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462 Cards in this Set
- Front
- Back
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Antidote used for lead poisoning
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Dimercaprol, EDTA
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Antidote used for cyanide poisoning
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Nitrites
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Antidote used for anticholinergic poisoning
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Physostigmine
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Antidote used for organophosphate/anticholinesterase poisoning
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Atropine, pralidoxime (2-PAM)
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Antidote used for iron salt toxicity
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Deferoxamine
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Antidote used for acetaminophen (APAP) toxicity
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N-acetylcysteine (Mucomyst)
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Antidote for arsenic, mercury, lead, and gold poisoning
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Dimercaprol
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Antidote used in poisonings: copper (Wilson's disease), lead, mercury, and arsenic
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Penicillamine
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Antidote used for heparin toxicity
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Protamine
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Antidote used for warfarin toxicity
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Vitamin and Fresh frozen plasma (FFP)
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Antidote for tissue plasminogen activator (t-PA), streptokinase
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Aminocaproic acid
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Antidote used for methanol and ethylene glycol
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Ethanol
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Antidote used for opioid toxicity
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Naloxone (IV), naltrexone (PO)
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Antidote used for benzodiazepine toxicity
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Flumazenil
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Antidote used for tricyclic antidepressants (TCA)
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Sodium bicarbonate
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Antidote used for carbon monoxide poisoning
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100% O2 and hyperbaric O2
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Antidote used for digitalis toxicity
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Digibind (also need to d/c digoxin, normalize K+, and lidocaine if pt. Is arrhythmic)
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Antidote used for beta agonist toxicity (eg. Metaproterenol)
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Esmolol
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Antidote for methotrexate toxicity
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Leucovorin
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Antidote for beta-blockers and hypoglycemia
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Glucagon
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Antidote useful for some drug induced Torsade de pointes
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Magnesium sulfate
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Antidote for hyperkalemia
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sodium polystyrene sulfonate (Kayexalate)
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Antidote for salicylate intoxication
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Alkalinize urine, dialysis
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Drugs used in bone homeostasis
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Available bisphosphonates
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Alendronate, etidronate, risedronate, pamidronate, tiludronate, and zoledronic acid
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MOA of Bisphosphonates
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Inhibits osteoclast bone resorption
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Only bisphosphonates available IV
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Etidronate
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Uses of bisphosphonates
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Osteoporosis, Paget's disease, and osteolytic bone lesions, and hypercalcemia from malignancy
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Major SE of bisphosphonates
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Chemical esophagitis
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Bisphosphonates that cannot be used on continuous basis because it caused osteomalacia
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Etidronate
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Used for prevention of postmenopausal osteoporosis in women
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Estrogen (HRT-Hormone replacement therapy)
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Increase bone density, also being tested for breast CA tx.
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Raloxifene (SERM-selective estrogen receptor modulator)
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Used intranasally and decreases bone resorption
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Calcitonin (salmon prep)
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Used especially in postmenopausal women, dosage should be 1500 mg
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Calcium
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Vitamin given with calcium to ensure proper absorption
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Vitamin D
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Difference between COX 1 and COX 2 "
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"COX 1 is found throughout the body and COX 2 is only
in inflammatory tissue |
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Drug that selectively inhibits COX 2
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Celecoxib, valdecoxib, and rofecoxib
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Irreversible, nonselective COX inhibitor
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Aspirin
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Class of drugs that reversibly inhibit COX
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NSAIDS
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Long acting beta 2 agonist used in asthma
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Salmeterol
