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616 Cards in this Set
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MOA mannitol
|
creates an osmotic diuresis because it can't leave the tubule
inhibits Na and Cl reabsorption in PC and ascendin loop |
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|
clinical uses of mannitol
|
to decrease intractranial pressure or intraocular pressure through volume depletion
|
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side effects of mannitol
|
can cause pulmonary edema d/t extracellular volume expansion, pulling water out of cells
hypernatremia |
|
|
contraindications of mannitol
|
CHF
pulmonary edema anuria severe renal failure severe dehydration |
|
|
how is mannitol administered?
|
parenterally (poorly absorbed PO)
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MOA spironolactone
|
K sparing diuretic, antagonizes aldosterone in the DCT, inhibiting Na reabsorption
|
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what effect does spironolactone have on Ca
|
decreases serum Ca levels by directly inhibiting its transport in the DCT
|
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clinical uses of spironolactone
|
HTN
pulmonary edema edema from CHF or cirrhosis, nephrotic syndrome primary hyperaldosteronism |
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side effects of spironolactone
|
gynecomastia (and other anti-androgenic effects)
hyperkalemia hyponatremia hypochlroemic acidosis (blocks aldosterone's effect on Na/H antiporter) |
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MOA amiloride
|
K sparing diuretic, directly inhibits Na reabsorption, independent of aldosterone
increased Ca reabsorption |
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uses of amiloride
|
treats ca stones
|
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differences between amiloride and triampterene?
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MOA similar, but triampterene has shorter t1/2
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MOA furosemide
|
loop diuretic, blocking NKCC
increased urinary excretion of K, Mg, Ca increases RBF without altering GFR |
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clinical uses for furosemide
|
edema
to increase urine output in ARF (although it doesn't alter the course of ARF) hypercalcemia hyperkalemia |
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side effects of furosemide
|
K wasting
metabolic alkalosis Mg depletion ototoxicity hyperuricemia |
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why does hyperuricemia result from furosemide use?
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increases urate reabsorption d/t increased proximal Na reabsorption
|
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contraindication of furosemide
|
sulfa allergy
|
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which is the only loop diuretic without a sulfa group?
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ethacrynic acid
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MOA HCTZ?
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block NaCl transport at the DCT
Enhanced Ca reaborption (because Na and Ca compete for ATP dependent reabsorption at DCT) |
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clinical uses of HCTZ?
|
HTN
edema DI (by inducing mild volume depletion) to stop recurrent renal calcium stones |
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contraindication of HCTZ
|
sulfa allergy
|
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side effects of HCTZ
|
hyperglycemia
hyperlipidemia hyperuricemia hypercalcemia melabolic alkalosis Mg depletion |
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MOA acetazolamide
|
Carbonic anhydrase inhibitor
so it inhibits the reabsorption of HCO3- in PCT also CA is in ciliary body of eye and in choroid plexus cells, so it decreases aqueous humor production and increases CSF production |
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uses for acetazolamide
|
acute altitude sickness
glaucoma treatment for alkalosis facilitate eexcretion of weak acid (as seen in tumor lysis syndrome) |
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side effects of acetazolamide
|
encephalopathy (from decreased excretion of NH3 in urine)
renal stones b/c calcium phosphate is less soluble in alkaline urine hyperchloremic metabolic acidosis |
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contraindications of acetazolamide
|
sulfa allergy
hepatic or renal dz hyperchloremic acidosis hyponatremia hypokalemia |
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what effect does furosemide have on the following serum levels:
K HCO3 Ca Mg urate |
decreased
increased decreased decreased increased |
|
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what effect does thiazide have on the following serum levels:
K HCO3 Ca Mg urate |
decrease
increase increased decreased increased |
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what effect does spironolactone have on the following serum levels:
K HCO3 Ca Mg urate |
increased
decreased decreased none none |
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what effect does amiloride have on the following serum levels:
K HCO3 Ca Mg urate |
increased
decreased increased none none |
|
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what effect does acetazolamide have on the following serum levels:
K HCO3 Ca Mg urate |
decreased
decreased none none none |
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which diuretics decrease Mg?
|
furosemide
HCTZ |
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which diuretics increase urate?
