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154 Cards in this Set
- Front
- Back
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Cell Wall Biosynthesis Inhibitors
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- Penicillin (beta lactam)
- Cephalosporins (beta lactam) - Vancomycin (glycopeptide) |
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Bactericidal
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Penicillin
Cephalosporins Vancomycin Aminoglycoside (Streptomycin/Gentamycin) Quinolones (Ciprofloxacin) Rifampicin |
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Bacteriostatic
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Tetracyclins
Macolides (Erythromycin) Chloramphenicol Sulfonamides |
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Penicillin/Amoxicillin
-cillin |
Beta-lactam; bactericidal; cell wall inhibitor
Can cause anaphylactic reaction due to allergy or hyperreactivity Effective most against gram + bacteria Inhibits transpeptidase and carboxypeptidase, and crosslinking |
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Cephalosporin
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Beta-lactam; bactericidal; cell wall inhibitor
Effective against gram - bacteria (PEK HEN) 3rd generation can cross BBB and used for meningitis More resistant to beta-lactamases Inhibits transpeptidase and carboxypeptidase, and crosslinking |
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Vancomysin
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Glycopeptide; cell wall inhibitor
Used to treat MRSA Binds to D-ala D-ala |
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Protein Synthesis Inhibitor: Binds to 30s Ribosome
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Streptomycin or Gentamycin (Aminoglycosides)
Tetracyline |
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Streptomycin/Gentamycin
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Aminoglycoside; bactericidal; 30S
Causes oto, neuro, nephrotoxicity Does not work on anaerobes |
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Tetracycline
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Bacteriostatic; 30S
Prevents binding of incoming tRNA Treat UTI, resp and skin infections |
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Protein Synthesis Inhibitor: Binds 50S Ribosome
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Erythromycin (Macrolide)
Chloramphenicol |
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Erythromycin
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Macrolide; bacteriostatic; 50S
Active against pneumonias |
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Chloramphenicol
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Bacteriostatic; 50S
Not first line due to toxicity Causes Grey Baby Syndrome |
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DNA Synthesis Inhibitor: Inhibits DNA Gyrase
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Ciprofloxacin (Quinolones)
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Ciprofloxacin
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Quinolones; Bactericidal; DNA gyrase
Treats UTI, resp and GI infections |
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RNA Synthesis Inhibitor: Inhibits RNA Polymerase
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Rifampicin/Rifampin/Rifamycin
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Rifampin/Rifamycin
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Bactericidal
Treats TB in combo w/ other drugs |
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Folate Synthesis Inhibitor: Anti-metabolite
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Sulfonamides
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Sulfonamide
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Bacteriostatic
Acts in synergy with Trimethoprim |
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5 Ways Drug Resistance is Formed
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1) Efflux pump: pump drugs out of cell
2) Alter membrane permeability 3) Degrade the drug (penicillinase/beta-lactamase) 4) Change or mutate the targets/binding sites 5) Transfer resistance genes via plasmids |
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Synergistic Drugs
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Beta-lactams + beta-lactamse inhibitors
Sulfonamides + Trimethoprim Penicillin + Aminoglycoside Amoxicillin + Clavulinic Acid (inhibits penicillinase) = Augmentin |
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Antagonistic Drugs
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Tetracycline + Penicillin (static + cidal)
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TB Drugs
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1) Rifampin
2) Isoniazid/INH (prophylaxis) 3) Pyrazinamide 4) Ethambutol 5) Streptomycin |
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How to Treat Helicobactor (duodenal ulcer)
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3-4 drugs: PPI to raise the pH, Antibiotic to kill the bacteria (amoxicillin, metronidazole, etc), and Bismuth to coat and heal GI surface
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Sulfa Containing Drugs (avoid for allergy reaction)
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Thiazide Diuretics
Loop Diuretics (Furosemide) Sulfa- drug |
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Anti-Histamines
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Reversible; Competitive Inhibitors; H1 blockers
- Diphenhydramine (Benadryl) - Cetirizine (Zyrtec) - Promethazine (Phenergan) - Fexofenadien (Allegra) - Loratadine (Claritin) |
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Diphenhydramine (Benedryl)
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1st generation
SE: anticholingeric effects, drowsiness, low GI effects For motion sickness PC: B |
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Cetirizine (Zyrtec)
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1st generation
SE: anticholinergic and sedative effects For hives PC: B |
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Promethazine (Phenergen)
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1st generation
SE: Sedative action For anti-emetic and motion sickness PC: C |
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Fexofenadien (Allegra)
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2nd generation
SE: little sedation due to low CNS penetration, no anticholinergic effects PC: C |
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Loratadine (Claratin)
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2nd generation
SE: little sedation, no anticholingergic effects PC: B |
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For Acute Anaphylaxis
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Use Epinephrine (NOT anti-histamines which is only for prevention)
- Acts on beta 2: prevent degranulation and bronchodilates - Acts on alpha 1: constricts blood vessels - Acts on beta 1: increase CO |
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Triple Response of Lewis
(local effects of histamine) |
1) capillary dilation --> local redness
2) arteriolar dilation --> red flare over larger area 3) increase capillary permeability --> wheal or local edema |
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Two Cells that Store Histamine
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1) Mast Cells
2) Eosinophils |
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Allergens Bind to What Receptor in Order to Release Histamine?
