Brs Pharmacology Flash Cards

Front 1

Autonomics:

Side effects include cycloplegia, flushing, confusion, increased body temperature, dry mouth, tachycardia, and constipation

Back 1

Atropine

[The side effects of this competitive muscarinic antagonist, as well as for all anticholinergics, are remembered as blind as a bat, red as a beet, mad as a hatter, hot as a hare, and dry as a bone.]

Front 2

Autonomics:

Muscarinic agonist used to treat postoperative urinary retention and atonic ileus

Back 2

Bethanechol

[A related drug, carbachol, has both muscarinic and nicotinic agonist properties and is primarily used in the management of glaucoma. Both drugs are resistant to metabolism by acetylcholinesterases.]

Front 3

Autonomics:

Short-acting anticholinesterase used to distinguish the diagnosis of myasthenia gravis from cholinergic crisis.

Back 3

Edrophonium

[Intravenous injection of this rapidly absorbed drug results in an appreciable increase in muscle strength.]

Front 4

Autonomics:

Indirect-acting sympathomimetic used in over-the-counter nasal decongestants

Back 4

Ephedrine

[It has many of the same actions as amphetamines, with less central nervous system [CNS] stimulation; it is found in Chinese herbs such as ma-huang; one enantiomer, pseudoephedrine, is found in many cold-relief medications.]

Front 5

Autonomics:

Adrenergic agonist used for acute asthma, anaphylactic shock, open-angle glaucoma, and cardiac resuscitation

Back 5

Epinephrine

[Adrenergic agonist with affinity for α₁, α₂, β₁, and β₂ receptors. At low concentrations the effects of the β receptors predominate. β₂ receptors cause vasodilation with decreased total peripheral resistance (TPR) and decreased diastolic pressure. At higher concentrations, β₁ receptors lead to increased cardiac contractility and increased heart rate.]

Front 6

Autonomics:

Prototypic β agonist used for the treatment of both acute heart failure and acute asthma

Back 6

Isoproterenol

[This agent has equivalent affinities for β₁ and β₂ receptors; the β₁ activity causes an increase in cardiac contractility and increased heart rate, resulting in increased stroke volume and cardiac output; the β₂ activity induces bronchodilation.]

Front 7

Autonomics:

Adregenergic antagonist used in the management of hypertension caused by pheochromocytoma; this agent is also used in the treatment of benign prostatic hyperplasia (BPH) but seldom for it's unfavorable side effects

Back 7

Phenoxybenzamine

[An irreversible α₁ and α₂ antagonist; a similar short-acting reversible antagonist, phentolamine, is used in the diagnosis of pheochromocytoma.]

Front 8

Autonomics:

Used in emergency situations for the treatment of both open- and narrow-angle glaucoma

Back 8

Pilocarpine

[Activation of muscarinic cholinergic receptors causes contraction of the ciliary muscles with opening of Schlemm's canal, allowing drainage of aqueous humor and a subsequent decrease in intraocular pressure.]

Front 9

Autonomics:

Used to treat hypertension and urinary retention; first-dose syncope is a significant side effect associated with this drug

Back 9

Prazosin

[A competitive α₁ antagonist. The use of this drug can lead to postural hypotension, inhibition of ejaculation, reflex tachycardia, nasal congestion, and miosis.]

Front 10

Autonomics:

Prototypical β antagonist used in the treatment of hypertension, glaucoma, migraines, and angina; as prophylaxis for myocardial infarctions; and at low doses to prevent performance anxiety

Back 10

Propanolol

[Nonselective β₁ and β₂ blocker, not to be used in patients with chronic obstructive pulmonary disease (COPD) and asthma, due to significant bronchoconstriction.]

Front 11

Autonomics:

Long-acting anticholinesterase used in the chronic treatment of myasthenia gravis

Back 11

Pyridostigmine

[Also used as an antidote to tubocurarine toxicity; neostigmine is a similar substance, although it has a shorter duration of action.]

Front 12

Autonomics:

Used to prevent motion sickness and delivered by a transdermal patch

Back 12

Scopolamine

[Competitive cholinergic antagonist with sedating and amnestic effects.]

Front 13

Autonomics:

Depolarizing neuromuscular blocker used to facilitate intubation, and as a skeletal muscle relaxant for general anesthesia

Back 13

Succinylcholine

[Functions as a cholinergic nicotinic agonist, facilitating the opening of sodium channels. A rare but significant side effect, malignant hyperthermia, can occure in some patients when used with halothane.]

Front 14

Autonomics:

Nondepolarizing neuromuscular ganglionic blockers used in surgical anesthesia

Back 14

Tubocurarine
Pancuronium
Muvacurium

[Neostigmine, physostigmine, and edrophonium can reverse the paralysis caused by these drugs. Tubocurarine is the most likely of this class to cause the release of histamine, leading to vasodilation and hypotension.]

Front 15

Diuretic used in the management of chronic glaucoma and acute mountain sickness; also used to alkalinize the urine in aspirin toxicity

Back 15

Acetazolamide

[Inhibits carbonic anhydrase in the proximal convoluted tubule; metabolic acidosis is a potential side effect.]

Front 16

Potassium-sparing diuretics that do not have anti-androgenic effects

Back 16

Amiloride
Triamterene

[Block sodium channels in the cortical collecting tubules; may cause hyperkalemic metabolic acidosis]

Front 17

Cough is a major side effect of this group of antihypertensive drugs

Back 17

ACE Inhibitors
(Captopril/Enalapril/Lisinopril)

[Inhibit the conversion of angiotensin I to angiotensin II; inhibit breakdown of bradykinin, resulting in cough and potent vasodilation]

Front 18

Most potent class of diuretics that inhibit the Na⁺/K⁺/Cl⁻ cotransporter in the thick ascending loop of Henle

Back 18

Loop diuretics
(Furosemide/Butamide)

[These sulfa drugs can cause hypercalcemia, ototoxicity, hyperuricemia, hypokalemia, and metabolic alkalosis; ethacrynic acid is a non-sulfa drug with similar effects]

Front 19

Diuretic that functions early in the distal convoluted tubule by inhibiting NaCl reabsorption

Back 19

Hydrochlorothiazide (HCTZ)

[Major side effects include hypokalemia, alkalosis, hyperuricemia, and hyperlipidemia]

Front 20

Angiotensin II receptor antagonist used as an antihypertensive drug

Back 20

Losartan

[Functions at the collecting tubules, like ACE inhibitors, but no cough as side effect. Again, like ACE inhibitors, this drug is teratogenic and, therefore, contraindicated during pregnancy.]

Front 21

Osmotic diuretic that works by extracting water from tissues into the blood; used in the treatment of hydrocephalus and increased intracranial pressure]

Back 21

Mannitol

[This diuretic functions primarily within the proximal convoluted tubules and is used to maintain high urine output in cases of severe hemolysis or rhabdomyolysis]

Front 22

This potassium-sparing diuretic is an aldosterone antagonist that functions at the collecting tubule

Back 22

Spironolactone

[Increases P450 activity and causes gynecomastia and other antiandrogenic effects]

Front 23

Originally developed as an antihypertensive agent, it is used topically because of the beneficial side effect of hypertrichosis

Back 23

Minoxidil

[Functions as a direct-acting vasodilator, as do nitroprusside and hydralazine]

Front 24

This diuretic is a potent vasodilator used in the treatment of malignant hypertension, but can cause significant postural hypotension

Back 24

Nitroprusside

[Functions to stimulate guanyl cyclase with an increase in cGMP within smooth muscle of the vasculature. Prolonged infusion can result in cyanide poisoning due to release of CN⁻.]

Front 25

Cardiovascular:

Extremely short-acting agent (15-20 seconds) administered IV for the control of atrioventricular (AV) nodal arrhythmias

Back 25

Adenosine

[The side effects of flushing and hypotension are short-lived as well, and do not limit the use of this agent]

Front 26

Cardiovascular:

Long-acting class II antiarrhythmic associated with pulmonary fibrosis, thyroid dysfunction, and corneal microdeposits

Back 26

Amiodarone

[This agent also blocks sodium channels, such as the class IA antiarrhythmics]

Front 27

Cardiovascular:

Used for the treatment of congestive heart failure, this agent contains two isomers, one with nonselective β blocking activity and one with α₁ blocking activity

Back 27

Carvedilol

[Labetolol has similar properties and has four diastereomers; the RR enantiomer is a nonselective β blocker, and the SR enantiomer is an α₁ blocker]

Front 28

Cardiovascular:

Bile acid-binding resins used in the management of hyperlipidemia

Back 28

Cholestyramine
Colestipol

[Bind bile acids, preventing enterohepatic recycling, thus diverting hepatic efforts to renew bile acids, instead of producing plasma lipids]

Front 29

Cardiovascular:

These agents function to slow conduction velocity by slowing the rate and rise of the action potential

Back 29

Class IA Antiarrhythmics
(Quinidine/Procainamide/Disopyramide)

[These agents help maintain sinoatrial (SA) rhythm after cardioconversion for atrial fibrillation, and may cause torsade de pointes arrhythmias. Quinidine may cause cinchonism, a type of poisoning that causes headache, vertigo, and tinnitus.]

Front 30

Cardiovascular:

Function to decrease the action potential duration by shortening the repolarization phase

Back 30

Class IB Antiarrhythmics
(Lidocaine/Mexiletine/Tocainide/Phenytoin)

[These agents are used for the treatment of ventricular arrhythmias, as well as for digitoxin-induced arrhythmias]

Front 31

Cardiovascular:

Used for the treatment of refractory ventricular arrhythmias, as well as for rapid atrial arrhythmias associated with Wolff-Parkinson-White syndrome

Back 31

Class IC Antiarrhythmics
(Flecainide/Propafenone)

[Function to slow conduction velocity in the atrial and ventricular cells but do not affect the action potential. They typically are used as a last resort, as their use is associated with drug-induced arrhythmias.]

Front 32

Cardiovasculae:

These agents decrease the automaticity of the pacemaker tissue of the heart, resulting in prolonged atrioventricular (AV) conduction and slower heart rate

Back 32

Class II Antiarrhythmics
(Propanolol/Esmolol)

[These β blockers decrease cAMP levels, resulting in reduced sodium and calcium currents. These agents are not to be used in cases of congestive heart failure.]

