Pharm Test 4

Front 1

autocrine

Back 1

hormone acts on releasing cell

Front 2

paracrine

Back 2

hormone acts on cell near releasing cell

Front 3

endocrine

Back 3

hormone acts on cell distant from releasing cell

Front 4

antidiuretic hormone secreted by...

Back 4

posterior pituitary

Front 5

oxytocin secreted by...

Back 5

posterior pituitary

Front 6

growth hormone secreted by...

Back 6

anterior pituitary

Front 7

prolactin secreted by...

Back 7

anterior pituitary

Front 8

FSH (__________) secreted by...

Back 8

follicle stimulating hormone; anterior pituitary

Front 9

LH (__________) secreted by...

Back 9

luteinizing hormone; anterior pituitary

Front 10

insulin secreted by...

Back 10

pancreas

Front 11

glucagon secreted by...

Back 11

pancreas

Front 12

somatostatin secreted by...

Back 12

pancreas

Front 13

parathyroid hormone secreted by...

Back 13

parathyroid gland

Front 14

T3/T4 secreted by...

Back 14

thryoid gland

Front 15

calcitonin secreted by...

Back 15

thyroid gland

Front 16

catecholamines secreted by...

Back 16

adrenal gland

Front 17

aldosterone secreted by...

Back 17

adrenal gland

Front 18

cortisol secreted by...

Back 18

adrenal gland

Front 19

estradiol (__________) secreted by...

Back 19

estrogen; ovary

Front 20

progesterone secreted by...

Back 20

ovary

Front 21

testosterone secreted by...

Back 21

ovaries, testes, adrenal glands

Front 22

posterior pituitary hormones

Back 22

antidiuretic hormone, oxytocin

Front 23

anterior pituitary hormones

Back 23

GH, PRL, FSH, LH, ACTH, TSH

Front 24

pancreas hormones

Back 24

insulin, glucagon, somatostatin, digestive enzymes

Front 25

parathyroid gland hormones

Back 25

parathyroid hormone

Front 26

thyroid gland hormones

Back 26

T3/T4, calcitonin

Front 27

adrenal gland hormones

Back 27

catecholamines, aldosterone, cortisol, testosterone

Front 28

ovary hormones

Back 28

estradiol, progesterone, testosterone

Front 29

testes hormones

Back 29

testosterone

Front 30

__________-__________-__________ __________ axis

Back 30

hypothalamic-pituitary-target organ axis

Front 31

GnRH name, pathway, & function

Back 31

-gonadotropin-releasing hormone
-hypothalamus > ant. pituitary gonadotrophs (LH, FSH) > testes/ovaries (testosterone, estrogen, progesterone)
-spermatogenesis/ovulation

Front 32

TRH name & pathway

Back 32

-thyrotropin-releasing hormone
-hypothalamus > pituitary thyrotrophs (TSH) > thyroid > T3/T4

Front 33

CRH name & pathway

Back 33

-corticotropin-releasing hormone
-hypothalamus > pituitary corticotrophs (ACTH) > adrenal glands > glucocorticoids

Front 34

GHRH name & pathway

Back 34

-growth hormone-releasing
hormone
-hypothalamus > ant. pituitary somatotrophs (GH) > throughout body

Front 35

PRF name, pathway, & function

Back 35

-prolactin-releasing factor
-hypothalamus > ant. pituitary lactotrophs/mammotrophs (PRL) > breasts
-lactation

Front 36

TSH

Back 36

thyroid-stimulating hormone

Front 37

ACTH

Back 37

adrenocorticotropic hormone

Front 38

GH

Back 38

growth hormone

Front 39

PRL

Back 39

prolactin

Front 40

gonadotrophic hormones

Back 40

LH, FSH (leuteinizing hormone, follicle-stimulating hormone)

Front 41

thyrotrophic hormones

Back 41

TSH (thyroid-stimulating hormone)

Front 42

corticotrophic hormones

Back 42

ACTH (adrenocorticotropic hormone)

Front 43

somatotrophic hormones

Back 43

GH (growth hormone)

Front 44

mammotrophic/lactotrophic hormones

Back 44

PRL (prolactin)

Front 45

hypothalamic factors (secreted by hypothalamus)

Back 45

GnRH, TRH, CRH, GHRH, PRF, dopamine

Front 46

pituitary cell types

Back 46

gonadotroph
corticotroph
somatotroph
thyrotroph
lactotroph/mammotroph

Front 47

1°/2°/3° hyperthyroidism is caused by a problem in the...

