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101 Cards in this Set
- Front
- Back
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Narcotic analgesic and antitussive agent.
Semi-synthetic opioid derived from codeine and thebaine. Physiologically and psychologically addicting. Dispensed in 5mg and 10 mg doses with 500 mg of acetaminophen. |
Hydrocodone/Vicodin
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Side effects of hydrocodone
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nausea, vomiting, and constipation
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How does hydrocodone work?
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binding to opioid mu receptors in brain and spinal cord.
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Which drug works on the COX-3 pathway?
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Acetaminophen
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What is NAPQI
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a highly reactive intermediary metabolite of acetaminophen responsible for liver toxicity. N-acetyl-p-benzo-quinone imine.
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What pathways become saturated in acetaminophen toxicity?
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sulfate and glucuronide
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What single dose can cause acetaminophen toxicity in adults?
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7-10 grams
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What chronic doses of acetaminophen have been linked to liver toxicity? death?
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4 grams and 5-6 grams daily
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What should never be consumed with acetaminophen?
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Alcohol
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What is the antidote to acute acetaminophen poisoning? What does it supply?
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N-Acetylcysteine (NAC), sulfhydryl groups
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Drug used to lower serum cholesterol levels via inhibition of the the hepatic enzyme HMG-CoA reductase
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Statins
Atorvastatin/Lipitor |
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What is the rate limiting step in hepatic cholesterol biosynthesis?
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HMG-CoA reduction to mevalonate
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What are the adverse reactions associated with Lipitor?
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myalgias, nausea, headache, insomnia, dizziness, and elevated hepatic transaminase concentrations.
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What three things can increase the risk for myopathy and rhabdomyolysis in patients taking Lipitor?
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renal impairment
serious concurrent illness concomitant use of agents which inhibit CYP P450 3A4 |
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What drugs are metabolized by CYP P450 3A4?
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Macrolide antibiotics
Quinolone antibiotics Metronidazole Azole antifungals Ca channel blockers All birth control pills H2 blockers PPIs Benzodiazepines SSRIs Antiepileptic medications Warfarin Anti-rejection drugs Drugs for the treatment of HIV/AIds |
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Which herbs inhibit CYP 3A4?
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Cat's claw
Dandelion Ginseng Licorice Milk thistle |
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What juice is a potent inhibitor of cytochrome P450 3A4?
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Grapefruit. The effect can occur in 30 minutes and last for 3 days.
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Which component of grapefruit juice inhibits CYP 3A4?
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Bergamottin and it's metabolite 6',7' hydroxybergamottin
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What herb is a cytochrome P450 inducer?
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St. John's wort
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What constituent of St. John's wort is thought oto be responsible for induction of cytochrome p450 3A4?
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Hyperforin
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Beta-lactam antibiotic that acts by inhibiting cross-linkage between peptidoglycans.
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Amoxicillin/Amoxil
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Contraindication for Amoxil use
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Penicillin allergy
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Common side effects of amoxil
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rash, nausea, and vomiting
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What severe diarrhea can occur during and up to several weeks after therapy with any antibiotic agent?
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pseudomembranous colitis from C. difficile overgrowth
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What enzyme produced by some bacteria confers resistance to beta lactam antibiotics?
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beta-lactamase
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What additive to Amoxil increases it's efficacy against beta-lactamase producing bacteria?
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Clavulanate
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What are the common side effects of Clavulanate?
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GI distress, nausea, vomiting, diarrhea
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Why aren't a 500 mg pill of Augmentin and two 250mg pills the same?
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Because the amount of Clavulanate will be doubled by taking 2 pills instead of just one. There are equal amounts of this additive in a 250 mg and a 500 mg pill.
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Angiotansin-converting enzyme inhibitor (ACE) used in the treatment of hyertension, CHF, post MI, and to reduce the renal and retinal complications of diabetes.
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Lisinopril/Prinivil or Zestril
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What does ACE do?
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It converts Angiotensin I into Angiotensin II which stimulates vasoconstriction and aldosterone release. The overall effect is to raise blood pressure.
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What does Aldosterone do?
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Aldosterone acts on kidney tubules to retain sodium and chloride ions and excrete potassium increasing blood volume and blood pressure.
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What are the most common adverse effects of Lisinopril?
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hypotension, persistent dry cough, hyperkalemia, headache, dizziness, fatigue, and nausea.
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What is the potentially fatal adverse effect of all ACE inhibitors due to increased bradykinins?
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Angioedema
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What supplements should be avoided by patients on ACE inhibitors?
