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632 Cards in this Set
- Front
- Back
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What drug is used to close a PDA?
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indomethacin
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What drug is used to keep PDA open? Why is that useful?
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Patency is maintained by PGE synthesis
May be necessary to sustain life in conditions such as transposition of the great vessels |
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Antihypertensive therapy
1. Essential HTN 2. CHF 3. Diabetes mellitus |
1. diuretics, ACE-I, ARBs, CCBs
2. diuretics, ACE-I, ARBs, B-blockers (compensated CHF), K+ sparing diuretics 3. ACE-I, ARBs, CCBs, diuretics, B-blockers, a-blockers |
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What HTN drugs are protective against diabetic nephropathy?
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ACE inhibitors
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What drug is first-line therapy for HTN in pregnancy (in addition to methyldopa)?
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hydralazine
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What three drugs block voltage-dependent L-type Ca channels of cardiac and SM --> reducing muscle contractility
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Nifedipine, verapamil, diltiazem
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What drug vasodilates by releasing NO in SM, causing an increase in cGMP and SM relaxation?
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Nitroglycerin
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1. Which drug vasodilates aterioles > veins?
2. Which drug vasodilates veings >> arteries? |
1. hydralazine
2. nitroglycerin |
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Which CCB has the largest effect on cardiac muscle?
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verapamil
(Verapamil = Ventricle) |
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Which drug is frequently co-administered with a B-blocker to prevent reflex tachycardia?
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hydralazine
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Name the toxicities for each of these drugs:
1. Hydralazine 2. CCBs 3. Nitroglycerin/isosorbide dinitrate |
1. Compensatory tachycardia, fluid retention, nausea, headache, angina; Lupus-like syndrome
2. Cardiac depression, AV block, peripheral edema, flushing, dizziness, constipation 3. Reflex tachy, hypotension, flushing, headache |
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1. Compensatory tachycardia, fluid retention, nausea, headache, angina; Lupus-like syndrome
2. Cardiac depression, AV block, peripheral edema, flushing, dizziness, constipation 3. Reflex tachy, hypotension, flushing, headache |
Name the toxicities for each of these drugs:
1. Hydralazine 2. CCBs 3. Nitroglycerin/isosorbide dinitrate |
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What is "Monday disease?"
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From industrial exposure to nitroglycerin (e.g. munitions workers)
--developed tolerance for vasodilating action during the work week, but lost tolerance over the weekend --resulted in tachycardia, dizziness, headache on re-exposure on Monday |
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What drug is used for angina and pulmonary edema, but can also be used as an aphrodisiac and erection enhancer?
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Nitroglycerin
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What three drugs can be used to treat malignant HTN?
What is the mechanism for each one? |
1. Nitroprusside = short-acting, increases cGMP via direct release of NO
2. Fenoldopam = D1 receptor agonist (relaxes renal vascular SM) 3. Diazoxide = K+ channel opener, hyperpolarizes and relaxes vascular SM |
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Name the drug that can cause these side effects:
1. Cyanide toxicity from CN release 2. Compensatory tachycardia, fluid retention 3. Hyperglycemia from reduction in insulin release 4. AV block |
1. Nitroprusside
2. Hydralazine 3. Diazoxide 4. CCBs |
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What is the goal/method of antianginal therapy? What 5 things are targeted?
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Reduce myocardial O2 consumption by decreasing...
1. End diastolic volume 2. Blood pressure 3. HR 4. Contractility 5. Ejection time |
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What two partial B-agonists are contraindicated in angina?
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Pindolol, acebutolol
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What agent is best at lowering LDL? How does that agent work? How does it affect HDL, TGs?
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Statins work by inhibiting mevalonate, a cholesterol precursor
HDL = slight increase TG = slight decrease |
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What agent is best for increasing HDL? How does it work? What are its effects on LDL, TGs?
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Niacin works by inhibiting lipolysis in adipose tissue, reducing hepatic VLDL secretion into circulation
LDL = moderate decrease TGs = slight decrease |
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What lipid-lowering agent tastes bad and causes GI discomfort? Why is it used? How does it work?
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Bile acid resins prevent intestinal absorption of bile acids, so the liver must use cholesterol to make more
LDL = moderate decrease HDL = slight increase TGs = slight increase |
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How does ezetimibe work? What is it used for?
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Prevents cholesterol reabsorption at SI brush border
LDL = moderate decrease HDL, TGs = no effect |
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What agent has the most potent effect on lowering TGs? How does it work? How does it affect LDL, HDL?
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"Fibrates" upregulate LPL --> increasing TG clearance
LDL = slight decrease HDL = slight increase |
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Side effects for each of these are...
1. Statins 2. Niacin 3. Bile acid resins 4. Ezetimibe 5. Fibrates |
Side effects of lipid-lowering drugs...
1. hepatotoxicity (increased LFTs), rhabdomyolysis 2. red, flushed face (which is decreased by aspirin or long-term use); hyperglycemia, hyperuricemia 3. Tastes bad, GI discomfort, less absorption of fat-soluble vitamins, cholesterol gallstones 4. Rare increase in LFTs 5. Myositis, hepatotoxicity, cholesterol gallstones |
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Side effects of lipid-lowering drugs...
1. hepatotoxicity (increased LFTs), rhabdomyolysis 2. red, flushed face (which is decreased by aspirin or long-term use); hyperglycemia, hyperuricemia 3. Tastes bad, GI discomfort, less absorption of fat-soluble vitamins, cholesterol gallstones 4. Rare increase in LFTs 5. Myositis, hepatotoxicity, cholesterol gallstones |
Side effects for each of these are...
1. Statins 2. Niacin 3. Bile acid resins 4. Ezetimibe 5. Fibrates |
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Which lipid-lowering agent exacerbates gout?
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Niacin
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Which two lipid-lowering agents can cause cholesterol gallstones?
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Niacin, Fibrates
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How does digoxin work?
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Directly inhibits Na/K ATPase
Leads to indirect inhibition of Na/Ca exchanger Increases intracellular Ca --> positive inotropy (increased contractility) |
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What is the clinical use of digoxin?
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CHF (increases contractility), a-fib (decreases conduction at AV node and depression at SA node)
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What is digoxin toxicity?
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Cholinergic = nausea, vomiting, diarrhea, blurry yellow vision (think Van Gogh)
ECG = increased PR, decreased QT, scooping, T-wave inversion, arrhythmia, hyperkalemia |
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What worsenes digoxin toxicity?
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1. Renal failure (decreased excretion)
2. Hypokalemia (permissive for digoxin binding at K-binding site on Na/K ATPase 3. Quinidine (decreases clearance; displaces digoxin from tissue-binding sites) |
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What is the antidote for digoxin toxicity?
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Slowly normalize K+
lidocaine cardiac pacer anti-dig Fab fragments Mg++ |
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List the class I anti-arrhythmics. What is there general mechanism?
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Na+ channel blockers = slow or block conduction, decrease the slope of phase 0 depolarization and increase threshold for firing in abnormal pacemaker cells
Class IA = "The Queen Proclaims Diso's pyramid" = Quinidine, Procainamide, Disopyramide Class IB = "I'd Buy Lidy's Mexican Tacos" = Lidocaine, Mexiletine, Tocainide Class IC = "Chipotle's Food has Excellent Produce" = Flecainide, Encainide, Propafenone |
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What effect to each of the sub-classes of class I antiarrhythmics have on AP duration?
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Class IA = increased AP duration
Class IB = decreased AP duration Class IC = no effect on AP duration |
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Which class is useful for both atrial and ventricular arrhythmias, especially reentrant and ectopic supraventricular and ventricular tachycardia?
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Class IA
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Which class is useful for acute ventricular arrhythmias (esp. post-MI) and in digitalis-induced arrhythmias?
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Class IB
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What class is useful in V-tachs that progress to VF and in intractable SVT?
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Class IC
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Which class is best post-MI and which is contraindicated post-MI?
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IB is Best post-MI
IC is Contraindicated post-MI |
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Which ion abnormality causes increased toxicity for all class I drugs?
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hyperkalemia
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What are the toxicities of IA, IB, and IC antiarrhythmics?
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IA = quinidine (cinchonism--headache, tinnitus); thrombocytopenia; TdP due to increased QT interval; procainamide (reversible SLE-like syndrome)
IB = local anesthetic; CNS stimulation/depression, CV depression IC = proarrhythmic, esp post-MI (contraindicated). Significantly prolongs refractory period in AV node |
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How do class II antiarrhythmics work?
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B-blockers: decrease cAMP and Ca++ currents. Suppress abnormal pacemaker cells by decreasing the slope of phase 4
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What is particularly sensitive to class IIs?
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AV node
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Which B-blocker is very short acting?
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Esmolol
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When are class IIs used?
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V-tach, SVT, slowing V rate during a-fib/a-flutter
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What are the toxicities of class IIs?
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Impotence, exacerbation of asthma
CV (bradycardia, AV block, CHF) CNS (sedation, sleep alterations) May mask the signs of hypoglycemia |
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Which class II drug can cause dyslipidemia? How do you treat an overdose?