Back 47

throid gland / pituitary gland / hypothalamus

Front 48

anterior pituitary name

Back 48

adenohypophysis

Front 49

posterior pituitary name

Back 49

neurohypophysis

Front 50

oxytocin function

Back 50

stimulates uterine contraction, promotes milk release during lactation

Front 51

enuresis (bedwetting) probable etiology

Back 51

lack of ADH secretion at night

Front 52

diabetes insipidous def., etiology, and symptoms

Back 52

-symptoms look like diabetes
-inadequate ADH secretion or renal receptors (V2) don't respond
-nocturia, polyuria, polydipsia

Front 53

thyroid feedback mechanism (+/-)

Back 53

-prolonged cold exposure, acute psychosis, and circadian rhythms induce TRH secretion
-severe stress inhibits TRH secretion
-T3/T4 inhibit TRH & TSH secretion

Front 54

___% of thyroid hormones are ___

Back 54

99.5%+; PPB

Front 55

hypo/hyperthyroidism S/S

Back 55

-hypo: ↓BMR
-hyper: ↑BMR, exophthalmos
-both: goiter, infertility

Front 56

Hashimoto's disease

Back 56

-chronic autoimmune thyroiditis (hyopthyroidism)
-T-cells attack antigen-like proteins on thyroid membrane, stimulating B-cells to produce Ab's against normal thyroid tissue

Front 57

chronic autoimmune thyroiditis

Back 57

Hashimoto's disease

Front 58

myxedema

Back 58

-end-stage of long-standing uncorrected hypothyroidism
-lethargy, stupor, hypothermia, delirium > coma > death

Front 59

end-stage of long-standing uncorrected hypothyroidism

Back 59

myxedema

Front 60

levothyroxine (L-thyroxine)-Synthroid

Pcol / Pharmacology / ADR

Back 60

-synthetic T4 > T3 in vivo
-↑BMR, ↑O2 consumption, ↑HR, ↑ cardiac hypertrophy, ↑BP, ↑ fat breakdown
-tachycardia, palpations, nervousness, insomnia, weight loss

Front 61

__________ ↓ orbital edema

Back 61

diuretics

Front 62

methimazole-Tapazole & propylthiouracil-PTU

Indications / Pcol

Back 62

-Graves disease
-inhibit biosynthesis of thyroid hormones by irreversibly inactivating peroxidase enzyme system in thyroid follicular cells

Front 63

Graves disease pathophys

Back 63

-autoimmune production of thyroid stimulating antibodies (IgG) > stimulate TSH receptor on surface of the thyroid cell > ↑ T3/T4 secretion (hyperthyroidism)
-75% have some ocular involvement

Front 64

hyperthyroidism Tx

Back 64

-immunosuppressives: cyclosporine & cyclophosphamide
-corticosteroids
-surgical ablation
-radioactive I

Front 65

proptosis (Graves) Tx

Back 65

-α-adrenergic blockers (topical & oral) to reverse upper eyelid retraction
-Botox
-tape eyes closed at night
-diuretics
-topical ABx
-lubricants

Front 66

Ca++ required for...

Back 66

-neurotransmitter release
-muscle contraction
-blood coagulation
-second messengers

Front 67

___% Ca++ stored in bone

Back 67

99

Front 68

PTH name & function

Back 68

-parathyroid hormone
-stimulates resorption (bone breakdown) > ↑ [Ca++]pl
-↑ reabsorption of Ca++ in kidneys
-↑ Ca++ absorption in GI

Front 69

osteoporosis pathophys & S/S

Back 69

-universal, gradual ↓ in bone mass > skeleton compromised and fractures with minimal trauma
-shortened stature, fractures, pain, vertebral body collapse, widow's hump