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Muscarinic antagonist used in asthma
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Ipratropium
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MOA action of cromolyn
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Mast cell stabilizer
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Antidote for severe CV toxicity of theophylline
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Beta blockers
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MOA of quinolones
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Inhibit DNA gyrase
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MOA of penicillin
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Block cell wall synthesis by inhibiting peptidoglycan cross-linkage
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Drug used for MRSA
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Vancomycin
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Vancomycin MOA
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Blocks peptidoglycan synthesis
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Type of resistance found with vancomycin
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Point mutation
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Meningitis prophylaxis in exposed patients
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Rifampin
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Technique used to diagnose perianal itching, and the drug used to treat it
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"Scotch tape technique and mebendazole
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Two toxicities of aminoglycosides
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nephro and ototoxicity
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DOC for Legionnaires' disease
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Erythromycin
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MOA of sulfonamides
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Inhibit dihydropteroate synthase
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Penicillins active against penicillinase secreting bacteria
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Methicillin, nafcillin, and dicloxacillin
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Cheap wide spectrum antibiotic DOC of otitis media
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Amoxicillin
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Class of antibiotics that have 10% cross sensitivity with penicillins
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Cephalosporins
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PCN active against pseudomonas
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Carbenicillin, piperacillin and ticarcillin
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Drug causes teeth discoloration
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Tetracycline
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MOA of tetracycline
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Decreases protein synthesis by inhibiting 30S ribosome
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Drug that causes gray baby syndrome and aplastic anemia
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Chloramphenicol
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Drug notorious for causing pseudomembranous colitis
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Clindamycin
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DOC for tx of pseudomembranous colitis
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Metronidazole
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Treatment of resistant pseudomembranous colitis
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ORAL vancomycin
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Anemia caused by trimethoprim
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Megaloblastic anemia
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Reason fluoroquinolones are contraindicated in children and pregnancy
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Cartilage damage
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DOC for giardia, bacterial vaginosis, pseudomembranous colitis, and trichomonas
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Metronidazole
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Treatment for TB patients (think RIPE)
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Rifampin, Isoniazid, Pyrazinamide, and Ethambutol
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Metronidazole SE if given with alcohol
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Disulfiram-like reaction
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Common side effect of Rifampin
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Red urine discoloration
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MOA of nystatin
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Bind ergosterol in fungal cell membrane
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Neurotoxicity with isoniazid (INH) prevented by
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Administration of Vit. B6 (pyridoxine)
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Toxicity of amphotericin
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Nephrotoxicity
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SE seen only in men with administration of ketoconazole
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Gynecomastia
|
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Topical DOC in impetigo
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Topical mupirocin (Bactroban)
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DOC for influenza A
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Amantadine
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DOC for RSV
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Ribavirin
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DOC for CMV retinitis
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Ganciclovir
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SE for ganciclovir
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Neutro, leuko and thrombocytopenia
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Anti-viral agents associated with Stephen Johnson syndrome
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Nevirapine, amprenavir
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HIV antiviral class known to have severe drug interactions by causing inhibition of metabolism
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Protease inhibitors
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Antivirals that are teratogens
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Delavirdine, efavirenz, and ribavirin
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Antivirals associated with neutropenia
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Ganciclovir, zidovudine, saquinavir, and interferon
