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260 Cards in this Set
- Front
- Back
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Digitoxin (Crystodigin) |
Digitalis Glycosides
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Digoxin (Lanoxin)
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Digitalis Glycosides
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Digoxin Immune Fab (Digibind)
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Digoxin Overdose Antidote
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Quinidine
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Antiarrhythmic Agent - Class 1A
Decrease automaticity Increase refractory period IV: dilate vessels (hypotension) Increase conduction thru AV Node |
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Procainamide (Pronestyl)
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Antiarrhythmic Agent
Class 1A |
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Disopyramide (Norpace)
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Antiarrhythmic Agent
Class 1A |
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Lidocaine (Xylocaine)
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Antiarrhythmic Agent
Class 1B |
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Mexelitine (Mexitil)
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Antiarrhythmic Agent
Class 1B Oral agent for ventricular arrhythmias |
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Flecainide (Tambocor)
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Antiarrhythmic Agent
Class 1C Oral agent for ventricular arrhythmias |
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PropranoLOL (Inderal)
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Antiaginal
Beta Blocking Agents Antiarrhythmic Agent Class II USE - Atrial tachycardia & Ventricular tachycardia |
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Amiodarone (Cordarone)
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Antiarrhythmic Agent
Class III 45 day half life USE - Ventricular arrhythmias (IV form) |
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Verapamil (Isoptin, Calan)
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Antiaginal
Calcium Channel Blockers Antiarrhythmic Agent - Class IV |
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Atropine
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Antiarrhythmic Agent
Other Anticholinergic IV Push for Antiarrhythmic use |
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NITRoglycerin Sublingual (Nitrostat)
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Antiaginal
Nitrates ACUTE ANGINA |
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NITRoglycerin Topical (Nitrol Ointment)
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Antiaginal
Nitrates Angina Prophylaxis |
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Isosorbide DiNITRate Tablet (Isordil, Sorbitrate)
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Antiaginal
Nitrates Angina Prophylaxis |
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Isosorbide MonoNITRate Tab (Monoket, Ismo)
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Antiaginal
Nitrates Angina Prophylaxis |
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NITRoglycerin Oral / SR Caps / Patch (NitroBid, Transderm Nitro, Tridil)
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Antiaginal
Nitrates Angina Prophylaxis |
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NITRoglycerin Injection
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Antiaginal
Nitrates Angina Prophylaxis |
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AtenoLOL (Tenormin)
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Antiaginal
Beta Blocking Agents |
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PropranoLOL (Inderal)
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Antiaginal
Beta Blocking Agents Antiarrhythmic Agent Class II |
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NadoLOL (Corgard)
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Antiaginal
Beta Blocking Agents |
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Verapamil (Isoptin, Calan)
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Antiaginal
Calcium Channel Blockers Antiarrhythmic Agent - Class IV IV push for Antiarrhythmic properties 2nd dose can be repeated in 5 minutes 90% effective |
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Nifedipine (Procardia XL)
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Antiaginal
Calcium Channel Blockers |
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Diltiazem (Cardizem)
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Antiaginal
Calcium Channel Blockers |
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Cholestyramine (Questran)
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Hypolipidemic Agents
Bile Sequestering Agents Increases Elimination (but tastes like sand) |
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Colestipol (Colestid)
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Hypolipidemic Agents
Bile Sequestering Agents Increases Elimination (but tastes like sand) |
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FenoFIBRate (Tricor)
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Hypolipidemic Agents
Fibric Acid Derivative Decreases Triglyceride production Drug interaction with -STATINS (rhybdomyolysis - total destruction of all muscles) |
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GemFIBRozil (Lopid)
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Hypolipidemic Agents
Fibric Acid Derivative Decreases Triglyceride production May increase HDL May reverse plaque formation Drug interaction with -STATINS (rhybdomyolysis - total destruction of all muscles) |
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-STATIN
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Hypolipidemic Agents
HMG CoA Reductase Inhibitor Decreases LDL production Need to monitor Liver Function and Retina |
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LovaSTATIN (Mevacor)
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Hypolipidemic Agents
HMG CoA Reductase Inhibitor Decreases LDL production |
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PravaSTATIN (Pravachol)
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Hypolipidemic Agents
HMG CoA Reductase Inhibitor Decreases LDL production |
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SimvaSTATIN (Zocor)
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Hypolipidemic Agents
HMG CoA Reductase Inhibitor Decreases LDL production |
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AtorvaSTATIN (Lipitor)
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Hypolipidemic Agents
HMG CoA Reductase Inhibitor Decreases LDL production |
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FluvaSTATIN (Lescol)
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Hypolipidemic Agents
HMG CoA Reductase Inhibitor Decreases LDL production |
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Nicotinic Acid (Nicobid) (Vitamin B3)
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Hypolipidemic Agents
Other Decreases Lipoprotein production Requires high doses - Flushing - Itching Contraindicated with DIABETES |
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WarfARIN (Coumadin)
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Anticoagulant
