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108 Cards in this Set
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bromocriptine and cabergoline
|
DA agonist- inhibit the release of prolactin.
used to prevent breast tenderness and lactation cabergoline every other day & less side effects than bromocriptine. |
SE= usu, orhtostatic hypo, and psych disturbances.
|
|
Somatropin and Somatrem
(native rhGH) and same with more methionine at amino terminus |
GH agonist-
used for growth failure in kids (turner's) and cachexia in AIDS pts., GI function in those w/ short bowel syndrome |
SE= edema (reduces with Tx time), myalgia, hyperglycemia & hypothyroidism.
Contra in DM and hypothyroidism or until 1 yr after leukemia Tx. |
|
Mecasermin/ Mecasermin rinfabate
|
recombinant human IGF-1 (not as effective as GH Tx)
Use: those unresponsive to GH therapy (IGF-1 deletion or GHr mutation or antibodies) inject 2xs/day |
SE: hypoglycemia (less with rinfabate; its inactive/bound). other SE sim to GH.
rinfabate not FDA approved, but only need once daily instead of 2xs. |
|
Octreotide
|
Octreotide
somatostatin analog (somatostatin inhibits hormone secretion) inhibits both pituitary and GI hormones. dec pancreatic and gastric acid and slows intestinal motility. use: treat acromegaly and excessive diarrhea. **can shrink tumor |
SE: GI, but subside with time,
gallstone and sludge, bradycardia contra: GB disease, DM, cardiac Dx & thyroid (somatostatin inhibs TSH) |
|
Pegvisomant
|
Pegvisomant
GH receptor antagonist Use: Tx of excess GH (acromegaly)= 97% normal IGF-1 levels acheived. |
unlike octreotide it won't shrink tumor but actually can make it grow; lack of negative feedback.
inject 1x/day |
|
Insulin- lispro
aspart glulisine |
rapid acting insulins.
can inject IV clear, neutral pH, zinc to extend shelf life. |
SE: usu. use regular insulin to treat ketoacidosis even though these can be given IV.
|
|
regular insulin
|
Fast acting
DOC for ketacidosis clear at neutral pH can be given IV |
SE: hypoglycemia, lipodystrophy (alternate injection site), edema. interactions with other drugs, visual disturbances, local allergic Rx.
|
|
NPH or Isophane insulin
|
NPH insulin// Isophane insulin
intermediate-acting insulin turbid suspension at neutral pH not for IV use |
|
|
insulin glargine
detemir |
both are long acting insulin
glargine is pH4.0 that preciptates in body to last longer detemir is myristoylated= bind to albumin=inc T1/2 |
gives a consistent baseline level of insulin
|
|
tolbutamide
|
1st gen sulfonylurea
stims insulin release from beta cells reduce serum glucagon safest in elderly-little hypoglycemia |
can cause hypoglycemia
some GI effects Weight gain contra in renal and hepatic Dx and pts with sulfa allergies |
|
Glyburide
Glimepiride |
2nd gen sulfonyureas-more potent
last 24 h= 1x/day less hypoglycemia than gen 1 Glimepiride most potent & cardioprotective |
contra in renal and hepatic pts
|
|
Glipizide
|
2nd gen sulfonylurea
t 1/2 2-3 hrs-least hypoglycemia ER version last 24 hr but more hypoglycemia |
contra in liver and renal pts
|
|
Repaglinide
|
Repaglinide
meglitinide- not sulfa derivative like sulfonylureas= safe in sulfa allgeric pts less effect on weight rapid acting- rec on K+= mimics insulin better and increases insulin release |
t 1/2= 1h
hypoglycemia contra: pregnancy, renal pts and those prone to hypoglycemia |
