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681 Cards in this Set
- Front
- Back
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Time it takes for amount of drug to fall to half of its value; this is a constant in first order kinetics (majority of drugs)
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Half-life (t1/2)
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Relates the amount of drug in the body to the plasma concentration
|
Volume of Distribution (VD)
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Plasma concentration of a drug at a given time
|
Cp
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The ratio of the rate of elimination of a drug to its plasma concentration
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CL Clearance
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The elimination of drug that occurs before it reaches the systemic circulation
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First pass effect
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The fraction of administered dose of a drug that reaches systemic circulation
|
Bioavailability (F)
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When the rate of drug input equals the rate of drug elimination
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Steady State
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This step of metabolism makes a drug more hydrophilic and hence augments elimination
|
Phase I
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Different steps of Phase I
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Oxidation
Reduction Hydrolysis |
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Inducers of Cytochrome P450 (4)
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Barbituates
Phenytoin Carbamazepine Rifampin |
|
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Inhibitors of CYP450 (5)
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Cimetidine
Ketoconazole Erythromycin Isoniazid Grapefruit |
|
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Products of Phase II Conjugation (3)
|
Glucuronate
Acetic Acid Glutathione Sulfate |
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Type of kinetics when a constant PERCENTAGE of substrate is metabolized per unit time
|
First Order Kinetics
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Drug elimination with a constant amount metabolized regardless of drug concentration
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Zero Order Kinetics
|
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Cp x (VD/F)
Target plasma concentration times (Volume Distribution divided by bioavailability) |
Loading Dose
|
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Cp x (CL/F)
Plasma Concentration x (Clearance divided by Bioavailability) |
Maintenance Dose
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Strength of interaction between drug and its receptor
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Affinity
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Selectivity of a drug for its receptor
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Specificity
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Amount of drug necessary to elicit a biologic effect; refers to the drug's strength
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Potency
|
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Maximum response achievable from a drug
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Efficacy
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Ability of a drug to produce 100% of the maximum response regardless of the potency
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Full Agonist
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Ability to produce less than 100% of the response
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Partial Agonist
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Ability to bind reversibly to the same site as the drug and without activating the effector system
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Competitive Antagonist
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Class of drugs with the ability to decrease the maximal response to an agonist
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Noncompetitive Antagonist
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A hormone whose MOA utilizes intracellular receptors
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Thyroid and Steroid Hormones
|
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A hormone whose MOA utilizes transmembrane receptors
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Insulin
|
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Class of drugs whose MOA utilizes ligand gated ion channels
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Benzodiazepines and Calcium Channel Blockers
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Median Effective dose required for an effect in 50% of population
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ED50
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Median toxic dose required for a toxic effect in 50% of population
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TD50
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Dose which is lethal to 50% of the population
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LD50
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Window between therapeutic effect and toxic effect
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Therapeutic Index
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Term for high margin of safety
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High Therapeutic Index
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Term for a narrow margin of safety
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Low Therapeutic Index
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Antidote used for lead poisoning
|
Dimercaprol, EDTA
|
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Antidote used for cyanide poisoning
|
Nitrites
|
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Antidote used for anticholinergic poisoning
|
Physostigmine
|
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Antidote used for organophosphate/anticholinesterase poisoning
|
Atropine
Pralidoxime (2-PAM) ** |
|
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Antidote used for iron salt toxicity
|
Deferoxamine
|
|
|
Antidote used for Acetaminophen (APAP) Toxicity
|
N-acetylcysteine (NAC)
Mucomyst * |
|
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Antidote for arsenic, mercury, lead, and gold poisoning
|
Dimercaprol
|
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Antidote used in poisonings - Cooper (Wilson's), lead, mercury, and arsenic
|
Penicillamine
|
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Antidote used for heparin overdose
|
Protamine
** |
|
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Antidote used for Warfarin toxicity
|
Vit K
Fresh Frozen Plasma (FFP) * |
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Antidote for t-PA, streptokinase
|
Aminocaproic Acid
** |
|
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Antidote used for methanol and ethylene glycol
|
Ethanol or
Fomepizole |
|
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Antidote used for opioid toxicity
|
Naloxone (IV)
Naltrexone (PO) * |
|
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Antidote used for Benzodiazepine Toxicity
|
Flumazenil
* |
|
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Antidote used for Tricyclic Antidepressants (TCA)
|
Sodium Bicarbonate
|
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|
Antidote used for Carbon Monoxide Poisoning
|
100% O2 and hyperbaric O2
|
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Antidote used for Digitalis Toxicity
|
Digibind
also d/c digoxin, normalize K+, lidocaine is arrhythmic |
|
|
Antidote used for B-agonist Toxicity (metaproterenol)
|
Esmolol
|
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Antidote for methotrexate toxicity
|
Leucovorin
|
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Antidote for B-blockers and hypoglycemia
|
Glucagon
|
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Antidote useful for some drug induced Torsade de Pointes
|
Magnesium Sulfate
|
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Antidote for Hyperkalemia
|
Sodium Polystyrene Sulfonate (Kayexalate)
|
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Antidote for salicylate intoxication
|
Alkalinize Urine
Dialysis |
|
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Constant proportion of cell population killed rather than a constant number
|
Log-kill hypothesis
|
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Treatment with cancer chemotherapy at high doses every 3-4 weeks, too toxic to be used continuously
|
Pulse Therapy
|
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Toxic effect of anticancer drug can be lessened by rescue agents
|
Rescue Therapy
|
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Drug used concurrently with toxic anticancer agents to reduce renal precipitation of urates
|
Allopurinol
|
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Pyrimidine analog that causes "Thymine-less Death" given with leucovorin rescue
|
5-fluoracil (5-FU)
|
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Drug used in cancer therapy causes Cushing-like symptoms
|
Prednisone
|
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Side effect of Mitomycin
|
SEVERE myelosuppression
|
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MOA of Cisplatin
|
Alkylating Agent
|
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Common Toxicities of Cisplatin
|
Nephro and ototoxicity
|
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Analog of hypoxanthine, needs HGPRTase for activation
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6-mercaptopurine (6-MP)
|
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Interaction with this drug requires dose reduction of 6-MP
|
Allopurinol
** |
|
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May protect against doxorubicin toxicity by scavenging free radicals
|
Dexrazoxane
* |
|
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Blows DNA (breaks DNA stands), limiting SE is pulmonary fibrosis
|
Bleomycin
* |
|
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Bleomycin+vinblastine+etoposide+cisplatin produce almost a 100% response when all agents are used for this neoplasm
|
Testicular Cancer
|
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|
ABVD regimen used for HD, but appears less likely to cause sterility and secondary malignancies than MOPP
|
Adriamycin (doxorubicin) +
Bleomycin + Vinblastine + Dacarbazine |
|
|
Regimen used for nonHidgkin's Lymphoma
|
CHOP
(Cyclophosphamide Doxorubicin Vincristine Prednisone) +Rituximad |
|
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Regimen used for breast cancer
|
CMF
(Cyclophosphamide Methotrexate Fluorouracil) +Tamoxifen if ER+ |
|
|
Alkylating agent, vesicant that causes tissue damage with extravasation
|
Mechlorethamine
|
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Anticancer drug also used in RA, produces acrolein in urine that leads to hemorrhagic cystitis
|
Cyclophosphamide
|
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Prevention of cyclophosphamide induced Hemorrhagic Cystitis
|
Hydration and Mercaptoethanesulfonate (MENSA)
|
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Microtubule inhibitor that causes peripheral neuropathy, foot drop (ataxia), and pins&needles sensation
|
Vincristine
|
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Interacts with microtubules (but unlike vinca which prevent disassembly of tubules), it stabilizes tubulin and -cells remain frozen in metaphase-
|
Paclitaxel (taxol)
** |
|
|
Toxicities include nephrotoxicity and ototoxicity, leading to a severe interaction with aminoglycosides
|
Cisplatin
|
|
|
Agent similar to cisplatin, less nephrotoxic, but greater myelosuppression
|
Carboplatin
|
|
|
Converts asparagine to aspartate and ammonia, denies cancer cells of essential AA (asparagine)
|
L-asparaginase
|
|
|
Used for HCL (Hairy Cell Leukemia); it stimulates NK cells
|
INF-a
|
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Anti-androgen used for prostate cancer
|
Flutamide (Eulexin)
|
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Anti-estrogen used for ER Breast Cancer
|
Tamoxifen
** |
|
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Aromatase inhibitor used in BC
|
Letrozole
Anastrozole |
|
|
Newer Estrogen Receptor antagonist used in advanced BC
|
Toremifene (Fareston)
|
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Some cell cycle specific anti-cancer drugs (6)
|
Bleomycin
Vinca Alkaloids Antimetabolites (4) - 5-FU, 6-MP, Methotrexate, Etoposide |
|
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Some cell cycle non-specific drugs (6)
|
Alkylating Agents (Mechlorethamine, Cyclophosphamide)
Antibiotics (Doxorubicin, Daunorubicin) Cisplatin Nitrosourea |
|
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Anti-emetics used in association with anti-cancer drugs that are 5-HT3 antagonists (Serotonin Receptor subtype)
|
Odansetron
Granisetron * |
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Nitrosoureas with high lipophilicity, used for -brain tumors-
|
Carmustine (BCNU)
Lomustine (CCNU) |
|
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Produces disulfiram-like reaction with ethanol
|
Procarbazine
|
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Somatostatin (SRIF) analog used for acromegaly, carcinoid, glucagonoma, and other GH producing pituitary tumors
|
Octeotide
|
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Somatotropin (GH) analog used in GH deficiency (dwarfism)
|
Somatrem
|
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GHRH analog used as diagnostic agent
|
Sermorelin
|
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GnRH agonist used for infertility or different types of CA depending on pulsatile or steady usage respectively
|
Ganirelix
|
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Dopamine (DA) agonist (used for Parkinson's), used also for hyperprolactinemia
|
Bromocriptine
* |
|
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Hormone inhibiting prolactin release
|
Dopamine
* |
|
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ACTH analog used for diagnosis of patients with corticosteroid abnormality
|
Cosyntropic
** |
|
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Synthetic analog of ADH hormone used for diabetes insipidus and nocturnal enuresis
|
Desmopressin (DDAVP)
|
|
|
SE of OCs
OCs? |
Increased thromboemoblic events
** |
|
|
Most widely used thyroid drugs such as Synthroid and Levoxyl contain
|
L-thyroxine (T4)
|
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T3 compound less widely used
|
Cytomel
|
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Anti-thyroid drugs (4)
|
Thioamides
Iodides Radioactive Iodine Ipodate |
|
|
Thomaide agents used in hyperthyroidism (2)
|
Methimazole
Propylthiouracil (PTU) |
|
|
Thioamide less likely to cross placenta, inhibits peripheral conversion of T4 to T3 in high doses, and should be used with extreme caution in pregnancy
|
Propylthiouracil (PTU)
* |
|
|
PTU (Propylthiouracil) MOA?
