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616 Cards in this Set

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MOA mannitol
creates an osmotic diuresis because it can't leave the tubule
inhibits Na and Cl reabsorption in PC and ascendin loop
clinical uses of mannitol
to decrease intractranial pressure or intraocular pressure through volume depletion
side effects of mannitol
can cause pulmonary edema d/t extracellular volume expansion, pulling water out of cells
hypernatremia
contraindications of mannitol
CHF
pulmonary edema
anuria
severe renal failure
severe dehydration
how is mannitol administered?
parenterally (poorly absorbed PO)
MOA spironolactone
K sparing diuretic, antagonizes aldosterone in the DCT, inhibiting Na reabsorption
what effect does spironolactone have on Ca
decreases serum Ca levels by directly inhibiting its transport in the DCT
clinical uses of spironolactone
HTN
pulmonary edema
edema from CHF or cirrhosis, nephrotic syndrome
primary hyperaldosteronism
side effects of spironolactone
gynecomastia (and other anti-androgenic effects)
hyperkalemia
hyponatremia
hypochlroemic acidosis (blocks aldosterone's effect on Na/H antiporter)
MOA amiloride
K sparing diuretic, directly inhibits Na reabsorption, independent of aldosterone
increased Ca reabsorption
uses of amiloride
treats ca stones
differences between amiloride and triampterene?
MOA similar, but triampterene has shorter t1/2
MOA furosemide
loop diuretic, blocking NKCC
increased urinary excretion of K, Mg, Ca
increases RBF without altering GFR
clinical uses for furosemide
edema
to increase urine output in ARF (although it doesn't alter the course of ARF)
hypercalcemia
hyperkalemia
side effects of furosemide
K wasting
metabolic alkalosis
Mg depletion
ototoxicity
hyperuricemia
why does hyperuricemia result from furosemide use?
increases urate reabsorption d/t increased proximal Na reabsorption
contraindication of furosemide
sulfa allergy
which is the only loop diuretic without a sulfa group?
ethacrynic acid
MOA HCTZ?
block NaCl transport at the DCT
Enhanced Ca reaborption (because Na and Ca compete for ATP dependent reabsorption at DCT)
clinical uses of HCTZ?
HTN
edema
DI (by inducing mild volume depletion)
to stop recurrent renal calcium stones
contraindication of HCTZ
sulfa allergy
side effects of HCTZ
hyperglycemia
hyperlipidemia
hyperuricemia
hypercalcemia
melabolic alkalosis
Mg depletion
MOA acetazolamide
Carbonic anhydrase inhibitor
so it inhibits the reabsorption of HCO3- in PCT
also CA is in ciliary body of eye and in choroid plexus cells, so it decreases aqueous humor production and increases CSF production
uses for acetazolamide
acute altitude sickness
glaucoma
treatment for alkalosis
facilitate eexcretion of weak acid (as seen in tumor lysis syndrome)
side effects of acetazolamide
encephalopathy (from decreased excretion of NH3 in urine)
renal stones b/c calcium phosphate is less soluble in alkaline urine
hyperchloremic metabolic acidosis
contraindications of acetazolamide
sulfa allergy
hepatic or renal dz
hyperchloremic acidosis
hyponatremia
hypokalemia
what effect does furosemide have on the following serum levels:
K
HCO3
Ca
Mg
urate
decreased
increased
decreased
decreased
increased
what effect does thiazide have on the following serum levels:
K
HCO3
Ca
Mg
urate
decrease
increase
increased
decreased
increased
what effect does spironolactone have on the following serum levels:
K
HCO3
Ca
Mg
urate
increased
decreased
decreased
none
none
what effect does amiloride have on the following serum levels:
K
HCO3
Ca
Mg
urate
increased
decreased
increased
none
none
what effect does acetazolamide have on the following serum levels:
K
HCO3
Ca
Mg
urate
decreased
decreased
none
none
none
which diuretics decrease Mg?
furosemide
HCTZ
which diuretics increase urate?
furosemide
HCTZ
contraindication of spironolactone
acute renal failure
MOA nitroprusside
vasodilation of arteries and veins
contact with RBC --> decomposition of drug and release of NO
NO, via activation of guanylate cyclase --> vasodilation
clinical uses of nitroprusside
HTN crisis
aortic dissection (must be given with B blocker)
CHF
side effects of nitroprusside
hypotension
reflex tachy
CN release
contraindications for nitroprusside
known inadequate cerebral circulation
hepatic/renal dz (increases thiocyanate toxicity)
MOA nitroglycerine
via guanylate cyclase --> increase cGMP which activates cAMP protein dependent kinases and leads to dephosphorylation of myosin light chains and decreased intracellular Ca
--> relaxation of veins and increased venous capacitance
uses of nitroglyceride
treats angina (decresae coronary asospasm)
CHF
HTN
side effects of nitroglycerine
hypotension, tachycardia, throbbing HA from meningeal arterial dilation
MOA captopril
ACE inhibitor
blocks formation of AII and degradation of bradykinin
so, inhibits constriction of efferent arteriole, and potentiates vasodilation caused by bradykinin
also causes venous vasodilation
uses of captopril
HTN
CHF
ischemic heart disease
decreases proteinuria and progression of nephropathy in diabetics
side effects of captopril
cough from increased bradykinin
can cause renal insufficiency b/c GFR is not increased in low volume states
contraindications of captopril
renal insufficiency
bilateral renal artery stenosis
MOA losartan
AII receptor blocker
uses of losartan
HTN
CHF
side effects of losartan
no cough
can't maintain GFR by vasodilation of efferent arterioles
MOA milrinone
inhibits PDE III --> dilation of arteries and veins
PDE III inactivates cAMP, so this process is inhibited
--> increased Ca reflux in myocardium, with increased cardiac contractility
uses of milrinone
refractory CHF
can increase mortality, and should ONLY be used if diuretics, digoxin, and vasodilators have failed
a-fib
side effects of milrinone
ventricular arrhythmias
hypotension
hepatotoxicity
MOA sildenafil
blocks PDE V action (thus potentiating the action of cGMP dependent kinases that activate phosphatases that encourage the relaxation of smoooth muscle)
also decreases the Ca concnetration --> smooth muscle relaxation
MOA digoxin
blocks the Na-K pump --> increased Na intracellularly
this inhibits the Na concentration gradient from forming, blocking the Ca from leaving the cells
this improves cardiac contractility
also slows the conduction through AV node
uses of digoxin
CHF
a fib, a flutter (slows conduction throuh AV nodE)
side effects of digoxin
narrow therapeutic window
visual disturbances, nausea, blurred vision
a-tac and AV block can result
contraindication of digoxin
hypokalemia
2nd/3rd degree heart block
WPW who develop a-fib --> increased impulses through accessory pathway --> VF
what abnormalities can be seen on the EKG on a person taking digoxin
incresaed PR, decreased QT, scooping of ST segments, T wave inersion
MOA phenytoin
increases na channel inactivation
MOA carbamazepine
increases na channel inactivation
MOA lamotrigine
blocks voltage gated na channels
MOA gabapentin
increases GABA release
MOA topiramate
blocks na channels, incresaes GABA release
MOA phenobarbital
increases GABA
MOA valproic acid
increases GABA, blocks na channels
MOA ethosuxamide
blocks ca channels in thalamus
MOA benzos
increases GABA
uses for phenytoin
everything but absence seizures
status epilepticus proph
usees for lamotrigine
