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823 Cards in this Set
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Relates the amount of drug in the body to the plasma concentration
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Volume of distribution (VD)
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Plasma concentration of a drug at a given time
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Cp
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The ratio of the rate of elimination of a drug to its plasma concentration
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Clearance (CL)
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The elimination of drug that occurs before it reaches the systemic circulation
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First pass effect
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The fraction of administered dose of a drug that reaches systemic circulation
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Bioavailability (F)
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When the rate of drug input equals the rate of drug elimination
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Steady state
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This step of metabolism makes a drug more hydrophilic and hence augments elimination
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Phase I
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Different steps of Phase I
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Oxidation, reduction, hydrolysis
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Inducers of Cytochrome P450 (CYP450)
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Barbiturates, phenytoin, carbamazepine, and rifampin
Barb dont eat Carbs and downs Riphen-Phen to INDUCE wt loss |
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Inhibitors of CYP450 (5)
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Cimetidine, ketoconazole, erythromycin, isoniazid and grapefruit juice
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Products of Phase II conjugation (3)
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Glucuronate, acetic acid, and glutathione sulfate
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Type of kinetics when a constant percentage of substrate is metabolized per unit time
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First order kinetics
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Drug elimination with a constant amount metabolized regardless of drug concentration
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Zero order kinetics
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Target plasma concentration times (volume of distribution divided by bioavailability)
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Loading dose (Cp*(Vd/F))
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Concentration in the plasma times (clearance divided by bioavailability)
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Maintenance dose (Cp*(CL/F))
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Strength of interaction between drug and its receptor
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Affinity
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Selectivity of a drug for its receptor
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Specificity
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Amount of drug necessary to elicit a biologic effect
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Potency
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Ability of drug to produce a biologic effect
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Efficacy
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Ability of a drug to produce 100% of the maximum response regardless of the potency
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Full agonist
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Ability to produce less than 100% of the response
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Partial agonist
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Ability to bind reversibly to the same site as the drug and without activating the effector system
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Competitive antagonist
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Class of drugs with ability to decrease the maximal response to an agonist
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Noncompetitive antagonist
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A hormone whose mechanism of action (MOA) utilizes intracellular receptors (2)
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Thyroid and steroid hormones
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A hormone whose MOA utilizes transmembrane receptors
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Insulin
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Classes of drugs whose MOA utilizes ligand gated ion channels (2)
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Benzodiazepines and calcium channel blockers
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Median effective dose required for an effect in 50% of the population
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ED50
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Median toxic dose required for a toxic effect in 50% of the population
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TD50
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Dose which is lethal to 50% of the population
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LD50
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Window between therapeutic effect and toxic effect
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Therapeutic index
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Term for a high margin of safety
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High therapeutic index
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Term for a narrow margin of safety
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Low therapeutic index
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Antidote used for lead poisoning
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Dimercaprol, EDTA
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Antidote used for cyanide poisoning
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Nitrites
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Antidote used for anticholinergic poisoning
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Physostigmine
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Antidote used for organophosphate/anticholinesterase poisoning
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Atropine, pralidoxime (2-PAM)
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Antidote used for iron salt toxicity
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Deferoxamine
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Antidote used for acetaminophen (APAP) toxicity
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N-acetylcysteine (Mucomyst)
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Antidote for arsenic, mercury, lead, and gold poisoning
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Dimercaprol
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Antidote used in poisonings: copper (Wilson's disease), lead, mercury, and arsenic
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Penicillamine
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Antidote used for heparin overdose
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Protamine
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Antidote used for warfarin toxicity
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Vitamin K and Fresh frozen plasma (FFP)
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Antidote for tissue plasminogen activator (t-PA), streptokinase
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Aminocaproic acid
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Antidote used for methanol and ethylene glycol (2)
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Ethanol or fomepizole
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Antidote used for opioid toxicity
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Naloxone (IV), naltrexone (PO)
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Antidote used for benzodiazepine toxicity
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Flumazenil
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Antidote used for tricyclic antidepressants (TCA)
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Sodium bicarbonate
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Antidote used for carbon monoxide poisoning
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100% O2 and hyperbaric O2
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Antidote used for digitalis toxicity
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Digibind
(also need to d/c digoxin, normalize K+, and give lidocaine if pt. is arrhythmic) |
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Antidote used for beta agonist toxicity (eg. Metaproterenol)
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Esmolol
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Antidote for methotrexate toxicity
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Leucovorin
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Antidote for beta-blockers and hypoglycemia
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Glucagon
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Antidote useful for some drug induced Torsade de pointes
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Magnesium sulfate
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Antidote for hyperkalemia
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sodium polystyrene sulfonate (Kayexalate)
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Antidote for salicylate intoxication (2)
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Alkalinize urine, dialysis
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Constant proportion of cell population killed rather than a constant number
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Log-kill hypothesis
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Treatment with cancer chemotherapy at high doses every 3-4 weeks, too toxic to be used continuously
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Pulse therapy
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Toxic effect of anticancer drug can be lessened by rescue agents
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Rescue therapy
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Drug used concurrently with toxic anticancer agents to reduce renal precipitation of urates
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Allopurinol
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Pyrimidine analog that causes "Thymine-less death" given with leucovorin rescue
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5-flouracil (5-FU)
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Drug used in cancer therapy causes Cushing-like symptoms
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Prednisone
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Side effect of Mitomycin
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SEVERE myelosuppression
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MOA of cisplatin
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Alkylating agent
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Common toxicities of cisplatin
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Nephro and ototoxicity
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Analog of hypoxanthine, needs HGPRTase for activation
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6-mercaptopurine (6-MP)
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Interaction with this drug requires dose reduction of 6-MP
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Allopurinol
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May protect against doxorubicin toxicity by scavenging free radicals
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Dexrazoxane
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Blows DNA (breaks DNA strands), limiting SE is pulmonary fibrosis
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Bleomycin
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Bleomycin+vinblastine+etoposide+cisplatin produce almost a 100% response when all agents are used for this neoplasm
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Testicular cancer
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ABVD regimen used for HD, but appears less likely to cause sterility and secondary malignancies than MOPP
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Adriamycin (doxorubicin) +bleomycin, vinblastine +dacarbazine
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Regimen used for non-Hodgkin's lymphoma
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CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) plus rituximab
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Regimen used for breast cancer
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CMF (cyclophosphamide, methotrexate, and fluorouracil) and tamoxifen if ER+
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Alkylating agent, vesicant that causes tissue damage with extravasation
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Mechlorethamine
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Anticancer drug also used in RA, produces acrolein in urine that leads to hemorrhagic cystitis
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Cyclophosphamide
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Prevention of cyclophosphamide induced hemorrhagic cystitis
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Hydration and mercaptoethanesulfonate (MESNA)
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Microtubule inhibitor that causes peripheral neuropathy, foot drop (eg. ataxia), and "pins and needles" sensation
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Vincristine
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Interact with microtubules (but unlike vinca which prevent disassembly of tubules), it stabilizes tubulin and cells remain frozen in metaphase
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Paclitaxel (taxol)
Pacman eats and they Freeze |
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Toxicities include nephrotoxicity and ototoxicity, leading to a severe interaction with aminoglycosides
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Cisplatin
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Agent similar to cisplatin, less nephrotoxic, but greater myelosuppression
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Carboplatin
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Converts asparagine to aspartate and ammonia, denies cancer cells of essential AA (asparagine)
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L-asparaginase
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Used for hairy cell leukemia; it stimulates NK cells
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Interferon alpha
I Found A hairy patient |
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Anti-androgen used for prostate cancer
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Flutamide (Eulexin)
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Anti-estrogen used for estrogen receptor + breast cancer
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Tamoxifen
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Aromatase inhibitor used in breast cancer
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Letrozole, anastrozole
Let Ana's aroma Taze you |
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Newer estrogen receptor antagonist used in advanced breast cancer
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Toremifene (Fareston)
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Some cell cycle specific anti-cancer drugs (6)
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Bleomycin, vinca alkaloids,
antimetabolites (eg., 5-FU, 6-MP, methotrexate, etoposide) |
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Some cell cycle non-specific drugs (6)
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Alkylating agents (eg., mechlorethamine, cyclophosphamide), antibiotics (doxorubicin, daunorubicin), cisplatin, nitrosourea
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Anti-emetics used in association with anti-cancer drugs that are 5-HT3 (serotonin receptor subtype ) antagonists
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Odansetron, granisetron
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Nitrosoureas with high lipophilicity, used for brain tumors
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Carmustine (BCNU) and lomustine (CCNU)
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Anticancer drug that produces disulfiram-like reaction with ethanol
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Procarbazine
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Somatostatin (SRIF) analog used for acromegaly, carcinoid, glucagonoma and other GH producing pituitary tumors
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Octreotide
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Somatotropin (GH) analog used in GH deficiency (dwarfism)
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Somatrem
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GHRH analog used as diagnostic agent
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Sermorelin
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GnRH agonist used for infertility or different types of CA depending on pulsatile or steady usage respectively
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Leuprolide
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GnRH antagonist with more immediate effects, used for infertility
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Ganirelix
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Dopamine (DA) agonist (for Parkinson's disease), used also for hyperprolactinemia
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Bromocriptine
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Hormone inhibiting prolactin release
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Dopamine
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ACTH analog used for diagnosis of patients with corticosteroid abnormality
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Cosyntropin
for an ACTHual diagnosis you must Co-Sign the form. |
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Synthetic analog of ADH hormone used for diabetes insipidus and nocturnal enuresis
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Desmopressin (DDAVP)
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SE of OCPs
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Increased thromboembolic events
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Most widely used thyroid drugs such as Synthroid and Levoxyl contain
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L-thyroxine (T4)
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T3 compound less widely used
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Cytomel (liothyronine)
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Anti-thyroid drugs (4)
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Thioamides, iodides, radioactive iodine, and ipodate
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Thioamide agents used in hyperthyroidism
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Methimazole and propylthiouracil (PTU)
Theo was hyper so they PUT him in a Meth Maze |
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Thioamide less likely to cross placenta, inhibits peripheral conversion of T4 to T3 in high doses, and should be used with extreme caution in pregnancy
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PTU
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PTU (propylthiouracil) MOA
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Inhibits thyroid hormone synthesis by blocking iodination of the tyrosine residues of thyroglobulin
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Can be effective for short term therapy of thyroid storm, but after several weeks of therapy causes an exacerbation of hyperthyroidism
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Iodide salts
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Dose may need to be increased during pregnancy or with Ocs due to increased TBG in plasma
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Thyroxine
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Permanently cures thyrotoxicosis, patients will need thyroid replacement therapy thereafter. Contraindicated in pregnancy
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Radioactive iodine
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Radio contrast media that inhibits the conversion of T4 to T3
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Ipodate
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Block cardiac adverse effects of thyrotoxicosis such as tachycardia, inhibits the conversion of T4 to T3
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Beta-blockers such as propranolol
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Vitamins containing iron should NOT be taken simultaneously with levothyroxine because
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Iron deiodinates thyroxine
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Thyroxine dose may need to be increased in hypothyroid patient during pregnancy because
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Estogens increase maternal TBG
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3 zones of adrenal cortex and their products
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Glomerulosa (mineralocorticoids), fasciculata (glucocorticoid=GC), and reticularis (adrenal androgens)
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Pneumonic for 3 zones of adrenal cortex
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GFR
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Agents used for Addison's disease, Congenital Adrenal Hyperplasia (CAH), inflammation, allergies, and asthma (as a local inhalation)
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Glucocorticoids
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Short acting glucocorticoids
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Cortisone and hydrocortisone (equivalent to cortisol)
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Intermediate acting glucocorticoids
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Prednisone, methylprednisolone, prednisolone, and triamcinolone
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Long acting glucocorticoids
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Betamethasone and dexamethasone
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Mineralocorticoids (2)
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Fludrocortisone and deoxycorticosterone
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Some side effects of corticosteroids (11)
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Osteopenia, impaired wound healing, stria, thinning of skin,
increased appetite, PUD, HTN, edema, increased risk of infection, euphoria, psychosis |
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Period of time of therapy after which GC therapy will need to be tapered
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5-7 days
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Used for Cushing's syndrome (increased corticosteroid)
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Dexamethasone suppression test
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Inhibits conversion of cholesterol to pregnenolone therefore inhibiting corticosteroid synthesis
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Aminoglutethimide
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Antifungal agent used for inhibition of all gonadal and adrenal steroids
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Ketoconazole
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Antiprogestin used as potent antagonist of GC receptor
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Mifepristone
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Diuretic used to antagonize aldosterone receptors
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Spironolactone
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Common SE of spironolactone
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Gynecomastia and hyperkalemia
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Slightly increased risk of breast cancer, endometrial cancer, heart disease (questionable), has beneficial effects on bone loss
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Estrogen
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Antiestrogen drugs used for fertility and breast cancer respectively
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Clomiphene and tamoxifen
fertility - clone a fiend |
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Common SE of tamoxifen and raloxifene
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Hot flashes
Boob meds give hot flashes |
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Selective estrogen receptor modulator (SERM) used for prevention of osteoporosis and prophylaxis in women with risk factors for breast cancer
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Raloxifene
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Non-steroidal estrogen agonist causes clear cell adenocarcinoma of the vagina in daughters of women who used it during pregnancy
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Diethylstilbestrol (DES)
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Estrogen mostly used in oral contraceptives (OC) (2)
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Ethinyl estradiol and mestranol
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Anti-progesterone used as abortifacient
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Mifepristone (RU-486)
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Constant low dose of estrogen and increasing dose of progestin for 21 days (last 5 days are sugar pills or iron prep)
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Combination oral contraceptives (OC)
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Oral contraceptive available in a transdermal patch
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Ortho-Evra
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Converted to more active form DHT by 5 alpha-reductase
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Testosterone
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5 alpha-reductase inhibitor used for benign prostatic hyperplasia (BPH) and male pattern baldness
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Finasteride (Proscar and Propecia respectively)
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Anabolic steroids that have potential for abuse (3)
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Nandrolone, oxymetholone, and oxandrolone
Nan is a strong as 2 Oxen drones on Meth |
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Anti-androgen used for hirsutism in females
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Cyproterone acetate
cypro-Hair-gone |
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Drug is used with testosterone for male fertility
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Leuprolide
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What do alpha cells in the pancreas produce?