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Metoprolol
Treat overdoes with glucagon |
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How do class III antiarrhythmics work?
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K+ channel blockers = increase AP duration, increase ERP
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What are side effects for the major class IIIs?
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Sotalol = TdP, excessive B-block
Ibutilide = TdP Bretylium = new arrhythmias, hypotension Amiodarone = pulmonary fibrosis, hepatotoxicity, hypo/hyper-thyroidism (also corneal/skin deposits leading to polydermatitis, neurologic effects, constipation, bradycardia, heart block, CHF) |
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What should you remember to check when using amiodarone?
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PFTs (pulmonary)
LFTs (liver) TFTs (thyroid) |
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How do class IVs work? Name 2.
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Verapamil, diltiazem decrease conduction velocity and increase both ERP and PR interval
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When are class IVs used?
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Prevention of nodal arrhythmias (e.g. SVT)
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What are the major toxicities of class IVs?
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Constipation, flushing, edema
CV (CHF, AV block, sinus node depression) |
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Other antiarrhythmics are...
1. adenosine 2. K+ 3. Mg++ ...what do they do? |
1. increase K+ flow out of cells --> hyperpolarization; decreases Ica (drug of choice for diagnosing/abolishing SVT). Very short acting (15sec). Toxicity includes flushing, hypotension, chest pain.
2. Depresses ectopic pacemakers in hypokalemia (e.g. digoxin toxicity) 3. Effect in TdP and digoxin toxicity |
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What blocks the effects of adenosine?
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theophylline
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Three forms of rapid acting insulin
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Lispro (Humulog)
Aspart Regular |
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Intermediate acting insulin
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NPH
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2 forms of long-acting insulin
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Glargine (Lantus)
Determir |
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Insulin uses beyond DM
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Life-threatening hyperkalemia
Stress-induced hyperglycemia Gestational diabetes |
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2 insulin toxicities
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Hypoglycemia
Hypersensitivity reaction (very rare) |
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Why shouldn't you use non-selective beta blockers in DM, and what should you use instead?
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Mask symptoms of hypoglycemia
Selective beta-1 blockers |
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Mechanism of sulfonylureas
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Close K_ channel in beta cell membrane --> depolarization --> triggers insulin release
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Why can't sulfonylureas be used in T1DM?
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Stimulates endogenous release: requires some islet function
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3 2nd generation sulfonylureas?
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Glyburide
Glimepiride Glipizide (1st generation: tolbutamide, chlorpropamide) |
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Toxicity of 2nd generation sulfonylureas?
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Hypoglycemia
(1st generation caused disulfiram-like effects) |
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Name the biguanide
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Metformin
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Effects of metformin
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Decreased gluconeogenesis
Increased glycolysis Increased peripheral glucose uptake (insulin sensitivity) |
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Which oral hypoglycemic can be used in patients without islet function?
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Metformin
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Patients on metformin must be monitored annually with what test?
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Creatinine
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Metformin toxicity?
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Lactic acidosis
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Metformin is contraindicated in these pts
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Renal failure, Cr >1.4
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Name the 6 classes of oral hypoglycemics
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Sulonylureas
Biguanides Glitazones/ thiazolidinediones alpha-glucosidase inhibitors Mimetics GLP-1 analogs |
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Mechanism of glitazones/ thiazolidinediones
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Increase insulin sensitivity in peripheral tissue; binds PPAR-gamma nuclear transcription regular
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Two types of glitazones
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Pioglitazone
Rosiglitazone |
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Three toxicities of glitazones
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Weight gain/ edema (can exacerbate CHF)
Hepatotoxicity CV toxicity |
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Glitazones are also used to treat these 3 diseases
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Metabolic syndrome
NASH PCOD |
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Two alpha-glucosidase inhibitors
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Acarbose
Miglitol |
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Mechanism of alpha-glucosidase inhibitors
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Inhibit intestinal brush-border alpha glucosidases --> delayed sugar hydrolysis and glucose absorption --> decreased postprandial hyperglycemia
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Toxicity of alpha-glucosidase inhibitors
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GI disturbances
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Mimetic
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Pramlintide (amylin analogue)
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Mechanism of pramlintide
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Inhibits secretion of glucagon
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Side effects of pramlintide
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Hypoglycemia
Nausea, diarrhea |
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GLP-1 analog
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Exenatide
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Mechanism of exenatide
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Increases insulin, decreases glucagon release
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Side effects of exenatide
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N/V
Pancreatitis |
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Two drugs used for hyperthyroidism
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Propylthiouracil
Methimazole |
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2 mechanisms of drugs for hyperthyroidism
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Inhibit organification of iodide
Inhibit coupling of MIT and DIT in thyroid hormone synthesis |
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Which drug also inhibits peripheral conversion of T4 to T3, propylthiouracil or methimazole?
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Propylthiouracil (beta blockers do as well)
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Enzyme responsible for oxidation and organification of iodide + coupling of MIT and DIT
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Peroxidase
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3 toxicities of propylthiouracil and methimazole
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Skin rash
Agranulocytosis Aplastic anemia (PTU can also cause hepatotoxicity) |
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Which drug is a possible teratogen, propylthiouracil or methimazole?
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Methimazole
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2 drugs for hypothyroidism (thyroxine replacement)
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Levothyroxine, triiodothyronine
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Use of synthetic thyroxine, besides hypothyroidism
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Myxedema
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4 toxicities of levothyroxine and triiodothyronine
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Tachycardia
Heat intolerance Tremors Arrhythmias |
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Drug for Turner Syndrome
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GH
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Another name for somatostatin
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Octreotide
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Rx for acromegaly?
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Somatostatin
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Rx for carcinoid, gastrinoma, glucagonoma, or VIPoma
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Somatostatin
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4 effects of oxytocin
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Stimulates labor
Uterine contractions Milk let-down Controls uterine hemorrhage |
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Synthetic ADH
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Desmopressin (DDAVP)
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Clinical use of desmopressin
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Pituitary (central, not nephrogenic) DI
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Two other uses of DDAVP
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Von Willebrand's disease
Enuresis |
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Demeclocycline is a ____ antagonist
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ADH
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Clinical use of demeclocycline
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SIADH
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3 toxicities of demeclocycline
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Nephrogenic DI
Photosensitivity Abnormalities of bone and teeth (is a tetracycline) |
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5 glucocorticoids
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Hydrocortisone, prednisone, triamcinolone, dexamethasone, beclomethasone
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Glucocorticoids decrease the production of ____ and ____ by inhibiting ____ and expression of _____
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Leukotrienes and prostaglandins
Phospholipase A2 COX-2 |
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Rx for Addison's disease
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Glucocorticoids
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Endrocrine toxicity of glucocorticoids
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Iatrogenic Cushing's syndrome
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Stopping glucocorticoids after chronic use can cause
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Adrenal insufficiency
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Why should acetaminophen be used in place of aspirin or ibuprofen in patients with thyroid problems?
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Aspirin/ ibuprofen can displace thyroid hormone from binding proteins
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4 H2 blockers
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Cimetidine, ranitidine, famotidine, nizatidine
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Mechanism of H2 blockers
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Reversible blocks of histamine H2 receptors --> decreased acid secretion by parietal cells
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Cimetidine toxicities
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Antiandrogenic
Can cross BBB (confusion, dizziness, headaches) Can cross placenta Decreases renal excretion of Cr (as does ranitidine) |
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When should H2 blockers be taken?
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Before meals
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Two PPIs
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Omeprazole, lansoprazole
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Mechanism of PPIs
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Irreversibly inhibit H/K ATPase in stomach parietal cells
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Clinical use of PPIs (4)
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PUD
Gastritis GERD Zollinger-Ellison syndrome |
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Toxicity of PPIs
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Increased risk of (hip) fractures
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2 clinical uses of bismuth-sucralfate
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Increase ulcer healing
Traveler's diarrhea |
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Mechanism of bismuth-sucralfate
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Bind to ulcer base, providing physical protection, and allow HCO3 secretion to re-establish pH gradient in mucous layer
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3 clinical uses of misoprostol
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Prevention of NSAID-induced ulcers
Maintenance of PDA Induce labor |
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Misoprostol is a ____ analog
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PGE1
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Mechanism of misoprostol
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Increase production and secretion of gastric mucous barrier
Decrease acid production |
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2 toxicities of misoprostol
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Diarrhea
Abortifacient |
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Rx for acute variceal bleeds
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Somatostatin
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Toxicity of octreotide
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Nausea, cramps, steatorrhea
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Effect of antacids on potassium
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All can cause hypokalemia
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How do antacids affect other drugs?
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Alter gastric and urinary pH, or delay gastric emptying
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Three antacids
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Aluminum hydroxide
Magnesium hydroxide Calcium carbonate |
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Toxicity of aluminum hydroxide
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Constipation & hypophosphatemia
Proximal muscle weakness Osteodrystrophy Seizures |
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Toxicity of magnesium hydroxide
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Diarrhea
Hyporeflexia Hypotension Cardiac arrest |
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Toxicity of calcium carbonate
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Hypercalcemia
Rebound acid increase |
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Which antacid may be given for constipation?
