophyllin
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Methylzanthines. Inhibit phosphodiesterase ->smooth muscle relaxation, anti-inflammatory. Effects: CNS,heart (inotrope/chronotrope), kidneys, increase gastric enzymes, reverse fatigue of diaphragm in COPD ***Monitor levels (cigarettes, charcole cooked foods), narrow theraputic window (seizures, tremors)
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Theobromine
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Methylzanthines. Inhibit phosphodiesterase ->smooth muscle relaxation, anti-inflammatory. Effects: CNS,heart (inotrope/chronotrope), kidneys, increase gastric enzymes, reverse fatigue of diaphragm in COPD ***Monitor levels (cigarettes, charcole cooked foods), narrow theraputic window (seizures, tremors)
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Caffeine
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Methylzanthines. Inhibit phosphodiesterase ->smooth muscle relaxation, anti-inflammatory. Effects: CNS,heart (inotrope/chronotrope), kidneys, increase gastric enzymes, reverse fatigue of diaphragm in COPD ***Monitor levels (cigarettes, charcole cooked foods), narrow theraputic window (seizures, tremors)
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Atropine
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Muscarinic antagonist, blocks secretions, blocks contraction of airways. Increase HR, decrease GI motility ***will not reverse bronchospasm
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Ipatropium bromide
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Muscarinic antagonist, blocks secretions, blocks contraction of airways. More selective than atropine, effective as B-agonist with COPD
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Tiotropium
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Muscarinic antagonist, blocks secretions, blocks contraction of airways. Long lasting (24 hours), use with COPD
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Beclomethasone, triamcinolole, flunisolide, fluticasone, budesonide, mometasene
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Aerosols for respiratory issues
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Cromalyn
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Mast cell stabilizer, alters Cl channels in cell membrane, inhibits mast cell degranulation. Use: pretreatment blocks bronchoconstriction due to: exercise, antigens, asprin. Reduce need from bronchodilators. For young patients with extrinsic asthma
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Nedocromil
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Mast cell stabilizer, inhibits degranulation (decrease cough), inhibits activation of eosinophils (inflammation). Use: pretreatment blocks bronchoconstriction due to: exercise, antigens, asprin. Reduce need from bronchodilators. For young patients with extrinsic asthma
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Zileuton
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Leukotriene inhibitor, decrease production of leukotrienes, decrease exacerbations, decrease effect on airway. Use: Aspirin induced asthma (reduce response to aspriin)
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Montelukast
Zafirlukast |
Leukotriene inhibitor, inhibition of leukotrienes binding to receptors.decrease exacerbations, decrease effect on airway. Use: Aspirin induced asthma (reduce response to aspriin)
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Omolizumab
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Anti IgE monoclonal antibodies. Targets protion of IgE that binds to mast cells. Decrease: severity, steroid requirement, exacerbations
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Phenytoin
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Binds to Na channels (inactivated), prolong AP, blocks repetative firing. Na, K, Ca conductance, prolong time until AP, alters: norepi, Ach, GABA. Non-sedative for partial and generalized tonic-clonic, high protein bound. ***nystagmus, diplopia, sedation, gingival hyperplasia, neuropathy
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Carbamazipine
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Blocks Na channels, blocks repetative firing, works pre-synapticly (decrease uptake and release of norepi). Use: partial seizure, bipolar, trigeminal neuralgia, CYP450 inducer, frequent dose adjustments. ***diplopia, anemia
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Phenobarbatol
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Enhance inhibitory process, supress abnormal neurons, prolong Cl opening, enhance GABA inhibition, decrease glutamate excitation. Sedating, age dosing (CYP450). Use: partial seizures, generalized tonic-clonic ***worsen: absence, atonic, infantile seizures. Confusion,slurred speech
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Primidone
Lamotrigine Felbamate |
anti-seizure
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Gabapentin/Pregabalin
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analog of GABA, not metabolized, not hepatic inducing. Use: partial seizures, generalized tonic-clonic, neuropathic pain
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Lacosamide
Levetiracetam Tiagabine Topiramate Zonisamide |
Anti-seizure
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ethosuximide
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used in generalized seizures. Mechanism involves Ca channels, not protein bound, ***Drug of choice for absence seizures
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Valproic Acid (sodium valproate)
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Blocks high frequency firing, increase GABA, decrease Na currents. Inhibits own metabolism, increased free fraction with high doses. Use: absence seizures, tonic-clonic, bipolar, migrains. ***Induce metabolism:phenytoin, phenobarb, carbama. Sedation
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Diazepam
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Benzodiazipine, long 1/2 life, decrease all levels of CNS, increase GABA action, not for chronic therapy (seizures become tolerant)
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Lorazepam
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Benzodiazipine, longer acting, more effective, decrease all levels of CNS, increase GABA action, not for chronic therapy (seizures become tolerant)
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Clonazepam
