Pharm Test #3

Front 1

Furosemide

Back 1

Sulfonamide LOOP diuretic. Inhibits Na+/K+/2Cl- pump (thick ascending loop) (this normally will remove all 3 form the urine, making it less concentrated). By Inhibiting it, the urine contains more solute and the Renal Medulla will become less hypertonic. LOOPs LOSE Ca2+ (Ca2+ and Mg2+ paracellular reabsorption is induced by the NKCC pump) USES: Edema, HTN, Hypercalcemia SIDE EFFECTS: OH DANG! Ototoxic, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis, Gout

Front 2

Spironolactone

Back 2

K+ Sparing Diuretic. Blocks Aldosterone receptors (in Cortical collecting Ducts, which would lead to increased Na+ reabsorption). USES: Hyperaldosteronism (Conn's), hypokalemia, CHF SIDE effects: Hyperkalemia (arrhythmia), can cause gynecomastia via antiandrogen effects. (other K+ sparing diuretics: Triamterene and Amiloride)

Front 3

Digoxin (aka Digitalis)

Back 3

Blocks Na+/K+ Pumps on myocytes, --> increases intercellular Na+ levels ---> decreases Na+/Ca2+ exchange ---> Increases Ca2+ inside the cell ---> which will decrease the HR (prolong phase 4 and 0 of the nodal action potential) and increase the force of contraction (increase Ca2+ release from sarcoplasmic reticulum) USES: CHF, Atrial Fib Side Effects: Cholinergic: Nausea, Vomiting, Diarrhea, blurry yellow vision, hyperkalemia

Front 4

Verapamil

Back 4

Anti-arrhythmic, Class 4, Ca2+ channel blocker. primary effect at AV node, decrease conduction velocity, increase PR interval and ERP(effective refractory period). USES: to prevent Nodal Arrhythmias, ex: SVT-supravetricular tach. SIDE effects: Constipation, flushing, edema, -- CHF, AV Block, sinus node depression.

Front 5

Amlodipine

Back 5

Ca2+ channel blocker, relaxes smooth muscle in arterioles, Decreases BP, and increases blow flow to heart (coronaries). USES: Angina, and HTN

Front 6

Valsartan

Back 6

ARB, angiotensin II receptor Blocker, USES: CHF, HTN, and Post-MI

Front 7

Amiodarone

Back 7

Anti-arrhythmic, K+ channel blocker - Class 3, (but really all 4 classes), increase AP duration, increase ERP (eff. refract. period), increase QT interval, SIDE EFFECTS: Must check LFTs, PFTs, TFTs - Liver toxic, pulmonary fibrosis, hypo/hyper thyroidism

Front 8

Digoxin (aka Digitalis)

Back 8

Blocks Na+/K+ Pumps on myocytes, --> increases intercellular Na+ levels ---> decreases Na+/Ca2+ exchange ---> Increases Ca2+ inside the cell ---> which will decrease the HR (prolong phase 4 and 0 of the nodal action potential) and increase the force of contraction (increase Ca2+ release from sarcoplasmic reticulum) Side Effects: Cholinergic: Nausea, Vomiting, Diarrhea, blurry yellow vision, hyperkalemia

Front 9

Dopamine

Back 9

Activates D1=D2 receptors > Beta > Alpha (inotropic and chronotropic) -- USES: treat shock (increases renal perfusion), and Heart failure

Front 10

Dobutamine

Back 10

Activates B1 > B2 , only inotropic, USES: treat shock, heart failure, and used in cardiac Stress Testing

Front 11

Inamrinone

Back 11

PDEIII (phosphodiesterase) inhibitor, increases cAMP, increases Ca2+, also has vasodilation activity. USES: Severe CHF SIDE effects: thrombocytopenia ---- Milrinone used instead

Front 12

Milrinone

Back 12

PDEIII (phosphodiesterase) inhibitor, increases cAMP, increases Ca2+, also has vasodilation activity. USES: Severe CHF

Front 13

Prazosin

Back 13

Blocks a1 receptors - USES: HTN, urinary retention from BPH SIDE effects:1st dose orthostatic hypotension, dizziness, headache.

Front 14

Phentolamine

Back 14

reversible Non-selective Alpha-adrenergic blocker - used to diagnose pheochromocytoma,

Front 15

Atenolol

Back 15

Block B1 selective > B2 receptors - USES: HTN, Anigina, MI, CHF SIDE effects: bradycardia, AV block, CHF

Front 16

Propranolol

Back 16

Non-selective blocker of Beta - adrenergic receptors B1=B2 - USES: HTN, CAD, tachycardia from hyperthyroidism, chronic migrains SIDE effects: bronchoconstriction (B2 blockade), Fasting hypoglycemia (B2 blockade), hypotension

Front 17

Sotalol

Back 17

non-selective blocker of Beta - adrenergic receptors B1=B2 - ALSO has K+ channel blocking activity (Class 3 anti-arrhythmic) (prolongs PR and OT intervals) - USES: HTN, atrial fibrillation. - SIDE effects:

Front 18

Labetalol

Back 18

Block both Alpha and Beta - adrenergic receptors - USES: refractory HTN

Front 19

Carvedilol

Back 19

Block both Alpha and Beta - adrenergic receptors - USES: CHF

Front 20

Clonidine

Back 20

Agonist at A2 receptors in the medulla - lowers NE release peripherally, - does NOT decrease renal blood flow so .. USES: HTN (especially in patients with renal disease). SIDE Effects: Rebound HTN if withdrawn quickly, bradycardia

Front 21

Fenoldopam

Back 21

Agonist at D1 receptors - splanchnic and renal vasodilation - USES: Severe HTN

Front 22

Captopril

Back 22

ACE Inhib. decreases Angiotensin II levels, prevents bradykinin breakdown (vasodilator), USES: CHF, HTN, diabetic renal disease SIDE effects: COUGH, Hyperkalemia, angioedema, proteinuria, taste problems, HypOtension, Rash, increased renin,

Front 23

Losartan

Back 23

ARB, angiotensin II receptor Blocker, (does not effect bradykinin degradation like ACE Inhibs) USES: CHF, HTN, and Post-MI, Diabetic nephropathy - SIDE effects: hyperkalemia and renal failure with patients who have renal insufficiency

Front 24

Spironolactone

Back 24

Blocks Aldosterone receptors - causes salt and water loss (since Na+ is normally exchanged for K+, it also lowers K+ excretion) -- USES: Hyperaldosteronism, CHF, hypertension -- SIDE effects: Hyperkalemia, gynecomastia, impotence, mentruation irregularites