|
furosemide
HCTZ |
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contraindication of spironolactone
|
acute renal failure
|
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MOA nitroprusside
|
vasodilation of arteries and veins
contact with RBC --> decomposition of drug and release of NO NO, via activation of guanylate cyclase --> vasodilation |
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clinical uses of nitroprusside
|
HTN crisis
aortic dissection (must be given with B blocker) CHF |
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side effects of nitroprusside
|
hypotension
reflex tachy CN release |
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contraindications for nitroprusside
|
known inadequate cerebral circulation
hepatic/renal dz (increases thiocyanate toxicity) |
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MOA nitroglycerine
|
via guanylate cyclase --> increase cGMP which activates cAMP protein dependent kinases and leads to dephosphorylation of myosin light chains and decreased intracellular Ca
--> relaxation of veins and increased venous capacitance |
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uses of nitroglyceride
|
treats angina (decresae coronary asospasm)
CHF HTN |
|
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side effects of nitroglycerine
|
hypotension, tachycardia, throbbing HA from meningeal arterial dilation
|
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MOA captopril
|
ACE inhibitor
blocks formation of AII and degradation of bradykinin so, inhibits constriction of efferent arteriole, and potentiates vasodilation caused by bradykinin also causes venous vasodilation |
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uses of captopril
|
HTN
CHF ischemic heart disease decreases proteinuria and progression of nephropathy in diabetics |
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side effects of captopril
|
cough from increased bradykinin
can cause renal insufficiency b/c GFR is not increased in low volume states |
|
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contraindications of captopril
|
renal insufficiency
bilateral renal artery stenosis |
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MOA losartan
|
AII receptor blocker
|
|
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uses of losartan
|
HTN
CHF |
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side effects of losartan
|
no cough
can't maintain GFR by vasodilation of efferent arterioles |
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MOA milrinone
|
inhibits PDE III --> dilation of arteries and veins
PDE III inactivates cAMP, so this process is inhibited --> increased Ca reflux in myocardium, with increased cardiac contractility |
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uses of milrinone
|
refractory CHF
can increase mortality, and should ONLY be used if diuretics, digoxin, and vasodilators have failed a-fib |
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side effects of milrinone
|
ventricular arrhythmias
hypotension hepatotoxicity |
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MOA sildenafil
|
blocks PDE V action (thus potentiating the action of cGMP dependent kinases that activate phosphatases that encourage the relaxation of smoooth muscle)
also decreases the Ca concnetration --> smooth muscle relaxation |
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MOA digoxin
|
blocks the Na-K pump --> increased Na intracellularly
this inhibits the Na concentration gradient from forming, blocking the Ca from leaving the cells this improves cardiac contractility also slows the conduction through AV node |
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uses of digoxin
|
CHF
a fib, a flutter (slows conduction throuh AV nodE) |
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side effects of digoxin
|
narrow therapeutic window
visual disturbances, nausea, blurred vision a-tac and AV block can result |
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contraindication of digoxin
|
hypokalemia
2nd/3rd degree heart block WPW who develop a-fib --> increased impulses through accessory pathway --> VF |
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|
what abnormalities can be seen on the EKG on a person taking digoxin
|
incresaed PR, decreased QT, scooping of ST segments, T wave inersion
|
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MOA phenytoin
|
increases na channel inactivation
|
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MOA carbamazepine
|
increases na channel inactivation
|
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MOA lamotrigine
|
blocks voltage gated na channels
|
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MOA gabapentin
|
increases GABA release
|
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MOA topiramate
|
blocks na channels, incresaes GABA release
|
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MOA phenobarbital
|
increases GABA
|
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MOA valproic acid
|
increases GABA, blocks na channels
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MOA ethosuxamide
|
blocks ca channels in thalamus
|
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MOA benzos
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increases GABA
|
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uses for phenytoin
|
everything but absence seizures
status epilepticus proph |
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usees for lamotrigine
|
everything but absence and status
|
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uses for carbamazepine
|
everything but absence and status
|
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uses for gabapentin
|
all seizures except absence and status
peripheral neuropathy |
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uses for topirimate
|
everything but absence and status
|
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uses for phenobarbital
|
everything but absence and status
|
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uses for valproic acid
|
everything but status
|
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uses for ethosuxamide
|
absence
|
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uses for benzos in epilepsy
|
acute status
|
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which anti-epileptic drugs are 1st line in pregnancy and children
|
phenobarbital
|
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which epi drug is 1st line for trigeminal neuralgia
|
carbamazepine
|
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which drug is used to treat peripheral neuropathy
|
gabapentin
|
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which drug is used to treat myoclonic seizures
|
valproic acid
|
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which drug is used to treat seizures in eclampsia
|
MgSO4 (1st line)
benzos |
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which epileptic drug --> sedation, tolerance, and dependence?
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benzos
|
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which epileptic drug --> aplastic anemia, liver toxicity, and teratogenesis?
|
carbamazepine
|
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which epileptic drug --> diplopia, ataxia?
|
carbamazepine
phenytoin |
|
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which epileptic drug --> GI distress, lethargy, headache?
|
ethosuxamide
|
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which epileptic drugs --> stevens johnson syndrome
|
ethosuxamide
lamotragine |
|
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which epileptic drug --> nystagmus, gingival hyperplasia, hirsutism?
|
phenytoin
|
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which epileptic drug --> SLE like sydnrome
|
phenytoin
|
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which epi drug --> spina bifida and other NTDs
|
valproic acid
|
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which epi drug --> kidney stones
|
topiramate
|
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which epilepsy drug --> malignant hyperthermia?
|
phenytoin
|
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how do you treat OD of barbiturates?
|
symptom management
|
|
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how do you treat OD of benzos?
|
flumazenil (competitive antagonist at GABA receptor)
|
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other than for epilepsy, what can phenytoin be used for?
|
anti-arrhythmic
|
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which is more dangerous in overdose: benzos or barbiturates?
|
barbiturates (longer t1/2 and more respiratory/cv depression)
|
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MOA l-dopa
|
l dopa crosses bbb (dopamine doesn't) so it is converted to dopamine by dopa decarboxylase in cns
|
|
|
carbidopa
|
peripheral decarboxylase inhibitor in order to increase bioavailability in brain and decrease peripheral side effects (since the conversion to da won't occur peripherally)
|
|
|
toxicity of l-dopa?
|
arrhythmias from peripheral conversion of DA
dyskinesia following lt admin akinesia between doses |
|
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MOA selegiline
|
selectively inhibits MAO-B, increasing availability of DA
|
|
|
use of selegiline
|
adjunctive to l-dopa in parkinsons
|
|
|
toxicityy of selegeliene
|
enhances l-dopa toxicity
|
|
|
MOA sumatriptan
|
5-HT1D agonst
--> vasoconstriction |
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use of sumatriptan
|
acute migraine
cluster headache attacks |
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what type of drug is bethanechol?
|
direct cholinergic agonist
|
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what type of drug is carbechol
|
direct cholinergic agonist
|
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what type of drug is pilocarpine
|
direct cholinergic agonist
|
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what type of drug is methacholine
|
direct cholinergic agonist
|
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|
what is the difference between direct cholinergic agonsts and indirect?