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Benzodiazipine, decrease all levels of CNS, increase GABA action, not for chronic therapy (seizures become tolerant) Use: absence seizures
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Clorazepate dipotassium
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Benzodiazepine, adjunct therapy, decrease all levels of CNS, increase GABA action, not for chronic therapy (seizures become tolerant)
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Buspirone
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Serotonin agonist, 5-HT 1a agonist, non-benzodiazipine anxiolytic
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Sumatriptan
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Serotonin agonist, 5-HR 2c agonist, Migrain headaches
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Phenoxybenzamine
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Serotonin antagonist, A1>A2, lowers BP, HR increase due to baroreceptors, inhibits NE reuptake, used for pheochromocytoma
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Cyproheptadine
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Serotonin antagonist, H1 blocking also, cold induced urticaria (hives), treat smooth muscle carcinoid tumor
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Ondansetron
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Serotonin antagonist, 5-HT3 inhibitor, blocks serotonin (peripherally on vagal nerve terminals, centrally in chemoreceptor trigger zone). Best for N/V without sedation
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Granisetron
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Serotonin antagonist, 5-HT3 inhibitor, blocks serotonin (peripherally on vagal nerve terminals, centrally in chemoreceptor trigger zone). Best for N/V without sedation
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Dolasetron
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Serotonin antagonist, 5-HT3 inhibitor, blocks serotonin (peripherally on vagal nerve terminals, centrally in chemoreceptor trigger zone). Best for N/V without sedation
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Palonosetron
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Serotonin antagonist, 5-HT3 inhibitor, blocks serotonin (peripherally on vagal nerve terminals, centrally in chemoreceptor trigger zone). Best for N/V without sedation. Longer duration of action
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Sodium Bicarbonate
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HCl = NaHCO3 -> CO2 + NaCl, caution with renal failure (met alkalosis)
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Calcium carbonate
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CaCO3 + HCl -> Co2 + CaCl2
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Magnesium Hydroxide
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Mg(OH)2 + HCl -> MgCl2 + H20, no gas, met alkalosis uncommon
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Aluminum Hydroxide
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Al(OH)3 + HCl -> AlCl3 + H20, no gas met alkalosis uncommon
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Unabsorbed Magnesium Salts
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osmotic diarrhea (cathartic), caution in renal failure (can't eliminate Mg)
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Unabsorbed Aluminum salts
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constipation, caution in renal failure (can't eliminate Al)
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Cimetidine
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H2 receptor antagonist, competitive inhibition H2, reduce gastric acid (PM>AM). Inhibits binding of dihydrotestosterone to androgen-R's, inhibits metabolism of estradiol, increase prolactin, inhibits CYP450's
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Ranitidine
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H2 Receptor antagonist, competitive inhibition of H2 receptor, reduce gastric acid (PM>AM)
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Famotidine
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H2 Receptor antagonist, competitive inhibition of H2 receptor, reduce gastric acid (PM>AM)
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Nizatidine
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H2 Receptor antagonist, competitive inhibition of H2 receptor, reduce gastric acid (PM>AM)
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Omeprazole
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Proton pump inhibitor, irreversibly inhibit gastric parietal cell proton pump, requires activation in acidic environment (prodrug) ***supression of acid barrier-bacterial entry into body, hypergastrinemia
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Esomeprazole (isomer of omeprazole, more active)
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Proton pump inhibitor, irreversibly inhibit gastric parietal cell proton pump, requires activation in acidic environment (prodrug) ***supression of acid barrier-bacterial entry into body, hypergastrinemia
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Lansoprazole
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Proton pump inhibitor, irreversibly inhibit gastric parietal cell proton pump, requires activation in acidic environment (prodrug) ***supression of acid barrier-bacterial entry into body, hypergastrinemia
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Rabeprazole
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Proton pump inhibitor, irreversibly inhibit gastric parietal cell proton pump, requires activation in acidic environment (prodrug) ***supression of acid barrier-bacterial entry into body, hypergastrinemia
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Pantoprazole
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Proton pump inhibitor, irreversibly inhibit gastric parietal cell proton pump, requires activation in acidic environment (prodrug) ***supression of acid barrier-bacterial entry into body, hypergastrinemia
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Sulcralfate
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mucosal protecitve, forms viscous/tenacious paste, binds to necrotic ulcer tissue, acts as barrier, ***rising Al levels in renal failure
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Misoprostol
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mucosal protective agent, analog of prostaglandin E (acid inhibitor, protects mucosa) ***diarrhea and cramping, stimulates uterine contractions. Prevention of NSAID induced ulcers