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Potassium, licorice
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A member of the thiazide group of diuretics commonly used to treat hypertension
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Hydrochlorothiazide/HCTZ
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How do the thiazide diuretics work?
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Inhibition of sodium and chloride reabsorption from the distal convoluted tubules of the kidney. Potassium wasting.
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Long term usage of thiazides has been linked to lowered levels of these 3 nutrients as well as an increase in?
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lowered magnesium, zinc, and folic acid; increased homosysteine.
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What drug is commonly paired with a thiazide diuretic?
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and ACE ingibitor (lisinopril)
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History of this disease is generally a contraindication to the use of a thiazide diuretic.
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Gout
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Botanical diuretics that can be used with Hydrochlorthizide
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Dandelion, horsetail, gravel root, buckthorn, cleavers, licorice, uva ursi
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Which herbs should not be used with potassium wasting diuretics due to their increase in urinary potassium loss?
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Rhamnus spp and licorice
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Beta blocker primarily used to tx cardiovascular diseases as well as act as a prophylactic to migraine headache and adjunct treatment in hyperthyroidism. (2)
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Atenolol/Tenormin
Metoprolol/Toprol XL |
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Beta-1 adrenergic receptors are located mainly in the
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heart
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Beta-2 adrenergic receptors are located in the
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lungs, vascular smooth muscle, skeletal muscle, gi tract, liver and uterus
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What type of beta blocker is Tenormin classified as?
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cardioselective
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What adverse effect is diminished by use of a selective beta blocker but still possible with high does?
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bronchospasm
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What are the potential side effects of Tenormin?
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hypotension, bradycardia, fatigue, dizziness, change in mentation, nausea, diarrhea, depression, loss of libido, erectile dysfunction, insomnia, and nightmares.
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Abrupt cessation of Tenormin can potentially cause...
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rebound hypertension and angina. Potentially and increased risk for the development of an MI or stroke.
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Why does Atenolol cause significantly fewer CNS system side effects compared to the non-selective beta blockers?
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it does not readily cross the blood brain barrier.
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Are beta blockers contraindicated in CHF?
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Trick question, they were, but studies in the late 1990s have shown positive effects in their decrease of morbidity and mortality in CHF patients.
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What dangerous condition can beta blockers mask? Why?
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Low blood sugar, they blunt the usual sympathetic nervous system response to hypoglycemia.
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Loop diuretic used in the treatment of hypertension, CHF and edema associated with either renal impairment or hepatic cirrhosis.
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Furosemide/Lasix
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How does Lasix act?
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Inhibition of the Na/K/Cl transporter in the thick ascending loop of Henle
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Is Lasix more or less potent than other diuretics?
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More
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What are the most common side effects associated with Lasix?
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hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, hyperuricemia
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Short acting benzodiazepine used to treat anxiety and panic attacks. Also used as a sedative.
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Alprazolam/Xanax
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How do benzodiazepines work?
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modulating the GABA receptor site at a site distinct from GABA and barbiturates. Potentiation of the GABA response
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What are the most common side effects of Alprazolam/Xanax?
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drowsiness, confusion, slurred speech, amnesia, vivid dreams and nightmares, hypoventilation, and the potential for respiratory arrest.
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Pradoxical side effects such as incrased anxiety, agitation or insomnia when using Alprazolam can indicate...
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too high of a dose or the concomitant use of alcohol.
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Long term effects of benzodiazepine use include:
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psychological and physical dependence. Tolerance to the drug's sedative effects but less to it's anxiolytic effects.
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Short acting beta2 receptor agonist used for the rrelief of bronchospasm in conditions such as asthma and COPD.
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Albuterol inhaler/Ventolin
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Specific indications for Albuterol are:
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acute asthma, symptom relief during maintenance therapy of asthma and COPD, and prophylaxis of exercise-induced asthma.
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Activation of beta 2 receptors results in
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the relaxation of bronchial smooth muscle with subsequent bronchodilation
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Common adverse effects of Albuterol include:
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tachycardia, palpitations, tremulousness, headache, and insomnia if used within an hour of bedtime.
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Long acting calcium channel blocker used in the treatment of hypertension, angina, and arrhythmias such as atrial fibrillation and arterial flutter.
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Amlodopine/Norvasc
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MOA of calcium channel blockers
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relaxing the smooth muscle in the arterial wall, decreasing peripheral resistance and reducing BP.
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Most common adverse reactions of Amlodopine/Norvasc
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hypotension, peripheral edema, h/a, dizziness, and nausea
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Synthetic T4
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Levothyroxine
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In what populations should the starting dose of Levothyroxine be reduced?