|
Inhibits thyroid hormone synthesis by blocking iodination of the tyrosine residues of thyroglobulin
|
|
|
Can be effective for -short term therapy- of thyroid storm, but after several weeks of therapy causes an exacerbation of hyperthyroidism
|
Iodide Salts
|
|
|
Dose may need to be increased during pregnancy or with OCs due to increased TBG in plasma
|
Thyroxine
** |
|
|
-Permanently cures thyrotoxicosis-, patients will need thyroid replacement therapy thereafter. Contraindicated in pregnancy
|
Radioactive Iodine
|
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-Radio contrast media- that inhibits the conversion of T4 to T3
|
Ipodate
|
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|
Block cardiac adverse effects of thryotoxicosis such as tachycardia, inhibits the conversion of T4 to T3
|
B-blockers (propranolol)
|
|
|
Vitamins containing iron should NOT be taken simultaneously with levothyroxine because
|
Iron deiodinates thyroxine
|
|
|
Thyroxine dose may need to be increased in hypothyroid patient during pregnancy because
|
Estrogens increase maternal TBG (thyroxine binding globulin)
|
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3 zones of adrenal cortex and their products
|
Glomerulosa (Mineralocorticoids)
Fasiculata (Glucocorticoids) Reticularis (Adrenal Androgens) |
|
|
Pneumonic for 3 zones of Adrenal Cortex
|
GFR
salt sugar sex |
|
|
Used for Addison's Diease, Adrenal Hyperplasia (CAH), inflammation, allergies, and asthma (as a local inhalation)
|
Glucocorticoids
|
|
|
Short acting Glucocorticoids (2)
|
Cortisone
Hydrocortisone (equivalent to cortisol) |
|
|
Intermediate acting GCs (4)
|
Prednisone
Methylprednisolone Prednisolone Triamcinolone |
|
|
Long acting GCs (2)
|
Betamethasone
Dexamethasone |
|
|
Mineralocorticoids (2)
|
Fludrocortisone
Deoxycorticosterone |
|
|
Some side effects of Corticosteroids (11 lol)
|
Osteopenia, impaired healing, increased infection risk, increased appetite, HTN, edema, euphoria, psychosis, stria, thinning of skin
|
|
|
Period of time of therapy after which GC therapy will need to be tapered
|
5 to 7 days
|
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|
Used for Cushing's Syndrome (increased corticosteroid)
~diagnosis |
Dexamethasone Suppression Test
|
|
|
Inhibits conversion of cholesterol to Pregnenolone therefore inhibiting corticosteroid synthesis
|
Aminoglutethimide
|
|
|
Antifungal agent used for inhibition of all gonadal and adrenal steroids
|
Ketoconazole
|
|
|
Antiprogestin used as potent antagonist of GC receptor
|
Mifepristone
|
|
|
Diuretic used to antagonize aldosterone receptors
|
Spironolactone
* |
|
|
Common SE of spironolactone
|
Gynecomastia and Hyperkalemia
** |
|
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Slightly increased risk of BC, Endometrial Cancer, Heart Dz, has beneficial effects on bone loss
|
Estrogen
|
|
|
Antiestrogen drugs used for fertility and breast cancer respectfully
|
Clomiphene and Tamoxifen
|
|
|
Common SE of Tamoxifen and Raloxifene
|
Hot Flashes
|
|
|
Selective Estrogen Receptor Modulator (SERM) used for -prevention of osteoporosis- and prophylaxis in women with increased risk factors for breast cancer
|
Raloxifene
** |
|
|
Non-steroidal estrogen agonist causes -Clear Cell Adenocarcinoma of the Vagina- in daughters of women who used it during pregnancy
|
Diethylstibestrol (DES)
|
|
|
Estrogen most commonly used in OCs
|
Ethinyl Estradoil and mestranol
|
|
|
Anti-progresterone used as abortifacient
|
Mifepristone (RU-486)
|
|
|
Constant low dose of estrogen and increasing dose of progestin for 21 days (last 5 dats are sugar pills or iron prep)
|
Combination OCs
|
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Oral Contraceptive available in transdermal patch
|
Ortho-Evra
|
|
|
Converted to DHT (more active form) by 5a-reductase
|
Testosterone
|
|
|
5a-reductase inhibitor used for BPH and male pattern baldness
|
Finasteride (Proscar and Propecia respectively)
|
|
|
Anabolic steroid that has potential for abuse (3)
|
Nandrolone
Oxymetholone Oxandrolone |
|
|
Anti-androgen used for hirsutism in females
|
Cyproterone Acetate
|
|
|
Drug is used with testosterone for male fertility
|
Leuprolide
** |
|
|
What do alpha cells in the pancreas produce?
|
Glucagon
|
|
|
What do beta cells in the pancreas produce?
|
Insulin
|
|
|
Where are beta cells found in the pancreas?
|
Islet of Langerhans
|
|
|
What do delta cells in the pancreas produce?
|
Somatostatin
|
|
|
Product of proinsulin cleavage used to assess insulin abuse
|
C-peptide
|
|
|
Exogenous Insulin contains ____ C-peptide
|
little
* |
|
|
Endogenous Insulin contains ____ C-peptide
|
normal
|
|
|
Very rapidly acting insulin, having fastest onset and shortest DoA
|
Lispro (Humalog)
Aspart Glulisine |
|
|
Rapid acting, crystalline zinc insulin used to reverse acute hyperglycemia
|
Regular (Humulin R)
|
|
|
Long acting insulin
|
Ultralente (Humulin U)
* |
|
|
Ultra long acting insulin, has over a day duration of action
|
Glargine (Lantus)
Detemir |
|
|
Major SE of Insulin
|
Hypoglycemia
|
|
|
Important in synthesis of glucose to glycogen in the liver
|
GLUT2
|
|
|
Important in muscle and adipose tissue for glucose transport across muscles and TG storage by lipoprotein lipase action
|
GLUT4
|
|
|
Examples of a-glucosidase inhibitors (AGI)
|
Acarbose
Miglitol |
|
|
MOA of AGI's
|
Act of intestine, delay digestion and absorption of glucose formed from digestion of starch and disaccharides
|
|
|
SE of AGI's
|
Flatulence (don't use Beano to treat), diarrhea, abdominal cramps
|
|
|
AGI associated with elevation of LFTs
|
Acarbose
|
|
|
Amino Acid derivative, active as an insulin secretagogue
|
Nateglinide
* |
|
|
MOA of Nateglinide
|
Insulin secretagogue, closes ATP-sensitive K+ channel
|
|
|
Biguanide
|
Metformin
|
|
|
Drugs available in combination with Metformin (3)
|
Glyburide
Glipizide Rosiglitazone |
|
|
MOA of Metformin
|
decreases hepatic glucose production and intestinal glucose absorption; increase insulin sensitivity
|
|
|
Vascular effects of Metformin
|
Decreased micro and macro vascular disease
|
|
|
Most important potential SE of Metformin
|
Lactic Acidosis
|
|
|
Incidence of hypoglycemia with metformin
|
none
|
|
|
Meglitinide class of drugs
|
Repaglinide
|
|
|
MOA of Repaglinide
|
Insulin release from pancreas; faster and shorter acting than sulfonylurea
|
|
|
First generation Sulfonylurea (3)
|
Chlopropamide
Tolbutamide Tolazamide etc |
|
|
2nd generation Sulfonylurea (3)
|
Glyburide
Glipizide Glimepiride etc |
|
|
MOA of both generations of Sulfonylureas
|
Insulin release from pancreas by modifying K+ channels
|
|
|
Common SE of sulfonylureas, repaglinide, and nateglinide
|
hypoglycemia
|
|
|
Sulfonylurea NOT recommended for elderly because of very long half life
|
Chlorpropamide
|
|
|
thiazolidinediones (3)
|
Pioglitazone
Rosiglitazone Troglitazone (withdrawn from market) |
|
|
Reason Troglitazone was withdrawn from market
|
Hepatic Toxicity
|
|
|
MOA of thiazolidinediones
|
Stimulate PPAR-gamma receptor to regulate CHO and Lipid Metabolism
|
|
|
SE of thiazolidinediones
|
Edema
Mild Anemia Interaction with CYP450 3A4 metabolized drugs |
|
|
Hyperglycemic agent that increases cAMP and results in glycogenolysis, gluconeogenesis, reverses hypoglycema, also used to reverse severe beta-blocker overdose and smooth muscle relaxation
|
Glucagon
|
|
|
Available bisphosphonates (6) used in bone homeostasis
|
Alendronate
Etidronate Risedronate Pamidronate Tiludronate Zoledronic Acid |
|
|
MOA of Bisphosphonates
|
Inhibits osteoclast bone resorption
|
|
|
Names of 3 Bisphosphonates available IV
|
Pamidronate
Zoledronate Ibandronate |
|
|
Uses of Bisphosphonates (4)
|
Osteoporosis
Paget's Disease Osteolytic Bone Lesions Hypercalcemia from malignancy |
|
|
Major SE of bisphosphonates
|
Chemical esophagitis
|
|
|
Bisphosphonate that -cannot be used on continuous basis- because it caused osteomalacia
|
Etidronate
|
|
|
Used for prevention of postmenopausal osteoporosis in women
|
Estrogen (HRT)
|
|
|
Increase bone density, also being tested for Breast Cancer prophylaxis
|
Raloxifene (SERM)
** |
|
|
Used intranasally and decreases bone resorption
|
Calcitonin (salmon prep)
* |
|
|
Used especially in postmenopausal women, dosage should be 1500mg (1.5g)
|
Calcium
|
|
|
Vitamin given with calcium to ensure proper absorption
|
Vitamin D
|
|
|
Disease caused by excess ergot alkaloids
|
St. Anthony's Fire
|
|
|
Endogenous substances commonly interpreted as histamine, serotonin, prostaglandins, and vasoactive peptides
|
Autocoids
|
|
|
Syndrome of hypersecretion of gastric acid and pepsin usually caused by gastrinoma; it is associated with severe peptic ulceration and diarrhea
|
Zollinger-Ellison Syndrome
|
|
|
Drug that causes contraction of the uterus
|
Oxytocin
* |
|
|
Distribution of histamine receptors (H1, H2, H3)
|
H1 - Smooth muscle
H2 - Stomach, Heart, Mast Cells H3 - Nerve Ending, CNS |
|
|
Prototype antagonist of H1 and H2 receptors (separate answers)
|
H1 - Diphenhydramine
H2 - Cimetidine |
|
|
1st generation anti-histamine that is highly sedating
|
Diphenhydramine
|
|
|
1st generation antihistamine that is least sedating
|
Chlorpheniramine
Cyclizine |
|
|
2nd generation antihistamines (3)
|
Fexofenadine
Loratadine Cetirizine |
|
|
Generation of antihistamine that has most CNS effects
|
First Generation due to being more lipid-soluble
|
|
|
Major indication for H1 receptor antagonist
|
Use in IgE mediated allergic reaction
|
|
|
Antihistamine that can be used for anxiety and insomnia and is not addictive
|
Hydroxyzine (Atarax)
|
|
|
H1 antagonist used in motion sickness (2..)