Front 25

Eplerenone

Back 25

Blocks Aldosterone receptors - causes salt and water loss (since Na+ is normally exchanged for K+, it also lowers K+ excretion) -- USES: Hyperaldosteronism, CHF, hypertension -- SIDE effects: Hyperkalemia,

Front 26

Aliskiren

Back 26

Renin Inhibitor - USES: HTN SIDE effects: Angioedema, Hyperkalemia, hypotension, increased uric acid - Gout, renal stones

Front 27

Hydralazine

Back 27

directly relaxes arteriolar (only) smooth muscle - USES: HTN, CHF - SIDE effects: reflex tachycardia (contraindicated in patients with CAD), durg-induced lupus

Front 28

Minoxidil

Back 28

Dilates arterial (only) smooth muscle - opens potassium channels --> hyperpolarizes the muscle (relaxation) - USES: HTN, Hair growth (rogaine) --- SIDE effects: reflex tachycardia (contraindicated in patients with CAD or ventricle Hypertrophy,

Front 29

Sodium Nitroprusside

Back 29

Metabolized to NO in the blood --> NO activates guanyl cyclase --> increased cGMP ---> relaxes smooth muscles in BOTH veins and arteries - USES: acute Hypertensive crisis - SIDE effects: CYANIDE poisoning, thiocyanate is the metabolite, MUST be taken IV, if oral ---> becomes cyanide in GI tract (treat with thiosulfate)

Front 30

Nifedipine

Back 30

Ca2+ channel blocker, relaxes smooth muscle in arterioles, Decreases BP, and increases blow flow to heart (coronaries). Smaller effect on cardiac tissue in comparison to Verapamil. USES: Angina, and HTN --- SIDE effects: hypotension, peripheral edema

Front 31

Amlodipine

Back 31

Ca2+ channel blocker, relaxes smooth muscle in arterioles, Decreases BP, and increases blow flow to heart (coronaries). Smaller effect on cardiac tissue in comparison to Verapamil. USES: Angina, and HTN --- SIDE effects: hypotension, peripheral edema

Front 32

Nicardipine

Back 32

Ca2+ channel blocker, relaxes smooth muscle in arterioles, Decreases BP, and increases blow flow to heart (coronaries). Smaller effect on cardiac tissue in comparison to Verapamil. USES: Angina, and HTN --- SIDE effects: hypotension, peripheral edema

Front 33

Clevidipine

Back 33

Ca2+ channel blocker, relaxes smooth muscle in arterioles, Decreases BP, and increases blow flow to heart (coronaries). Smaller effect on cardiac tissue in comparison to Verapamil. USES: Angina, and HTN --- SIDE effects: hypotension, peripheral edema

Front 34

Verapamil / diltiazem

Back 34

Anti-arrhythmic, Class 4, Ca2+ channel blocker. primary effect at AV node, decrease conduction velocity, increase PR interval and ERP(effective refractory period). USES: to prevent Nodal Arrhythmias, ex: SVT-supravetricular tach. SIDE effects: Constipation, flushing, edema, -- CHF, AV Block, sinus node depression.

Front 35

Guanadrel

Back 35

false neurotransmitter, taken up and stored as NE but has no effect, replaces NE -- USES: HTN -- SIDE effects: if given IV it will initially release NE and increase BP

Front 36

Reserpine

Back 36

Binds to vesicles in neurons, inhibits transport of NE and Dopamine into vesicles -- leads to sympathetic dysfunction, and takes days-weeks to resynthesize vesicles after discontinuing treatment -

Front 37

Guanabenz / clonidine / guanfacine

Back 37

Alpha 2 -adrenergic agonist - low dose only A2a (CNS) agonist - but high dose A2b agonist (smooth muscle, peripheral) and can cause intial vasoconstriction (increase BP)

Front 39

Nitroglycerin

Back 39

dilates venous (more) and arteries, USES: treat hypertensive crisis in patients with cardiac ischemia or after bypass surgery

Front 40

Esmolol

Back 40

short acting B1 blocker, USES: aortic dissection, post-op HTN,

Front 41

Aliskiren

Back 41

Renin inhibitor, USES: HTN

Front 42

Captopril

Back 42

ACE Inhibitor, shorter half life, less effective in blacks, USES: HTN, CHF, MI, diabetic neuropathy, SIDE effects: COUGH, Hyperkalemia, hypotension, altered taste, decreased renal function (dec GFR), --- Contraindication: Renal impairment (artery stenosis), hypotension, pregnant, hyperkalemia, ---- DRUG interactions: NSAIDs, Digoxin, K+ sparing diuretics, Thiazide(loop) diuretics.

Front 43

Enalapril

Back 43

ACE Inhibitor, Longer half life, less effective in blacks, USES: HTN, CHF, MI, diabetic neuropathy, SIDE effects: COUGH, Hyperkalemia, hypotension, altered taste, decreased renal function (dec GFR), --- Contraindication: Renal impairment (artery stenosis), hypotension, pregnant, hyperkalemia, ---- DRUG interactions: NSAIDs, Digoxin, K+ sparing diuretics, Thiazide(loop) diuretics.

Front 44

Losartan

Back 44

ARB, angiotensin II receptor Blocker, (does not effect bradykinin degradation like ACE Inhibs) USES: CHF, HTN, and Post-MI, Diabetic nephropathy - SIDE effects: hyperkalemia and renal failure with patients who have renal insufficiency

Front 45

Spironolactone

Back 45

K+ Sparing Diuretic. Blocks Aldosterone receptors (in Cortical collecting Ducts, which would lead to increased Na+ reabsorption). USES: Hyperaldosteronism (Conn's), hypokalemia, CHF SIDE effects: Hyperkalemia (arrhythmia), can cause gynecomastia, impotence via antiandrogen effects. weak androgen antagonist, weak progesterone agonist. (other K+ sparing diuretics: Triamterene and Amiloride)

Front 46

Eplerenone

Back 46

K+ Sparing Diuretic. Blocks Aldosterone receptors (in Cortical collecting Ducts, which would lead to increased Na+ reabsorption). USES: Hyperaldosteronism (Conn's), hypokalemia, CHF SIDE effects: Hyperkalemia (arrhythmia), less antiandrogen effect. (other K+ sparing diuretics: Triamterene and Amiloride)

Front 47

Nitroglycerin

Back 47

Releases NO which will activate guanyl cyclase ---> increase cGMP ---> dilation of venules, dilation of coronary arteries. USES: Stable, unstable, variant (prinzmetal) angina, CHF, and MI ---- SIDE effects: hypotension, headaches, dizzy, weak, reflex tachycardia ---- Contraindications: Patients on Sildenafil, hypotensive, Hypertrophic cardiomyopathy, diastolic heart failure