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Glucagon
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What do beta cells in the pancreas produce?
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Insulin
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Where are beta cells found in the pancreas?
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Islets of Langerhans
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What do delta cells in the pancreas produce?
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Somatostatin
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Product of proinsulin cleavage used to assess insulin abuse
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C-peptide
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Exogenous insulin contains
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Little C-peptide
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Endogenous insulin contains
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Normal C-peptide
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Very rapid acting insulin, having fastest onset and shortest duration of action
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Lispro (Humalog), aspart, glulisine
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Rapid acting, crystalline zinc insulin used to reverse acute hyperglycemia
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Regular (Humulin R)
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Long acting insulin
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Ultralente (humulin U)
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Ultra long acting insulin, has over a day duration of action (2)
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Glargine (Lantus), detemir
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Major SE of insulin
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Hypoglycemia
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Receptor important in synthesis of glucose to glycogen in the liver
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GLUT 2
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Important in muscle and adipose tissue for glucose transport across muscles and TG storage by lipoprotein lipase activation
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GLUT 4
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Two examples of alpha-glucosidase inhibitors (AGI)
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Acarbose, miglitol
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MOA of AGI's
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Act on intestine, delay digestion and absorption of glucose formed from digestion of starch and disacchrides
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SE of AGI's (3)
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Flatulence (do not use beano to tx), diarrhea, abdominal cramps
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Alpha-glucosidase inhibitor associated with elevation of LFT's
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Acarbose
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Amino acid derivative, active as an insulin secretagogue
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Nateglinide (Starlix)
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MOA of nateglinide
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Insulin secretagogue - closes ATP-sensitive K+ channel
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Biguanide
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Metformin
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Drugs available in combination with metformin
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Glyburide, glipizide, and rosiglitazone (Glucovance, Metaglip, Avondamet)
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MOA of metformin (3)
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Decreases hepatic glucose production
Decrease intestinal glucose absorption Increase insulin sensitivity |
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Vascular effects of metformin
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Decreased micro and macro vascular disease
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Most important potential SE of metformin
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Lactic acidosis
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Incidence of hypoglycemia with metformin
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none
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Meglitinide class of drugs
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Repaglinide
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MOA of repaglinide
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Insulin release from pancreas; faster and shorter acting than sulfonylurea
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First generation sulfonylureas (3)
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Chlorpropamide, tolbutamide, tolazamide, etc.
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Second generation sulfonylurea (3)
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Glyburide, glipizide, glimepiride, etc.
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MOA of both generations of sulfonylureas
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Cause insulin release from pancreas by modifying K+ channels
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Common SE of sulfonylureas, repaglinide, and nateglinide
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Hypoglycemia
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Sulfonylurea NOT recommended for elderly because of very long half life
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Chlorpropamide
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Thiazolidinediones (3)
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Pioglitazone, Rosiglitazone, Troglitazone (withdrawn/d from market)
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Reason troglitazone was withdrawn from market
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Hepatic toxicity
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MOA of thiazolindinediones
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Stimulate PPAR-gamma receptor to regulate CHO and lipid metabolism
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SE of Thiazolindinediones (3)
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Edema, mild anemia; interaction with drugs that undergo CytP450 3A4 metabolism
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Hyperglycemic agent that increases cAMP and results in glycogenolysis, gluconeogenesis, reverses hypoglycemia, also used to reverse severe beta-blocker overdose and smooth muscle relaxation
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Glucagon
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Available bisphosphonates (6)
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Alendronate, etidronate, risedronate, pamidronate, tiludronate, and zoledronic acid
come to Z bone PEAR-T |
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MOA of Bisphosphonates
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Inhibits osteoclast bone resorption
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Only bisphosphonate available IV
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Etidronate
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Uses of bisphosphonates (4)
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Osteoporosis, Paget's disease, and osteolytic bone lesions, and hypercalcemia from malignancy
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Major SE of bisphosphonates
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Chemical esophagitis
esophogonates |
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Bisphosphonate that cannot be used on continuous basis because it caused osteomalacia
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Etidronate
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Used for prevention of postmenopausal osteoporosis in women
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Estrogen (HRT-Hormone replacement therapy)
|
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Increase bone density, also being tested for breast CA prophylaxis
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Raloxifene (SERM-selective estrogen receptor modulator)
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Used intranasally and decreases bone resorption
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Calcitonin (salmon prep)
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Used especially in postmenopausal women, dosage should be 1500 mg
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Calcium
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Vitamin given with calcium to ensure proper absorption
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Vitamin D
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Disease caused by excess ergot alkaloids
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St. Anthony's Fire
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Endogenous substances commonly interpreted as histamine, serotonin, prostaglandins, and vasoactive peptides
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Autocoids
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Syndrome of hypersecretion of gastric acid and pepsin usually caused by gastrinoma; it is associated with severe peptic ulceration and diarrhea
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Zollinger-Ellison Syndrome
|
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Drug that causes contraction of the uterus
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Oxytocin
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Distribution of histamine receptors H1, H2, and H3
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Smooth muscle; stomach, heart, and mast cells; nerve endings, CNS respectively
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Prototype antagonist of H1 and H2 receptors (2)
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Diphenhydramine and cimetidine, respectively
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1st generation antihistamine that is highly sedating
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Diphendydramine
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1st generation antihistamines that are least sedating (2)
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Chlorpheniramine or cyclizine
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2nd generation antihistamines (3)
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fexofenadine, loratadine, and cetirizine
Allegra, Claritin, Zyrtec |
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Generation of antihistamine that has the most CNS effects
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First generation due to being more lipid-soluble
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Major indication for H1 receptor antagonist
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Use in IgE mediated allergic reaction
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Antihistamine that can be used for anxiety and insomnia and is not addictive
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hydroxyzine (Atarax)
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H1 antagonist used in motion sickness (3)
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Dimenhydrinate, meclizine, and other 1st generation
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Most common side effect of 1st generation antihistamines
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Sedation
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Lethal arrhythmias resulting from concurrent therapy with azole fungals (metabolized by CYP 3A4) and these antihistamines which inhibit the 3A4 iso-enzyme.
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Terfenadine and astemizole (have been removed from the market)
aSTEMIzole |
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H2 blocker that causes the most interactions with other drugs
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Cimetidine
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Clinical use for H2 blockers
|
Acid reflux disease, duodenal ulcer and peptic ulcer disease
|
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Receptors for serotonin (5HT-1) are located where?