- Decreases production of vitamin K dependent clotting factors in the liver - High protein binding (99% protein bound) - leads to many drug interactions - Monitor Prothrombin Time - Effect of each dose not seen for 3 days - Must maintain consistent vitamin K diet |
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HepARIN
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Anticoagulant
Activates Antithrombin III (blocks Prothrombin from converting to Thrombin) Injectable administration only |
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EnoxapARIN (Levenox)
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Anticoagulant / Low Molecular Weight Heparin
- Less bleeding reactions - Subcutaneous administration - Can be utilized for ambulatory care therapy |
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DaltepARIN (Fragmin)
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Anticoagulant / Low Molecular Weight Heparin
- Less bleeding reactions - Subcutaneous administration - Can be utilized for ambulatory care therapy |
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Protamine Sulfate
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Heparin Antidote
- Binds excess heparin (1mg binds 100 units of heparin) - Excess Protamine Sulfate has anticoagulant properties |
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Aspirin
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Antiplatelet Drug
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Dipyridamole (Persantine)
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Antiplatelet Drug
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Clopidogrel (Plavix)
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Antiplatelet Drug
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Streptokinase (Streptase)
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Thrombolytic Agents
Indirect acting - reaction required something else - Stimulates conversion of plasminogen to plasmin USE - Pulmonary Embolism |
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Urokinase (Abbokinase)
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Thrombolytic Agents
Direct Acting - reaction occurs with the drug alone USE - Utilized to open clotted catheters |
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Alteplase (Activase)
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Thrombolytic Agents
Direct Acting - reaction occurs with the drug alone USE - Pulmonary Embolism - Myocardial Infarction - Stroke (clot, not aneurysm) within 6 hrs. |
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Ferrous Sulfate (Feosol)
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Anemia Treatment
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Iron Dextran (Imferon)
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Anemia Treatment
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Cyanocobalamin (Vitamin B-12)
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Anemia Treatment
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Folic Acid
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Anemia Treatment
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Leucovorin (Welcovorin)
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Anemia Treatment
Folinic Acid |
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Epoetin Alfa (Epogen)
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Anemia Treatment
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Filgrastim (Neupogen)
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Granulocyte Colony-Stimulating Factor
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DesmoPRESSIN (DDAVP)
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Hormonal Agent
Posterior Pituitary |
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VasoPRESSIN (Pitressin)
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Hormonal Agent
Posterior Pituitary |
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Oxytocin (Syntocin)
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Hormonal Agent
Posterior Pituitary |
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CorticoTROPIN (Acthar, ACTH)
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Hormonal Agent
Anterior Pituitary |
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CosynTROPIN (Cortrosyn)
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Hormonal Agent
Anterior Pituitary |
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ThyroTROPIN (Thropar)
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Hormonal Agent
Anterior Pituitary |
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Somatrem (ProTROPIN)
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Hormonal Agent
Anterior Pituitary GROWTH HORMONE |
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FludrocortiSONE (Florinef)
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Hormonal Agent
Adrenocorticoid Mineralocorticoid |
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BeclometheSONE (QVar, Beconase)
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Hormonal Agent
Adrenocorticoid Glucocorticoid For Asthma (oral inhalant) and nasal allergies |
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DexamethaSONE (Decadron)
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Hormonal Agent
Adrenocorticoid Glucocorticoid For asthma |
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FluticaSONE (Flonase)
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Hormonal Agent
Adrenocorticoid Glucocorticoid Rhinitis |
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Flunisolide (Aerobid)
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Hormonal Agent
Adrenocorticoid Glucocorticoid For Asthma |
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HydrocortiSONE (Cortef)
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Hormonal Agent
Adrenocorticoid Glucocorticoid For skin rash, acute breathing disorders and asthma |
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MethylprednisoLONE (Medrol)
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Hormonal Agent
Adrenocorticoid Glucocorticoid For breathing disorders (inj) and asthma Tapering dose |
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PredniSONE
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Hormonal Agent
Adrenocorticoid Glucocorticoid For arthritis and asthma |
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TriamcinoLONE (Aristocort, Azmacort)
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Hormonal Agent
Adrenocorticoid Glucocorticoid For arthritis, inj into joint, not systemic topical for rash or psoriasis |
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Aminoglutethimide (Cytadren)
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Hormonal Agent
Inhibition of Adrenocorticoid Synthesis |
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Mitotame (Lysodren)
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Hormonal Agent
Adrenocorticolytic |
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Conjugated ESTrogen (Premarin)
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Female Sex Hormone
Estrogen For Post Menopausal symptoms |
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ESTrodiol Valerate (Delestrogen)
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Female Sex Hormone
Estrogen For Post Menopausal symptoms |
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Ethinyl ESTradiol (Estinyl)