Front 70

osteoporosis etiology

Back 70

-drug induced (>7.5mg prednisone equiv.)
-estrogen deficiency > ↑ bone breakdown
-↓Ca++ absorption with ↑ age
-↓ sun exposure
-↓ kidney/liver function

Front 71

primary regulators of adult bone mass

Back 71

-physical activity
-Ca++ intake
-reproductive/hormonal endocrine status
-genetics

Front 72

HRT

Back 72

hormone replacement therapy

Front 73

___% of dietary Ca++ absorbed normally, absorption ↑ with excess...

Back 73

25-35; vitamin D

Front 74

body cannot absorb more than ___ elemental Ca++ at one time

Back 74

500-600mg

Front 75

body cannot absorb more than 500-600mg __________ at one time

Back 75

elemental Ca++

Front 76

Ca++ indications & DI

Back 76

-prevention/Tx osteoporosis, neutralize stomach acid
-↓ absorption of ABx

Front 77

alendronate-Fosamax & risendronate-Actonel

Class / Indications / DI

Back 77

-bisphosphanates
-prevention/Tx osteoporosis, corticosteroid induced osteoporosis, Paget's disease
-don't take within 1/2-1hr of other meds (bind to everything, including other drugs)

Front 78

alendronate-Fosamax & risendronate-Actonel

Pcol

Back 78

-suppresses osteoclast activity
-binds to and becomes permanent part of bone > ↑ bone mass, resistant to enzymatic hydrolysis

Front 79

bisphosphanates

Drugs / Indications

Back 79

-alendronate-Fosamax & risendronate-Actonel
-prevention/Tx osteoporosis, corticosteroid induced osteoporosis, Paget's disease

Front 80

Paget's disease def. & S/S

Back 80

-disorder of bone remodeling (good quantity, poor quality)
-deformity, pain

Front 81

calcitonin-Miacalcin/Calcimar

Indications / Pcol

Back 81

-post-menopausal Tx (not preventative) of osteoporosis, hypercalcemia
-synthesized and secreted by thyroid parafollicular cells; inhibits osteoclast activity > ↓ [Ca++]pl

Front 82

vasomotor symptoms (menopause)

Back 82

"hot flashes"

Front 83

gastroesophageal reflux disease (GERD) def., pathophys, & S/S

Back 83

-gastric acid reflux > esophageal mucosal damage
-weak lower esophageal sphincter; anatomical alterations in obesity & pregnancy
-burning pain radiating into chest/throat during/after meals, reflex burping; asthma type symptoms: wheezing, coughing, SoB

Front 84

peptic ulcer disease location & etiology

Back 84

-duodenum 5-10x more than gastric
-helicobactor pylori > secrete inflammatory enzymes; ulcerogenic drugs (NSAIDs, ASA, corticosteroids) > ↓ PG synthesis > ↓ gastric epithelial cell secretion of mucous & HCO3

Front 85

PG role in GI

Back 85

stimulate gastric epithelial cells to secrete mucous & HCO3

Front 86

HCO3

Back 86

bicarbonate; protective buffer against gastric acids

Front 87

Mg OH, Al OH-Alternagel, Ca++ carbonate-Tums, Mg OH + Al OH-Gelusil II/Mylanta II

Class / Gen. info / Pcol / DI

Back 87

-antacids
-not first line but work well, available OTC in many forms (chews, liquid, powder, gum)
-neutralize acid effectively by buffering excessive H+ with OH-
-don't stop acid secretion > short-term
-interfere with absorption of many drugs

Front 88

antacids

Drugs

Back 88

-Mg OH
-Al OH-Alternagel
-Ca++ carbonate-Tums
-Mg OH + Al OH-Gelusil II, Mylanta II

Front 89

cimetidine-Tagamet, ranitidine-Zantac, famotidine-Pepcid

Class / Gen. info / Pcol

Back 89

-histamine H2 receptor antagonists
-available OTC & OTC combinations
-competitive reversible blockade of H2 receptors on parietal cells > ↓HCl secretion