everything but absence and status
uses for carbamazepine
everything but absence and status
uses for gabapentin
all seizures except absence and status
peripheral neuropathy
uses for topirimate
everything but absence and status
uses for phenobarbital
everything but absence and status
uses for valproic acid
everything but status
uses for ethosuxamide
absence
uses for benzos in epilepsy
acute status
which anti-epileptic drugs are 1st line in pregnancy and children
phenobarbital
which epi drug is 1st line for trigeminal neuralgia
carbamazepine
which drug is used to treat peripheral neuropathy
gabapentin
which drug is used to treat myoclonic seizures
valproic acid
which drug is used to treat seizures in eclampsia
MgSO4 (1st line)
benzos
which epileptic drug --> sedation, tolerance, and dependence?
benzos
which epileptic drug --> aplastic anemia, liver toxicity, and teratogenesis?
carbamazepine
which epileptic drug --> diplopia, ataxia?
carbamazepine
phenytoin
which epileptic drug --> GI distress, lethargy, headache?
ethosuxamide
which epileptic drugs --> stevens johnson syndrome
ethosuxamide
lamotragine
which epileptic drug --> nystagmus, gingival hyperplasia, hirsutism?
phenytoin
which epileptic drug --> SLE like sydnrome
phenytoin
which epi drug --> spina bifida and other NTDs
valproic acid
which epi drug --> kidney stones
topiramate
which epilepsy drug --> malignant hyperthermia?
phenytoin
how do you treat OD of barbiturates?
symptom management
how do you treat OD of benzos?
flumazenil (competitive antagonist at GABA receptor)
other than for epilepsy, what can phenytoin be used for?
anti-arrhythmic
which is more dangerous in overdose: benzos or barbiturates?
barbiturates (longer t1/2 and more respiratory/cv depression)
MOA l-dopa
l dopa crosses bbb (dopamine doesn't) so it is converted to dopamine by dopa decarboxylase in cns
carbidopa
peripheral decarboxylase inhibitor in order to increase bioavailability in brain and decrease peripheral side effects (since the conversion to da won't occur peripherally)
toxicity of l-dopa?
arrhythmias from peripheral conversion of DA
dyskinesia following lt admin
akinesia between doses
MOA selegiline
selectively inhibits MAO-B, increasing availability of DA
use of selegiline
adjunctive to l-dopa in parkinsons
toxicityy of selegeliene
enhances l-dopa toxicity
MOA sumatriptan
5-HT1D agonst
--> vasoconstriction
use of sumatriptan
acute migraine
cluster headache attacks
what type of drug is bethanechol?
direct cholinergic agonist
what type of drug is carbechol
direct cholinergic agonist
what type of drug is pilocarpine
direct cholinergic agonist
what type of drug is methacholine
direct cholinergic agonist
what is the difference between direct cholinergic agonsts and indirect?
direct directly stimulate cholinergic receptors and indirect inhibit their breakdown via AChE
uses of bethanechol
activates bladder and bowel smooth muscle (used post-op for ileus adn urinary retention)
uses of carbechol
glaucoma
pupillary contraction
release of intraocular pressure
uses of pilocarpine
potent stimulator for saliva, sweat, and tears
uses of methacholine
challenge test for asthma dx
action of methacholine
stimulates muscarinic receptors in airway
class: neostigmine
indirect cholinomimetic
class pyrodostigmine
indirect cholinomimetic
class: edrophonium
indirect cholinomimetic
class: physostigmine
indirect cholinomimetic
class: echothiophate
indirect cholinomimetic
uses for neostigmine
post-op and neurogenic ileus and urinary retention
MG
reversal of NM junction blockade
uses for pyridostigmine
MG
uses for edrophonium
to dx MG
uses for physostigmine
glaucoma and atropine OD
uses for echothiophate
glaucoma
which indirect ACh agonist penetrates CNS
physostigmine
what are the symptoms of organophosphate poisoning
DUMBBELSS
Diarrhea
Urination
Miosis
Bradycardia
Bronchospasm
Excitation of skel muscle
Lacrimation
Sweating
Salivation
antidote to organophosphate poisoning
atropine + pralidoxime
what is pralidoxime
antagonist used to regenerate active cholinesterase
MOA of epi in tx of glaucoma
increases outflow of aqueous humor
MOA brimonidine in tx of glaucoma
(alpha agonist)
decreases aqueous humor synth
MOA beta blockers in tx of glaucoma
decreases aqueous humor secretion
MOA acetazolamide in tx of glaucoma
decreas aqueous humor secretion d/t decreaed HCO3
MAO cholinomimetics in tx of glaucoma
increased outflow of aqueous humor
which drug should be used in a glaucoma emergency
pilocarpine (direct ACh mimetic)
MOA latanoprost in tx of glaucoma
PGF-alpha, increases outflow of aqueous humor
which glaucoma drugs decrease the synth of aqueous humor?
beta-blockers
brimonidine
acetazolamide
which glaucoma drugs increase outflow of aqueous humor?
epi
cholinomimetics
PGF2alpa (latanoprost)
MOA atropine
muscarinic antagonist
toxicity of atropine
dry as a bone
hot as a hare
mad as a hatter
red as a beet
blind as a bat
Effects Nitrates have on:
EDV
BP
Contractility
HR
Ejection time
MV O2
down
down
up (reflex)
up (reflex)
down
down
Effects B-blockers have on:
EDV
BP
Contractility
HR
Ejection time
MV O2
up
down
down
down
up
down
effects b-blockers + nitrates have on:
EDV
BP
Contractility
HR
Ejection time
MV O2
no effect, or down
down
little, no effect
down
little/no effect
down a lot!
MOA CCBs
block voltage dependent ca channels of cardiac and smooth muscle, reducing muscle contractility
In decreasing effect, which CCBs have most effect on vascular smooth muscle?
nifedipine > diltiazem > verapemil
in decreasign effeect, which CCBs have most effect on heart?
verapamil > diltiazem > nifedipine
which CCB can't be used for arrhythmias?
nifedipine
toxicity of CCBs
cardiac depression
flushing
peripheral edema
dizziness
constipation
which CCB is most similar to nitrates in effect?
nifedipine (makes sense... nifedipine works most strongly on vascular smooth muscle)
which CCB is most similar to b-blockers in effect?
verapamil (makes sense... verapamil works most strongly on heart)
MOA statins?
HMG-CoA reductase inhibitors
blocks formation of cholesterol from HMG-CoA
MOA niacin
blocks the export of cholesterol from the hepatocyte to the blood
MOA bile resins
binds cholesterol in the gut so they can't get to the hepatocytes
MOA ezetimibe
cholesterol absorption blocker
so, prevents cholesterol from entering hepatocytes from gut
MOA fibrates
increases action of lipoprotein lipase, encouraging the breakdown of VLDL --> LDL
also decreases hepatic synthesis and secretion of VLDL
increases HDL by decreasing TG (results from decreased VLDL) --> decresaed exchange of cholestreryl esters from HDL --> lipoproteins
which cholesterol agents affect endogenous production of cholesterol?
fibrates
niacin
lovastatin
which cholesterol agents affect absorption of exogenous cholesterol
ezetimibe
bise acid resins
effects of statins on:
LDL
HDL
TGs
down A LOT
up
down
effects of niacin on
LDL
HDL
TGs
down a lot (not as much as statins)
up A LOT
down
effects of bile acid resins on
LDL
HDL
TGs
down a lot (not as much as statins)
none
slightly UP
effects of ezetimibe on
LDL
HDL
TGs
down a lot (not as much as statins)
none
none
effects of fibrates on:
LDL
HDL
TGs
down a little
up
DOWN A FRIGGIN TON!
what 2 cholesterol drugs, if taken concurrently, will cause rhabdomyolysis
statins and fibrates
which cholesterol drugs increase LFTs?
your lft's are not SEF (safe)