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Female Sex Hormone
Estrogen Most common estrogen in BCP |
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MESTranol
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Female Sex Hormone
Estrogen Most common estrogen in BCP |
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ESTropipate (Ogen)
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Female Sex Hormone
Estrogen For Post Menopausal symptoms |
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DienESTrol (AVC)
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Female Sex Hormone
Estrogen For Post Menopausal symptoms - Atrophic Vaginitis |
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MeGESTrol (Megace)
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Female Sex Hormone
Progesterone For Endometrial Cancer & increases appetite |
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Norethindrone (Norlutin)
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Female Sex Hormone
Progesterone Common component in BCP |
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MedroxyproGESTerone (Provera)
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Female Sex Hormone
Progesterone 3 mo. inj for birth control |
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Ethynodiol (Ovulen)
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Female Sex Hormone
Progesterone Common component in BCP |
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NorGESTerol (Ovral)
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Female Sex Hormone
Progesterone Common component in BCP For ovulatory failure |
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FluoxymeSTERONE (Halotestin)
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Male Sex Hormone
Adrogenic |
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MethyltestoSTERONE (Oreton)
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Male Sex Hormone
Adrogenic |
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TestoSTERONE Cypionate (Depo-Testosterone)
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Male Sex Hormone
Adrogenic |
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Nandrolone Dacanoate (Deca-Durabolin)
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Male Sex Hormone
Anabolic |
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Stanozolol (Winstrol)
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Male Sex Hormone
NOT A BETA BLOCKER |
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Levothyroxine (Synthroid)
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Thyroid Agent - Synthetic T4
Tx for Hypothyroidism |
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Liothyronine (Cytomel)
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Thyroid Agent- Synthetic T3
Tx for Hypothyroidism |
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Thyroid
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Thyroid Agent
Tx for Hypothyroidism |
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Propylthiouracil (Propacil)
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Thyroid Agent
Tx for Hyperthyroidism |
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Methimazole (Tapazole)
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Thyroid Agent
Tx for Hyperthyroidism |
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Potassium Iodide (SSKI)
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Thyroid Agent
Tx for Hyperthyroidism |
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Sodium Iodide I-131
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Thyroid Agent
Tx for Hyperthyroidism |
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Lispro (Humalog)
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Hypolglycemic Agent
Insulin Ultra Short Acting |
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Insulin (Regular)
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Hypolglycemic Agent
Insulin Rapid Acting |
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Isophane Insuline Suspension (NPH)
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Hypolglycemic Agent
Insulin Intermediate Acting |
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Extended Insuline Zinc Suspension (Ultralente)
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Hypolglycemic Agent
Insulin Long Acting |
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Glargine (Lantus)
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Hypolglycemic Agent
Insulin Long Acting |
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ChlorpropaMIDE (Diabenese)
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Hypolglycemic Agent
Oral Hypoglycemic Agent 1st Generation Sulfonylureas |
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TolazaMIDE (Tolinase)
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Hypolglycemic Agent
Oral Hypoglycemic Agent 1st Generation Sulfonylureas |
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TolbutaMIDE (Orinase)
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Hypolglycemic Agent
Oral Hypoglycemic Agent 1st Generation Sulfonylureas |
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Glipizide (Glucotrol)
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Hypolglycemic Agent
Oral Hypoglycemic Agent 2nd Generation Sulfonylureas |
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Glyburide (DiaBeta, Micronase)
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Hypolglycemic Agent
Oral Hypoglycemic Agent 2nd Generation Sulfonylureas |
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Glimepiride (Amaryl)
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Hypolglycemic Agent
Oral Hypoglycemic Agent 2nd Generation Sulfonylureas |
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Metformin (Glucophage)
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Hypolglycemic Agent
Oral Hypoglycemic Agent Biguanide |
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RosigLITAZONE (Avandia)
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Hypolglycemic Agent
Oral Hypoglycemic Agent Thiazolidinedione |
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PiogLITAZONE (Actos)
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Hypolglycemic Agent
Oral Hypoglycemic Agent Thiazolidinedione |
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Acarbose (Precose)
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Hypolglycemic Agent
Oral Hypoglycemic Agent Misc. |
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Glucagon
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Reverse Hypoglycemia
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Diazoxide (Proglycem)
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Reverse Hypoglycemia
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Cardiac Glycoside Pharmacology - Low Dose
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Increased contractility of heart (Increased inotropic effect / cannot pump Ca++ out of cardiac cell / leads to greater contractility and duration)
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Cardiac Glycoside Pharmacology - High Dose
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Decreased AV Node conduction (keeps gate closed longer) (Decreased chronotropic effect / used in atrial fibrillation)
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Cardiac Glycoside Therapeutic Monitoring