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MgOH2
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3 clinical uses of infliximab
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Crohn's
Ulcerative colitis RA |
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Infliximab is a monoclonal Ab targeting?
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TNF-alpha
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3 toxicities of infliximab
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Respiratory infection
Fever Hypotension |
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2 uses for sulfasalazine
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Crohn's and ulcerative colitis
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Sulfasalazine is a combo of these two drugs
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Sulfapyridine (antibacterial)
5-aminosalicylic acid (anti-inflammatory) |
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Toxicities of sulfasalazine
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Malaise, nausea
Sulfonamide toxicity Reversible oligospermia |
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Ondansetron is a ____ antagonist
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5-HT3
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Ondansetron is used as a
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Centrally-acting antiemetic
Used for postop vomiting and in chemo pts |
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Toxicities of ondansetron
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Headache
Constipation |
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Metoclopramide is a ____ receptor antagonist
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D2
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Metoclopramide is used for _____ in diabetics and post-surgery
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Gastroparesis
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This drug increases resting tone, contractility, LES tone, and motility in the GI tract
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Metoclopramide
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What is the effect of metoclopramide on colon transport time?
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No change
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Toxicity of metoclopramide
|
Parkinsonian effects
Also restlessness, drowsiness, fatigue, depression, nausea, diarrhea |
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Metoclopramide interacts with 2 drug classes?
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Digoxin
Diabetic agents |
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Metoclopramide is contraindicated in?
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Small bowel obstruction
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Heparin's effect on:
Antithrombin Thrombin Xa |
Activates
Decreases Decreases |
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Why is heparin used in pregnancy instead of warfarin?
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Cannot cross placenta
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Test to monitor for pts on heparin?
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PTT
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Test to monitor for pts on warfarin?
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INR
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Rapid reversal of heparin with?
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Protamine sulfate (positively charged)
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4 advantages of LMWH?
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Better bioavailability
Longer half-life Sub-Q administration No need for lab monitoring |
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Disadvantage of LMWH?
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Not easily reversible
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LMWHs have a greater effect on
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Xa
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Main toxicity of heparin?
|
Heparin-induced thrombocytopenia (HIT)
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HIT ensues when heparin binds to ?
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Platelet factor IV
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Pathophys of HIT
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Heparin binds paltelet factor IV--> Ab production --> Abs bind and activate platelets --> platelets are cleared --> thrombocytopenic, hypercoagulable state
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Two direct thrombin inhibitors
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Lepirudin
Bivalirudin |
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Clinical utility of direct thrombin inhibitors
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Pts with HIT
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Four toxicities of warfarin
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Bleeding
Teratogenic Skin/ tissue necrosis Drug-drug interactions |
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Rapid reversal of warfarin overdose
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FFP
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Non-urgent reversal of warfarin overdose
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Vitamin K
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Advantage of warfarin administration over heparin?
|
Available orally
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4 thrombolytics
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Streptokinase
Urokinase tPA (alteplase) APSAC (anistreplase) |
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Main toxicity of thrombolytics
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Bleeding
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Thrombolytic toxicity treated with
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Aminocaproic acid (inhibitor of fibrinolysis)
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6 toxicities of aspirin
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Gastric ulceration
Bleeding Hyperventilation Reye's Syndrome Tinnitus (CN VIII) Interstitial nephritis/ acute renal failure |
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Mechanism of ASA
|
Acetylates and irreversibly inhibits cyclooxygenase to prevent conversion of arachidonic acid to TxA2
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Blood test affected by ASA
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Bleeding time
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2 mechanisms of clopidogrel and ticlopidine
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Irreversibly block ADP receptors --> inhibit platelet aggregation
Prevent glycoprotein IIb/IIIa expression --> inhibit fibrinogen binding |
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Toxicity of ticlopidine
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Neutropenia
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Abciximab is a monoclonal Ab that binds to ______ to prevent platelet aggregation
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Glycoprotein receptor IIb/IIIa
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Antimetabolites work in this phase of the cell cycle
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S phase
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Vinca alkaloids and taxols work in this phase of the cell cycle
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M phase
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Etoposide works in these 2 phases of the cell cycle
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S and G2
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Bleomycin works in this phase of the cell cycle
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G2
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MTX inhibits
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dihydrofolate reductase --> dTMP
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Drug for leukemias, lymphomas, choriocarcinoma, and sarcomas
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MTX
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Non-neoplastic uses of MTX
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Abortion
Ectopic pregnancy RA Psoriasis |
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Leucovorin rescue is used after toxicity from what drug?
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MTX
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Leucovorin rescue is used to decrease what toxicity of MTX?
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Myelosupression
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Another term for folinic acid
|
Leucovorin
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Mechanism of leucovorin rescue
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Cofactor for thymidylate synthase (in lieu of THF)
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5 antimetabolites
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MTX, 5-FU, 6-MP, 6-TG, cytarabine (ara-C)
|
|
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4 toxicities of MTX
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Myelosuppression
Macrovesicular fatty change in liver Mucositis Teratogenic |
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How is leucovorin used with 5-FU?
|
To increase cell kill, rather than to decrease toxicity
|
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5-FU overdose can be rescued with?
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Thymidine
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2 toxicities of 5-FU
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Myelosuppression
Photosensitivity |
|
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Mechanism of 5-FU
|
Pyrimidine analog, bioactivated to 5F-dUMP, which complexes folic acid and inhibits thymidylate synthase
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MTX and 5-FU are
|
Synergistic
|
|
|
5-FU is used for
|
Colon cancer and other solid tumors
Basal cell carcinoma (topical) |
|
|
6-MP decreases
|
De novo purine synthesis (is a purine analog)
|
|
|
6-MP is used for leukemias and lymphomas except
|
CLL
Hodgkin's |
|
|
3 systems with toxicity from 6-MP
|
BM
GI Liver |
|
|
6-MP is metabolized by ?
|
Xanthine oxidase (so toxicity is increased with allopurinol, which inhibits this enzyme)
|
|
|
6-TG is used for
|
ALL
|
|
|
What distinguishes the drug interactions of 6-MP and 6-TG?
|
6-TG can be given with allopurinol (and commonly is, to prevent uric acid stones from tumor lysis syndrome)
|
|
|
Antimetabolite drug that is a pyrmidine analog
|
Cytarabine (ara-C)
|
|
|
Cytarabine inhibits ?
|
DNA polymerase
|
|
|
Another name for cytarabine?
|
Ara-c
|
|
|
Ara-C is used for
|
AML
ALL High-grade non-Hodgkin's lymphoma |
|
|
Toxicities of ara-C (3)
|
Leukopenia
Thrombocytopenia Megaloblastic anemia |
|
|
Drug used for childhood tumors
|
Dactinomycin
|
|
|
3 tumors treated with dactinomycin
|
Ewing's sarcoma, Wilms' tumor, rhabdomyosarcoma
|
|
|
Mechanism of dactinomycin
|
Intercalates in DNA
|
|
|
Toxicity of dactinomycin
|
Myelosuppression
|
|
|
Doxorubicin (adriamycin) and daunorubicin are in what class of antibiotics
|
Anthracyclines
|
|
|
Mechanism of anthracycline antibiotics
|
Generate free radicals
Noncovalently intercalate in DNA |
|
|
Clinical use of doxorubicin and daunorubicin
|
Hodgkin's lymphoomas
Myelomas, sarcomas, and solid tumors |
|
|
3 toxicities of doxorubicin and daunorubicin
|
Cardiotoxicity
Myelosuppression Alopecia |
|
|
Drug given to prevent cardiotoxicity from doxorubicin
|
Dexrazoxane (iron-chelating agent)
|
|
|
Mechanism of bleomycin
|
Induces free radical formation --> breaks in DNA strands
|
|
|
2 clinical uses of bleomycin
|
Testicular cancer
Hodgkin's lymphoma |
|
|
Two toxicities of bleomycin
|
Pulmonary fibrosis
Skin changes |
|
|
Mechanism of etoposide (and teniposide)
|
Inhibits topoisomerase II --> DNA degradation
|
|
|
Clinical use of etoposide
|
Small cell carcinoma of lung and prostate
Testicular carcinoma |
|
|
3 toxicities of etoposide
|
Myelosuppression
GI irritation Alopecia |
|
|
Mechanism of cyclophosphamide and ifosfamide
|
Covalently X-link (interstrand) DNA at guanine-7
|
|
|
Cyclophosphamide and ifosfamide must be bioactivated by
|
Liver
|
|
|
Use of cyclophosphamide and ifosfamide
|
Hon-Hodgkin's lymphoma
Breast and ovarian carcinomas |
|
|
2 toxicities of cyclophosphamide and ifosfamide
|
Myelosuppression
Hemorrhagic cystitis |
|
|
Prevention of hemorrhagic cystitis in cyclophosphamide and ifosfamide treatment with?
|
Mesna (thiol group binds toxic metabolite)
|
|
|
Which alkylating agent can be used for brain tumors?