statins
ezetimibe
fibrates
which cholesterol drug --> GI discomfort
bile acid resins
antidote to dig toxicity
anti-dig Fab fragment s
slowly normalize K
lidocaine
cardiac pacer
MOA of class I anti-arrhythmics
class II?
class III?
class Iv?
Na channel blockers
B-blockers
K channel blockers
CCBs
which drugs are in class Ia anti-arrythmics?
Quinidine
Amiodarone
Procainamide
Disopyramide
which drugs are in the class Ib anti-arrhythmics?
I Be with my Lid To Mex(ico)

lidocaine
tocainide
mexiletine
which drugs are in the class Ic anti-arrythmics?
See (C)! And Can't (EnCain) We FLEe if we PROP up PHENOMS?

encainide
flecainide
propafenone
MOA class IA anti-arrhythmics?
increased AP duration
increased ERP
increased QT interval
uses for class IA anti-arrhythmics
atrial and ventricular arrhythmias (esp reentrant and ectopic)
SVT and VT
MOA for class IB anti-arrhythmics
decreases AP duration
use for class IB anti-arrhythmics
acute ventricular arrhythmias, esp post MI
MOA for class IC anti-arrhythmics
no effect on AP
uses for class IC anti-arrhythmics
VT --> FV
inretractable SVT
LAST resort
toxicity of quinidine
cinchonism (HA, tinnitus, thrombocytopenia, torsades de pointes from increased QT interval)
toxiciyt of procainamide
SLE-like syndrome (reversible)
toxicity of IB anti-arrhythmics?
local anesthetic
CNS stimulation/depression
CV depression
toxicity of IC anti-arrhythmics
pro-arrhythmic (esp post-MI)
prolongs refractory period
receptor selectivity for epi?
all are equal
receptor selectivity for NorE
a1 = a2 > b1
receptor selectivity for isoproteronol
B1=b2
receptor selectivity for DA
d1 = d2 > B > a
receptor selectivity for dobutamine
b1 > b2
receptor selectivity for phenylephrine
a1 > a2
receptor selectivity for albuterol
b2 > b1
receptor selectivity for terbutaline
b2 > b1
MOA amphetamine
indirect general sympathetic agonist
releases stored catecholamines
MOA epehderine
indirect and direct sympathomimetic
stimulates release of NE from sympathetic neurons
MOA cocaine
blocks reuptake of NorE and DA
MOA clonidine
centrally acting alpha agonist
decreased central adregnergic outflwo
uses for epi
anaphylaxis
glaucoma
asthma
hyptotension
uses for norE
hypotension (but decreases renal perfusion)
uses for isoproterenol
rare... AV block
uses for DA
shock (increases renal perfusion)
heart failure
uses for dobutamine
shock
heart failure
cardiac stress testing
uses for amphetamines
narcolepsy
obesity
ADD
uses for ephedrine
nasal decongestion
urinary incontinence
hypotension
uses for phenylephrine
pupil dilator
vasoconstriction
nasal decongestion
uses for albuterol
asthma
uses for terbutaline
asthma
uses for cocaine
vasoconstriction
local anesthetic
uses for clonidine
HTN (esp with renal dz b/c it doesn't decrease blood flow to kidney)
examples of inhaled anesthetics
halothane
enflurane
isoflurane
(-ane)
MOA inhaled anesthetics
unknown
effects of inhaled anesthetics
myocardial depression
respiratory depression
n/v
increased cerebral blood flow
decreased cerebral demand
toxicity of halothane
hepatotoxicity
toxicity of methoxyflurane
nephrotoxicity
toxicity of enflurane
pro-convulsant
toxicity of any inhaled anesthetic
malignant hyperthermia (rare)
types of drugs used as IV anesthetics
BB King on optiates proposes foolishly
Barbiturates
benzos
Ketamine (arylclohxamines)
opiates
Propofol
which barbiturate is commonly used as an IV anesthetic?
thiopental
uses of thiopental
induction of anesthesia
short surgical procedures
which is the most common anesthetic used for endoscopy?
what is it administered with?
midazolam
gaseous anesthetics and narcotics
side effects of midazolam
post-op respiratory depression
hypotension
amnesia
how is the respiratory depression from midazolam treated?
flumezanil
side effects of arylcyclohexamines
bad dreams
CV stimulation
disorientation
hallucinations
increased cerebral blood flow
benefit of propofol
less post-op nausea than thiopental
what is combined with opiates during general anesthesia?
other CNS depressants
MOA local anesthetics
block Na channels by binding to specific receptors in inner portion of channel
examples of atypical antipsychotics
olanzapine
clozapine
risperidone
examples of typical antipsychotics
thioridazine
haloperidol
fluphenazine
chlorpromazine
MOA typical antipsychotics
block D2 receptor
MOA atypical antipsychotics
blocks dopamine and 5HT receptors
clinical uses of typical antipsychotics
schizophrenia
psychosis
acute mania
Tourette's
clinical uses for atypical antipsychotics
schizophrenia (+ and - sx)
clinical uses for olanzapine
OCD
anxiety d/o
depression
mania
Tourette
toxicity associated with typical antipsychotics
EPS
endocrine effects
anti-muscarinic effects (dry mouth) hypotension (from blocking alpha receptors), sedation (from blocking histamine receptors)
NMS
tardive dyskinesia
what is tardive dyskinesia
stereotypical oral-facial movements d/t blocking DA receptors
what is NMS
rigidity
myoglobinuria
autonomic instability
hyperpyrexia
tx of NMS
dantrolene and DA agonists
toxicity associated wiht atypical antipsychotics
less EPS and anti-cholinergic effects
Clozapine --> agranulocytosis
uses for lithium
bipolar
blocks relapse and acute manic events
toxicity of lithium
LMNOP
movement (tremor)
nephrogenic DI
hypOthyroidism
Pregnancy problems
MOA buspirone
stimulates 5HT1a receptors
uses of buspirone
anxiolysis for GAD
benefits of buspirone
doesnt cause sedation or addiction
doens't interfere with alcohol
examples of ssri's
fluoxetine
sertraline
paroxetine
citalopram
clincical uses for ssri
OCD
endogenous depression
eating d/o
examples of tricyclic antidepressants
imipramine
amitriptyline
desipramine
nortiptyline
clomipramine
doxepin
MOA TCA
blocks reuptake of NorE and 5HT
uses for TCAs
major depression
bedwetting (imipramine)
OCD (clomipramine)
which TCA is used for bedwetting
imipramine
which tCA is used for OCD
clomipramine
examples of heterocyclic anti-depressants
you need BUtane in your VEINs to MURder for a MAP of alcaTRAZ