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Bismuth subsalicylate
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mucosal protective, blackening of stool/tongue, salicylate toxicity
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Bethanechol
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Promotes GI motility, use in GERD, impared gastric emptying (long term narcs), ester of choline (looks like ACh)
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Metoclopramide
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Dopamine D2 receptor antagonist, potentiates cholinergic smooth muscle stimulation. use in GERD, impared gastric emptying (long term narcs). Somnolence, nervousness, dystonic reactions, increase prolactin. enters CNS, anti-emetic
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Cisapride
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use in GERD, impared gastric emptying (long term narcs), torsades (removed from US)
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erythromycin
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macrolid antibiotic, pro-kinetic activity in stomach, used with diabetic gastroparesis, intestinal pseudo-obstruction
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Castor oil
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laxative, local irritant, increases intestinal motility
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Cascara, Senna, Aloes
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Contain emodin alkaloids, stimulates peristalsis in colon. Chronic use keeps bowels distended (leads to dependance)
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Bisacodyl
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Colonic stimulant, action may be prolonged with enterohepatic circulation
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Hydrophilic colloids
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indigestible parts of fruits, vegetables and seeds. Forms gels in large intestine (distention, stimulates peristalsis), cramping. Psyllium seed, methylcellulose, bran
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Milk of magnesia
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osmotic laxative, avoid prolonged use in renal failure
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lactulose, sorbitol
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non-absorbable sugars, prevent/treat chronic constipation
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Magnesium citrate, sodium phosphate
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prompt bowel evacuation
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polyethlene glycol
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non-absorbable osmotically active sugar, no intravascular fluid/electrolyte loss, no cramps/gas, tastless
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Mineral oil
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stool softener, easier to pass stool, fatty compounds around stool to lubricate
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glycerin supositories
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stool softener, easier to pass stool, fatty compounds around stool to lubricate
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Docusate
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stool softener, easier to pass stool, fatty compounds around stool to lubricate
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Diphenoxyalete (with atropine)
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Anti-diarrheal, inhibits ACh release through presynaptic opioid receptors in enteric nervous system (heteroreceptor). High doses penetrate CNS, can be addicting (contains atropine to decrease addiction). Prolongs duration of diarrhea in pt's with shigella or salmonilla(diarrhea helps rid toxins)
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Loperamide
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anti-diarrheal, inhibits ACh release through presynaptic opioid receptors in enteric nervous system (heteroreceptors), less sedation, non-analgesic. Prolongs duration of diarrhea in pt's with shigella or salmonilla(diarrhea helps rid toxins)
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Kaolin, Pectin
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indigestible carbohydrate (binds to toxins from bacteria)
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Bile salt resins
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useful in pt's with overproduction of bile salts, can be used topically for pt's to protect skin
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Octreotide
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anti-diarrheal, long acting synthetic somatostatin analog. Significantly inhibits secretion of gastric/pancreatic enzymes, slows motility, increases duration of action of somatostatin. Low doses increase motility, high doses decrease motility. Use: gastric tumors, portal HTN, varacies
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Diphenhydramine, hydroxyzine
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anti-emetic, anti-histamine. antimuscarinic, sedation, use with n/v with motion sickness, breakthrough n/v with chemo
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Prochlorperazine, promethazine
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anti-emetic, phenothiazine. Block dopamine R's in the chemoreceptor trigger zone, sedation. Promethazine caustic->extravisation
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Metoclopramide
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Dopamine antagonist, anti-emetic
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Aprepitant, Fosaprepitant
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anti-emetic, substance P antagonist. Neuokinin 1 receptor blocker (brainstem nuclei of the dorsal vagal complex). Prevention of n/v. Use with steroids and 5-ht3 inhibitor (15% better post-op n/v)
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Dronabinol
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anti-emetic, marijuana derivative. Used when other anti-emetics are ineffective
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Dexamethasone
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anti-emetic, passes blood brain barrier, use with 5-HT3 for better efficacy