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HIV med used to reduce transmission during birth
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AZT (zidovudine)
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Drug used for African sleeping sickness
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Suramin
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Drug used in Chagas disease
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Nifurtimox
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Cephalosporins able to cross the BBB
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Cefixime (2nd) and 3rd generation
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Drug used for N. gonorrhea in females
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Ceftriaxone
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Cephalosporin causes kernicterus in neonates
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Ceftriaxone or cefuroxime
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SE of INH
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Peripheral neuritis and hepatitis
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Aminoglycoside that is least ototoxic
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Streptomycin
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Drug used in exoerythrocytic cycle of malaria
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Primaquine
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Oral antibiotic of choice for moderate inflammatory acne
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Minocycline
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Drug of choice for leprosy
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Dapsone
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DOC for herpes and its MOA
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Acyclovir and inhibits thymidine kinase Acyclovir and inhibits thymidine kinase
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Anti-microbials that cause hemolysis in G6PD-deficient patients
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Sulfonamides
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MOA of erythromycin
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Inhibition of protein synthesis at the 50s subunit of ribosome
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Anti-biotic frequently used for chronic UTI prophylaxis
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sulfamethoxazole/ trimethoprim
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Lactam that can be used in PCN allergic patients
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Aztreonam
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SE of imipenem
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Seizures
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Anti-viral with a dose limiting toxicity of pancreatitis
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Didanosine
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Anti seizure Drugs
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Most frequent route of metabolism
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Hepatic enzymes
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Mechanisms of action for Phenytoin, Carbamazepine, Lamotrigine
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Sodium blockade
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MOA for benzodiazepines and barbiturates
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GABA-related targets
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MOA for Ethosuximide
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Calcium channels
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MOA for Valproic acid at high doses
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Affect calcium, potassium, and sodium channels
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Drugs of choice for generalized tonic-clonic and partial seizures
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Valproic acid and Phenytoin
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DOC for febrile seizures
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Phenobarbital
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Drugs of choice for absence seizures
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Ethosuximide and valproic acid
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Drug of choice for myoclonic seizures
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Valproic acid
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Drugs of choice for status epilepticus
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IV diazepam or phenytoin (for prolonged therapy not acute)
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Drugs that can be used for infantile spasms
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Corticosteroids
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Anti-seizure drugs used also for bipolar affective disorder (BAD)
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Valproic acid, carbamazepine, phenytoin and gabapentin
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Anti-seizure drugs used also for Trigeminal neuralgia
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Carbamazepine
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Anti-seizure drugs used also for pain of neuropathic orgin
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Gabapentin
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Anti-seizure agent that exhibits non-linear metabolism, highly protein bound, causes fetal hydantoin syndrome, and stimulates hepatic metabolism
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Phenytoin
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SE of phenytoin
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Gingival hyperplasia, nystagmus, diplopia and ataxia
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Anti-seizure agent that induces formation of liver drug-metabolism enzymes, is teratogen and can cause craniofacial anomalies and spina bifida
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Carbamazepine
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Agent that inhibits hepatic metabolism, is hepatotoxic and teratogen that can cause neural tube defects and gastrointestinal distress
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Valproic acid
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Laboratory value required to be monitored for patients on valproic acid
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Serum ammonia and LFT's
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SE for Lamotrigine
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Stevens-Johnson syndrome
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SE for Felbamate
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Aplastic anemia and acute hepatic failure
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Anti-seizure medication also used in the prevention of migraines