What do they do? |
Mostly in the brain, and they mediate synaptic inhibition via increased K+ conductance
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5HT-1d agonist used for migraine headaches (3)
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Sumatriptan, naratriptan, and rizatriptan
|
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Triptan available in parenteral and nasal formulation
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Sumatriptan
|
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H1 blocker that is also a serotonin antagonist
|
Cyproheptadine
|
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Agents for reduction of postpartum bleeding (3)
|
Oxytocin, ergonovine and ergotamine
|
|
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Agents used in treatment of carcinoid tumor (3)
|
Ketanserin, cyproheptadine, and phenoxybenzamine
|
|
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5HT-3 antagonist used in chemotherapeutic induced
emesis (4) |
Ondansetron, granisetron, dolasetron, alosetron
|
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5HT-3 antagonist that has been associated with QRS and QTc prolongation and should not be used in patients with heart disease
|
Dolasetron
|
|
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DOC to treat chemo-induced nausea and vomiting
|
Odansetron
|
|
|
Drug used in ergot alkaloids overdose, ischemia and gangrene
|
Nitroprusside
|
|
|
Reason ergot alkaloids are contraindicated in pregnancy
|
Uterine contractions
|
|
|
SE of ergot alkaloids
|
Hallucinations resembling psychosis
|
|
|
Ergot alkaloid used as an illicit drug
|
LSD
|
|
|
Dopamine agonist used in hyperprolactinemia
|
Bromocriptine
|
|
|
Peptides causing increased capillary permeability and edema (2)
|
Bradykinin and histamine
|
|
|
Mediator of tissue pain, edema, inactivated by ACE, and may be a contributing factor to the development of angioedema
|
Bradykinin
|
|
|
Drug causing depletion of substance P (vasodilator)
|
Capsaicin
|
|
|
Prostaglandins that cause abortions
|
Prostaglandin E1 (misoprostol) PGE2, and PGF2alpha
|
|
|
Difference between COX 1 and COX 2
|
COX 1 is found throughout the body and COX 2 is only in inflammatory tissue
|
|
|
Drug that selectively inhibits COX 2
|
Celecoxib and rofecoxib
|
|
|
Inhibitor of lipoxygenase
|
zileuton (Zyflo)
|
|
|
Major SE of zileuton
|
Liver toxicity
|
|
|
Inhibitor of leukotrienes (LTD4) receptors and used in asthma
|
Zafirlukast and montelukast
|
|
|
Used in pediatrics to maintain patency of ductus arteriosis
|
PGE1
|
|
|
Prostaglandin approved for use in severe pulmonary HTN
|
PGI2 (epoprostenol)
|
|
|
Prostaglandin used in the treatment of impotence
|
Alprostadil
|
|
|
Irreversible, nonselective COX inhibitor
|
Aspirin
|
|
|
Class of drugs that reversibly inhibit COX
|
NSAIDS
|
|
|
Primary endogenous substrate for Nitric Oxidase Synthase
|
Arginine
|
|
|
MOA and effect of nitric oxide
|
Stimulates cGMP which leads to vascular smooth muscle relaxation
|
|
|
Long acting beta 2 agonist used in asthma
|
Salmeterol
|
|
|
Muscarinic antagonist used in asthma
|
Ipratropium
|
|
|
MOA action of cromolyn
|
Mast cell stabilizer
|
|
|
Methylxanthine derivative used as a remedy for intermittent claudication
|
Pentoxifylline
|
|
|
MOA of corticosteroids"
|
inhibit phospholipase A2
|
|
|
SE of long term (>5 days) corticosteroid therapy and remedy
|
Adrenal suppression and weaning slowly, respectively
|
|
|
MOA of quinolones
|
Inhibit DNA gyrase
|
|
|
MOA of penicillin
|
Block cell wall synthesis by inhibiting peptidoglycan cross-linkage
|
|
|
Drug used for MRSA
|
Vancomycin
|
|
|
Vancomycin MOA
|
Blocks peptidoglycan synthesis
|
|
|
Type of resistance found with vancomycin
|
Point mutation
|
|
|
Meningitis prophylaxis in exposed patients
|
Rifampin
|
|
|
Technique used to diagnose perianal itching, and the drug used to treat it
|
Scotch tape technique and mebendazole
|
|
|
Two toxicities of aminoglycosides
|
nephro and ototoxicity
|
|
|
DOC for Legionnaires' disease
|
Erythromycin
|
|
|
MOA of sulfonamides
|
Inhibit dihydropteroate synthase
|
|
|
Penicillins active against penicillinase secreting bacteria
|
Methicillin, nafcillin, and dicloxacillin
|
|
|
Cheap wide spectrum antibiotic DOC for otitis media
|
Amoxicillin
|
|
|
Class of antibiotics that have 10% cross sensitivity with penicillins
|
Cephalosporins
|
|
|
PCN active against pseudomonas
|
Carbenicillin, piperacillin and ticarcillin
|
|
|
Antibiotic causing red-man syndrome, and prevention
|
Vancomycin, infusion at a slow rate and antihistamines
|
|
|
Drug causes teeth discoloration
|
Tetracycline
|
|
|
MOA of tetracycline
|
Decreases protein synthesis by inhibiting 30S ribosome
|
|
|
Drug that causes gray baby syndrome and aplastic anemia
|
Chloramphenicol
|
|
|
Drug notorious for causing pseudomembranous colitis
|
Clindamycin
|
|
|
DOC for tx of pseudomembranous colitis
|
Metronidazole
|
|
|
Treatment of resistant pseudomembranous colitis
|
ORAL vancomycin
|
|
|
Anemia caused by trimethoprim
|
Megaloblastic anemia
[TMP inhibits dihydrofolate reductase --> defect in folate metabolism --> megaloblastic anemia] |
|
|
Reason fluoroquinolones are contraindicated in children and pregnancy
|
Cartilage damage
|
|
|
DOC for giardia, bacterial vaginosis, pseudomembranous colitis, and trichomonas
|
Metronidazole
|
|
|
Treatment for TB patients (think RIPE)
|
Rifampin, Isoniazid, Pyrazinamide, and Ethambutol
|
|
|
Metronidazole SE if given with alcohol
|
Disulfiram-like reaction
|
|
|
Common side effect of Rifampin
|
Red urine discoloration
|
|
|
MOA of nystatin
|
Bind ergosterol in fungal cell membrane
|
|
|
Neurotoxicity with isoniazid (INH) prevented by
|
Administration of Vit. B6 (pyridoxine)
|
|
|
Toxicity of amphotericin
|
Nephrotoxicity
|
|
|
SE seen only in men with administration of ketoconazole
|
Gynecomastia
|
|
|
Topical DOC in impetigo
|
Topical mupirocin (Bactroban)
|
|
|
DOC for influenza A
|
Amantadine
|
|
|
DOC for RSV
|
Ribavirin
|
|
|
DOC for CMV retinitis
|
Ganciclovir
|
|
|
SE for ganciclovir (3)
|
Neutro, leuko and thrombocytopenia
|
|
|
Anti-viral agents associated with Stephen Johnson syndrome (2)
|
Nevirapine, amprenavir
|
|
|
HIV antiviral class known to have severe drug interactions by causing inhibition of metabolism
|
Protease inhibitors
|
|
|
Antivirals that are teratogens
|
ribavirin, efavirenz, and delavirdine
red dead baby |
|
|
Antivirals associated with neutropenia (4)
|
Ganciclovir, zidovudine (AZT), saquinavir, and interferon
GASI |
|
|
HIV med used to reduce transmission during birth
|
AZT (zidovudine)
|
|
|
Drug used for African sleeping sickness
|
Suramin
|
|
|
Drug used in Chagas disease
|
Nifurtimox
|
|
|
Cephalosporins not able to cross BBB
|
Cefixime
|
|
|
Cephalosporins able to cross the BBB
|
Cefuroxime (2nd) generation and Ceftazidime
|
|
|
Drug used for N. gonorrhea in females
|
Ceftriaxone
|
|
|
Cephalosporin causes kernicterus in neonates
|
Ceftriaxone or cefuroxime
|
|
|
SE of INH (2)
|
Peripheral neuritis and hepatitis
|
|
|
Aminoglycoside that is least ototoxic
|
Streptomycin
|
|
|
Drug used in exoerythrocytic cycle of malaria
|
Primaquine
|
|
|
Oral antibiotic of choice for moderate inflammatory acne
|
Minocycline
|
|
|
Drug of choice for leprosy (3)
|
Dapsone, rifampin and clofazimine combination
Dap a Clof on yo faz, b4 you Riph it off |
|
|
DOC for herpes and its MOA
|
Acyclovir; incorporated into viral DNA and chain termination
|
|
|
Anti-microbials that cause hemolysis in G6PD-deficient patients
|
Sulfonamides
|
|
|
MOA of erythromycin
|
Inhibition of protein synthesis at the 50s subunit of ribosome
|
|
|
Anti-biotic frequently used for chronic UTI prophylaxis
|
sulfamethoxazole/ trimethoprim
|
|
|
Lactam that can be used in PCN allergic patients
|
Aztreonam
|
|
|
SE of imipenem
|
Seizures
|
|
|
Anti-viral with a dose limiting toxicity of pancreatitis
|
Didanosine
|
|
|
Common side effect of hypnotic agents
|
Sedation
|
|
|
Occurs when sedative hypnotics are used chronically or at high doses
|
Tolerance
|
|
|
The most common type of drug interaction of sedative hypnotics with other depressant medications
|
Additive CNS depression
|
|
|
Benzodiazepines used to promote sleep (3)
|
Temazpam, triazolam, flurazepam
Try Temaz Flur a good night's sleep |
|
|
Benzodiazepine used for anxiety
|
alprazolam (Ativan)
I get anxious at the van |
|
|
Non-benzodiazepine used as an anxiolytic
|
buspirone (Buspar)
|
|
|
Non-benzodiazepine used for sleep
|
Zolpidem
|
|
|
Major effect of benzodiazepines on sleep at high doses
|
REM is decreased
|
|
|
Neurologic SE of benzodiazepines
|
Anterograde amnesia
|
|
|
Reason benzos are used cautiously in pregnancy
|
Ability to cross the placenta
|
|
|
Main route of metabolism for benzodiazepines
|
Hepatic
|
|
|
Benzodiazepines that undergo extrahepatic conjugation (which are useful in older or hepatically impaired) (3)
|
Lorazepam, oxazepam, and temazepam
LOT |
|
|
MOA for benzodiazepines
|
increase the FREQUENCY of GABA-mediated chloride ion channel opening
|
|
|
Antidote to benzodiazepine overdose (antagonist that reverses the CNS effects)
|
Flumazenil
|
|
|
Benzodiazepine with useful relaxant effects in skeletal muscle spasticity of central origin
|
Diazepam
|
|
|
Benzodiazepine that has efficacy against absence seizures and in anxiety states, such as agoraphobia
|
Clonazepam
|
|
|
Benzodiazepines that are the most effective in the treatment of panic disorder
|
Alprazolam and Clonazepam
If you Panic, I'll Pass on that Clone Ass, Pam. |
|
|
Benzodiazepine that is used for anesthesia
|
Midazolam
|
|
|
DOC for status epilepticus
|
diazepam (Valium)
|
|
|
Longer acting benzodiazepines used in the management of withdrawal states of alcohol and other drugs
|
Chlordiazepoxide (Librium) and Diazepam (Valium)
Val withdrew a book from the Library |
|
|
Benzodiazepines having active metabolites, long half lives, and a high incidence of adverse effects (4)
|
diazepam (Valium), Flurazepam, chlordiazepoxide (Librium), and clorazepate
After a LONG night of studying Val left the Library in a Flury and Clorzed the door behind her. |
|
|
Barbiturates may precipitate this hematologic condition
|
Acute intermittent porphyria
|
|
|
Barbiturates decrease the effectiveness of many other drugs via this pharmacokinetics property
|
Liver enzyme INDUCTION
|
|
|
Barbiturates MOA
|
Increase the DURATION of GABA-mediated chloride ion channels
|
|
|
Barbiturate used for the induction of anesthesia
|
Thiopental
|
|
|
Site of action for zaleplon and zolpidem
|
Benzodiazepine receptor BZ1 (although do not have a benzodiazepine ring structure)
|
|
|
Good hypnotic activity with less CNS SE than most benzodiazepines (2)
|
zolpidem (Ambien), zaleplon (Sonata)
|
|
|
Agent that is a partial agonist for the 5-HT1A receptor
|
Buspirone
|
|
|
Drug of choice for generalized anxiety disorder, NOT effective in acute anxiety
|
Buspirone
|
|
|
Agent that is metabolized to acetaldehyde by alcohol dehydrogenase and microsomal ethanol-oxidizing system (MEOS)
|
Ethanol
|
|
|
Agent with zero-order kinetics
|
Ethanol
|
|
|
Rate limiting step of alcohol metabolism
|
Aldehyde dehydrogenase
|
|
|
System that increases in activity with chronic ethanol exposure and may contribute to tolerance
|
MEOS
|
|
|
Enzyme that metabolizes acetaldehyde to acetate
|
Aldehyde dehydrogenase
|
|
|
Agents that inhibit alcohol dehydrogenase (4)
|
Disulfiram, metronidazole, certain sulfonylureas and cephalosporins
|
|
|
Agent used in the treatment of alcoholism, if alcohol is consumed concurrently, acetaldehyde builds up and results in nausea, headache, flushing, and hypotension
|
Disulfiram
|
|
|
The most common neurologic abnormality in chronic alcoholics
|
Peripheral neuropathy (also excessive alcohol use is associated with HTN, anemia, and MI)
|
|
|
Agent that is teratogen and causes a fetal syndrome
|
Ethanol
|
|
|
Agent that is the antidote for methanol overdose (2)
|
Ethanol, fomepizole
|
|
|
Drug that inhibits alcohol dehydrogenase and is used in ethylene glycol exposure
|
Fomepizole
|
|
|
Most frequent route of metabolism