Front 33

Cardiovascular:

Used for the treatment of recurrent ventricular arrhythmias; many of these agents can precipitate torsade de pointe arrhythmias

Back 33

Class II Antiarrhythmics
(Sotalol/Ibutilide/Bretylium/Amiodarone)

[These agents prolong the action potentials by blocking potassium channels.]

Front 34

Cardiovascular:

Used for atrial arrhythmias and nodal re-entry, as well as hypertension and angina, these agents inhibit Ca⁺2 voltage channels

Back 34

Class IV Antiarrhythmics
(Verapamil/Diltiazem)

[Note: nifedipine has a similar mechanism of action, but it is used only for hypertension and angina; as it has no effect on heart tissue, it is not a class IV agent]

Front 35

Cardiovascular:

Centrally-acting α₂ agonist that reduces sympathetic autonomic nervous system outflow, resulting in decreased blood pressure

Back 35

Clonidine

[A major side effect of this drug is rebound hypertension, in the event of abrupt discontinuation]

Front 36

Cardiovascular:

Used in the management of congestive heart failure, these drugs are reversible inhibitors of Na⁺/K⁺ ATPase

Back 36

Digitoxin
Digoxin

[Unlike digitoxin, digoxin is shorter-acting and excreted by the kidneys; patients with low K⁺, low Mg⁺2, high Na⁺, or high Ca⁺2 can experience arrhythmias with either agent]

Front 37

Cardiovascular:

Agents that decrease triglycerides dramatically by stimulating lipoprotein lipase

Back 37

Gemfibrozil
Fenofibrate
Clofibrate

[Clofibrate has been associated with gallstones and hepatobiliary neoplasms]

Front 38

Cardiovascular:

Antihypertensive drug that blocks the release of norepinephrine by displacing it from intracellular vesicles

Back 38

Guanethidine

[Side effects include serious orthostatic hypotension; the effects of the drug are antagonized by tricyclic antidepressants]

Front 39

Cardiovascular:

Used for the treatment of ventricular arrhythmias, especially following myocardial infarction, because it works only on ischemic tissue

Back 39

Lidocaine

[This class IB antiarrhythmic has little effect on the ECG of normal (nonischemic) heart tissue. It is given intravenously, although similar agents (mexiletine and tocainide) are given orally.]

Front 40

Cardiovascular:

This α₂ agonist decreases adrenergic outflow from the CNS, resulting in decreased peripheral resistance and decreased blood pressure

Back 40

Methyldopa

[This drug can haptenate red blood cell proteins, resulting in autoimmune hemolytic anemia]

Front 41

Cardiovascular:

Lipid-lowering agent that causes cutaneous flushing, which can be avoided by administering concurrently with aspirin

Back 41

Niacin

[Directly reduces the secretion of VLDLs from and apolipoprotein synthesis by the liver, while increasing HDLs]

Front 42

Cardiovascular:

Causes an increase in cGMP within vascular smooth muscle, resulting in decreased preload to the heart and decreased blood pressure

Back 42

Nitroglycerin

[Administered as a sublingually to decrease first-pass metabolism; potential side effects include cyanide poisoning, postural hypotension, headache, and flushing]

Front 43

Cardiovascular:

Antihyperlipidemic agent that may prevent atherosclerosis by acting as an antioxidant

Back 43

Probucol

[Rarely used for the treatment of hyperlipidemia because it decreases HDLs as well as LDLs; may be efficacious in preventing restenosis after angioplasty]

Front 44

Cardiovascular:

This rarely used antihypertensive agent blocks the storage and release of catecholamines and serotonin from neurons

Back 44

Reserpine

[This drug readily enters the CNS and can cause suicidal depression and Parkinsonian symptoms]

Front 45

Cardiovascular:

Inhibit the rate-limiting enzyme of cholesterol synthesis, HMG-CoA reductase, resulting in dramatically decreased LDL levels

Back 45

Statins
(Lovastatin/Pravastatin/Simvastatin/Atorvastatin)

[May cause elevated liver enzymes, myositis with increased creatinine kinase from skeletal muscle, and rarely, rhabdomyolysis]

Front 46

CNS:

Intermediate-acting benzodiazepine used for the treatment of panic disorder and phobias

Back 46

Alprazolam

[Both alprazolam and clonazepam have sedative effects and can cause physiologic dependence; buspirone is an alternative drug that binds 5-HT1A receptors with minimal abuse potential]

Front 47

CNS:

Used in the management of depression, it inhibits the reabsorption of both norepinephrine and serotonin within the synapse

Back 47

Amitriptyline

[Other tricyclic antidepressants include nortryptyline, imipramine, and despiramine. Major side effects of this class include sedation, orthostatic hypotension, and cardiac arrhythmias.]

Front 48

CNS:

Orally active antispasmolytic agent

Back 48

Baclofen

[GABA receptor agonist that functions on inhibitory pathways in the spinal cord]

Front 49

CNS:

Because of its low toxicity, this local anesthetic can be used on large surface areas and is available over the counter as an ointment

Back 49

Benzocaine

[This ester-type compound, like cocaine, has surface activity, or the ability to work on superficial nerves when applied to mucous membranes. Other ester-type compounds include the short-acting procaine and the long-acting tetracaine.]

Front 50

CNS:

This antimuscarinic is used in the management of Parkinson disease, improving tremors and rigidity, but does little for bradykinesia

Back 50

Benztropine

[As for all antimuscarinics, contraindications include prostatic hyperplasia, GI obstruction, and closed-angle glaucoma, and are more common in older patients]

Front 51

CNS:

Drug used in the treatment of Parkinson disease as well as in the treatment of prolactinoma

Back 51

Bromocriptine

[This ergot derivative acts as a D2 agonist, improving extrapyramidal function, and also inhibits the release of prolactin from the pituitary gland. Unlike a similar agent, pergolide, bromocriptine maintains its effectiveness over time.]

Front 52

CNS:

This long-acting amide-type local anesthetic can cause severe hypotension and arrhythmias if inadvertently given intravenously

Back 52

Bupivacaine

[Local anesthetics bind to sodium channels in the open and inactive state, slowing recovery from depolarization 10- to 1000-fold]

Front 53

CNS:

Antidepressant used in the management of nicotine withdrawal in patients seeking to stop cigarette smoking with minimal sedation

Back 53

Bupropion

[This second-generaltion heterocyclic antidepressant inhibits the reuptake of norepinephrine. Newere third-generation agents used for depression, such as venlafaxine, inhibit the reuptake of serotonin as well.]

Front 54

CNS:

This agent is used in the treatment of partial and generalized seizures, bipolar disorder, and is the primary agent used in the treatment of trigeminal neuralgia

Back 54

Carbamazepine

[Inhibits sodium channels on neurons; it's use may result in idiosyncratic blood disorders such as aplastic anemia and agranulocytosis]

Front 55

CNS:

Second-line treatment for schizophrenia that is better for the negative symptoms of the disease

Back 55

Clozapine

[Atypical antipsychotic, associated with agranulocytosis, that blocks the D4 receptor]

Front 56

CNS:

The only local anesthetic with vasoconstrictor activity, but is rarely used

Back 56

Cocaine

[Has been widely replaced with the use of synthetics such as benzocaine and proparacaine. Other local anesthetics are administered with epinephrine to increase the duration of action and lower the effective dose.]

Front 57

CNS:

Used for the treatments of anxiety and ethanol dependence; also a primary agent in the treatment of status epilepticus

Back 57

Diazepam

[This long-acting, prototypic benzodiazepine binds to the GABA-A receptor, increasing the frequency of chloride channel opening]

Front 58

CNS:

Used in the treatment of Parkinson's disease, it inhibits the enzyme catechol-O-methyltransferase (COMT)

Back 58

Entacapone

[This agent inhibits the conversion of levodopa to 3-O-methyldopa in the periphery. A similar agent, tolcapone, has been associated with acute liver failure.]

Front 59

CNS:

Preferred agent in the treatment of absence seizures

Back 59

Ethosuximide

[Postulated to function by inhibiting T-type calcium channels in thalamic neurons. Use has been associated with the development of Stevens-Johnson syndrome.]

Front 60

CNS:

Opioid used in the induction of anesthesia, and also for postoperative analgesia

Back 60

Fentanyl

[If used in conjunction with droperidol and nitrous oxide, it can produce a state of neuroleptanesthesia, resulting in both analgesia and amnesia]

Front 61

CNS:

Popular drug used for the treatment of depression, it is the prototype of the selective serotonin reuptake inhibitors (SSRI)

Back 61

Fluoxetine

[Common side effects of this and other SSRI's, such as sertraline, paroxetine, and citalopram, include headache, insomnia, nausea, and sexual dysfunction; these agents also are used in the management of obsessive compulsive disorder (OCD), social phobias, bulimia, and alcohol dependence]

Front 62

CNS:

This analog of GABA is used in the treatment of partial seizures, as well as in the management of peripheral neuropathy

Back 62

Gabapentin

[Other available agents for seizures include lamotrigine, which may cause life-threatening Stevens-Johnson syndrome and epidermal necrolysis, and vigabatrin, which inhibits GABA transaminases]

Front 63

CNS:

The most potent inhaled halogenated anesthetic, with the lowest minimal alveolar concentration (MAC), but now rarely used for surgical anesthesia in children and asthmatics

Back 63

Halothane

[The use of halothane has been largely replaced by isoflurane, sevoflurane, and desflurane. Rare but significant side effects include the development of malignant hyperthermia and fulminant hepatitis]

Front 64

CNS:

Dissociative anesthetic that causes hallucinations and disorientation on recovery

Back 64

Ketamine

[Side effects are due to an increase in cerebral blood flow, and can be reduced by preoperative use of benzodiazepines]

Front 65

CNS:

Used in the treatment of Parkinson's disease, this precursor crosses the blood-brain barrier and is converted to dopamine

Back 65

L-dopa (Levodopa)

[Administered with the decarboxylase inhibitor carbidopa (which does not cross the blood-brain barrier) to increase bioavailability and to limit peripheral side effects]

Front 66

CNS:

Mood stabilizer that is a first-line drug for the treatment of bipolar affective disorder

Back 66

Lithium

[Inhibits the secondary messengers inositol triphosphate (IP3) and diacylglycerol (DAG) and causes tremor, hypothyroidism, polydipsia, and polyuria]

Front 67

CNS:

Amphetamine used in the management of attention deficit disorder (ADD) and narcolepsy

Back 67

Methylphenidate (Ritalin, Concerta)

[Increases alertness and decreases appetite by stimulating the release of catecholamines; it is a controlled substance with abuse potential]

Front 68

CNS:

Inhaled anesthetic that never reaches the level of surgical anesthesia without the addition of another agent, it is safe and the induction and recovery are extremely rapid

Back 68

Nitrous Oxide

[This gas has a high minimal alveolar concentration (MAC) and a low blood/gas partition. It is usually administered with an intravenous anesthetic such as thiopental, and is commonly used in dental procedures.]