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- Apical Pulse (hold dose if under 60 BPM
- Serum drug level - Narrow Therapeutic Index - Serum K+ (caution with HYPOkalemia) - Serum Ca+ (caution with HYPERcalcemia) EKG |
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Cardiac Glycoside Toxicities
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AV Block
Sinus Bradycardia Arrhythmias Yellow-Green Halo Vision CNS - headache - weakness - anorexia |
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Cardiac Glycoside Uses
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CHF
Adjunct therapy for atrial fibrillation (not to treat atrial fibrillation but to prevent ventricular fibrillation) |
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Refractoriness
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Responsiveness of a cardiac membrane during recovery of previous activity (nothing is going to happen)
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AntiArrhythmics - Mechanism of Action
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Decrease automaticity
Increase refractory period |
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Quinidine - Adverse Rx & Toxicity
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Adverse Rx - Arrhythmogenic
Toxicities - Tinnitus - Headache - Nausea / vomiting - Vertigo |
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Quinidine - Use
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Atrial Tachycardia
Atrial fibrillation - use Digoxin as adjunt therapy |
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Procainamide - Adverse Rx
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Lupus-like Syndrome
Dose related - reversible Arrhythmogenic |
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Procainamide - Use
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Atrial Tachycardia
Atrial Fibrillation Ventricular Arrhythmia - IV use when lidocaine fails or is contra-indicated |
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Procainamide - Pharmacology
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Decreases automaticity
Increases refractory period Slows AV conduction (Do not use Digoxcin) |
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Disopyramide - Pharmacology
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Decreases automaticity
Increases refractory period No effect on AV conduction Strong anticholinergic |
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Disopyramide - Use
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Atrial Tachycardia
Atrial Fibrillation |
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Disopyramide - Contraindication
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CHF
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Lidocaine - Pharmacology
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Local Anesthetic
Antiarrhythmic - LOADING DOSE (IV use only) High therapeutic index (safe) |
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Lidocaine - Adverse Effects
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CNS Toxicity
- Tinnitus - Respiratory depression - Seizure |
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Lidocaine - Use
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Ventricular Arrhythmias
Digoxin toxicity arrhythmias |
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AntiArrhythmia Agents (AAA)
Class 1B & 1C |
Mexelitine
Tocainide Flecainide - oral agents for ventricular arrhythmias - similar to Lidocaine |
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Amiodarone (Cordarone) - Adverse Reactions
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- Cataract
- Pulmonary fibrosis - HYPOthyroid |
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Verapamil (Isoptin, Calan) - Use
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Atrial tachycardia
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Atropine - Use
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Sinus Dradycardia
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Angina - definition
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Imbalance between myocardial O2 requirement vs. O2 delivery
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Angina - Etiology
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- Atherosclerosis
- Vasospasm (Prinzmetal) - HYPERtension - Anemia - Thyrotoxicosis - CHF |
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Angina - Precipitating Factors
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- Overeating
- Exercise - Intense emotional stimuli - Extremes of heat and cold - Medications (sympathomimetics, anorectic agents, antidepressants) - Smoking |
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Nitrates - Pharmacology
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- Coronary artery vasodilation
- Peripheral artery dilation - Peripheral venous dilation (PRIMARY MECHANISM) (increases venous pooling, decreasing return to heart / decreases amount of blood to pump / decreases work load / decreases O2 demand) |
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Nitrates - Use
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- Acute Angina (relief of pain)
- Prophylactic (decreasing incidence of anginal pain by administering medication routinely or prior to exertion) |
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Nitrate - Caution
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- Tolerance develops to constant blood levels
- Increased IOP - Headaches - Syncope - Cutaneous flushing |
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Nitrate Sublingual
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- use lowest dose
- administer as tablet or spray - 1 dose every 5 minutes for 3 dose max. - tablets leave a burning sensation (sign they are still effective) - Store in glass bottle (plastic absorbs NG) - store in cool non-humid place |
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Nitrate Ointment
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- dosed by inch
- remove previous application - placed on skin surface with good blood supply - use gloves when applying to avoid tolerance and HYPOtension |
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Nitrate Patch
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- takes time to get to therapeutic levels (24 hrs)
- remove at bedtime to prevent tolerance |
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Nitrate Injection
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- for unstable angina
- for post-cardiac surgery - administer using non-plastic injection tubing - decreases pre-load & after-load |
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Beta Blocker - Pharmacology
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- Decreases heart rate
- Decreases cardiac work load - Decreases cardiac oxygen demand - Low dose administration - Abrupt withdrawal exacerbates cardiac ischemia |
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Calcium Channel Blockers - Use
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Classical Angina - Decreases cardiac work load ⇨demand
Vasospasm Angina - increases O2 supply by dilating coronary arteries ⇨delivery |
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Hypolipidemic Agents - Use
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Atherosclerosis
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Hypolipidemic Agents - Risk Factors