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IgE Receptor
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Rx
Sig q.d, b.i.d, t.i.d, q.i.d prn qod ac, pc qtts |
prescription
directions once a day, twice, three times, four times a day as needed every other day before meals, after meals drops |
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Drug Expiration
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Legend drugs - expire 1 year from date issued
Controlled drugs - C3-4 expire 6 months from date issued; C2 expire 7 days from date issued (ensures supervision and follow up) |
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Drug Prescribing Tips
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Avoid trailing zeros
Always use leading zeros 2.2 kg per 1 lb Drug Name X mg Dispense #X Sig: 1 capsule PO 3x a day for _______ |
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Schedule I (C1) drugs
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Highest abuse risk w/ no safe medical use
Heroin, Marijuana, LSD, PCP, cocaine |
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Schedule II (C2) drugs
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Have safe and accepted medical use
Morphone, oxycodone, methylphenidate, dextroamphetamine |
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Schedule III (C3) drugs
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Acetaminophen/codeine (Tylenol), acetaminophen/hydrocodone (Vicodin)
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Schedule IV (C4) drugs
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Diazepam (Valium), alprazolam (Xanax), phenobarbital, chloral hydrate
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Schedule V (C5) drugs
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Stimulant and narcotic drugs for antitussive and antidiarrheal purposes
Imodium |
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Pregnancy Category X Drugs
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Warfarin
Misoprostal (PG analog; decreases acid) Accutane |
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Anti-Arrhythmic Drugs
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Class I Na Channel Blocker
Class II Beta Blocker Class III Potassium Channel Blocker Class IV Calcium Channel Blocker SE; arrhythmias |
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Lidocaine or Quinidine
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Class I Na channel blocker; used in hospital
Blocks open Na channels to increase threshold and increase depolarization Decreases HR SE: arrhythmias, drowsiness, slurred speech, paraesthesia, agitation, confusion, seizures |
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Propanolol, Atenolol, Sotalol (-olol)
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Class II Beta Blocker
Act on pacemaker cells AP on SA and AV node, decrease phase 4 depolarization slope and prolongs refractory period; O2 demand decreases Decrease HR, CO, antagonize Epi/NE SE: bronchoconstriction, bradycardia, hypotension, hypoglycemia, sexual impairment |
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Adenosine, Amiodarone, Ibutylide
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Class III K+ channel blockers
Inhibit repolarizing K channels and prolong refractory period, hyperpolarizes SE: arrhythmias Amiodarone for VTach and VFib; monitor for pulmonary fibrosis or hypo/hyperthyroidism Adenosine for SVT |
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Verapamil, Nifedipine
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Class IV calcium channel blocker
Slows AP upstroke in SA and AV nodes Decrease HR and contractility SE: arrhythmias and hypotension More useful against atrial flutter and AFib |
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Anti-Anginals
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Nitrates - relax smooth muscle
- Nitroglycerin - Isosorbide dinitriate - Sodium nitroprusside |
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Nitroglycerin, Isosorbide dinitrate, Sodium nitroprusside
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Treat angina, chronic ischemic heart disease, hyptertensive emergency
Conversion to NO (increase NO levels), increase cGMP, increase myosin phosphate --> smooth muscle relaxation, reduced preload SE: hypotension, flushing, throbbing headache, reflex tachycardia, cyanide poisoning (give with beta blocker for tachycardia) |
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Inotropes
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Increases intracellular calcium and CO, used on CHF patients
- Dobutamine - Digoxin - Milrinone, Amrinone, Theophylline |
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Dobutamine
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Beta 1 agonist
Increases cAMP, increase contractility and CO, HR SE; HTN, tachycardia, heart remodeling, NV |
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Digoxin