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Valproic acid
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Carbamazepine may cause
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Agranulocytosis
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Anti-seizure drugs used as alternative drugs for mood stabilization
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Carbamazepine, gabapentin, lamotrigine, and valproic acid
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Extrapyramidal dysfunction is more common with these agents, which block this subtype of dopamine receptor
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Older antipsychotic agents, D2 receptors
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Side effects occuring in antipsychotics that block dopamine
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Hyperprolactinemia, menorrhea, galactorrhea, confusion, mood changes, decreased sexual interest, and weight gain
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Antipsychotics that reduce positive symptoms only
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Older antipsychotics
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Newer atypical antipsychotics that also improve some of the negative symptoms and help acute agitation
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Olanzapine, aripiprazole, and sertindole
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Antipsychotic used in the treatment of psychiatric symptoms in patients with dementia
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Risperidone
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Atypical antipsychotic causing high prolactin levels
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Risperidone
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Newer atypical antipsychotic used for bipolar disorder, known to cause weight gain, and adversely affect diabetes
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Olanzapine
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Agent more frequently associated with extrapyramidal side effects that can be treated with benzodiazepine, diphenhydramine or muscarinic blocker
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Haloperidol
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Drug used in neuroleptic malignant syndrome
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Dantrolene
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Agents may exacerbate tardive dyskinesias (may be irreversible and there is no treatment)
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Muscarinic blockers
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Antipsychotic having the strongest autonomic effects
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Thioridazine
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Antipsychotic having the weakest autonomic effects
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Haloperidol
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Antipsychotic that does not block muscarinic or histamine receptors, and it prolongs the QT interval
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Sertindole
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Only phenothiazine not exerting antiemetic effects, can cause visual impairment due to retinal deposits, and high doses have been associated with ventricular arrhythmias
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Thioridazine
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Agent having no effect on D2 receptors, blocks D4, reserved for resistant schizophrenia, and can cause agranulocytosis
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Clozapine
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Anti-psychotic not shown to cause tardive dyskinesia
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Clozapine
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Anti-psychotics available in depot preparation
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Fluphenazine and haloperidol
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Reduced seizure threshold
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Low-potency typical antipsychotics and clozapine
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Orthostatic hypotension and QT prolongation
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Low potency and risperidone
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Increased risk of developing cataracts
|
Quetiapine
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Major route of elimination for Lithium
|
Kidneys
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Patients being treated with lithium, who are dehydrated, or taking diuretics concurrently, could develop
|
Lithium toxicity
|
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Drug increases the renal clearance hence decreases levels of lithium
|
Theophylline
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Lithium is associated with this congenital defect
|
Cardiac anomalies and is contraindicated in pregnancy or lactation
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DOC for bipolar affective disorder
|
Lithium
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SE of lithium
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Tremor, sedation, ataxia, aphasia, thyroid enlargement, and reversible diabetes insipidus
|
|
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Example of three antidepressants that are indicated for obsessive compulsive disorder
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Clomipramine, fluoxetine and fluvoxamine
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Neurotransmitters affected by the action of antidepressants
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Norepinephrine and serotonin
|
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Usual time needed for full effect of antidepressant therapy
|
2 to 3 weeks
|
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Population group especially sensitive to side effects of antidepressants
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Elderly patients
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All antidepressants have roughly the same efficacy in treating depression, agents are chosen based on these criterion
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Side-effect profile and prior pt response
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Well-tolerated and are first-line antidepressants
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SSRI's, bupropion, and venlafaxine
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Monoamine oxidase inhibitors (MAOI)
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Most useful in patients with significant anxiety, phobic features, hypochondriasis, and resistant depression
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Monamine oxidase inhibitors
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Condition will result from in combination of MAOI with tyramine containing foods (ex. wine, cheese, and pickled meats)