Front 48

Isosorbide Dinitrate

Back 48

Chewable, longer duration (2-3hrs) -- Releases NO which will activate guanyl cyclase ---> increase cGMP ---> dilation of venules, dilation of coronary arteries. USES: Stable, unstable, variant (prinzmetal) angina, CHF, and MI ---- SIDE effects: hypotension, headaches, dizzy, weak, reflex tachycardia ---- Contraindications: Patients on Sildenafil, hypotensive, Hypertrophic cardiomyopathy, diastolic heart failure

Front 49

Isosorbide -5-mononitrate

Back 49

Releases NO which will activate guanyl cyclase ---> increase cGMP ---> dilation of venules, dilation of coronary arteries. USES: Stable, unstable, variant (prinzmetal) angina, CHF, and MI and ---- SIDE effects: hypotension, headaches, dizzy, weak, reflex tachycardia ---- Contraindications: Patients on Sildenafil, hypotensive, Hypertrophic cardiomyopathy, diastolic heart failure

Front 50

Verapamil

Back 50

Ca2+ channel blocker (L-type) --- more cardiac effect, will decrease HR, contractility, and conduction through the AV node (increases PR interval), --- USES: Variant Angina, stable, and unstable angina, and MI. and SVT's like artial fib --- SIDE effects: cardiac arrest, bradycardia, AV block, CHF (contraindicated in patient with heart failure)

Front 51

Nifedipine

Back 51

Ca2+ channel blocker (L-type) --- more effects on Vasculature, it decreases BP (and has a relfex tachycardia and increase in CO) --- USES: Variant Angina, stable, and unstable angina, and MI. --- SIDE effects: hypotension, and at high conc. bradycardia, AV block

Front 52

Nimodipine

Back 52

Ca2+ channel blocker (L-type) --- more effects on Vasculature (specifically Cerebral vessels), it decreases BP (and has a relfex tachycardia and increase in CO) --- USES: may reduce vasospasm and mortality after subarachnoid hemorrhage, Variant Angina, stable, and unstable angina, and MI. --- SIDE effects: hypotension, and at high conc. bradycardia, AV block

Front 53

Dilitazem

Back 53

Ca2+ channel blocker (L-type) --- more effect on the heart, decreases HR, contractility, and conduction through the AV node, (but unlike Verapamil - also has inhibitory effect on the sympathetic nervous system) --- USES: Variant , stable, unstable angina. MI, and SVT's like Atrial Fib --- SIDE effects: cardiac arrest, bradycardia, AV block, CHF (contratindicated in patients with heart failure)

Front 54

Sotalol

Back 54

Non-selective Beta-Blocker --- USES: angina, arrhythmia, post MI --- SIDE effects: erectile dysfunction, depression, insomnia, --- Contraindication: Not for patients with asthma (B2 blockade = bronchoconstriction) Not to be used in Prinzmetal (variant) angina (B2 blockade = vasoconstiction, increased pre-load, and afterload - decreases coronary flow)

Front 55

No new drugs - Good lecture to put it all together

Front 56

Quinidine

Back 56

Class 1a - Na+ channel blocker - antiarrythmic - binds active state - decreases Phase 0 upstroke velocity, also blocks K+ channels which prolongs repolarization (increases QT interval)

Front 57

Procainamide

Back 57

Class 1a - Na+ channel blocker - antiarrythmic - binds active state - decreases Phase 0 upstroke velocity, also blocks K+ channels which prolongs repolarization (increases QT interval)

Front 58

Lidocaine

Back 58

Class 1b - Na+ channel blocker - antiarrythmis - binds BOTH inactive and active - MILD Na+ blockade, little K+ block so NO increase in QT interval

Front 59

Flecainide

Back 59

Class 1 C - Na+ channel blocker - antiarrythmic - STRONG Na+ channel blockade NO effect on repol. - NO increase in QT

Front 60

Amiodarone

Back 60

Class 3 (but also 1,2,4) K+ channel blocker - antiarrhythmic, alters lipid membrane - USES: V Tach or V Fib, atrial fib --- SIDE effects: long QT, hyper/hypothyroidism, liver enzyme inc, neuropathy, corneal deposits. INHIBITS CYP3A4, 2C9, (interactions with digoxin, warfarin, etc.)

Front 61

Sotalol

Back 61

Class 3 K+ channel blocker, but also Class 2 non-selective B blocker - USES: severe V tach --

Front 62

Carvedilol

Back 62

(and labetalol) 3rd gen Beta blocker - Class 2 antiarrhythmic - B1 selective with alpha blockade (vasodilation)

Front 63

Ibutilide

Back 63

Class 3 antiarrhythmic - K+ channel blocker - but also enhances slow Na+ inward current and therefore prolongs QT even more --- SIDE effects: long QT leading to serious torsades de pointes

Front 64

Bretylium

Back 64

Class 3 antiarrhythmic - K+ channel blocker - but also is an antihypertensive drug - acts like guanethidine and will replace NE in storage vesicles (initial release of NE) which lowers the amount of NE released --- Acts mainly on purkinje fibers ---USES: only in recurrent V tach or Fib

Front 65

Adenosine

Back 65

activates K+ current in atria SA and AV nodes - shortens the Action Potential and slows automaticity, increases AV refractory period --- USES: PSVT

Front 66

digoxin

Back 66

Inhibits the Na+/K+ ATPase - USES: CHF with reentry V tach --- positive inotrope, but also acts at the vagus nerve as a negative chronotrope

Front 67

K+ ion

Back 67

K+ levels must be carefully monitored as Hyper or Hypo K+ can cause arrhythmia, --- HYPO can cause EADs DADs and ectopic beats in myocytes --- HYPER can depolarize membranes and slow the conduction velocity

Front 68

Acetazolamide

Back 68

Carbonic anhydrase inhibitor (proximal tubule) --- Diuretic --- less Cl-/H+ excreted and more HCO- excreted --- leads to hyperchloremic acidosis after a few days of use --- USES: edematous patients with metabolic alkalosis, alkalinates the urine --- SIDE effects: renal stones, potassium loss

Front 69

Mannitol

Back 69

Osmotic diruetic --- lowers water reabsorption in prox tubule --- increased urine volume --- USES: acute renal failure --- TOxicity: dehydration, HYPERnatremia (due to excess water loss compared to Na+) this leads to Extracellular volume expansion

Front 70

Furosemide (aka Lasix)