|
Nitrosoureas (cross BBB)
|
|
|
Toxicity of nitrosoureas
|
CNS (dizziness, ataxia)
|
|
|
Busulfan is used for
|
CML
|
|
|
Busulfan toxicity
|
Pulmonary fibrosis, hyperpigmentation
|
|
|
4 antitumor antibiotics
|
Dactinomycin
Doxorubicin/ daunorubici Bleomycin Etoposide/ teniposide |
|
|
3 alkylating agents
|
Cyclophosphamide/ ifosfamide
Nitrosoureas Busulfan |
|
|
Mechanism of vincristine and vinblastine
|
Bind tubulin and block polymerization of MTs so spindle cannot form
|
|
|
Mechanism of paclitaxel and other taxols
|
Hyperstabilize polymerized MTs in M-phase so mitotic spindle can't break down
|
|
|
3 uses of vincristine/ vinblastine
|
Hodgkin's lymphoma
Wilms' tumor Choriocarcinoma |
|
|
2 uses of taxols
|
Ovarian and breast carcinomas
|
|
|
Toxicity of vincristine (2)
|
Neurotoxicity (areflexia, peripheral neuritis)
Paralytic ileus |
|
|
Toxicity of vinblastine
|
BM suppression
|
|
|
Toxicity of taxols (2)
|
Myelosuppression
Hypersensitivity |
|
|
Mechanism of cisplatin and carboplatin
|
Cross-link DNA
|
|
|
4 uses of cisplatin/ carboplatin
|
Testicular, bladder, ovary, and lung carcinomas
|
|
|
2 toxicities of cisplastin/ carboplatin
|
Nephrotoxicity and acoustic nerve damage
|
|
|
Prevent nephrotoxicity from cisplatin with
|
Amifustine (thiol-based free radical scavenger) and hydration
|
|
|
Hydroxyurea inhibits
|
Ribonucleotide reductase
|
|
|
Hydroxyurea is specific for
|
(S-phase specific)
|
|
|
3 uses for hydroxyurea
|
Melanoma
CML SCD (increases HbF) |
|
|
Toxicity of prednisone
|
Cushing-like symptoms
Immunosuppression Cataracts, acne, osteoporosis, HTN, PUD, hyperglycemia, psychosis |
|
|
2 SERMs
|
Tamoxifen
Raloxifene |
|
|
SERMs are receptor antagonists in ____ and agonists in ____
|
Breast, bone
|
|
|
Why is raloxifene preferred over tamoxifene?
|
No increase in endometrial carcinoma b/c is an antagonist (whereas tamoxifen is a partial agonist)
|
|
|
Trastuzumab is a monoclonal Ab against ?
|
HER-2 (erb-B2)
|
|
|
Toxicity of trastuzumab
|
Cardiotoxicity
|
|
|
Imatinib is a
|
bcr-abl tyrosine kinase inhibitor
|
|
|
2 clinical uses of imatinib
|
CML
GI stromal tumors |
|
|
Toxicity of imatinib
|
Fluid retention
|
|
|
Rituximab is a monoclonal Ab against ?
|
CD20
|
|
|
2 uses of rituximab
|
Non-Hodgkin's lymphoma
RA (with MTX) |
|
|
Lipoxygenase pathway yields
|
Leukotrienes
|
|
|
This leukotriene is a neutrophil chemotactic agent
|
LTB4
|
|
|
These three leukotrienes promote bronchoconstriction
|
LTC4, LTD4, LTE4
|
|
|
Corticosteroids inhibit both
|
Phospholipase A2 and synthesis of COX-2
|
|
|
Another name for PGI2
|
Prostacyclin
|
|
|
____ inhibits platelet aggregation and promotes vasodilation
|
PGI2
|
|
|
Ketorolac is this type of medicine?
|
NSAID
|
|
|
Used to close a PDA
|
Indomethacin
|
|
|
5 toxicities of NSAIDs
|
Renal damage
Fluid retention Aplastic anemia GI distress Ulcers |
|
|
2 toxicities from COX-2 inhibitors
|
Increased risk of thrombosis
Sulfa allergy |
|
|
Overdose of acetaminophen produces
|
Hepatic necrosis
|
|
|
Antidote for acetaminophen overdose (and mechanism)
|
N-acetylcysteine (regenerates glutathione)
|
|
|
Etidronate, pamidronate, alendronate, risedronate, and zoledronate are
|
Bisphosphonates
|
|
|
Mechanism of bisphosphonates
|
Inhibit osteoclastic activity
Reduce both formation and resorption of hydroxyapatite |
|
|
3 uses of bisphosphonates
|
Malignancy-associated hypercalcemia
Paget's disease of bone Postmenopausal osteoporosis |
|
|
4 toxicities of bisphosphonates
|
Corrosive esophagitis (except zoledronate)
Nausea Diarrhea Osteonecrosis of the jaw |
|
|
3 drugs for gout
|
Colchicine (acute gout; alternative is indomethacin)
Allopurinol (chronic gout) Probenecid (chronic gout) |
|
|
Mechanism of colchicine
|
Binds and stabilizes tubulin to inhibit polymerization, impairing leukocyte chemotaxis and degranulation
|
|
|
Mechanism of allopurinol
|
Inhibits xanthine oxidase, decreasing conversion of xanthine to uric acid
|
|
|
Mechanism of probenecid
|
Inhibits reabsorption of uric acid in PCT (and secretion of penicillin)
Is a uricosuric |
|
|
Side effect of colchicine
|
GI side effects
|
|
|
Additional usage of allopurinol
|
In lymphoma and leukemia to prevent tumor lysis associated urate nephropathy
|
|
|
Allopurinol increases the concentrations of these 2 drugs
|
Azathioprine and 6-MP (both normally metabolized by xanthine oxidase)
|
|
|
Drug not to give in gout
|
Salicylates (all but highest doses depress uric acid clearance w/ minor uricosuric activity)
|
|
|
3 TNF-alpha inhibitors
|
Etanercept
Infliximab Adalimumab |
|
|
Etanercept is a
|
Recombinant form of human TNF receptor that binds TNF (soluble form w/ Fc Ig)
|
|
|
Chimeric anti-TNF Ab
|
Infliximab
|
|
|
Human anti-TNF Ab
|
Adalimumab
|
|
|
All TNF-alpha inhibitors should be given with
|
MTX
|
|
|
3 TNF-alpha inhibitors
|
Etanercept
Infliximab Adalimumab |
|
|
Etanercept is a
|
Recombinant form of human TNF receptor that binds TNF (soluble form w/ Fc Ig)
|
|
|
Chimeric anti-TNF Ab
|
Infliximab
|
|
|
Human anti-TNF Ab
|
Adalimumab
|
|
|
All TNF-alpha inhibitors should be given with
|
MTX
|
|
|
TNF alpha inhibitor that predisposes to infections (e.g. reactivation of latent TB)
|
Infliximab
|
|
|
5 categories of drugs used for glaucoma
|
Alpha-agonists
Beta-blockers Diuretics Cholinomimetics Prostaglandin |
|
|
Glaucoma drug to avoid in closed-angle glaucoma
|
Alpha-agonists
|
|
|
Two alpha agonists used in glaucoma
|
Epi
Brimonidine |
|
|
Mechanism of alpha-agonists for glaucoma
|
Decrease AH synthesis
|
|
|
3 beta blockers used in glaucoma
|
Timolol, betaxolol, carteolol
|
|
|
Mechanism of beta blockers for glaucoma
|
Decrease AH secretion
|
|
|
Diuretic used in glaucoma
|
Acetazolamide
|
|
|
Mechanism of acetazolamide in glaucoma
|
Decrease AH secretion due to decreased HCO3- (via inhibition of carbonic anhydrase)
|
|
|
Examples of direct and indirect cholinomimetics used for glaucoma
|
Direct: pilocarpine, carbachol
Indirect: physostigmine, echothiophate |
|
|
Mechanism of cholinomimetics for glaucoma
|
Increase outflow of AH (contract ciliary muscle and open trabecular meshwork into canal of Schlemm)
|
|
|
When is pilocarpine used in glaucoma?