buproprion
venlafaxine
mirtazapine
maportiline
trazodone
examples of MAOIs
phenelzine
tranylcypromine
class thioridizine
typical antipsychotic
class haloperidol
typical antipsychotic
class fluphenazine
typical antipsychotic
class chlorpromazine
typical antipsychotic
class clozapine
atypical antipsych
Class olazapine
atypical antipsych
class risperidone
atypical antipsych
class fluoxetine
ssri
class paroxetine
ssri
class sertraline
ssri
class citalpram
ssri
class imipramine
tca
class amitriptyline
tca
class desipramine
tca
class nortiptyline
tca
class clomipramine
tca
class doxepin
tca
class buprorpion
heterocyclic
class venlafaxine
heterocyclic
class mirtazapine
heterocyclic
class maprotiline
heterocyclic
class trazadone
heterocyclic
class phenylzine
maoi
class tranylcypromine
maoi
toxicity associated with ssri
gi distress
anorgasmi a
seratonin syndrome if given with maoi
sx of seratonin syndrome
hyperthermia
muscle rigidity
cv collapse
how long does it take for antidepressants to work
2-3 wks
side effects of tca
sedation
alpha-blocking effects
atropine like effects (tachy, urinary retention)
which generation of tca s have more anticholinergic effects? give an example of the drug
3rd
amitryptyline
which tca is least sedating
desipramine
toxicity assocaited with tcas
tri-c's
convulsions
coma
cardiotoxicity

respiratory depression
hyperpyrexia
confusion and hallucination in elderly (d/t anticholinergic effects)
which class of drugs is used to treat alcohol w/d
benzos
which class of drugs is used to treat anorexia/bulemia
ssri
which drugs are used to treat anxiety
buspirone
benzos/barbiturates (take a shorter time to work)
MAOI
which drugs are ssris?
paroxetine
fluoxetine
sertriline
citalopram
which class of drugs is used to treat atypical depression
maoi
which class of drugs is used ot treat bipolar d/o
lithium
carbamazepine
valproic acid
which drugs are used to treat depression
ssri
tca
which drugs are used to treat depression with insomnia
trazadone
mirtazapine
which drugs are used totreat OCD
climipramine
ssri
olanzepine
which drugs are used to treat panic d/o
tca
buspirone
toxicity associated with maois
hypertensive crisis associated with ingesting wine/cheese (tyramine)
drug interactions assicated with maois
b-blockers
ssri
(--> both cause seratonin syndrome)
MOA venlafaxine
inhibits 5HT, NorE, and DA reuptake
toxicity of venlafaxine
stimulant effects
sedation
nausea
constipation
increased BP
MOA mirtazapine
alpha-2 antagonist (increased release of NorE and 5HT) and potent 5HT2, 3 receptor antagonist
toxicity of mirtazapine
sedation
increased appetite
weight gain
dry mouth
moa maprotiline
blocks NorE reuptake
toxicity of maprotiline
sedation
orthostatic hypotension
moa trazadone
inhibits 5HT reuptake
toxicity of trazadone
sedation
nausea
priapism
postural hypotension
MOA dantroline
blocks the release of ca from SR of skeletal muscles
uses of dantroline
nms
malignant hyperthermia
wha tcan cause malignant hyperthermia
inhalation of anesthetics and succinylcholine
what are the different types of NM blocking agents
depolarizing and nondepolarizing
ex of a depolarizing NM blocking agent
succinylcholine
ex of nondepolarizing NM blockign agent
anything with a "cur" in it
uses of NM blockign agents
to paralyze muscles in surgery or mechanical ventilation
what are the 2 phases of depolarizing NM blockade?
1: continuous depolarization
2: gradual repolarization with resistance
how do you reverse the depolarizing blockade at phase 1?
phase 2?
administer cholinesterase inhibitors (eg: neostigmine or physostimine) during PHASE #2!!!!
if you give them during phase 1, the paralysis is increased.
how do you reverse the non-depolarizing blockade?
cholinesterase inhibitors (eg: neostigmine, edrophonium)
how is NorE going to affect BP?

HR?
A>B so....
systolic will increase
diastolic will increase

HR decreases (reflex brady)
how is epi going to affect BP?

HR?
nonselective so...
systolic will increase being controlled by a1
diastolic will decrease, being controlled by beta

HR will increase (b1)
how does isoproterenol affect BP?
HR?
B1=B2 so...
systolic decreases
diastolic decreaes