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Cardiac glycoside
Inhibits Na,k-ATPase pump, increasing calcium and contractility, CO SE: arrhythmias, weakness Fast onset, short half-life Narrow therapeutic window Monitor for hypokalemia Antidote: digoxin immune Fab fragment |
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Milrinone, Amrinone, Theophylline
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Cardioselective, highly toxic, hospital setting
PDE inhibitor, increase contractility and CO SE: arrhythmias and hypotension |
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Drugs with Low Therapeutic Index
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Digoxin, PDE inhibitors, theophylline, Warfarin, Heparin
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Anti-Hypertensives
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Volume Regulation
- Renin inhibitors (Aliskaren) - ACEI (-pril) - ARB (-sartan) - K-sparing diuretic - Calcium channel blocker (-dipine) - Direct Vasodilators |
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Aliskaren
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Renin inhibitor
Binds to renin and inactivates, less Na retention SE: hyperkalemia, angioedema |
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-pril
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ACEI
Blocks conversion, decrease peripheral vascular resistance, decrease Na retention SE: cough, angioedema, mental confusion, Hyperkalemia |
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-sartan
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ARB
Blocks binding of Ang II, decrease aldosterone, decrease vasoconstriction, less Na retention SE: no cough, angioedema, mental confusion |
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-dipine
Amlodipine, Verapamil |
Calcium channel blocker
Decrease afterload, relax smooth muscle |
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Minoxidil
Hydralazine |
Direct vasodilators
Open K channels, increase cGMP, relax smooth muscles, lower cardiac work load |
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Drugs that Cause Hyperkalemia
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Aliskaren, Captopril, Losartan, Spironolactone
(renin inhibitor, ACEi, ARB, aldosterone blocker) |
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Diuretics
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Carbonic Anhydrase Inhibitor (Acetazolamide)
Loop diuretics (Furosemide) Thiazide diuretics (Hydrochlorothiazide) Osmotic Diuretics (Mannitol) Potassium-Sparing Diuretics (Spironolactone, Amiloride) |
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Acetazolamide
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Carbonic anhydrase inhibitor
Inhibits reabsorption of HCO3 in PT Weak diuretic Good for glaucoma, epilepsy, mountain sickness |
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Furosemide
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Loop diuretic
Inhibits tri-transporter on ascending LOH, increases calcium excretion Fast acting Good for edema and nephrotic syndrome edema SE: Hypokalemia, hyperuricemia Most effective |
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Hydrochlorothiazide
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Thiazide diuretic
Inhibits Na/Cl cotransporter in DT, calcium reabsorption good for HTN, edema, hypercalciuria, diabetes insipidus (with low Na diet) SE: hypokalemia, hyperuricemia, hypercalcemia, hyperglycemia Most commonly used |
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Mannitol
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Osmotic diuretics
Freely filtered and no reabsorption, water follows IV only |
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Spironolactone
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Potassium sparing diuretic
Aldosterone antagonist Inhibit reabsorption of Na and secretion of K; prevents loss of K |
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Amiloride
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Potassium sparing diuretic
Blocks Na channels Prevent loss of K |
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Immunosuppresant Drugs
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For autoimmune disease and transplantation
- Adenocorticosteroid (Predinsone) - T cell activation inhibitors (Cyclosporin, Tacrolimus, Sirolimus) - Anti-metabolites (Methotrexate, Mycophenolic Acid, Azathoprine) - Alkylating agent (Cyclophosphamide) - Mast cell stabilizers (Cromolyn) |
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Prednisone, Predisolone
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Adenocorticosteroid analogs
Made from cholesterol Anti-inflammatory; inhibits phospholipase A-2 --> less inflammatory mediators Slow onset, alters gene transcription Used for SLE SE: Cushing's, hyperglycemia, hyperlipidemia, edema, weight gain |
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What Happens if Stop Prednisone Abruptly?