|
Hepatic enzymes
|
|
|
Mechanisms of action for Phenytoin, Carbamazepine, Lamotrigine
|
Sodium channel blockade
|
|
|
MOA for benzodiazepines and barbiturates
|
GABA-related targets
|
|
|
MOA for Ethosuximide
|
Calcium channels
|
|
|
MOA for Valproic acid at high doses
|
Affect calcium, potassium, and sodium channels
|
|
|
Drugs of choice for generalized tonic-clonic and partial seizures
|
Valproic acid and Phenytoin
Val-partial, Pheny-tonic |
|
|
DOC for febrile seizures
|
Phenobarbital
|
|
|
Drugs of choice for absence seizures (2)
|
Ethosuximide and valproic acid
It Sux when Val is absent |
|
|
Drug of choice for myoclonic seizures
|
Valproic acid
|
|
|
Drugs of choice for status epilepticus (2)
|
IV diazepam for short term (acute) treatment; phenytoin for prolonged therapy
|
|
|
Drugs that can be used for infantile spasms
|
Corticosteroids
|
|
|
Anti-seizure drugs used also for bipolar affective disorder (BAD) (4)
|
Valproic acid, carbamazepine, phenytoin and gabapentin
|
|
|
Anti-seizure drug used also for Trigeminal neuralgia
|
Carbamazepine
|
|
|
Anti-seizure drug used also for pain of neuropathic orgin
|
Gabapentin
|
|
|
Anti-seizure agent that exhibits non-linear metabolism, highly protein bound, causes fetal hydantoin syndrome, and stimulates hepatic metabolism
|
Phenytoin
|
|
|
SE of phenytoin (4)
|
Gingival hyperplasia, nystagmus, diplopia and ataxia
Big Gums, Hairy NADs |
|
|
Anti-seizure agent that induces formation of liver drug-metabolism enzymes, is teratogen and can cause craniofacial anomalies and spina bifida
|
Carbamazepine
|
|
|
Anti seizure agent that inhibits hepatic metabolism, is hepatotoxic and teratogen that can cause neural tube defects and gastrointestinal distress
|
Valproic acid
|
|
|
Laboratory value required to be monitored for patients on valproic acid
|
Serum ammonia and LFT's
|
|
|
SE for Lamotrigine
|
Stevens-Johnson syndrome
|
|
|
SE for Felbamate
|
Aplastic anemia and acute hepatic failure
|
|
|
Anti-seizure medication also used in the prevention of migraines
|
Valproic acid
|
|
|
Carbamazepine may cause
|
Agranulocytosis
|
|
|
Anti-seizure drugs used as alternative drugs for mood stabilization (4)
|
Carbamazepine, gabapentin, lamotrigine, and valproic acid
|
|
|
MOA of general anesthetics
|
Most are thought to act at GABA-A receptor - chloride channel
|
|
|
Inhaled anesthetic with a low blood/gas partition coefficient
|
Nitrous oxide
|
|
|
Inversely related to potency of anesthetics
|
Minimum alveolar anesthetic concentration (MAC)
|
|
|
Inhaled anesthetics metabolized by liver enzymes which has a major role in the toxicity of these agents (2)
|
Halothane and methoxyflurane
Angel on Meth |
|
|
Most inhaled anesthetics SE
|
Decrease arterial blood pressure
|
|
|
Inhaled anesthetics are myocardial depressants (2)
|
Enflurane and halothane
An Angels Heart En Flowers |
|
|
Inhaled anesthetic causes peripheral vasodilation
|
Isoflurane
|
|
|
Inhaled anesthetic that may sensitize the myocardium to arrhythmogenic effects of catecholamines and has produced hepatitis
|
Halothane
Halothane causes Hepatits |
|
|
Inhaled anesthetic, less likely to lower blood pressure than other agents, and has the smallest effect on respiration
|
Nitrous oxide
|
|
|
Fluoride released by metabolism of this inhaled anesthetic may cause renal insufficiency
|
Methoxyflurane
|
|
|
Prolonged exposure to this inhaled anesthetic may lead to megaloblastic anemia
|
Nitrous oxide
megaNOblastic anemia |
|
|
Pungent inhaled anesthetic which leads to high incidence of coughing and vasospasm
|
Desflurane
desflurane is desgusting |
|
|
DOC for malignant hyperthermia that may be caused by use of halogenated anesthetics
|
Dantrolene
|
|
|
IV barbiturate used as a pre-op anesthetic
|
Thiopental
|
|
|
Benzodiazepine used adjunctively in anesthesia
|
Midazolam
|
|
|
Benzodiazepine receptor antagonist, it accelerates recovery from benzodiazepine overdose
|
Flumazenil
|
|
|
This produces "dissociative anesthesia", is a cardiovascular stimulant which may increases intracranial pressure, and hallucinations occur during recovery
|
Ketamine
|
|
|
Opioid associated with respiratory depression, but is used in high risk patients who may not survive full general anesthetia
|
Fentanyl
|
|
|
State of analgesia and amnesia produced when fentanyl is used with droperidol and nitrous oxide
|
Neuroleptanesthesia
|
|
|
Produces both rapid anesthesia and recovery, has antiemetic activity and commonly used for outpatient surgery, may cause marked hypotension
|
Propofol
|
|
|
MOA of local anesthetics (LA's)
|
Block voltage-dependent sodium channels
|
|
|
This may enhance activity of local anesthetics
|
Hyperkalemia
|
|
|
This may antagonize activity of local anesthetics
|
Hypercalcemia
|
|
|
Almost all local anesthetics have this property and sometimes require the administration of vasoconstrictors (ex. Epinephrine) to prolong activity
|
Vasodilation
|
|
|
Local anesthetic with vasoconstrictive property, favored for head, neck, and pharyngeal surgery
|
Cocaine
|
|
|
Longer acting local anesthetics which are less dependent on vasoconstrictors (2)
|
Tetracaine and bupivacaine
|
|
|
These LA's have surface activity
|
Cocaine and benzocaine
|
|
|
Most important toxic effects of most local anesthetics
|
CNS toxicity
|
|
|
Commonly abused LA which has cardiovascular toxicity including severe hypertension with cerebral hemorrhage, cardiac arrhythmias, and myocardial infarction
|
Cocaine
|
|
|
local anesthetic causing methemoglobinemia
|
Prilocaine
Priloglobin |
|
|
Class of drugs structurally related to acetylcholine, used to produce muscle paralysis in order to facilitate surgery or artifical ventilation. Full doses lead to respiratory paralysis and require ventilation
|
Neuromuscular blocking drugs
|
|
|
These drugs strongly potentiate and prolong effect of neuromuscular blockade (NMB) (3)
|
Inhaled anesthetics, especially isoflurane, aminoglycosides, and antiarrhythmic
Triple A - for NM blockAde |
|
|
These prevent the action of Ach at the skeletal muscle endplate to produce a "surmountable blockade," effect is reversed by cholinesterase inhibitors (ex. neostigmine or pyridostigmine)
|
Nondepolarizing type antagonists
|
|
|
Agent with long duration of action and is most likely to cause histamine release
|
Tubocurarine
|
|
|
Non-depolarizing skeletal muscle antagonist that has short duration
|
Mivacurium
minicurium |
|
|
Skeletal muscle agent that can block muscarinic receptors
|
Pancuronium
The Block in the Muscle Car caused a Pandamonium |
|
|
Skeletal muscle agent that undergoes Hofmann elimination (breaks down spontaneously)
|
Atracurium
|
|
|
One depolarizing blocker that causes continuous depolarization and results in muscle relaxation and paralysis, causes muscle pain postoperatively and myoglobinuria may occur
|
Succinylcholine
|
|
|
During Phase I these agents worsen muscle paralysis by succinylcholine, but during phase II they reverse the blockade produced by succinylcholine
|
Cholinesterase inhibitors
|
|
|
Agents acting in the CNS or in the skeletal muscle, used to reduce
abnormally elevated tone caused by neurologic or muscle end plate disease |
Spasmolytic drugs
|
|
|
Facilitates GABA presynaptic inhibition
|
Diazepam
|
|
|
GABA agonist in the spinal cord
|
Baclofen
spine is in your back |
|
|
Similar to clonidine and may cause hypotension
|
Tizanidine
|
|
|
DOC for malignant hyperthermia by acting on the sacroplasmic reticulum or skeletal muscle
|
Dantrolene
|
|
|
Agent used for acute muscle spasm
|
Cyclobenzaprine
|
|
|
Irreversible condition resulting from the use of antipsychotics, reserpine at high doses, and MPTP (by-product of illicit meperidine analog)
|
Drug induced Parkinsonism
|
|
|
Agent used in drug therapy of Parkinson's instead of Dopamine (which has low bioavailability and does not cross the BBB)
|
L-dopa (levodopa)
|
|
|
This is combined with L-dopa, inhibits DOPA decarboxylase (active only peripherally) which allows lower effective doses of L-dopa and allows for fewer SE's (GI distress, postural hypotension, and dyskinesias)
|
Carbidopa
|
|
|
Clinical response that may fluctuate in tx of Parkinson's dx
|
On-off-phenomenon
|
|
|
Anti-Parkinson's drug which increases intraocular pressure and is contraindicated in closed angle glaucoma
|
Levodopa
|
|
|
Ergot alkaloid that is a partial agonist at D2 receptors in the brain, used for patients who are refractory or cannot tolerate levodopa, causes erythromelalgia
|
Bromocriptine
|
|
|
Non ergot agents used as first-line therapy in the initial management of Parkinson's (2)
|
Pramipexole and ropinirole
|
|
|
Enhances dopaminergic neurotransmission SE's include CNS excitation, acute toxic psychosis and livedo reticularis
|
Amantadine
|
|
|
Inhibitor of MAO type B which metabolizes dopamine, used adjunct to levodopa or as sole agent in newly diagnosed patients
|
Selegiline
|
|
|
Inhibitors of catechol-O-methyltransferase (COMT), used as adjuncts in Parkinson's dx and cause acute hepatic failure (monitor LFT's)
|
Entacapone and Tolcapone
EntaCOMTpone TolCOMTpone |
|
|
Agent decreases the excitatory actions of cholinergic neurons. May improve tremor and rigidity but have LITTLE effect on bradykinesia. Atropine-like side effects
|
Benztropine
|
|
|
Agent effective in physiologic and essential tremor
|
Propranolol
|
|
|
Agents used in Huntington's Disease
|
Tetrabenazine (amine depleting drug), Haloperidol (antipsychotic)
The Angel was Hunting 4 Benzes |
|
|
Agents used in Tourette's dx
|
Haloperidol or pimozide
The Angel was cussing at the Pimp when she found out she had Tourettes |
|
|
Chelating agent used in Wilson's disease
|
Penicillamine
|
|
|
Extrapyramidal dysfunction is more common with these agents, which block this subtype of dopamine receptor
|
Older antipsychotic agents, D2 receptors
|
|
|
MOA of neuroleptics
|
Dopamine blockade
|
|
|
Side effects occuring in antipsychotics that block dopamine (7)
|
Hyperprolactinemia, menorrhea, galactorrhea,
confusion, mood changes, decreased sexual interest, and weight gain |
|
|
Antipsychotics that reduce positive symptoms only
|
Older antipsychotics
|
|
|
Newer atypical antipsychotics that also improve some of the negative symptoms and help acute agitation
|
Olanzapine, aripiprazole, and sertindole
Dr. Alonzo is Certain Ari's a pimp for New Atypical Psychos |
|
|
Antipsychotic used in the treatment of psychiatric symptoms in patients with dementia
|
Risperidone
|
|
|
Atypical antipsychotic causing high prolactin levels
|
Risperidone
|
|
|
Newer atypical antipsychotic used for bipolar disorder, known to cause weight gain, and adversely affect diabetes
|
Olanzapine
Alonzo is a fat bipolar diabetic |
|
|
Antipsychotic agent more frequently associated with extrapyramidal side effects that can be treated with benzodiazepine, diphenhydramine or muscarinic blocker
|
Haloperidol
|
|
|
Drug used in neuroleptic malignant syndrome
|
Dantrolene
|
|
|
Agents may exacerbate tardive dyskinesias (may be irreversible and there is no treatment)
|
Muscarinic blockers
|
|
|
Antipsychotic having the strongest autonomic effects
|
Thioridazine
(Autonomazine) |
|
|
Antipsychotic having the weakest autonomic effects
|
Haloperidol
|
|
|
Only phenothiazine not exerting antiemetic effects, can cause visual impairment due to retinal deposits, and high doses have been associated with ventricular arrhythmias
|
Thioridazine
|
|
|
Agent having no effect on D2 receptors, blocks D4, reserved for resistant schizophrenia, and can cause fatal agranulocytosis
|
Clozapine
dont leave your Cloze on D 4loor |
|
|
Anti-psychotic not shown to cause tardive dyskinesia
|
Clozapine
|
|
|
Anti-psychotics available in depot preparation
|
Fluphenazine and haloperidol
|
|
|
Antipsychotics with reduced seizure threshold
|
Low-potency typical antipsychotics and clozapine
|
|
|
Antipsychotics that cause orthostatic hypotension and QT prolongation
|
Low potency APs and risperidone
|
|
|
Antipsychotic with Increased risk of developing cataracts
|
Quetiapine
Qatar-acts |
|
|
Major route of elimination for Lithium
|
Kidneys
|