|
Dimenhydrinate
Meclizine other 1st generations |
|
|
Most common SE of 1st generation antihistamines
|
Sedation
|
|
|
Lethal arrhythmias resulting from concurrent therapy with azole fungals (CYP3A4 metabolized) and these antihistamines which inhibit CYP3A4 (2)
|
Terfenadine
Astemizole both already removed from market |
|
|
H2 blocker that causes the most interference with other drugs
|
Cimetidine
* |
|
|
Clinical use for H2 blockers (3)
|
Acid Reflux
Duodenal Ulcer Peptic Ulcer |
|
|
Receptors for Serotonin (5HT-1) are located (+MoA)
|
Mostly in the brain, and they mediate synaptic inhibition via increased K+ conductance
|
|
|
5HT-1d agonist used for migraine headaches (3)
|
Sumatriptan
Naratriptan Rizatriptan ** |
|
|
Triptan available in parenteral and nasal formulations
|
Sumatriptan
|
|
|
H1 blocker that is also a serotonin antagonist
|
Cyproheptadine
|
|
|
Agents for reduction of postpartum bleeding (3)
|
Oxytocin
Ergonovine Ergotamine ** |
|
|
Agents used in treatment of carcinoid tumor (3)
|
Ketaserin
Cyproheptadine Phenoxybenzamine ** |
|
|
5HT-3 antagonist used in chemotherapeutic induced emesis (4)
|
Ondansetron
Granisetron Dolasetron Alosetron *** |
|
|
5HT-3 antagonist that has been associated with QRS and QTc prolongation and should not be used in patients with heart disease
|
Dolasetron
|
|
|
DOC to treat chemo-induced nausea and vomiting
|
Odansetron
** |
|
|
Drug used in ergot alkaloid overdose, ischemia and gangrene
|
Nitroprusside
|
|
|
Reason ergot alkaloids and contraindicated in pregnancy
|
Uterine Contractions
|
|
|
SE of ergot alkaloids
|
Hallucinations resembling psychosis
|
|
|
Ergot alkaloid used as an illicit drug
|
LSD
|
|
|
Dopamine agonist used in hyperprolactinemia
|
Bromocriptine
* |
|
|
Peptide causing increased capillary permeability and edema
|
Bradykinin and Histamine
|
|
|
Mediator of tissue pain, edema, inactivated by ACE, and may be a contributing factor to the development of angioedema
|
Bradykinin
* |
|
|
Drug causing depletion of Substance P (vasodilator)
|
Capsaicin
* |
|
|
Prostaglandins that cause abortions (3)
|
PGE1
PGE2 PGF2alpha |
|
|
Difference between COX 1 and COX 2
|
COX1 is found throughout the body and COX2 is only found in inflammatory tissue
|
|
|
Drug that selectively inhibits COX2 (2)
|
Celecoxib
Rofecoxib |
|
|
Inhibitor of Lipoxygenase
|
Zileuton
* |
|
|
Major SE of Zileuton
|
Liver Toxicity
|
|
|
Inhibitor of Leukotrienes (LTD4) receptors and used in asthma (2)
|
Zafirlukast
Montelukast |
|
|
Used in pediatrics to maintain patency of Ductus Arteriosis
|
PGE1
|
|
|
Approved for use in severe pulmonary HTN
|
PGI2 (Epoprostenol)
|
|
|
Prostaglandin used in the treatment of impotence
|
Alprostadil
* |
|
|
Irreversible, nonselective COX inhibitor
|
Aspirin
|
|
|
Class of drugs that reversibly inhibit COX
|
NSAIDS
|
|
|
Primary endogenous substrate for Nitric Oxidase Synthase
|
Arginine
|
|
|
MOA and effect of nitric oxide
|
Stimulates cGMP which leads to vascular smooth muscle relaxation
* |
|
|
Long acting Beta-2 agonist used in asthma
|
Salmeterol
|
|
|
Muscarinic antagonist used in asthma
|
Ipratropium
* |
|
|
MOA of Cromolyn
|
Mast Cell stabilizer
* |
|
|
Methylxanthine derivative used as a remedy for intermittent claudication
|
Pentoxifylline
|
|
|
MOA of corticosteroids
|
inhibition of phospholipase A2
|
|
|
SE of long term (>5days) corticosteroid therapy and remedy
|
Adrenal Suppression
Weaning slowly * |
|
|
MOA of Quinolones
|
Inhibit DNA Gyrase
** |
|
|
MOA of penicillin
|
Block cell wall synthesis by inhibiting peptidogylcan cross-linkage
|
|
|
Drug use for MRSA
|
Vancomycin
* |
|
|
Vancomycin MOA
|
Blocks cell wall synthesis by sequestration
|
|
|
Genetic basis of low level resistance found with vancomycin
|
point mutation
|
|
|
Meningitis prophylaxis for persons in contact with patients
|
Ciprofloxacin or Rifampin (for children less than 4 years old)
|
|
|
Technique to treat perianal itchning and drug used to treat it
|
Scotch Tape Technique
Mebendazole |
|
|
Two toxicities of aminoglycosides
|
Nephrotoxicity
Ototoxicity |
|
|
DOC for Legionnaire's Diease
|
Moxifloxacin
|
|
|
MOA Sulfonamides
|
Inhibit dihydropteroate synthase
* |
|
|
Penicillins active against penicillinase secreting bacteria (3)
|
Methicillin
Nafcillin Dicloxacillin |
|
|
Cheap wide spectrum antibiotic, DOC for otitis media
|
Amoxicillin
*** |
|
|
Class of antibiotics that have 10% cross sensitivity with penicillins
|
Cephalosporins
|
|
|
PCN active against pseudomonas (4)
|
Ceftazidime
Imipenem Piperacillin Ticarcillin |
|
|
Antibiotic causing Red-man syndrome, and prevention
|
Vancomycin
infusion at a slow rate and antihistamines |
|
|
Drug causes teeth discoloration
|
Tetracycline
|
|
|
MOA of Tetracycline
|
Decreases protein synthesis by inhibiting 30S ribosome
|
|
|
Drug that causes Grey Baby Syndrome and Aplastic Anemia
|
Choramphenicol
|
|
|
Drug notorious for causing pseudomembranous colitis
|
Clindamycin
|
|
|
DOC for tx of mild Pseudomembranous Colitis
|
Metronidazole
** |
|
|
Treatment of severe/relapsing pseudomembranous colitis
|
ORAL Vancomycin
|
|
|
Anemia caused by trimethoprim
|
Megaloblastic Anemia
* |
|
|
Reason fluoroquinolones are contraindicated in children and pregnancy
|
Cartilage damage
|
|
|
DOC for Giardia
|
Metronidazole
* |
|
|
DOC for Bacterial Vaginosis
|
Metronidazole
* |
|
|
DOC for Trichomonas
|
Metronidazole
* |
|
|
Treatment for TB? (+ how to remember)
|
Rifampin
Isonaizid Pyrazinamide Ethambutol RIPE |
|
|
Metronidazole SE if given with alcohol
|
Disulfram-like reaction
|
|
|
Common SE of Rifampin
|
Red urine discoloration
* |
|
|
MOA of nystatin
|
bind ergosterol in fungal cell membrane
|
|
|
Neurotoxicity with isonaizid (INH) prevented by
|
Administration of Vitamin 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
|
Oseltamivir
* |
|
|
DOC for RSV
|
Ribavirin
|
|
|
DOC for CMV retinitis
|
Ganciclovir
|
|
|
SE for Ganciclovir
|
Neutro/Leuko/Thrombocyto - penia
|
|
|
Anti-viral agents associated with Steven Johnson Syndrome
|
Nevirapine
Amprenavir |
|
|
HIV antivirals class known to have severe drug interactions by causing inhibition of metabolism
|
Protease Inhibitors
* |
|
|
Antivirals that are teratogens (3)
|
Delavirdine
Efavirenz Ribavirin (DERrrrratorgens) |
|
|
Antivirals associated with neutropenia (4)
|
Ganciclovir
Zidovudine Saquinavir Interferon |
|
|
HIV med used to prevent perinatal transmission
|
Nevirapine
|
|
|
Drug used for African Sleeping Sickness
|
Suramin
|
|
|
Drug used in Chagas Disease
|
Nifurtimox
|
|
|
Cephalosporins able to cross BBB (3)
|
Ceftazidime
Ceftriaxone Cefotaxime |
|
|
Oral 3rd generation Cephalosporins NOT able to cross BBB
|
Cefixime
|
|
|
Drug used for N Gonorrhea in females
|
Ceftriaxone
* |
|
|
Cephalosporin causes kernicterus in neonates (2)
|
Ceftriaxone
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
|
|
|
DOC for Leprosy (3)
|
COMBINATION OF:
Dapsone Rifampin Clofazimine |
|
|
DOC for Herpes and its MOA
|
Acyclovir
phosphorylation, incorperation into viral DNA, and chain termination * |
|
|
Anti-bacterials that cause hemolysis in G6PD deficient patients
|
Sulfonamides
* |
|
|
MOA of Erythromycin
|
Inhibition of protein synthesis at the 50S subunit of ribosome
|
|
|
Antibiotic frequently used for Chronic UTI prophylaxis
|
Sulfamethoxazole/Trimethoprim (TMP/SMX)
|
|
|
Lactams that can be used in PCN allergic patients
|
Aztreonam
Carbapenems |
|
|
SE of Imipenem
|
Seizures
|
|
|
Antiviral with a dose limiting toxicity of Pancreatitis
|
Didanosine
|
|
|
Common side effect of hypnotic agents
|
sedation
|
|
|
Occurs when sedative hypnotics are used chronically or at high doses
|
tolerance
|
|
|
The most common type of drug interaction of sedative products with other depressant medications