Back 70

Loop diuretic (Na/K/2Cl transporter inhibitor) - Thick ascending loop (most potent type of diuretic) --- USES: Acute Pulmonary edema, nephrotic edema, hypercalcemia, --- SIDE effects: HYPO, K+,Na+, Mg+, HYPER, uricemia, glycemia (but HCTZ, more common), hypersensitivity Rxn with interstitial nephritis

Front 71

Bumetanide

Back 71

Loop diuretic (Na/K/2Cl transporter inhibitor) - Thick ascending loop (most potent type of diuretic) --- USES: Acute Pulmonary edema, nephrotic edema, hypercalcemia, --- SIDE effects: HYPO, K+,Na+, Mg+, HYPER, uricemia, glycemia (but HCTZ, more common), hypersensitivity Rxn with interstitial nephritis

Front 72

Torsemide

Back 72

Loop diuretic (Na/K/2Cl transporter inhibitor) - Thick ascending loop (most potent type of diuretic) --- USES: Acute Pulmonary edema, nephrotic edema, hypercalcemia, --- SIDE effects: HYPO, K+,Na+, Mg+, HYPER, uricemia, glycemia (but HCTZ, more common), hypersensitivity Rxn with interstitial nephritis

Front 73

Ethacrynic Acid

Back 73

Loop diuretic (Na/K/2Cl transporter inhibitor) - Thick ascending loop (most potent type of diuretic) --- USES: Acute Pulmonary edema, nephrotic edema, hypercalcemia, --- SIDE effects: HYPO, K+,Na+, Mg+, HYPER, uricemia, glycemia (but HCTZ, more common), hypersensitivity Rxn with interstitial nephritis, ALSO ototoxicity and GI bleeding

Front 74

Chlorothiazide

Back 74

Diurectic, inhibits Na/Cl symport in distal tubule - increases Na+,Cl+ and K+ excretion, but leads to reabsorption of Ca+ --- USES: essential HTN, CHF, nephrogenic DI --- SIDE effects: HYPO K+, HYPER, glycemia, uricemia, lipidemia, calcemia

Front 75

Polythiazide

Back 75

Diurectic, inhibits Na/Cl symport in distal tubule - increases Na+,Cl+ and K+ excretion, but leads to reabsorption of Ca+ --- USES: essential HTN, CHF, nephrogenic DI --- SIDE effects: HYPO K+, HYPER, glycemia, uricemia, lipidemia, calcemia

Front 76

Methyclothiazide

Back 76

Diurectic, inhibits Na/Cl symport in distal tubule - increases Na+,Cl+ and K+ excretion, but leads to reabsorption of Ca+ --- USES: essential HTN, CHF, nephrogenic DI --- SIDE effects: HYPO K+, HYPER, glycemia, uricemia, lipidemia, calcemia

Front 77

Hydrochlorothiazide (HCTZ)

Back 77

diurectic, inhibits Na/Cl symport in distal tubule - increases Na+,Cl+ and K+ excretion, but leads to reabsorption of Ca+ --- USES: essential HTN, CHF, nephrogenic DI --- SIDE effects: HYPO K+, HYPER, glycemia, uricemia, lipidemia, calcemia

Front 78

Bendroflumethazide

Back 78

diurectic, inhibits Na/Cl symport in distal tubule - increases Na+,Cl+ and K+ excretion, but leads to reabsorption of Ca+ --- USES: essential HTN, CHF, nephrogenic DI --- SIDE effects: HYPO K+, HYPER, glycemia, uricemia, lipidemia, calcemia

Front 79

Chlorthalidone

Back 79

diurectic, inhibits Na/Cl symport in distal tubule - increases Na+,Cl+ and K+ excretion, but leads to reabsorption of Ca+ --- USES: essential HTN, CHF, nephrogenic DI --- SIDE effects: HYPO K+, HYPER, glycemia, uricemia, lipidemia, calcemia

Front 80

Quinethazone

Back 80

diurectic, inhibits Na/Cl symport in distal tubule - increases Na+,Cl+ and K+ excretion, but leads to reabsorption of Ca+ --- USES: essential HTN, CHF, nephrogenic DI --- SIDE effects: HYPO K+, HYPER, glycemia, uricemia, lipidemia, calcemia

Front 81

Indapamide

Back 81

diurectic, inhibits Na/Cl symport in distal tubule - increases Na+,Cl+ and K+ excretion, but leads to reabsorption of Ca+ --- USES: essential HTN, CHF, nephrogenic DI --- SIDE effects: HYPO K+, HYPER, glycemia, uricemia, lipidemia, calcemia

Front 82

Metolazone

Back 82

diurectic, inhibits Na/Cl symport in distal tubule - increases Na+,Cl+ and K+ excretion, but leads to reabsorption of Ca+ --- USES: essential HTN, CHF, nephrogenic DI --- SIDE effects: HYPO K+, HYPER, glycemia, uricemia, lipidemia, calcemia

Front 83

Spironolactone

Back 83

inhibits aldosterone (in collecting tubule) --- postassium sparing diurectic -- used WITH other diuretics in order to reduce K+ loss, and have slight additive diueretic effect, --- USES: CHF --- SIDE effects: endocrine = gynecomastia, menstrual irregularities, impotence, decreased libido, hyperkalemia

Front 84

Eplerenone

Back 84

competitively inhibits aldosterone (collectiing tubule) --- postassium sparing diurectic -- used WITH other diuretics in order to reduce K+ loss, and have slight additive diueretic effect, --- USES: CHF --- SIDE effects: less endocrine effects compared to spironolactone, but Hyperlipidemia, hyperkalemia

Front 85

Triamterene

Back 85

Potassium sparing diuretic - aldosterone INDEPendent --- blocks Na+ channel in collecting tubule, SIDE effects: Hyper K, azotemia, crystalluria, triamterene stones, acute renal failure

Front 86

Amiloride

Back 86

potassium sparing diuretic - aldosterone INDEPendent --- blocks Na+ channel in collecting tubule, SIDE effects: Hyper K

Front 87

Aspirin

Back 87

Irreversibly blocks COX enzyme --- prevents formation of TXA2 --- USES: CAD and unstable angina --- SIDE effects: GI bleeding and peptic ulcer dz

Front 88

Clopidogrel

Back 88

Irreversibly blocks ADP receptors (thienopyridine - a pro drug) --- prevents acitivation which would stimuilate expression on GP2b/3a --- USES: CAD and unstable angina --- SIDE effects: bleeding, peptic ulcer

Front 89

Ticlopidine

Back 89

Irreversibly blocks ADP receptors (thienopyridine - a pro drug) --- prevents acitivation which would stimuilate expression on GP2b/3a --- USES: CAD and unstable angina --- SIDE effects: bleeding, peptic ulcer

Front 90

Dipyramidole

Back 90

Inhibits cAMP phosphodiesterase -- increases cAMP levels, and acts like Thienopyridines, but also is a vasoDilator, USES: prophylaxis of heart valve thrombi, prevention of stroke recurrence.