|
direct directly stimulate cholinergic receptors and indirect inhibit their breakdown via AChE
|
|
|
uses of bethanechol
|
activates bladder and bowel smooth muscle (used post-op for ileus adn urinary retention)
|
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uses of carbechol
|
glaucoma
pupillary contraction release of intraocular pressure |
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uses of pilocarpine
|
potent stimulator for saliva, sweat, and tears
|
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uses of methacholine
|
challenge test for asthma dx
|
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action of methacholine
|
stimulates muscarinic receptors in airway
|
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class: neostigmine
|
indirect cholinomimetic
|
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class pyrodostigmine
|
indirect cholinomimetic
|
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class: edrophonium
|
indirect cholinomimetic
|
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class: physostigmine
|
indirect cholinomimetic
|
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class: echothiophate
|
indirect cholinomimetic
|
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|
uses for neostigmine
|
post-op and neurogenic ileus and urinary retention
MG reversal of NM junction blockade |
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uses for pyridostigmine
|
MG
|
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uses for edrophonium
|
to dx MG
|
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uses for physostigmine
|
glaucoma and atropine OD
|
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uses for echothiophate
|
glaucoma
|
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which indirect ACh agonist penetrates CNS
|
physostigmine
|
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|
what are the symptoms of organophosphate poisoning
|
DUMBBELSS
Diarrhea Urination Miosis Bradycardia Bronchospasm Excitation of skel muscle Lacrimation Sweating Salivation |
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antidote to organophosphate poisoning
|
atropine + pralidoxime
|
|
|
what is pralidoxime
|
antagonist used to regenerate active cholinesterase
|
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MOA of epi in tx of glaucoma
|
increases outflow of aqueous humor
|
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MOA brimonidine in tx of glaucoma
|
(alpha agonist)
decreases aqueous humor synth |
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MOA beta blockers in tx of glaucoma
|
decreases aqueous humor secretion
|
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MOA acetazolamide in tx of glaucoma
|
decreas aqueous humor secretion d/t decreaed HCO3
|
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MAO cholinomimetics in tx of glaucoma
|
increased outflow of aqueous humor
|
|
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which drug should be used in a glaucoma emergency
|
pilocarpine (direct ACh mimetic)
|
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MOA latanoprost in tx of glaucoma
|
PGF-alpha, increases outflow of aqueous humor
|
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|
which glaucoma drugs decrease the synth of aqueous humor?
|
beta-blockers
brimonidine acetazolamide |
|
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which glaucoma drugs increase outflow of aqueous humor?
|
epi
cholinomimetics PGF2alpa (latanoprost) |
|
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MOA atropine
|
muscarinic antagonist
|
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|
toxicity of atropine
|
dry as a bone
hot as a hare mad as a hatter red as a beet blind as a bat |
|
|
Effects Nitrates have on:
EDV BP Contractility HR Ejection time MV O2 |
down
down up (reflex) up (reflex) down down |
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Effects B-blockers have on:
EDV BP Contractility HR Ejection time MV O2 |
up
down down down up down |
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effects b-blockers + nitrates have on:
EDV BP Contractility HR Ejection time MV O2 |
no effect, or down
down little, no effect down little/no effect down a lot! |
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|
MOA CCBs
|
block voltage dependent ca channels of cardiac and smooth muscle, reducing muscle contractility
|
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|
In decreasing effect, which CCBs have most effect on vascular smooth muscle?
|
nifedipine > diltiazem > verapemil
|
|
|
in decreasign effeect, which CCBs have most effect on heart?
|
verapamil > diltiazem > nifedipine
|
|
|
which CCB can't be used for arrhythmias?
|
nifedipine
|
|
|
toxicity of CCBs
|
cardiac depression
flushing peripheral edema dizziness constipation |
|
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which CCB is most similar to nitrates in effect?
|
nifedipine (makes sense... nifedipine works most strongly on vascular smooth muscle)
|
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which CCB is most similar to b-blockers in effect?
|
verapamil (makes sense... verapamil works most strongly on heart)
|
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|
MOA statins?
|
HMG-CoA reductase inhibitors
blocks formation of cholesterol from HMG-CoA |
|
|
MOA niacin
|
blocks the export of cholesterol from the hepatocyte to the blood
|
|
|
MOA bile resins
|
binds cholesterol in the gut so they can't get to the hepatocytes
|
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MOA ezetimibe
|
cholesterol absorption blocker
so, prevents cholesterol from entering hepatocytes from gut |
|
|
MOA fibrates
|
increases action of lipoprotein lipase, encouraging the breakdown of VLDL --> LDL
also decreases hepatic synthesis and secretion of VLDL increases HDL by decreasing TG (results from decreased VLDL) --> decresaed exchange of cholestreryl esters from HDL --> lipoproteins |
|
|
which cholesterol agents affect endogenous production of cholesterol?
|
fibrates
niacin lovastatin |
|
|
which cholesterol agents affect absorption of exogenous cholesterol
|
ezetimibe
bise acid resins |
|
|
effects of statins on:
LDL HDL TGs |
down A LOT
up down |
|
|
effects of niacin on
LDL HDL TGs |
down a lot (not as much as statins)
up A LOT down |
|
|
effects of bile acid resins on
LDL HDL TGs |
down a lot (not as much as statins)
none slightly UP |
|
|
effects of ezetimibe on
LDL HDL TGs |
down a lot (not as much as statins)
none none |
|
|
effects of fibrates on:
LDL HDL TGs |
down a little
up DOWN A FRIGGIN TON! |
|
|
what 2 cholesterol drugs, if taken concurrently, will cause rhabdomyolysis
|
statins and fibrates
|
|
|
which cholesterol drugs increase LFTs?