|
Emergenices
|
|
|
Side effects of cholinomimetics for glaucoma
|
Miosis
Cyclospasm |
|
|
Prostaglandin used in glaucoma
|
Latanoprost (PGF-2alpha)
|
|
|
Mechanism of latanoprost for glaucoma
|
Increase outflow of AH
|
|
|
Side effect of latanoprost
|
Darkens color of iris (browning)
|
|
|
7 opioid analgesics
|
Morphine, fentanyl, codeine, heroin, methadone, meperidine, dextromethorphan
|
|
|
3 intrinsic opioid receptors
|
Mu = morphine
Delta = enkephalin Kappa = dynorphin |
|
|
Opioids are agonists at opioid receptors, causing
|
K+ channels to open (efflux)
Ca channels to close Both --> decreased synaptic transmission |
|
|
Opioids decrease release of these 5 neurotransmitters
|
ACh, NE, 5HT, glutamate, substance P
|
|
|
Other than pain and methadone addiction programs, 3 clinical uses for opioids
|
Cough suppression (dextromethorphan)
Diarrhea (loperamide and diphenoxylate) Acute pulmonary edema |
|
|
7 side effects of opioids
|
Addiction
Respiratory depression Constipation Miosis Addictive CNS depression with other drugs Biliary colic from smooth muscle cell contraction in the sphincter of Oddi Histamine-released --> vasodilation |
|
|
Tolerance does not develop to these 2 opioid side effects
|
Miosis
Constipation |
|
|
Tolerance is mediated by ____ (neurotransmitter) activating ____ (its receptor), leading to ______ of the opioid receptors
|
Glutamate ---> NMDA activation --> phosphorylation of opioid receptors
|
|
|
Tolerance can be decreased with _____ antagonists
|
NMDA (e.g. ketamine, dextromethorphan)
|
|
|
Partial agonist at opioid mu receptors, agonist at kappa receptors
|
Butorphanol
|
|
|
Advantage of butorphanol over other opioids
|
Less respiratory depression than full agonists
|
|
|
Toxicity of butorphanol
|
Causes withdrawal if on full agonist
|
|
|
Tramadol is a ____ opioid agonist that also inhibits ____ and ____ reuptake
|
Weak
Serotonin and NE |
|
|
Additional side effect of tramadol
|
Decreased seizure threshold
|
|
|
12 epilepsy drugs
|
Phenytoin
Carbamazepine Lamotrigine Gabapentin Topiramate Phenobarbital Valproic acid Ethosuximide Benzos Tiagabine Vigabatrin Levetiracetam |
|
|
All epilepsy drugs can be used for partial seizures except
|
Ethosuximide
Benzos |
|
|
First line for tonic-clonic seizures (3)
|
Phenytoin
Carbamazepine Valproic acid |
|
|
First line Rx for absence seizures
|
Ethosuximide (valproic acid also possibly)
|
|
|
1st line of acute treatment of status epilepticus
|
Benzos
|
|
|
1st line for prophylaxis of status epilepticus
|
Phenytoin
|
|
|
Unique mechanism of ethosuximide
|
Blocks thalamic T-type Ca2+ channels
|
|
|
Epilepsy drugs that block/ inactivate Na channels (5)
|
Phenytoin
Carbamazepine Lamotrigine Topiramate Valproic acid |
|
|
Epilepsy drugs that increase GABA (7)
|
Topiramate
Phenobarbital Valproic acid Benzos Tiagabine Vigabatrin Levetiracetam |
|
|
Epilepsy drugs that work on both Na channels and GABA
|
Topiramate
Valproic acid |
|
|
Epilepsy drug that was designed as a GABA analog, but primarily inhibits HVA Ca channels
|
Gabapentin
|
|
|
Epilepsy drug to use in pregnant women or children
|
Pehnobarbital
|
|
|
Best drug for myoclonic seizures
|
Valproic acid
|
|
|
2 drugs to use in seizures of eclampsia
|
Benzos
MgSO4 (1st line) |
|
|
1st line drug for trigeminal neuralgia
|
Carbamazepine
|
|
|
Other uses of gabapentin besides epilepsy (3)
|
Peripheral neuropathy
Bipolar disorder Fibromyalgia |
|
|
Prodrome of malaise and fever followed by apid onset of erythematous/ purpuric macules (oral, ocular, genital); skin lesions may progress to epidermal necrosis and sloughing
|
Stevens-Johnson Syndrome (and TEN)
|
|
|
Anti-epileptic drugs (AED) that cause SJS (3)
|
Carbamazepine
Ethosuximide Lamotrigine |
|
|
Side effects of carbamazepine
|
Diplopia
Ataxia Blood dyscrasias (agranulocytosis, aplastic anemia) Liver toxicity Teratogenesis Induction of P-450 SIADH SJS |
|
|
AED that can cause urticaria
|
Ethosuximide
|
|
|
AED that can cause NTDs in fetus
|
Valproic acid
|
|
|
AED that can cause fatal hepatotoxicity (follow with LFTs)
|
Valproic acid
|
|
|
AED that can cause agranulocytosis
|
Carbamazepine
|
|
|
AED that can cause aplastic anemia
|
Carbamazepine
|
|
|
AED that can cause fetal hydantoin syndrome
|
Phenytoin
|
|
|
AED known for weight gain
|
Valproic acid
|
|
|
Side effects of phenytoin (10)
|
Nystagmus
Diplopia Ataxia Sedation Gingival hyperplasia Hirsutism Megaloblastic anemia Teratogenesis (fetal hydantoin syndrome) SLE-like syndrome Induction of P450 |
|
|
AED known for weight loss
|
Topiramate
|
|
|
AED known for mental dulling
|
Topiramate
|
|
|
AED associated w/ kidney stones
|
Topiramate
|
|
|
AED associated with megaloblastic anemia
|
Phenytoin
|
|
|
2 AEDs associated with diplopia and ataxia
|
Carbamazepine and phenytoin
|
|
|
Phenytoin is a class ___ antiarrhythmic
|
1B
|
|
|
AED associated with SLE-like syndrome
|
Phenytoin
|
|
|
Why does phenytoin cause a megaloblastic anemia?
|
Decreased folate absorption
|
|
|
Compare the mechanism of barbiturates to benzodiazepines
|
Both facilitate GABA A action by acting on the Cl- channel
Barbiturates increase the duration of opening Benzos increase the frequency of opening |
|
|
Rx for barbiturate overdose?
|
Symptom management (assist respiration, increase BP)
|
|
|
Effect of benzos on REM sleep
|
Decrease it
|
|
|
Benzos are used in treatment of withdrawal from?
|
Alcohol (DTs)
|
|
|
3 sleep problem indications for benzos
|
Insomnia
Night terrors Sleepwalking |
|
|
Short-acting benzos
|
Triazolam
Oxazepam Midazolam Alprazolam |
|
|
Which benzos should be used for acute anxiety?
|
Short-acting
|
|
|
Highest addictive potential with these benzos
|
Short-acting
|
|
|
Rx for benzo overdose
|
Flumazenil (competitive antagonist at GABA benzo receptor)
|
|
|
Best drugs for insomnia
|
ZaZolEs
Zaleplon Zolpidem Eszopiclone |
|
|
Action of ZaZolEs is reversed by
|
Flumazenil
|
|
|
3 toxicities of zazoles
|
Ataxia, headaches, confusion
|
|
|
Anesthetic principle: increased blood solubility causes ____ onset of action
|
lower
|
|
|
Inhaled anesthetics caused _____ cerebral blood flow
|
Increased (and deceased cerebral metabolic demand)
|
|
|
Toxicity of halothane
|
Hepatotoxicity
|
|
|
Toxicity of methoxyflurane
|
Nephrotoxicity
|
|
|
Inhaled anesthetic that is a proconvulsant
|
Enflurane
|
|
|
5 categories of IV anesthetics
|
Barbiturates
Benzos Arylcyclohexylamines (ketamine) Opiates Propofol |
|
|
Best for induction of anesthesia/ short procedures
|
Barbiturates (also propofol, which has less postop nauseua than thiopental)
|
|
|
Barbiturates ____ cerebral blood flow
|
Decrease
|
|
|
Ketamine ____ cerebral blood flow
|
Increases
|
|
|
2 groups of local anesthetics
|
Esters
Amides (have 2 Is in name) |
|
|
3 esters
|
Procaine
Cocaine Tetracaine |
|
|
3 amides
|
Lidocaine
Mepivacaine Bupivacaine |
|
|
Mechanism of local anesthetics
|
Bind Na channels (receptors on inner portion)
Preferentially bind activated channels, so most effective in rapidly firing neurons |
|
|
Local anesthetics penetrate membrane in _____ form, then bind to ion channels in ____ form
|
Uncharged
Charged |
|
|
In infected (acidic) tissue, is more or less anesthetic needed?
|
More (alkaline anesthetics are charged and cannot penetrate)
|
|
|
Order of pain blockade based on size and myelination
|
Small myelinated
Small unmyelinated Large myelinated Large unmyelinated |
|
|
Order of loss of neurons based on sensation transmitted
|
Pain first > temp > touch > pressure (last)
|
|
|
Local anesthetics should be given with what other drug class
|
Vasoconstrictors (epinephrine)
|
|
|
Why are local anesthetics given with EPI?
|
To enhance local action and decrease bleeding
|
|
|
Which local anesthetic is not given with EPI?
|
Cocaine
|
|
|
If a patient is allergic to esters, should give?
|
Amides
|
|
|
Toxicity of cocaine
|
Arrhythmias
|
|
|
Toxicity of bupivacaine
|
Severe CV toxicity
|
|
|
3 toxicities of local anesthetics
|
CNS excitation
HTN Hypotension |
|
|
Depolarizing NM blockade provided by
|
Succinyl choline
|
|
|
Nondepolarizing NM blockade provide by
|
Tubocurarine and the curiums (e.g. atracurium, rocuronium)
|
|
|
NM blockade drugs are selective for the ____ receptor
|
Motor nicotinic (vs. autonomic nicotinic)
|
|
|
3 complications of succinyl choline
|
Hypercalcemia
Hyperkalemia Malignant HTN |
|
|
2 phases of succinylcholine blockade (prolonged depolarization and repolarized but blocked): antidote for each?