Front 91

Prasugrel

Back 91

Irreversibly blocks ADP receptors (thienopyridine- a pro drug) --- prevents acitivation which would stimuilate expression on GP2b/3a --- USES: CAD and unstable angina --- SIDE effects: bleeding and even hemorrhagic stroke, peptic ulcer ---- NEW drug, faster onset, more potent, and less variation due to p450 polymorphs -

Front 92

Abciximab

Back 92

Antibody against GP2b/3a - IV during angioplasty -- Expensive, excessive bleeding or major hemorrhage may occur

Front 93

Eptifibatide

Back 93

peptide that Inhibits GP2b/3a - shorter duration of action compared to abciximab - less expensive

Front 94

Tirofiban

Back 94

reversible, non-peptide inhibitor of GP2b/3a, similar to eptifibatide

Front 95

Heparin (Unfractioned)

Back 95

Binds and activates Antithrombin III --- antithrombin III will inhibit Thrombin, and factors 9,10,11,12 --- half life increases with dose --- Monitor aPTT, target 1.5-2.5 times normal --- Unfrac. Heparin is not cleared by the kidney so it is used for patients with compromised renal function (in comparison to LMWH) --- SIDE effects: bleeding (reversed by protamine sulfate when severe), HIT - heparin induced thrombocytopenia (immune reaction)

Front 96

LMW Heparin

Back 96

Bind and activates Antithrombin III - However, will not help inhibit thrombin, Mainly acts by inhibiting Factor 10. --- aPTT is not used to monitor therapy --- USES: 1st line to treat thromoboembolism, prevent PE, angina and MI --- SIDE effects: bleeding, NEVER give heparin to patients undergoing brain, spinal cord or eye surgery.

Front 97

Enoxaparin, et al

Back 97

Is a Low molcular wieght heparin --- binds and activates Antithrombin III --- which inhibits Factor 10

Front 98

Protamine Sulfate

Back 98

Used to treat heparin induced severe bleeding, is a basic protein (binds to and neutrolizes the acidic heparin molecule) ---DOES NOT reverse LMWH overdose

Front 99

Fondaparinux

Back 99

selective inhibitor of Factor 10a. smaller than LMWH but also cleared by the kidneys (like LMWH) --- USES: prophylaxis for DVT

Front 100

Lepirudin

Back 100

irudin = inhibitor, reversible, of thrombin --- both clot bound and circulating thrombin, cleared by the kidneys (like LMWH), so caution with those with renal impairment

Front 101

Bivalirudin

Back 101

irudin = inhibitor, reversible, of thrombin --- both clot bound and circulating thrombin, cleared by the kidneys (like LMWH), so caution with those with renal impairment

Front 102

Argatroban

Back 102

inhibits thrombin --- but cleared by the liver p450 enzyme, use with caution with liver problem patients

Front 103

Warfarin

Back 103

Inhibits vitamin K epoxide reductase --- this stops activation of factors 2,7,9,10 - monitor PT and INR --- USES: Post MI to prevent stroke or PE, Atrial fib, prosthetic heart valve

Front 104

Dabigatran

Back 104

direct thrombin inhibitor, prodrug, superiority over warfarin in stroke prevention from atrial fib

Front 105

Rivaroxaban

Back 105

direct factor 10a inhibitor - prevents Venous thromboembolism following knee or hip replacement

Front 106

Urokinase

Back 106

normally produced in the kidney --- directly converts plasminogen to plasmin ---

Front 107

Streptokinase

Back 107

facilitates the conversion of plasminogen to plasmin --- 5% of patients have allergic response

Front 108

Anistreplase

Back 108

mix of streptokinase and human plasminogen

Front 109

t-PA

Back 109

activates plasminogen, but ONLY in the presence of Fibrin, so no systemic activation of plasmin, which is good

Front 110

Fish Oil

Back 110

omega - 3 FAs can be made into TXA3 - which is a vasodilator that blocks platelet aggregation --- however, aspirin would negate the positive effects by inhibiting COX and therefore the produciton of TXA3

Front 111

Niacin

Back 111

Decreases VLDL synthesis --- Increases HDL (more than any other drug) --- USES: hetero fam hypercholesterolemia, mixed lipemia, combined hyperlipoprotenemia, DYSBETAlypoproteinemia, Lipoprotein A hyperlipoproteinemia ----- SIDE effects: flushing (treat with aspirin or laropiprant), pruritis, rash, hyperuricemia

Front 112

Fenofibrate

Back 112

Fibric acid derivative -- activates PPARa = increases lipoprotein lipase activity, decreases VLDL synth, increases HDL --- reduces risk of MI or CHD --- USES: severe hypertriglyceridemia, DYSBETAlipropeinemia SIDE EFFECTS: --- myopathy and rhabdomyolysis = when COMBINED WITH STATIN !!! --- anemia and gallstones also reported

Front 113

Colestipol

Back 113

Binds bile acids --> prevents reabsorption --> leads to liver creating more bile acids via cholesterol --> leads to more uptake of LDL, IDL VLDL by the liver... via increase in ApoB100 and ApoE receptor expression. USES: heterozygous Fam hypercholesterolemia, hyperlipidemia --- SIDE effects: constipation, bloating, rarely steatorrhea or gallstones

Front 114

Cholestyramine

Back 114

Binds bile acids --> prevents reabsorption --> leads to liver creating more bile acids via cholesterol --> leads to more uptake of LDL, IDL VLDL by the liver... via increase in ApoB100 and ApoE receptor expression. USES: heterozygous Fam hypercholesterolemia, hyperlipidemia --- SIDE effects: constipation, bloating, rarely steatorrhea or gallstones

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Colesevelam

Back 115

Binds bile acids --> prevents reabsorption --> leads to liver creating more bile acids via cholesterol --> leads to more uptake of LDL, IDL VLDL by the liver... via increase in ApoB100 and ApoE receptor expression. USES: heterozygous Fam hypercholesterolemia, hyperlipidemia --- SIDE effects: LESS SIDE EFFECTS, and LESS DRUG INTERACTIONS constipation, bloating, rarely steatorrhea or gallstones

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Lovastatin

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HMG CoA reductase inhibitor (indirectly upregulates ApoE and ApoB100 receptors (lowers LDL) --- activated in GI tract --- 30% absorbed -- big first pass metabolism -- and large first pass metabolism in liver (%5 bioavail) --- USES: fam hypercholesterolemia, or combined hyperlipidemia --- SIDE effects: mild hepatotoxic , myopathy (reversible), rhabdomyolysis at high dose.