HR increases (reflex tachy)
what will happen to BP if you administer an alpha blockade after giving epi?
it will decrease and then increase slightly
net depressor effect b/c b2 takes over --> vasodilatioN
what will happen to BP if you administer an alpha blockade after giving phenylephrine?
A1>a2
there is no depressor effect seen in this situation b/c phenylephrine is a pure alpha agonist
what toxicities are seeen after giving 1st dose of an al blocker?
orthostatic hypotension
ha
dizziness
what toxicities are seen aftter giving phenoxybenzamine
orthostatic hypotension
reflex tachy
what drugs are used to treat pheo?
phenoxybenzamine (irreversible alpha blocker)
phentolamine (reversible alpha blocker)
which drugs are 1st generation H1 blockers?
diphenhydramine
dimenhydrinate
chlorpheniramine
which drugs are 2nd generation H1 blockers?
loratadin e
fexofenadine
desloratadine
what are 1st generation H1 blockers used for?
allergy
motion sickness
sleep aid
what are the 2nd gen H1 blockers used for?
allergy
toxicity of 1st gen H1 blockers?
sedation
anti-muscarinic
anti-alpha-adrenergic
toxicity of 2nd gen H1 blockers
less sedating than 1st generation
what are the different classes of drugs that treat asthma?
nonspecific beta agonists
b2 agonists
methylxanthines
muscaranic antagonists
cromalyn
corticosteroids
antileukotrienes
MOA isoproterenol
B1=B2 so, innervates bronchial smooth muscle and causes bronchodilation
MOA albuterol
B2 agonist, --> bronchodilation
MOA salmeterol
b2 agonist --> bronchodilation
when is albuterol used?
during acute exacerbation of asthma
when is salmeterol used?
for asthma proph
MOA theophylline
bronchodilation by inhibiting phosphodiesterase, decreasing cAMP hydrolysis
inhibits effects of adenosine on bronchial smooth muscle (prevents bronchoconstriction)
adverse effects of salmeterol
tremor and arrhythmia
toxicity of theophylline
cardio and neurotoxicity
MOA ipratropium
muscarinic antagonist
competitively blocks muscarinic receptors, preventing bronchoconstriction
MOA cromolyn
prevents release of mediators from mast cells
when is cromolyn used
asthma proph, ineffective during acute asthma attack
MOA beclomethasone
inhibits synth of all cytokines
prevents formation of arachidonic acid by blocking phospholipase A2
inactivates NF-KB (transcription factor for TNF-alpha)
when are corticosteroids used in asthma treatment
1st line tx for chronic asthma
examples of anti-leukotrienes?
zileuton
zafirlukast
montelukast
MOA zileuton
5-lipoxygenase inhibitor
blocks conversion of arachidonic acid to LT
MOA zafirlukast?
blocks LT receptors
MOA montelukast
blocks LT recpetors
when is zafirlukast used
to treat aspirin induced asthma
when is montelukast used
to treat aspirin induced asthma
which asthma drug blocks a phosphodiesterase
what is the net result?
theophylline
cAMP levels are raised
which asthma drug blocks adenlyate cyclase?
what is the net result?
b-agonist
cAMP levels are raised
which drugs are expectorants?
guaifenesin
n-acetylcystine
MOA guaifenesin
doesn't suppress cough reflex
removes excess sputum
MOA n-acetylcystine
mucolytic (loosens plugs in CF pts)
MOA finasteride
5-alpha reductase blocker
MOA flutamide
competitive inhibitor of androgen at testosterone receptor
MOA ketoconazole in reproductive system
blocks 17,20 lyase and 3-beta-hydroxylase, inhibiting steroid synthesis
uses of finasteride
BPH
male pattern baldness
uses of flutamide
prostate cancer
uses of ketoconazole
pcos, to prevent hirsutism
MOA leuprolide
GnRH analog with agonist properties when used in pulsatile manner
antagonist properties when used in continuous fashion
uses for leuprolide
infertility (pulsatile)
prostate cancer (continuous, used with flutamide)
uterine fibroids
toxicity of leurpolide
antiandrogen
n/v
MOA sildenafil
inhibits cGMP phosphodiesterase --> increased cGMP --> maintains smooth muscle relaxation in corpus cavernosum
--> increased blood flow and erection
clinical use of sildenafil
erectile dysfunction
toxicity of sildenafil
blue-green color vision
h/a
flushing
dyspepsia
LIFE THREATENING HYPOTENSION IN PTS TAKING NITRATES!!!!!
MOA clomiphene
partial estrogen agonist at pituitary gland
this stimulates LH and FSH release --> ovulation
use of clomiphene
fertility treatment
toxicity of clomiphene
hot flashes
ovarian enlargement
multiple pregnancies
visual disturbances
MOA mifepristone
competitive inhibitor of progestin at progesterone receptors
use of mifepristone
prevents implantation of fetus
toxicity of mifepristone
heavy bleeding
GI effects
abdominal pain
risks associated with HRT
endometrial cancer, if regimen is just with estrogen
which leukotriene is a neutrophil attractant?
LTB4
which LT --> bronchoconstriction
LTC4, D4, E4
what reaction does phospholipase A2 catalyze
phospholipids --> arachidonic acid
what rxn does COX catalyze?
arachidonic acid --> PGG, PGH (endoperoxides)
what rxn does lipoxygenase catalyze?
arachidonic acid --> HPETEs (hydroperoxides)
what drug blocks lipoxygenase
zileuton
what drug blocks COX
NSAIDS
acetominophen
cox-2 inhibitors
what drugs block the effects of leukotrienes?
zafirleukast
montelukast
actions of PGE?
increased uterine tone
decreased bronchial tone
decreased vascular tone
examples of nsaids
ibuprofen
naproxen
indomethacin
ketorolac
mech of nsaids
reversibly inhibits cox 1 and 2, blocking PG synth
uses for nsaids
antipyretic
analgesic
anti-inflammatory
what drug is used to close PDA
indomethacin
toxicity of nsaids
renal damage
aplastic anemia
GI distress
ulcers
MOA cox2 inhibitors
reversibly inhibits cox2, maintaining gastric mucosa (cox2 is found only in inflammatory cels that mediate inflamm and pain)
risks associated with cox 2 inibitors
thrombosis
less gi risk
MOA actaminophen
reversibly inhibits cox (mostly in cns)
inactivated peripherally
uses of acetaminophen
antipyretic
analgesic
NOT AN ANTI INFLAMMATORY!!!!!!!
toxicity of acetaminophen
how?
hepatic necrosis
a metabolite of acetaminophen depletes glutathione and forms toxic tissue adducts in liver
how is toxic hepatic damage from acetaminophen treated
moa?
n-acetylcysteine - it regenerates glutathione
drugs that treat gout
colchicine
allopurinol
probenecid
indomethacin
NSAIDS
And said: "I be napping in Keto"
ibuprofin
naproxen
indomethacin
ketorolac
which gout drugs are used to treat chronic gout?
allopurinol
probenecid
which gout drugs are ued to treat acute gout
colchicine
indomethacin
MOA colchicine
depolymerizes MT, impairing WBC chemotaxis and degranuation
side effects of colchicine
gi
what drug is a good alternative to colchicine?
indomethacin (less toxic, more commonly used)
MOA probenecid
inhibits resorption of uric acid
MOA allopurinal
inhibits xanthine oxidase, so less formation of uric acid
aside from gout, what else can allopurinal be used to treat?
can help with sx of tumor lysis syndrome, seen in lymphoma/leukemia following chemo
what is the original source of uric acid
purines from diet and broken down nucleic acids
fxn of xanthine oxidase
hypoxanthine --> xanthine --> uric acid (blocked by allopurinol)
describe interference of probenecid and penicillin
inhibits secretion of penecillin
what promotes tubular secretion of uric acid
diuretics and low dose salicylates
MOA etanercept
recombinant form of TNF receptor that binds TNF-alpha
uses for etanercept
RA
psoriasis
ankylosing spondylitis
MOA infliximab
TNF-alpha AB
uses for infliximab
crohns dz
RA
ankylosing spondylitis
toxicity of infliximab
predisposes to infection (reactivates latent TB)
MOA cyclosporine
binds to cyclophilins, blocking differentiation and activiation of t cells by inhibiting calcineruin (prevents the production of IL2 and receptor)
fxn of calcineurin
phosphatase that activates IL2
use for cyclosporine
suppress organ transplants
treats some autoimmune d/o
toxicity of cyclosporine
predisp to viral infx and lymphoma
NEPHROTOXIC (prevent w mannitol diuresis)
MOA tacrolimus
binds FK-binding protein, inhibiting the secretion of IL2 and other cytokines
uses of tacrolimus
immunosuppression following organ transplant
toxicity of tacrolimus
nephrotoxic
peripheral neuropath y
HTN
pleural effusion
hyperglycemia
moa azathioprine
interferes with metabolism and synth of nucleic acids
toxic to prolif wbc
uses of azathioprine
kidney transplant
autoimmune d/o
glomerulonephritis
hemolytic anemia
toxicity of azathioprine
bone marrow suppression
what is the active metabolite of azathioprine
how is it metabolized
implication
mercaptopurine
xanthine oxidase
toxic effects may be increased by allopurinol
which drugs cause pulmonary fibrosis?
"when she wears her bustle, bubbly amy gets pulmonary fibrosis"