Front 90

histamine H2 receptor antagonists

Drugs / Use

Back 90

-cimetidine-Tagamet, ranitidine-Zantac, famotidine-Pepcid
-antacids

Front 91

lansoprazole-Prevacid, omeprazole-Prilosec, esomeprazole-Nexium

Class / Pcol

Back 91

-proton pump inhibitors (PPIs)
-forms irreversible bond with & inhibits H+/K+ ATPase (proton pump) in gastric parietal cells for 24hr; proton pumps last stage of HCl secretion > ↓ regardless of stimulation

Front 92

proton pump inhibitors

Drugs / Use

Back 92

-lansoprazole-Prevacid, omeprazole-Prilosec, esomeprazole-Nexium
-antacids

Front 93

Prevpac

Dosage / Use

Back 93

-BID 10-14 days
-elimination of helicobacter pylori in peptic ulcer disease

Front 94

drug used for elimination of helicobacter pylori in peptic ulcer disease

Back 94

Prevpac

Front 95

effect of pepsin in GI

Back 95

stimulates HCl secretion

Front 96

sucralfate-Carafate

Pcol

Back 96

cytoprotective actions: complex of AlOH and sucrose form sticky gel that binds to and coats ulcer site, protecting from HCl & aiding in healing; complexes & inactivates pepsin (stimulates HCl secretion)

Front 97

drug that forms sticky gel that binds to and coats ulcer site

Back 97

sucralfate-Carafate

Front 98

vitamin A / β-carotene source and ophthalmic & systemic function

Back 98

-carotenes from plants, vit A from animals; β-carotene precursor to vit A
-retinal epithelial tissue growth & differentiation; mucin layer of tear film; retinol active form in rods (retinol + opsin = rhodopsin)
-↑ immune function, ↓ certain malignancies

Front 99

vitamins C & E ophthalmic & systemic functions

Back 99

-potentially ↓ARMD and cataract development, ↓ intraocular inflammation
-anti-oxidants

Front 100

zinc functions & gen. info

Back 100

-antibacterial actions, neuroprotective
-causes Cu depletion, must supplement

Front 101

ARMD (wet) etiology & vit./mineral Tx

Back 101

-oxidative damage due to reactive O2 species
-preventative (antioxidants): A, C, E, zinc, lutein
-B vitamins ↓ homocysteine levels which may be elevated in ARMD

Front 102

night blindness vit./mineral Tx

Back 102

vitamin A

Front 103

optic neuritis vit./mineral Tx

Back 103

B6 & B12

Front 104

dry eye keratitis vit./mineral Tx

Back 104

vitamin A

Front 105

ranibizumab-Lucentis & pegaptanib-Macugen

Class / Indications / Pcol / Admin

Back 105

-monoclonal antibodies (MABs)
-ARMD (wet)
-selective vascular endothelial growth factor (VEGF) antagonist
-intravitreal

Front 106

lutein

Class / Ingredients / Proposed benefits / Gen. info

Back 106

-herbal
-carotenoid
-anti-oxidant, improve vision with cataracts & AMRD, stop phototoxic blue light from hitting macula
-provides pigment to macula

Front 107

zeaxanthin

Class / Ingredients / Proposed benefits / Gen. info

Back 107

-herbal
-carotenoid
-anti-oxidant, stop phototoxic blue light from hitting macula
-provides pigment to macula

Front 108

herbal carotenoids with potential benefit for ARMD

Back 108

-lutein
-zeaxanthin

Front 109

acute pain is typically...

Back 109

nociceptive

Front 110

chronic pain is typically __________, has an __________ component, and involves pain __________

Back 110

neuropathic; inflammatory; sensitization (know it's coming)

Front 111

nociceptive pain receptor stimuli (molecules) & neurotransmitters

Back 111

-substance P, bradykinin, leukotrienes
-glutamate**, substance P, serotonin (5-HT)

Front 112

allodynia

Back 112

pain from a stimulus not normally painful

Front 113

"wind-up" phenomenon

Back 113

-constant pain from peripheral nerves can lead to CNS sensitization to pain
-with hyperalgesia, new pain circuits form
-the longer pain goes untreated, the harder it becomes to treat

Front 114

neuropathic pain examples

Back 114

-fibromyalgia
-peripheral neuropathies
-post-herpetic neuralgia

Front 115

CNS modulation of pain

Back 115

-descending pathway activation ↓ perception of pain by inhibiting nerve excitatory impulses
-endogenous opioids found throughout descending spinal cord pathways

Front 116

opioids def. & examples

Back 116

-endogenous NTs
-endorphins, enkephalins, dynrophin

Front 117

opiates def.