|
Metformin-DOC for type II DM
|
biguanide
inc insulin action at mus and fat slows GI absorb of glucose reduces glucagon and gluconeogenesis dec macrovasc events no weight gain safe in children 10+ |
lactic acidosis and diarrhea
hypoglycemia when combo w/ sulfonylureas or insulin contra: preg or breast feeding, lactic acid conditions (renal, hepatic, alcoholic or tissue hypoxia diseases:CHF and COPD) |
|
Pioglitazone
Rosiglitazone |
"insulin sensitizers"
PPAR gamma r ligands increase glucose trans into fat cells can use with metformin but not insulin in type II can dec LDL and prevent type II oral 1-2 /day |
weight gain and edema
black box on rosiglitazone for MI and angina contra: CHF pts, hepatic pts and pregnant |
|
Ascarbose
Miglitol |
Ascarbose and Miglitol
Alpha-glucosidae inhibitors reduce glucose absorption dec postprandial glucose; not fasting can use w/ metformin or sulfon's or insulin no weight gain |
flatulence, diarrhea; GI
contra: preg, hep/ren/GI pts |
|
Exenatide
Liraglutide |
GLP-1 agonist resistant to DPP-IV degradation
postpran and fasting glucose better control may inc beta cell #/function weight loss-slows gastric empty=pt eats less exan= SC inject b4 2 main meals lira= 1 SC inject/day |
Exenatide; acute pancreatitis and pancreatic and thyroid CA risk(Lira black box)
|
|
Sitagliptan
|
DPP-IV inhibitors
potentiates effects of incretin homones dec postpran and fast glucose no weight gain oral 1/day |
acute pancreatitis and risk panc CA
Contra: slow GI pts and preg/BF |
|
Pramlintide
|
synthetic analog of amylin (amylin works w/ insulin to dec glucose)
slows gastric emptying suppress glucagon postpran modulates appetite in CNS weight loss SC inject 3/day- must use with insulin in type I and II |
SE: GI and hypoglycemia
contra: slow GI pts, preg/BF |
|
Bromocriptine
|
Bromocriptine
DA agonist- inhibits excessive symp tone=less hepatic glucose production dec fast.postpran FA and TAGs reduces cardiovascular end point problems by unknown mec oral within 2 hr of wake lower dose and faster peak than bromo used for other indications |
usual effects
psych, hallucination & fibrotic complications at higher doses |
|
Glucagon
|
inc blood glucose when glycogen is available
reg glucos, aa and FA potent inotropic and chronotropic effects on heart-used in beta block o/d IM.IV, SC no oral |
not as effective in kids or starved, adrenal insufficient or chronic hypoglycemic pts
profound relax of intestines onset is gradual |
|
Diazoxide
|
Diazoxide
non-diuretic thiazide, vasodialtor and hyperglycemic inhibits insulin secretion or dec peripheral glucose utiliaztion use: pts with insulinoma oral; duration 24-36 h |
SE: hyperglycemia with poss ketoacidosis,Na/h2o retention-->hypotension, excess hair growth in kids
|
|
Gonadorelin
|
Short acting GnRH agonist
not available in US anymore Use; treat infertility, delayed puberty SC injection or pumps |
SE: less likely to cause ovarian hyperstim then LH or FSH
|
|
Leuprolide
Goserelin |
Leuprolide and Goserelin
long-acting GnRH agonist contiunous administration causes intial surge then inhibition of gonadatropin release Use: prostate CA to reduce androgen, treat precocious puberty |
SE: menopausal symp in women, testicular atrophy. initial rise in testosterone in men with prostate CA may cause bone pain (give anti-androgen simultaneously).