|
|
Patients being treated with lithium, who are dehydrated, or taking diuretics concurrently, could develop
|
Lithium toxicity
|
|
|
Drug increases the renal clearance hence decreases levels of lithium
|
Theophylline
|
|
|
Lithium is associated with this congenital defect
and is contraindicated in |
Cardiac anomalies and is contraindicated in pregnancy or lactation
|
|
|
DOC for bipolar affective disorder
|
Lithium
|
|
|
Concern using lithium
|
Low therapeutic index
|
|
|
SE of lithium (6)
|
Tremor, sedation, ataxia, aphasia, thyroid enlargement, and reversible diabetes insipidus
|
|
|
Example of three antidepressants that are indicated for obsessive compulsive disorder
|
Clomipramine, fluoxetine and fluvoxamine
|
|
|
Neurotransmitters affected by the action of antidepressants
|
Norepinephrine and serotonin
|
|
|
Usual time needed for full effect of antidepressant therapy
|
2 to 3 weeks
|
|
|
Population group especially sensitive to side effects of antidepressants
|
Elderly patients
|
|
|
All antidepressants have roughly the same efficacy in treating depression, agents are chosen based on these criterion
|
Side-effect profile and prior pt response
|
|
|
Well-tolerated and are first-line antidepressants (3)
|
SSRI's, bupropion, and venlafaxine
|
|
|
Most useful in patients with significant anxiety, phobic features, hypochondriasis, and resistant depression
|
Monamine oxidase inhibitors
Miedo (Phobia) Anxiety Overly Depressed I'm Gonna Die! (hypochondriasis) |
|
|
Condition will result from in combination of MAOI with tyramine containing foods (ex. wine, cheese, and pickled meats)
|
Hypertensive crisis
|
|
|
MAOI should not be administered with SSRI's or potent TCA's due to development of this condition
|
Serotonin syndrome
|
|
|
Sedation is a common side effect of these drugs, they lower seizure threshold, uses include BAD, acute panic attacks, phobias, enuresis, and chronic pain and their overdose can be deadly
|
Tricyclic antidepressants (TCA)
|
|
|
Three C's associated with TCA toxicity
|
Coma, Convulsions, Cardiac problems (arrhythmias and wide QRS)
|
|
|
Agents having higher sedation and antimuscarinic effects than other TCA's
|
Tertiary amines
|
|
|
TCA used in chronic pain, a hypnotic, and has marked antimuscarinic effects
|
Amitriptyline
|
|
|
TCA used in chronic pain, enuresis, and ADD
|
Imipramine
(Im a Peein') |
|
|
TCA with greatest sedation of this group, and marked antimuscarinic effects, used for sleep
|
Doxepin
|
|
|
TCA used in obsessive compulsive disorder (OCD), most significant of TCA's for risk of seizure, weight gain, and neuropsychiatric signs and symptoms
|
Clomipramine
|
|
|
Secondary amines that have less sedation and more excitation effect
|
Nortriptyline, Desipramine
|
|
|
Side effects seen with tricyclic antidepressants (4)
|
Muscarinic blockade (dry mouth, constipation);
weak alpha-1 block (orthostatic hypotension); weak histamine block (sedation) |
|
|
Antidepressant associated with neuroleptic malignant syndrome
|
Amoxapine
A malignant antidepressant, a Mox on both your houses |
|
|
Antidepressant associated with seizures and cardiotoxicity
|
Maprotiline
seizing all over the map |
|
|
Antidepressant having stimulant effects similar to SSRI's and can increase blood pressure
|
Venlafaxine
|
|
|
Antidepressant inhibiting norepinephrine, serotonin, and dopamine reuptake
|
Venlafaxine
ven diagram - gets all three |
|
|
Antidepressant also used for sleep that causes priapism
|
trazodone
trazoBONE |
|
|
Antidepressant which is inhibitor of CYP450 enzymes and may be associated with hepatic failure
|
Nefazodone
|
|
|
Heterocyclic antidepressants least likely to affect sexual performance, used for management of nicotine withdrawal, SE's include dizziness, dry mouth, aggravation of psychosis, and seizures
|
Bupropion
|
|
|
Antidepressant with MOA as alpha 2 antagonist, has effects on both 5-HT and NE, blocks histamine receptors, and is sedating
|
Mirtazapine
|
|
|
SE of mirtazapine
|
Liver toxicity, increased serum cholesterol
Taz got a Fatty Liver |
|
|
Except for these agents all SSRI have significant inhibition of CytP450 enzymes
|
Citalopram and its metabolite escitalopram
|
|
|
Side effects frequently seen with SSRIs
|
CNS stimulation; GI upset
|
|
|
Antidepressants with no effect on BP, no sedation
|
SSRIs
|
|
|
SSRI with long T1/2 and can be administered once weekly for maintenance, not acute tx
|
Fluoxetine
|
|
|
SSRI indicated for premenstrual dysphoric disorder
|
Fluoxetine (Sarafem)
|
|
|
Some of SSRIs' therapeutic effects beside depression (5)
|
Panic attacks, social phobias, bulimia nervosa, and PMDD (premenstrual dysphoric disorder), OCD
|
|
|
SSRI less likely to cause a withdrawal syndrome
|
Fluoxetine
|
|
|
Inhibit synaptic activity of primary afferents and spinal cord pain transmission neurons
|
Ascending pathways
|
|
|
Activation of these receptors close Ca2+ ion channels to inhibit neurotransmitter release
|
Presynaptic mu, delta, and kappa receptors
|
|
|
Activation of these receptors open K+ ion channels to cause membrane hyperpolarization
(Targeted by opioids) |
Postsynaptic Mu receptors
|
|
|
Tolerance to all effects of opioid agonists can develop except (2)
|
Miosis and constipation
|
|
|
All opioids except this agent (which has a muscarinic blocking action) cause pupillary constriction
|
Meperidine
|
|
|
SE of these drugs include dependence, withdrawal syndrome, sedation, euphoria, respiratory depression nausea and vomiting, constipation, biliary spasm, increased ureteral and bladder tone, and reduction in uterine tone
|
Opioid Analgesics
|
|
|
Strong opioid agonists
|
Morphine, methadone, meperidine, and fentanyl
|
|
|
Opioids used in anesthesia
|
Morphine and fentanyl
|
|
|
Opioid used in the management of withdrawal states
|
Methadone
|
|
|
Opioid available trans-dermally
|
Fentanyl
|
|
|
Opioid that can be given PO, by epidural, and IV, which helps to relieve the dyspnea of pulmonary edema
|
Morphine
|
|
|
Use of this opioid with MAOI can lead to hyperpyrexic coma, and with SSRI's can lead to serotonin syndrome
|
meperidine (Demerol)
|
|
|
Moderate opioid agonists
|
Codeine, hydrocodone, and oxycodone
|
|
|
Weak opioid agonist, poor analgesic, its overdose can cause severe toxicity including respiratory depression, circulatory collapse, pulmonary edema, and seizures
|
Propoxyphene
|
|
|
Partial opioid agonist, considered a strong analgesic, has a long duration of action and is resistant to naloxone reversal
|
Buprenorphine
|
|
|
Opioid antagonist that is given IV and had short DOA
|
Naloxone
|
|
|
Opioid antagonist that is given orally in alcohol dependency programs
|
Naltrexone
|
|
|
These opioid agents are used as antitussive
|
Dextromethorphan, Codeine
|
|
|
These agents are used as antidiarrheal
|
Diphenoxylate, Loperamide
|
|
|
Abused Inhalant anesthetics (3)
|
NO, chloroform, and diethyl ether
|
|
|
Abused drugs: Toxic to the liver, kidney, lungs, bone marrow, peripheral nerves, and cause brain damage in animals, sudden death has occurred following inhalation (2)
|
Fluorocarbons and Industrial solvents
|
|
|
Abuse of theses cause dizziness, tachycardia, hypotension, and flushing
|
Organic nitrites
|
|
|
Causes acne, premature closure of epiphyses, masculinization in females, hepatic dysfunction, MI, and increases in libido and aggression
|
Steroids
|
|
|
Readily detected markers that may assist in diagnosis of the cause of a drug overdose include (7)
|
Changes in heart rate, blood pressure, respiration, body temperature, sweating, bowel signs, and pupillary responses
Vitals(4) + pupils, sweating and bowels |
|
|
Opioids most commonly abused by health care professionals (5)
|
Heroin, morphine, oxycodone, meperidine and fentanyl
|
|
|
This route is associated with rapid tolerance and psychologic dependence
|
IV administration
|
|
|
Leads to respiratory depression progressing to coma and death
|
Overdose of opioids
|
|
|
Lacrimation, rhinorrhea, yawning, sweating, weakness, gooseflesh, nausea, and vomiting, tremor, muscle jerks, and hyperpnea are signs of this syndrome
|
Abstinence syndrome
|
|
|
Treatment for opioid addiction
|
Methadone, followed by slow dose reduction
|
|
|
This agent may cause more severe, rapid and intense symptoms to a recovering addict
|
Naloxone
|
|
|
Sedative-Hypnotics action (3)
|
Reduce inhibition, suppress anxiety, and produce relaxation
|
|
|
Additive effects when Sedative-Hypnotics used in combination with these agents
|
CNS depressants
|
|
|
Common mechanism by which overdose result in death
|
Depression of medullary and cardiovascular centers
|
|
|
Date rape drug
|
Flunitrazepam (rohypnol)
|
|
|
The most important sign of withdrawal syndrome
|
Excessive CNS stimulation (seizures)
|
|
|
Treatment of withdrawal syndrome involves (4)
|
Long-acting sedative-hypnotic or a gradual reduction of dose, clonidine or propranolol
|
|
|
These abused agents are CNS depressants
|
Ethanol, Barbiturates, and Benzodiazepines
|
|
|
Withdrawal from this drug causes lethargy, irritability, and headache
|
Caffeine
|
|
|
W/D from this drug causes anxiety and mental discomfort
|
Nicotine
|
|
|
Treatments available for nicotine addiction (5)
|
Patches, gum, nasal spray, psychotherapy, and bupropion
|
|
|
Chronic high dose abuse of nicotine leads to (7)
|
Psychotic state,
overdose causes agitation, restlessness, tachycardia, hyperthermia, hyperreflexia, and seizures |
|
|
Tolerance is marked and abstinence syndrome occurs
|
Amphetamines
|
|
|
Amphetamine agents
|
Dextroamphetamines and methamphetamine
|
|
|
These agents are congeners of Amphetamine
|
DOM, STP, MDA, and MDMA "ecstasy"
|
|
|
Overdoses of this agent with powerful vasoconstrictive action may result in fatalities from arrhythmias, seizures, respiratory depression, or severe HTN (MI and stroke)
|
Cocaine "super-speed"
|
|
|
Most dangerous of the currently popular hallucinogenic drugs, OD leads to nystagmus, marked hypertension, and seizures, presence of both horizontal and vertical nystagmus is pathognomonic
|
PCP
|
|
|
Removal of PCP may be aided by what 3 things
|
Urinary acidification and activated charcoal or continual nasogastric suction
|
|
|
THC is active ingredient, SE's include impairment of judgment, and reflexes, decreases in blood pressure and psychomotor performance occur
|
Marijuana
|
|
|
This agent has greater affinity for muscarinic receptors and used for postoperative and neurogenic ileus and urinary retention
|
Bethanechol
|
|
|
Only direct acting agent that is very lipid soluble and used in glaucoma
|
Pilocarpine
|
|
|
This agent used to treat dry mouth in Sjögren's syndrome
|
Cevimeline
|
|
|
Indirect-Acting ACh Agonist, alcohol, short DOA and used in diagnosis of myasthenia gravis
|
Edrophonium
|
|
|
Carbamate with intermediate action, used for postoperative and neurogenic ileus and urinary retention
|
Neostigmine
|
|
|
Treatment of atropine overdose and glaucoma (because lipid soluable). Enters the CNS rapidly and has a stimulant effect, which may lead to convulsions
|
Physostigmine
|
|
|
Treatment of myasthenia gravis
|
Pyridostigmine
|
|
|
Antiglaucoma organophosphate
|
Echothiophate
|
|
|
Associated with an increased incidence of cataracts in patients treated for glaucoma
|
Long acting cholinesterase inhibitors
Long overdue for some cataracts |
|
|
Scabicide organophosphate
|
Malathion
|
|
|
Organophosphate anthelmintic agent with long DOA
|
Metrifonate
|
|
|
Toxicity of organophosphate:
|
DUMBELSS (diarrhea, urination, miosis, bronchoconstriction, excitation of skeletal muscle and CNS, lacrimation, salivation, and sweating)
|
|
|
The most frequent cause of acute deaths in cholinesterase inhibitor toxicity
|
Respiratory failure
|
|
|
The most toxic organophosphate
|
Parathion
|
|
|
Treatment of choice for organophosphate overdose
|
Atropine
|
|
|
This agent regenerates active cholinesterase and is a chemical antagonist used to treat organophosphate exposure
|
Pralidoxime
|
|
|
Prototypical drug is atropine
|
Nonselective Muscarinic Antagonists
|
|
|
Two agents used to treat manifestations of Parkinson's disease and EPS
|