Front 69

CNS:

This older agent used in the treatment of depression increases levels of amine neurotransmitters by inhibiting their breakdown

Back 69

Monoamine oxidase inhibitors (MAOI)
(Phenelzine/Tranylcyromine/Isocarboxazid)

[Consumption of foods such as cheese, which contain tyramine (an indirect-acting sympathomimetic) while on MAOIs can result in hypertensive crisis. If taken with selective serotonin reuptake inhibitors (SSRIs), life threatening serotonin syndrome can result.]

Front 70

CNS:

Used as a sedative; also us a first-line drug for tonic-clonic seizures in children and in the treatment of patients with Crigler-Najjar syndrome type II

Back 70

Phenobarbital

[As a long-acting, prototypic barbituate, it binds to GABA receptors, increasing the duration of chloride channel opening with neuronal inhibition]

Front 71

CNS:

Drug used for the treatment of partial and tonic-cloninc seizures and status epileptics, as well as being a class IB antiarrhythmic

Back 71

Phenytoin

[Side effects include gigival hyperplasia, hirsutism, anemia, and birth defects, because it interferes with folate absorption]

Front 72

CNS:

This agent has the largest number of extrapyramidal side effects of all the atypical antipsychotics

Back 72

Risperidone

[Atypical antipsychotics block the D2 and the 5-HT2 receptors, contributing to high sedation. More recently introduced agents such as olanzapine have no extrapyramidal effects]

Front 73

CNS:

Agent used in the treatment of Parkinson's disease that forestalls the use of levodopa

Back 73

Ropinirole

[This agent has a lower incidence of postural hypertension, dyskinesia, vomiting, and hallucination, unlike most dopamine agonists. It is not an ergot derivative; a similar agent, pramipexole, also is used]

Front 74

CNS:

Inhibits the degradation of dopamine in the central nervous system and is used as an adjuvant to levodopa in the treatment of Parkinson's disease

Back 74

Selegiline

[Inhibits monoamine oxidase B, which selectively degrades dopamine]

Front 75

CNS:

Ultra-short-acting barbituate used intravenously for the induction of surgical anesthesia

Back 75

Thiopental

[Due to its high lipid solubility, this agent enters the CNS within 1 minute; it can be used only for short surgical procedures, because it rapidly redistributes to other tissues]

Front 76

CNS:

Side effects of this antipsychotic include torsade de pointes arrhythmias and retinal deposits

Back 76

Thioridazine

[This low-potency antipsychotic blocks most dopamine receptors in the CNS, and can cause postural hypotension, sedation, and CNS depression]

Front 77

CNS:

Used in the treatment of most forms of epilepsy, including generalized tonic-clonic, partial, absence, and myoclonic seizures, and in the treatment of bipolar disorder

Back 77

Valproic Acid

[This agent has been associated with the development of neural tube defects when administered to pregnant women]

Front 78

CNS:

Although not a benzodiazepine, it has similar effects and is used as a hypnotic with less dependence liability

Back 78

Zolpidem

[Functions by binding to benzodiazepine (BDZ) receptors and thus results in similar actions with less amnesia and less muscle relaxation; also like benzodiazepines, its actions are antagonized by flumazenil]

Front 79

Drugs of Abuse:

Causes feelings of euphoria and self-confidence, and, at chronic high doses, delusions and paranoia

Back 79

Amphetamines

[Function as indirect sypathomimetic by releasing stored catecholamines]

Front 80

Drugs of Abuse:

Overdose often results in fatalities from arrhythmias, myocardial infarctions, or seizures

Back 80

Cocaine

[Inhibits catecholamine reuptake, resulting in cardiotoxicity and hypertensive episodes]

Front 81

Drugs of Abuse:

Used in the treatment of alcoholism in compliant patients, causing flushing, vomiting, and hypertension when alcohol is consumed

Back 81

Disulfram

[Inhibits aldehyde dehydrogenase, resulting in the toxic accumulation of acetaldehyde. Drugs with similar side effects are said to cause a disulfram-like reaction.]

Front 82

Drugs of Abuse:

Congener of amphetamine that results in increased intrapersonal communications and increased sexual drive

Back 82

Ecstasy

[Methylene dioxymethamphetamine (MDMA) use is often associated with "rave" parties and in teenagers of higher socioeconomic status]

Front 83

Drugs of Abuse:

Rapidly acting benzodiazepine used as a "date-rape" drug

Back 83

Flunitrazepam (Rohypnol)

[Due to its amnestic properties, this drug often is added to alcohol, making the victim incapable of resisting or remembering being raped]

Front 84

Drugs of Abuse:

Hallucinogenic agent that causes "psychedelic" perceptual effects and can lead to a "bad trip" or panic attack

Back 84

Lysergic Acid Diethylamide (LSD)

["Highs" also are associated with somatic effetcs, such as nausea, parethesias, and weakness; such effects are also seen with the use of mescaline and psilocybin]

Front 85

Drugs of Abuse:

"High" is associated with euphoria, disinhibition, laughter, changes in perception, and hunger

Back 85

Marijuana

[The active ingredient, tetrahydrocannabinol (THC), can be used medically to lower intraocular pressure in glaucoma]

Front 86

Drugs of Abuse:

Used in the management of opioid withdrawal and maintenance programs for addicts

Back 86

Methadone

[Used to treat the nausea, chills, sweats, lacrimation, cramps, rhinorrhea, yawning, piloerection, diarrhea, and tremor due to opioid withdrawal]

Front 87

Drugs of Abuse:

A by-product of incorrectly synthesized illicit street opioids, this contaminant can cause irreversible parkinsonism

Back 87

MPTP (I-methyl-4-phenyl-1,2,3,6-tetrahydropyridine)

[Causes the destruction of dopaminergic neurons of the nigrostriatal tract]

Front 88

Drugs of Abuse:

Overdose causes constricted pupils, clammy skin, nausea, drowsiness, and respiratory depression with possible coma and death

Back 88

Opioids
(Heroin/Morphine/Meperidine/Fentanyl)

[Modulate synaptic transmission by binding mu (morphine), delta (enkephalin), and kappa (dynorphin) receptors]

Front 89

Drugs of Abuse:

Hallucinogen that often causes psychotic reactions and impaired judgement leading to reckless behavior

Back 89

Phencyclidine (PCP)

[Also known as "angel dust"; overdose leads to nystagmus, life-threatening hypertension, and seizures]

Front 90

Anti-Inflammatory:

Commonly used analgesic and antipyretic, but unlike NSAIDs, has no anti-inflammatory properties

Back 90

Acetaminophen

[Weak inhibitor of cyclooxygenase (COX), it inhibits prostaglandin synthesis in the central nervous system; a related prodrug, phenacetin, is no longer available due to nephrotoxicity]

Front 91

Anti-Inflammatory:

Used in the management of chronic gout and as an adjunct to cancer chemotherapy, to slow the production of uric acid

Back 91

Allopurinol

[Results in suicide inhibition of xanthine oxidase with resultant increase of xanthine and hypoxanthine, both of which are more soluble and less likely to form crystals than uric acid]

Front 92

Anti-Inflammatory:

Nonsteroidal anti-inflammatory drug (NSAID) with analgesic, antipyretic, antiplatelet, and anti-inflammatory properties that irreversibly inhibits cyclooxygenase

Back 92

Aspirin (acetylsalicylic acid)

[Inhibits the formation of prostaglandin E (PGE), decreases pain and fever, and decreases the synthesis of PGE in the stomach, predisposing to acute gastritis]

Front 93

Anti-Inflammatory:

Used topically for the treatment of rheumatoid arthritis because it depletes substance P

Back 93

Capsaicin

[Component of chili peppers that impairs the release of substance P, the potent neurotransmitter for pain sensation]

Front 94

Anti-Inflammatory:

NSAID used in the treatment of rheumatoid arthritis and other chronic conditions, with a decreased risk of ulcers and other GI bleeds

Back 94

Celecoxib

[Celecoxib and a similar drug, rofecoxib, selectively inhibit cyclooxygenase-2 (COX-2) present only in leukocytes; these agents do not inhibit COX-1 that produces protective prostaglandins in the stomach; as sulfa drugs, they both can cause hypersensitivity in some patients]

Front 95

Anti-Inflammatory:

Used for the treatment of acute attacks of gouty arthritis, because it impairs leukocyte function

Back 95

Colchicine

[Inhibits microtuble assembly, and therefore, leukocyte migration and phagocytosis of uric acid crystals]

Front 96

Anti-Inflammatory:

Used in the treatment of transplant patients and patients with autoimmune diseases, as it impairs T cell production of interleukin-2 (IL-2)

Back 96

Cyclosporin

[Binds to cyclophilins and inhibits the transcription of cytokine genes; a similar agent, tacrolimus, binds to the immunophilin FK-binding protein (FKBP) and functions similarly; both display dose-limiting nephrotoxicity]

Front 97

Anti-Inflammatory:

Monoclonal antibody used in the management of patients with renal allografts

Back 97

Daclizumab

[Binds to the high affinity interleukin-2 (IL-2) receptor expressed on activated T cells; the side effects are minimal compared to agents such as cyclosporin or tacrolimus]

Front 98

Anti-Inflammatory:

Used in the treatment of rheumatoid arthritis and inflammatory bowel disease, a recombinant protein that inhibits the effects of tumor necrosis factor alpha (TNF-α)