Back 117

exogenous compounds with opioid function

Front 118

antinociception def. & physiology

Back 118

-↓ in pain by a descending pathway through spinal cord periaqueductal gray area
-activated by release of opioids > act on opioid receptors in CNS > stimulate release of GABA (inhibitory NT in pain pathways)

Front 119

gamma aminobutyric acid (GABA) function

Back 119

inhibitory NT in pain pathways

Front 120

glutamate function

Back 120

stimulatory NT in pain pathways

Front 121

opioid pain receptor subtypes

Back 121

mu, delta, kappa

Front 122

opioid pain receptor subtype with the most analgesic effects

Back 122

mu

Front 123

sites of opioid action include receptor stimulation in the...

Back 123

PNS and in specific regions of the CNS

Front 124

opioid systemic physiological actions

Back 124

-analgesia: ↑ pain threshold & alter brain's perception of pain
-euphoria
-resp. depression (esp. mu receptors)
-sedation & mental depression
-↓ cough reflex
-↓ GI contractions & secretions
-histamine release: itching, urticaria

Front 125

opioid ocular physiological actions

Back 125

-excitation of parasympathetic NS > miosis (pinpoint pupils with toxicity, pathognomonic), ↑ accomm., ↓IOP

Front 126

pain management levels 1 & 2

Back 126

1) non-opioid analgesics (APAP, ASA, NSAIDs): short-term, non-severe relief
2) opioids (codeine, morphine, oxycodone, etc): moderate to severe pain; short-term preferred due to addiction; efficacy not good in chronic pain Tx, body develops tolerance

Front 127

pain management levels 3 & 4

Back 127

3)adjuvant analgesics (antidepressants, anticonvulsants, corticosteroids, local anesthetics): main Tx for neuropathic pain
4) palliative care: comfortable at end of life

Front 128

acetaminophen (APAP)-Tylenol

MOA / Pcol

Back 128

-exact MOA unknown, suspect COX-3 involvement in brain
-CNS acting to ↑ pain threshold; antipyretic (↓ fever); lacks anti-inflammatory and antiplatelet effects

Front 129

acetaminophen (APAP)-Tylenol

ADR

Back 129

-hepatic toxicity / potentially fatal (g/day): 4/7 acute, 2.6/4 chronic
-alcoholics: toxicity at normal doses
-toxicity in narcotic analgesic combinations (e.g. Vicodin)
-nausea & vomiting in hours; jaundice, hepatic & renal failure days to weeks

Front 130

mu receptor functions

Back 130

-supraspinal and spinal analgesia
-sedation
-inhibition of respiration
-slowed GI transit

Front 131

delta receptor functions

Back 131

-supraspinal and spinal analgesia

Front 132

kappa receptor functions

Back 132

-supraspinal and spinal analgesia
-slowed GI transit

Front 133

glutamate acts on _____ and _____ receptors

Back 133

AMPA (α-amino-methyl-proprionic acid); NMDA (n-methyl D-aspartate)

Front 134

opioid mu, delta, and kappa agonists __________ transmitter release from presynaptic terminals of...

Back 134

↓; nociceptive primary afferents

Front 135

opioid mu agonists can __________ secondary afferent neurons directly and inhibit transmission of pain impulse going to the...

