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165 Cards in this Set
- Front
- Back
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What would be a good anti-nausea drug?
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Promethazine
- 1st generation anti-histamine - high anti-emetic effects |
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Does Loratadine have an anti-emetic effect?
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NO
2nd generation anti-histamine |
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does Fexofenadine have an anti-emetic effect?
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NO
2nd generation anti-histamine |
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does Chlorpheniramine have an anti-emetic effect?
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NO
1st generation anti-histamine |
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what does histamine cause?
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redness
inflammation bronchoconstriction |
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what drugs are used in the treatment of primary arterial hypertension?
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Epoprostenol
PGI2 |
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what is Dinoprostone?
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PGE2
abortifacient labor induction cervical ripening |
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what is Alprostadil?
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PGE1 to maintain ductus arterious
ED |
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what is Latanoprost?
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PGF2-alpha analog
reduction of elevated intraocular pressure |
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What is used to control postpartum bleeding?
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Carboprost tromethamine
PGF2-alpha analog |
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What is Dinoprostone?
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PGE2 abortifacent, labor induction, cervical ripening
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what is Alprostadil?
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to maintain ductus arteriousus
ED |
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what is Epoprostenol?
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PGI2
pulmonary HTN |
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why is the reason that some anti-histamines have sedative effect and others do not?
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1st generation antihistamines cross the BBB and interact with the cholinergic/muscarinic receptors
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why are most ergot related drugs completely contraindicated during pregnancy?
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They can trigger an abortion.
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T/F
amitriptyline is commonly used to prevent tension type Headaches. |
False
Amitriptyline is only used in severe chronic cases of tension type headache |
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If there is a risk of caffeine use in pregnancy, it is highest during the?
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first trimester
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While drugs should be avoided as much as possible, the first drug to try in acute treatment of migraines should be:
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Acetaminophen
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T/F
Verapamil will likely have more cardiac effects than dihydropyridines. |
True
non-dihydropyridines have greater cardiac effects than dihydropyridines. |
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TQ
As a general rule, which of the following classes of diuretics has the greatest long term anti-hypertensive effect? - potassium sparing - carbonic anhydrase inhibitors - loop diuretics - thiazide diuretics - osmotic diuretics |
Thiazide diuretics
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which class of diuretics causes the most diuresis?
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Loop diuretics
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which of the following classes of diuretics can be used to decrease the formation of some types of kidney stones?
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thiazide diuretics
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a 72 y/o man recently started taking diuretics and having trouble maintaining his blood pressure while standing and complains that he has almost fainted several times. Physical exam indicates he is mildly dehydrated. He takes the following list of drugs. Which is the cause of this patient's complaint?
Amiloride Acetaminophen Amitriptyline Furosemide Verapamil |
Furosemide
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the diuretic most strongly associated with a reduction of morbidity and mortality in heart failure is:
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Spironolactone
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which drug is more likely to be used to treat essential HTN in a person with normal cardiac function?
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Chlorthalidone (thiazide diuretic)
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Winter break is here and you are about to leave on a 5 day trip for a remote mountain at an altitude exceeding 9000 feet. You obtain a prescription for acetazolamide to help prevent altitude sickness because you know it will:
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counteract the respiratory alkalosis induced by rapid respiration.
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Which of the following is a PGE1 analog and is used for GI protection during long term NSAID therapy in non-regnant patients?
- Alprostadil - epoprostenol - amitriptyline - lanaoprost - misprostol |
Misoprostol
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All of the following can be used in the acute treatment of an acute migraine except?
- Sumatriptan - Ibuprofen - Acetaminophen - Caffeine - Verapamil |
Verapamil
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what anticonvulsants and antidepressants are used for prophylaxis of migraines?
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Divalproex sodium
Amitriptyline Fluoxetine Phenezine |
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What Calcium Channel blockers are used for migraine prophylaxis?
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Verapamil (have greater Cardiac effects)
Nimodipine Nifedipine |
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Are b-blockers used for migraine prophylaxis or acute treatment?
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prophylaxis
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Propanlol/Timolol
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b-blockers used in the prophylactic treatment of migraines
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what is the mechanism of action of b-blockers being used for prophylactic treatment of migraines?
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blunt the initial vasoconstriction phase by reducing blood pressure
- no intrinsic sympathometic effect |
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what type of drug is Methysergide? what is it used for?