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Insulin lispro, insulin aspart, apidra
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Rapid acting insulin, peak 1 hr, duration 6-8 hrs, used preprandial, does not form hexanes
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Regular insulin (humulin-R, novolin-R),
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Short acting, Onset 30min after sc, duration 5-7 hrs, can be given IV
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NPH (neutral protamine hegadorn or isophane)
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intermediate acting, humulin-N, Novolin N, onset delayed by combining with protamine, onset 2-4 hrs, peak 4-6 hrs, duration 8-12 hrs. Used in combination products
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Glardine (lantus)
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Long acting, analog of insulin, precipitates after SC injection (crystals), onset 5 hrs, peakless (peak is a plateau), duration 24 hrs
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Levemir
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Insulin Pen, peak 1-2 hrs, duration up to 24 hrs
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Tolbutaminde
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1st generation sulfonylurea, increase insulin release from pancreas (binds K channels on Beta cells). After months of treatment, insulin levels return to pretreatment levels. metabolized in liver, duration 4-5 hrs, least potent, Sulfanomide
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Chlorpropamide
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1st generation sulfonylurea, increase insulin release from pancreas (binds K channels on Beta cells). After months of treatment, insulin levels return to pretreatment levels. Risk of jaundice, hyperuremic flush with etoh, dilutional hyponatremia, longest duration of action, slow liver metabolism
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Tolazamide, acetohexamide
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1st generation sulfonylurea, increase insulin release from pancreas (binds K channels on Beta cells). After months of treatment, insulin levels return to pretreatment levels. Intermediate acting, duration 12-24 hrs, metabolized in liver
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Glyburide
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2nd generation sulfanylurea, potent, fewer adverse effects, caution with CV disease and elderly. Flushing with etoh, metabolized in liver. Duration 18-24 hrs, onset 1.5 hrs
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glipizide
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2nd generation sulfanylurea, potent, fewer adverse effects, caution with CV disease and elderly. Shortest acting 2nd generation, extended release gives 24 hrs action, less hypoglycemia
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glimepiride
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2nd generation sulfanylurea, potent, fewer adverse effects, caution with CV disease and elderly. Lower glucose levels with lower dose, long duration, metabolized by liver
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Repaglinide
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Meglitinide, increase insulin release. Regulates insulin release by regulating K channels of Beta cells. Fast onset, peak 1 hr, 4-5 hr duration, liver metabolized. Taken pre-prandial
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Nateglinide
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D-phenylalanine derivative, stimulates rapid insulin release, close K channels, low incidence of hypoglycemia, taken pre-prandial
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Metformin
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Biguanide, stimulation of glycolysis, increase glucose removal from blood, decrease gluconeogenesis, slow GI absorption, decrease glucagon. In renal failure can cause increase lactic acid. GI effects. Euglycemic (no hypoglycemia), T1/2 1.5-2 hrs, no increased weight
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Troglitazone
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Thiazolidinedione, enhance tissue insulin sensitivity, rise in LDL, redistribute fat (decrease visceral fat), euglycemic, drops TGL, rise HDL. ***Liver failure, off market
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Rosiglitazone
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Thiazolidinedione, enhance tissue insulin sensitivity, rise in LDL, redistribute fat (decrease visceral fat), euglycemic, drops TGL, rise HDL. Edema, no liver toxicity profile
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Acarbose, Miglitol
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Alpha-glucosidase inhibitor, inhibits enzyme needed to breakdown complex starches (complex starches stay in GI tract), gas forming (sugars ferment), if hypoglycemic->give simple sugars. Miglitol 6x more potent in inhibiting sucrose
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Pramlintide (Symlin)
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synthetic amylin, supress glucagon release, decrease appetite, encourage insulin release, decrease gastric emptying time. Given SC, not wt loss, used in DM II
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exenatide (byetta)
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incretin memetic (works like amylin), decreased gastric emptying time, loss appetite, increase insulin release (increase B-cell mass)
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Sitagliptin
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Inhibits dipeptidyl peptidase-4 -> increased incritin DPP-4 degrades incretin), rare hypoglycemia, oral, wt loss
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Glucagon
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increases blood glucose (breakdown of glycogen, increase gluconeogenesis, increase ketogenesis-fat breakdown), synthesized in A-cells of pancreas, potent inotrope/chronotrope, given for beta-blocker OD, relaxes intestines
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Aspirin
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irreversible COX inhibitor, inhibit granulocyte adherance, stabilize lysosomes, inhibit migration of neutrophils and macrophages. Stop 1 week prior to surgeries, increase gastric ulcers, Salicylism-kidney can't keep up with metabolism, respiratory alkalosis (increased ventilation), metabolic acidosis.