Back 98

Etanercept

[Administered IV this drug is a fusion between the extracellular domain of the TNF-α receptor and the Fc portion of an antibody; a similar monoclonal antibody, infliximab, also binds and inhibits TNF-α]

Front 99

Anti-Inflammatory:

Drug used in the treatment of severe rheumatoid arthritis, because it decreases lysosomal and macrophage function

Back 99

Gold salts

[Side effects include dermatitis, hematotoxicity, and nephrotoxicity]

Front 100

Anti-Inflammatory:

Reversible inhibitors of cyclooxygenase widely used as over-the-counter pain relievers

Back 100

Ibuprofen
Naproxen
Piroxicam

[These agents share many of the same side effects as aspirin, but are more efficacious analgesics and anti-inflammatories; however, they lack aspirin's long duration and antiplatelet effects]

Front 101

Anti-Inflammatory:

High-potency NSAID used in the treatment of gout and arthritis, and closure of a patent ductus arteriosus

Back 101

Indomethacin

[Conversly, prostaglandin E (PGE) can be used to maintain a patent ductus arteriosus in congenital cyanotic heart disease]

Front 102

Anti-Inflammatory:

The only parenteral NSAID, used primarily for its analgesic (rather than anti-inflammatory) properties

Back 102

Ketorolac

[Its systemic route of delivery substantially decreases GI irritation]

Front 103

Anti-Inflammatory:

Unlike most opioid agonists, this derivative does not cause biliary spasms, and is preferred, therefore, as an analgesic for pancreatitis and cholecystitis

Back 103

Meperidine

[Causes relaxation of the sphincter of Oddi; all opioids are contraindicated in cases of head injury, because they cause increased intracranial pressure]

Front 104

Anti-Inflammatory:

Used in the prevention of headaches, this ergot derivative has no value in the treatment of acute migraine attacks

Back 104

Methylsergide

[Because this agent blocks serotonin (5-HT) receptors, it can be used in the treatment of carcinoid tumors; notable side effects include retroperitoneal and subendocardial fibroplasia]

Front 105

Anti-Inflammatory:

Uricosuric agent used in the treatment of chronic gout, and also to increase the effective concentration of weakly acidic drugs such as penicillins

Back 105

Probenecid

[Both probenecid and sulfinpyrazone compete with uric acid for reabsorption in the proximal tubules of the kidney, and also inhibit the secretion of weak acids]

Front 106

Anti-Inflammatory:

Given to Rh-negative mothers within 72 hours of giving birth to an Rh-positive child, to prevent the development of hemolytic disease of the newborn (erythroblastosis fetalis) in subsequent Rh-positive pregnancies

Back 106

RhoGAM

[Fetal Rh-positive red blood cells that enter the maternal circu;ation are opsonized by these antibodies against the Rh (D) antigen, preventing the mother from producing anti-Rh antibodies]

Front 107

Anti-Inflammatory:

Serotonin agonist used in the treatment of acute migraines and cluster headaches

Back 107

Sumatriptan

[Binds to the HT1d receptor, causing vasoconstriction of the cerebral vasculature]

Front 108

Anti-Inflammatory:

Notorious for causing teratogenic effects, such as phocomelia ("flipper limbs"); has gained attention as a potent immunosuppressant

Back 108

Thalidomide

[Used in the treatment of systemic lupus erythematosus (SLE), multiple myeloma, and leprosy, its effects are due to its ability to suppress the production of tumor necrosis factor alpha (TNF-α)]

Front 109

Blood:

Monoclonal antibody used as an anticoagulant, preventing restenosis after coronary angioplasty

Back 109

Abciximab

[Antibodies against the glycoprotein IIb/IIIa receptor on platelets, preventing platelet aggregation]

Front 110

Blood:

Used in the treatment of acute bleeding in patients with hemophilia and other coagulopathies

Back 110

Aminocaproic acid

[An orally active inhibitor of plasminogen activation, thereby inhibiting fibrinolysis; tranexamic acid is a similar agent]

Front 111

Blood:

Recombinant product used in the treatment of anemia associated with renal failure

Back 111

Erythropoietin (Epoetin Alfa)

[Also used to treat anemia associated with bone marrow transplants or toxic drug reactions]

Front 112

Blood:

Will correct the anemia, but not the neurologic deficits caused by vitamin B₁₂ deficiency

Back 112

Folic Acid

[Vitamin B₁₂ deficiency must be ruled out before treating megaloblastic anemia with folic acid]

Front 113

Blood:

Rapid-acting, intravenously administered anticoagulant, used for acute myocardial infarction and prevention of deep vein thrombosis (DVT) following prolonged immobilization

Back 113

Heparin

[Binds to and activates antithrombin III, resulting in the inactivation of thrombin and other clotting factors; unlike warfarin, it does not cross the placenta and thus may be used during pregnancy. Protamine sulfate is used to reverse the effects of heparin.]

Front 114

Blood:

Used in the management of sickle cell anemia, as well as for various myeloid neoplasms

Back 114

Hydroxyurea

[May decrease the incidence of sickle cell crisis, by increasing levels of fetal hemoglobin (HbF); it also inhibits DNA synthesis by blocking the conversion of ribonucleotides to deoxyribonucleotide]

Front 115

Blood:

Recombinantly produced granulocyte-macrophage colony-stimulating factor (GM-CSF), used in the management of patients undergoing chemotherapy

Back 115

Sargramostim

[A similar agent, G-CSF (e.g., filgrastim), is used for similar applications, but affects only granulocytes]

Front 116

Blood:

A bacterial product of Streptococcus pyogenes, used in the treatment of coronary artery thrombosis

Back 116

Streptokinase

[Complexes with and catalyzes the conversion of plasminogen to plasmin; it is a significantly cheaper, although debatably equivalent, agent to tissue plasminogen activator (tPA)]

Front 117

Blood:

Platelet antiaggregant, used for the prevention of transient ischemic attacks (TIA) in patients with aspirin sensitivity

Back 117

Ticlopidine

[Interferes with the binding of fibrin to the glycoprotein IIIb/IIIa receptor on platelets]

Front 118

Blood:

Created through the use of recombinant DNA technology, this agent is used for coronary artery thrombosis and ischemic stroke

Back 118

Tissue Plasminogen Activator (t-PA)
(Alteplase/Reteplase)

[Converts fibrin-bound plasminogen to plasmin, resulting in dissolution of thrombi]

Front 119

Blood:

Orally administered anticoagulant, used in the management and prophylaxis of venous thrombosis, myocardial infarction, and stroke

Back 119

Warfarin

[Coumadin compound that interferes with the vitamin K-dependent carboxylation of clotting factors II, VII, IX, and X]

Front 120

Blood:

Used for the treatment of traveler's diarrhea

Back 120

Bismuth Subsalicylate

[Helps decrease fluid secretion by the bowel; also used with metronidazole and tetracycline for the treatment of Helicobacter pylori-associated peptic ulcer disease]

Front 121

Gastrointestinal:

Chronic indigestion of this antacid with milk can induce milk-alkali syndrome

Back 121

Calcium Carbonate

[Can result in hypercalcemic alkalosis with the development of renal calculi]

Front 122

Gastrointestinal:

Used in the treatment of gastroesophageal reflux disease (GERD), this histamine blocker is associated with gynecomastia and galactorrhea

Back 122

Cimetidine

[The stronger the H2 blockers, ranitidine and famotidine, do not inhibit the hepatic P450 system and, therefore, do not cause antiandrogenic effects]

Front 123

Gastrointestinal:

Prokinetic agent used in the treatment of upper gastrointestinal dysfunction, such as gastroesophageal reflux disease (GERD) or gastroparesis with delayed gastric emptying

Back 123

Cisapride

[Stimulates peristalsis by promoting the release of acetylcholine from postganglionic nerves of the myenteric plexus. High doses have been associated with long QT syndrome.]

Front 124

Gastrointestinal:

Opioid derivatives used in the treatment of diarrhea, because they suppress gastrointestinal motility

Back 124

Diphenoxylate
Loperamide

[Whereas diphenoxylate is formulated with antimuscarinic alkaloids; both preparations have minimal abuse potential]

Front 125

Gastrointestinal:

This preparation is used to treat emesis and nausea associated with chemotherapy, and contains the active ingredient in marijuana

Back 125

Dronabinol

[This schedule III drug, which contains tetrahydrocannabinol (THC), is a controlled substance with approved medical use and moderate potential for dependence]

Front 126

Gastrointestinal:

Commonly used proemetic agent used in cases of ingestion of caustic substances or mineral oils

Back 126

Ipecac Syrup

[Orally administered substance that acts directly on the chemoreceptor trigger zone in the medulla]

Front 127

Gastrointestinal:

Among the most popular antacids used in the United States, neither is absorbed and, therefore, neither causes systemic effects

Back 127

Magnesium Hydroxide
Aluminum Hydroxide

[Magnesium hydroxide also has a strong laxative effect, whereas aluminum hydroxide causes constipation]

Front 128

Gastrointestinal:

This prokinetic agent is used to prevent emesis (e.g., post-anesthesia or due to cancer chemotherapy), because it blocks D2 receptors in the area prostrema that trigger vomiting

Back 128

Metoclopramide

[Functions to facilitate acetylcholine, while antagonizing the action of dopamine on the enteric nervous system. Side effects include sedation, diarrhea, and extrapyramidal symptoms.]