|
your lft's are not SEF (safe)
statins ezetimibe fibrates |
|
|
which cholesterol drug --> GI discomfort
|
bile acid resins
|
|
|
antidote to dig toxicity
|
anti-dig Fab fragment s
slowly normalize K lidocaine cardiac pacer |
|
|
MOA of class I anti-arrhythmics
class II? class III? class Iv? |
Na channel blockers
B-blockers K channel blockers CCBs |
|
|
which drugs are in class Ia anti-arrythmics?
|
Quinidine
Amiodarone Procainamide Disopyramide |
|
|
which drugs are in the class Ib anti-arrhythmics?
|
I Be with my Lid To Mex(ico)
lidocaine tocainide mexiletine |
|
|
which drugs are in the class Ic anti-arrythmics?
|
See (C)! And Can't (EnCain) We FLEe if we PROP up PHENOMS?
encainide flecainide propafenone |
|
|
MOA class IA anti-arrhythmics?
|
increased AP duration
increased ERP increased QT interval |
|
|
uses for class IA anti-arrhythmics
|
atrial and ventricular arrhythmias (esp reentrant and ectopic)
SVT and VT |
|
|
MOA for class IB anti-arrhythmics
|
decreases AP duration
|
|
|
use for class IB anti-arrhythmics
|
acute ventricular arrhythmias, esp post MI
|
|
|
MOA for class IC anti-arrhythmics
|
no effect on AP
|
|
|
uses for class IC anti-arrhythmics
|
VT --> FV
inretractable SVT LAST resort |
|
|
toxicity of quinidine
|
cinchonism (HA, tinnitus, thrombocytopenia, torsades de pointes from increased QT interval)
|
|
|
toxiciyt of procainamide
|
SLE-like syndrome (reversible)
|
|
|
toxicity of IB anti-arrhythmics?
|
local anesthetic
CNS stimulation/depression CV depression |
|
|
toxicity of IC anti-arrhythmics
|
pro-arrhythmic (esp post-MI)
prolongs refractory period |
|
|
receptor selectivity for epi?
|
all are equal
|
|
|
receptor selectivity for NorE
|
a1 = a2 > b1
|
|
|
receptor selectivity for isoproteronol
|
B1=b2
|
|
|
receptor selectivity for DA
|
d1 = d2 > B > a
|
|
|
receptor selectivity for dobutamine
|
b1 > b2
|
|
|
receptor selectivity for phenylephrine
|
a1 > a2
|
|
|
receptor selectivity for albuterol
|
b2 > b1
|
|
|
receptor selectivity for terbutaline
|
b2 > b1
|
|
|
MOA amphetamine
|
indirect general sympathetic agonist
releases stored catecholamines |
|
|
MOA epehderine
|
indirect and direct sympathomimetic
stimulates release of NE from sympathetic neurons |
|
|
MOA cocaine
|
blocks reuptake of NorE and DA
|
|
|
MOA clonidine
|
centrally acting alpha agonist
decreased central adregnergic outflwo |
|
|
uses for epi
|
anaphylaxis
glaucoma asthma hyptotension |
|
|
uses for norE
|
hypotension (but decreases renal perfusion)
|
|
|
uses for isoproterenol
|
rare... AV block
|
|
|
uses for DA
|
shock (increases renal perfusion)
heart failure |
|
|
uses for dobutamine
|
shock
heart failure cardiac stress testing |
|
|
uses for amphetamines
|
narcolepsy
obesity ADD |
|
|
uses for ephedrine
|
nasal decongestion
urinary incontinence hypotension |
|
|
uses for phenylephrine
|
pupil dilator
vasoconstriction nasal decongestion |
|
|
uses for albuterol
|
asthma
|
|
|
uses for terbutaline
|
asthma
|
|
|
uses for cocaine
|
vasoconstriction
local anesthetic |
|
|
uses for clonidine
|
HTN (esp with renal dz b/c it doesn't decrease blood flow to kidney)
|
|
|
examples of inhaled anesthetics
|
halothane
enflurane isoflurane (-ane) |
|
|
MOA inhaled anesthetics
|
unknown
|
|
|
effects of inhaled anesthetics
|
myocardial depression
respiratory depression n/v increased cerebral blood flow decreased cerebral demand |
|
|
toxicity of halothane
|
hepatotoxicity
|
|
|
toxicity of methoxyflurane
|
nephrotoxicity
|
|
|
toxicity of enflurane
|
pro-convulsant
|
|
|
toxicity of any inhaled anesthetic
|
malignant hyperthermia (rare)
|
|
|
types of drugs used as IV anesthetics
|
BB King on optiates proposes foolishly
Barbiturates benzos Ketamine (arylclohxamines) opiates Propofol |
|
|
which barbiturate is commonly used as an IV anesthetic?
|
thiopental
|
|
|
uses of thiopental
|
induction of anesthesia
short surgical procedures |
|
|
which is the most common anesthetic used for endoscopy?
what is it administered with? |
midazolam
gaseous anesthetics and narcotics |
|
|
side effects of midazolam
|
post-op respiratory depression
hypotension amnesia |
|
|
how is the respiratory depression from midazolam treated?
|
flumezanil
|
|
|
side effects of arylcyclohexamines
|
bad dreams
CV stimulation disorientation hallucinations increased cerebral blood flow |
|
|
benefit of propofol
|
less post-op nausea than thiopental
|
|
|
what is combined with opiates during general anesthesia?