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Magnesium choline salicylate, sodium salicylate, salicylsalicylate
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non-acetylated salicylates, anti-inflammatory, less effecive analgesic than ASA, good for asthma pts, bleeding tendencies or renal dysfunction
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Celecoxib
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Cox-2 selective inhibitors, acts on induced sites of inflammation without effecting action of Cox-1. Analgesic, antipyretic, anti-inflammatory, fewer GI effects,no platelet effects. Sulfanomide, 19% increased risk of CVA & MI, absorption decreased with food, CYP-2C9
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Rofecoxib
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Cox-2 selective inhibitors. 53% increased risk for CVA&MI, off market
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Valdecoxib
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Cox-2 selective inhibitors, 23% increased risk CVA&MI, off market
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Etoricoxib
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2nd generation Cox-2 inhibitor, not yet released
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Diclofenac
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non-selective Cox inhibitor, potent, decreases arachadonic acid availability, 20% have Gi effects (use with misoprostol-increase prostaglandins), liver issues
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Diflunisal
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non-selective cox inhibitor, effective in bone CA pain, clearance depends on renal function
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Etodolac
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Non-selective Cox inhibitor, slight cox-2 selective, post-op CABG relief
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Fenoprofen
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non-selective cox inhibitor, rare toxic effect of interstitial nephritis
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Ibuprophen
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non-selective cox inhibitor, less GI irritation than ASA, rare:aplastic anemia, 2nd line therapy in closing patent ductus arteriosis
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indomethacin
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non-selective cox inhibitor, potent, may inhibit phospholipase A & C (decreased arachadonic acid -> decreased leukotrienes and prostaglandins, decrease T and B cell proliferation, GI effects, 1st line for patent ductus arteriosis, sweet's syndrome (high fever)
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Ketoprofen
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non-selective cox inhibitor, inhibits cyclooxygenase and lipooxygenase
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Ketololac
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non-selective cox inhibitor, analgesic more than anti-inflammatory, use more than 5 days associated with renal issues and ulcers, decreases need for opioids
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Nabumetone
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non-selective cox inhibitor, only non-acid NSAID, may be less damaging to GI tract
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Naproxen
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non-selective cox inhibitor, free fraction 41% higher in females, low GI effects (2x that of ibuprofen), slows bleeding in menstruation
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Oxaprozin
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non-selective cox inhibitor, long 1/2 life
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Sulindac
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non-selective cox inhibitor, Toxic effect: stevens-johnsons syndrome (skin sloughing), liver isssues. Prodrug, supress polyposis
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acetaminophen
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Prostaglandin inhibitor, decrease fever and pain (not an NSAID), increase hepatic enzymes, use in pts allergic to ASA, hemophelia, hx of PUD, ASA bronchoconstriction
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Heparin
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accelerates AT III interaction with proteases, binds to AT III causes conformational change. ***HIT, BLEEDING, protamine is reversal
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Enoxaparin, Dalteparin, Tinzaparin
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Low molecular weight heparin, inhibits activated factor X, less effect on thrombin. Use: prevent DVT, thromboembolic disease, more stable plasma levels
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Hirudin
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Direct thrombin inhibitor, bind to both active and substrate sites of thrombin, action independant of AT III, can inactivate fibrin in thrombi. From leeches, used with reattaching digits, monitor APTT
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Lepiruden (recombinant)
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Direct thrombin inhibitor, bind to both active and substrate sites of thrombin, little effect on plts or bleeding time, used for pts with HIT, no antidote
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Bivalirudin
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direct thrombin inhibitor, bind to both active and substrate sites of thrombin, inhibits plt activation, fast onset, short 1/2 life
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Argatroban
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direct thrombin inhibitor, binds only to thrombin active sites, thrombin inhibitor, short 1/2 life
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Melagatron
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direct thrombin inhibitor, binds only to thrombin active sites
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Warfarin
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blocks gamma-carboxylation of glutamate residues (prothrombin, factor VII, IX, X, protein C & S), birth defects, bleeding disorder of fetus. 99% protein bound, 8-12 hr delay in onset of action, start with small dose, Reverse with Vit K, FFP, factor 9
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Streptokinase
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fibrinolytic