|
No antidote for Phase I (potentiated by cholinesterase inhibitors)
Phase II: cholinesterase inhibitors |
|
|
Reversal of nondepolarizing NM blockade
|
Cholinesterase inhibitors (neostigmine, edrophonium, etc.)
|
|
|
Treatment of malignant HTN
|
Dantrolene
|
|
|
Another use of dantrolene
|
Neuroleptic malignant syndrome (toxicity of antipsychotics)
|
|
|
Mechanism of dantrolene
|
Prevents release of Ca from sarcoplasmic reticulum
|
|
|
4 strategies in PD treatment
|
Agonize dopamine receptors
Increase dopamine Prevent dopamine breakdown Curb excess cholinergic activity |
|
|
3 drugs that agonize dopamine receptors
|
Bromocriptine
Pramipexole Ropinirole |
|
|
Two drugs that increase dopamine
|
Amantadine
L-dopa |
|
|
Mechanism and toxicity of amantadine
|
May increase dopamine release (also an antiviral)
Causes ataxia |
|
|
Why is L-Dopa given instead of dopamine?
|
Dopamine cannot cross BBB
|
|
|
What drug is always given with L-Dopa?
|
Carbidopa
|
|
|
Mechanism of carbidopa
|
Peripheral decarboxylase inhibitor (icnreases bioavailability of L-dopa in brain and limits peripheral side effects)
|
|
|
Two drugs that prevent dopamine breakdown
|
MAOB inhibitor (selegiline)
COMT inhibitors (entacapone, tolcapone) |
|
|
Best antimuscarinic for PD?
|
Benztropine
|
|
|
Benzotropine improves ____ and _____ but has little effect on ____
|
Tremor and rigidity
Bradykinesia |
|
|
Best drugs for essential or familial tremors
|
Beta-blockers
|
|
|
L-dopa is converted to dopamine in the CNS by ______
|
Dopa decarboxylase
|
|
|
3 toxicities of L-dopa
|
Arrhythmias (from peripheral conversion to dopamine)
Dyskinesia (from long-term use) Akinesia (btwn doses) |
|
|
MAO-B selectivity metabolizes ____ over ____ and ____
|
Dopamine
NE and 5HT |
|
|
2 classes of drugs in Alzheimer's treatment
|
NMDA receptor antagonists
Acetylcholinesterase inhibitors |
|
|
NMDA receptor antagonist
|
Memantine
|
|
|
Memantine helps prevent _____, mediated by _____
|
Excitotoxicity
Ca |
|
|
3 toxicities of memantine
|
Dizzines
Confusion Hallucinations |
|
|
3 acetylcholinesterase inhibitors used in Alzheimer's
|
Donepezil
Galantamine Rivastigmine |
|
|
3 toxicities of cholinesterase inhibitors
|
Nausea
Dizziness Insomnia |
|
|
In Huntington's disease, ____ is increased while ___ and ___ are decreased
|
Dopamine
GABA and ACh |
|
|
Dopamine antagonist used in Huntington's
|
Haloperidol
|
|
|
Two amine depleting drugs used in Huntington's
|
Reserpine
Tetrabenazine |
|
|
Sumatriptan is a ______ agonist
|
5HT-1B/1D agonist
|
|
|
Sumatriptan has these 2 clinical uses
|
Acute migraine
Cluster headaches |
|
|
3 effects of sumatriptan
|
Vasoconstriction
Inhibition of trigeminal activation Vasoactive peptide release |
|
|
2 toxicities of sumatriptan
|
Coronary vasospasm
Mild tingling |
|
|
Sumatriptan is contraindicated in pts with ___ or _____
|
CAD
Prinzmetal's angina |
|
|
Rx for anorexia/ bulimia
|
SSRIs
|
|
|
Rx for anxiety (4)
|
Benzos
Buspirone SSRIs Venlafazine (SNRI) |
|
|
Rx for ADHD (2)
|
Amphetamines
Methylphenidate (Ritalin) |
|
|
Rx for atypical depression (2)
|
MAOIs
SSRIs |
|
|
Rx for depression with insomnia
|
Mirtazapine
|
|
|
Rx for OCD (2)
|
SSRIs
Comipramine |
|
|
Rx for panic disorder (3)
|
SSRIs
TCAs Benzos |
|
|
Rx for Tourette's syndrome
|
Antipsychotics (haloperidol)
|
|
|
Rx for social phobias
|
SSRIs
|
|
|
5 antipsychotics (typical)
|
Haloperidol + azines (trifluoperazine, fluphenazine, thioridazine, chlorpromazine)
|
|
|
Mechanism of typical antipsychotics
|
Block dopamine D2 receptors, increasing cAMP
|
|
|
4 clinical uses of antipsychotics (neuroleptics)
|
Schizophrenia (primarily positive symptoms, as they may exacerbate negative symptoms)
Psychosis Acute mania Tourette's syndrome |
|
|
Which antipsychotics are high potency, and which are low potency?
|
High: haloperidol, trifluoperazine, fluphenazine
Low: thioridazine, chlorpromazine |
|
|
High potency antipsychotics have ___ side effects, while low potency antipsychotics have _____
|
Neurologic side effects (extrapyramidal symptoms)
Non-neurologic (anticholinergic, antihistamien, and alpha blockade) |
|
|
Evolution of extrapyramidal side effects
|
Dystonia (spasm, stiffness)--> akinesia (parkinsonism)--> akathisia (restlessness)-->
tardive dyskinesia (4 hrs, days, weeks, months) |
|
|
Treat EPS with?
|
Bentropine or trihexyphenidyl
(other drugs for Parkinsonism can exacerbate psychosis) |
|
|
What is tardive dyskinesia?
|
Sterotypic oral-facial movements
Often irreversible |
|
|
Endocrine side effects of antipsychotics
|
Dopamine receptor antagonist --> hyperprolactinemia --> galactorrhea (worst with risperidone, an atypical antipsychotic)
|
|
|
Side effects of antipsychotics from block muscarinic, alpha, and histamine receptors
|
Dry mouth/ constipation
Hypotension Sedation |
|
|
Clinical sequelae of neuroleptic malignant syndrome (NMS)
|
FEVER
Fever Encephalopathy Vitals unstable (autonomic instability) Elevated enzymes Rigidity of muscles (and myoglobinuria) |
|
|
Treatment of neuroleptic malignant syndrome
|
Dantrolene
Agonists (e.g. bromocriptine) |
|
|
6 atypical antipsychotics
|
Olanzapine
Clozapine Quetiapine Risperidone Aripiprazole Ziprasidone |
|
|
Atypical antipsychotics block these 4 receptor types
|
5-HT2
Dopamine Alpha H1 |
|
|
Drug of choice for both positive and negative symptoms of schizophrenia?
|
Atypical antipsychotics (better side effect profile)
|
|
|
Olanzapine used for (besides schizophrenia) (5)
|
OCD
Anxiety Depression Mania Tourette's |
|
|
Two atypical antipsychotics that may cause significant weight gain
|
Olanzapine
Clozapine |
|
|
Clozapine has these 2 serious side effects
|
Agranulocytosis (monitor WBC weekly)
Seizures |
|
|
Best treatment for bipolar disorder
|
Mood stabilizers (lithium, and antiepileptics, e.g. valproic acid, carbamazepine, and lamotrigine)
|
|
|
Other than bipolar, lithium is also used to treat
|
SIADH
|
|
|
Side effects of Lithium
|
LMNOP
Movement (tremor) Nephrogenic diabetes insipidus (polyuria and polydipsia, b/c is an ADH antagonist) hypOthyroidism Pregnancy problems (causes Ebstein anomaly and malformation of great vessels) Also sedation, edema, and heart block |
|
|
Buspirone is used for
|
Generalized anxiety disorder
|
|
|
Buspirone stimulates ____ receptors
|
5-HT-1A
|
|
|
Advantage of buspirone over barbiturates/ benzos
|
Doesn't interact w/ alcohol
No sedation/ addiction/ tolerance |
|
|
Buspirone is also used for
|
Smoking cessation
|
|
|
7 tricyclic antidepressants (TCAs)
|
Imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin, amoxapine
|
|
|
Mechanism of TCAs
|
Block reuptake of NE and serotonin
|
|
|
3 uses of all TCAs
|
Major depression
Fibromyalgia Diabetic neuropathy |
|
|
Additional clinical use of imipramine
|
Bedwetting
|
|
|
Additional clinical use of clomipramine
|
OCD
|
|
|
3 main side effects
|
Sedation (from histamine blockade)
Orthostatic hypotension (from alpha blockade) Anticholinergic (tachycardia, urinary retention) |
|
|
More anticholinergic effects with ____ TCAs than ____
|
3rd generation (amitriptyline) than 2nd generation (nortriptyline)
|
|
|
Least sedating and lowest seizure threshold of the TCAs?
|
Desipramine
|
|
|
5 main toxicities of TCAs
|
Convulsions
Coma Cardiotoxicity (arrhythmias) Respiratory depression Hyperpyrexia |
|
|
Toxicity of TCAs in elderly
|
Confusion and hallucinations from anticholinergic side effects (so use 2nd generation, like nortriptyline, which has fewer anticholinergic side effects)
|
|
|
Treatment of CV toxicity for TCAs?