Front 129

Gastrointestinal:

Eicosanoid preparation used to prevent peptic ulcers in patients taking high doses of NSAIDs for conditions such as rheumatoid arthritis

Back 129

Misoprostol

[This prostaglandin E (PGE) analog decreases gastric acid production and increases mucus production, protecting the lining of the stomach]

Front 130

Gastrointestinal:

Proton pump inhibitor used in the treatment of gastroesophageal reflux disease (GERD), gastric and duodenal ulcers, Helicobacter pylori gastritis, and Zollinger-Ellison syndrome (gastrinoma)

Back 130

Omeprazole

[Irreversibly inhibits the H⁺/K⁺ ATPase on the luminal side of parietal cells]

Front 131

Gastrointestinal:

Central-acting antiemetic used to control postoperative vomiting and vomiting in chemotherapy patients

Back 131

Ondansetron

[5-HT3 inhibitor that functions at the chemoreceptive area of the area postrema]

Front 132

Gastrointestinal:

Used in the treatment of peptic ulcers, because it polymerizes and selectively coats necrotic ulcerated tissue

Back 132

Sucralfate

[Requires an acidic environment to polymerize, and therefore, cannot be used in the presence of antacids or H2 blockers]

Front 133

Respiratory:

β-adrenergic antagonists used in the treatment of hypertension for patients with asthma or chronic obstructive pulmonary disease (COPD), and smokers

Back 133

Acebutolol
Atenolol
Metoprolol

[Selective β₁ blockers that decrease blood pressure, with no bronchoconstriction at low doses]

Front 134

Respiratory:

Prototypic adrenergic agonist, available as an inhaler, used for the management of bronchospasm in asthmatics

Back 134

Albuterol

[Other selective β₂ agonists include metaproterenol, terbutaline, and salmeterol]

Front 135

Respiratory:

Synthetic glucocorticoid that readily penetrates the airway mucosa; used in the management of asthma

Back 135

Beclomethasone

[Beclomethasone and a related agent, budesonide, have very short half-lives in the bloodstream, and therefore cause less systemic effects than other glucocorticoids]

Front 136

Respiratory:

Stabilizes mast cell and basophil membranes, preventing the release of histamine in asthmatics

Back 136

Cromolyn Sodium

[Used for prophylaxis only, not for the treatment of acute asthma attacks]

Front 137

Respiratory:

Opioid agonist available in many over-the-counter cough syrups

Back 137

Dextromethorphan

[Antitussive agent that depresses the cough center in the medulla; unlike dextromethorphan, codeine provides analgesia and has a higher abuse potential]

Front 138

Respiratory:

Antihistaminics used for the treatment of allergic conditions (e.g., hay fever, urticaria, atopy), as well as for the treatment of motion sickness

Back 138

Diphenhydramine
Chlorpheniramine

[Inhibit the binding of histamine to H1 receptors; such as older agents have anticholinergic effects, contributing to sedative side effects]

Front 139

Respiratory:

Nonsedating antihistaminics used for the treatment of allergy

Back 139

Fexofenadine
Loratadine

[These second-generation antihistaminics do not readily enter the CNS, preventing sedation]

Front 140

Respiratory:

Aerosolized antimuscarinic agent, used in the treatment of chronic obstructive pulmonary disease (COPD) and asthma

Back 140

Ipratropium

[Not as effective as β₂ agonists; dry mouth is a major side effect]

Front 141

Respiratory:

Long-acting β₂ agonist used for prophylaxis of asthma

Back 141

Salmeterol

[This agent works for 12 hours or more; it may cause tremors and arrhythmias]

Front 142

Respiratory:

A methylxanthine used in the treatment of asthma for its bronchodilatory effects

Back 142

Theophylline

[Inhibits phosphodiesterase, thereby inhibiting the degradation of cAMP to AMP; other methylxanthines include caffeine and theobromine found in cocoa]

Front 143

Respiratory:

Used in the treatment of asthma, selectively inhibiting leukotriene synthesis

Back 143

Zileutin

[Leukotrienes can also be inhibited by the LTD4 and LTE4 antagonists zafirlukast and montelukast]

Front 144

Endocrine:

Oral hypoglycemic agent that functions within the intestinal lumen, decreasing postprandial hyperglycemia, although there are no effects on fasting sugar

Back 144

Acarbose

[Inhibits α-galactosidase, an enzyme required for rapid absorption of most dietary sugars]

Front 145

Endocrine:

These compounds reduce bone resorption and formation, and are used in the treatment of osteoporosis (postmenopausal, senile, or glucocorticoid-induced) and Paget's disease

Back 145

Bisphosphonates
(Alendronate/Etidronate/Pamidronate/Risedronate)

[Characterized by poor oral availability and cannot be taken with food; may cause esophageal ulcerations, so must be taken with large amounts of water, and the patient must remain upright for at least 30 minutes afterward]

Front 146

Endocrine:

Used in the treatment of hyperprolactinemia e.g., due to a pituitary adenoma

Back 146

Bromocriptine

[Ergot alkaloid with dopaminergic activity, inhibiting the release of prolactin]

Front 147

Endocrine:

Used for the treatment of osteoporosis, this hormone produced by the thyroid decreases bone breakdown, and decreases serum calcium and phosphate levels

Back 147

Calcitonin

[Also used in the treatment of acute hypercalcemia and Paget's disease; salmon calcitonin is used because it is more potent and has a longer half-life; it is administered intranasally or by injection]

Front 148

Endocrine:

Fertility drug used to induce ovulation in annovulatory women, although its use may be associated with multiple births

Back 148

Clomiphene

[Blocks negative feedback to the pituitary, increasing the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to stimulate ovulation]

Front 149

Endocrine:

A synthetic analog adrenocorticotropin (ACTH) used to diagnose patients with abnormalities of cortisol production, e.g., Addison's disease

Back 149

Cosyntropin

[Proteolytic cleavage of preproopiomelanocortin (POMC) forms ACTH and melaocyte-stimulating hormone (MSH), as well as beta-endorphin and metenkephalin]

Front 150

Endocrine:

Used in the treatment of endometriosis and fibrocystic disease of the breast

Back 150

Danazol

[Inhibits several P450 enzymes involved in gonadal steroid synthesis]

Front 151

Endocrine:

An antidiuretic hormone (ADH) receptor agonist used for the treatment of pituitary diabetes insipidus

Back 151

Desmopressin
Vasopressin

[Desmopressin is a V2-selective agonist that facilitates water reabsorption from the collecting tubules. Vasopressin is both a V1 and V2 agonist; its V1 activity increases vascular smooth muscle tone, and therefore is used in the treatment of esophageal varices.]

Front 152

Endocrine:

Use of this estrogen compound by pregnant women has been associated with the development of clear cell adenocarcinoma of the vagina of their daughters

Back 152

Diethylstilbestrol (DES)

[May be used as postcoital ("morning after") birth control, and for the treatment of testicular tumors

Front 153

Endocrine:

Synthetic estrogen with high oral availability, used in contraceptive pills as well as in hormone replacement therapy (HRT)

Back 153

Ethinyl Estradiol Mestranol

[Increasingly controversial, HRT has been shown to decrease the risk of coronary artery disease, to slow the progression of osteoporosis, and to ameliorate hot flashes in postmenopausal women; it does, however, carry a risk of breast and ovarian cancer]

Front 154

Endocrine:

Antiandrogenic compound used in the treatment of benign prostatic hyperplasia and alopecia

Back 154

Finasteride

[Inhibits 5α-reductase, and thus the conversion of testosterone to dihydrotestosterone (DHT]

Front 155

Endocrine:

Used for mineralocorticoid deficiency, this agent has a long duration of action, and is a naturally occuring precursor to aldosterone

Back 155

Fludrocortisone

[Used in conjunction with glucocorticoids in postadenalectomy therapy]

Front 156

Endocrine:

This ultra-rapid-acting human insulin is administered immediately before meals

Back 156

Insulin Lispro

[An altered form of insulin that enters the circulation more rapidly than crystalline zinc (regular) insulin]

Front 157

Endocrine:

A synthetic thyroid hormone used in the treatment of hypothyroidism, as seen in Hashimoto's thyroiditis, myxedema, and patients on lithium

Back 157

Levothyroxine (T4)

[T4 is converted in the periphery to T3, the active form of thyroid hormone. Liothyronine, synthetic T3, is faster-acting, but more expensive and, therefore is used less frequently.]

Front 158

Endocrine:

Oral hypoglycemic agent that does not require functional pancreatic islet cells and decreases postprandial glucose levels without resultant hypoglycemia or weight gain

Back 158

Metformin

[Biguanide compound that functions by increasing peripheral glycolysis, and therefore hepatic gluconeogenesis, resulting in a decrease in serum glucose levels]

Front 159

Endocrine:

Abortifacient steroid receptor antagonist known as the "morning after" pill

Back 159

Mifepristone (RU486)

[Blocks the binding of progesterone to cytoplasmic receptors, preventing successful implantation]

Front 160

Endocrine:

Synthetic progesterone analog used in oral contraceptives and implantable contraceptive devices

Back 160

Norgestrel

[Norgestrel and similar agents, such as norethindrone and medroxyprogesterone, may be used in hormone replacement therapy, and to prevent abnormal uterine bleeding]

Front 161

Endocrine:

A synthetic analog of somatostatin, used in the treatment of many endocrine tumors, including carcinoid, gastrinoma, and somatropic pituitary ademoma

Back 161

Octreotide

[This octapeptide is used instead of somatostatin, because it has a longer half-life]

Front 162

Endocrine:

Normally produced in the posterior pituitary, this hormone is used to stimulate and reinforce labor, as well as stimulate milk ejection from nursing mothers

Back 162

Oxytocin

[Stimulates contraction of uterine smooth muscle for labor; stimulates contraction of the myoepithelial cells of the mammary glands to eject milk]

Front 163

Endocrine:

Oral agent used in the treatment of hyperthyroidism

Back 163

Propylthiouracil

[Inhibits the iodination and coupling reactions in thyroid hormone synthesis. Methimazole also is used, although it can cross the placenta and enter breast milk.]