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Elderly patients or patients with known cardiac disease.
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What should patient avoid taking within 4 hours of taking Levothyroxine? Within 3 hours?
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4: calcium or iron
3: soy products |
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What agents lower thyroid hormone absorption?
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antacids that contain aluminum
the ulcer medication: sucralfate/Carafate Bile acid sequestrants |
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What are the adverse side effects of Levothyroxine?
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palpitations, nervousness, headache, difficulty sleeping, insomnia, weight loss (8lbs or less), increased appetite, weight gain.
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What condition mandates a replacement of cortisol prior to initiation of thyroid replacement in order to prevent death due to circulatory collapse?
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Addison's disease
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60 mg / grain of Armour Thyroid is equivalent to how much Levothyroxine? Cytomel?
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100 mcg Levothyroxine
25 mcg Cytomel |
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Biguanide class oral hypoglycemic drug
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Metformin/Glucophage
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What are two conditions other than Diabetes Mellitus that are associated with insulin resistance and treated with Metformin?
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Polycystic ovarian syndrome
NASH |
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What are the effects of Metformin?
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decreased absorption of glucose from the GI tract, reduction of hepatic gluconeogenesis, and increased insulin sensitivity in both skeletal muscle and adipose tissue.
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Side effects of metformin
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GI upset including diarrhea, cramps, nausea, and vomiting
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What deficiency is associated with long term use of Metformin? What is increased
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B12
homocystine |
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What is a serious potential side effect of Metformin?
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Lactic acidosis
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Consumption of what can increase the risk of developing lactic acidosis?
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Alcohol
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SSRI used to treat depression, anxiety, OCD, panic disorder, and post traumatic stress disorder
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Sertraline/Zoloft
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Adverse effects of zoloft
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nausea, vomiting, confusion, dizziness, increased risk of osteoporosis, sleep disturbance (insomina and hypersomnia), decreased libido, anorgasmia, and serotonin syndrome.
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What are the symptoms of serotonin syndrome?
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abdominal pain, diarrhea, HTN, agitation, tachycardia, diaphoresis, shivering, and hyperthermia (104).
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SSRI's are now recognized as having the potential to raise
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suicide risk
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What are the symptoms of serotonin syndrome?
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abdominal pain, diarrhea, HTN, agitation, tachycardia, diaphoresis, shivering, and hyperthermia (104).
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The use of antidepressant medication is strictly contraindicated in any individual taking a
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MAOI
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Taking this herb will diminish the drug effect of Sertraline as well as increase the risk for serotonin syndrome
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St. John's wort
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Discontinuation of antidepressant drugs has been shown to potentially cause
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dizziness, paresthesias, confusion, chills, hot flashes, sweating, anxiety, irritability, incrased sensitivity to bright lights or loud sounds, and worsening depression
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SSRI antidepressant similar to Sertraline.
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Escitalopram/Lexapro
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NSAID used for pain, fever, swelling, arthritis, and dysmenorrhea that acts via reversible inhibition of COX enzymes.
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Ibuprofen
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Common adverse effects of Ibuprofen...
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nausea, dyspepsia, GI ulceration and bleeding, diarrhea, headache, dizziness, diminished blood clotting, salt and fluid retention, and HTN. Elevated risk of MI
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Chronic NSAID use is a risk factor for the development of.....in both men and women
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Hypertension
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First generation cephalospirin antibiotic used to treat bacterial pharyngitis, tonsillitis, sinusitis, otitis media, pneumonia, skin and soft tissue infectoins
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Cephalexin/Keflex
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Side effects of Cephalexin
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nausea, vomiting, diarrhea, oral and vaginal candidiasis, C. diff superinfection
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Short acting benzodiazepine-like sedative that potentiates GABA effects.
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Zolpidem/Ambien
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Macrolide antibiotic derived from Erythromycin
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Azithromycin/Zithromax
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Prevents bacteria from growing by interfering with bacterial protein synthesis - binding 50s subunit on bacterial ribosome.
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Azithromycin/Zithromax
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What conditions would one use Azithromycin to treat?
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Bacterial infections including: otitis media, tonsillitis, sinusitis, bronchitis, and pneumonia.
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What are the instructions for a Z-pak?
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a double dose of medication (500 mg) on the first day of treatment and subsequent treatment with one 250 mg dose for four additional days.
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Which antiboitic is notable for its significantly longer half-life?
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Azithromycin
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