contra: preg and BF |
|
Cetrorelix
|
Cetrorelix
GnRH antagonist Use: supress endogenous LH and FSH for ART SC inject 4-5 days vs 3 wks w/ Leuprolide |
SE: none, well tolerated
|
|
hMG (human menopausal gonadotropins)
Menotropins |
FSH drug
Tx: to stim follicle production contains both FSH and LH. from urine of postmen women stimulates the develop of ovarian follicles and spermatogenesis |
|
|
hCG
from urine of pregnant women |
Use: binds to the LH receptor
Longer T1/2 than LH. rhCG subcut hCG IM |
|
|
Ethinyl estradiol
Mestranol |
synthetic estrogens- only in OCs
very potent Use: contraception, decrease uterine bleeding, supress ovulation or excess ovarian androgens or treat adrongen dependent CA (prostate) |
SE: Migraines, thromboembolism and blood clots
Contra: estrogen dependent breast CA, thromobotic disorders , smoking. |
|
conjugated equine estrogens
synthetic conjugated estrogens esterified estrogens |
horse
plant estrogens Use: HRT |
same as OC
|
|
Diethylstillbestrol
|
non-steroid with estrogenic activity
primary hypogonadism: pts 11-13 to stimulate puberty and growth |
SE: developmental abnormalities to fetus when exposed in utero
|
|
Tamoxifen
|
SERM (selective estrogen receptor modulator)
agonist in uterus and bone antagonist in breast Use: Tx estrogen depend breast cancer |
SE: inc risk of uterine CA
|
|
Raloxifene
|
Raloxifene
SERM- antagonist in breast and uterus agonist in bone Use: prevent postmen osteoporosis lowers ttl and LDL chol |
SE: hot flashes and DVT risk
|
|
Fulvestrant
|
Fulvestrant
full estrogen receptor antagonist Use: in pts with Tamoxifen resistant tumors |
SE: hot flashes
|
|
Anastrozole
|
Aromatase inhibitor
non-steroidal competitive inhib of aromatase Use: Tx of advanced breast CA in postmen women; Tamox -resistant |
SE: menopause sympt
|
|
Progesterone
Medroxyprogesterone |
Pregane (progest derivaitve)
medroxy-doesn't require inject Use: OC and prevent enodmetrial hyperplasia in HRT |
SE: inc BP, depression and drowsiness,
|
|
Norethindrone
|
estrane- synthetic progest from testosterone
Use: OC and HRT |
SE: inc BP and depression
*may reduce plasma HDL |
|
Norgestrel
|
Gonanes- have selective progestin activity
Use: OC or HRT |
SE: inc BP, depression, drowsy
|
|
Mifepristone (RU 486)
|
Progesterone receptor blocker
prevents progestin binding Use: pregnancy termination, or implantation prevention antagonizes glucocorticoid receptor |
SE: GI and vag bleeding
Contra: pregnancy that want to keep or BF, anemics, pts on glucocorts or anticoags |
|
Danozol
|
Danozol
Weak progestin,androgen &glucocorticoid that supresses ovarian function Use: Tx of endometriosis |
SE: weight gain, hirsiutism
Contra: liver pts, preg or BF |
|
Drospirenone/ethinyl estradiol (Yaz)
|
Combo estrogen and spironolactone (progesterone agonist effect).
Use: contraception, water retention and PMDD |
SE: drospirenone has some low andronergic effects
|
|
Testosterone
Methyltestosterone |
anabolic and andronergic
Use: testicular deficiency; pre/post-pubertal hypogonadism in women in combo with diethystilbestrol for female hypopituitarism hypoproteinemia of nephrosis and negative nitrogen balance in post-op, burn and premature pts |
SE: dec testosterone production/spermatogenesis in men
masculinization in women, psuedohermaphroditism in fetus, oily skin,acne, dec HDL and agression |
|
Flutamide
|
Flutamide
androgen receptor antagonist Use: prostate CA (w/leuprolide), topically for hirsuitism and male pattern baldness |
SE: mild hepatotox, libido effects
|
|
Finasteride
Dutasteride |
Finasteride and Dutasteride
Inhibits 5a-reductase (enzyme that converts testosterone to DHT) Use: Tx of BPH, male pattern baldness |
SE: reduces PSA; mask prostate CA?, teratogenic- male fetus abnormalities.
|
|
Oxytocin
|
Use: induce labor at term, prevent post partum hemorrhage
IV,IM or nasal |
SE: water intox (ADH-like effects)
uterine rupture(large dose) anaphylaxis sinus bradycardia of fetus from extreme uterine contractions |
|
Ergonivine maleate
|
Ergonivine maleate
activate serotonin and a-andrenergic receptors on smooth muscle Use: contract uterus after delivery of placenta action 30 sec after IV, 10 min after oral |
Contra: never to induce labor--> fetal hypoxia, hep/ren failure
|
|
Dinoprostone
|
syntehtic prostaglandin E2
Use: induce expulsion of uterine contents(suppository) or cervical ripening prior to delivery(gel) |
SE: GI, severe v/diarrhea
contra: fetal distress, Hx of difficult deliveries |
|
MgSO4
|
relaxes uterine muscle; mech unknown
Use: preterm labor (notFDA) or preeclamptic pts to prevent convulsions IV-slowly (hypotension or asystole if too fast) |
SE: depressed reflexes and causes weakness, circulatory collapse and CNS/resp depression.