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Methysergide is a 5-HT2 antagonist
used for migraine prophylaxis |
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how long does it take for the actions of methysergide to take effect?
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affect for migraine prophylaxis takes 1-2 days to develop
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what is a worrisome effect of methysergide?
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chronic use may cause fibroplastic changes
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what are some examples of other various drugs used in the prophylactic treatment of migraines?
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Gabapentine
Feverfew/giner ACE inhibitors Vitamin B2 Butterbur Coenzyme Q10 |
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What is Ergotamine used for?
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Acute migraine treatment
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what type of drug is Ergotamine?
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5-HT1D/B agonist
used in the acute treatment of migraines |
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what is an adverse effect of Ergotamine?
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drug abuse/dependence
- prolonged vasospasm > gangrene of extremities/bowel infarction |
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What is Sumatriptan used for?
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acute migraine treatment
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what type of drug is Sumatriptan?
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5-HT1D/B agonist
used in acute migraine treatment |
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What is isomethepetene used for?
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acute treatment of migraines
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what is tamadol used for?
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acute migraine treatment
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what is Butorphanol used for?
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acute migraine tx
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what is acetaminophen/codeine used for?
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acute migraine tx
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what is acetaminophen/aspirin/caffeine used to tx?
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acute migraine tx
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what is prochlorperazine used for?
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acute migraine tx
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what is Sumatriptan/naproxen used to treat?
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acute migraine treatment
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when is amytriptyline used to treat tension type headaches?
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prevention in chronic severe cases of TTH
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what is used in the acute treatment for TTH?
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NSAIDS
muscle relaxers |
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what is the DOC for preventative treatment of cluster headaches?
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Verapamil
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Name the drugs used for preventative treatment of cluster headaches?
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Verapamil (DOC)
Topiramate (anticonvulsant) Glucocorticoids |
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what drugs are used for acute treatment of cluster headaches?
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oxygen
triptans ergotamine/DHE Intranasal lidocaine |
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what are possible side effects of CCB?
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Dihydropyridine: dizziness, edema, gingivial hyperplasia, headache, tachycardia, serum levels increased by azole anti-fungals and grapefruit juice
Non-dihyropyridine: AV block, bradycardia, constipation, dizziness, edema, gingival hyperplasia, headache, heart failure |
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what are CCB used to treat?
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migraine prophylaxis
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what are the clinical uses for antihistamines?
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allergic reactions
motion sickness vestibular disturbances nausea, vomiting, sleep aid |
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what are the toxicities associated with antihistamines?
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sedation
antimuscarinic effects anti-alpha-adrenergic |
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what is a common ending with 1st generation antihistamines?
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name usually ends in
"-en/-ine" or "-en/-ate" |
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what is Diphenhydramine?
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antihistamine
can be used as local anesthetic DOA: 8 hours High sedative effect High anti-emetic effect High anti-cholinergic effect |
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what is Chlorpheniramine?
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1st generation antihistamine
- DOA 6 hours - medium sedative effect - no anti-emetic effect - medium anti-cholinergic effect |
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what is Pyrilamine?
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1st generation antihistamine
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what is Clemastine?
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1st generation antihistamine
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What is Hydroxiyzine?
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metabolized to Cetrizine
- DOA of 6 hours - High sedative effect - high anti-emetic effect - medium anti-cholinergic effect |
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what is Brompheniramine?
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1st generation antihistamine
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what is Promethazine?
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1st generation antihistamine
useful for treatment of N/V can be used as local anesthetic |
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what is Dimenhydrinate?
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1st generation antihistamine
- DOA: 8 hours - High sedative effect - Medium anti-emetic effect - High anticholinergic effect |
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what is Meclizine?
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1st generation antihistamine
- DOA: 12 hours - Medium sedative effect - High anti-emetic effect - used for treatment of N/V induced by motion sickness - best if used prophylactically - Medium anticholinergic effect |
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What do 2nd generation antihistamines usually end in?
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"- adine"
clinical use: allergy |
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which type of antihistamine have greater sedative effects?
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1st generation antihistamines because they cross the blood brain barrier act on muscarinic receptors
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what is fexofenadine?
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2nd generation antihistamine
DOA: 12 hours very low sedative effect no antiemetic effect very low anticholinergic effect |
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what is Loratadine?