Front 164

Endocrine:

This estrogen partial agonist is used to prevent osteoporosis in postmenopausal women

Back 164

Raloxifene

[It also increases serum high-density lipoprotein (HDL), protecting against atherosclerosis and heart disease; unlike another selective estrogen receptor modulator (SERM), tamoxifen, it does not increase the risk of endometrial carcinoma]

Front 165

Endocrine:

This insulin secretagogue has a rapid onset, but shorter duration of action, than sulfonylureas

Back 165

Repaglinide

[Belongs to a class of drugs known as meglitinides, which facilitate insulin release from pancreatic β cells by binding to potassium channels]

Front 166

Endocrine:

These agents increase cell sensitivity to insulin, by stimulating the peroxisomal proliferator gamma (PPARγ) nuclear receptor

Back 166

Rosiglitazone
Pioglitazone

[PPARγ regulates a number of genes involved in carbohydrate metabolism, The first member of this class, troglitazone, was removed from the market because it caused hepatotoxicity]

Front 167

Endocrine:

Oral hypoglycemic agents used to stimulate the release of endogenous insulin from β cells

Back 167

Sulfonylureas
(Glyburide/Glipizide)

[Stimulate the closure of potassium channels, resulting in depolarization of β cells and the release of preformed insulin in vesicles]

Front 168

Endocrine:

This form of insulin is given in the morning and in the evening, to maintain basal levels of insulin for 12 to 24 hours

Back 168

Ultralente Insulin

[Supplemented throughout the day with Insulin Lispro; a modified version of human insulin, insuline glargine, has an even longer duration of action]

Front 169

Antimicrobials:

Oral, topical, and intravenous preparations are available for this drug, used to reduce symtomatology of herpes simplex virus (HSV) infection, although it does not inhibit the reactivation of herpes

Back 169

Acyclovir

[This guanosine analog is activated by the thymidine kinase of herpes viruses (including herpes simplex, varicella zoster, and Epstein-Barr) and functions as a chain terminator when incorporated into viral DNA during replication]

Front 170

Antimicrobials:

Used for the prophylaxis of influenza A and rubella viral infection if given within 48 hours of exposure; also used in the treatment of Parkinson's disease

Back 170

Amantadine

[A similar drug, rimantadine, has several antiviral effects with a longer half-life; both drugs inhibit the fusion of viral particles within an endosome in a cell. Amantadine is not effective against influenza B, which lacks the M2 protein to which amantadine binds.]

Front 171

Antimicrobials:

Ineffective against anaerobes, due to the requirement for oxygen to be taken up by the organism

Back 171

Aminoglycosides
(Gentamicin/Streptomycin/Tobramycin/Amikacin/Neomycin)

[Bactericidal inhibitors of mRNA translation at the 30S ribosome; these agents are associated with significant nephrotoxicity and ototoxicity]

Front 172

Antimicrobials:

Polyene antifungal agent used for the treatment of systemic mycosis and intrathecally for the treatment of fungal meningitis

Back 172

Amphotericin B

[This drug disrupts fungal membranes by binding to ergosterol, which induces pore formation. Side effects include chills, fever, hypotension, and dose-limiting nephrotoxicity, all of which are less severe when using liposomal formulations.]

Front 173

Antimicrobials:

This extended-spectrum penicillin is used to treat infections with gram-negative organisms such as Haemophilus spp., E. coli, Listeria spp., Proteus spp., and Salmonella spp.

Back 173

Ampicillin

[Often administered with penicillinase inhibitors; a similar drug, amoxiciliin, often is preferred because of its greater oral bioavailability and decreased gastrointestinal irritability]

Front 174

Antimicrobials:

Although it works similarly to penicillins and cephalosporins, this monobactam is resistant to β-lactamases, and displays no cross-allergenicity with penicillins

Back 174

Aztreonam

[Although it is ineffective against gram-positive or anaerobic bacteria, it works synergistically with aminoglycosides against gram-negative rods

Front 175

Antimicrobials:

Inhibitor of bacterial cell wall synthesis, this agent is available as a topical preparation in many over-the-counter antibacterial ointments

Back 175

Bacitracin

[This peptide antibiotic inhibits cell wall synthesis in gram-positive organisms; causes severe nephrotoxicity if used systemically]

Front 176

Antimicrobials:

These extended-spectrum penicillins are particularly useful against infection with Pseudomonas and Enterobacter spp.

Back 176

Carbenicillin
Piperacillin
Ticarcillin

[These agents can be used with penicillinase inhibitors and work synergistically with aminoglycosides]

Front 177

Antimicrobials:

Used for the treatment of septic meningitis, because this cephalosporin has good penetration into the central nervous system

Back 177

Ceftriaxone

[It demonstrates coverage against the leading causes of bacterial meningitis, including Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae; other third-generation cephalosporins such as cefixime, also are the drug of choice for treatment of Neisseria gonorrhoeae infection]

Front 178

Antimicrobials:

Causes cyanosis and cardiovascular collapse in premature neonates deficient in hepatic gluconosyltransferase (gray baby syndrome)

Back 178

Chloramphenicol

[A bacteriostatic inhibitor of protein synthesis, blocking peptidyl transferase activity at the 50S ribosome]

Front 179

Antimicrobials:

Associated with myelosuppression, and rarely, an idiosyncratic, irreversible aplastic anemia

Back 179

Chloramphenicol

[Because of its inhibition of red blood cell maturation, it is rarely used systemically; it is available as a topical preparation]

Front 180

Antimicrobials:

Primary drug used for acute attacks and prophylaxis of malarial infection, although resistance is common

Back 180

Chloroquine

[This drug kills parasites within erythrocytes [schizonticidal]; it disrupts hemoglobin breakdown, with the accumulation of heme, which is toxic to the organism]

Front 181

Antimicrobials:

Administered with penicillins to enhance their antimicrobial effects

Back 181

Clavulanic Acid
Sulbactam
Tazobactam

[Inhibit β-lactamases, resulting in increased microbial coverage]

Front 182

Antimicrobials:

Antibiotic associated with the development of pseudomembranous colitis, due to overgrowth of Clostridium difficile

Back 182

Clindamycin

[A bacteriostatic inhibitor of protein synthesis, methylating the 50S ribosomal subunit, used in the treatment of serious anaerobic infections due to Bacteroides spp.]

Front 183

Antimicrobials:

Used in combined regimens for the treatment of HIV infection, this drug is associated with a dose-limiting pancreatitis

Back 183

Didanosine (ddl)

[Other nucleoside reverse transcriptase inhibitors (NRTI) include zidovudine (ZDT), zalcitabine (ddC), lamivudine (3TC), and stavudine (d4T); lamivudine is unique in that it also inhibits the reverse transcriptase of hepatitis B virus]

Front 184

Antimicrobials:

Side effects of this widely used antibiotic include gastrointestinal irritation and a hypersensitivity-based acute cholestatic hepatitis

Back 184

Erythromycin

[Bacteriostatic inhibitor of protein synthesis, functioning on the 50S ribosome; erythromycin and the other macrolides, azithromycin and clarithromycin, show good coverage against Mycoplasma, Corynebacterium, Chlamydia, Legionella, and Bordetella spp.]

Front 185

Antimicrobials:

Can cause tendon damage in adults, and is contraindicated in children and pregnant women because of damage to developing cartilage

Back 185

Fluoroquinolones
(Ciprofloxacin/Norfloxacin)

[Bactericidal inhibitor of DNA gyrase, used for gram-negative rods, Neisseria spp., and some gram-positive organisims]

Front 186

Antimicrobials:

Imidazole antifungal used for the treatment of fungal meningitis, because it can cross the blood-brain barrier

Back 186

Fluconazole

[The drug inhibits the formation of ergosterol, and lacks the antiendocrine effects seen with ketoconazole. It is also used for prophylaxis against Cryptococcus neoformans, and it is effective in the treatment of esophageal and oropharyngeal candidiasis.]

Front 187

Antimicrobials:

Back-up drug used for the treatment of cytomegalovirus infection in immunocompromised patients, when resistance to ganciclovir develops

Back 187

Foscarnet

[The drug does not require phosphorylation by viral kinases and inhibits viral DNA polymerase at a different site than ganciclovir; it also is not metabolized by viral transferases, which render ganciclovir ineffective.]

Front 188

Antimicrobials:

Used for the treatment of retinitis and other infections associated with cytomegalovirus (CMV)

Back 188

Ganciclovir

[Guanosine analog converted by CMV to a triphosphorylated form which inhibits the viral polymerase; given IV, it has good penetration to the eye and CNS, but causes neutropenia, leukopenia, and thrombocytopenia]

Front 189

Antimicrobials:

Given orally, this antifungal accumulates in keratinized tissue and is effective against dermatophyte infections, such as ringworm (tinea)

Back 189

Griseofulvin

[The drug binds to tubulin, inferfering with microtubule function, thus inhibiting mitosis]

Front 190

Antimicrobials:

Broad-spectrum β-lactamase-resistant carbapenem, administered in conjunction with cilastatin

Back 190

Imipenem

[Used against gram-positive cocci, gram-negative rods, and anaerobes. It is metabolized by renal dihydropeptidase, which is blocked by the coadministration of cilastatin.]

Front 191

Antimicrobials:

Protease inhibitors used in combined treatment regimens for HIV infection

Back 191

Indinavir
Ritonavir
Saquinavir
Nelfinavir

[These agents inhibit the protease encoded by HIV pol gene and required for the production of infectious virions; these compounds are metabolized by the cytochrome P450 system]

Front 192

Antimicrobials:

This agent is recommended for the prophylaxis of tuberculosis in skin test converters and in people who have close contact with patients with active disease. It is also the primary drug in most multidrug regimens for the treatment of active tuberculosis.

Back 192

Isoniazid (INH)

[Inhibits the synthesis of mycolic acid in the mycobacterial cell wall; because it is acetylated by the liver, side effects include peripheral neuritis in slow acetylators and hepatitis in fast acetylators. Due to the emergence of multidrug- resistant strains of Mycobacterium tuberculosis, multidrug regimens also include ethambutol, pyrazinamide, rifampin, and streptomycin.]