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Muscle and joint pain, fever, low BP and difficulty bleeding
Adrenal glands need time to remake cortisol so taper over a week |
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Cyclosporin
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T Cell Activation inhibitor
Used for transplants; prevent rejection SE: nephrotoxicity, HTN, hyperlipidemia |
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Tacrolimus
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T Cell Activation inhibitor
Prophylaxis; prevent rejection SE: nephrotoxicity, neurotoxicity, GI upset, HTN, hyperkalemia, hyperglycemia 100x more potent |
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Sirolimus (Rapamycin)
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Inhibits mTOR and arrests late phase of T cell activation
Manage graft rejection, used with Tacrolimus SE: hepatic artery thrombosis, teratogenic Low toxicity to kidneys |
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Methotrexate
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Anti-metabolites; inhibits folic acid metabolism
Used for RA SE: toxic to BM and GI |
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Mycophenolic Acid
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Inhibits IMP dehydrogenase, lowers dGTP pool
Used for kidney transplant, SLE, RA SE: diarrhea and vomiting |
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Azathioprine
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Inhibits DNA synthesis and suppresses lymphocyte proliferation
Used for prophylaxis of kidney and liver grafts SE: toxin to BM, liver and kidney |
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Cyclophosphamide
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Alkylating agent - kills rapidly dividing cells
Used for SLE with corticosteroids SE: toxic to BM, GI, bladder cancer |
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Cromolyn
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Mast cell stabilizer
Decrease release of inflammatory mediators Prophylaxis only |
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Platelet Aggregation Inhibitors, Anticoagulants, Thrombolytics
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Platelet Inhibitors
- Aspirin - Clopidogrel (plavix) - Abciximab Anticoagulants - Coumadin (Warfarin) - Heparin - Hirudin Thrombolytics - tPA |
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Aspirin
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Platelet inhibitor and NSAID
COX 1 and COX 2 inhibitor, decreases PG, decreases thromboxane A2 Used for prophylaxis and acute MI SE: GI upset, bleeding, increases Warfarin levels, Reye's syndrome for kids Toxicity --> CNS stimulation then depression (give sodium bicarbonate) |
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Clopidogrel (Plavix)
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Platelet inhibitor
Binds to platelet receptor, prevents aggregation Mostly prophylactic and for acute MI SE: bleeding, liver problems, GI upset, rash, headache |
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Abciximab
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Platelet Inhibitor
Binds to platelet receptor, prevents aggregation IV Fab fragment of monoclonal antibody, use with aspirin or heparin SE: bleeding, hypotension, NV, headache |
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Coumadin (Warfarin)
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Anticoagulant; thromboemolism prophylaxis
Antagonizes Vitamin K and decreases clotting factor synthesis SE: bleeding, hepatitis, NV, tissue necrosis, baldness, bone loss Antidote: Vit K or fresh plasma |
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Heparin
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Anticoagulant; thromboemolism prophylaxis
Binds to antithrombin III and increase rate of clotting factor degradation IV or SubQ SE: bleeding, thrombocytopenia, bone loss Antidote: protamine sulfate |
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Hirudin
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Peptide with anticoagulant properties
Prevents or dissolves formation of clots and thrombi |
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tPA
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Endogenous thrombolytic drug
Converts plasminogen to plasmin increasing thrombolysis SE; bleeding, stroke Fibrin specific; treats MI, CVA, PE |
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Difference Between Anticoagulant and Thrombolytic?