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2nd generation antihistamine
DOA: 24 hours Very low sedative effect no antiemetic effect very low anticholinergic effect |
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what is Cetirizine?
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2nd generation antihistamine
it is a metabolite of hydroxyzine DOA is 24 hours low sedative effect no antiemetic effect very low anticholinergic effect |
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what is Desloratadine?
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2nd generation antihistamine
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what is Terfenadine?
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2nd generation antihistamine
pulled from the market due to potential for PVCs |
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what is Astemizole?
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2nd generation antihistamine
pulled from the market due to risk for PVCs |
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Name the intranasal antihistamine?
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Azelastine
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what is Azelastine used for?
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intranasal antihistamine
used in allergic rhinitis relieves sneezing, itching, watery discharge |
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what are the side effects of Azelastine?
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drowsiness/sedation
headache dry mouth weight gain |
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what are the effects of histamine on the VSM?
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vasodilates and edema
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what are the effects of histamine on NVSM?
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contraction of bronchioles and other NVSM
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which type of receptor is the predominate affecter of bronchoconstriction?
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H1 receptors
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what is the predominate affecter of bronchodilation?
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H2 receptors
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what is Scopolamine?
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1st generation anti-histamine used for motion sickness and vestibular disturbances
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what is the mechanism of action of antihistamines?
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competitive antagonist prevents the actions of histamine already released from mast cells
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how are antihistamines metabolized?
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by the liver
- CYP3A4 isoenzyme may induce the P450 system |
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what is Buspirone?
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5-HT agnoist
5-HT1A selective anti-anxiety and depression |
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what is Sumatriptan?
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5-HT agonist
5-HT1b/d agonist reversing migraines/cluster headaches Acute migraine attacks |
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T/F Sumatriptan is used for treatment of acute migraines?
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True
not for prophylaxis |
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what is Tegaserod?
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5-HT4 agonist
used in management of IBS |
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what is Methysergide?
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5-HT2 antagonist
used for Migraine Prophylaxis diarrhea in carcinoid syndrome |
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Cyprohepatadine
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5-HT2 antagonist
antiperistaltic in carcinoid crisis DOC in urticaria, purititis counteract sexual dysfunction in 5-HT-RI |
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what is the DOC for urticaria?
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Cyproheptadine
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Clozapine
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5-HT2 antagonist
-negative symptoms for schizophrenia |
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what is a side effect of Clozapine?
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agranulocytosis may occur
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Name 3 5-HT2 antagonist
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Methysergide
Cyprohepatadine Clozapine |
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name two 5-HT3 antagonist
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Ondansetron
Granisetron Dolasetron |
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Ondansetron
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5-HT3 antagonist
tx GI disorders & chemo induced nausea and vomiting |
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Granesetron/Dolasetron
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5-HT3 antagonist
GI disorders chemo induced N/V |
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Sibutramine
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5-HT reuptake inhibitor
anoretic/appetite suppression - negative CV effects |
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Name a 5-HT reuptake inhibitor
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Sibutramine
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Alprostadil
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PGE1
tx: fetal ductus arteriosus IV infusion maintain until surgery |
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what is a side effect of Alprostadil?
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may cause apnea in neonates
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T/F Alprostadil is used in the treatment of ED?
|
True
intracavernous injection intraurethral deposit adverse side effect: penile pain |
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T/F
Misoprostol is contraindicated in pregnancy. |
True
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Misoprostol
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PGE1 analog
tx: gastric protection from patient with chronic NSAID use to prevent peptic ulcer |
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what is Dinoprostone?
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PGE2 analog
|
|
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Dinoprostone
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PGE2 inhibitor
tx: abortifacient - hydatiform mole - cervical ripening prep for labor administered: vaginal suppository |
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What is Carboprost?
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PGF-2a
|
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Carboprost
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PGF-2a
tx; vasoconstriction - post partum bleeding and abortifaceint administered: Deep IM injection |
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What is Latanoprost, Travoprost, Unoprotone used for?
|
PGF-2a
ocular therapy - Glaucoma: reduction in intraocular pressure |
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what drugs are used in the treatment of pulmonary arterial hypertension?
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Epoprostenol
Treprostinil - PGI2 and PGI2 analog |
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mechanism of action of Epoprostenol?