|
other CNS depressants
|
|
|
MOA local anesthetics
|
block Na channels by binding to specific receptors in inner portion of channel
|
|
|
examples of atypical antipsychotics
|
olanzapine
clozapine risperidone |
|
|
examples of typical antipsychotics
|
thioridazine
haloperidol fluphenazine chlorpromazine |
|
|
MOA typical antipsychotics
|
block D2 receptor
|
|
|
MOA atypical antipsychotics
|
blocks dopamine and 5HT receptors
|
|
|
clinical uses of typical antipsychotics
|
schizophrenia
psychosis acute mania Tourette's |
|
|
clinical uses for atypical antipsychotics
|
schizophrenia (+ and - sx)
|
|
|
clinical uses for olanzapine
|
OCD
anxiety d/o depression mania Tourette |
|
|
toxicity associated with typical antipsychotics
|
EPS
endocrine effects anti-muscarinic effects (dry mouth) hypotension (from blocking alpha receptors), sedation (from blocking histamine receptors) NMS tardive dyskinesia |
|
|
what is tardive dyskinesia
|
stereotypical oral-facial movements d/t blocking DA receptors
|
|
|
what is NMS
|
rigidity
myoglobinuria autonomic instability hyperpyrexia |
|
|
tx of NMS
|
dantrolene and DA agonists
|
|
|
toxicity associated wiht atypical antipsychotics
|
less EPS and anti-cholinergic effects
Clozapine --> agranulocytosis |
|
|
uses for lithium
|
bipolar
blocks relapse and acute manic events |
|
|
toxicity of lithium
|
LMNOP
movement (tremor) nephrogenic DI hypOthyroidism Pregnancy problems |
|
|
MOA buspirone
|
stimulates 5HT1a receptors
|
|
|
uses of buspirone
|
anxiolysis for GAD
|
|
|
benefits of buspirone
|
doesnt cause sedation or addiction
doens't interfere with alcohol |
|
|
examples of ssri's
|
fluoxetine
sertraline paroxetine citalopram |
|
|
clincical uses for ssri
|
OCD
endogenous depression eating d/o |
|
|
examples of tricyclic antidepressants
|
imipramine
amitriptyline desipramine nortiptyline clomipramine doxepin |
|
|
MOA TCA
|
blocks reuptake of NorE and 5HT
|
|
|
uses for TCAs
|
major depression
bedwetting (imipramine) OCD (clomipramine) |
|
|
which TCA is used for bedwetting
|
imipramine
|
|
|
which tCA is used for OCD
|
clomipramine
|
|
|
examples of heterocyclic anti-depressants
|
you need BUtane in your VEINs to MURder for a MAP of alcaTRAZ
buproprion venlafaxine mirtazapine maportiline trazodone |
|
|
examples of MAOIs
|
phenelzine
tranylcypromine |
|
|
class thioridizine
|
typical antipsychotic
|
|
|
class haloperidol
|
typical antipsychotic
|
|
|
class fluphenazine
|
typical antipsychotic
|
|
|
class chlorpromazine
|
typical antipsychotic
|
|
|
class clozapine
|
atypical antipsych
|
|
|
Class olazapine
|
atypical antipsych
|
|
|
class risperidone
|
atypical antipsych
|
|
|
class fluoxetine
|
ssri
|
|
|
class paroxetine
|
ssri
|
|
|
class sertraline
|
ssri
|
|
|
class citalpram
|
ssri
|
|
|
class imipramine
|
tca
|
|
|
class amitriptyline
|
tca
|
|
|
class desipramine
|
tca
|
|
|
class nortiptyline
|
tca
|
|
|
class clomipramine
|
tca
|
|
|
class doxepin
|
tca
|
|
|
class buprorpion
|
heterocyclic
|
|
|
class venlafaxine
|
heterocyclic
|
|
|
class mirtazapine
|
heterocyclic
|
|
|
class maprotiline
|
heterocyclic
|
|
|
class trazadone
|
heterocyclic
|
|
|
class phenylzine
|
maoi
|
|
|
class tranylcypromine
|
maoi
|
|
|
toxicity associated with ssri
|
gi distress
anorgasmi a seratonin syndrome if given with maoi |
|
|
sx of seratonin syndrome
|
hyperthermia
muscle rigidity cv collapse |
|
|
how long does it take for antidepressants to work
|
2-3 wks
|
|
|
side effects of tca
|
sedation
alpha-blocking effects atropine like effects (tachy, urinary retention) |
|
|
which generation of tca s have more anticholinergic effects? give an example of the drug
|
3rd
amitryptyline |
|
|
which tca is least sedating
|
desipramine
|
|
|
toxicity assocaited with tcas
|
tri-c's
convulsions coma cardiotoxicity respiratory depression hyperpyrexia confusion and hallucination in elderly (d/t anticholinergic effects) |
|
|
which class of drugs is used to treat alcohol w/d
|
benzos
|
|
|
which class of drugs is used to treat anorexia/bulemia
|
ssri
|
|
|
which drugs are used to treat anxiety
|
buspirone
benzos/barbiturates (take a shorter time to work) MAOI |
|
|
which drugs are ssris?