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Anticoagulant is for prevention and thrombolytic is for breaking clots that have already formed
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Warfarin versus Heparin
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Warfarin:
Oral, IM; 24-48 hours onset, long half life, PT/INR, crosses placental barrier; VIt K antidote Heparin: IV, immediate onset, short half life, PTT, does not cross placental barrier, protamine sulfate antidote |
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Iron Toxicity
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Antidote: desferrioxamine
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Warfarin Toxicity
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Antidote: Vitamin K
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Heparin Toxicity
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Antidote: Protamine sulfate
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Tylenol Toxicity
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Antidote: N-acetylcysteine
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Plasmin or tPA Toxicity
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Antidote: Aprotinin or Aminocaproic Acid
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Beta Blocker Toxicity
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Antidote: Glucagon
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Cyanide Toxicity
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Antidote: Nitrites
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Digoxin Toxicity
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Antidote: Digoxin Immune Fab Fragment
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-olol
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beta blockers
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-dipine
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one type of calcium channel blocker
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-zosin
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alpha 1 receptor blocker
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-caine
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anti-arrhythmic
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-pril
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ACEI
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-sartan
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ARB
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-statin
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HMG CoA reductase inhibitor
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-tidine
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H2 receptor antagonists
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-prazole
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PPI
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-mal
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monoclonal antibody
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Hemostatics and Anti-anemia Drugs
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Microcytic anemia
Macrocytic/megaloblastic anemia Aplastic anemia Hemolytic anemia |
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Microcytic Anemia
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Iron deficiency
Smaller than normal RBCs Tx: ferrous sulfate Antidote: desferrioxmine |
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Macrocytic/Megalobasltic Anemia
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Vitamin deficiency (vegetarian)
Large RBCs but cannot carry enough O2 Tx: folic acid or B12 supplement |
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Aplastic Anemia
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Decrease RBCs production from erythropoietin (kidney problems, radio or chemotherapy, DM)
Tx: EPO |
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Hemolytic Anemia
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RBC lysis before 120 day lifecycle (sickle cell, B-thalassemia)
Tx: hydroxyurea reduces pain crisis, increase bilirubin |
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Lipid Lowering Drugs
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- Statins
- Niacin - Fibrates - Ezetimibe - Bile Acid binding resins |
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Statins
Lovastatin, Pravastatin, etc |
Decreases cholesterol synthesis by inhibiting HMG CoA reductase and less VLDL is released
Liver makes less cholesterol SE: elevated transaminases - liver damage |
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Niacin
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Prevents lipolysis, decreases VLDL and LDL
SE; flushing, hepatotoxicity, hypoglycemia |
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Fibrates
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Enhances VLDL catabolism, increase HDL
SE: gallstones, competes with Warfarin, dyspepsia |
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Ezetimibe
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Prevents intestinal reabsorption of cholesterol
= more cholesterol in feces |
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Bile Acid
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Bind and remove bile acids into feces, lower plasma cholesterol levels
SE: constipation and malabsorption |
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Respiratory Drugs
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Bronchodilators
- Beta 2 agonist (albuterol) - Alpha 1 antagonist/Muscarinic blocker (Ipatropium) - PDE inhibitor (Theophylline) Anti-inflammatory - Oral glucocorticoids (Prednisone, Cromolyn) |
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Albuterol, Salmetrol
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Beta 2 agonist
SE: tremors, tachycardia, palpitations, hyperglycemia, hypokalemia |
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Ipratropium
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Alpha 1 antagonist
Decrease calcium SE: blurred vision, constipation, bad taste and dry mouth, urinary retention |
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Theophylline/Caffiene
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PDE inhibitor
Narrow therapeutic window SE: nausea, arrhythmias, seizures |
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NSAIDs
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Inhibit PG synthesis
- Aspirin - Acetaminophen (Tylenol) - Ibuprofen (Advil) - Naproxen (Aleve) - Indomethacin (Indocin) - COXIBs |
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Acetaminophen (Tylenol)
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Peripheral COX inhibitor, NSAID