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direct vasodilation of pulmonary and systemic vascular beds
inhibition of platelet aggregation (PGI2 inhibitor) |
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how is Treprostinil administered and for what?
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continuous SC infusion and inhalation tx for PAH
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how would a patient be transitioned from Epoprostenol to Treprostinil for treatment of PAH?
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gradual transition in the hospital
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what are the effects of serotonin on VSM?
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vasoconstriction in most vascular beds
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what is the effect of serotonin on NVSM?
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contraction of GI and other NVSM
stimulation of platelet aggregation |
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what is the mechanism of action of Sumitriptan?
|
5-HT1b/d agonist
constriction of intracranial blood vessels > inhibit release of pro-vasodilatory Neuropeptides from nerve terminals ending in cerebral perivascular space |
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what are some possible adverse side effects of Epoprostenol?
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high incidence of dizziness, headaches, N/V, diarrhea, myalgia, flushing, tachycardia
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why is Misoprostol contraindicated in pregnancy?
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adverse effects: uterine contraction and diarrhea
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what is the mechanism of action of Latanoprost?
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increase aqueous fluid outflow
|
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what is an adverse side effect associated with Latanoprost?
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increased brown color of iris by increasing melanin in melanocytes
> may lead to permanent color change |
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describe the dose-response curve of a thiazide diuretic?
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thiazides have a relatively flat dose-response curve and a limited maximal response
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describe the dose response curve of a loop diuretic.
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loop diuretics produce a dose dependent diuresis throughout therapeutic dosage range
|
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when administering an ACE-I with a potassium sparing diuretic what might the side effects be?
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Hyperkalmeia
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what might be an adverse outcome of administration of NSAIDS and potassium sparing diuretics?
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renal failure
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what are the adverse side effects of osmotic diuretics?
|
heart failure, N/V, pulmonary congestion/edema
|
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what are the adverse side effects of Carbonic adhydrase inhibitors?
|
hyperchloremic metabolic acidosis
neuropathy NH3 toxicity sulfa allergy |
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name 4 thiazide drugs.
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Hydrochlorothiazide
Chlorthalidone Indapamide Metolazone |
|
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what is the MOA of thiazides?
|
inhibit NaCl reabsorption in the early distal tubule
reduce the diluting capacity of the nephron decrease calcium excretion (increase reabsorption) |
|
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what category of a drug for pregnancy is Indapamine?
|
Group B or D according to new literature
|
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what are the common adverse side effects of thiazide diuretics?
|
blood cell deficiencies
increased cholesterol increased glucose increased uric acid levels in the blood |
|
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what are common drug interactions with thiazide diuretics?
|
potentiate the diuretic effect of loop diuretics
|
|
|
what are the clinical uses of thiazide diuretics?
|
HTN
Edema Nephroliathiasis nephrogenic diabetes insipidus |
|
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what are the clinical uses of Loop diuretics?
|
Edema
HTN Hyperkalemia: increase urinary K+ excretion acute renal failure: increase rate of urine flow anion overdose: prevents bromide, fluroide, iodide from being reabsorbed hypercalcemia- promote calcium diuresis |
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what is a common adverse side effect of loop diuretics?
|
Ototoxic
|
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what is a common side effect of spironolactone?
|
gynecomastia
|
|
|
Spironolactone
|
Potassium sparing diuretic
competitive antagonist for aldosterone receptor |
|
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what is the mechanism of action of Triamterene/Amiloride?
|
inhibit sodium influx through channels in the luminal side of membrane
increase sodium excretion and decrease potassium secretion |
|
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name 3 potassium sparing diuretics.
|
Spironolactone
Amiloride Triamterene |
|
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Clinical uses of potassium sparing diuretics. (Triamterene, amiloride, spironolactone)
|
useful in preventing hypokalemia in patient taking thiazide/loop diuretic when K+ supplements are ineffective
heart failure hyperaldosteronism |
|
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what drug improves long term outcome of heart failure patients?
|
Spironolactone
|
|
|
adverse side effects of Potassium sparing diuretics.
|
hyperkalemia
GI distress |
|
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name two osmotic diuretics.
|
Glycerol
Mannitol |
|
|
mechanism of action fo glycerol/mannitol.
|
increase tubular fluid osmolarity > increased urine flow
|
|
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why is mannitol useful in the treatment of acute renal failure?