|
NaHCO3
|
|
|
4 SSRIs
|
Fluoxetine
Paroxetine Sertraline Citalopram |
|
|
4 uses of SSRIs
|
Depression
OCD Bulimia Social phobias |
|
|
3 toxicities of SSRIs
|
GI distress
Sexual dysfunction (anorgasmia) Serotonin syndrome |
|
|
Symptoms of serotonin syndrome
|
Hyperthermia, muscle rigidity, CV collapse, flushing, diarrhea, seizures
|
|
|
Rx for serotonin syndrome
|
Cyproheptadine (5-HT2 receptor antagonist)
|
|
|
2 SNRIs
|
Venlafaxine
Duloxetine |
|
|
Other than depression, venlafaxine is indicated for ? and duloxetine is indicated for?
|
Generalized anxiety disorder
Diabetic peripheral neuropathy |
|
|
Most common toxicity of SNRIs
|
HTN (monitor)
|
|
|
Other toxicities of SNRIs
|
Stimulant effects, sedation, nausea
|
|
|
4 MAOIs
|
Phenelzine
Tranylcypromine Isocarboxazid Selegiline (selective for MAO-B) |
|
|
Mechanism of MAO inhibitors
|
Increase levels of amine neurotransmitters (NE, serotonin, dopamin)
|
|
|
3 uses of MAOIs
|
Atypical depression
Anxiety Hypochondriasis |
|
|
MAOIs can cause a _____ crisis
|
Hypertensive (with ingestion of tyramine, e.g. from wine and cheese, or with beta agonists)
|
|
|
MAOIs are contraindicated with
|
SSRIs or meperidine (to prevent serotonin syndrome)
|
|
|
4 atypical depressants
|
Bupropion, mirtazapine, maprotiline, and trazodone
|
|
|
Bupropion is a ?
|
NDRI (increases NE and dopamine)
|
|
|
Bupropion is also used for
|
Smoking cessation
|
|
|
Side effects of bupropion (3)
|
Stimulant effects (tachycardia, insomnia)
Headache Seizure (in bulimic pts) |
|
|
Advantage of the side effect profiles of bupropion and mirtazapine?
|
No sexual side effects
|
|
|
2 mechanisms of mirtazapine
|
Alpha-2 antagonist (increasing release of NE and serotonin)
5HT2 and 3 receptor antagonist |
|
|
Toxicity of mirtazapine
|
Sedation, increased appetite, weight gain
|
|
|
Mechanism of maprotiline
|
Blocks NE reuptake
|
|
|
Toxicity of maprotiline (2)
|
Sedation
Orthostatic hypotension |
|
|
Trazodone: mechanism and use
|
Primarily inhibits serotonin reuptake
Used for insomnia (high doses needed for antidepressant effects) |
|
|
4 toxicities of trazodone
|
Priapism (painful prolonged erection)
Postural hypotension Sedation Nausea |
|
|
Osmotic diuretic
|
Mannitol (increases tubular fluid osmolarity, producing increased urine flow)
|
|
|
4 uses of mannitol
|
Shock
Drug overdose Increased ICP or IOP |
|
|
2 toxicities of mannitol
|
Pulmonary edema
Dehydration |
|
|
2 contraindications of mannitol
|
CHF
Anuria |
|
|
Mannitol works in the?
|
Proximal convoluted tubule
|
|
|
Acetazolamide works in the?
|
Proximal convoluted tubule
|
|
|
Mechanism of acetazolamide
|
Carbonic anhydrase inhibitor
Causes self-limited NaHCO3 diureses and reduction in total body HCO3 stores (Na and HCO3 lost in urine) |
|
|
Why is acetazolamide a weak diuretic?
|
Kidney still has time to make up for Na lost
|
|
|
4 uses of acetazolamide
|
Glaucoma
Urinary alkalinization Metabolic alkalosis Altitude sickness |
|
|
4 toxicities of acetazolamide
|
Hyperchloremic metabolic acidosis
Neuropathy NH3 toxicity Sulfa allergy |
|
|
____ causes metabolic acidosis while ____ causes metabolic alkalosis (diuretics)
|
Acetazolamide
HCTZ |
|
|
Mechanism of loop diuretics
|
Inhibit cotransport system (Na, K, 2 Cl), abolishing hypertonicity of medulla and preventing concentration of urine
|
|
|
Where do loop diuretics work?
|
Thick ascending limp of the loop of Henle
|
|
|
Loops lose _____
|
Calcium
|
|
|
Clinical use of loop diuretics (3)
|
Edematous state (CHF, cirrhosis, nephrotic syndrome, pulmonary edema)
HTN Hypercalcemia |
|
|
Toxicity of furosemide
|
OH DANG, i lost my loop earrings
Ototoxicity Hypokalemia Dehydration Allergy (sulfa) Nephritis (interstitial) Gout |
|
|
What drug is used for diuresis in pts allergic to sulfa drugs?
|
Ethacrynic acid (phenoxyacetic acid derivative; NOT a sulfonamide; same action as furosemide)
|
|
|
What diuretic can be used in hyperuricemia/ acute gout (although not to treat gout)
|
Ethacrynic acid
|
|
|
Mechanism of thiazide diuretics?
|
Inhibit NaCl reabsorption in early distal tubule, reducing diluting capacity of the nephron
|
|
|
Where do thiazide diuretics work
|
Early distal tubule
|
|
|
4 uses of thiazide diuretics
|
HTN
CHF Idiopathic hypercalciuria Nephrogenic diabetes inspidus |
|
|
Why do thiazide diuretics decrease the risk of kidney stones?
|
Decrease calcium excretion (hypocalciurics, can cause hypercalcemia though)
|
|
|
Toxicity of HCTZ
|
Hyper GLUC
Hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia Hypokalemic metabolic alkalosis, hyponatremic, and sulfa allergy |
|
|
4 K+ sparing diuretics
|
Spironolactone, eplerenone
Triamterene, Amiloride |
|
|
Where do the K+ sparing diuretics work?
|
Cortical collecting tubule
|
|
|
Mechanism of spironolactone and eplerenone?
|
Competitive aldosterone receptor antagonists
|
|
|
Eplerenone has fewer _____ side effects than spironolactone
|
Androgenic (is selective for aldosterone receptor)
|
|
|
All diuretics increase?
|
Urine NaCl
|
|
|
Which diuretic classes cause acidemia?
|
Carbonic anhydrase inhibitors and K+ sparing (aldosterone blockade prevents both K+ secretion and H+ secretion)
|
|
|
Which diuretic classes cause alkalemia?
|
Loop diuretics and thiazides
3 mechanisms: volume contraction, K+ exciting cells in exchange for H+ entering cells, and H+ being exchanged for Na+ in cortical collecting duct due to low K+ state |
|
|
Hypocalcemia with _____, hypercalcemia with _____
|
Loop diuretics
Thiazides |
|
|
3 ACE inhibitors
|
Captopril, enalapril, lisinopril
|
|
|
Mechanism of ACE inhibitors
|
Inhibit angiotensin-converting enzyme, with 2 effects:
Decreases levels of angiotensin II Prevents inactivation of bradykinin (--> more bradykinin), a potent vasodilator |
|
|
Is renin release increased or decreased with ACE inhibitors?
|
Increased (loss of feedback inhibition, though the renin cannot produce its downstream effects)
|
|
|
3 uses of ACEIs
|
HTN
CHF Diabetic renal disease |
|
|
Mechanism of cough in ACEIs
|
Increased bradykinin
|
|
|
Treat cough from ACEIs with
|
Replacement of ACEI with an ARB (e.g. losartan)
|
|
|
Toxicity of ACEIs
|
CAPTOPRIL + hyperkalemia
Cough Angioedema Proteinuria Taste changes hypOtension Pregnancy problems (fetal renal damage) Rash Increased renin Lower angiotensin II |
|
|
ACEIs should be avoided in pts with?