|
paroxetine
fluoxetine sertriline citalopram |
|
|
which class of drugs is used to treat atypical depression
|
maoi
|
|
|
which class of drugs is used ot treat bipolar d/o
|
lithium
carbamazepine valproic acid |
|
|
which drugs are used to treat depression
|
ssri
tca |
|
|
which drugs are used to treat depression with insomnia
|
trazadone
mirtazapine |
|
|
which drugs are used totreat OCD
|
climipramine
ssri olanzepine |
|
|
which drugs are used to treat panic d/o
|
tca
buspirone |
|
|
toxicity associated with maois
|
hypertensive crisis associated with ingesting wine/cheese (tyramine)
|
|
|
drug interactions assicated with maois
|
b-blockers
ssri (--> both cause seratonin syndrome) |
|
|
MOA venlafaxine
|
inhibits 5HT, NorE, and DA reuptake
|
|
|
toxicity of venlafaxine
|
stimulant effects
sedation nausea constipation increased BP |
|
|
MOA mirtazapine
|
alpha-2 antagonist (increased release of NorE and 5HT) and potent 5HT2, 3 receptor antagonist
|
|
|
toxicity of mirtazapine
|
sedation
increased appetite weight gain dry mouth |
|
|
moa maprotiline
|
blocks NorE reuptake
|
|
|
toxicity of maprotiline
|
sedation
orthostatic hypotension |
|
|
moa trazadone
|
inhibits 5HT reuptake
|
|
|
toxicity of trazadone
|
sedation
nausea priapism postural hypotension |
|
|
MOA dantroline
|
blocks the release of ca from SR of skeletal muscles
|
|
|
uses of dantroline
|
nms
malignant hyperthermia |
|
|
wha tcan cause malignant hyperthermia
|
inhalation of anesthetics and succinylcholine
|
|
|
what are the different types of NM blocking agents
|
depolarizing and nondepolarizing
|
|
|
ex of a depolarizing NM blocking agent
|
succinylcholine
|
|
|
ex of nondepolarizing NM blockign agent
|
anything with a "cur" in it
|
|
|
uses of NM blockign agents
|
to paralyze muscles in surgery or mechanical ventilation
|
|
|
what are the 2 phases of depolarizing NM blockade?
|
1: continuous depolarization
2: gradual repolarization with resistance |
|
|
how do you reverse the depolarizing blockade at phase 1?
phase 2? |
administer cholinesterase inhibitors (eg: neostigmine or physostimine) during PHASE #2!!!!
if you give them during phase 1, the paralysis is increased. |
|
|
how do you reverse the non-depolarizing blockade?
|
cholinesterase inhibitors (eg: neostigmine, edrophonium)
|
|
|
how is NorE going to affect BP?
HR? |
A>B so....
systolic will increase diastolic will increase HR decreases (reflex brady) |
|
|
how is epi going to affect BP?
HR? |
nonselective so...
systolic will increase being controlled by a1 diastolic will decrease, being controlled by beta HR will increase (b1) |
|
|
how does isoproterenol affect BP?
HR? |
B1=B2 so...
systolic decreases diastolic decreaes HR increases (reflex tachy) |
|
|
what will happen to BP if you administer an alpha blockade after giving epi?
|
it will decrease and then increase slightly
net depressor effect b/c b2 takes over --> vasodilatioN |
|
|
what will happen to BP if you administer an alpha blockade after giving phenylephrine?
|
A1>a2
there is no depressor effect seen in this situation b/c phenylephrine is a pure alpha agonist |
|
|
what toxicities are seeen after giving 1st dose of an al blocker?
|
orthostatic hypotension
ha dizziness |
|
|
what toxicities are seen aftter giving phenoxybenzamine
|
orthostatic hypotension
reflex tachy |
|
|
what drugs are used to treat pheo?
|
phenoxybenzamine (irreversible alpha blocker)
phentolamine (reversible alpha blocker) |
|
|
which drugs are 1st generation H1 blockers?
|
diphenhydramine
dimenhydrinate chlorpheniramine |
|
|
which drugs are 2nd generation H1 blockers?
|
loratadin e
fexofenadine desloratadine |
|
|
what are 1st generation H1 blockers used for?
|
allergy
motion sickness sleep aid |
|
|
what are the 2nd gen H1 blockers used for?
|
allergy
|
|
|
toxicity of 1st gen H1 blockers?
|
sedation
anti-muscarinic anti-alpha-adrenergic |
|
|
toxicity of 2nd gen H1 blockers
|
less sedating than 1st generation
|
|
|
what are the different classes of drugs that treat asthma?
|
nonspecific beta agonists
b2 agonists methylxanthines muscaranic antagonists cromalyn corticosteroids antileukotrienes |
|
|
MOA isoproterenol
|
B1=B2 so, innervates bronchial smooth muscle and causes bronchodilation
|
|
|
MOA albuterol
|
B2 agonist, --> bronchodilation
|
|
|
MOA salmeterol
|
b2 agonist --> bronchodilation
|
|
|
when is albuterol used?
|
during acute exacerbation of asthma
|
|
|
when is salmeterol used?
|
for asthma proph
|
|
|
MOA theophylline
|
bronchodilation by inhibiting phosphodiesterase, decreasing cAMP hydrolysis
inhibits effects of adenosine on bronchial smooth muscle (prevents bronchoconstriction) |
|
|
adverse effects of salmeterol
|
tremor and arrhythmia
|
|
|
toxicity of theophylline
|
cardio and neurotoxicity
|
|
|
MOA ipratropium
|
muscarinic antagonist
competitively blocks muscarinic receptors, preventing bronchoconstriction |
|
|
MOA cromolyn
|
prevents release of mediators from mast cells
|
|
|
when is cromolyn used
|
asthma proph, ineffective during acute asthma attack
|
|
|
MOA beclomethasone
|
inhibits synth of all cytokines
prevents formation of arachidonic acid by blocking phospholipase A2 inactivates NF-KB (transcription factor for TNF-alpha) |
|
|
when are corticosteroids used in asthma treatment
|
1st line tx for chronic asthma
|
|
|
examples of anti-leukotrienes?