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Male > 45 year old, Female > 55 y/o
Family history of Coronary Heart Disease (CHD) HYPERtension Low HDL <40mg/dl Smoking |
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Target LDL (mg/dl)
No CHD & < 2 risk factors No CHD & > 2 risk factors CHD |
<160 mg/dl
<130 mg/dl <100 mg/dl |
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Hypolipidemic Consequences
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- Increased atherosclerosis
- Coronary Artery Disease - HYPERtension - Stroke - Peripheral Vascular Disease |
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VLDL
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Triglycerides
Decreases with lowering saturated fats in diet |
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LDL
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Cholesterol
Does not decrease with lowering cholesterol |
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HDL
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Increases with exercise - protectant
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Phytonadione (Vitamin K)
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Warfarin overdose antidote
- Administer via subcutaneous route |
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Wafarin - USE
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- Continuation therapy of heparin therapy for approximately 6 months
- Deep Venous Thrombosis - Pulmonary Embolism - Cardiac Valve Replacement - Atrial Fibrillation - life long therapy |
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Coagulation Cascade
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- Clotting factors activated
- Prothrombin converted to Thrombin (blocked by Antithrombin III) - Fibrinogen converted to Fibrin - Fibrin forms a lattice - Platelets bind to the lattice |
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Heparin - Administration
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- Subcutaneous - to prevent post operative clotting or bedridden patient clotting
- Heparin Flush - Constant infusion following bolus dose - Treatment of deep venous thrombosis, pulmonary embloism - Eventually may switch to Warfarin |
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Heparin - Monitoring
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- Activated Partial Thromoboplastin Time (APTT) 1 1/2 to 2 1/2 time control
- Bleeding - No intramuscular injuections |
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Low Molecular Weight Heparins
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- Less bleeding reactions
- Subcutaneous administration - Can be utilized for ambulatory care therapy |
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Thrombolytic
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- Dissolves clot (huge concern for bleeding for Heart Attack or Stroke
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Iron Deficiency Anemia
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Hypochromic microcytic anemia (RBC small & pale in color)
Decreaces RBC and decreased hemoglobin Decreased O2 binding Can cause high output cardiac failure Causes of Iron Deficiency Anemia: Blood loss & inadequate diet or absorption |
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Iron Deficiency Anemia Therapy
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Oral - Replacement may require 6 months
Intramuscular (2 ml max.) - Z-track adminisitration & limited daily volume IV - (Limited to 100 mg per day) required for quick iron replacement (prenancy, ulcerative colitis) |
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Megaloblastic Anemia
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= Large RBC
Folic acid or Cyanocobalamin (Vitamin B12) deficiency Replacement with the wrong vitamin can mask the deficiency |
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Cyanocobalamin (B12) Deficiency
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Irreversible nerve damage
Constipation Causes of Cyanocobalamin Deficiency: Poor Diet (vegetarian) Lack of Intrinsic Factor (produced in stomach) Onset of symptoms - 1 year Also know as Pericious Anemia |
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Folic Acid Deficiency
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No Nerve Damage
Diarrhea Causes Folic Acid Deficiency: Poor Diet (alcoholics) Drug interactions Phenytoin - blocks absorption Birth Control Pills Taking Methotrexate or co-trimoxazole (Block converting to active form of the vitamin tetrahydrofolate) |
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Folic acid deficiency therapy
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Oral Folic Acid supplementation
LEUCOVORIN (active tetrahydrofolate) is utilized to overcome deficienceis associated with methotrexate and co-trimoxazaole |
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Normochromic Normocytic Anemia
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= normal RBC but not enough of them
Associated with chronic disease states -renal disease, cancer, HIV |
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Erythropoietin
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Hormone produced in the knidney to stimulate RBC production in bone marrow
Synthetic genetically engineered hormone in commercially available Helps avoid the need for transfusions |
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WBC Deficiency
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Associated with cancer chemotherapy
Prone to infections Example of agents that promote production of granulocytes - Filgrastim (Neupogen) |
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Antidiuretic hormone (ADH)
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Posterior pituitary
In Diabetes insipidus ADH is not produced Synthetic replacement therapy - desmoPRESSIN or vasoPRESSIN |
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Oxytocin
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Posterior pituitary
Induces labor contraction, induces prolatin to start lactation Also contracts uterus to stop bleed after birth |
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Adrenocorticotropin Hormone (ACTH)
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Anterior Pituitary
Stimulates adrenal gland to produce adrenocorticosteroid hormones (cortisol & aldosterone) Stopped by negative feedback (thermostat analogy) Drug used to diagnose Addison's Disease |
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Thyroid Stimulating Hormone
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Anterior Pituitary
Stimulates thyroid gland to produce thyroxine Stopped by negative feedback Drug used to diagnose hypothyroidism |
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Growth Hormone
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Anterior Pituitary
Drug used to treat dwarfism |
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Follicle Stimulating Hormone (FSH)
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Anterior Pituitary
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Luteinizing Hormone (LH)
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Anterior Pituitary
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Prolactin
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Anterior Pituitary
Used to produce breast milk no medication |