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Simvastatin

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HMG CoA reductase inhibitor (indirectly upregulates ApoE and ApoB100 receptors (lowers LDL) --- activated in GI tract --- BETTER absorbed than lovastatin, 2x potency --- USES: fam hypercholesterolemia, or combined hyperlipidemia --- SIDE effects: mild hepatotoxic , myopathy (reversible), rhabdomyolysis at high dose.

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Atorvastatin

Back 118

HMG CoA reductase inhibitor --- ACTIVE drug given --- reduces LDL cholesterol by 50-60%

Front 119

Rosuvastatin

Back 119

HMG CoA reductase inhibitor --- similar to atrovastatin --- but HIGHer incidence of SIDE effects like rhabdomyolysis and renal failure

Front 120

Ezetimibe

Back 120

inhibits the absorption of cholesterol at the brush border of intestinal villi --- when combined with a statin LDL is lowered by another 25% --- Does not prevent or reduce plaque build-up , NO evidence that it reduces Coronary events or stroke

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Laropiprant

Back 121

D2 prostaglandin inhibitor --- Used to treat flushing from Niacin use)

Front 122

Neomycin

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Exerts a complimentary effect with NIACIN --- helps lower cholesterol levels --- USED in: fam hypercholest, fam combined hyperlipid

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Gemfibrozil

Back 123

Like Fenofibrate --- Fibric acid derivative --- activates PPARa but not as good as fenofibrate

Front 124

Somatotropin

Back 124

recombinant hGH --- USED: to treat hypopituitary dwarfism (subcutaneous or IM) --- glucocorticoids can retard growth rate (fyi) ---

Front 125

Sermorelin

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recombinant GHRH --- USED: to treat hypopituitary dwarfism (alternative)

Front 126

Somatomedin C

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aka IGF-1

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Mecasermin

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recombinant IGF-1 ( with IGF-BP3, which binds IGF-1 and increases half life) --- USED: to treat HYPERpituitary dwarfism (Laron syndrome), due to defective GH receptors

Front 128

Pegvisomant

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GH blocker --- binds to GH receptor and blocks binding of endogenous GH --- decreases IGF-1 production --- USES: Acromegaly --- SIDE effects: nausea diarrhea, chest pain, flu symptoms

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Bromocriptine

Back 129

Dopamine agonist (D2) --- USED: to treat acromegaly (50% respond, possibly because these tumors are both prolactin and GH secreting), aslo used for hyperprolactinemia (prolactinoma), Parkinson's Dz, Neuroleptic malignant syndrome ---- Bromocriptine will stop the symptoms of hyperprolactinemia (galactorrhea and amenorrhea) as well as shrink the tumor (adenoma, if present)

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Octreotide

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Somatostatin analog (with increased half life compared to endogenous SST) --- supresses GH, and ACTH, TSH, insulin, glucagon, VIP --- USES: Acromegaly, pancreatic cholera (due to VIPoma, MEN1 assn)

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Thyroid USP

Back 131

used to treat HYPOthyroidism, potency varies with each preperation

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Thyroglobulin

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used to treat HYPOthyroidism, potency varies with each preperation

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Levothyroxine

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Used to treat HYPOthyroidism, Specifically MYXedema

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Sodium Liothyronine (T3)

Back 134

Used to treat HYPOthyroidism, SHORT-acting

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Liotrix Euthyroid

Back 135

Used to treat HYPOthyroidism, 4:1 mix of T4 and T3

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Methimazole

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Used to treat HYPERthyroidism or Thyrotoxicosis, Inhibits thyroid Peroxidase, --- which blocks activation of Iodine --- this drug gets into mother's breast milk so breast feeding is not advised

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Propylthiouracil

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Used to treat HYPERthyroidism or Thyrotoxicosis, Inhibits thyroid Peroxidase, --- which blocks activation of Iodine --- this drug gets into mother's breast milk so breast feeding is not advised --- ALSO use with caution in Pregnant patients becuase PTU crosses the placenta

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Lugol's Solution

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Used to treat HYPERthyroidism or thyrotoxicosis --- KI and I2, this type of iodine will interfere with thyroid function, --- used in combination with methimazole or PTU

Front 139

I131 (Radioactive Iodine)

Back 139

Used to treat HYPERthyroidism, especially for destroying TOXIC adenoma, --- NEVER use in Pregnant patient

Front 140

Calcitriol

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1,25 D3 --- upregulates calcium binding transport protein in the gut --- increases Ca2+ absorption, also increases Ca2+ release from bone

Front 141

Ergocalciferol (Vitamin D)

Back 141

D2 made by fungi and yeast --- can also be hydroxylated to 1,25 D2 which has similar effects as D3

Front 142

Raloxifene

Back 142

SERM (selective estrogen receptor modulator) --- stimulates estrogen receptor on bone, but inhibits estrogen on breast --- USES: ERP Breast cancer, postmenopausal osteoporosis ---

Front 143

Alendronate

Back 143

Bisphosphonate, which inhibits osteoclast breakdown and demineralization of bone. It deposits in newly formed bone and protects it. ---USES: Osteoporosis, Paget's disease --- SIDE effects: heartburn and esophageal irritation, also after 5 years of treatment increased risk of non-traumatic femur fracture

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Risedronate

Back 144

Bisphosphonate, which inhibits osteoclast breakdown and demineralization of bone. It deposits in newly formed bone and protects it. ---USES: Osteoporosis, Paget's disease --- SIDE effects: heartburn and esophageal irritation, also after 5 years of treatment increased risk of non-traumatic femur fracture

Front 145

Ibandronate (aka Boniva)

Back 145

Bisphosphonate, which inhibits osteoclast breakdown and demineralization of bone. It deposits in newly formed bone and protects it. ---USES: Osteoporosis, Paget's disease --- ONLY need to take it once per MONTH --- SIDE effects: heartburn and esophageal irritation, also after 5 years of treatment increased risk of non-traumatic femur fracture

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Zoledronic Acid

Back 146

Bisphosphonate, which inhibits osteoclast breakdown and demineralization of bone. It deposits in newly formed bone and protects it. ---USES: Osteoporosis, Paget's disease --- ONLY need IV Infusion once per YEAR --- SIDE effects: fever, flu-like symptoms, myalgia (rare, but osteonecrosis of jaw)

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Prednisone

Back 147

Used to treat vitamin D intoxication --- blocks intestinal absorption of Ca2+ and lowers the hypercalcemia seen with D3 intox

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Teriparatide

Back 148

human PTH1-34 --- Stimulates osteoBlasts, stimulates new bone growth, decreases incidence of vertebral fracture --- Used to treat osteoporosis

Front 149

Adrenocorticotropin

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ACTH is released by the pituitary and activates MC2R Melanocortin receptor, Stimulates the production of Glucocorticoids

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Corticotropin Releasing Factor

Back 150

Released by the hypothalamus, stimulates the release of ACTH... increased levels of cortisol will ihibit the release of both CRF and ACTH. Negative feedback

Front 151

Cortisol

Back 151

Corisol is released by the zona fasiculata (adrenal cortex), --- involved in carbohydrate, protein, and lipid metabolism --- binds GRalpha receptor intracellularly, then together they binds the cis-acting elements to effect mRNA transcription.