|
|
Nifedipine
|
Nifedipine
Ca++ channel blocker Use: preterm labor (not FDA) now a 1st line with B2 antagonists not availalbe. |
SE: flushing, h/a, hypotension
|
|
Indomethicin
|
Indomethicin
NSAID Use; preterm labor (not FDA) by reducing prostaglandin synthesis |
SE: GI irritation, risk of partial closure of the fetal ductus arteriosus
|
|
Progesterone
|
Use: prophylactically weeks 16-37 to maintain pregnancy- only in high risk women
|
|
|
Nitroglycerin
|
emergency use only; uterine rupture
|
contra: in uncorrected hypovolemia, severe anemia, intracranial pressure and cardiac issues
|
|
Ethanol
|
direct relax of myometrium and inhibition of oxytocin
inject 7.5 ml/kg for 2 hrs then 1.5 for up to 10 hrs |
|
|
Cortisone
Hydrocortisone |
equal mineralcorticois and glucocorticoid properties
Use: in pts with adrenal insufficiency |
|
|
Prednisone
Prednisolone (prednisone converts to prednisolone in liver) |
more glucocorticoid activity than mineral.
Use: anti-inflammatory with salt retaining effects |
SE: with long term use: dec immunity, peptic ulcers, dec glucose tolerance, osteoporosis, glaucoma, cataracts, restlessness,CNS effects (occur rapidly after Tx onset), muscle wasting and Na adn water retention, truncal obesity, increase appetite, buffalo hump, adrenal insufficiency if stopped abruptly.
Contra: immune compromised, heart/ HTN pts, osteoporotic pts, first trimester of preg. |
|
Triamcinolone
Methylprednisolone |
Triamcinolone and Methylprednisolone
Glucocorticoids almost no mineralcorticoid acitivity Use: highest anti-inflamm effects with no Na retaining |
SE: usual glucocorticoid effects
|
|
Dexamethasone
|
glucocorticoid
Use: cerebral edema; enters CNS use when endogenous cortisol levels have to be measured ; no cross react |
SE: usual glucocorticoid
|
|
Fluticasone
|
glucocorticoid
Use: inhaled for intranasal to Tx asthma and rhinitis |
|
|
Aminoglutethimide
|
corticosteroid inhibitor
inhibits the conversion of cholesterol to pregnenolone= inhibits all steroid synthesis Use: off market, used for Cushing's meta breast CA and prostate CA unresponsive to other treatments |
can cause adrenal insufficiency. must give corticosteroids concomitantly
Inhibits estrogen synth, less effect on testosterone |
|
Ketoconazole
|
Oral anti-fungal that inhibits steroidogenesis at higher doses (inhibits 17a-hydroxylase)= dec androgens then cortisol.
Use: Cushing's pts before surgery or radiation or long term mgnt. |
SE: reversible heptox, gynecomastia, impotence and dec libido
|
|
Mitotane
|
Mitotane
Adrenocorticolytic; selective atrophy of zona fasciulata/reticularis of adrenal gland. not in US Use: primary adrenal carcinoma, instigate remission of Cushing's |
SE: severe GI
Conra; inc met of phenytoin and warfarin |
|
Metyrapone
|
Metyrapone
inhibits terminal enzyme in cortisol synth. *request compassion use from Novartis Use: short term symptomatic until Cushing's determined *only one in class OK for pregnant |
SE: GI, hirsuitism
less toxicity than mitotane |
|
Mifepristone RU486
|
antagonist of progesterone receptor and at high doses glucocorticoids
Use: abortions and inoperable ectopic ACTH secretion and adrenal carcinoma |
SE: gut pain, amenorrhea
|
|
Spironolactone
|
K+ sparing diuretic that at high doses has anti-andronergic effects.
Use: HTN, Hirsuitism and ascites |
SE: hyperkalemia, gynecomastia and menstrual irregularities
|
|
Levothyroxine Na+
Liothyronoine Na+ |
Levo=Na+ salt of T4; DOC
Lio= Na+ salt of T3;works faster, but not for maintenance Use: hypothyroidism, Hashimoto's, thyrotropin-dependent carcinoma |
SE: hyperthyroidism, palpatations, tachycardia, weight loss, insominia, heat intolerance
|
|
Methimazole (DOC)
Propylthiouracil |
inhibits synthesis of thyroid hormone
Use: DOC for Grave's; if used before radioactive iodine= less chance of thyroid storm. |
PTU- black box for severe liver injury/failure.