Analgesic and antipyretic for infections 10x = toxic, 20x = fatal Antidote: Mucomyst (acetylcysteine) |
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Ibuprofen (Advil)
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NSAID
Analgesic, antipyretic, and anti-inflammatory Reduces pain due to RA SE: nausea, heartburn, epigastric pain |
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Naproxen (Aleve)
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NSAID
Analgesic, antipyretic, and anti-inflammatory Use with PPI, long half life 20x more potent than Aspirin SE: GI bleeds/performations, thrombosis, MI, stroke, renal failure |
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Indomethacin (Indocin)
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NSAIDs
Anti-inflammatory for acute gouty arthritis and alkylosing spondylitis Promotes closure of PDA in newborns |
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COXIBs (celecoxib)
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Selective NSAIDs; targets COX2
Anti-inflammatory SE: severe GI events, risk of heart attack or stroke For RA and osteoarthritis |
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Anti-Parasites
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Malaria, Worms, Lice
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Malaria
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Heme Polymerization Interference: Quinine, Chloroquine
Membrane damage: Mefloquine Targets Liver: Primaquine (for dormant forms) For P. Falciparum: Artemisinin For prophylaxis: Chloroquine |
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Worms
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Metronidazole (flagyl): inhibit DNA replication
Albendazole Mebendazole Pyrantel: NM blocking Praziquantel: for trematodes, increases permeability Ivermectin: affects Cl channel, drug for river blindness, for nematodes Diethylcarbamazine: drug for elephantiasis, for nematodes |
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Lice
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Permethrin (and scabies)
Malathion |
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Anti-Fungal Drugs
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Polyene Macrolides (Amphotericin B)
Flucytosine Azoles Allylamines Achinocandins |
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Amphotericin B
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Polyene Macrolide
Forms hole in fungal membrane IV |
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Flucytosine
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Transported into cell, blocks RNA and DNA synthesis
Fungistatic; for systemic Combne with amphotericin B or itraconazole |
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Azoles (Itraconazole)
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Inhibits cell wall synthesis
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Allylamides (Terbinafine)
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Fungicidal
Deposited into hair, skin, nails |
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Echinocandins
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-cidal for Candida, effective against yeast and molds
IV |
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Anti-Viral Drugs
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HIV
Enfuvirtide Maraviroc AZT, ddl, Tenfovir Nevirapine Raltegravir Ritonavir, Indinavir Acyclovir Gancyclovir Ribavirin IFN-alpha, Lamivudine, Adeforvir IFN-alpha, Ribavirin Amantadine Oseltamivir (Tamiflu) Zanamivir (Relenza) |
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HIV Life Cycle Drugs
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Enfuviride: fusion inhibitor btwn host and HIV membrane
Maraviroc: entry inhibitor, blocks receptor and prevent virus entry into CD4 AZT, ddl, Tenofovir: nuceloside reverse transciptase inhibitor Nevirapine: non-nucleoside reverse transcriptase inhibitor Raltegravir: integrase inhibitor; prevents integration of viral DNA into chromosome Ritonavir: protease inhibitor, inhibits final assembly of virions in infected cells Combo: 2 NRTI or NNRTIs + one protease inhibitor (+ritonavir), OR NNRTI, OR integrase inhibitor |
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Acyclovir
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NRTI
Inhibits DNA synthesis, nucleic acid chain terminator For Herpes |
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Gancyclovir
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NRTI
Inhibits DNA synthesis, nucleic acid chain terminator For CMV |
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Ribavirin
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For RSV
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IFN-alpha, Lamivudine, Adeforvir
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For Hep B
Suppress viral replication viral polymerase inhibitor, inhibitors of nucelic acid synthesis |
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IFN-alpha and Ribavirin
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For Hep C
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Amantadine
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Influenza A only; prophylaxis
M2/H+ channel inhibitors, prevent acidification of viral particle |
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Oseltamivir (Tamiflu)
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Influenza A and B, prophylaxis
Neuraminidase inhibitor Prevents release of new virus from infected cells, increase viral aggregation, decrease spread |
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Zanamivir (Relenza)
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Influenza A and B
Neuraminidase inhibitor Prevents release of new virus from infected cells, increase viral aggregation, decrease spread |
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Drugs of Abuse
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Alcohol
Nicotine Stimulants (cocaine, amphetamine) Narcotics (heroin, opium, codeine) Benzodiazepines |
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Alcohol
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decrease excitability
Tx: Aversive (Disulfiram/Antabuse), Diazepam |
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Nicotine
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Tx: Verenicline (Chantix)
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Stimulants (cocaine, amphetamine, methamphetamine)
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Enters CNS and inhibits reuptake of dopamine
increase release of dopamine |
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Narcotics (opium, heroin, codeine)
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Tx heroin: methadone
Tx: opium: nalaxone |