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Adrenocorticosteroids
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Produced in the adrenal cortex
Regulated by ACTH Synthesized from cholesterol MINERALOCORTICOID & GLUCOCORTICOID |
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Mineralocorticoids
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Electrolyte homeostatsis (e.g. aldosterone)
increases loss of K+ and retention of Na+ and H2O |
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Glucocorticoid
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Carbohydrate, fat, & protein metabolism (e.g. cortisol)
side effect is (increases loss of K+ and retention of Na+ and H2O) |
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Cushing's Disease
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High output of adrenocorticosteroids
Hypertension Fat Redistribution |
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Addison's Disease
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Need 2 drugs to treat (mineralocorticoids and glucocorticoids)
Low Production of adrenocorticosteroids (they lose Na+ and H2O =>hypotensive High K+ and Low Na+ & H2O |
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Adrenocorticosteroid Pharmacology
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LIPID METABOLISM
Lipogenesis and Lipolysis Fat redistribution: buffalo hump, moon face ELECTROLYTE BALANCE - Na+ & H2O rention - Increased Blood Pressure - Potassium Loss Addison's: opposite effect-hyperkalemia and circulatory collapse CARBOHYDRATE METABOLISM -protection under physical stress -protect glucose dependent brain function (stimulates gluconeogenisis -production of glucose in the liver) (reduces peripheral glucose utilization) (insensitivity to insulin) |
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Long term use of Corticosteroids =>
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Depression
Addison's disease Apathy Psychosis Decrease WBC (specifically lymphocytes) Decrease Immune Response Anti-inflammatory response Retard Growth in Children (bone growth) |
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Corticosteroids Withdrawal =>
|
-Acute adrenal insufficiency
-fever -myalgia (muscle pain) -arthralgia (joint point) -malaise AVOID BY GRADUAL WITHDRAWAL OF THERAPY |
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Corticosteroids (consequences of prolonged therapy)
|
-adrenal suppression
-fluid & electrolyte imbalance -peptic ulceration -depression -cataracts -osteoporosis |
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Corticosteroids Use =>
|
-Adrenal Insufficiency (Addison's - administer both mineralo- and gluco-corticoids)
-Rheumatoid Arthritis (anti-inflamm & immune response) -Allergic disorder - not anaphylactic (immune response) -Asthma (anti-inflamm & immune response) -Ocular disease - avoid if viral infecton (anti-inflamm) -Skin disorder (anti-inflamm & immune response) Lymphcytic leukemia (hematologic) -AMINOGLUTETHIMIDE used in cancer Tx for those cancers produced by sex hormone) - decreases production of sterol including sex hormones -MITOTANE(used in cancer to destroy the adrenal gland (adrenocorticolytic) |
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Estrogen
|
-Produced in ovaries, adrenal gland and testes
-Regulated by FSH -Stimulates growth & development of sexual organs -Stops growth - closes epiphyseal plate -Menstrual Cycle - growth of endometrium and blood supply |
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Estrogen Metabolic Effects
|
-Retention of Na+ & H2O
-Alter Glucose tolerance -Prevent negative calcium balance -Carcinogenic (uterine, DES babies with cervical cancer, breast) |
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Estrogen Therapeutic Use
|
-Oral/patch contraception with progesterone
- Menopausal symptoms -Increase bone density (no longer approved for this use) -Atrophic vaginitis -Dysmenorrhea -Cancer - Prostate |
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Estrogen Side Effects
|
-Nausea - tolerance develops
-mid-cycle bleeding -breast tenderness -increased blood clotting (avoid in smokers and avoid BCP after 45) |
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Specific Estrogen Receptor Modulator
|
Non-estrogen that stimulates estrogen receptor
-Indicated for increased bone density for those that cannot tolerate estrogens - - RALOXIFENE (Evista) - NOT AN ESTROGEN |
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Progesterone
|
-Produced in corpus luteum after ovulation
-Regulated by LH -Corpus luteum regresses after 14 days if ovum is not fertilized -Prepares endometrium for implantation -Increases basal body temp 1 degree C. |
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Progesterone Therapeutic Use
|
-Uterine bleed due to ovulatory failure
-Dysmenorrhea -Contraception with or without estrogens -Tx for endometrial cancer |
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Oral/Patch Contraceptives
|
-99% effective (non-compliance usually the cause of failure)
-Stops Ovulation -Cervical gland produces mucous so sperm cannot pass -Progesterone alone administered daily Progesterone w/estrogen administered for 21day - 7 days off -Not effective during the first month of therapy -If one dose is missed then double the next dose -If 2 doses are missed then double up for 2 days and use alternate form of BC -3 days w/o estrogen menses starts -Discontinue for 3 months prior to pregnancy SIDE EFFECTS: nausea/vomiting, headache, weight gain, acne (lower incidence with tri-phasic BCP) & melasma (brown spots on face) LONG TERM RISKS: decreased fertility, thromboembolism & cancer |
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ADRENOCORTICOIDS
-LONE -SONE |
MINERALOCORTICOID
FludrocortiSONE (Florinef) - p.o. GLUCOCORTICOID BeclomethaSONE (QVar, Beconase) - inhal DexamethaSONE (Decadron) - p.o., inj., inhal FluticaSONE (Flonase) – nasal inhal Flunisolide (Aerobid) - inhal HydrocortiSONE (Cortef) - inj, p.o., topical MethylprednisoLONE (Medrol) - inj., p.o. PredniSONE - p.o. TriamcinoLONE (Aristocort, Azmacort) - p.o., inj, topical |
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INHIBITION OF ADRENOCORTICOID SYNTHESIS
|
Aminoglutethimide (Cytadren)
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ADRENOCORTICOLYTIC
|
Mitotane (Lysodren)
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ESTROGENS
-EST- EST- |
Conjugated ESTrogen (Premarin) - p.o., inj., topical
ESTrodiol Valerate (Delestrogen) - inj. Ethinyl ESTradiol (Estinyl) - p.o. MESTranol - p.o. ESTropipate (Ogen) - p.o. (*) DienESTrol (AVC) - topical, supp |
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PROGESTERONE
-GEST- |
MeGESTrol (Megace) - p.o.
Norethindrone (Norlutin) - p.o. MedroxyproGESTerone (Provera) - p.o., inj Ethynodiol (Ovulen) - p.o. NorGESTerol (Ovral) - p.o. |
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ANDROGENIC
-STERONE |
FluoxymeSTERONE (Halotestin) - p.o.
MethyltestoSTERONE (Oreton) - p.o. TestoSTERONE Cypionate (Depo-Testosterone) - inj. |
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ANABOLIC
|
Nandrolone Decanoate (Deca-Durabolin) - inj
Stanozolol (Winstrol) - p.o. |
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ANTICOAGULANTS
-ARIN |
WarfARIN (Coumadin)
HepARIN - inj. EnoxapARIN (Levenox) - inj DaltepARIN (Fragmin) - inj |
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HEPARIN ANTIDOTE
|
Protamine Sulfate - inj.