|
Additive CNS depression
|
|
|
Benzodiazepines used to promote sleep (3)
|
Temazpan
Trizolam Flurazepam |
|
|
Benzodiazepam used for anxiety
|
alprazolam
|
|
|
non-Benzodiazepine used as an anxiolytic
|
Buspirone
|
|
|
Non-Benzodiazepine used for sleep
|
Zolpidem
|
|
|
Major effect of benzodiazepines on sleep at high doses
|
REM is decreased
* |
|
|
Neurologic SE of benzos
|
Anterograde amnesia
|
|
|
Reason benzos are used cautiously in pregnancy
|
Ability to cross placenta
* |
|
|
Main route of metabolism for benzos
|
Hepatic
|
|
|
Benzodiazepines that undergo extrahepatic metabolism (useful in older or hepatically impaired patients) (3)
|
Lorazepam
Oxazepam Temazepam |
|
|
MOA for Benzodiazepines
|
Increase the frequency of GABA mediated chloride channel opening
|
|
|
Antidote to benzodiazepine overdose (antagonist that reverses the CNS effects)
|
Flumazenil
* |
|
|
Benzodiazepine with useful relaxant effects in skeletal muscle spasticity of central origin
|
Diazepam
|
|
|
Benzodiazepine that has efficacy against absence seizures and in anxiety states such as agoraphobia
|
Clonazepam
|
|
|
Benzodiazepines most effect in the treatment of panic disorder (2)
|
Alprazolam
Clonazepam |
|
|
Benzodiazepine that is used for anesthesia
|
Midazolam
|
|
|
DOC for status epilepticus
|
Diazepam
|
|
|
Longer acting benzodiazepine used in the management of withdrawal states of alcohol and other drugs (comb of 2)
|
Chlordiazepoxide
Diazepam |
|
|
Agents having active metabolites, long half lives, and high incidence of adverse effects (4)
|
Diazepam
Flurazepam Chlordiazepoxide Clorazepate |
|
|
Barbituates may precipitate this hematologic condition
|
Acute intermittent porphyria
|
|
|
Barbituates decrease the effectiveness of many other drugs via the pharmacokinetics property
|
Liver enzyme INDUCTION
|
|
|
Barbiturates MOA
|
Increase the DURATION of GABA mediated chloride ion channels
|
|
|
Barbiturate used for the induction of anesthesia
|
Thiopental
|
|
|
Site of action of Zaleplon Zolpidem
|
Benzodiazepine receptopr BZ1 (although do no have a benzodiazepine ring structure)
|
|
|
Good hypnotic activity with less CNS SE than most Benzodiazepines
|
Zolpidem
Zaleplon |
|
|
Agent that is a partial agonist to the 5-HT1a receptor
|
Buspirone
|
|
|
DOC for Generalized Anxiety Disorder, NOT effective in acute anxiety
|
Buspirone
|
|
|
Agent that is metabolized to acetaldehyde by alcohol dehydrogenase and microsomal ethanol-oxidizing system (MEOS)
|
Ethanol
* |
|
|
Agent with zero-order kinetics
|
Ethanol
|
|
|
Rate limiting step of alcohol metabolism
|
Aldehyde dehydrogenase
|
|
|
System that increased in activity with chronic ethanol exposure and may contribute to tolerance
|
MEOS
* |
|
|
Enzyme that metabolizes acetaldehyde to acetate
|
Aldehyde Dehydrogenase
|
|
|
Agents that inhibit acetaldehyde dehydrogenase (~4)
|
Disulfram
Metronidazole Certain Sulfonylureas Certain Cephalosporins |
|
|
Agent that inhibits alcohol dehydrogenase and its clinical use
|
Fomepizole
used to prevent formation of toxic metabolites from methanol and ethylene glycol ingestion |
|
|
Agent used in the treatment of alcoholism, if alcohol is consumed concurrently, acetaldehyde builds up and results in nausea, headache, flushing, and hypotension
|
Disulfram
|
|
|
The most common neurologic abnormality in chronic alcoholics
|
Peripheral Neuropathy (also htn, anemia, mi)
* |
|
|
Agent that is teratogen and causes a fetal syndrome
|
Ethanol
|
|
|
Agent that is the antidote for methanol overdose
|
Ethanol and Fomepizole
|
|
|
Drug that inhibits alcohol dehydrogenase and is used in ethylene glycol exposure
|
Fomepizole
|
|
|
Most frequent route of metabolism for anti-seizure drugs
|
Hepatic enzymes
|
|
|
MOA for Phenytoin, Carbamazepine, Lamotrigine
|
Sodium Channel blockade
|
|
|
MOA for benzodiazepines and barbituates
|
GABA-related targets
|
|
|
MOA for Ethosuximide
|
Calcium Channels
|
|
|
MOA for Valproic Acid @ high doses
|
Affect Ca/K/Na Channels
|
|
|
DOC(2) for generalized tonic-clonic and partial seizures
|
Valproic Acid
Phenytoin * |
|
|
DOC for Febrile Seizures
|
Phenobarbital
|
|
|
DOC (2) for absence seizures
|
Ethosuximide
Valproic Acid * |
|
|
DOC for myoclonic seizures
|
Valproic Acid
* |
|
|
DOC for status epilepticus
|
IV Diazepam (acute)
Phenytoin prolonged |
|
|
Drugs that can be used for infantile spasms
|
Corticosteroids
|
|
|
Anti-seizure drugs used also for bipolar affective disorder (BAD) (4)
|
Valproic Acid
Carbamazepine Phenytoin and Gabapentin |
|
|
Anti-seizure drugs also used in Trigeminal Neuralgia
|
Carbamazepine
|
|
|
Anti-seizure drugs used also for pain of neuropathic origin
|
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 Ataxia * |
|
|
Anti-seizure agent that induces formation of liver drug-metabolism enzymes, is teratogenic, and can cause craniofacial anomalies and spina bifida
|
Carbamazepine
|
|
|
Agent that inhibits hepatic metabolism, is hepatotoxic and teratogen that can cause neural tube defecs and GI distress
|
Valproic Acid
|
|
|
Laboratory value required to be monitored for patients on valproic acid
|
Serum Ammonia and LFTs
|
|
|
SE for Lamotrigine
|
SJS
|
|
|
SE for Felbamate
|
Aplastic Anemia and Acute Hepatic Failure
|
|
|
Anti-seizures medication also used in the prevention of migraines
|
Valproic Acid
|
|
|
Carbamazepine may cause
|
Agranulocytosis
|
|
|
Anti-seizure drugs used as -alternative drugs- for mood stabilization (4)
|
Carbamazepine
Gabapentin Lamotrigine Valproic Acid |
|
|
MOA of general anesthetics
|
Most are thought to act at GABA-A receptor Chloride Channel
|
|
|
Inhaled anesthetic with a low blood/gas partition coefficient
|
Nitrous Oxide
|
|
|
Inversely related to potency of anesthetics
|
Minimum Alveolar Anesthetic Concentration (MAC)
|
|
|
Inhaled anesthetics metabolized by liver enzymes which has a major role in the toxicity of these agents (2)
|
Halothane
Methoxyflurane |
|
|
Most inhaled anesthetics SE
|
Decreased arterial blood pressure
|
|
|
Inhaled anesthetics which are myocardial depressants (2)
|
Enflurane
Halothane |
|
|
Inhaled Anesthetic which causes peripheral vasodilation
|
Isoflurane
|
|
|
Inhaled anesthetic that may sensitize the myocardium to arrhythmogenic effects of catecholamines and has produced hepatitis
|
Halothane
|
|
|
Inhaled anesthetic, less likely to lower blood pressure than other agents, and has the smallest effect of respiration
|
Nitrous Oxide
|
|
|
Fluoride released by metabolism of this inhaled anesthetic may cause renal insufficiency
|
Methoxyflurane
|
|
|
Prolonged exposure to this inhaled anesthetic may lead to megaloblastic anemia
|
Nitrous Oxide
|
|
|
Pungent inhaled anesthetic which leads to high incidence of coughing and vasospasm
|
Desflurane
|
|
|
DOC for malignant hyperthermia that may be caused by use of halogenated anesthetics
|
Dantrolene
* |
|
|
IV barbiturate used as a pre-op anesthetic
|
Thiopental
|
|
|
Barbiturate used adjunctively in anesthesia
|
Midazolam
|
|
|
Benzodiazepine receptor antagonist, accelerates recovery from benzodiazepine overdose
|
Flumazenil
* |
|
|
This produces a "dissociative anesthesia", is a cardiovascular stimulant which may increase intracranial pressure, and hallucinations occur during recovery
|
Ketamine
|
|
|
Opioid associated with respiratory depression, but is used in high risk patients who may not survive full general anesthesia
|
Fentanyl
* |
|
|
State of analgesia and amnesia produced when Fentanyl is used with Droperidol and Nitrous Oxide
|
Neuroleptanesthia
|
|
|
Produces both rapid anesthesia and recovery, has antiemetic activity and commonly used for outpatient surgery, may cause marked hypotension
|
Propofol
|