|
Bilateral renal artery stenosis, b/c ACEIs significantly decrease GFR by preventing constriction of efferent arterioles
|
|
|
GnRH analog
|
Leuprolide
|
|
|
Leuprolide is a ____ when used in a pulsatile manner and ____ when used continuously
|
Agaonist
Antagonist |
|
|
3 uses of leuprolide
|
Infertility (pulsatile)
Prostate cancer (continuous + flutamide) Uterine fibroids |
|
|
Toxicity of leuprolide
|
Antiandrogen
N/V |
|
|
3 uses of testosterone
|
Hypogonadism/ promote dev't of secondary sex characteristics
Stimulate anabolism to promote recovery after burn/ injury Treat ER-positive breast cancer |
|
|
Exemestane is a ____ inhibitor
|
Aromatase
|
|
|
Exemestane is used to treat
|
ER-positive breast cancer
|
|
|
4 toxicities of testosterone
|
Females: masculinization
Males: gonadal atrophy (by feedback inhibition of LH) Premature closure of epiphyseal plate Increases LDL/ decreases HDL |
|
|
4 antiandrogens
|
Finasteride, flutamide, ketoconazole, spironolactone
|
|
|
Mechanism of finasteride
|
5alpha reductase inhibitor
|
|
|
Two uses of finasteride
|
BPH
Male-pattern hair loss |
|
|
Mechanism of flutamide
|
Nonsteroidal competitive inhibitor of androgens at testosterone receptor
|
|
|
Use of flutamide
|
Prostate carcinoma (can use with continuous leuprolide)
|
|
|
Ketoconazole inhibits ____ to inhibit steroid ____
|
Demolase
synthesis |
|
|
Spironolactone inhibits steroid ____
|
binding
|
|
|
Ketoconazole and spironolactone are used in
|
PCOS to prevent hirsutism
|
|
|
2 side effects of ketoconazole and spironolactone
|
Gynecomastia
Amenorrhea |
|
|
3 uses of estrogen in women
|
Hypogonadism or ovarian failure
Menstrual abnormalities HRT in postmenopausal women |
|
|
1 use of estrogen in men
|
Androgen-dependent prostate cancer
|
|
|
4 toxicities of estorgen
|
Increased risk of endometrial cancer
Bleeding in postmenopausal women Increased risk of thrombi With DES: clear cell adenocarcinoma in vagina of females with DES exposure in utero |
|
|
2 contraindications of estrogen
|
ER-positive breast cancer
History of DVTs |
|
|
Estrogen partial agonists are also called
|
Selective estrogen receptor modulators (SERMs)
|
|
|
3 SERMs
|
Clomiphene
Tamoxifen Raloxifene |
|
|
Mechanism of clomiphene
|
Partial agonist at estrogen receptors in hypothalamus, so prevents feedback inhibition, increasing release of LH and FSH
|
|
|
2 uses of clomiphene
|
Infertility and PCOS
|
|
|
4 toxicities of clomiphene
|
Hot flashes
Ovarian enlargement Multiple simultaneous pregnancies Visual disturbances |
|
|
Raloxifene is used to treat
|
Osteoporosis
|
|
|
Tamoxifen is used to treat and prevent recurrence of
|
ER-positive breast cancer
|
|
|
Two uses of hormone replacement therapy
|
Relief/ prevention of menopausal symptoms
Osteoporosis |
|
|
Why is progesterone used in HRT?
|
Unopposed estrogen increases the risk of endometrial cancer
|
|
|
Possible increased risk of ___ with HRT?
|
CVD
|
|
|
3 aromatase inhibitors
|
Anastrozole
Exemestane Letrozole |
|
|
Aromatase inhibitors are used in ____ to treat ____
|
Postmenopausal women
Breast cancer |
|
|
Why are aromatase inhibitors used?
|
Because postmenopausal women have estrogen due to peripheral conversion
|
|
|
Progestins reduce ___ and increase ____ of endometrium
|
Growth
Vascularization |
|
|
3 uses of progestins
|
OCPs
Endometrial cancer Abnormal uterine bleeding |
|
|
Mifepristone is a competitive inhibitor of ____
|
Progestins (at progesterone receptor)
|
|
|
Mifepristone is used to
|
Terminate pregnancy
|
|
|
Mifepristone is administered with
|
Misoprostol (PGE1)
|
|
|
3 toxicities of mifepristone
|
Heavy bleeding
GI (N/V, anorexia) Abdominal pain |
|
|
Mechanism of oral contraceptives
|
Prevent estrogen surge, so LH surge/ ovulation don't occur
|
|
|
OCP effect on:
risk of endometrial and ovarian cancer |
Decrease
|
|
|
OCP effect on:
Lipids |
Increase triglycerides
|
|
|
OCP effect on:
incidence of ectopic pregnancy |
Decrease
|
|
|
OCP effect on:
incidence of pelvic infections |
Deccrease
|
|
|
OCP effect on:
CVD risk |
Puts pts in a hypercoaguable state
|
|
|
4 side effects of OCPs
|
Depression
Weight gain Nausea HTN |
|
|
Contraindications of OCPs (3)
|
Smokers >35yo
History of thromboembolism/ stroke History of estrogen-dependent tumors |
|
|
Dinoprostone is a ____ analog
|
PGE2
|
|
|
Dinoprostone causes 3 things
|
Cervical dilation
Uterine contraction Both helping to induce labor |
|
|
2 beta-2 agonists that relax the uterus
|
Ritodrine/ terbutaline
|
|
|
Use of ritodrine/ terbutaline
|
Reduce premature uterine contractions
|
|
|
Tamsulosin: drug type and use
|
alpha-1 antagonist used to treat BPH by inhibiting smooth muscle contraction
|
|
|
Tamsulosin is specific for ____ receptors, so doesn't cause _____
|
alpha-1A/D receptors found on prostate
orthostatic hypotension (by afefcting vascular alpha-1B receptors) |
|
|
Sildenafil and vardenafil: mechanism
|
Inhibit cGMP phosphodiesterase, causing increased cGMP, smooth muscle relaxation in the corpus cavernosum, increased blood flow, and penile erection
|
|
|
Other than erectile dysfunction, sildenafil is also used to treat
|
Pulmonary artery hypertension
|
|
|
4 toxicities of sildenafil
|
Headache
Flushing Heartburn Impaired blue-green color vision |
|
|
Sildenafil is contraindicated in pts taking ____ because of the risk of life-threatening _____
|
Nitrates
Hypotension |
|
|
Are H1 blockers reversible or irreversible inhibitors of H1 histamine receptors?
|
Reversible
|
|
|
3 first generation H1 blockers
|
Diphenhydramine, dimenhydrinate, chlorpheniramine
|
|
|
3 second generation H1 blockers
|
Loratadine, fexofenadine, desloratadine, cetirizine
|
|
|
Clinical uses of 1st generation H1 blockers
|
Allergy
Motion sickness Sleep aid |
|
|
Clinical uses of 2nd generation H1 blockers
|
Allergy
|
|
|
Why are 2nd generation H1 blockers less sedating?
|
Decreased entry into the CNS
|
|
|
This drug blocks both H1 and H2 receptors; used for anaphylactic reactions (and as an antidepressant)
|
Doxepin
|
|
|
Bronchoconstriction is mediated by two things
|
Inflammatory processes
Sympathetic tone |
|
|
6 types of asthma drugs
|
Beta-agonist (nonspecific and beta-2s)
Methylxanthines Muscarinic antagonists Cromolyn sodium Corticosteroids Antileukotrienes |
|
|
Which nonspecific beta agonist is used is asthma?
|
Isoproterenol
|
|
|
Adverse effect of isoproterenol
|
Tachycardia
|
|
|
Two beta-2 agonists used in asthma
|
Albuterol and salmeterol
|
|
|
Which beta-2 agonist is used for acute asthma exacerbations?
|
Albuterol
|
|
|
Which beta-2 agonist is used as a long-acting agent for prophylaxis
|
Salmeterol
|
|
|
Adverse effects of salmeterol (2)
|
Tremor
Arrhythmias |
|
|
Example of a methylxanthines
|
Theophylline
|
|
|
Mechanism of theyphylline-induced bronchodilation?
|
Inhibits phosphodiesterase --> decreases cAMP hydrolysis
|
|
|
2 serious toxicitis of theophylline
|
Cardiotoxicity
Neurotoxicity |
|
|
Theophylline blocks action of?
|
Adenosine (antiarrhythmic that increases K+ efflux)
|
|
|
Theophylline cardiotoxicity is treated with?
|
Beta blockers
|
|
|
Muscarinic antagonists used in asthma
|
Ipratropium
|
|
|
Ipratropium is also used for
|
COPD
|
|
|
Mechanism of cromolyn sodium
|
Prevents release of mediators from mast cells
|
|
|
Is cromolyn sodium used for prophylaxis or treatment of asthma?
|
Prophylaxis (not effective during an acute attack)
|
|
|
1st line therapy for chronic asthma
|
Corticosteroids
|
|
|
2 corticosteroids used in asthma
|
Beclomethasone
Prednisone |
|
|
2 mechanisms of corticosteroids in asthma
|
Inhibit synthesis of cytokines
Inactivate NF-kappa beta, the TF that induces production of TNF-alpha |
|
|
3 antileukotrienes used in asthma
|
Zileuton, zafirlukast, montelukast
|
|
|
Mechanism of zileuton
|
5-liposygenase pathway inhibitor (Blocks conversion of arachidonic acid to leukotrienes)
|
|
|
Mechanism of zafirlukast and montelukast
|
Block leukotriene receptors
|
|
|
Best treatment for aspirin-induced asthma
|
Zafirlukast, montelukast
|
|
|
2 expectorants
|
Guaifenesin
N-acetylcysteine |
|
|
Mechanism of guaifenesin
|
Removes excess sputum (doesn't suppress cough reflex)
|
|
|
N-acetylcysteine has 2 clinical uses
|
Expectorant/ mucolytic
Antidote for acetaminophen toxicity |
|
|
N-acetylcysteine is used as an expectorant in which pts
|
CF patients (can loosen mucous plugs)
|
|
|
Bosentan is used to treat
|
Pulmonary hypertension
|
|
|
Mechanism of bosentan
|
Competitive antagonist of endothelin-1 receptors --> decreases pulmonary vascular resistance
|