SE: itching,rash,granulocytopenia and agranulocytosis, sore throat. low dose in pregnancy to prevent goiter and cretinism |
|
Iodide
|
decreases synthesis of T3 and T4. and rapid dec in thyroid hormone release.
used prior to surgery because dec vascularity of gland. prevents uptake of radioactive iodine |
SE: effects wear off after 6-8 weeks; not long term Tx.
|
|
Radioactive Iodine
|
becomes trapped in gland and beta rays destroy the gland.
Use: hyperthyroid in elderly and those w/heart Dx for thyroid ablation low doses diagnostic |
SE: hypothyroidism
|
|
Propranolol
|
B-blocker
Use: reduce s/s of hyperthyroidism and dec peripheral conversion of T4 to T3 not a monotherapy; given w/ thiomides |
Contra: pts with COPD or asthma, caution in DM; can use Ca+ channel blockers if propranolol is contraindicated
|
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Calcitonin
|
hormone that antagonizes action of PTH and inhibits bone reabsorb of Ca+ and phosphate by osteoclasts
Use: prevent vert compression fractures Intranasal or inject |
SE: allergic Rx, rhinitis and sinusitis w/ intranasal form, n/v
|
|
Teriparatide
|
Teriparatide
recombinant PTH (new Tx for ostoeporosis) only anabolic osteoporisis Tx, but effects diminish w/time; use on ly 18-24 mos. hypoparathyroidism |
SE: osteosarcoma (black box), inc serum Ca= and dec serum phos
contra: open epiphysis , radiation therapy |
|
Denosumab
|
Denosumab
human monoclonal antibody against RANK lligand (RANK-l needed for maturation of osteoclast) inc bone mass and strength in cortical and trabecular bone Use: severe osteoporisis, |
SE: hypocalcemia, cellulitis
Contra: hypocalcemia; fix this 1st |
|
Alendronate (Fosamax)
|
Bisphosphonate-oral binds Ca+ salts and substitutes phosphate molecule forming a complex that inhibits bone breakdown and resorption
|
SE:GI irritation, n/v (must take 2 hrs before b-fast,
osteonecrosis of jaw following dental work. Contra: pts with esophageal Dx, pts who can't stay upright for hour. Ca+ supplement that day will inhibits it's absorb |
|
Zoledronic acid
Pamidronate (off label) |
IV- Bisphosphonates
Use: DOC for osteoporosis administer once every 3 mos or once/yr may require coadmin of Ca+ and Vit D during therapy |
SE: renal tox if administered too fast
|
|
Aluminum Hydroxide
Magnesium Hydroxide (Maalox) |
inorganic bases
neutralize gastric acid often combined due to opposing actions of diarrhea(Mg) and constipation(Al). |
SE: systemic absorption of Al, Mg and Ca if renal impaired.
* can interfere with absorb of sulfonamides, valproic acid and L-dopa, dec bioavail of phenytoin and digitalis. increase renal clear of salicylates and phenobarbs |
|
Sodium bicarbonate (tums)
|
acid neutralization
|
same as Mg/Al hyddroxides with drug interactions.
elderly take them as "candy" |
|
Cimetidine
Ranitidine Nizatidine |
Cimetidine // Ranitidine // Nizatidine
H2 Histamine receptor antagonist (g-protein linked= inc cAMP=stim H+/K+ATPase proton pump= H+) Use: GERD, PUD and Zollinger-Ellison syndrome |
SE: low incidence.
Cimetidine at high doses is antiandrogenic and use to treat hirsiutism in females. drug interactions: warfarin, phenytoin, theophylline, phenobarb, some benzos, Propanolol, digoxin, qunidine, TCAs, nifedipine |
|
Omeprazole
Esomeprazole Rabeprazole |
Proton pump inhibitor (irreversible)- final stage of Gastric acid production, by binding of the activated drug to the H+/K+ATPase in the parietal cell.
Use: DOC for GERD, and esophagitis. last 24-48 h Long term Tx common. best on empty stomach. |
SE: dec absorb of Ca+ = risk of osteoporosis.