|
|
MOA of LA (Local Anesthetics)
|
Block voltage-dependent sodium channels
|
|
|
This may enhance activity of local anesthetics
|
Hyperkalemia
|
|
|
This may antagonize activity of LAs
|
Hypercalcemia
|
|
|
Almost all local anesthetics have this property and sometimes require the administration of vasoconstrictors (ex - epinephrine) to prolong activity
|
Vasodilation
|
|
|
LA with vasoconstrictive properties favored for head, neck, and pharyngeal surgery
|
Cocaine
|
|
|
Longer acting LAs which are less dependent on vasoconstrictors (2)
|
Tetracaine
Bupivacaine |
|
|
These LAs have surface activity (2)
|
Cocaine
Benzocaine |
|
|
Most important toxic effects of most local anesthetics
|
CNS toxicity
|
|
|
Commonly abused LA which has cardiovascular toxicity including severe HTN with cerebral hemorrhage, cardiac arrhythmias, and MI
|
Cocaine
|
|
|
LA causing methemoglobinemia
|
Prilocaine
|
|
|
Structurally related to Acetylcholine, used to produce muscle paralysis in order to facilitate surgery of artificial ventilation. Full doses lead to respiratory paralysis and require ventilation
|
Neuromuscular blocking drugs
|
|
|
These drugs strongly potentiate and prolong effect of NMB (Neuromussular blockade)
|
Inhaled anesthetics, especially isoflurane, aminoglycosides, and antiarrhythmics
|
|
|
These prevent the action of Ach at the skeletal muscle endplate to produce a "surmountable blockade", effect is reversed by cholinesterase inhibitors (ex. neostigmine or pyridostigmine)
|
Nondepolarizing type antagonists
|
|
|
Agent with long duration of action and is most likely to cause histamine release
|
Tubocurarine
|
|
|
Non-depolarizing skeletal muscle antagonist that has short duration
|
Mivacurium
|
|
|
Skeletal muscle agent that can block muscarinic receptors
|
Pancuronium
|
|
|
Skeletal muscle agent that undergoes Hofmann elimination (breaks down spontaneously)
|
Atracurium
|
|
|
One depolarizing blocker that causes continuous depolarization and results in muscle relaxation and paralysis, causes muscle pain postoperatively and myoglobinuria may occur
|
Succinylcholine
|
|
|
During Phase I these agents worsen muscle paralysis by succinylcholine, but during Phase II they reverse the blockade produced by succinylcholine
|
Cholinesterase Inhibitors
|
|
|
Agents acting in the CNS or in the skeletal muscle, used to reduce abnormally elevated tone caused by neurologic or muscle end plate disease
|
Spasmolytic Drugs
|
|
|
Facilitates GABA presynaptic inhibition
|
Diazepam
|
|
|
GABA agonist in the spinal cord
|
Baclofen
|
|
|
Similar to Clonidine and may cause hypotension
|
Tizanidine
|
|
|
DOC for malignant hyperthermia by acting on the sacroplasmic reticulum of skeletal muscle
|
Dantrolene
* |
|
|
Agent used for acute muscle spasm
|
Cyclobenzaprine
|
|
|
Irreversible condition resulting from the use of antipsychotics, reserpine at high doses, and MPTP (by-product of illicit meperidine analog)
|
Drug induced Parkinsonism
* |
|
|
Agent used in drug therapy of Parkinson's instead of Dopamine which has low bioavailability and does not cross the BBB
|
L-dopa
|
|
|
This is combined with L-dopa, inhibits DOPA decarboxylase (active only peripherally) which allows lower effective doses of L-dopa and allows for fewer SE's (GI distress, postural hypotension, and dyskinesias)
|
Carbidopa
|
|
|
Clinical response that may fluctuate in treatment of Parkinson's Disease
|
On-Off Phenomenon
|
|
|
Anti-Parkinson's drug which increases intraocular pressure and is contraindicated in closed angle glaucoma
|
Levodopa
|
|
|
Ergot Alkaloid that is a partial agonist at D2 receptors in the brain, used for patients who are refractory or cannot tolerate Levodopa, causes erythromelaglia
|
Bromocriptine
|
|
|
Non ergot agents used as first-line therapy in the initial management of Parkinson's (2)
|
Pramipexole
Ropinirole |
|
|
Enhances dopaminergic neurotransmission SE's include CNS excitation, acute toxic psychosis, and livedo reticularis
|
Amantadine
|
|
|
Inhibitor of MAO type B which slows down metabolism of Dopamine, used adjunct to levodopa or as sole agent in newly diagnosed patients
|
Selegiline
|
|
|
Inhibitors of Catechol-O-Methyltransferase (COMT), used as adjuncts in Parkinson's Disease and cause acute hepatic failure (monitor LFTs)
|
Tolcapone
|
|
|
Agent decreases the excitatory actions of cholinergic neurons. May improve tremor and rigidity but have LITTLE effect on bradykinesia. Atropine-like SEs
|
Benztropine
|
|
|
Agent effective in physiologic and essential tremor
|
Propranolol
|
|
|
Agents used in Huntington's Disease (2)
|
Tetrabenazine (amine depleting drug)
Reserpine |
|
|
Agents used in Tourette's Dz (3)
|
Haloperidol
Pimozide Clonidine |
|
|
Chelating agent used in Wilson's Disease
|
Penicillamine
|
|
|
ANTIPSYCHOTICS
Extrapyramidal dysfunction is more common with these agents, which block this subtype of dopamine receptor |
Older Antipsychotic agents, D2 receptors
|
|
|
ANTIPSYCHOTICS
MOA of Neuroleptics |
Dopamine blockade
|
|
|
ANTIPSYCHOTICS
SEs occuring in antipsychotics that block dopamine (7) |
Hyperprolactinemia
Menorrhea Galactorrhea Confusion Mood Changes Decreased Sexual Interest Weight Gain * |
|
|
ANTIPSYCHOTICS
Antipsychotics that reduce positive symptoms only |
Older Antipsychotics
|
|
|
ANTIPSYCHOTICS
Newer atypical antipsychotics that also improve some of the negative symptoms and help acute agitation (3) |
Olanzapine
Aripiprazle Sertindole |
|
|
ANTIPSYCHOTICS
Antipsychotic used in treatment of psychiatric symptoms in patients with dementia |
Risperidone
* |
|
|
ANTIPSYCHOTICS
Atypical antipsychotic causing high prolactin levels |
Risperidone
* |
|
|
ANTIPSYCHOTICS
Newer Atypical antipsychotic used for bipolar disorder, known to cause weight gain, and adversely affect diabetes |
Olanzapine
|
|
|
ANTIPSYCHOTICS
Agent more frequently associated with extrapyramidal side effects that can be treated with benzodiazepine, diphenhydramine, or muscarinic blocker |
Haloperidol
|
|
|
ANTIPSYCHOTICS
Drug used in neuroleptic malignant syndrome |
Dantrolene
* |
|
|
ANTIPSYCHOTICS
Agents may exacerbate tardive dyskinesias (may be irreversible and there is no treatment) |
Muscarinic Blockers
|
|
|
ANTIPSYCHOTICS
Antipsychotic having the strongest autonomic effects |
Thioridazine
* |
|
|
ANTIPSYCHOTICS
Antipsychotic having the weakest autonomic effects |
Haloperidol
|
|
|
ANTIPSYCHOTICS
Only phenothiazine not exerting antiemetic effects, can cause visual impairment due to retinal deposits, and high doses have been associated with ventricular arrhythmias |
Thioridazine
|
|
|
ANTIPSYCHOTICS
Agent having no effect on D2 receptors, blocks D4, reserved for resistant schiophrenia, and can cause fatal agranulocytosis |
Clozapine
** |
|
|
ANTIPSYCHOTICS
Antipsychotic not shown to cause Tardive Dyskinesia |
Clozapine
* |
|
|
ANTIPSYCHOTICS
antipsychotic available in a depot preparation (2) |
Fluphenazine
Haloperidol |
|
|
ANTIPSYCHOTICS
Reduced seizure threshold |
Low-potency typical antipsychotics and clozapine
|
|
|
ANTIPSYCHOTICS
Orthostatic HTN and QT prolongation |
Low potency phenothiazines and ziprasidone
|
|
|
ANTIPSYCHOTICS
Increased risk of developing cataracts |
Quetiapine
|
|
|
LITHIUM
Major route of elimination |
Kidneys
* |
|
|
LITHIUM
Patients being treated with lithium, who are dehydrated or taking diuretics concurrently, could develop |
Lithium toxicity
* |
|
|
LITHIUM
Drug increases the renal clearance hence decreases levels of lithium |
Theophylline
|
|
|
LITHIUM
Associated with this congenital defect |
cardiac anomalies and is contraindicated in pregnancy and lactation
|
|
|
DOC for bipolar affective disorder
|
Lithium
* |
|
|
LITHIUM
Concern using lithium |
Low therapeutic index