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Prednisolone

Back 152

4x the glucocorticoid action of corisol, and less mineralocorticoid action

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Dexamethasone

Back 153

Very potent glucocorticoid and NO mineralocorticoid effect, also feedback inhibits ACTH production and therefore lowers endogenous corticosteroid production

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Cortisone

Back 154

INACTIVE until metabolized, similar effects to cortisol but less glucocorticoid effect

Front 155

Prednisone

Back 155

INACTIVE until metabolized, 4x the glucocorticoid activity, lowered mineralocorticoid activity

Front 156

Fluticasone

Back 156

First Pass metabolism is extensive, which results in fewer side effects

Front 157

Mometasone

Back 157

First Pass metabolism is extensive, which results in fewer side effects

Front 158

Beclomethasone

Back 158

More rapidly metabolized in the lungs, so fewer systemic side effects, administered via Inhalation

Front 159

Aldosterone

Back 159

VERY VERY potent Mineralocorticoid effect ---

Front 160

Mifepristone

Back 160

very potent ANTI-glucocorticoid effect --- Used to induce early-term ABORTION via antiprogestational effect

Front 161

Spironolactone

Back 161

Inhibits Aldosterone --- Treats HTN and CHF --- SIDE effects: hyperkalemia (potassium sparing), gynecomastia and impotence (anti-androgen), menstural issues (anti progestin)

Front 162

Eplerenone

Back 162

Selective mineralocorticoid receptor inhibitor --- like spironolactone but with less anti-anderogen, anti-progestin side effects ---

Front 163

Androstenedione

Back 163

Weak androgen produced in the zona reticularis --- main sources of androgens in females, metabolized to estrogens in males, --- this increases estrogens, and also lowers HDL

Front 164

Dehydroepiandrsterone

Back 164

Weak androgen produced in the zona reticularis --- main sources of androgens in females, metabolized to estrogens in males, --- this increases estrogens, and also lowers HDL

Front 165

Estradiol

Back 165

Produced from testosterone via Aromatase

Front 166

Testosterone

Back 166

made from androstenedione via 17B hyrdoxysteroid DH

Front 167

Metyrapone

Back 167

Blocks 11b-hydroxylase --- this causes a decrease in coritisol and aldosterone, however, there is less effect on mineralocortioid suppression becuase the precursor 11-deoxycorticosterone has mineralocorticoid effects.

Front 168

Aminoglutethimide

Back 168

Inhibts P450 scc (side chain cleavage) which normally makes pregnenalone from cholesterol... this leads to DECREASE in ALL ADRENAL steroid biosynthesis --- also inhibits aromatase (whic normally converts testosterone to estradiol...

Front 169

Testosterone Enanthate

Back 169

Transdermal treatment for HYPOgonadism

Front 170

Testoderm

Back 170

testosterone film taped onto scrotum (testes) --- used to treat Andropause or the decrease in testosterone with age

Front 171

Androderm

Back 171

Skin patch with testosterone AND permeation enhancers

Front 172

AndroGel

Back 172

GEL with permeation enhancers and testosterone, rubbed on shoulders

Front 173

Danazol

Back 173

orally active androgen (targets liver) --- stimulates compliment esterase inhibitors ---- Used to treat Hereditary Angioedema, which is due to defective C1-esterase inhibitor, therefore there is overactive compliment which caused vascular permeability --> angioedema

Front 174

Stanozolol

Back 174

orally active androgen (targets liver) --- stimulates compliment esterase inhibitors ---- Used to treat Hereditary Angioedema, which is due to defective C1-esterase inhibitor, therefore there is overactive compliment which caused vascular permeability --> angioedema

Front 175

Leuprolide

Back 175

GnRH agonist --- indirectly downregulates LH and FSH and therefore testosterone and estradiol

Front 176

Flutamide

Back 176

Inhibits Androgen receptors --- reactively increases LH, therefore Leuprolide (GnRH agonist) is added to limit this effect --- USED to treat METASTATIC PROSTATE cancer

Front 177

Bicalutamide

Back 177

Inhibits Androgen receptors --- reactively increases LH, therefore Leuprolide (GnRH agonist) is added to limit this effect --- USED to treat METASTATIC PROSTATE cancer

Front 178

Cyproterone acetate

Back 178

Weak inhibitor of androgen receptor --- used to treat HIRSUTISM in women

Front 179

Finasteride

Back 179

5a redcutase inhibitor Type II (which would make DHT from testosterone) --- Used to treat BPH and also Male pattern baldness (propecia)

Front 180

Dutasteride

Back 180

Blocks both Type I and II 5a reductase ---- therefore it works in all tissues

Front 181

Equilin

Back 181

equine estrogen, avoids 1st pass metabolism by addition of SO4 --- Used to treat: hypogonadism, Post-menopause HRT,

Front 182

17a-ethinyl estradiol

Back 182

17a modifcation makes it Orally active,

Front 183

Norethindrone

Back 183

Progesterone derivative added to ethinyl estradiol for HRT --- decreased risk of bone fracture and colon cancer --- BUT, INCreased risk of: MI, stroke, blood clots, breast cancer

Front 184

Tamoxifen

Back 184

SERM (selective estrogen receptor modulator) --- For treating estrogen receptor positive BREAST cancer --- it is an inhibitor of estrogen at breast tissue but and AGONIST at bone and endometirum, this decreases osteoporosis, but increases risk of endometrial cancer and thrombosis

Front 185

Raloxifene

Back 185

SERM (selective estrogen receptor modulator) --- For treating estrogen receptor positive BREAST cancer --- it is an inhibitor of estrogen at breast tissue and endometrium but and AGONIST at BONE --- Therefore it is used to TREAT Osteoporosis

