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136 Cards in this Set

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Used for Cushing's syndrome (increased corticosteroid)
Dexamethasone suppression test
Antifungal agent used for inhibition of all gonadal and adrenal steroids
Ketoconazole
Diuretic used to antagonize aldosterone receptors
Spironolactone
Common SE of spironolactone
Gynecomastia and hyperkalemia
Slightly increased risk of breast cancer, endometrial cancer, heart disease (questionable), has beneficial effects on bone loss
Estrogen
Antiestrogen drugs used for fertility and breast cancer respectively
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 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
Diethylstilbestrol (DES)
Estrogen mostly used in oral contraceptives (OC)
Ethinyl estradiol and mestranol
Anti-progesterone used as abortifacient
Mifepristone (RU-486)
Constant low dose of estrogen and increasing dose of progestin for 21 days (last 5 days are sugar pills or iron prep)
Combination oral contraceptives (OC)
Oral contraceptive available in a transdermal patch
Ortho-Evra
Converted to more active form DHT by 5 alpha-reductase
Testosterone
5 alpha-reductase inhibitor used for benign prostatic hyperplasia (BPH) and male pattern baldness
Finasteride (Proscar and Propecia respectively)
Anabolic steroid that has potential for abuse
Nandrolone, oxymetholone, and oxandrolone
Anti-androgen used for hirsutism in females
Cyproterone acetate
Drug is used with testosterone for male fertility
Leuprolide
Constant proportion of cell population killed rather than a constant number
Log-Killed hypothesis
Treatment with cancer chemotherapy at high doses every 3-4 weeks, too toxic to be used continuously
Pulse Therapy
Toxic effect of anticancer drug lessened by rescue agents
Rescue Therapy
Drug used concurrently with toxic anticancer agents to reduce renal precipitations of urates
Allopurinol
Pyrimidine analog that causes Thiamine-less death given with leucovorin rescue
5 FU
Drug used in cancer therapy causes Cushing-like symptoms
Prednisone
Side Effect of Mitomycin
SEVERE Myelosuppression
MOA of cisplatin
DNA alkylating
Common toxicities of cisplatin
Nephro and ototoxicity
Analog of hypoxanthine, needs HGPRTase for activation
6-Mercaptopurine 6-MP
Interaction with this drug requires dose reduction of 6-MP
Allopurinol
May protect against doxorubicin toxicity by scavenging free radicals
Dexrazoxane
Blows DNA breaks DNA strands, limiting SE is pulmonary fibrosis
Bleomycin
Bleomycin+vinblastine+etoposide+cisplatin produce almost a 100% response when all agents are used for this neoplasm
Testicular cancer
MOPP regiment used in Hodgkin's disease
Mechlorethamine+oncovorin(vincristine)+procarbazine, and prednisone
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 non-Hodgkin's lymphoma
COP ( cyclophosphamide, oncovin (vincristine) and predisone
Regimen used for breast cancer
CMF ( cyclophosphamise, methotrexate, and flurouracil and tamoxifen if ER+)
Alkylating agent, vesicant that causes tissue damage with extravasation
Mechlorethamine
Anticancer drug also used in RA, produces acrolein in urine that leads to hemorrhagic cystitis
Cyclophosphamide
Prevention of cyclophosphamide induced hemorrhagic cystitis
Hydration and mercaptoethanesulfonate, MESNA
Microtubule inhibitor that causes peripheral neuropahty foot drop( eg ataxia), and pins and needles sensation
Vincristine
Interact 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 myleosuppression
Carboplatin
Converts asparagine to aspartate and ammonia, denies cancer cells of essential AA ( asparagine)
L-asparagine
Used in hairy cell leukemia; it stimulates NK cells
Interferon alpha
Anti-androgen used for prostate cancer
Flutamide (Eulexin)
Anti-estrogen used for estrogen receptor + breast cancer
Tamoxifen
Newer estrogen receptor antagonist used in advanced breast cancer
Toremifene (Fareston)
Some cell cycle specific anti-cancer drugs
Bleomycin, vinca alkaloids, antimetabolites ( eg 5-FU, 6-MP, methotrexate, etoposide)
Some cell cycle non-specific drugs
Alkylating agents (eg mechlorethamine, cyclophosphamide), antobiotics ( doxorubicin, daunorubicin), cisplatin, nitrosurea
Anti-emetics used in association with anti-cancer drugs that are 5-HT3 ( serotonin receptor subtype) antagonist
Odansetron, granisetron
Nitrosources with high lipophilicity, used in brain tumors
Carmustine (BCNU) and Lomustine (CCNU)
Produces disulfiram-like reaction with ethanol
Procarbazine
Agent with zero order kinetics
Ethanol
Rate limiting step of Alcohol metabolism
Aldehyde Dehydrogenase
Agents that inhibit alcohol dehydrongenase
Disulfiram, metronidazole, certain sulfonylureas and cephalosporins
Agent that is metabolized by alcohol dehydrogenase and MEOS
Ethanol
Agent used in the treatment of alcoholism, if alcohol is consumed concurrently, acetaldehyde builds up and results in nausea, headache, flushing, and hypotension
Disulfiram
System that increases in activity with chronic ethanol exposure and may contribute to tolerance
MEOS
The most common neurologic abnormality in chronic alcoholics
Peripheral neuropathy (also excessive alcohol use is associated with HTN, anemia, and MI)
Agent that is teratogen and causes a fetal syndrome
Ethanol
Agent that is the antidote for methanol overdose
Ethanol, fomepizol
Drug that inhibits alcohol dehydrogenase and is used in ethylene glycol exposure
Fomepizole
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
Halothane and methoxyflurane
Most inhaled anesthetics SE
Decrease arterial blood pressure
Inhaled anesthetics are myocardial depressants
Enflurane and halothane
Inhaled anesthetic 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 on 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
Benzodiazepine used adjunctively in anesthesia
Midazolam
Benzodiazepine receptor antagonist, it accelerates recovery from benzodiazepine overdose
Flumazenil
This produces "dissociative anesthesia", is a cardiovascular stimulant which may increases 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 anesthetia
Fentanyl
State of analgesia and amnesia produced when fentanyl is used with droperidol and nitrous oxide
Neuroleptanesthesia
Produces both rapid anesthesia and recovery, has antiemetic activity and commonly used for outpatient surgery, may cause marked hypotension
Propofol
What are the four stages of anesthesia?