Front 193

Antimicrobials:

Antihelminthic agent used for the treatment of river blindness (caused by Onchocerca volvulus) and threadworm infection (Strongyloides stercoralis)

Back 193

Ivermectin

[Increases GABA-mediated neurotransmission, but since it does not cross the human blood-brain barrier, it selectively affects the nematode, resulting in paralysis of the worm]

Front 194

Antimicrobials:

Used for the treatment of mycotic infections, these agents inhibit hormone production and result in gynecomastia

Back 194

Azoles
(Ketoconazole/Itraconazole/Fluconazole)

[These drugs interfere with fungal cell wall synthesis by inhibiting the 14α-demethylation of lanosterol; the demethylation is catalyzed by the cytochrome P450 system]

Front 195

Antimicrobials:

Used for the treament of many helminth infections, it is the drug of choice for pinworms, the most common helminth infection in the United States

Back 195

Mebendazole

[Functions by inhibiting microtubule synthesis and glucose uptake in helminths; related drugs such as albendazole and thiabendazole are alternatives]

Front 196

Antimicrobials:

Narrow-spectrum, penicillinase-resistant β-lactam antibiotics, used to treat penicillin-resistant Staphylococcus aureus

Back 196

Methicillin
Nafcillin
Dicloxacillin

[Bulkier R-groups on the penicillin backbone prevent degradation by penicillinases]

Front 197

Antimicrobials:

Antiprotozoal agent used in the treatment of amebiasis, trichomoniasis, and giardiasis, as well as for pseudomembranous colitis

Back 197

Metronidazole

[Undergoes activation by anaerobes and parasites to create products that interfere with nucleic acid synthesis, resulting in cytotoxicity]

Front 198

Antimicrobials:

Aminoglycoside given orally for prophylaxis in bowel surgery, and also used to treat hepatic encephalopathy

Back 198

Neomycin

[This drug prevents the growth of GI flora and the accumulation of nitrogenous microbial metabolites, which contribute to the development of hepatic encephalopathy; too toxic to be administered IV, but often used topically in over-the-counter antibiotic ointments]

Front 199

Antimicrobials:

Nonnucleoside reverse-transcriptase inhibitors (NNRTIs) used in the management of HIV infection

Back 199

Nevirapine
Delavirdine
Efavirenz

[Because these drugs bind to a unique site on reverse transcriptase, there is no cross-resistance with the nucleoside reverse-transcriptase (NRTIs); the NNRTIs are all metabolized by the P450 system]

Front 200

Antimicrobials:

Trypanosomicidal drug used for the treatment of Chagas disease

Back 200

Nifurtimox

[Drugs used to treat African trypanosomiasis include pentamidine, suramin, and melarsoprol]

Front 201

Antimicrobials:

Urinary antiseptic that requires acidification and therefore is ineffective systemically, although toxic levels can accumulate with renal failure

Back 201

Nitrofurantoin

[Can cause GI side effects, rash, hemolysis in glucose-6-phosphate dehydrogenase deficiency patients]

Front 202

Antimicrobials:

"Swish and swallow" treatment for oral candidiasis, or topically for the treatment of diaper rash

Back 202

Nystatin

[Disrupts fungal membrane permeability by binding to ergosterol]

Front 203

Antimicrobials:

Orally active antiviral drug used to decrease the duration and symptoms of influenze A infection

Back 203

Oseltamivir

[Zanamivir is a similar drug, but it is administered intranasally; both drugs function as neuroaminidase inhibitors, preventing the spread of virus from cell to cell]

Front 204

Antimicrobials:

This group of bactericidal antibiotics inhibits the transpeptidation step during cell wall synthesis, resulting in the activation of autolytic enzymes, which destroy the bacteria

Back 204

Penicillins

[The mechanism of cephalosporins is nearly identical; major side effects include hypersensitivity and urticaria, and rarely, anaphylaxis leading to life-threatening asphyxiation]

Front 205

Antimicrobials:

This antibiotic disrupts bacterial membranes and is often too toxic to be administered systemically, although it is safe topically

Back 205

Polymyxin B

[This agent acts as a cationic detergent that disrupts the membrane; systemic use causes neurotoxicity and acute tubular necrosis]

Front 206

Antimicrobials:

Primary drug used for the treatment of trematode (fluke) and cestode (tapeworm) infections

Back 206

Praziquantel

[Increases calcium permeability in the worm resulting in paralysis; niclosamide, which functions by uncoupling oxidative phosphorylation (inhibiting ATP production) or by activating ATPases, often is used with praziquantel in cestode infections]

Front 207

Antimicrobials:

Antihelmenthic agent, often used with mebendazole for the treatment of roundworm, pinworm, and hookworm infections

Back 207

Pyrantel Pamoate

[Stimulates nicotinic receptors in the nematode, resulting in a spastic paralysis]

Front 208

Antimicrobials:

Used for the treatment of chloroquine-resistant malarial infection due to Plasmodium falciparum

Back 208

Quinine

[Blocks DNA replication and RNA transcription in P. falciparum within erythrocytes; a common side effect is cinchonism, a constellation of symptoms including headache, vertigo, blurred vision, and tinnitus; a related drug, mefloquine, has fewer side effects and is used as prophylaxis in chloroquine-resistant areas]

Front 209

Antimicrobials:

Administered as an aerosol, this drug is used for the treatment of respiratory syncytial virus (RSV) infection

Back 209

Ribavirin

[Guanosine analog that inhibits formation, the capping of viral mRNA, and viral RNA-dependent RNA polymerase activity; also used for the management of viral hemorrhagic fevers and hepatitis C infection]

Front 210

Antimicrobials:

Rarely used alone, except for the treatment of the meningococcal carrier state, this drug imparts a red-orange color to secretions

Back 210

Rifampin

[Inhibits DNA-dependent RNA polymerase; often used in a combined drug regimen for Mycobacterium tuberculosis because of rapid resistance if used alone]

Front 211

Antimicrobials:

This class of antibiotics that inhibits protein synthesis and is effective in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE)

Back 211

Streptogramins

[Synercid is a mixture of quinupristin and dalfopristin; use has been associated with arthralgias and myalgias, as well as inhibition of P450 enzymes]

Front 212

Antimicrobials:

Contraindicated in pregnant women and children, because it causes bone dysplasia and defects in dental enamel

Back 212

Tetracycline

[Broad-spectrum bacteriostatic drug that inhibits the 30S ribosome and thus protein synthesis; provides good coverage against Mycoplasma, Chlamydia, Rickettsia, and Vibrio spp.]

Front 213

Antimicrobials:

These two drugs create a block in successive reactions for folate synthesis; also often used to treat urinary tract infections

Back 213

Trimethoprim and Sulfamethoxazole

[Trimethoprim blocks bacterial dihydrofolate reductase and can cause megaloblastic anemia; sulfamethoxazole blocks dihydropteroate synthase and can cause hypersensitivity reactions and hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD or G6PDH) deficiency]

Front 214

Antimicrobials:

Rapid IV infusion is associated with diffuse flushing ("red man" syndrome)

Back 214

Vancomycin

[Used for the treatment of methicillin-resistant Staphylococcus aureus (MRSA), and pseudomembranous colitis due to Clostridium difficile; side effects can be limited by infusion over a prolonged period and coadministration of antihistamines]

Front 215

Antimicrobials:

Commonly used as part of highly active anti-viral therapy (HAART), this HIV drug is used for prophylaxis of needlestick transmission and of transmission to neonated from infected mothers during birth

Back 215

Zidovudine (ZDV)

[Formerly known as AZT, phosphorylation of this agent by host cell enzymes results in inhibiting viral reverse transcriptase, as well as functioning as a chain terminator.
AZT slows HIV spread significantly, but does not stop it entirely. This allows HIV to become AZT resistant over time, and for this reason AZT is usually used in conjunction with other nucleoside reverse transcriptase inhibitors (NRTIs) and anti-viral drugs. In this form, AZT is used as an ingredient in Combivir and Trizivir, among others.]

Front 216

Cancer:

Inhibits the enzyme aromatase and is used for the treatment of estrogen-dependent breast cancer

Back 216

Anastrozole

[An inhibitor of steroid synthesis, it inhibits the conversion of androstenedione to estrone. Aminoglutethimide is a similar drug that inhibits the conversion of cholesterol to pregnenolone, and is used for the same types of cancers]

Front 217

Cancer:

This antineoplastic agent is used for the treatment of testicular carcinoma and squamous cell carcinoma; it can cause life-threatening pulmonary fibrosis

Back 217

Bleomycin

[The drug is a mixture of glycoproteins that results in the production of free radicals after binding to DNA, creating single-and double-stranded breaks. This G2 phase inhibitor is a part of the ABVD regimen (adriamycin, bleomycin, vinblastine, and dacarbazine) for Hodgkin's disease]

Front 218

Cancer:

Highly lipophilic nitrosureas that readily cross the blood-brain barrier and are used for the treatment of many brain tumors

Back 218

Carmustine (BCNU)
Lomustine (CCNU)

[These alkylating agents result in DNA cross-linking and strand breaks]

Front 219

Cancer:

Platinum-containing compound used in the treatment of testicular and lung cancers

Back 219

Cisplatin

[Acts as an alkylating agent and causes nephrotoxicity and acoustic nerve damage; a similar agent, carboplatin, has less nephrotoxicity and neurotoxicity, but greater myelosuppression]

Front 220

Cancer:

Alkylating agent used for the treatment of non-Hodgkin's lymphoma and breast and ovarian carcinomas

Back 220

Cyclophosphamide

[The major side effect, hemorrhagic cystitis, may be decreased by vigorous hydration and the use of mesna]

Front 221

Cancer:

Part of the AVDB regimen, an antibiotic-type compound used in the treatment of myelomas, sarcomas, and lymphomas

Back 221

Doxorubicin (Adriamycin)

[Intercalates in DNA to decrease replication and transcription; this drug is associated with significant cardiotoxicity and dilated cardiomyopathy. Daunorubicin is a similar drug and is used primarily for the treatment of acute myelogenous leukemia (AML) and acute lymphocytic leukemia (ALL).]