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Urokinase
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fibrinolytic, lyse thrombus from within
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Tissue plasminogen activator (t-PA)
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fibrinolytic, activates plasminogen bound to fibrin, avoids systemic activation
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Alteplase
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fibrinolytic, recombinant t-PA
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Reteplase
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fibrinolytic, human t-PA with several amino acids deleted
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Tenecteplase
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fibrinolytic, longer 1/2 life
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Clopidogrel, ticlopidine
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anti-platelet, irreversible inhibtion of ADP pathway of platelets, n/v, GI effects, thrombocytopenia pupura, no effect on prostaglandin metabolism, clopidogrel 8.7% better than ASA with reducing ischemia
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Abciximab
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IIb/IIIa receptor blockers, antiplatelet, inhibit aggregation, monoclonal antibody against IIb/IIIa
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Eptifibatide
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IIb/IIIa receptor blockers, antiplatelet, inhibit aggregation, mediates binding of fibrinogen to receptor
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Tirofiban
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IIb/IIIa receptor blockers, antiplatelet, inhibit aggregation, amino acid which is main sequence for IIb/IIIa receptors
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Dipyridamole
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anti-platelet directed drug, inhibits adenosine uptake and cGMP phosphodiesterase
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Cilostazol
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anti-platelet directed drugs, phosphodiesterase inhibitor, inhibits plt aggregation
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Vitamin K
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biologic activity on prothrombin and factors VII, IX, X. For Vit K deficiency or decreased prothrombin activity. Fat soluble, found in green leafy veg, slow IV/PO
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Desmopressin Acetate
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increases factor VIII activity, mild hemophilia A, von willebrands
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Aminocaproic acid
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inhibits plasminogen activation, prevents breakdown of fibrin. Adjunct in hemophilia, post-fibrinolytic therapy, aneurysms, post-op bleeding
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Cortisone, Prednisone, Predisolone, Methylprednisolone
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Short-medium acting glucocorticoids. Changes DNA transcription, increases serum glucose, stimulate lipolysis, decrease: muscle/bone mass,growth, inflammation. supress pituitary. euphoria->depression, ulcers, fat redistribution. Use:inflammation, allergies, hematologic disordes, addison's, adrenalcortical insufficiency, congenital adrenal hyperplasia, transplants
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Triamcinolone
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Intermediate acting glucocorticoid, Changes DNA transcription, increases serum glucose, stimulate lipolysis, decrease: muscle/bone mass,growth, inflammation. supress pituitary. euphoria->depression, ulcers, fat redistribution. Use:inflammation, allergies, hematologic disordes, addison's, adrenalcortical insufficiency, congenital adrenal hyperplasia, transplants
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Betamethasone, dexamethasone
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Long acting glucocorticoids, Changes DNA transcription, increases serum glucose, stimulate lipolysis, decrease: muscle/bone mass,growth, inflammation. supress pituitary. euphoria->depression, ulcers, fat redistribution. Use:inflammation, allergies, hematologic disordes, addison's, adrenalcortical insufficiency, congenital adrenal hyperplasia, transplants
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Fludrocortisone, desoxycorticosteroneacetate
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Mineralocorticoid, promote reabsorption of Na (distal tubule, proximal tubule), effects: sodium and fluid retention, loss of K
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Metyrapone
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adrenocortical antagonist, inhibitor of steroid synthesis. effects: salt and water retention, hair growth
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aminoglutethimide
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adrenocortical antagonist, block conversion of cholesterol to pregnenolone. Use: breast Ca with dexamethasone/hydrocortisone to decrease estrogen
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Ketoconazole
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adrenocortical antagonist, antifungal, inhibitor of adrenal and gonadal steroid synthesis, used in cushings when tumor can't be removed
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Mifeprestone (RU486)
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Adrenocortical antagonist, strong anti-progesterone, generalized glucocorticoid release, stimulate uterine contractions. Use: cushings (eliminate carb intolerance, normalize BP, correct thyroid/gonadal supression), used when tumor can't be removed
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Spironolactone
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Competes with aldosterone for binding sites, reverses aldosteronism, effects: Hirsutism in women, K sparing diuretic (slows Na/K/ATPase)
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Epleronone
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aldosterone antagonist, effects: hyperkalemia, Na retention, use: hypertension
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Drospirenone
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adrenocortical antagonist, Progestin in oral contraception
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