Stage 1: Analgesia
Stage 2: Disinhibition
Stage 3: Surgical anesthesia
Stage 4: Medullary depression
A patient has decreased awareness of pain with/without amnesia. Counsciousness may be impaired but not lost
Stage 1 Analgesia
A patient appears to be delirious and excited. Amensia occurs, reflexes enhanced, respiration it typically irregular.
Stage 2 Disinhibition
A patient is unconscious, has no pain reflexes, respiration is regular, and BP normal
Stage 3 surgical anesthesia
A patient has severe respiratory and CV depression and requires mechanical and pharm support.
Stage 4 Medullary depression
What is the general protocol for anesthesia in major surgery?
IV drugs to induce anesthetic state
Inhaled anesthetics to maintain
Neuromuscular blockade
What is the possible MOA of general anesthetics?
Increase threshold firing of CNS neurons
A drug that has a higher solubility will have what type of blood:gas partition coefficient?
A larger/ wider Blood:Gas partition coefficient
Drugs with a low blood gas:partition coefficient do what?
equilibrate more rapidly and enter the brain
The speed of induction of an anesthetic depends on several factors:
1: solubility
2. Inspired gas partial pressure
3: Ventilation Rate
4: Pulmonary Blood Flow
5: Arteriovenous concentration gradient
How does inspired gas partial pressure effect the speed of conduction of anesthesia?
A high partial pressure in the lungs = a higher level in the blood
How does ventilation rate affect the speed of induction of anesthesia?
The more rapid the vent, the more rapid the rise in alveolar and blood and then eventually brain
How does pulmonary blood flow affect the speed of conduction?
A high pulmonary blood flow slows the partial pressure and thus the speed of onset
How does arteriovenous concentration gradient affect the speed of conduction of anesthesia?
?
Describe the process of termination of anesthesia?
Redistribution of the drug form the brain to the blood and elimination of the drug thru the lungs
The rate of recovery is faster with
Agents of low blood:gas partition
Inhaled anesthetics metabolized by the liver
Halothane and methoxyflurane
What are the MAC values for older people and infants?
Lower
How can inhaled anesthetics lead to an increase in intracranial pressure?
B/c they decrease brain metabolic rate
Reduce vascular resistance and increase cerebral blood flow
This drug may cause spike and wave activity and muscle twitching
Enflurane
This drug has a high MAC value and causes marked analgesia and amnesia
Nitrous Oxide
These inhaled anesthetics cause myocardial depression which decrease cardiac output
Enflurane and Halothane
These inhaled anesthetics cause peripheral vasodilation
Isoflurane
This inhaled anesthetic may sensitize myocardium to arrhythmogenic effects of cathecolamines
Halothane
This drug is less likely to lower blood pressure
Nitrous Oxide
What affect does inhaled anesthetics have on respiratory system?
Increase in rate of respiration
TV and minute ventilation are decreased
LEADS to INCREASE in CO2
Which drug has the least effect on respiration?
Nitrous Oxide
This drug causes postoperative hepatitis during shock or severe stress.
Halothane
Prolonged exposure of this drug decreases methionine synthase activity and causes megaloblastic anemia
Nitrous oxide
This drug may cause renal insufficiency after prolong exposure
Methoxyflurane and Fluoride
Uncontrolled release of calcium by the SR of skeletal muscle leads to muscle spasm, hyperthermia, autonomic liability
Malignant Hyperthermia
Which drugs can cause malignant hyperthermia?
Halogenated anesthetics
Drug used in the treatment of malignant hypertermia
Dantrolene
These agents are used for the induction of anesthetics and short surgical procedures
Barbiturates
Barbiturates are eliminated via
hepatic metabolism
These IV anesthetics can be used due decrease intracranial pressure
Barbiturates
IV BZ drug used for induction that has slower onset and longer duration of action
Midazolam (BZ)
BZ drug that causes severe postoperative respiratory depression
Midazolam
Antagonist used in the tx of severe respiratory depression
Flumazenil
Associated with dissociated disorder
Ketamine
MOA of Ketamine
antagonist of glutamic acid, blocking the NMDA receptor
This IV drug is a cardiovascular stimulant and lead to increase intracranial pressure
ketamine
Emergence reactions, disorientation, excitation, and hallucinations that occur with recovery
Ketamine
Class of drugs used to treat Ketamine post-operative effects
BZ
Class of IV anesthetics that cause chest wall rigidity and impair ventilation
Morphine and fentanyl
Reversal of respiratory depression caused by opioids
Naloxone
Neuroleptanesthesia
Fentanyl+droperidol+Nitrous oxide
a state of quiescence, altered awareness, and analgesia produced by a combination of an opioid analgesic and a neuroleptic.
Opioids used in the induction of anesthesia
Alfentanil and remifentanil
Opioid that has rapid recovery b/c of blood and tissue esterases
Remifentanil
Produces anesthesia similar to barbiturates but rapid recovery
Propofol
Has antiemetic actions and recovery is not delayed after prolonged use
Propofol
This drug is used in outpatient surgery as a balanced anesthetic
Propofol
Can cause marked hypotension thru decreased peripheral resistance
Propofol