Back 135

hyperpolarize; somatosensory areas of the forebrain

Front 136

drug schedules I-III

Back 136

I: no medical use, high abuse risk; LSD, heroin, ecstacy
II: high abuse risk, may lead to severe dependence; fentanyl, morphine, oxycodone
III: abuse may lead to low/moderate dependence; codeine & hydrocodone combinations, anabolic steroids

Front 137

drug schedules IV-V

Back 137

IV: abuse may lead to limited dependence; alprazolam-Xanax, diazepam-Valium, propoxyphene-Darvon
V: least potential for abuse, may lead to limited dependence; codeine cough syrups, diphenoxylate + atropine-Lomotil

Front 138

WHO 3-Step ladder

Back 138

1: mild; ASA, APAP, NSAIDs
2: moderate; APAP combinations, tramadol
3: severe; morphine, hydromorphone, methadone, levorphanol, fentanyl, oxycodone

Front 139

opium derived from __________, contains __________, and is synthesized into __________

Back 139

poppys; morphine; heroin

Front 140

analgesic layering

Back 140

sustained release analgesics combined with short-acting analgesics for breakthrough pain

Front 141

opioid analgesic general pcol

Back 141

-agonist, partial agonist, or antagonist on the 3 opioid receptor subtypes
-majority agonists on mu receptor

Front 142

spinal analgesia

Back 142

opioid agonists act on primary afferent neurons and inhibit release of excitatory NTs (e.g. glutamate)

Front 143

mu opioid agonists bind to mu receptors on __________ tract neurons to...

Back 143

spinothalamic; ↓ excitatory impulse/action potential generation

Front 144

opioid analgesic general ADR

Back 144

-GI (10%): nausea (21%), vomiting, constipation (15%)
-CNS (10%): sedation, dizziness
-respiratory depression in overdose
-avoid alcohol & sedatives when on opioids

Front 145

opioid tolerance manifests within __________ and can be limited by...

Back 145

2-3 weeks; opioid rotation -> cross-tolerance to other opioids can be minimal

Front 146

psychological dependence

Back 146

desire without physiological manifestations

Front 147

withdrawal syndrome S/S

Back 147

intense dysphoria (anxiety, restlessness, depression), nausea/vomiting, muscle aches, lacrimation, rhinorrhea, mydriasis, piloerection (erection of hair on skin), sweating, diarrhea, yawning, fever

Front 148

withdrawal syndrome usually lasts no more than...

Back 148

2-4 days

Front 149

opioid use in recommended doses may result in __________ but rarely results in __________

Back 149

withdrawal syndrome; addiction

Front 150

morphine-MS Contin/Kadian, meperidine-Demerol, oxycodone-Oxycontin, methadone-Dolophine

Class / Gen. info

Back 150

-full (strong) opioid agonists, schedule II
-most efficacious, high abuse risk

Front 151

full (strong) opioid agonist drugs

Back 151

-morphine-MS Contin/Kadian
-meperidine-Demerol
-oxycodone-Oxycontin
-methadone-Dolophine

Front 152

methadone-Dolophine

Pcol / Indications

Back 152

-mu opioid agonist, NMDA receptor antagonist, inhibits serotonin & NE reuptake
-Tx of opioid addiction, tolerance & dependency develop more slowly

Front 153

hydrocodone + APAP-Vicodin

Class / Gen. info

Back 153

-mild to moderate opioid agonist, schedule III
-#1 selling drug and abused narcotic analgesic

Front 154

codeine + APAP-Tylenol #3

Class / Gen. info / ADR

Back 154

-mild to moderate opioid agonist, schedule III
-antitussive (cough suppressant)
-codeine synthesized from morphine, requires liver metabolism, ~8% of Caucasions lack CYP isoenzymes required
-CNS (>10%): drowsiness
-GI (>10%): neasea, constipation

Front 155

mild to moderate opioid agonists

Back 155

-hydrocodone + APAP-Vicodin
-codeine + APAP-Tylenol #3

Front 156

tramadol-Ultram, tramadol + APAP-Ultracet

Class / Gen. info / Contraindications

Back 156

-weak opioid agonists, not controlled
-moderate to severe pain; much less potential for respiratory depression; can be layered with other opioids
-can cause seizures in epileptics

Front 157

tramadol-Ultram, tramadol + APAP-Ultracet

Pcol

Back 157

-weak mu receptor agonist
-primary mechanism: inhibits reuptake of serotonin (mainly) and NE (somewhat)

Front 158

propoxyphene + APAP-Darvocet

Class / Gen. info / Contraindications / ADR

Back 158

-weak opioid agonists
-low efficacy, low abuse risk
-avoid in elderly
-↑ risk of arrhythmia and seizures