Front 186

Letrozole

Back 186

Aromatase inhibitor, Used to treat BREAST cancer, (no risk of thrombosis, endometrial cancer or hot flashes)

Front 187

Insulin

Back 187

Normal Human hormone produced by B-cells in the islets of the pancreas --- realeased in response to elevated Glucose or GLP-1 (glucagon-like peptide) --- Normally stored as a hexamer with Zinc --- stimulates gylcogen sythesis in the Liver --- glucose/amino acid uptake in the muscle --- lipogenesis in the adipose tissue

Front 188

Insulin Lispro (aka Humalog)

Back 188

Absorbed very rapidly compared to other insulins, it can be injected just prior to eating (compared to regular insulin which must be injected 30 minutes beforehand)

Front 189

NPH Insulin (aka Isophane)

Back 189

Long duration insulin, but has a peak concentration at 8-12 hours

Front 190

Zinc extended Insulin

Back 190

Long duration insulin, but has a peak concentration at 8-12 hours, also lasts 36 hours

Front 191

Insulin glargine

Back 191

ULTRA LONG acting synthetic insulin prep, does not produce a peak concentration like other insulins

Front 192

Insulin determir

Back 192

LONG acting synthetic insulin, does not produce a peak concentration, injected twice a day subcut. and gives a smooth background insulin all day.

Front 193

Tolbutamide

Back 193

First generation sulfonylurea --- Inhibits K+ efflux from B-cells in the pancreas --- causes depolarization and Ca2+ influx and release of Insulin

Front 194

Glyburide

Back 194

Second generation sulfonylurea --- 200x more potent that tolbutamide ---- also inhibits K+ efflux, depol B-cell, Ca2+ influx, release of insulin

Front 195

Glipizide

Back 195

Second generation sulfonylurea --- 200x more potent that tolbutamide ---- also inhibits K+ efflux, depol B-cell, Ca2+ influx, release of insulin

Front 196

Metformin

Back 196

Used to treat Type II diabetes, Inhibits Gluconeogenesis in the liver, thereby reducing fasting and post-prandial hyperglycemia, almost never causes hypoglycemia --- However, rarely it may cause Lactic Acidosis (can be fatal)

Front 197

Acarbose

Back 197

Alpha-glucosidase inhibitor --- inhibits breakdown of sucrose in the gut which reduces hyperglycemia following a meal (used to treat Type II diabetes) --- SIDE effects: Gas, bloating, and diarrhea

Front 198

Pioglitazone

Back 198

A "glitizone" --- decreases insulin resistance --- activates the PPARgamma nuclear receptor --- this increases insulin sensitivity by increasing glucose transporters on cell membranes of skeletal muscle and adipose cells --- may also reduce gluconeogenesis in the liver --- May reduce risk of MI and stroke

Front 199

Repaglinide

Back 199

Not a sulfonylurea, But mechanism of action is the same, K+ efflux inhibition, depol cell, Ca2+ influx, release of insulin

Front 200

Sitagliptin phosphate

Back 200

Causes and increase in GLP-1 --- mech: inhibits DPP-4 (dipeptidyl peptidase) which breaks down GLP-1 ---> therefore GLP-1 levels increase which stimulate insulin release and inhibits glucagon release

Front 201

Levonorgestrel IUD

Back 201

IUD containing a progestin (Levonorgestrel) --- lasts 5 years --- prevents fertilization via: sterile inflammation, destruction of sperm, and inhibition of ovulation --- Benefits: lowers menstural bleeding, no system exposure to hormones, can be used during lactation period (post-partum), --- SIDE effects: Acne, need to check for string (make sure its still there), risk of uterine perf, pelvic infection (1st 20 days) --- increased likelihood of PIC if patient has gonorrhea, or chlamydia

Front 202

Norplant

Back 202

6 rods implanted that release levonorgestrel --- 5 years protection, suppressed ovulation, thickens cervical mucus, thins endometrium --- benfits: ease, can be used during lactation, decreases anemia, PID, endometrial cancer, ectopic preg --- SIDE effects: irregular bleeding (66%), weight gain, headaches, acne, mood changes, mastalgia (breast pain) , requires minor surgery

Front 203

Depo-Provera

Back 203

subcutaneous injection (every 3 months) --- depot-medroxy progesterone --- inhibits ovulation, thickens cervical mucus, thins edometrium --- Benefits: ease, can be used during lactation, decreases anemia, PID, ectopic preg, endometrial cancer --- SIDE effects: Irregular mesturation, Amenorrhea (50% by 1 year, 80% by 3 years) , weight gain, acne, mood changes, headaches, bone loss

Front 204

Estrogen/Progesterone Ocs

Back 204

inhibits LH surge (ovulation), thickens cervical mucus, increases fibrinogen, factor V, VII, and X, increases risk of thromboembolism ---- Benefits: lowers risk of: PID, dysmenorrhea, Acne, RA, osteoporosis, endometrial cancer and ovarian cancer --- RISKS: increased risk of thromboembolism (stop smoking, do not use if patient has Hx or HTN, PE, DVT, CAD or diabetes), increased risk of cervical cancer (need pap smear), breast tenderness, nausea, fluid retention

Front 205

Progestin-only OC

Back 205

do not consistently inhibit ovulation

Front 206

NuvaRing

Back 206

Placed in vagina for 3 weeks, then removed for a week... - Benefits likely similar to OCPs --- SIDE effects: vaginal discharge, vaginitis, spotting, nausea, breast tenderness

Front 207

PlanB

Back 207

89% reduction in pregnancy risk --- contains ONLY levonorgestrel --- 1 pill

Front 208

Preven

Back 208

2 pills, each has Levonorgestrel and estradiol --- less total levonorgestrel than PlanB

Front 209

LoOrvral

Back 209

4 pills, estradiol and Norgestrel (only .3mg) --- note that this is not levonorgestrel

Front 210

Clomiphene

Back 210

SERM (selective estrogen receptor modulator) used to increase frequency of ovulation during each period (with infertility) --- binds to HYPOTHALAMIC estrogen receptors, which slows receptor replenishment, and decreases estrogens negative feedback effect on the release of GnRH ----> INCREASES GnRH , this favors release of FSH ---- It is CONTRAindicated after conception has occurred --- SIDE effects: Flushing, blurred vision, headache

Front 211

Gonadotropins

Back 211

LH and FSH --- LH activates the theca cell to make androgens and FSH activates the granulosa cell to make aromatase to convert androgens to estrogen --- Used to induce ovulation if Clomiphene fails or for hypothalamic anovulatory issues --- Drug of choice to Harvest eggs during IVF ---