busulfan
bleomcyin
amiodarone
which drugs cause gyneomastia
"Some drugs create awesome knockers"

spironolactone
digitalis
cimetidine
alcoholism
ketoconazole
(estrogen)
which drugs cause SLE like syndrome
"it's not HIPP to have lupus"

hydralazine
inh
procainamide
phenytoin
which drugs --> osteoporosis
CHO

corticosteroids
heparin
which drug --> gingival hyperplasia
phenytoin
which drugs --> photosensitivity
Amy played Tetris on her cell phone in the sun

amiodarone
sulfonamides
tetracycline
which drugs --> tendonitis and tendon rupture in kids
fluoroquinolones
which drug --> gray baby syndrome
chloramphenicol
which drugs --> agranulocytosis
colchicine
carbamazepine
clozapine
which drugs --> atropine like side effects
tricyclics
which drugs --> cardiac toxicity
Dawn sat on the Docks mending her red, broken heart

doxorubicin
daunorubicin
which drugs --> torsades de pointes
Ia and III aniarrhytmics
cisapride
which drugs --> focal/massive hepatic necrosis
Hello Val! Have a seat before your liver dies!

halothane
valproic acid
acetaminophen
which drug --> fanconi's syndrome
expired tetracycline
which drug --> interstitial nephritis
methicillin
which drugs --> hemorrhagic cystitis
cyclophosphamide
ifosfamide
which drug --> hepatitis
INH
which drugs --> pseudomembranous colitis
I have to take a CLAMP

clindamycin
ampicillin
which drugs --> nephrotoxicity AND ototoxicity
"if you call, i won't be able to hear you in the bathroom"

Cisplatin
aminoglycoside
loop diuretics
which drugs --> seizures
buproprion
imipenem
clistatin
which drugs --> DI
lithium
demeclocycline
which drugs --> aplastic anemia
chloramphenicol
benzene
NSAIDS
which drug --> coronary vasospasm
cocaine
which drugs --> flushing
AIDEN was in the VAN FLUSHING NIACIN and CALCIUM

niacin
CCB
adenosine
vancomycin
which drug --> hemolysis in G6PD pts
sulfonamides
INH
aspirin
ibuprofen
primaquine
nitrofurantoin
whch drugs --> acute aholestatic hepatitis
macrolides
which drugs --> cinchonism
quinidine
quinine
which drugs --> disulfiram like rxn
metronidazole
some cephalosporins
procarbazine
sulfonylureas
which drug --> neurotoxicity/nephrotoxicty
polymyxins
uses for cytarabine
AML
examples of nitrosureas
"you MUST not let the Nitro go to your head, or you'll do a strip tease- a sin!"

carmustine
lmoustine
semustine
streptozacin
uses for nitrosureas
brain tumors (incl. GBM)
uses of the -platins
Platinum treated BOLTs
breast
ovarian
lung
testicular
uses for busulfan
"I will bustle to treat my dark CaMeL"
CML
adverse effects of busulfan
"I will bustle to treat my DARK CaMeL"

hyperpigmentation
pulmonary fibrosis
uses for rubicins
"MS. Hodgkin's will LOB the RED ball"
myeloma
sarcoma
Hodkin's
lung
ovarian
breast
uses for dactinomycin
"children ACT out"
rhabdomyosarcoma
wilm's tumor
ewing sarcoma
MOA 6MP
blocks do novo purine synth, activated by HGPRTase
which 2 drugs work synergistically with each other to prevent DNA replicaion?
5-FU
MTX
MOA MTX
blocks DHF reductase, preventing DHF --> THF
MOA 5FU
blocks thymidylate synthase (preventing dUMP --> dTMP)
which cancer agen has minimal myelosuppression?
bleomycin
leucovorin
folinic acid that can reverese some of the myelosuppression associated with MTX (doesn't do anything for 5FU myelosuppression)
"rescue agent" for 5FU
thymidine
which cancer agent --> macrovesicular fatty change in liver?
MTX
cancer agents that alkylate DNA
AL KEELED over when the BUS hit the PLATE the NIGHT he was on his CYCLE