Front 159

weak opioid agonists

Back 159

-tramadol-Ultram
-tramadol + APAP-Ultracet
-propoxyphene + APAP-Darvocet

Front 160

dextromethorphan-Benyln/Robitussin, Vicks Formula 44, hydrocodone + Hycodan/Hydrotuss/Codiclear/Tussionex

Class / Indications / Pcol

Back 160

-Antitussives (cough suppressant)
-COPD patients with persistent, irritating, non-productive cough
-depresses cough centers in medulla oblongata

Front 161

dextromethorphan-Benyln/Robitussin, Vicks Formula 44, hydrocodone + Hycodan/Hydrotuss/Codiclear/Tussionex

Gen. info

Back 161

-chemically related to morphine, lacks narcotic properties in therapeutic doses
-OTC as liquid, capsules, lozenges, syrup
-abuse: "dexing;" hallucinations, intox, out of body experience; brain damage, death

Front 162

antitussives

Use / Drugs

Back 162

-cough suppressants
-dextromethorphan-Benyln/Robitussin, Vicks Formula 44, hydrocodone + Hycodan/Hydrotuss/Codiclear/Tussionex

Front 163

naloxone-Narcan

Class / Indications / Pcol / Gen. info

Back 163

-opioid receptor antagonist
-Tx of opioid dependence; can reverse coma & respiratory depression from opioid overdose; no analgesia
-mu, kappa, & delta receptor antagonist
-initiates withdrawal symptoms w/in minutes

Front 164

opioid receptor antagonist drugs

Back 164

naloxone-Narcan

Front 165

estrone pathway

Back 165

pituitary (ACTH) > adrenal glands (testosterone) > adipose > estrone

Front 166

estrogen physiologic effects

Back 166

-reproductive organ & 2° sexual development
-improves lipid profiles > delays atherosclerotic diseases (until menopause)
-↓ bone breakdown, ↑ intestinal Ca++ absorption

Front 167

menopause ↓ in __________ and __________ secretion by the __________ is a __________ process

Back 167

estrogen; progesterone; ovary; slow and gradual

Front 168

effects of estrogen loss

Back 168

-↑ CV disease, bone loss, skin dryness & loss of elasticity
-genitourinary: infections, vaginal dryness or atrophy, urinary incontinence
-CNS: vasomotor symptoms, insomnia, emotional lability, cognitive function change

Front 169

estradiol def.

Back 169

natural estrogen produced in body

Front 170

17β estradiol, phytoestrogens, conjugated equine estrogens (CEE)-Premarin, ethinyl estradiol

Class

Back 170

-estrogen replacements
-birth control (ethinyl estradiol)

Front 171

raloxifene-Evista, tamoxifen-Nolvadex

Class / Indications / Pcol / ADR

Back 171

-selective estrogen receptor modulator (SERM)
-osteoporosis, HRT, breast cancer prevention (only use for tamoxifen)
-bind to diff. parts of estrogen receptor in diff. organs w/ diff. affinities > variable pcol effects
-↓VA, CME

Front 172

__________ has most benefit for osteoporosis but has ↑ __________

Back 172

Premarin; CV disease risk

Front 173

Premarin

Back 173

conjugated equine estrogens (CEE)

Front 174

progestin physiologic effects

Back 174

-↓ gonadotropin secretion (esp. LH) > ↓ follicle development
-preps endometrium for implantation
-↓ endometrial proliferation & cancer; secretory endometrium development
-maintains pregnancy: ↓ uterine contractility, ↑ mammary gland proliferation

Front 175

medroxyprogesterone-Provera/Cycrin/Amen/Curretab

Gen. info / Use

Back 175

-most similar to endogenous progesterone, highly selective for progesterone receptors
-HRT

Front 176

norethindrone-Micronor/Nor-Qd/Aygestin/Ortho-Novum

Gen. info / Use

Back 176

-resemble testosterone; more andronergic effects
-birth control

Front 177

progestin indications

Back 177

-post-menopausal HRT, contraception w/ or w/out estrogens, endometriosis (endometrial-like tissue grows in other areas of the body, causing pain and irregular bleeding