Interact with phenytoin, diazepam and warfarin |
|
Sucralfate
|
aluminum salt of sulfated sucrose.
polymerizes and forms a sticky protective barrier in stomach Use: protects ulcer craters from acid as they heal |
SE: constipation
DI: digitalis, tetracycline and phenytoin |
|
Misoprostol
|
Misoprostol
prostaglandin E1 analogue Use: prevent ulceration by NSAIDs |
SE: usu
Contra: preg=induces uterine contractions and abortion |
|
Metoclopramide
|
D2 receptor antagonist
(DA slows GI) inc GI motility and tone of smooth muscle; antiemetic |
SE: extrapyramidal symptoms
Contra in parkinson's and pregnancy. |
|
Bethanechol
|
Muscarinic agonist
Use: inc tone and motility of GI; post operative ileus or increase lower esophegeal tone |
SE: usu muscarinic; diarrhea, sweating, sweating, urinary incontinence
|
|
Erythromycin
|
antibiotic
strong contractions of GI via stimulation of motilin; usu a side effect Use: bowel dysmotility and rapid clearance of stomach contents |
|
|
Glycopyrrolate
Dicyclomine |
Glycopyrrolate// Dicyclomine
antimuscarinic agents Use: gastrointestinal antispasmotics; dec intestinal overactivity, cramping and spasms |
SE: sedation, dry mouth and constipation
|
|
Amitriptyline
|
TCA
Use: treatment of irritable bowel syndrome; anticholinergic effects dec spasticity and dec pain. |
|
|
Ondansetron
|
Ondansetron
5HT3 receptor antagoinist; selective Use: treat vomiting from chemo and vagal stimulation |
SE: dizziness and constipation
|
|
Prochlorperazine (Compazine)
Promethazine (Phenergan) |
block DA, muscarinic and histamine receptors
Use: post-op n/v, |
SE: significant sedation due to block of Histamine and muscarinic
|
|
Dronabinol
(pot) |
mech not well undrstood
Use: antiemetic and appetite stimulator. |
|
|
Magnesium hydroxide
sodium salts (fleet) Lactulose Polyethylene glycol (colon prep) |
Osmotic laxatives
Fleet orally or as enema lactulose also used in pts with cirrhosis to dec ammonia buildup all can be used as an intestinal prep for bowel surgery or colonoscopy |
SE: intense shitting (I'm get tired, give me a break, however it is true).
Contra: sodium salts (fleet) in pts with CHF. |
|
Docusate sodium (Colase)
|
emulsifying agent that allows water to penetrate the colonic contents and soften them by inc water absorption when taken orally.
|
|
|
Lubiprostone
|
Prostaglandin E derivative
inc intestinal fluid secretion via luminal Cl- channels. Use: soften stools and reduce bloating and promote spontaneous BMs. do not develop tolerance as in other laxatives. |
SE: mild; the usu n, h/a and diarrhea
|
|
Loperamide (imodium)
|
opioid analogue
decreased peristalsis at low dose w/little abuse risk(no CNS effects) |
SE: abdominal pain. distention, constipation, dry mouth and n/v
high doses- CNS effects and respiratory depression |
|
Dipehnoxylate/atropine (Lomotil)
|
combo of opiod diphenoxylate and atropine (anticholinergic)
Use: antidiarrheal |
SE: diphenoxylate has CNS and abuse potential therefore combined with atropine which has unpleasant effects; blurred vision and dry mouth, to reduce abuse potential.
SE: anorexia, pruritis and numbness in extremities Contra: ulcerative colitis and pts with drug abuse Hx or to Tx diarrhea with organisms that penetrate the gut. |
|
Simethicone (gas-Ex)
|
antiflatulent that coats and dissipates gas to make it pass with less of a noticeable effect.
|
|
|
Bismuth; pepto bismol
|
absorbs excess water and may absorb some microbial toxins
salicylate inhibits prostaglandins; antiinflammatory Use: traveller's diarrhea |
SE: black/darkened stools
contra: aspirin allergic pts and children; Reyes syndrome (use Bismuth citrate instead) |
|
Isoproterenol
|
B-andrenergic agonist; non-selective.