|
zileuton
zafirlukast montelukast |
|
|
MOA zileuton
|
5-lipoxygenase inhibitor
blocks conversion of arachidonic acid to LT |
|
|
MOA zafirlukast?
|
blocks LT receptors
|
|
|
MOA montelukast
|
blocks LT recpetors
|
|
|
when is zafirlukast used
|
to treat aspirin induced asthma
|
|
|
when is montelukast used
|
to treat aspirin induced asthma
|
|
|
which asthma drug blocks a phosphodiesterase
what is the net result? |
theophylline
cAMP levels are raised |
|
|
which asthma drug blocks adenlyate cyclase?
what is the net result? |
b-agonist
cAMP levels are raised |
|
|
which drugs are expectorants?
|
guaifenesin
n-acetylcystine |
|
|
MOA guaifenesin
|
doesn't suppress cough reflex
removes excess sputum |
|
|
MOA n-acetylcystine
|
mucolytic (loosens plugs in CF pts)
|
|
|
MOA finasteride
|
5-alpha reductase blocker
|
|
|
MOA flutamide
|
competitive inhibitor of androgen at testosterone receptor
|
|
|
MOA ketoconazole in reproductive system
|
blocks 17,20 lyase and 3-beta-hydroxylase, inhibiting steroid synthesis
|
|
|
uses of finasteride
|
BPH
male pattern baldness |
|
|
uses of flutamide
|
prostate cancer
|
|
|
uses of ketoconazole
|
pcos, to prevent hirsutism
|
|
|
MOA leuprolide
|
GnRH analog with agonist properties when used in pulsatile manner
antagonist properties when used in continuous fashion |
|
|
uses for leuprolide
|
infertility (pulsatile)
prostate cancer (continuous, used with flutamide) uterine fibroids |
|
|
toxicity of leurpolide
|
antiandrogen
n/v |
|
|
MOA sildenafil
|
inhibits cGMP phosphodiesterase --> increased cGMP --> maintains smooth muscle relaxation in corpus cavernosum
--> increased blood flow and erection |
|
|
clinical use of sildenafil
|
erectile dysfunction
|
|
|
toxicity of sildenafil
|
blue-green color vision
h/a flushing dyspepsia LIFE THREATENING HYPOTENSION IN PTS TAKING NITRATES!!!!! |
|
|
MOA clomiphene
|
partial estrogen agonist at pituitary gland
this stimulates LH and FSH release --> ovulation |
|
|
use of clomiphene
|
fertility treatment
|
|
|
toxicity of clomiphene
|
hot flashes
ovarian enlargement multiple pregnancies visual disturbances |
|
|
MOA mifepristone
|
competitive inhibitor of progestin at progesterone receptors
|
|
|
use of mifepristone
|
prevents implantation of fetus
|
|
|
toxicity of mifepristone
|
heavy bleeding
GI effects abdominal pain |
|
|
risks associated with HRT
|
endometrial cancer, if regimen is just with estrogen
|
|
|
which leukotriene is a neutrophil attractant?
|
LTB4
|
|
|
which LT --> bronchoconstriction
|
LTC4, D4, E4
|
|
|
what reaction does phospholipase A2 catalyze
|
phospholipids --> arachidonic acid
|
|
|
what rxn does COX catalyze?
|
arachidonic acid --> PGG, PGH (endoperoxides)
|
|
|
what rxn does lipoxygenase catalyze?
|
arachidonic acid --> HPETEs (hydroperoxides)
|
|
|
what drug blocks lipoxygenase
|
zileuton
|
|
|
what drug blocks COX
|
NSAIDS
acetominophen cox-2 inhibitors |
|
|
what drugs block the effects of leukotrienes?
|
zafirleukast
montelukast |
|
|
actions of PGE?
|
increased uterine tone
decreased bronchial tone decreased vascular tone |
|
|
examples of nsaids
|
ibuprofen
naproxen indomethacin ketorolac |
|
|
mech of nsaids
|
reversibly inhibits cox 1 and 2, blocking PG synth
|
|
|
uses for nsaids
|
antipyretic
analgesic anti-inflammatory |
|
|
what drug is used to close PDA
|
indomethacin
|
|
|
toxicity of nsaids
|
renal damage
aplastic anemia GI distress ulcers |
|
|
MOA cox2 inhibitors
|
reversibly inhibits cox2, maintaining gastric mucosa (cox2 is found only in inflammatory cels that mediate inflamm and pain)
|
|
|
risks associated with cox 2 inibitors
|
thrombosis
less gi risk |
|
|
MOA actaminophen
|
reversibly inhibits cox (mostly in cns)
inactivated peripherally |
|
|
uses of acetaminophen
|
antipyretic
analgesic NOT AN ANTI INFLAMMATORY!!!!!!! |
|
|
toxicity of acetaminophen
how? |
hepatic necrosis
a metabolite of acetaminophen depletes glutathione and forms toxic tissue adducts in liver |
|
|
how is toxic hepatic damage from acetaminophen treated
moa? |
n-acetylcysteine - it regenerates glutathione
|
|
|
drugs that treat gout
|
colchicine
allopurinol probenecid indomethacin |
|
|
NSAIDS
|
And said: "I be napping in Keto"
ibuprofin naproxen indomethacin ketorolac |
|
|
which gout drugs are used to treat chronic gout?
|
allopurinol
probenecid |
|
|
which gout drugs are ued to treat acute gout
|
colchicine
indomethacin |
|
|
MOA colchicine
|
depolymerizes MT, impairing WBC chemotaxis and degranuation
|
|
|
side effects of colchicine
|
gi
|
|
|
what drug is a good alternative to colchicine?