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ANTIPLATELET DRUGS
|
Aspirin - p.o.
Dipyridamole (Persantine) - p.o. Clopidogrel (Plavix) – p.o. |
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THROMBOLYTIC AGENTS
-ASE |
Streptokinase (Streptase) - inj.
Urokinase (Abbokinase) - inj. Alteplase (Activase) - inj. |
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ANEMIA TREATMENT
|
Ferrous Sulfate (Feosol) - p.o.
Iron Dextran (Imferon) - inj. Cyanocobalamin (Vitamin B-12) - inj Folic acid - inj., p.o. Leucovorin (Welcovorin) - inj., p.o. Epoetin Alfa (Epogen) - inj. |
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GRANULOCYTE COLONY-STIMULATING FACTOR
|
Filgrastim (Neupogen) - inj
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POSTERIOR PITIUTARY
-PRESSIN |
DesmoPRESSIN(DDAVP) - inhal
VasoPRESSIN (Pitressin) - inj. Oxytocin (Syntocin) - inj. |
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ANTERIOR PITIUTARY
|
CorticoTROPIN (Acthar, ACTH) - inj
CosynTROPIN (Cortrosyn) - inj ThyroTROPIN (Thropar) - inj Somatrem (ProTROPIN) - inj - Growth Hormone |
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DIGITALIS GLYCOSIDES
|
Digitoxin (Crystodigin) - inj, p.o.
Digoxin (Lanoxin) - inj, p.o. |
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DIGOXIN OVERDOSE ANTIDOTE
|
Digoxin Immune Fab (Digibind) – inj.
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ANTIARRHYTMIC AGENTS
|
Quinidine - inj., p.o.
Procainamide (Pronestyl) - inj, p.o. Procainamide Sustained Release (Procan SR, Pronestyl SR) Disopyramide (Norpace) - p.o. Lidocaine (Xylocaine) - inj. Mexelitine (Mexitil) - p.o. Flecainide (Tambocor) p.o. Propranolol (Inderal) - inj. Amiodarone (Cordarone) - p.o. Verapamil (Isoptin, Calan) - inj. Atropine - inj. |
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ANTIANGINAL
Nitrates Agents for Acute Angina |
NITRoglycerin Sublingual (Nitrostat)
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ANTIANGINAL
Nitrates -NITR Agents for Angina Prophylaxis |
NITRoglycerin Topical (Nitrol Ointment)
Isosorbide DiNITRate Tablet (Isordil, Sorbitrate) Isosorbide MonoNITRate Tab (Monoket, Ismo) NITRoglycerin Oral, Sustained Release Caps (NitroBid) NITRoglycerin Patch (Transderm Nitro) NITRoglycerin Injection (Tridil) |
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ANTIANGINAL
Beta Adrenergic Blocking Agents -LOL |
AtenoLOL (Tenormin) - p.o.
PropranoLOL (Inderal) - p.o. NadoLOL (Corgard) - p.o. |
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ANTIANGINAL
Calcium Channel Blockers |
Verapamil (Isoptin, Calan) - p.o.
Nifedipine (Procardia XL) - p.o. Diltiazem (Cardizem) - p.o. |
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HYPOLIPIDEMIC AGENTS
Bile Sequestering Agents |
Cholestyramine (Questran)
Colestipol (Colestid) |
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HYPOLIPIDEMIC AGENTS
Fibric Acid Derivative -FIBR- |
FenoFIBRate (Tricor)
GemFIBRozil (Lopid) |
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HYPOLIPIDEMIC AGENTS
HMG CoA Reductase Inhibitor -STATIN |
LovaSTATIN (Mevacor)
PravaSTATIN (Pravachol) SimvaSTATIN (Zocor) AtorvaSTATIN (Lipitor) FluvaSTATIN(Lescol) |
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HYPOLIPIDEMIC AGENTS
Other |
Nicotinic Acid (Nicobid)
|
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TREATMENT OF HYPOTHYROIDISM
|
Levothyroxine (Synthroid) - p.o., inj
Liothyronine (Cytomel) - p.o., inj Thyroid - p.o. |
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TREATMENT OF HYPERTHYROIDISM
|
Propylthiouracil (Propacil)
Methimazole (Tapazole) Potassium Iodide (SSKI) Sodium Iodide I-131 |
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|
INSULIN
|
Ultra Short Acting
Lispro (Humalog) 2 ************************************** Rapid Acting Insulin (Regular) ************************************** Intermediate Acting Isophane Insulin Suspension (NPH) ************************************** Long Acting Extended Insulin Zinc Suspension (Ultralente) Glargine (Lantus) |
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ORAL HYPOGLYCEMIC AGENTS
First Generation Sulfonylureas |
Chlorpropamide (Diabenese)
Tolazamide (Tolinase) Tolbutamide (Orinase) |
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ORAL HYPOGLYCEMIC AGENTS