|
|
|
LITHIUM
SEs (6) |
Tremor
Sedation Ataxia Aphasia Thyroid Enlargement Reversible Diabetes Insipidus |
|
|
ANTIDEPRESSANTS
Example of 3 indicated for OCD |
Clomipramine
Fluoxetine Fluvoxamine |
|
|
ANTIDEPRESSANTS
Neurotransmitters affected by the action of antidepressants |
Norepinephrine and Serotonin
|
|
|
ANTIDEPRESSANTS
Usual time needed for full effect |
2 to 3 weeks
|
|
|
ANTIDEPRESSANTS
Population group especially sensitive to SEs |
Elderly
|
|
|
ANTIDEPRESSANTS
All have roughly the same efficacy in treating depression, agents chosen based on these criterion (2) |
SE profile
Prior pt response |
|
|
ANTIDEPRESSANTS
Well-tolerated and are first-like antidepressants |
SSRIs
Bupropion Venlafaxine |
|
|
ANTIDEPRESSANTS
Most useful in patients with significant anxiety, phobic features, hypochondriasis, and resistant antidepression |
MOAIs
|
|
|
ANTIDEPRESSANTS
Condition will result from in combination of MAOI with Tyramine containing foods (wine, cheese, pickled meats) |
Hypertensive Crisis
|
|
|
ANTIDEPRESSANTS
MAOI should not be administered with SSRIs or potent TCAs due to the development of |
Serotonin Syndrome
|
|
|
ANTIDEPRESSANTS
Sedation is a common SE of these drugs, they lower seizure threshold, uses include BAD, acute panic attacks, phobias, enuresis, and chronic pain and their overdose can be deadly |
TCAs
|
|
|
ANTIDEPRESSANTS
Three C's associated with TCA toxicity |
Come
Convulsions Cardiac (arrhythmias and wide QRS) |
|
|
ANTIDEPRESSANTS
Agents having higher sedation and antimuscarinic effects than other TCAs |
Tertiary amines
|
|
|
ANTIDEPRESSANTS
TCA used in chronic pain, a hypontic, and has marked antimuscarinic effects |
Amitriptyline
|
|
|
ANTIDEPRESSANTS
TCA used in chronic pain, enuresis, and ADD |
Imipramine
* |
|
|
ANTIDEPRESSANTS
TCA with greatest sedation of this group, and marked antimuscarinic effects, used for sleep |
Doxepin
|
|
|
ANTIDEPRESSANTS
TCA used in OCD, most signification of TCAs for risk of seizures, weight gain, and neuropsychiatric sign and symptoms |
Clomipramine
|
|
|
ANTIDEPRESSANTS
Secondary Amines that have less sedation and more excitation effect (2) |
Nortiptyline
Desipramine |
|
|
ANTIDEPRESSANTS
SEs seen with TCAs |
Muscarinic Blockade causes constipation and dry mouth
Weak a1 block causes orthostatic hypotension Weak Histamine block causes sedation |
|
|
ANTIDEPRESSANTS
Antidepressant associated with neuroleptic malignant syndrome |
Amoxapine (Heterocyclic)
|
|
|
ANTIDEPRESSANTS(Heterocyclics)
Antidepressant associated with seizures and cardiotoxicity |
Maprotiline
|
|
|
ANTIDEPRESSANTS(Heterocyclics)
Antidepr. having stimulant effects similar to SSRIs and can increase blood pressure |
Venlafaxine
|
|
|
ANTIDEPRESSANTS(Heterocyclics)
Antidepressant inhibiting NE, Serotonin, and Dopamine reuptake |
Venlafaxine
|
|
|
ANTIDEPRESSANTS
Antidepr. also used for sleep that causes priapism |
Trazodone (heterocyclic)
|
|
|
ANTIDEPRESSANTS
inhibitor of CYP450 enzymes and may be associated with hepatic failure |
Nefazodone (hetercyclic)
|
|
|
ANTIDEPRESSANTS
Heterocyclic antidepr. least likely to affect sexual performance, used for management of nicotine withdrawal, SE's include dizziness, dry mouth, aggravation of psychosis, and seizures |
Bupropion
* |
|
|
ANTIDEPRESSANTS
antidepr with MOA as alpha2 antagonist, has effects on both 5-HT and NE, blocks histamine receptors, and is sedating |
Mirtazapine
|
|
|
ANTIDEPRESSANTS
SE of Mirtazapine |
Liver Toxicity, increased serum cholesterol
|
|
|
ANTIDEPRESSANTS
Except for these agents all SRRI have significant inhibition of CYP450s |
Citalopram and its metabolite escitalopram
|
|
|
ANTIDEPRESSANTS
SEs frequently seen with SSRIs (2) |
CNS Stimulation
GI Upset |
|
|
ANTIDEPRESSANTS
Antidepr with no effect on BP, no sedation |
SSRIs
|
|
|
ANTIDEPRESSANTS
SSRI with long t1/2 and can be administered once weekly for maintenance, no acute treatment |
Fluoxetine
|
|
|
ANTIDEPRESSANTS
SSRI indicated for premenstrual dysphoric disorder |
Fluoxetine (Sarafem)
|
|
|
ANTIDEPRESSANTS
Some of SSRI's therapeutic effects besides depression (5) |
Panic Attacks
Social Phobias Bulimia Nervosa PMDD OCD |
|
|
ANTIDEPRESSANTS
SSRI 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
|
|
|
OPIOID ANALGESICS/ANTAGONISTS
Activation of these receptors close Calcium Ion Channels to inhibit neurotransmitter release |
Presynaptic Mu/delta/kappa receptors
* |
|
|
OPIOID ANALGESICS/ANTAGONISTS
Activation of these receptors open K+ ion channels to cause membrane hyperpolarization |
Postsynaptic Mu receptors
|
|
|
OPIOID ANALGESICS/ANTAGONISTS
Tolerance to all effects of opioid agonists can develop except |
miosis
constipation * |
|
|
OPIOID ANALGESICS/ANTAGONISTS
All opioids except this agent (which has a muscarinic blocking action) cause pupillary constriction |
Meperidine
|
|
|
OPIOID ANALGESICS/ANTAGONISTS
SE of these drugs include dependence, withdrawal syndrome, sedation, euphoria, respiratory depression, N/V/Constipation, biliary spasm, increased ureteral and bladder tone, and reduction in uterine tone |
Opioid Analgesics
|
|
|
OPIOID ANALGESICS/ANTAGONISTS
Strong opioid agonists (4) |
Morphine
Methadone Meperidine Fentanyl |
|
|
OPIOID ANALGESICS/ANTAGONISTS
Opioids used in anesthesia (2) |
Morphine
Fentanyl |
|
|
OPIOID ANALGESICS/ANTAGONISTS
Opioid used in the management of withdrawal states |
Methadone
* |
|
|
OPIOID ANALGESICS/ANTAGONISTS
Opioid available trans-dermally |
Fentanyl
* |
|
|
OPIOID ANALGESICS/ANTAGONISTS
Opioid that can be given PO, epidural, and IV which helps to relieve the dyspnea of Pulmonary Edema |
Morphine
* |
|
|
OPIOID ANALGESICS/ANTAGONISTS
Use of this opioid with MAOI can lead to hyperpyrexic coma, and with SSRIs can lead to serotonin syndrome |
Meperidine
|
|
|
OPIOID ANALGESICS/ANTAGONISTS
Moderate Opioid Agonists (3) |
Codeine
Hydrocodone Oxycodone * |
|
|
OPIOID ANALGESICS/ANTAGONISTS
Weak opioid agonist, poor analgesic, its overdose can cause severe toxicity including respiratory depression, circulatory collapse, pulmonary edema and seizures |
Propoxyphene
|
|
|
OPIOID ANALGESICS/ANTAGONISTS
Partial agonist, considered analgesic, has a long duration of action and is resistant to Naloxone reversal |
Buprenophrine
|
|
|
OPIOID ANALGESICS/ANTAGONISTS
Opioid antagonist that is given IV and has short DOA |
Naloxone
|
|
|
OPIOID ANALGESICS/ANTAGONISTS
Opioid antagonist that is given orally in alcohol dependency programs |
Naltrexone
* |
|
|
OPIOID ANALGESICS/ANTAGONISTS
These agents are used as antitussive (2) |
Dextromethorphan
Codeine |
|
|
OPIOID ANALGESICS/ANTAGONISTS
These agents are used as antidiarrheals (2) |
Diphenoxylate
Loperamide |
|
|
DRUGS OF ABUSE
Inhalant Anesthetics |
NO
Chloroform Diethyl Ether |
|
|
DRUGS OF ABUSE
Toxic to liver, kidney, lungs, bone marrow, peripheral nerves, and cause brain damage in animals, sudden death has occurred following inhalation |
Fluorocarbons
Industrial Solvents |
|
|
DRUGS OF ABUSE
Cause dizziness, tachycardia, hypotension, and flushing |
Organic Nitrites
|
|
|
DRUGS OF ABUSE
Causes acne, premature closure of epiphyses, masculinization in females, hepatic dysfunction, MI, and increases in libido and aggression |
Steroids
|
|
|
DRUGS OF ABUSE
Readily detected markers that may assist in diagnosis of the cause of a drug overdose include: |
Changes in heart rate, blood pressure, respiration, temperature, sweating, bowel signs, pupillary responses
* |
|
|
OPIOID ANALGESICS
Most commonly abused in heatlh care professionals? (5) |
Heroin
Morphine Oxycodone Meperidine Fentanyl |
|
|
OPIOID ANALGESICS
This route is associated with rapid tolerance and psychologic dependence |
IV administration
|
|
|
OPIOID ANALGESICS