Front 178

progestin Pcol

Back 178

-binds to progesterone receptors > antagonizes estrogen-induced effects (e.g. endometrial hypertrophy in uterus)
-↓ FSH/LH secretion > ↓ endometrial cell stimulation (endometriosis Tx)

Front 179

progesterone/progestin opposes the actions of __________

Back 179

estrogen

Front 180

post-menopausal Tx

Back 180

-w/out uterus: estrogen alone (raloxifene); progestin for endometrial cancer, no uterus = no endometrial tissue
-w/ uterus: estrogen + progestin
-HRT combination drugs (Prempro)

Front 181

Prempro

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HRT combination drug: conj. estrogen + medroxyprogesterone

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HRT combination drug: conj. estrogen + medroxyprogesterone

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Prempro

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pre-menopausal estrogen seems to prevent __________ while post-menopausal estrogen HRT significantly...

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major disease states; ↓ menopausal symptoms but ↑ many major disease states

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estrogen / estrogen + progestin HRT effects on breast cancer, endometrial cancer, osteoporosis/fractures, & CVD

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↑ , ↑↑ , ↓ , ↑
↑- , ↓ , ↓ , ↑-

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Ovral

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50ug estrogen/progestin combination drug

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Ortho-Cyclen, Loestrin/Minestrin

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sub-50ug monophasic estrogen/progestin combination drugs

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Tri-Cyclen

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sub-50ug multiphasic estrogen/progestin combination drug

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Ovrette

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progestin drug

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estrogen/progestin combination drugs

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-Ovral
-Ortho-Cyclen
-Loestrin/Minestrin
-Tri-Cyclen

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progestin drugs

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-Ovrette
-medroxyprogesterone-Provera/Cycrin/Amen/Curretab
-norethindrone-Micronor/Nor-QD/Aygestin/Ortho-Novum

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oral contraceptive

Pcol / Alternate use

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-continuous estrogens and progestins inhibit release of GnRH, FSH, and LH; ↑ cervical mucous > ↓ sperm movement
-regulating menstrual cycles, e.g. for irregular bleeding, endometriosis

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oral contraceptive

Gen. info / Administration

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-synthetic estrogens used more frequently; very effective (pregnancy rates 1-2%)
-oral monophasic, bi-phasic, tri-phasic, and seasonal; transdermal; progestin only (Ovrette, Plan B)

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progestin only slightly {more/less} effective than combination drugs

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less

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combination oral contraceptive benefits & ADRs

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-↓ ovarian & endometrial cancer, acne, and abnormal menstrual cycles, no ↑ in breast cancer
-↑ clotting disorders, women over 35 who smoke ↑ risk of MI and stroke

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androgen production

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testes > (5-α-reductase) > 5-α-dihydrotestosterone (DHT) production in prostate gland & seminal vesicles

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DHT

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5-α-dihydrotestosterone

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androgen physiological effects

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-androgenic actions of testosterone & DHT: maturation, virilization, libido, ↑ aggression
-anabolic actions of testosterone: ↑ protein synthesis, muscle mass, bone growth; ↑ renal retention of N & electrolytes; ↑ erythropoiesis; atherogenic (↑LDL, ↓HDL)

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testosterone

Gen. info / Pcol / Indications

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-abuse: anabolic steroids
-bind to intracellular androgen receptors
-androgen HRT: impotence, growth, hypogonadism, male menopause; levels ↓ w/ age; anabolic effects (↑ muscle after injury)

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testosterone ADR

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-virtually every organ affected by androgens
-masculinization (>10%); CV (>10%): edema, Na+ retention, atherogenic; hepatic dysfunction (1-10%); CNS: paranoia, mania, delirium, homicidal rage; sterility (1-10%)

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long-term androgen use leads to _________ through what mechanism?

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sterility; ↓GnRH, LH, & FSH secretion > ↓ testis size & sperm production

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finasterid-Proscar

Class / Indications / Pcol

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-antiandrogen
-benign prostatic hyperplasia (BPH, not a cancer); alopecia (loss of hair)
-synthetic testosterone analog, competitive inhibitor of 5-α-reductase > ↓DHT production > ↓ prostate hyperplasia