|
Hypertensive crisis
|
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MAOI should not be administered with SSRI's or potent TCA's due to development of this condition
|
Serotonin syndrome
|
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Tricyclic antidepressants (TCA)
|
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|
|
Sedation is a common side effect of these drugs, they lower seizure threshold, uses include BAD, acute panic attacks, phobias, enuresis, and chronic pain and their overdose can be deadly
|
Tricyclic antidepressants (TCA)
|
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Three C's associated with TCA toxicity
|
Coma, Convulsions, Cardiac problems (arrhythmias and wide QRS)
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Agents having higher sedation and antimuscarinic effects than other TCA's
|
Tertiary amines
|
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TCA used in chronic pain, a hypnotic, and has marked antimuscarinic effects
|
Amitriptyline
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TCA used in chronic pain, enuresis, and ADD
|
Imipramine
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TCA with greatest sedation of this group, and marked antimuscarinic effects, used for sleep
|
Doxepin
|
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TCA used in obsessive compulsive disorder (OCD), most significant of TCA's for risk of seizure, weight gain, and neuropsychiatric signs and symptoms
|
Clomipramine
|
|
|
Secondary amines that have less sedation and more excitation effect
|
Nortriptyline, Desipramine
|
|
|
Antidepressant associated with neuroleptic malignant syndrome
|
Amoxapine
|
|
|
Antidepressant associated with seizures and cardiotoxicity
|
Maprotiline
|
|
|
Antidepressant having stimulant effects similar to SSRI's and can increase blood pressure
|
Venlafaxine
|
|
|
Antidepressant inhibiting norepinephrine, serotonin, and dopamine reuptake
|
Venlafaxine
|
|
|
Antidepressant also used for sleep that causes priapism
|
Trazodone
|
|
|
Antidepressant which is inhibitor of CYP450 enzymes and may be associated with hepatic failure
|
Nefazodone
|
|
|
Heterocyclic antidepressants least likely to affect sexual performance, used for management of nicotine withdrawal, SE's include dizziness, dry mouth, aggravation of psychosis, and seizures
|
Bupropion
|
|
|
Antidepressant with MOA as alpha 2 antagonist, has effects on both 5-HT and NE, blocks histamine receptors, and is sedating
|
Mirtazapine
|
|
|
SE of mirtazapine
|
Liver toxicity, increased serum cholesterol
|
|
|
Selective serotonin reuptake inhibitors (SSRI)
|
|
|
|
Except for these agents all SSRI have significant inhibition of CytP450 enzymes
|
Citalopram and its metabolite escitalopram
|
|
|
SSRI with long T1/2 and can be administered once weekly for maintenance, not acute tx
|
Fluoxetine
|
|
|
SSRI indicated for premenstrual dysphoric disorder
|
Fluoxetine (Sarafem)
|
|
|
Some of SSRIs' therapeutic effects beside depression
|
Panic attacks, social phobias, bulimia nervosa, and PMDD premenstrual dysphoric disorder), OCD
|
|
|
SSRI's less likely to cause a withdrawal syndrome
|
Fluoxetine
|
|
|
Opioid Analgesics & Antagonists
|
|
|
|
Difference between COX 1 and COX 2 "
|
"COX 1 is found throughout
|
|
|
Drug that selectively inhibits COX 2
|
Celecoxib, valdecoxib, and rofecoxib
|
|
|
Irreversible, nonselective COX inhibitor
|
Aspirin
|
|
|
Class of drugs that reversibly inhibit COX
|
NSAIDS
|
|
|
Long acting beta 2 agonist used in asthma
|
Salmeterol
|
|
|
Muscarinic antagonist used in asthma
|
Ipratropium
|
|
|
MOA action of cromolyn
|
Mast cell stabilizer
|
|
|
Antidote for severe CV toxicity of theophylline
|
Beta blockers
|
|
|
MOA of quinolones
|
Inhibit DNA gyrase
|
|
|
MOA of penicillin
|
Block cell wall synthesis by inhibiting peptidoglycan cross-linkage
|
|
|
Drug used for MRSA
|
Vancomycin
|
|
|
Vancomycin MOA
|
Blocks peptidoglycan synthesis
|
|
|
Type of resistance found with vancomycin
|
Point mutation
|
|
|
Meningitis prophylaxis in exposed patients
|
Rifampin
|
|
|
Two toxicities of aminoglycosides
|
nephro and ototoxicity
|
|
|
DOC for Legionnaires' disease
|
Erythromycin
|
|
|
MOA of sulfonamides
|
Inhibit dihydropteroate synthase
|
|
|
Penicillins active against penicillinase secreting bacteria
|
Methicillin, nafcillin, and dicloxacillin
|
|
|
Cheap wide spectrum antibiotic DOC of otitis media
|
Amoxicillin
|
|
|
Class of antibiotics that have 10% cross sensitivity with penicillins
|
Cephalosporins
|
|
|
PCN active against pseudomonas
|
Carbenicillin, piperacillin and ticarcillin
|
|
|
Drug causes teeth discoloration
|
Tetracycline
|
|
|
MOA of tetracycline
|
Decreases protein synthesis by inhibiting 30S ribosome
|
|
|
Drug that causes gray baby syndrome and aplastic anemia
|
Chloramphenicol
|
|
|
Drug notorious for causing pseudomembranous colitis
|
Clindamycin
|
|
|
DOC for tx of pseudomembranous colitis
|
Metronidazole
|
|
|
Treatment of resistant pseudomembranous colitis
|
ORAL vancomycin
|
|
|
Anemia caused by trimethoprim
|
Megaloblastic anemia
|
|
|
Reason fluoroquinolones are contraindicated in children and pregnancy
|
Cartilage damage
|
|
|
DOC for giardia, bacterial vaginosis, pseudomembranous colitis, and trichomonas
|
Metronidazole
|
|
|
Treatment for TB patients (think RIPE)
|
Rifampin, Isoniazid, Pyrazinamide, and Ethambutol
|
|
|
Metronidazole SE if given with alcohol
|
Disulfiram-like reaction
|
|
|
Common side effect of Rifampin
|
Red urine discoloration
|
|
|
MOA of nystatin
|
Bind ergosterol in fungal cell membrane
|
|
|
Neurotoxicity with isoniazid (INH) prevented by
|
Administration of Vit. B6 (pyridoxine)
|
|
|
Toxicity of amphotericin
|
Nephrotoxicity
|
|
|
SE seen only in men with administration of ketoconazole
|
Gynecomastia
|
|
|
Topical DOC in impetigo
|
Topical mupirocin (Bactroban)
|
|
|
DOC for influenza A
|
Amantadine
|
|
|
DOC for RSV
|
Ribavirin
|
|
|
DOC for CMV retinitis
|
Ganciclovir
|
|
|
SE for ganciclovir
|
Neutro, leuko and thrombocytopenia
|
|
|
Anti-viral agents associated with Stephen Johnson syndrome
|
Nevirapine, amprenavir
|
|
|
HIV antiviral class known to have severe drug interactions by causing inhibition of metabolism
|
Protease inhibitors
|
|
|
Antivirals that are teratogens
|
Delavirdine, efavirenz, and ribavirin
|
|
|
Antivirals associated with neutropenia
|
Ganciclovir, zidovudine, saquinavir, and interferon
|
|
|
HIV med used to reduce transmission during birth
|
AZT (zidovudine)
|
|
|
Drug used for African sleeping sickness
|
Suramin
|
|
|
Drug used in Chagas disease
|
Nifurtimox
|
|
|
Cephalosporins able to cross the BBB
|
Cefixime (2nd) and 3rd generation
|
|
|
Drug used for N. gonorrhea in females
|
Ceftriaxone
|
|
|
Cephalosporin causes kernicterus in neonates
|
Ceftriaxone or cefuroxime
|
|
|
SE of INH
|
Peripheral neuritis and hepatitis
|
|
|
Aminoglycoside that is least ototoxic
|
Streptomycin
|
|
|
Drug used in exoerythrocytic cycle of malaria
|
Primaquine
|
|
|
Oral antibiotic of choice for moderate inflammatory acne
|
Minocycline
|
|
|
Drug of choice for leprosy
|
Dapsone
|