Leads to respiratory depression progressing to coma and death |
Overdose of Opioids
|
|
|
OPIOID ANALGESICS
Lacrimation, rhinorrhea, yawning, sweating, weakness, gooseflesh, nausea and vomiting, tremor, muscle jerks, and hyperpnea are signs of this syndrome |
Abstinence Syndrome
|
|
|
OPIOID ANALGESICS
Treatment of Opioid addiction |
Methadone, followed by slow dose reduction
|
|
|
OPIOID ANALGESICS
This agent many cause more severe, rapid and intense symptoms to a recovering addict |
Naloxone
* |
|
|
Sedative-Hypnotics
Action |
Reduce inhibition, supress anxiety, and produce relaxation
|
|
|
Sedative-Hypnotics
Additive effects when Sedative-Hypnotics used in combination with these agents |
CNS depressants
|
|
|
Sedative-Hypnotics
Common mechanism by which overdose results in death |
depression of medullary and cardiovascular centers
|
|
|
"Date Rape drug"
|
Flunitrazepam (Rohypnol)
* |
|
|
Sedative-Hypnotics
most important sign of withdrawal syndrome |
Excessive CNS stimulation (seizures)
|
|
|
Sedative-Hypnotics
treatment of withdrawal syndrome involves |
Long-acting Sedative-Hypnotic or a gradual reduction of dose, clonidine or propranolol
|
|
|
Sedative-Hypnotics
These agents are CNS depressants |
Ethanol, barbituates, and benzodiazepines
* |
|
|
Stimulants
Withdrawal from this drug causes lethargy, irritability, and headache |
Caffeine
|
|
|
Stimulants
W/D from this drug causes anxiety and mental discomfort |
Nicotine
|
|
|
Stimulants
Treatments available for nicotine addiction |
Patches
Gum Nasal Spray Psychotherapy Bupropion * |
|
|
Stimulants
Chronic high dose abuse of nicotine leads to |
Psychotic state, overdose causes agitation, restlessness, tachycardia, hyperthermia, hyperreflexia, and seizures
|
|
|
Stimulants
Tolerance is marked and abstinence syndrome occurs |
Amphetamines
|
|
|
Stimulants
Amphetamine agents |
Dextroamphetamines
Methamphetamine |
|
|
Stimulants
These agents are congeners of Amphetamine |
DOM
STP MDA MDMA "Ecstacy" |
|
|
Stimulants
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"
|
|
|
Most dangerous of the currently popular hallucinogenic drugs, OD leads to nystagmus, marked HTN, and seizures. Presence of both horizontal and vertical 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 judgement and reflexes, decreases in blood pressure, and psychomotor performance occur
|
Marijuana
* |
|
|
Direct-acting Cholinomimetic Agonists
This agent has greater affinity for muscarinic receptors and used for postoperative and neurogenic ileus and urinary retention |
Bethanechol
* |
|
|
Direct-acting Cholinomimetic Agonists
Only direct acting agent that is very lipid soluble and used in glaucoma |
Pilocarpine
|
|
|
This agent used to treat dry mouth in Sjogren's Syndrome
|
Cevimeline
|
|
|
Indirect-acting Ach agonist, alcohol, short DOA and used in diagnosis of myasthenia gravis
|
Edrophonium
|
|
|
Carbamate with intermediate action, used for +A1170 postoperative and neurogenic ileus and urinary retention
|
Neostigmine
|
|
|
Treatment of atropine overdose and glaucoma (because lipid soluble). Enters the CNS rapidly and has a stimulant effect, which may lead to convulsions
|
Physostigmine
|
|
|
Treatment of Myasthenia Gravis
|
Pyridostigmine
|
|
|
Antiglaucoma organophosphate
|
Echothiophate
|
|
|
Associated with an increased incidence of cataracts in patients treated for glaucoma
|
LA Cholinesterase inhibitors
|
|
|
Scabicide Organophosphate
|
Malathion
|
|
|
Organophosphate anthelmintic agent with long DOA
|
Metrifonate
|
|
|
Toxicity of Organophosphate
|
DUMBELSS
Diarrhea, urination, miosis, bronchoconstriction, excitation of SkM/CNS, Lacrimation, Salivation, and Sweating * |
|
|
The most frequent cause of acute deaths in cholinesterase inhibitor toxicity
|
Respiratory failure
|
|
|
The most toxic organophosphate
|
Parathion
|
|
|
Treatment of choice for organophosphate overdose
|
Atropine
|
|
|
This agent regenerates active cholinesterase and is a chemical antagonist used to treat organophosphate exposure
|
Pralidoxime
|
|
|
Prototypical drug is atropine
|
Nonselective muscarinic antagonists
|
|
|
Treatment manifestations of Parkinson's Disease and EPS
|
Benztropine
Trihexyphenidyl * |
|
|
Treatment of Motion Sickness
|
Scopolamine
Meclizine * |
|
|
Cholinoreceptor blockers & Cholinesterase Regenerators
Produce mydriasis and cycloplegia (3) |
Atropine
Homatropine C1208 Tropicamide * |
|
|
Cholinoreceptor blockers & Cholinesterase Regenerators
Bronchodilation in asthma and COPD |
Ipratropium
* |
|
|
Cholinoreceptor blockers & Cholinesterase Regenerators
Reduce transient hyper GI motility |
Dicyclomine
Methscopolamine |
|
|
Cholinoreceptor blockers & Cholinesterase Regenerators
Cystitis, postoperative bladder spasms, or incontinence (2) |
Oxybutynin
Dicyclomine |
|
|
Toxicity of anticholinergics
|
Block SLUD (salivation, lacrimation, urination, defecation)
|
|
|
Antother pneumonic for anticholinergic toxicity
|
Dry as a bone
Red as a beet Mad as a hatter Hot as a hate Blind as a bat |
|
|
Atropine fever is the most dangerous effect and can be lethal in this population group
|
Infants
|
|
|
Contraindications to the use of atropine (3)
|
Infants
Closed angle glaucoma Prostatic hypertrophy |
|
|
Nicotinic Antagonists
Limiting adverse effect of ganglion blockade that patients usually are unable to tolerate |
Severe HTN
|
|
|
Nicotinic Antagonists
Reversal of blockade by neuromuscular blockers |
Cholinesterase inhibitors
|
|
|
Tubocurarine is the prototype, pancuronium, atracurium, vecuronium are newer short acting agents, produce competitive block at end plate nicotinic receptor, causing flaccid paralysis
|
Nondepolarizing neuromuscular blockers
|
|
|
Only member of depolarizing neuromuscular blocker, causes fasciculation during induction and muscle pain after use; has short DoA
|
Succinylcholine
|
|
|
Chemical antagonists that bind to the inhibitor of ACh estrace and displace the enzyme (if aging has not occurred)
|
Cholinesterase regenerators, pralidoxime
|
|
|
Used to treat patients exposed to insecticides such as parathion
|
Pralidoxime
Atropine |
|
|
Pneumonic for beta receptors
|
You have 1 Heart (Beta 1) and 2 lungs (Beta 2)
* |
|
|
This is the DOC for anaphylactic shock
|
Epinephrine
* |
|
|
Phenylisopropylamines that are used legitimately and abused for narcolepsy, ADD, 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
|
|
|
Newer alpha 2 agonist (apraclonidine and brimonidine)
|
Reduce aqueous secretion
|
|
|
Short acting Beta2 agonist that is DOC in treatment of acute asthma but not recommended for prophylaxis
|
Albuterol
|
|
|
Longer acting Beta2 agonist is recommended for prophylaxis of asthma
|
Salmeterol
|
|
|
These agents increase cardiac output 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 decongestants, and used in therapy of spinal shock (temporary maintenance of blood pressure which may help maintain perfusion)
|
Alpha1 agonist
* |
|
|
Shock due to septicemia or MI is made worse by
|
Increasing afterload and tissue perfusion declines
|
|
|
Epinephrine is often mixed with a 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
|
|
|
Sympathetic agent which stimulates heart rate and can dilate vessels in skeletal muscle at low doses
|
Epinephrine
|
|
|
Mast cells to reduce release of histamine and inflammatory mediators
|
Epinephrine
|
|
|
Agent used in shock because is dilates coronary arteries and increases renal blood flow
|
Dopamine
|
|
|
Agent which stimulates cardiac contractile force more than rate with little effect on total peripheral resistance
|
Dobutamine
|
|
|
Long acting sympathomimetic, sometimes used to improve urinary continence in children and elderly with enuresis
|
Ephedrine
|
|
|
Alpha 1 agonist toxicity
|
HTN
* |
|