Second Generation Sulfonylureas |
Glipizide (Glucotrol)
Glyburide (DiaBeta, Micronase) Glimepiride (Amaryl) |
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|
ORAL HYPOGLYCEMIC AGENTS
Biguanide |
Metformin (Glucophage)
|
|
|
ORAL HYPOGLYCEMIC AGENTS
Thiazolidinedione -LITAZONE |
RosigLITAZONE (Avandia)
PiogLITAZONE (Actos) |
|
|
ORAL HYPOGLYCEMIC AGENTS
Miscellaneous |
Acarbose (Precose)
|
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|
REVERSE HYPOGLYCEMIA
|
Glucagon - inj
Diazoxide (Proglycem) - p.o. |
|
|
Androgens
|
Produced in testes
Regulated by LH Promotes growth Regulates reproductive organs Spermatogenesis Closes epiphyseal plate |
|
|
Androgens - Anabolic properties
|
Increase muscle mass
Increase nitrogen balance Increase production of RBCs |
|
|
Androgens - Therapeutic Use
|
Hypogonadism
Promote anabolism in chronic debilitating diseases Treatment of Anemia Treatment of estrogen induced cancers |
|
|
Androgens - Side Effects
|
Female masculinization - baldness, atrophy of sex organs
Decrease growth in children Na+ and H2O retention Hepatic Cancer Hypercalcemia |
|
|
Thyroid Hormone - Role
|
Regulate growth and development
Regulate basal metabolic rate Regulate cardiac output Lipolytic activity on cholesterol |
|
|
Hypothyroidism
|
Myxedema - adults
Cretenism - children |
|
|
Treatment for Hyperthyroidism
|
-Inhibitors of T3 and T4 synthesis (PROPYLTHIOURACIL & METHIMAZOLE)
Contraindication: pregnancy & breat feeding High concentration of Iodide - provides negative feedback to thyroid gland for 72 hours Pre-operative use to prepare patient for surgery (SUPER SATURATED POTASSIUM IODIDE SSKI) also used as an expectorant Radioactive Iodide (SODIUM IODIDE I-131) -onset of action days to weeks |
|
|
Increases Blood Glucose
|
glucose intake
gulcagon corticosteroids |
|
|
Decreases Blood Glucose
|
insulin
oral hypoglycemic agents |
|
|
DIABETES MELLITUS (juvenile onset & Type 1)
|
Most severe form of DM
Complications include diabetic ketoacidosis decreased synthesis and release of insulin from pancreas |
|
|
DIABETES MELLITUS (adult onset & Type 2)
|
Usually overweight
Functional beta cells in pancreas and/or decrease sensitivity of peripheral cells to insulin No ketoacidosis associated |
|
|
DIABETES MELLITUS - consequences
|
cardiac disease
renal disease blindness peripheral vascular disease gangrene polyneuropathy |
|
|
Regular Insulin
|
Onset less than 1 hr
Adjunct with longer acting - drow up in syringe first Treat ketoacidosis Parenteral 1 Nutrition ONLY REGULAR INSULIN CAN BE ADMINISTERED IV |
|
|
Intermediate Insulin
|
Onset 2 hours
Duration 24 hours |
|
|
Long acting Insulin
|
Onset 3 hours
Duration 30 hours |
|
|
Sulfonylureas (oral hypoglycemics)
Step 1 -AMIDE (1st Gen) |
First Generation - if one fails at maximum dose all will fail
2nd Generation - If one fails at maixmum dose, other may be effective Increases BETA cell production of insulin SIDE EFFECTS TOLBUTAMIDE - tinnitus CHLORPROPAMIDE - jaundice hypoglygemia cardiovascular abnormalities |
|
|
Biguanide (oral hypoglycemics)
|
Step 1 or Step 2
METFORMIN can cause LACTIC ACIDOSIS Increases peripheral cell sensitivity to insulin Avoid with renal impairment or with radiologic dyes |
|
|
Thiazolidinedione (oral hypoglycemics)
-LITAZONE |
Step 2 or Step 3
Increases sensitivity of peripheral & hepatic cells to insulin LIVER FAILURE, CARDIAC ABNORMALITIES |
|
|
Misc. (oral hypoglycemics)
|
Step 3 or Step 4
ACARBOSE Decreased absorption of disaccharides Min. effect on blood sugar |
|
|
Tx of Hypoglycemic reactions
|
Glucose
Glucagon DIAZOXIDE - tx fro non-diabetics with chronic hypoglycemia |
|
|
Low Dose of Cardiac Glycosides
|
Increased contractility of heart
|
|
|
High Dose of Cardiac Glycosides
|
Decreased AV Node Conduction
|
|
|
CHF w/ Cardiac Glycoside
|
Loop Diuretic
ACE Inhibitor K+ Sparing Diuretic Beta Blocker |
|
|
IV Verapamil
|
Atrial Tachycardia
Max 2 |
|
|
Prinzmetal Angina
|
Vasospasm
Verapamil |
|
|
Antianginal that will decrease heart rate
|
Beta Blocker
|
|
|
Adrenocorticolytic Agent
|
MITOTAME
|
|
|
Common Estrogen in BCP
|
Ethinyl Estradiol
|
|
|
Enhances elimination of lipoproteins
|
Cholestyramine & Colestipol
|
|
|
Decreases production of lipoproteins
|
Nicotinic Acid
|