|
|
DOC for herpes and its MOA
|
Acyclovir and inhibits thymidine kinase Acyclovir and inhibits thymidine kinase
|
|
|
Anti-microbials that cause hemolysis in G6PD-deficient patients
|
Sulfonamides
|
|
|
MOA of erythromycin
|
Inhibition of protein synthesis at the 50s subunit of ribosome
|
|
|
Anti-biotic frequently used for chronic UTI prophylaxis
|
sulfamethoxazole/ trimethoprim
|
|
|
Lactam that can be used in PCN allergic patients
|
Aztreonam
|
|
|
SE of imipenem
|
Seizures
|
|
|
Anti-viral with a dose limiting toxicity of pancreatitis
|
Didanosine
|
|
|
Most frequent route of metabolism
|
Hepatic enzymes
|
|
|
Mechanisms of action for Phenytoin, Carbamazepine, Lamotrigine
|
Sodium blockade
|
|
|
MOA for benzodiazepines and barbiturates
|
GABA-related targets
|
|
|
MOA for Ethosuximide
|
Calcium channels
|
|
|
MOA for Valproic acid at high doses
|
Affect calcium, potassium, and sodium channels
|
|
|
Drugs of choice for generalized tonic-clonic and partial seizures
|
Valproic acid and Phenytoin
|
|
|
DOC for febrile seizures
|
Phenobarbital
|
|
|
Drugs of choice for absence seizures
|
Ethosuximide and valproic acid
|
|
|
Drug of choice for myoclonic seizures
|
Valproic acid
|
|
|
Drugs of choice for status epilepticus
|
IV diazepam or phenytoin (for prolonged therapy not acute)
|
|
|
Drugs that can be used for infantile spasms
|
Corticosteroids
|
|
|
Anti-seizure drugs used also for bipolar affective disorder (BAD)
|
Valproic acid, carbamazepine, phenytoin and gabapentin
|
|
|
Anti-seizure drugs used also for Trigeminal neuralgia
|
Carbamazepine
|
|
|
Anti-seizure drugs used also for pain of neuropathic orgin
|
Gabapentin
|
|
|
Anti-seizure agent that exhibits non-linear metabolism, highly protein bound, causes fetal hydantoin syndrome, and stimulates hepatic metabolism
|
Phenytoin
|
|
|
SE of phenytoin
|
Gingival hyperplasia, nystagmus, diplopia and ataxia
|
|
|
Anti-seizure agent that induces formation of liver drug-metabolism enzymes, is teratogen and can cause craniofacial anomalies and spina bifida
|
Carbamazepine
|
|
|
Agent that inhibits hepatic metabolism, is hepatotoxic and teratogen that can cause neural tube defects and gastrointestinal distress
|
Valproic acid
|
|
|
Antibiotic causing red-man syndrome, and prevention
|
Vancomycin, infusion at a slow rate and antihistamines
|
|
|
Laboratory value required to be monitored for patients on valproic acid
|
Serum ammonia and LFT's
|
|
|
SE for Lamotrigine
|
Stevens-Johnson syndrome
|
|
|
SE for Felbamate
|
Aplastic anemia and acute hepatic failure
|
|
|
Anti-seizure medication also used in the prevention of migraines
|
Valproic acid
|
|
|
Carbamazepine may cause
|
Agranulocytosis
|
|
|
Anti-seizure drugs used as alternative drugs for mood stabilization
|
Carbamazepine, gabapentin, lamotrigine, and valproic acid
|
|
|
Extrapyramidal dysfunction is more common with these agents, which block this subtype of dopamine receptor
|
Older antipsychotic agents, D2 receptors
|
|
|
Side effects occuring in antipsychotics that block dopamine
|
Hyperprolactinemia, menorrhea, galactorrhea, confusion, mood changes, decreased sexual interest, and weight gain
|
|
|
Antipsychotics that reduce positive symptoms only
|
Older antipsychotics
|
|
|
Newer atypical antipsychotics that also improve some of the negative symptoms and help acute agitation
|
Olanzapine, aripiprazole, and sertindole
|
|
|
Antipsychotic used in the treatment of psychiatric symptoms in patients with dementia
|
Risperidone
|
|
|
Atypical antipsychotic causing high prolactin levels
|
Risperidone
|
|
|
Newer atypical antipsychotic used for bipolar disorder, known to cause weight gain, and adversely affect diabetes
|
Olanzapine
|
|
|
Agent more frequently associated with extrapyramidal side effects that can be treated with benzodiazepine, diphenhydramine or muscarinic blocker
|
Haloperidol
|
|
|
Drug used in neuroleptic malignant syndrome
|
Dantrolene
|
|
|
Agents may exacerbate tardive dyskinesias (may be irreversible and there is no treatment)
|
Muscarinic blockers
|
|
|
Antipsychotic having the strongest autonomic effects
|
Thioridazine
|
|
|
Antipsychotic having the weakest autonomic effects
|
Haloperidol
|
|
|
Antipsychotic that does not block muscarinic or histamine receptors, and it prolongs the QT interval
|
Sertindole
|
|
|
Only phenothiazine not exerting antiemetic effects, can cause visual impairment due to retinal deposits, and high doses have been associated with ventricular arrhythmias
|
Thioridazine
|
|
|
Agent having no effect on D2 receptors, blocks D4, reserved for resistant schizophrenia, and can cause agranulocytosis
|
Clozapine
|
|
|
Anti-psychotic not shown to cause tardive dyskinesia
|
Clozapine
|
|
|
Anti-psychotics available in depot preparation
|
Fluphenazine and haloperidol
|
|
|
Reduced seizure threshold
|
Low-potency typical antipsychotics and clozapine
|
|
|
Orthostatic hypotension and QT prolongation
|
Low potency and risperidone
|
|
|
Increased risk of developing cataracts
|
Quetiapine
|
|
|
Major route of elimination for Lithium
|
Kidneys
|
|
|
Patients being treated with lithium, who are dehydrated, or taking diuretics concurrently, could develop
|
Lithium toxicity
|
|
|
Drug increases the renal clearance hence decreases levels of lithium
|
Theophylline
|
|
|
Lithium is associated with this congenital defect
|
Cardiac anomalies and is contraindicated in pregnancy or lactation
|
|
|
DOC for bipolar affective disorder
|
Lithium
|
|
|
SE of lithium
|
Tremor, sedation, ataxia, aphasia, thyroid enlargement, and reversible diabetes insipidus
|
|
|
Example of three antidepressants that are indicated for obsessive compulsive disorder
|
Clomipramine, fluoxetine and fluvoxamine
|
|
|
Neurotransmitters affected by the action of antidepressants
|
Norepinephrine and serotonin
|
|
|
Usual time needed for full effect of antidepressant therapy
|
2 to 3 weeks
|
|
|
Population group especially sensitive to side effects of antidepressants
|
Elderly patients
|
|
|
All antidepressants have roughly the same efficacy in treating depression, agents are chosen based on these criterion
|
Side-effect profile and prior pt response
|
|
|
Well-tolerated and are first-line antidepressants
|
SSRI's, bupropion, and venlafaxine
|
|
|
Most useful in patients with significant anxiety, phobic features, hypochondriasis, and resistant depression
|
Monamine oxidase inhibitors
|
|
|
Condition will result from in combination of MAOI with tyramine containing foods (ex. wine, cheese, and pickled meats)
|
Hypertensive crisis
|
|
|
MAOI should not be administered with SSRI's or potent TCA's due to development of this condition
|
Serotonin syndrome
|
|
|
Sedation is a common side effect of these drugs, they lower seizure threshold, uses include BAD, acute panic attacks, phobias, enuresis, and chronic pain and their overdose can be deadly
|
Tricyclic antidepressants (TCA)
|
|
|
Three C's associated with TCA toxicity
|
Coma, Convulsions, Cardiac problems (arrhythmias and wide QRS)
|
|
|
Agents having higher sedation and antimuscarinic effects than other TCA's
|
Tertiary amines
|
|
|