Busulfan
Platins
Nitrosureas
cyclophosphamide/ifosfamide
which alkylating agent requires bioactivation
nitrosureas
uses for -phosphamides
"No Hodgkin's will see FOSSE with BO that smells like phospho"

non-hodgkin's
breast
ovarian
which drugs intercalate in DNA?
3D
doxorubicin
daunorubicin
dactinomycin
which cancer agents generate free radicals
"Wear red to show the bleeding of the free radicalS"

doxorubicin
daunorubicin
bleomycin
which receptors are associaed with Gq
HAVe 1 M&M
H1
alpha 1
V1
M1, M3
which receptors are associated with Gi
MAD 2's
M2
alpha 2
D2
which receptors are associated with Gs
B1, B2, D1, H2, V2
major fxns of M2
decreases HR
major fxns of M3
increase exocrine gland secretion
major fxns of D1
relaxes vascular smooth muscle
major fxns of D2
modulates transmimtter release in brain
major fxns of H1
ubcreases basak abd bronchial mucus production, contraction of bronchioles, pruritis, pain
major fxns of H2
increase gastric acid secretion
major fxn of V1
constricts vascular smooth muscle
major fxn of V2
increas water permeability and reabsorption in CT of kidney
MOA hemicholinium
blocks the transport of choline into cholinergic neurons, blocking the production of ACh
MOA vesamicol
blocks the transporter that brings Acetyl CoA + Choline CHAT into vesicles
MOA botulinum
blocks the release of ACh vesicles
MOA metyrosine
blocks conversion of tyrosine into DA
MOA reserpine
blocks DA transporter into vesicles that form NE
MOA guanethidine
inhiits release of NorE from noraderenergic neurons
MOA amphetamine
increase release of NorE from vesicles
MOA pralodoxime
reactivates AChE after it's been inhibited by pesticides
treatment for salicylate OD
alkalinize urine
dialysis
treatment of antimuscarinics OD
physostigmine salicyate
treatment of b-blocker od
glucagon
tx of digitalis od
stop dig
normalize K
\lidocaine
anti-dig Fab fragments
Mg
tx iron toxicity
deferoxamine (chelating agent)
tx fo lead poisoning
EDTA
dimercaprol
succimer
penicillamine
tx of arsenic toxicity
dimercaprol
succimer
tx hg toxicity
dimercaprol
succimer
tx au toxicity
dimercaproli
succimer
penicillamine
tx cu toxicity
penicillamine
tx cn toxicyt
nitrite
hydroxocobalamin
thiosulfate
tx methemoglobin toxicity
methylene blue
tx CO toxcity
100% o2, hyperbaric pressure
tx of methanol od
ethanol
dialysis
fomepizole
tx of ethylene glycol od
etoh
dialysis
foempizole
tx of opiod toxicity
nalaxone
naltrexone
tx of benzo od
flumazenil
tx of ca od
NaHCO3
tx of heparin toxicity
protamine sulfate
tx of warfarin toxicity
vitamin k
ffp
x tpa toxicity
aminocaproic acid
tx streptokinase toxicity
aminocaproic acid
sx of iron od
fever
sweating
abdominal pains
diarrhea
cyanosis
weakness
examples of insulin drugs (and give duration of action)
lispro (short)
insulin (short)
NPH (intermediate)
lente and ultralente (long acting)
clinical uses of insulin analogs
DM I
life-threatening hyperkalemia (insulin increases K entry into cells)
stress induced hyperglycemia
examples of 1st generation sulfonylureas
tolbutaminde
chlorpropamide
examples of 2nd generation sulfonylureas
glyburide
glimepiride
glipizide
MOA sulfonylureas
when glucose enters the cell, the ATP level rises
high ATP:ADP closes K channel
this causes Ca influx --> insulin release
these drugs enoucrage this process by closing k channels
(basically stimulates the release of endogenous insulin)
uses of sulfonylureas
DM II
reqires some islet cell fxn, so useless in DM I
toxicity associated with sulfonylureas (1st gen)
diulfuram effects
toxicity associated with 2nd generation sulfonylureas
hypoglycemia
examples of biguanides
metformin
MOA metformin
unknown, but might decrease gluconeogenesis, increase glycolysis and decrease serum glucose levels
clinical use of metformin
can be used in pts without islet cell fxn
adverse effects of metformin
lactic acidosis
MOA glitazones
incresaes target cell response to insulin
clinical use for glitazones
DM II
toxicity associated with glitazones
weight gain
edema
hepatotoxicity
examples of alpha-glucosidase inhibitors
acarbose
miglitol
MOA alpha-glucosidase inhibitors
inhibits intestinal brush border alpha-glucosidases
delays sugar hydrolysis and glucose absorption
decreasesd post-prandial hyperglycemia
clinical use of alpha glucosidase inhibitors
DM II
MOA orlistat
inhibits pancreatic lipase
clinical use of orlistat
obesity management
toxcicity of orlistat
gi discomfort
steatorrhea
reduced absorption of fat soluble vitamins
ha
MOA sibutramine
sympathommimetic 5HT and NorE reuptake inhibitor
uses of sibutramine
short term and long term obesity management
toxicity of sibutramine
htn
tachycardia
uses of GH
GH deficiency
turner's syndrome
uses of somatostatin
acromegaly
carcinoid
gastrinoma
glucagonoma
uses of octeroitide
(aka somatostatin)
acromegaly
carcinoid
gastrinoma
glucagonoma
uses of adh
pituitary DI
MOA propylthiouracil
inhibits organification and coupling of thyroid hormone synthesis
decreased peripheral conversion of T4 --> T3
Which drugs block peptidoglycan cross-linking
Cephalosporin
-cillins
-nam/-nem
which drugs block peptidoglycan synthesis?
"I will backtrack in my van or on my cycle to find my peppy synth"
bacitracin
vancomycin
cycloserine
which drugs block bacterial/fungal cell wall synth
polymyxins
which drugs disrupt fungal cell membranes
amphotericin b
nystatin
-azoles
which drugs block NT synth
"Try my cell phone - I blocked the New Cleo"
Sulfonamides
trimethoprim
which drugs block DNA synth
"TOPless DANcing Queen" (insert abba song here... :)
Topoisomerase
Quinolones
which drugs block mRNA synth
"the Rif-Raf RAN around the block"
rifampin
Which drugs block protein synth at the 50S subunit?
"There are MICE IN LINE to see 50 year-old GRANdma make MACRoni and CHLORide"
-mycins
linezolid
-gramins
macrolides
chloramphenicol
which drugs block protein synth at the 30S subunit
"I MEAN NO harm, but you are playing TETRIS at 30 years old!"

Aminoglycosides
tetracyclines
MOA penicillin
it binds to penicillin binding proteins
blocks the cross-linking of peptidoglycan
activates autolytic enzymes
uses for penicillin
gram + cocci and rods
GNR
spirochetes
which penicillins are the penicillinase resistant?
"Penny resisted NApkins and CLOX when I MET her"
Nafcillin
dicloxacillin
methicillin
clinical uses for penicillinase resistant penicillins?
S. aureus (except for MRSA)
why are penicillinase resistant penicillins resistant to penicillinase
bulikier R group
how is MRSA resistant to methicillin
altered penicillin binding protein target site
adverse reaction to methicillin
interstitial nephritis
examples of aminopenicillins
ampicillin
amoxicillin
what is clavulanic acid
penicillinase inhibitor
clinical uses for aminopenicillins
"ampicillin/amoxicillin HELPS kill enterococci"
H. influenza
e. coli
Listeria monocytogenes
Proteus mirabilis
Salmonella
Enterococci
anti-pseudomonal drugs
"Take Piper in the Car, Sue"
ticarcillin
piperacillin
carbenicillin
MOA cephalosporins
same as penicillins, less susceptible to penicillinases
uses for 1st generation cephalosporins
PEcK
Proteus
E coli
Klebsiella
uses for 2nd generation cephalosporins
HEN PEcKS
H. flu
Enterobacter
Neisseria