Benztropine, trihexyphenidyl
|
|
|
Treatment of motion sickness (2)
|
Scopolamine, meclizine
|
|
|
Antimuscarinics that produce mydriasis and cycloplegia (3)
|
Atropine, homatropine, tropicamide
|
|
|
Anticholinergic causing bronchodilation in asthma and COPD
|
Ipratropium
|
|
|
Reduce transient hyper GI motility
|
Dicyclomine, methscopolamine
|
|
|
Anticholinergics used in cystitis, postoperative bladder spasms, or incontinence (2)
|
Oxybutynin, dicyclomine
cystitis - cyclomine |
|
|
Toxicity of anticholinergics
|
block SLUD (salivation, lacrimation, urination, defecation
|
|
|
Another mnemonic for anticholinergic toxicity
|
"dry as a bone, red as a beet, mad as a hatter, hot as a hare, blind as a bat"
|
|
|
Atropine fever is the most dangerous effect and can be lethal in this population group
|
Infants
|
|
|
Contraindications to use of atropine (3)
|
Infants, closed angle glaucoma, prostatic hypertrophy
|
|
|
Limiting adverse effect of ganglion blockade that patients usually are unable to tolerate
|
Severe hypertension
|
|
|
These agents cause reversal of blockade by neuromuscular blockers
|
Cholinesterase inhibitors
|
|
|
Tubocurarine is the prototype, pancuronium, atracurium, vecuronium are newer short acting agent, produce competitive block at end plate nicotinic receptor, causing flaccid paralysis
|
Nondepolarizing Neuromuscular Blockers
|
|
|
Only member of depolarizing neuromuscular blocker, causes fasciculation during induction and muscle pain after use; has short duration of action
|
Succinylcholine
|
|
|
Chemical antagonists that bind to the inhibitor of ACh Estrace and displace the enzyme (if aging has not occurred)
|
Cholinesterase regenerators, pralidoxime
|
|
|
Used to treat patients exposed to insecticides such as parathion
|
Pralidoxime, atropine
|
|
|
Pneumonic for beta receptors
|
You have 1 heart (Beta 1) and 2 lungs (Beta 2)
|
|
|
This is the drug of choice for anaphylactic shock
|
Epinephrine
|
|
|
Phenylisopropylamines that are used legitimately and abused for narcolepsy, attention deficit disorder, and weight reduction
|
Amphetamines
|
|
|
Alpha agonist used to produce mydriasis and reduce conjunctival itching and congestion caused by irritation or allergy, it does not cause cycloplegia
|
Phenylephrine
|
|
|
Newer alpha 2 agonist (apraclonidine and brimonidine) treat glaucoma by acting to
|
Reduce aqueous secretion
|
|
|
Short acting Beta 2 agonists that is drug of choice in treatment of acute asthma but not recommended for prophylaxis
|
albuterol
alBu2rol |
|
|
Longer acting Beta 2 agonist is recommended for prophylaxis of asthma
|
Salmeterol
|
|
|
These agents increase cardiac output and may be beneficial in treatment of acute heart failure and some types of shock
|
Beta1 agonists
|
|
|
These agents decrease blood flow or increase blood pressure, are local decongestants, and used in therapy of spinal shock (temporary maintenance of blood pressure which may help maintain perfusion
|
Alpha1 agonists
|
|
|
Shock due to septicemia or myocardial infarction is made worse by
|
Increasing afterload and tissue perfusion declines
|
|
|
Epinephrine is often mixed with a local anesthetic to
|
Reduce the loss from area of injection
|
|
|
Chronic orthostatic hypotension can be treated with this drug
|
Midodrine
|
|
|
Beta 2 agonist used to suppress premature labor, but cardiac stimulatory effects may be hazardous to mother and fetus
|
Terbutaline
|
|
|
Sympathetic agent which stimulates heart rate and can dilate vessels in skeletal muscle at low doses
|
Epinephrine
|
|
|
Sympathomimetic that works on mast cells to reduce release of histamine and inflammatory mediators
|
Epinephrine
|
|
|
Agent used in shock because it dilates coronary arteries and increases renal blood flow
|
Dopamine
|
|
|
Agent which stimulates cardiac contractile force more than rate with little effect on total peripheral resistance
|
Dobutamine
|
|
|
Long acting sympathomimetic, sometimes used to improve urinary continence in children and elderly with enuresis
|
Ephedrine
|
|
|
Alpha 1 agonist toxicity
|
Hypertension
|
|
|
Beta 1 agonist toxicity
|
Sinus tachycardia and serious arrhythmias
|
|
|
Beta 2 agonist toxicity
|
Skeletal muscle tremor, tachycardia
|
|
|
The selective agents loose their selectivity at
|
high doses
|
|
|
Nonselective alpha-blocking drug, long acting and irreversible, and used to treat pheochromocytoma. Blocks 5-HT, so occasionaly used for carcinoid tumor. Blocks H1 and used in mastocytosis
|
Phenoxybenzamine
|
|
|
Nonselective alpha-blocking drug, short acting and reversible, used for rebound HTN from rapid clonidine withdrawal, and Raynaud's phenomena
|
Phentolamine
|
|
|
Selective Alpha 1 blockers used for hypertension, BPH, may cause first dose orthostatic hypotension (3)
|
Prazosin, terazosin, doxazosin
|
|
|
Selective Alpha-1A blocker, used for BPH, but with little effect on HTN
|
Tamsulosin
|
|
|
Selective Alpha 2 blocker used for impotence (controversial effectiveness)
|
Yohimbine
|
|
|
Selective B1 Receptor blockers that may be useful in treating patients even though they have asthma
|
Acebutolol, atenolol, esmolol, metoprolol
|
|
|
Combined alpha and beta blocking agents that may have application in treatment of CHF
|
Labetalol and carvedilol
|
|
|
Beta blockers with partial agonist activity (intrinsic sympathomimetic activity), cause some bronchodilation and may have an advantage in treating patients with asthma (2)
|
Pindolol and acebutolol
|
|
|
This beta blocker lacks local anesthetic activity (a property which decreases protective reflexes and increases the risk of corneal ulceration) and used in treating glaucoma
|
Timolol
|
|
|
This parenteral beta blocker is a short acting (minutes)
|
Esmolol
|
|
|
This beta blocker is the longest acting
|
Nadolol
|
|
|
These beta blockers are less lipid soluble
|
Acebutolol and atenolol
|
|
|
This beta blocker is highly lipid soluble and may account for side effects such as nightmares
|
Propranolol
|
|
|
Clinical uses of these agents include treatment of HTN, angina, arrhythmias, chronic CHF, and selected post MI patients
|
Beta blockers
|
|
|
Toxicity of these agents include bradycardia, AV blockade, exacerbation of acute CHF; signs of hypoglycemia may be masked (tachycardia, tremor, and anxiety)
|
Beta blockers
|
|
|
Cholinomimetics that increase outflow, open trabecular meshwork, and cause ciliary muscle contraction (3)
|
Pilocarpine, carbachol, physostigmine
PCP |
|
|
Nonselective alpha agonists that increases outflow, probably via the uveoscleral veins (2)
|
Epinephrine, dipivefrin
uveosclero - vefrine |
|
|
Selective alpha agonists that decreases aqueous secretion (2)
|
Apraclonidine, brimonidine
|
|
|
These Beta blockers decrease aqueous secretion
|
Timolol (nonselective), betaxolol (selective)
|
|
|
This diuretic decreases aqueous secretion due to lack of HCO3- ion. Causes drowsiness and paresthesias, alkalinization of the urine may precipitate calcium salts, hypokalemia, acidosis
|
Acetazolamide
|
|
|
This prostaglandin causes increased aqueous outflow
|
Prostaglandin PGF2a
|
|
|
Inhibit angiotensin-converting enzyme (ACE)
|
ACE inhibitors
|
|
|
Captopril and enalapril (-OPRIL ending) are
|
ACE inhibitors
|
|
|
SE of ACE inhibitors (2)
|
Dry cough, hyperkalemia
|
|
|
ACE inhibitors are contraindicated in (2)
|
pregnancy and with K+
|
|
|
Losartan and valsartan block
|
Angiotensin receptor
|
|
|
Angiotensin receptor blockers do NOT cause
|
Dry cough
|
|
|
Agents that block L-type calcium channel
|
Calcium channel blockers
|
|
|
CCB contraindicated in CHF
|
Verapamil
|
|
|
CCB with predominate effect on arteriole dilation
|
Nifedipine
|
|
|
SE of CCB (3)
|
Constipation, edema, and headache
|
|
|
Agents that reduce heart rate, contractility, and O2 demand
|
Beta-blockers
|
|
|
Subset of B-blockers that are more cardioselective
|
Beta-1 selective blockers
|
|
|
Cardioselective Beta 1-blockers
|
Atenolol, acebutolol, and metoprolol
|
|
|
Beta-blockers should be used cautiously in (3)
|
Asthma (bronchospastic effects),
diabetes (block signs of hypoglycemia) and peripheral vascular disease |
|
|
Non-selective Beta-blocker also used for migraine prophylaxis
|
Propranolol
|
|
|
SE of beta blockers (4)
|
Bradycardia, SEXUAL DYSFUNCTION,
decrease in HDL, and increase in Triglycerols (TG) |
|
|
Alpha 1selective blockers (3)
|
Prazosin, terazosin and doxazosin (-AZOSIN ending)
|
|
|
Non-selective alpha1 blocker used to treat pheochromocytoma
|
Phenoxybenzamine
|
|
|
For rebound HTN from rapid clonidine withdrawal
|
Phentolamine
|
|
|
A1a-selective blocker with no effects on HTN used for BPH
|
Tamsulosin (Flomax)
|
|
|
SE of alpha blockers
|
Orthostatic hypotension (especially with first dose) and reflex tachycardia
|
|
|
Presynaptic Alpha 2 agonists used in HTN, and acts centrally (2)
|
Clonidine, and methyldopa
|
|
|
SE of methyldopa (2)
|
Positive Comb's test, depression
|
|
|
Methyldopa is contraindicated in
|
Geriatrics due to its CNS (depression) effects
|
|
|
SE of clonidine (3)
|
Rebound HTN, sedation, dry mouth
|
|
|
Direct vasodilator of arteriolar smooth muscle
|
Hydralazine
|
|
|
SE of hydralazine
|
Lupus-like syndrome
|
|
|
Arterial vasodilator that works by opening K+ channels
|
Minoxidil
|
|
|
SE of minoxidil
|
Hypertrichosis
|
|
|
IV Drug used Hypertensive Crisis
|
Nitroprusside
|
|
|
Nitroprusside vasodilates
|
Arteries and veins
|
|
|
Toxicity caused by nitroprusside and treatment
|
Cyanide toxicity treated with sodium thiosulfate
|
|
|
Carbonic anhydrase inhibitor
|
Acetazolamide
|
|
|
Diuretic used for mountain sickness and glaucoma
|
Acetazolamide
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SE of acetazolamide (5)
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Paresthesias, encephalopathy in patients with hepatic impairment,
acidosis, alkalinization of the urine (which may ppt. Ca salts), and hypokalemia |
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MOA of loop diuretics
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inhibits Na+/K+/2Cl- cotransport
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Site of action of loop diuretics
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Thick ascending limb
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SE of loop (furosemide) diuretics (3)
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Hyperuricemia, hypokalemia and ototoxicity
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Aminoglycosides used with loop diuretics potentiate adverse effect
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Ototoxicity
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Loops lose and thiazide diuretics retain
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Calcium
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MOA of thiazide diuretics
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Inhibit Na+/Cl- cotransport
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Site of action of thiazide diuretics
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Work at early distal convoluted tubule
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Class of drugs that may cause cross-sensitivity with thiazide diuretics
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Sulfonamides
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SE of thiazide (HCTZ) diuretics (3)
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Hyperuricemia, hypokalemia and hyperglycemia
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Potassium sparing diuretics inhibit
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Na+/K+ exchange
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Diuretic used to treat primary aldosteronism
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Spironolactone
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SE of spironolactone (3)
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Gynecomastia, hyperkalemia, and impotence
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Osmotic diuretic used to treat increased intracranial pressure
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Mannitol