TCA used in chronic pain, a hypnotic, and has marked antimuscarinic effects
|
Amitriptyline
|
|
|
TCA used in chronic pain, enuresis, and ADD
|
Imipramine
|
|
|
TCA with greatest sedation of this group, and marked antimuscarinic effects, used for sleep
|
Doxepin
|
|
|
TCA used in obsessive compulsive disorder (OCD), most significant of TCA's for risk of seizure, weight gain, and neuropsychiatric signs and symptoms
|
Clomipramine
|
|
|
Secondary amines that have less sedation and more excitation effect
|
Nortriptyline, Desipramine
|
|
|
Antidepressant associated with neuroleptic malignant syndrome
|
Amoxapine
|
|
|
Antidepressant associated with seizures and cardiotoxicity
|
Maprotiline
|
|
|
Antidepressant having stimulant effects similar to SSRI's and can increase blood pressure
|
Venlafaxine
|
|
|
Antidepressant inhibiting norepinephrine, serotonin, and dopamine reuptake
|
Venlafaxine
|
|
|
Antidepressant also used for sleep that causes priapism
|
Trazodone
|
|
|
Antidepressant which is inhibitor of CYP450 enzymes and may be associated with hepatic failure
|
Nefazodone
|
|
|
Heterocyclic antidepressants least likely to affect sexual performance, used for management of nicotine withdrawal, SE's include dizziness, dry mouth, aggravation of psychosis, and seizures
|
Bupropion
|
|
|
Antidepressant with MOA as alpha 2 antagonist, has effects on both 5-HT and NE, blocks histamine receptors, and is sedating
|
Mirtazapine
|
|
|
SE of mirtazapine
|
Liver toxicity, increased serum cholesterol
|
|
|
Selective serotonin reuptake inhibitors (SSRI)
|
|
|
|
Except for these agents all SSRI have significant inhibition of CytP450 enzymes
|
Citalopram and its metabolite escitalopram
|
|
|
SSRI with long T1/2 and can be administered once weekly for maintenance, not acute tx
|
Fluoxetine
|
|
|
SSRI indicated for premenstrual dysphoric disorder
|
Fluoxetine (Sarafem)
|
|
|
Some of SSRIs' therapeutic effects beside depression
|
Panic attacks, social phobias, bulimia nervosa, and PMDD premenstrual dysphoric disorder), OCD
|
|
|
SSRI's less likely to cause a withdrawal syndrome
|
Fluoxetine
|
|
|
Opioid Analgesics & Antagonists
|
|
|
|
Inhibit synaptic activity of primary afferents and spinal cord pain transmission neurons
|
Ascending pathways
|
|
|
Activation of these receptors close Ca2+ ion channels to inhibit neurotransmitter release
|
Presynaptic mu, delta, and kappa receptors
|
|
|
Activation of these receptors open K+ ion channels to cause membrane hyperpolarization
|
Postsynaptic Mu receptors
|
|
|
Tolerance to all effects of opioid agonists can develop except
|
Miosis and constipation
|
|
|
All opioids except this agent (which has a muscarinic blocking action) cause pupillary constriction
|
Meperidine
|
|
|
SE of these drugs include dependence, withdrawal syndrome, sedation, euphoria, respiratory depression nausea and vomiting, constipation, biliary spasm, increased ureteral and bladder tone, and reduction in uterine tone
|
Opioid Analgesics
|
|
|
Strong opioid agonists
|
Morphine, methadone, meperidine, and fentanyl
|
|
|
Opioids used in anesthesia
|
Morphine and fentanyl
|
|
|
Opioid used in the management of withdrawal states
|
Methadone
|
|
|
Opioid available trans-dermally
|
Fentanyl
|
|
|
Opioid that can be given PO, by epidural, and IV, which helps to relieve the dyspnea of pulmonary edema
|
Morphine
|
|
|
Use of this opioid with MAOI can lead to hyperpyrexic coma, and with SSRI's can lead to serotonin syndrome
|
Meperidine
|
|
|
Moderate opioid agonists
|
Codeine, hydrocodone, and oxycodone
|
|
|
Weak opioid agonist, poor analgesic, its overdose can cause severe toxicity including respiratory depression, circulatory collapse, pulmonary edema, and seizures
|
Propoxyphene
|
|
|
Partial opioid agonist, considered a strong analgesic, has a long duration of action and is resistant to naloxone reversal
|
Buprenorphine
|
|
|
Opioid antagonist that is given IV and had short DOA
|
Naloxone
|
|
|
Opioid antagonist that is given orally in alcohol dependency programs
|
Naltrexone
|
|
|
These agents are used as antitussive
|
Dextromethorphan, Codeine
|
|
|
These agents are used as antidiarrheal
|
Diphenoxylate, Loperamide
|
|
|
Drugs of Abuse
|
|
|
|
Inhalant anesthetics
|
NO, chloroform, and diethyl ether
|
|
|
Toxic to the liver, kidney, lungs, bone marrow, peripheral nerves, and cause brain damage in animals, sudden death has occurred following inhalation
|
Fluorocarbons and Industrial solvents
|
|
|
Cause dizziness, tachycardia, hypotension, and flushing
|
Organic nitrites
|
|
|
Causes acne, premature closure of epiphyses, masculinization in females, hepatic dysfunction, MI, and increases in libido and aggression
|
Steroids
|
|
|
Readily detected markers that may assist in diagnosis of the cause of a drug overdose include
|
Changes in heart rate, blood pressure, respiration, body temperature, sweating, bowel signs, and pupillary responses
|
|
|
Opioid Analgesics
|
|
|
|
Most commonly abused in health care professionals
|
Heroin, morphine, oxycodone, meperidine and fentanyl
|
|
|
This route is associated with rapid tolerance and psychologic dependence
|
IV administration
|
|
|
Leads to respiratory depression progressing to coma and death
|
Overdose of opioids
|
|
|
Lacrimation, rhinorrhea, yawning, sweating, weakness, gooseflesh, nausea, and vomiting, tremor, muscle jerks, and hyperpnea are signs of this syndrome
|
Abstinence syndrome
|
|
|
Treatment for opioid addiction
|
Methadone, followed by slow dose reduction
|
|
|
This agent may cause more severe, rapid and intense symptoms to a recovering addict
|
Naloxone
|
|
|
Sedative-Hypnotics
|
|
|
|
Sedative-Hypnotics action
|
Reduce inhibition, suppress anxiety, and produce relaxation
|
|
|
Additive effects when Sedative-Hypnotics used in combination with these agents
|
CNS depressants
|
|
|
Common mechanism by which overdose result in death
|
Depression of medullary and cardiovascular centers
|
|
|
"Date rape drug"
|
Flunitrazepam (rohypnol)
|
|
|
The most important sign of withdrawal syndrome
|
Excessive CNS stimulation (seizures)
|
|
|
Treatment of withdrawal syndrome involves
|
Long-acting sedative-hypnotic or a gradual reduction of dose, clonidine or propranolol
|
|
|
These agents are CNS depressants
|
Ethanol, Barbiturates, and Benzodiazepines
|
|
|
Stimulants
|
|
|
|
Withdrawal from this drug causes lethargy, irritability, and headache
|
Caffeine
|
|
|
W/D from this drug causes anxiety and mental discomfort
|
Nicotine
|
|
|
Treatments available for nicotine addiction
|
Patches, gum, nasal spray, psychotherapy, and bupropion
|
|
|
Chronic high dose abuse of nicotine leads to
|
Psychotic state, overdose causes agitation, restlessness, tachycardia, hyperthermia, hyperreflexia, and seizures
|
|
|
Tolerance is marked and abstinence syndrome occurs
|
Amphetamines
|
|
|
Amphetamine agents
|
Dextroamphetamines and methamphetamine
|
|
|
These agents are congeners of Amphetamine
|
DOM, STP, MDA, and MDMA "ecstasy"
|
|
|
Overdoses of this agent with powerful vasoconstrictive action may result in fatalities from arrhythmias, seizures, respiratory depression, or severe HTN (MI and stroke)
|