Proteus
E. coli
Klebsiella
Serratia
examples of 1st generation cephalosporins
"You FAILed the FIRST PHASE"
cefazolin
cephalexin
examples of 2nd generation cephalosporins
"Wait a SECOND! You SEE, FOX FUR is a FACt"
cefoxitin
cefuroxime
cefaclor
3rd generation cephalosporins
"If you are THIRsty, try a FOTO TAZER"

Cefotaxime
Ceftazidime
ceftriaxone
clinical uses of aztreonam
klebsiella
pseudomonas
serratia
(GNR only, nothing against gm + or anaerobes)
who is given aztreonam
penicillin allergic pts
pts w renal insuff that can't tolerate aminoglycosides
what is cilastatin?
inhibits renal dihydropeptidase I
always administered with imipenem
clinical uses for imipenem/meropenem?
gram + cocci
GNR
anaerobes
#1 for enerobacter
toxicity of imipenem, meropenem
gi distress
rash
seizures
(all occcur at high plasma levels)
MOA aminoglycosides
'cidal/static?
inhibits formation of initiation complex --> misreads mRNA
requires O2 for uptake, so won't work against anaerobes
'cidal
which drugs are aminoglycosides?
"Mean GNATS canNOT kill anaerobes"
Gentamicin
Neomycin
Amikacin
Tobramycin
Streptomycin
toxicity of aminoglycosides
"Mean GNATS canNOT kill anaerobes"
Nephrotoxicity (esp if used with cephalosporin)
Ototoxicity (esp w/ loop diuretic)
Teratogen
Uses for tetracyclines
VACUUM THe BedRoom
V. cholera
Acne
Chlamydia
Ureaplasma
Urealyticum
Mycoplasma pneumoniae
Tularemia
H. Pylori
Borrelia Burgodorferi
Rickettsia
MOA tetracyclines
'cidal/static?
binds 30S and prevents attachment of aminoacyl RNA
static
foods to avoid when takin tetracyclines
don't take with milk, iron, or antacids b/c it will inhibit absorption in gut
which tetracycline is fecally eliminated?
doxycycline (can be used in renal failure)
toxicity of tetracyclines
photosensitivity
gi discomfort
discoloration of teeth
inhibits bone growth in kids
contraindications of tetracyclines
pregnancy
what drug can act as a diuretic in SIADH
demeclocycline (ADH antagonist)
examples of macrolides
the MACRO WREATH's CLARity is EZ to see
Erythromycin
Clarithromycin
Azithromycin
MOA macrolides
cidal/static?
blocks protein transloation by binding to the 50S ribosomal subunit
clinical uses for macrolides
URIs
pneumonia
STDs
gm + cocci (for pts allergic to penicillin)
Mycoplasma
Chlamydia
Legionella
Neisseria
toxicity of macrolides
GI discomfort
acute cholestatic hepatitis
eosinophilia
skin rash
increases serum [] theophylline and oral anti-coagulants
MOA chloramphenicol
cidal/static?
binds 50S, inhibiting peptidyl transferase
static
clinical uses for chloramphenicol
meningitis
toxicities associated with chloramphenicol
anemia
aplastic anemia
gray baby sndrome
what causes gray baby syndrome
premature infants lack UDP gluuronyl transferase
MOA clindamycin
cidal/static?
blocks peptide bond formation at 50S ribosomal subunit
static
clinical uses for clindamycin
treats anaerobic infections (above the diaphragm)
toxicity of clindamycin
c. diff overgrowth
fever
diarrhea
MOA sulfonamides
cidal/static?
PABA antimetabolites inhibit dihydropterate synthase
static
clinical uses for sulfonamides
gram +/-
nocardia
chlamydia
which sulfonamide can be used to treat simple uti's
triple sulfa
toxicity associated with sulfonamides
hypersensitivity
hemolysis with G6PD deficiency
tubulointerstitial nephritis
kernicterus in infants
displaces other drugs from albumin
MOA trimethoprim
static/cidal?
inhibtits bacterial dihydrofolate reductase
static
clinical use of trimethoprim
used in combo with sulfamethoxaole
treats recurrent uti's, shigella, salmonella, PCP
toxicity of trimethoprim
megaloblastic anemia
leukopenia
granulocytopenia

(TMP = treats marrow poorly)
examples of fluorquinolones
-floxacins
MOA fluoroquinolones
cidal/static?
inhibits topoisomerase II (DNA gyrase)
cidal
toxicity associated with fluoroquinolones
gi upset
superinfections
skin rashes
h/a
dizziness
cartilage damage
bone pain
tendonitis, tendon rupture (adults)
myalgia and leg cramps in kids

"fluoroquinolones hurt attachments to your bones"
contraindications of fluoroquinolones
pregnant women
children
MOA metronidazole
static/cidal?
forms toxic metabolites in bacterial cell
cidal
clinical uses for metronidazole
anti-protazoal
GET GAP on the METRO

Giardia
Entamoeba
Trichomonas
Gardnerella vaginalis
Anaerobes
H. PYLORI
treats anaerobic infx below the diaphragm (as opposed to clindamycin, which treats them above the diaphragm)
toxocitiy of metronidazole
disulfiram like rxns with etoh
h/a
metallic taste
MOA polymyxins
bind to cell membranes of bacteria and disrupt osmotic properties
act like detergents
clinical uses for polymyxins
resistant gram - infxs
toxicity associated with polymxyins
neurotoxicity
acute renal tubular necrosis
1st line anti-TB drugs
INH-SPIRE

streptomycin
pyrazinamide
isoniazid
rifampin
ethambutol
2nd line anti-tb drug
cycloserine
drugs for tb proph
INH alone
MOA INH
decreased synth of mycolic acid
toxicity of INH
hemolysis in G6PD deficiency
neurotoxicity (prevent with B6)
hepatotoxicity
SLE-like syndrome

INH = Injures Neurons and Hepatocytes
MOA rifampin
inhibits DN Adependent RNA polymerase
(the rif-raf RAN around the block)
uses for rifampin
m. tb
delays resistance to dapsone when treating leprosy
meningococcal proph
proph in contacts of children with HiB
4Rs of rifampin
RNA polymerase inhibitor
Revs up microsomal p450
Red/orange body fluids
rapid resistance if used alone
meningococcal proph
rifampin (drug of choice)
minocycline
gonorrhea proph
ceftriaxone
proph in a pt with h/o repeated uti's
tmp-smx
proph against PCP
tmx-smp (drug of choice)
aerosolized pentamide
proph against endocarditis with surgical/dental procedures
penicillins