|
Beta 1 agonist toxicity
|
Sinus tachycardia and serious arrhythmias
|
|
|
Beta 2 agonist toxicity
|
Skeletal muscle tremor, tachycardia
|
|
|
The selective agents loose their selectivity at
|
high doses
|
|
|
Nonselective alpha-blocking drug, long acting and irreversible, and used to treat pheochromocytoma. Blocks 5-HT, so occasionally used for carcinoid tumor. Blocks H1 and used in mastocytosis
|
Phentolamine
|
|
|
Selective Alpha 1 blocker used for hypertension, BPH, may cause first dose orthostatic hypotension (3)
|
Prazosin
Terazosin Doxazosin * |
|
|
Selective Alpha 1A blocker used for BPH, but with little effect on HTN
|
Tamsulosin
|
|
|
Selective Alpha 2 blocker used for impotence (controversial effectiveness)
|
Yohimbine
|
|
|
Selective B1 receptor blockers that may be useful in treating patients even though they have asthma (4)
|
Acebutolol
Atenolol Esmolol Metoprolol * |
|
|
Combined alpha and beta blocking agents that may have application in treatment of CHF (2)
|
Labetalol and Carvedilol
|
|
|
Beta blockers partial agonist activity (intrinsic sympathomimetic activity) cause some bronchodilation and may have an advantage in treating patients with asthma (2)
|
Pindolol
Acebutolol |
|
|
This beta blocker lacks local anesthetic activity (a property which decreases protective reflexes and increases the risk of corneal ulceration) and used in treating glaucoma
|
Timolol
* |
|
|
This parenteral beta blocker is short acting
|
Esmolol
|
|
|
This beta blocker is the longest acting
|
Nadolol
|
|
|
These beta blockers are less lipid soluble (2)
|
Acebutolol
Atenolol |
|
|
This beta blocker is highly lipid soluble and may account for SEs such as nightmares
|
Propanolol
|
|
|
Clinical uses of these agents include treatment of HTN, angina, arrhythmias, chronic CHF, and selected post MI patients
|
Beta Blockers
|
|
|
Toxicity of these agents include bradycardia, AV blockage, exacerbation of acute CHF; signs of hypoglycemia may be masked (tachycardia, tremor, and anxiety)
|
Beta Blockers
|
|
|
Cholinomimetics that increase outflow, open trabecular meshwork, and cause ciliar muscle contraction (3)
|
Pilocarpine
Carbachol Physostigmine |
|
|
Nonselective alpha agonist that increases outflow, probably via the uveoscleral veins (2)
|
Epinephrine
Dipivefrin |
|
|
Selective alpha agonists that decrease aqueous secretion (2)
|
Apraclonidine
Brimonidine |
|
|
These beta blockers decrease aqueous secretion (2)
|
Timolol (nonselective)
Betaxolol (Selective) * |
|
|
This diuretic decreases aqueous secretion due to lack of HCO3- ion. Causes drowsiness and paresthesias, alkalinization of the urine may precipitate calcium salts, hypokalemia, acidosis
|
Acetazolamide
|
|
|
This agent causes increased aqueous outflow
|
PGF2a
|
|
|
Inhibit ACE
|
ACE inhibitors
* |
|
|
Captopril and enalapril (-OPRIL ending) are
|
ACE inhibitors
* |
|
|
SE of ACE inhibitors
|
Dry Cough
Hyperkalemia * |
|
|
ACE inhibitors are contraindicated in
|
pregnancy
with K+ * |
|
|
Losartan and Valsartan block
|
Angiotensin receptor
* |
|
|
Angiotensin receptor blockers do NOT cause
|
Dry cough
* |
|
|
Agents that block L-type calcium channel
|
Calcium channel blockers
|
|
|
CCB containdicated in CHF
|
Verapamil
* |
|
|
CCB with predominate effect on arteriole dilation
|
Nifedipine
|
|
|
SE of CCB
|
Constipation
Edema Headache * |
|
|
Agents that reduce heart rate, contractility, and O2 demand
|
Beta Blockers
* |
|
|
Beta Blockers that are more cardioselective
|
Beta 1 selective blockers
|
|
|
Cardioselective B1 blockers (3)
|
Atenolol
Acebutolol Metoprolol * |
|
|
Beta blockers should be used cautiously in
|
Asthma (bronchospastic)
Diabetes (block signs of hypoglycemia) Peripheral Vascular Disease |
|
|
Nonselective beta blocker also used for migraine prophylaxis
|
Propanolol
|
|
|
SE of beta blockers
|
Bradycardia
SEXUAL DYSFUNCTION Decrease in HDL Increase in TGs * |
|
|
Alpha1 selective blockers (3)
|
Prazosin
Terazosin Doxazosin (AZOSIN endings) * |
|
|
Nonselective alpha1 blockers use to treat pheochromocytoma
|
Phenoxybenzamine
|
|
|
For rebound HTN from rapid clonidine withdrawal
|
Phentolamine
|
|
|
A1a selective blocker with no effects on HTN used for BPH
|
Tamsulosin (Flomax)
* |
|
|
SE of alpha blockers
|
Orthostatic hypotension (especially with first dose)
Reflex Tachycardia * |
|
|
Presynaptic alpha2 agonist used in HTN, and acts centrally (2)
|
Clonidine
Methyldopa |
|
|
SE of methyldopa
|
Positive Coomb's test (tests for autoimmune hemolytic anemia)
Depression |
|
|
Methyldopa is contraindicated in
|
Geriatrics due to its CNS depression effects
|
|
|
SE of Clonidine
|
Rebound HTN
Sedation Dry Mouth |
|
|
Direct vasodilator of arteriolar smooth muscle
|
Hydralazine
|
|
|
SE of Hydralazine
|
Lupus-like syndrome
* |
|
|
Arterial vasodilator that works by opening K+ channels
|
Minoxidil
|
|
|
SE of minoxidil
|
Hypertrichosis
|
|
|
IV drug used in hypertensive crisis
|
Nitroprusside
|
|
|
Nitroprusside vasodilates
|
arteries and veins
|
|
|
toxicity caused by nitroprusside and treatment
|
Cyanide toxicity treated with sodium thiosulfate
|
|
|
Carbonic anhydrase inhibitor
|
Acetazolamide
|
|
|
Diuretic used for mountain sickness and glaucoma
|
Acetazolamide
* |
|
|
SE of Acetazolamide
|
Paresthesias
Alkalization of urine (may ppt Ca salts) Hypokalemia Acidosis Encephalopathy in patients with hepatic impairment * |
|
|
MOA of Loop Diuretics
|
Inhibits Na/K/2Cl contransport
|
|
|
Site of action of loop diuretics
|
Thick ascending limb
* |
|
|
SE of loop (furosemide) diuretics
|
Hyperuricemia
Hypokalemia Ototoxicity * |
|
|
Aminogylcosides used with loop diuretics potentiate adverse effect
|
Ototoxicity
|
|
|
Loops lose and thiazide diuretics retain
|
Calcium
* |
|
|
MOA of thiazide diuretics
|
Inhibit Na/Cl cotransport
|
|
|
Site of action of thiazide diuretics
|
early DCT
* |
|
|
Class of drugs that may cause cross-sensitivity with thiazide diuretics
|
Sulfonamides
|
|
|
SE of thiazide (HCTZ) diuretics (3)
|
Hyperuricemia
Hypokalemia Hyperglycemia * |
|
|
Potassium sparing diuretics inhibit
|
Na/K exchange
* |
|
|
Diuretic used to treat primary aldosteronism
|
Spironolactone
* |
|
|
SE of spironolactone (3)
|
Gynecomastia
Hyperkalemia Impotence * |
|
|
Osmotic Diuretic used to treat increased intracranial pressure
|
Mannitol
* |
|
|
ADH agonist used for pituitary diabetes insipidus
|
Desmopressin (DDAVP)
|
|
|
Used for SIADH
|
Demeclocycline
|
|
|
SE of Demeclocycline
|
Bone marrow and teeth discoloration for children under 8 years of age
|
|
|
MOA of class 1a (eg procainamide), class 1b (eg lidocaine), and class 1c (eg Flecainide) antiarrhythmics
|
Sodium Channel Blockers
* is this true? |
|
|
SE of Procainamide
|
Lupus-like syndrome
|
|
|
Limiting SE of Quinidine
|
Prolongs QT interval
* |
|
|
Other SEs of Quinidine
|
Thrombocytopenic Purpura
CINCHONISM |
|
|
Major drug interaction with Quinidine
|
Increases concentration of Digoxin
|
|
|
DOC for management of acute ventricular arrhythmias
|
Amiodarone
* |
|
|
DOC for digoxin induced arrhythmias
|
Phenytoin
|
|
|
SE of Phenytoin
|
Gingival Hyperplasia
|
|
|
Class of anti-arrhythmics that has a pro-arrhythmic effect (CAST trial), therefore are used as -last- line agents
|
Class 1C (Flecainide, propafenone, moricizine)
|
|
|
Class II antiarrhytmics are
|
Beta blockers
|
|
|
Antiarrhythmic that exhibits Class II and Class III properties
|
Sotalol
|
|
|
SE of Sotalol
|
prolongs QT and PR interval
|
|
|
Used IV for acute arrhythmias during surgery
|
Esmolol
|
|
|
Anti-arrhythmics that decrease mortality
|
Beta blockers
|
|
|
MOA of class III antiarrhythmics
|
K+ channel blockers
|
|
|
Class III antiarrhytmic that exhibits properties of all 4 classes
|
Amiodarone
|