Cocaine "super-speed"
|
|
|
Hallucinogens
|
|
|
|
Most dangerous of the currently popular hallucinogenic drugs, OD leads to nystagmus, marked hypertension, and seizures, presence of both horizontal and vertical nystagmus is pathognomonic
|
PCP
|
|
|
Removal of PCP may be aided
|
Urinary acidification and activated charcoal or continual nasogastric suction
|
|
|
THC is active ingredient, SE's include impairment of judgment, and reflexes, decreases in blood pressure and psychomotor performance occur
|
Marijuana
|
|
|
Sympathomimetics
|
|
|
|
Pneumonic for beta receptors
|
You have 1 heart (Beta 1) and 2 lungs (Beta 2)
|
|
|
This is the drug of choice for anaphylactic shock
|
Epinephrine
|
|
|
Phenylisopropylamines that are used legitimately and abused for narcolepsy, attention deficit disorder, and weight reduction
|
Amphetamines
|
|
|
Alpha agonist used to produce mydriasis and reduce conjunctival itching and congestion caused by irritation or allergy, it does not cause cycloplegia
|
Phenylephrine
|
|
|
Epinephrine and dipivefrin are used for
|
Glaucoma
|
|
|
Newer alpha 2 agonist (apraclonidine and brimonidine) treat glaucoma
|
Reduce aqueous synthesis
|
|
|
Short acting Beta 2 agonists that is drug of choice in treatment of acute asthma but not recommended for prophylaxis
|
Albuterol
|
|
|
Longer acting Beta 2 agonists is recommended for prophylaxis of asthma
|
Salmeterol
|
|
|
These agents increase blood flow and may be beneficial in treatment of acute heart failure and some types of shock
|
Beta1 agonists
|
|
|
These agents decrease blood flow or increase blood pressure, are local decongestant, and used in therapy of spinal shock (temporary maintenance of blood pressure which may help maintain perfusion
|
Alpha1 agonists
|
|
|
Shock due to septicemia or myocardial infarction is made worse by
|
Increasing afterload and tissue perfusion declines
|
|
|
Often mixed with local anesthetic to
|
Reduce the loss from area of injection
|
|
|
Chronic orthostatic hypotension can be treated with
|
Midodrine
|
|
|
Beta 2 agonist used to suppress premature labor, but cardiac stimulatory effects may be hazardous to mother and fetus
|
Terbutaline
|
|
|
Long acting sympathomimetic, sometimes used to improve urinary continence in children and elderly with enuresis
|
Ephedrine
|
|
|
Alpha 1 agonist toxicity
|
Hypertension
|
|
|
Beta 1 agonist toxicity
|
Sinus tachycardia and serious arrhythmias
|
|
|
Beta 2 agonist toxicity
|
Skeletal muscle tremor
|
|
|
The selective agents loose their selectivity at
|
high doses
|
|
|
Adrenoceptor Blocker
|
|
|
|
Nonselective alpha-blocking drug, long acting and irreversible, and used to treat pheochromocytoma. Blocks 5-HT, so occasionaly used for carcinoid tumor. Blocks H1 and used in mastocytosis
|
Phenoxybenzamine
|
|
|
Nonselective alpha-blocking drug, short acting and reversible, used for rebound HTN from rapid clonidine withdrawal, and Raynaud's phenomena
|
Phentolamine
|
|
|
Selective Alpha 1 blocker used for hypertension, BPH, may cause first dose orthostatic hypotension
|
Prazosin, terazosin, doxazosin
|
|
|
Selective Alpha 2 blocker used for impotence (controversial effectiveness)
|
Yohimbine
|
|
|
Beta-Blocking Drugs
|
|
|
|
SelectiveB1 Receptor blockers that may be useful in treating patients with asthma
|
Acebutolol, atenolol, esmolol, metoprolol
|
|
|
Combined alpha and beta blocking agents that may have application in treatment of CHF
|
Labetalol and carvedilol
|
|
|
Beta blockers partial agonist activity (intrinsic sympathomimetic activity) cause some bronchodilation and may have an advantage in treating patients with asthma
|
Pindolol and acebutolol
|
|
|
This beta blocker lacks local anesthetic activity (decreases protective reflexes and increases the risk of corneal ulceration) and used in treating glaucoma
|
Timolol
|
|
|
This parenteral beta blocker is a short acting
|
Esmolol
|
|
|
This beta blocker is the longest acting
|
Nadolol
|
|
|
These beta blockers are less lipid soluble
|
Acebutolol and atenolol
|
|
|
This beta blocker is highly lipid soluble and may account for side effects such as nightmares
|
Propranolol
|
|
|
Clinical uses of these agents include treatment of HTN, angina, arrhythmias, and chronic CHF
|
Beta blockers
|
|
|
Toxicity of these agents include bradycardia, AV blockade, exacerbation of acute CHF, signs of hypoglycemia may be masked (tachycardia, tremor, and anxiety)
|
Beta blockers
|
|
|
NSAIDS and DMARDS
|
|
|
|
MOA of NSAIDS
|
inhibit prostaglandin synthesis by inhibiting cyclo-oxygenase (cox)
|
|
|
Difference between aspirin and other NSAIDS
|
Aspirin irreversibly inhibits cyclooxygenase
|
|
|
Four main actions of NSAIDS
|
Anti-inflammatory, analgesia, antipyretic and antiplatelet activity
|
|
|
Agent used for closure of patent ductus arteriosus
|
Indomethacin
|
|
|
Aspirin is contraindicated in children with viral infection
|
Potential for development of Reye's syndrome
|
|
|
SE of salicylates
|
Tinnitus, GI bleeding
|
|
|
NSAID also available as an ophthalmic preparation
|
Diclofenac
|
|
|
NSAID available orally, IM and ophthalmically
|
Ketoralac
|
|
|
NSAID that is used for acute condition, such as pre-op anesthesia and has limited duration (<5 days) of use due to nephrotoxicity
|
Ketoralac
|
|
|
Newer NSAIDs that selectively inhibit COX-2
|
Celecoxib and rofecoxib
|
|
|
COX 2 inhibitors may have reduced risk of
|
Gastric ulcers and GI Bleeding
|
|
|
COX 2 inhibitors should be used cautiously in pts with
|
Pre-existing cardiac or renal disease
|
|
|
Acetaminophen only has
|
Antipyretic and analgesic activity
|
|
|
SE of acetaminophen
|
Hepatotoxicity
|
|
|
Antidote for acetaminophen toxicity
|
N-acetylcysteine
|
|
|
Drugs-Modifying Anti-Rheumatic Agents (DMARDS)
|
|
|
|
DMARDs are slow acting drugs for
|
Rheumatic disease
|
|
|
MOA of gold salts
|
Alter activity of macrophages and suppress phagocytic activity of PMNs
|
|
|
SE of gold salts
|
Dermatitis of the mouth aplastic anemia and agranulocytosis
|
|
|
Causes bone marrow suppression
|
Methotrexate
|
|
|
SE of penicillamine
|
Aplastic anemia and renal
|
|
|
Interferes with activity of T-lymphocytes
|
Hydroxychloroquine
|
|
|
Anti-malarial drug used in rheumatoid arthritis (RA)
|
Hydroxychloroquine
|
|
|
SE of hydroxychloroquine
|
Retinal destruction and dermatitis
|
|
|
MOA of Leflunomide (newer agent)
|
Inhibiting Dihydroorotate Dehydrogenase which leads to decreased pyrimidine synthesis
|
|
|
Proteins that prevent action of tumor necrosis factor alpha (TNF-alpha)
|
Infliximab and etanercept
|
|
|
Anti-rheumatic agent also used for ulcerative colitis
|
Sulfasalazine
|
|
|
Drugs used in Gout
|
|
|
|
NSAIDS used in gout
|
Indomethacin and phenylbutazone
|
|
|
NSAID contraindicated in gout
|
Aspirin
|
|
|
SE of phenylbutazone
|
Aplastic anemia and agranulocytosis
|
|
|
MOA of Colchicine (used in acute gout)
|
Selective inhibitor of microtubule assembly
|
|
|
SE of colchicine
|
Kidney and liver toxicity
|
|
|
Agent used to treat chronic gout by increasing uric acid secretion
|
Probenecid and sulfinpyrazone
|
|
|
Allopurinol treats chronic gout by inhibiting
|
Xanthine oxidase
|