Front 222

Cancer:

Inhibitor of topoisomerase II used for the treatment of small cell carcinoma of the lung and prostate, and testicular cancers

Back 222

Etoposide

[G2 phase-specific inhibition, resulting in double-stranded DNA breaks and degradation]

Front 223

Cancer:

Inhibits thymidylate synthase, resulting in thymineless death, and is used for the treatment of colon cancer and superficial tumors, such as basal cell carcinoma

Back 223

Fluorouracil (5-U)

[This S-phase antimetabolite causes myelosuppression]

Front 224

Cancer:

Androgen receptor antagonist, used for the treatment of carcinoma of the prostate

Back 224

Flutamide

[Used to antagonize residual androgens after orchiectomy; side effects include gynecomastia and libido changes]

Front 225

Cancer:

Recombinantly produced cytokine, used for the hairy cell leukemia

Back 225

Interferon Alpha

[Also used for the treatment of chronic myelogenous leukemia (CML), malignant melanoma, and Kaposi's sarcoma; it normally is produced by virally infected cells to prevent infection of adjacent cells]

Front 226

Cancer:

Gonadotropin-releasing hormone (GnRH) agonists, used for the treatment of metastatic carcinoma of the prostate

Back 226

Leuprolide
Goserelin
Nafarelin

[May be used for the treatment of endometriosis, benign prostatic hyperplasia, and precocious puberty; if administered in a pulsatile manner, they stimulate the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), and can thus be used in the management of infertility]

Front 227

Cancer:

Purine metabilites, used for the treatment of leukemias and lymphomas

Back 227

Mercaptopurine (6-MP)
Thioguanine (6-TG)

[Requires activation by hypoxanthine-guanine phosphoribosyltransferase (HGPRT), and inhibits many enzymes involved in purine metabolism]

Front 228

Cancer:

Folic acid analog, used for the treatment of leukemias, non-Hodgkin's lymphoma, rheumatoid arthritis, and therapeutic abortions

Back 228

Methotrexate

[S phase inhibitor of dihydrofolate reductase, leading to decreased DNA and protein synthesis; the accompanying myelosuppression can be treated with leucovorin]

Front 229

Cancer:

Microtubule stabilizing agent, used for the treatment of lung, ovarian, breast cancer, head and neck cancer, and advanced forms of Kaposi's sarcoma

Back 229

Paclitaxel

[Derived from the yew tree, this M phase agent prevents the mitotic spindle from breaking down and thus inhibits completion of anaphase]

Front 230

Cancer:

Glucocorticoid used for the treatment of leukemias and lymphomas, as well as for rheumatoid arthritis and asthma

Back 230

Prednisone

[Triggers apoptosis and can lead to hypercortisolism with Cushing-like symptoms. Drug must be tapered gradually to prevent life-threatening adrenal insufficiency.]

Front 231

Cancer:

Monoclonal antibody used for the treatment of low-grade non-Hodgkin's lymphoma

Back 231

Rituximab

[Binds to the CD20 antigen on B cells; adverse reactions are associated with infusion, and include fever, chills, headache, and nausea]

Front 232

Cancer:

Primary agent used in the treatment of estrogen receptor-positive breast cancer

Back 232

Tamoxifen

[An estrogen receptor partial agonist, which may increase the risk of endometrial carcinoma]

Front 233

Cancer:

Monoclonal antibody used for the treatment of metastatic breast cancer

Back 233

Trastuzumab

[Binds to the receptor tyrosine kinase Erb-B2 (HER-2), overexpressed on some breast cancers)

Front 234

Cancer:

Vinca alkaloid used as part of the MOPP regimen for lymphomas, Wilms tumor, and choriocarcinomas

Back 234

Vincristine (Oncovin)

[M phase inhibitor that blocks microtubule polymerization and spindle formation; a similar agent, vinblastine, is part of the ABVD regimen. The ABVD regimen includes the combined used of adriamycin, bleomycin, vinblastine, and dacarbazine whereas the MOPP regimen includes the use of mechlorethamine, Oncovin (vincristine), procarbazine, and prednizone.]

Front 235

Toxicology:

Used to treat the ingestion of suicidal doses of acetaminophen

Back 235

N-Acetylcysteine

[Given early, it may protect from the development of fulminant hepatic failure]

Front 236

Toxicology:

Antispasmodic used for the treatment of malignant hyperthermia and neurologic malignant syndrome

Back 236

Dantrolene

[Decreases the release of calcium from the sarcoplasmic reticulum]

Front 237

Toxicology:

Used for the treatment of acute iron toxicity

Back 237

Deferoxamine

[Rapid infusion has been associated with hypotensive shock]

Front 238

Toxicology:

Fab fragment antibody used for the treatment of digitalis toxicity

Back 238

Digibind

[Treatment also includes the correction of Mg⁺2 and K⁺, as well as lidocaine for induced arrhythmias]

Front 239

Toxicology:

Agent used to treat heavy metal poisoning due to lead, arsenic, and mercury

Back 239

Dimercaprol

[Given parenterally, it chelates metals, preventing them from damaging proteins; succimer is an orally available derivative used for similar applications]

Front 240

Toxicology:

Ingestion, industrial inhalation, or absorption through the skin causes metabolic acidosis and the precipitation of damaging oxalate crystals in the kidney

Back 240

Ethylene Glycol

[A major component of antifreeze, toxicity is managed by the administration of ethanol]

Front 241

Toxicology:

Used in the event of benzodiazepine overdose

Back 241

Flumazenil

[This benzodiazepine derivative antagonizes the actions of benzodiazepines and zolpidem, although it does not block the actions of barbiturates]

Front 242

Toxicology:

Intoxicant that can cause retinal damage and blindness along with metabolic acidosis and coma

Back 242

Methanol

[Damage is due to the conversion to formaldehyde by the liver; the treatment includes ethanol, which competes for alcohol dehydrogenase]

Front 243

Toxicology:

Used to treat the symptoms of opioid overdose

Back 243

Naltrexone
Naloxone

[Pure antagonists, primarily of mu opioid receptors]

Front 244

Toxicology:

Anticholinesterases used as insecticides and as possible agents of chemical warfare, inducing motor paralysis, respiratory depression, and convulsions

Back 244

Organophosphates
(Isoflurophate/Echothiophate/Parathion)

[Antidote includes the use of atropine and acetylcholinesterase regenerators, such as pralidoxime]

Front 245

Toxicology:

Derivative of penicillin with the ability to chelate copper ions, used for the treatment of copper toxicity

Back 245

Penicillamine

[Also used for the treatment of Wilson's disease, and an adjunct therapy for rheumatoid arthritis]

Front 246

Shared Effects:

Drugs that cause significant ototoxicity and nephrotoxicity

Back 246

Aminoglycosides (antibiotics)
Loop Diuretics
Cisplatin (Antineoplastic)

[Vancomycin rarely is associated with mild ototoxicity and nephrotoxicity, although both may become significant when used in conjunction with aminoglycosides]

Front 247

Shared Effects:

Drugs that lead to pulmonary fibrosis and subsequent restrictive lung disease

Back 247

Bleomycin (Antineoplastic)
Amiodarone (Class IA Antiarrhythmic)
Busulfan (Antineoplastic)

[Patients may manifest with dyspnea, tachypnea, and eventual cyanosis, with a decreased forced expiratory volume at 1 second (FEV₁) and a decreased forced vital capacity (FVC)]

Front 248

Shared Effects:

Drugs that cause gynecomastia

Back 248

Cimetidine (Antiulcer)
Ketoconazole (Antifungal)
Spironolactone (Antihypertensive)

[All compete for androgen receptors, leading to antiandrogenic effects]

Front 249

Shared Effects:

Common drugs that inhibit hepatic P450 system

Back 249

Cimetidine (Antiulcer)
Ketoconazole (Antifungal)
Erythromycin (Antibiotic)

[Such drugs potentiate the action of other drugs which are normally metabolized by the P450; often doses must be lowered when such drugs are used together]

Front 250

Shared Effects:

Drugs that can cause massive hepatic necrosis

Back 250

Halothane (Anesthetic)
Acetaminophen (Analgesic)
Valproic Acid (Anticonvulsant)

[Histologically, damage to the liver is indistinguishable from that chronic viral hepatitis]

Front 251

Shared effects:

Drugs that cause a systemic lupus erythematosus (SLE)-like syndrome

Back 251

Hydralazine (Vasodilator)
Procainamide (Class IA Antiarrhythmic)
Isoniazid (Antituberculoid)
Phenytoin (Anticonvulsant)

[Symptoms include arthralgias, myalgias, skin rashes, and fever]

Front 252

Shared effects:

Drugs that inhibit microtubule function

Back 252

Mebendazole (Antihelminthic)
Thiabendazole (Antihelminthic)
Paclitaxel (Antineoplastic)
Vincristine (Antineoplastic)
Colchicine (Antigout)
Griseofulvin (Antifungal)

[These agents either block intracellular transport, interfere with locomotion, or disrupt the formation of the mitotic spindle]

Front 253

Shared effects:

Drugs that cause a disulfram-like reaction

Back 253

Metronidazole (Antibiotic)
Certain cephalosporins (Antibiotic)
Procarbazine (Antineoplastic)

[Cause flushing, headache, nausea, sweats, hypotension, and confusion]

Front 254

Shared effects:

Drugs that cause cutaneous flushing on administration

Back 254

Niacin (Antihyperlipidemic)
Calcium Channel Blockers
Adenosine (Antiarrhythmic)
Vancomycin (Antibiotic)

[Often this side effect can be controlled by slow infusion or coadministration with histamine blockers]

Front 255

Shared effects:

Bactericidal antibiotics

Back 255

Penicillins
Cephalosporins
Vancomycin
Aminoglycosides
Fluoroquinolones
Metronidazole

[Most of the other antibiotics are bacteriostatic]

Front 256

Shared effects:

Drugs that induce the hepatic P450 system

Back 256

Phenytoin (Anticonvulsant)
Carbamazepine (Anticonvulsant)
Griseofulvin (Antifungal)
Rifampin (Antituberculoid)
Barbiturates
Chronic Ethanol Use

[The hepatic P450 microsomal mixed function oxidase system is involved in phase I metabolism of many drugs]

Front 257

Shared effects:

Drugs that cause a Stevens-Johnson syndrome, a febrile, erosive hemorrhagic crusting on the lips and oral mucosa of children

Back 257

Sulfonamides (Antibiotic)
Ethosuximide (Anticonvulsant)
Lamotrigine (Anticonvulsant)

[Other agents such as penicillins, barbiturates, salicylates, hydantoins, and antimalarials may be associated with a less severe form of erythema multiforme, with macules, papules, vesicles, and bullae]

Front 258

Shared effects:

Drugs that can cause hemolysis in patients with glucose-6 phosphate dehydrogenase (G6PD) deficiency

Back 258

Sulfonamides (Antibiotic)
Isoniazid (Antituberculoid)
Primaquine (Antimalarial)

[In patients with G6PD deficiency, these agents cause oxidative stress on RBCs because of a deficit of reducing equivalents of nicotinamide adenine dinucleotide phosphate (NADPH), normally generated by the hexose monophosphate shunt]

Front 259

Shared effects:

Drugs that cause photosensitivity

Back 259

Tetracycline (Antibiotic)
Amiodarone (Class IA Antiarrhythmic)
Sulfonamides (Antibiotics)

[Barbituates can precipitate photosensitivity in patients with acute intermittent porphyria]