|
mannitol is useful in the tx of ARF because its filtered but not reabsorbed > water follows > prevents anuria
|
|
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what osmotic diuretic can be used to decrease intracranial pressure?
|
mannitol
|
|
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what osmotic diuretics can be used to reduce intraocular pressure?
|
glycerol & mannitol
- reduces TBW > cation content > reduction in intracellular volume |
|
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what is an adverse side effect of Acetazolamide?
|
metabolic acidosis
(ACIDazolamide causes ACIDosis) |
|
|
mechanism of action of carbonic anhydrase inhibitors?
|
blocks NaHCO3 reabsorption > NaHCO3 diuresis > reduction in total HCO3 stores
|
|
|
name 2 Carbonic Anhydrase inhibitors.
|
Acetazolamide
Dorzolamide |
|
|
mechanism of action of loop diuretics.
|
inhibit co-transport system Na+/K+/Cl- of thick ascending limb of loop of Henele
- abolishes hypertonicity of medulla > prevents concentration of urine - stimulates PG release > vasodilates afferent arteriole - increases calcium excretion (Loops Lose Calcium) |
|
|
what are possible toxicities of loop diuretics?
|
Ototoxicity
Hypokalemia Dehydration Allergy Nephrtiis Gout (OH DANG!) |
|
|
what are possible drug interactions between loop diuretics and NSAIDS?
|
diuretic effect is decreased by NSAIDS
|
|
|
what is the possible drug interaction between loop diuretics and ACE-I?
|
excessive HYPOtension
|
|
|
which of the following agents has not shown effectiveness in the prophylactic treatment of migraine headaches?
Zolmitriptan Methysergide Verapamil Naproxen Amitriptylin |
Zolmitriptan: the triptan agents are only effective in the acute treatment of migraine headaches. They are 5-HT1B/D receptors in the cerebral vessels that produce vasoconstriction inhibiting the release of inflammatory substances
|
|
|
use of sumitriptan is contraindicated in which of the following conditions?
- postpartum women - uncontrolled HTN - moderate to unresponsive severe migraines - hepatic insufficiency - renal dysfunction |
uncontrolled HTN
tiptans can increase blood pressure by constriction of peripheral smooth muscle. This is also a contraindication for using ergot agents such as DHE and ergotamine |
|
|
what mechanism causes the effect of triptan drugs?
|
stimulation of serotonin 5-HTd receptors
|
|
|
Methysergide is indicated for the treatment of migraine because it has which one of the following effects?
- it prevents release of serotonin - it is a 5-HT1b/d agonist - it inhibits the COX2 enzyme - it is an antagonist at 5HT2 receptors it blocks calcium channels |
it is an antagonist at 5HT2 receptors
Methysergide is indicated for the tx of migraine or better stated the prophylactic treatment to prevent migraine headaches because of its antagonist activity at serotonin receptors |
|
|
a 35 year old woman with a history of migraine reports to her physician that the last time she used her medicine to stop an acute attack she felt numbness and tingling in her extremities and blanching cyanosis of her fingers. Which of the following medications did she take?
methysergide sumatriptan DHE tramadol naproxen |
DHE is an ergot alkaloid and these agents are known to cause vasoconstriction and paresthesia in the extremities, especially in high doses
|
|
|
which of the following antihistamines would be best used to treat mild nausea and vomiting due to motion sickness?
cetrizine fexofenadine loratadine diphendyramine meclizine |
meclizine
|
|
|
which of the following describes the major difference between the 1st and 2nd genration antihistamines?
- selectivity at H1 receptors - ability to cross the BBB - effectiveness in treating allergies - potency at blocking H1 receptors - indications for use |
ability to cross the BBB
|
|
|
of the major serotonin receptors identified and used as targets for therapeutic agents, which one is teh only one considered ligand gated ion channel?
5HT1B 5HT1D 5HT2 5HT3 5HT4 |
5HT3
|
|
|
which of the following drugs is teh same as PGI2 and is used for the treatment of PAH?
Misoprostol Alprostadi Epoprostenol Treprostinil Travoprost |
Epoprostenol
|
|
|
Latanoprost is an agonist at the PGF2 receptors and is effective in the treatment of:
|
ocular hypertension and open angle glaucoma
|