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ADH agonist used for pituitary diabetes insipidus
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Desmopressin (DDAVP)
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Used for SIADH
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Demeclocycline
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SE of demeclocycline
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Bone marrow and teeth discoloration for children under 8 years of age
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MOA of class I A (eg. Procainamide), class IB (eg. Lidocaine), and class IC (eg. Flecainide) antiarrhythmics
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Sodium channel blockers
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SE of procainamide
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Lupus-like syndrome
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Limiting side effect of Quinidine
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Prolongs QT interval
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Other side effects of Quinidine (2)
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Thrombocytopenic purpura, and CINCHONISM
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Major drug interaction with Quinidine
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Increases concentration of Digoxin
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DOC for management of acute ventricular arrhythmias
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Amiodarone
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DOC for digoxin induced arrhythmias
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Phenytoin
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SE of phenytoin
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Gingival hyperplasia
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Class of anti-arrhythmics that has a pro-arrhythmic effect (CAST trial), therefore are used as last line agents
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Class IC (flecainide, propafenone, moricizine)
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Class II antiarrhythmics are
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B-blockers
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Antiarrhythmic that exhibits Class II and III properties
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Sotalol
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Side effect of sotalol
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prolongs QT and PR interval
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Used intravenously for acute arrhythmias during surgery
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Esmolol
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Anti-arrhythmics that decrease mortality
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B-blockers
B savin your life |
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MOA of class III antiarrhythmics
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Potassium channel blockers
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Class III antiarrhythmic that exhibits properties of all 4 classes
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Amiodarone
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Specific pharmacokinetic characteristic of amiodarone
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Prolonged half-life, up to six weeks
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Antiarrhythmic effective in most types of arrhythmia
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Amiodarone
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SE of Amiodarone (6)
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Cardiac dysfunction,
photosensitivity, skin (blue smurf syndrome), Pulmonary fibrosis, thyroid and corneal deposits |
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MOA of class IV antiarrhythmics
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Calcium channel blockers
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Life threatening cardiac event that prolong QT leads to
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Torsades de pointes
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Agent to treat torsades de pointes
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Magnesium sulfate
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Drug used supraventricular arrhythmias
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Digoxin
|
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DOC for paroxysmal supraventricular tachycardia (PSVT)
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Adenosine
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Adenosine's MOA
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Activation on an inward K+ current and inhibition of Ca++ current resulting in marked HYPERPOLARIZATION
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Anti-arrhythmic with 15 second duration of action
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Adenosine
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MOA of sildenafil (Viagra)
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Inhibits phosphodiesterase-5, enhancing effects of nitric oxide-activated increases in cGMP
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Drugs used in the management of angina (4)
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Aspirin, Nitrates, CCB, and Beta blockers
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Aspirin reduces mortality in unstable angina by
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Platelet aggregation inhibition
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MOA of nitrates (3 parts)
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Relax vascular smooth muscle,
at low doses dilate veins and at high doses dilate arterioles |
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Nitrate used for acute anginal attacks
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Nitroglycerin sublingual tablets
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Nitrate used to prevent further attacks
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Oral and transdermal forms of nitroglycerin
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Nitrate free intervals are needed due to
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Decrease Tolerance
|
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SE of nitrates (4)
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Postural hypotension, reflex tachycardia,
hot flashes, and throbbing headache due to meningeal artery dilation |
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CCB are DOC for
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Prinzmetal's angina
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Beta blockers are used for which type of anginal attack
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Classic
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MOA of Cardiac glycosides (eg. digoxin)
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Indirectly increase intracellular calcium and cardiac contractility by inhibiting Na+/K+ ATPase
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Digoxin is used in (2)
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Atrial fibrillation and CHF
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Digoxin toxicity can be precipitated by
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Hypokalemia
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Antidote for digoxin toxicity
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Digibind
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Phosphodiesterase inhibitors that increase mortality and have been found to have NO beneficial effects (2)
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Amrinone and milrinone
Amir's Mill benefits None |
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SE of amrinone
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Thrombocytopenia
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Beta 1 agonists used in acute CHF
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Dobutamine and dopamine
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Diuretics work in CHF by
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Reducing preload
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Beta blockers work in CHF by
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Reducing progression of heart failure (never use in acute heart failure)
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Peptide drug used to treat CHF
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Nesiritide (BNP)
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MOA of nesiritide
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Increasing sodium excretion and decreases arterial and venous tone
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SE of nesiritide (2)
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Excessive hypotension and kidney failure
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"Nephiritide"
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Agent used in CHF that is a selective alpha and nonselective beta blocker
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Carvedilol
|
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Agent used in acutely decompensated CHF resembling natriuretic peptide
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Nesiritide (Natrecor)
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Vitamin K dependent anticoagulant
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Warfarin (PT)
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Warfarin is contraindicated in
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Pregnancy
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Anticoagulant of choice in pregnancy
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Heparin
|
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Heparin (PTT) increases activity of
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Antithrombin 3
|
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Route of administration of warfarin
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Oral
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Routes of administration of heparin
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IV and IM (only LMW)
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SE of both warfarin and heparin
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Bleeding
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SE of heparin
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Heparin induced thrombocytopenia (HIT)
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Alternative anticoagulant used if HIT develops
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Lepirudin
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Antidote to reverse actions of warfarin
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Vitamin K or fresh frozen plasma
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Antidote to reverse actions of heparin
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Protamine sulfate
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MOA of aspirin
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Irreversibly blocking cyclooxygenase
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Agents used to treat MI and to reduce incidence of subsequent MI (2)
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Aspirin, metoprolol (Lopresor)
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SE of Aspirin
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GI bleeding
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Antiplatelet drug reserved for patients allergic to aspirin
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Ticlopidine