Use: bronchodilation |
SE: heart side effects (tachycardia, etc) = rarely used
|
|
Albuterol
Levalbuterol Pirbuterol |
selective B2 agonists. 1st line drug for asthmatics
Use: for fast aciting bronchodilation for acute asthma attack- without the B1 stimulation to the heart. Albuterol has an oral form as well as inhaled |
SE: levalbuterol few SE than albuterol.
Pirbuterol hard to use in acute attack because no spacer on inhaler. |
|
Salmeterol
Salmeterol/Fluticasone (Advair) |
Beta 2 bronchoselective dilators with long action.
Use: prophylactically to dec likelihood of bronchospasm and for nocturnal asthma. salmeterol/fluticasone= Beta 2 agonist&corticosteroid. |
SE: not for acute attacks, take 20 minutes to work.
need to be combined with a corticosteroid if not already(Advair). does not replace fast-acting; need both |
|
Ipratroprium(Atrovent)
Tiotropium (spiriva) |
muscarinic antagonist- quaternary ammonium compound that stays in the lungs and slowly bronchodilates.
Use: COPD and emphysema often with a B2 agonist, when beta isn't enough or tolerated |
SE; cough, dry mouth and paradoxical bronchconstriction
|
|
Theophylline
|
CNS stimulant; elevates mood and decreases fatigue by blocking adenosine receptors. also a phophosdiesterase inhibitor and relaxes smooth muscle of bronchiles.increases diaphragm contraction. Oral
|
SE: cardiac stimulation and diuretic, insomnia and nervousness, low therapeutic index.
DI: phenytoin, smoking, Oral contraceptive inc clearance, Cimetidine dec clearance |
|
Beclomethasone
Flunisolide Fluticasone |
Beclomethasone, Flunisolide and Fluticasone
corticosteroids Use: severe asthma, dec inflammation, should always be used with a long-acting B agonist |
SE: not with short term use
SE: oropharyengeal candidiasis, hoarseness and dec in bone density(use spacer to dec swallowed drug). |
|
Zafirlukast
Montelukast Pranlukast |
block the leukotriene receptor.
oral, must take chronically. Use: decrease need for inhaled oral steroids; still need a B2 agonist attack inhaler. |
SE: few slight inc in URI, sore throat.
|
|
Zileuton
|
Zileuton
blocks 5-lipoxygenase= dec synthesis of leukotrienes. Use: same as leukotriene inhibitors may also dec asthmatic reaction to aspirin and NSAIDs. |
SE: few same as leukotriene inhibitors
|
|
Cromolyn sodium
|
Cromolyn sodium
inhibits the release of histamine from mast cells Use: treat allergic asthma esp in kids, inhaled several xs/day to be prophylactic. load for 2-3 months for full effect. DOC for inflammation in children |
SE: bad taste
|
|
Omalizumab
|
Omalizumab
monoclonal ab targeted at IgE Use: prevent allergic reactions in pt with mod-severe asthma and dec need for steroids. food allergy treatment as well. inject SC every 2-4 weeks |
|
|
Diphenhydramine(benadryl)
Promethazine (phenergan) Hydroxyzine |
antihistamine- sedating
antiemtic and anaticholenergic activity Use: allergies, antiemetic and motion sickness |
SE: very sedating first generation antihistamines due to enter the CNS
|
|
Brompheniramine maleate
Cholorpheniramine maleate |
moderately sedating first gen antihistamine; bulkier and don't cross the BBB as readily as sedating first gen H1 blockers.
|
SE: still sedating just not as much as other 1st gen.
dry mouth |
|
Loratadine
Desloratidine Levocetirizine Certirizine Fexofenadine |
second generation non-sedating antihistamines H1 antagonists
are much bulkier and don't get into the CNS and cause sedation and they are not anticholenergic. better at preventing than treating |
SE: Cetirizine elimnated by kidney only; caution in renal pts.
liver tox poss in rest 2nd gen metabolized by CYp3A4= possibility of drug interactions. all antihistamines may lower siezure threshold and are teratogenic; don't use in pregnancy. |
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Azelastine
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Azelastine
Nasal H1 antihistamine non-competitive H1 blocker and also decreases the release of histamine from mast cells Use: allergic rhinitis |
SE:
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