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SE for ticlopidine (2)
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Neutropenia and agranulocytosis
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Effective in preventing TIA's (2)
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Clopidogrel and ticlopidine
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Prevents thrombosis in patients with artificial heart valve
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Dipyridamole
think: valve is upside down pyramid |
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Block glycoprotein IIb/IIIa involved in platelet cross-linking (3)
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Abciximab, tirofiban and eptifibatide
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MOA of thrombolytics
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Degradation of fibrin clots and are administered IV
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Thrombolytics are used for (2)
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Pulmonary embolism and DVT
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Thrombolytic that can cause allergic reaction
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Streptokinase
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Thrombolytic used for acute MI and ischemic (non hemorrhagic) CVA
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Tissue plasmin activator
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SE of tPA
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Cerebral hemorrhage
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Antidote for thrombolytics
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Aminocaproic acid
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Agent to treat hypochromic microcytic anemias
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Ferrous sulfate
|
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Chelating agent used in acute iron toxicity
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Deferoxamine
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Agent for pernicious anemia
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Cyanocobalamin (Vit B12)
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Agent used for neurological deficits in megaloblastic anemia
|
Vitamin B12
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Agent used for megaloblastic anemia (but does NOT reverse neurologic symptoms) and decrease neural tube defects during pregnancy
|
Folic acid
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Agent used for anemias associated with renal failure
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Erythropoietin
|
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Agent used neutropenia especially after chemotherapy
|
G-CSF (filgrastim) and GM-CSF (sargramostim)
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Treatment of patients with prior episodes of thrombocytopenia after a cycle of cancer chemotherapy
|
Interleukin 11 (oprelvekin)
|
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Drugs decrease intestinal absorption of cholesterol
|
Bile acid-binding resins
|
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Cholestyramine and colestipol are
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Bile acid-binding resins
|
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Major nutritional side effect of bile acid-binding resins
|
Impair absorption of fat soluble vitamin absorption (A,D,E,K)
|
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MOA of lovastatin (STATIN)
|
inhibits HMG COA reductase
|
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HMG CoA reductase inhibitors are contraindicated in
|
Pregnancy
|
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MOA of drug or foods (grapefruit juice) that increase statin effect
|
Inhibit Cytochrome P450 3A4
|
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SE of HMG COA reductase inhibitors (2)
|
Rhabdomyolysis and Hepatotoxicity
|
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Monitoring parameter to obtain before initiation of STATINS
|
LFT's
|
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Decreases liver triglycerol synthesis
|
Niacin
|
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SE of niacin
|
Cutaneous flush
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Cutaneous flush and be reduced by pretreatment with
|
Aspirin
|
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Fibrates (gemfibrozil) increase activity of
|
Lipoprotein lipase
|
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Most common SE of fibrates
|
Nausea
|
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Fibrates are contraindicated in
|
Pregnancy
|
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Concurrent use of fibrates and statins increases risk of
|
Rhabdomyolysis
|
|
|
New class of drugs that works by inhibiting absorption of intestinal cholesterol and can be given concurrently with the Statins
|
Ezetimibe (Zetia)
|
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MOA of NSAIDS
|
inhibit prostaglandin synthesis by inhibiting cyclo-oxygenase (cox)
|
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Difference between aspirin and other NSAIDS
|
Aspirin irreversibly inhibits cyclooxygenase
|
|
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Four main actions of NSAIDS
|
Anti-inflammatory, analgesia, antipyretic and antiplatelet activity
|
|
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Agent used for closure of patent ductus arteriosus
|
Indomethacin
|
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Aspirin is contraindicated in children with viral infection
|
Potential for development of Reye's syndrome
|
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SE of salicylates (2)
|
Tinnitus, GI bleeding
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NSAIDs also available as an ophthalmic preparation (2)
|
Diclofenac, ketoralac
|
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|
NSAID available orally, IM and ophthalmically
|
Ketoralac
|
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|
NSAID that is used for acute condition, such as pre-op anesthesia and has limited duration (<5 days) of use due to nephrotoxicity
|
Ketoralac
|
|
|
Newer NSAID that selectively inhibits COX-2
|
Celecoxib
|
|
|
COX 2 inhibitors may have reduced risk of (2)
|
Gastric ulcers and GI Bleeding
|
|
|
COX 2 inhibitors should be used cautiously in pts with
|
Pre-existing cardiac or renal disease
|
|
|
Acetaminophen only has
|
Antipyretic and analgesic activity
|
|
|
SE of acetaminophen
|
Hepatotoxicity
|
|
|
Antidote for acetaminophen toxicity
|
N-acetylcysteine
|
|
|
DMARDs are slow acting drugs for
|
Rheumatic disease
|
|
|
Initial DMARD of choice for patients with RA
|
Methotrexate
|
|
|
Drug ofter used in combination with TNF - alpha inhitors for RA
|
Methotrexate
|
|
|
DMARD that causes bone marrow suppression
|
Methotrexate
|
|
|
SE of penicillamine
|
Aplastic anemia and renal toxicity
|
|
|
Interferes with activity of T-lymphocytes
|
Hydroxychloroquine
|
|
|
Anti-malarial drug used in rheumatoid arthritis (RA)
|
Hydroxychloroquine
|
|
|
SE of hydroxychloroquine (2)
|
Retinal destruction and dermatitis
think of blind man with itchy skin and malaria |
|
|
MOA of Leflunomide (newer agent)
|
Inhibiting dihydroorotate dehydrogenase which leads to
decreased pyrimidine synthesis, decreased T cell proliferation and decreased antibody production by B cells |
|
|
Proteins that prevent action of tumor necrosis factor alpha (TNF-alpha)
|
Adalimumab, infliximab and etanercept
|
|
|
Anti-rheumatic agent also used for ulcerative colitis
|
Sulfasalazine
|
|
|
Anti-rheumatic agent also used for Chron's disease
|
Infliximab
|
|
|
NSAID used in gout
|
Indomethacin
|
|
|
NSAID contraindicated in gout
|
Aspirin
|
|
|
MOA of colchicine (used in acute gout)
|
Selective inhibitor of microtubule assembly
|
|
|
SE of colchicine
|
Kidney and liver toxicity, diarrhea
|
|
|
Agents used to treat chronic gout by increasing uric acid secretion and excretion (2)
|
Probenecid and sulfinpyrazone
|
|
|
Allopurinol treats chronic gout by decreasing uric acid production by inhibiting
|
Xanthine oxidase
|
|
|
Rapid acting insulins that do not self-aggregate (3)
|
lispro insulin, aspart insulin, glulisine insulin
|
|
|
Peakless long acting insulin
|
Insulin glargine
|
|
|
DOC for paroxysmal supraventricular tachycardia; has high efficacy and short duration of action
|
Adenosine
|
|
|
**not a required one liner***
SE of methimazole |
Agranulocytosis
this was on the Kaplan Comlex Q bank |
|
|
*** not a required one liner ***
DOC for benign essential tremor and alternative drug used if pt has asthma. |
propranolol
primidone |
|
|
***Not a required oneliner***
DOC for Loa Loa, Wucheria bancrofti, Toxocara canis |
diethylcarbamazine
|
|
|
***Not a required oneliner***
DOC for T.solium and D.latum |
praziquantel
|
|
|
***Not a required oneliner***
DOC for Onchcerca volvulus |
ivermectin
|
|
|
***Not a required oneliner***
DOC for most nematodes (ie Enterobius, Ascaris, Trichinella, Strongyloides, Ancylostoma, Necator) |
mebendazole
|
|
|
***Not a required oneliner***
DOC for Schistosoma, Clonorchis sinensis [trematodes] |
praziquantel
|
|
|
***Not a required oneliner***
1st generation cephalosporins cover |
PEcK
Proteus, E. Coli, Klebsiella and gram+ cocci |
|
|
***Not a required oneliner***
2nd generation cephalosporins cover |
HEN PEcKS
Haemophilus, Enterobacter, Neisseria, Proteus, E.coli, Klepsiella, Serratia and gram+ cocci |
|
|
***not a required one liner***
affective for both atrial and ventricular arrhythmias, especially re-entrant and ectopic SVT and VT. |
Quinidine, Procainamide, Disopyramide - Class 1A
|
|
|
***not a required one liner***
Useful in acute ventricular arrhythmias (especially post MI) and in digitalis induced arrhythmias |
Lidocaine, Mexileteine Tocainide - Class 1B
|
|
|
***not a required one liner***
Useful in VT that progress to Vfib and in intractable SVT. Usually used as last resort in refractory tachyarrhythmias |
Flecainide, Encainide, Propafenone - Class 1C
|
|
|
***not a required one liner***
Toxicity of Class 1A AARs (Q,P,D) |
cinchonism(Q); torsade due to increasd QT interval; SLE (P)
|
|
|
***not a required one liner***
Toxicity of Class 1B AARs (L,M,T) |
local anesthesisa, CNS stim/depr, CV depr
|
|
|
***not a required one liner***
Toxicity of Class 1C AARs (F,E,P) |
proarrhythmic (especially post MI), significantly prolongs refractory period in AV node
|
|
|
***not a required one liner***
Used for VT, SVT, slowing ventricular rate during Afib and Aflut |
Class 2 (Beta blockers)
|
|
|
***not a required one liner***
Toxicity of class 2 AARs (B-blockers) |
impotence, asthma exacerbation, bradycardia, AV block, may mask hypoglycemia, CNS (sedation, sleep alteration)
|
|
|
***not a required one liner***
These are the Class 3 AARs (SIBDA) |
sotalol, ibutilide, bretyliuum, dofetilide, amiodarone
|
|
|
***not a required one liner***
what to check when using amiodarone |
PFT, LFT, TFT
|
|
|
***not a required one liner***
toxicity of sotalol |
torasade
|
|
|
***not a required one liner***
these suppress abnormal pacemakers by decreasing the slope if phase 4 (AV node particularly sensitive leading to increased PR interval) |
Class 2 (Beta blockers)
|
|
|
***not a required one liner***
These AARs INCREASE AP duration as well as increase ERP. Used when other antiarrhthymics fail. Cause increased QT interval |
Class 3 (K blockers) SIBDA
|
|
|
***not a required one liner***
these AARs primarily affect AV nodal cells. They decrease conduction velocity, increase ERP, increase PR. They're used in the prevention of nodal arhythmias |
class 4 (Ca blockers) VD
|
|
|
***not a required one liner***
toxicity of diltiazem, verapamil |
constipation, flushing, edema, CHF, Avblock, sinus node depression
|
|
|
***not a required one liner***
DOC for DC/TX SVT, very short acting, effects blocked by theophyline |
adenosine
|
|