|
indomethacin (less toxic, more commonly used)
|
|
|
MOA probenecid
|
inhibits resorption of uric acid
|
|
|
MOA allopurinal
|
inhibits xanthine oxidase, so less formation of uric acid
|
|
|
aside from gout, what else can allopurinal be used to treat?
|
can help with sx of tumor lysis syndrome, seen in lymphoma/leukemia following chemo
|
|
|
what is the original source of uric acid
|
purines from diet and broken down nucleic acids
|
|
|
fxn of xanthine oxidase
|
hypoxanthine --> xanthine --> uric acid (blocked by allopurinol)
|
|
|
describe interference of probenecid and penicillin
|
inhibits secretion of penecillin
|
|
|
what promotes tubular secretion of uric acid
|
diuretics and low dose salicylates
|
|
|
MOA etanercept
|
recombinant form of TNF receptor that binds TNF-alpha
|
|
|
uses for etanercept
|
RA
psoriasis ankylosing spondylitis |
|
|
MOA infliximab
|
TNF-alpha AB
|
|
|
uses for infliximab
|
crohns dz
RA ankylosing spondylitis |
|
|
toxicity of infliximab
|
predisposes to infection (reactivates latent TB)
|
|
|
MOA cyclosporine
|
binds to cyclophilins, blocking differentiation and activiation of t cells by inhibiting calcineruin (prevents the production of IL2 and receptor)
|
|
|
fxn of calcineurin
|
phosphatase that activates IL2
|
|
|
use for cyclosporine
|
suppress organ transplants
treats some autoimmune d/o |
|
|
toxicity of cyclosporine
|
predisp to viral infx and lymphoma
NEPHROTOXIC (prevent w mannitol diuresis) |
|
|
MOA tacrolimus
|
binds FK-binding protein, inhibiting the secretion of IL2 and other cytokines
|
|
|
uses of tacrolimus
|
immunosuppression following organ transplant
|
|
|
toxicity of tacrolimus
|
nephrotoxic
peripheral neuropath y HTN pleural effusion hyperglycemia |
|
|
moa azathioprine
|
interferes with metabolism and synth of nucleic acids
toxic to prolif wbc |
|
|
uses of azathioprine
|
kidney transplant
autoimmune d/o glomerulonephritis hemolytic anemia |
|
|
toxicity of azathioprine
|
bone marrow suppression
|
|
|
what is the active metabolite of azathioprine
how is it metabolized implication |
mercaptopurine
xanthine oxidase toxic effects may be increased by allopurinol |
|
|
which drugs cause pulmonary fibrosis?
|
"when she wears her bustle, bubbly amy gets pulmonary fibrosis"
busulfan bleomcyin amiodarone |
|
|
which drugs cause gyneomastia
|
"Some drugs create awesome knockers"
spironolactone digitalis cimetidine alcoholism ketoconazole (estrogen) |
|
|
which drugs cause SLE like syndrome
|
"it's not HIPP to have lupus"
hydralazine inh procainamide phenytoin |
|
|
which drugs --> osteoporosis
|
CHO
corticosteroids heparin |
|
|
which drug --> gingival hyperplasia
|
phenytoin
|
|
|
which drugs --> photosensitivity
|
Amy played Tetris on her cell phone in the sun
amiodarone sulfonamides tetracycline |
|
|
which drugs --> tendonitis and tendon rupture in kids
|
fluoroquinolones
|
|
|
which drug --> gray baby syndrome
|
chloramphenicol
|
|
|
which drugs --> agranulocytosis
|
colchicine
carbamazepine clozapine |
|
|
which drugs --> atropine like side effects
|
tricyclics
|
|
|
which drugs --> cardiac toxicity
|
Dawn sat on the Docks mending her red, broken heart
doxorubicin daunorubicin |
|
|
which drugs --> torsades de pointes
|
Ia and III aniarrhytmics
cisapride |
|
|
which drugs --> focal/massive hepatic necrosis
|
Hello Val! Have a seat before your liver dies!
halothane valproic acid acetaminophen |
|
|
which drug --> fanconi's syndrome
|
expired tetracycline
|
|
|
which drug --> interstitial nephritis
|
methicillin
|
|
|
which drugs --> hemorrhagic cystitis
|
cyclophosphamide
ifosfamide |
|
|
which drug --> hepatitis
|
INH
|
|
|
which drugs --> pseudomembranous colitis
|
I have to take a CLAMP
clindamycin ampicillin |
|
|
which drugs --> nephrotoxicity AND ototoxicity
|
"if you call, i won't be able to hear you in the bathroom"
Cisplatin aminoglycoside loop diuretics |
|
|
which drugs --> seizures
|
buproprion
imipenem clistatin |
|
|
which drugs --> DI
|
lithium
demeclocycline |
|
|
which drugs --> aplastic anemia
|
chloramphenicol
benzene NSAIDS |
|
|
which drug --> coronary vasospasm
|
cocaine
|
|
|
which drugs --> flushing
|
AIDEN was in the VAN FLUSHING NIACIN and CALCIUM
niacin CCB adenosine vancomycin |
|
|
which drug --> hemolysis in G6PD pts
|
sulfonamides
INH aspirin ibuprofen primaquine nitrofurantoin |
|
|
whch drugs --> acute aholestatic hepatitis
|
macrolides
|
|
|
which drugs --> cinchonism
|
quinidine
quinine |
|
|
which drugs --> disulfiram like rxn
|
metronidazole
some cephalosporins procarbazine sulfonylureas |
|
|
which drug --> neurotoxicity/nephrotoxicty
|
polymyxins
|
|
|
uses for cytarabine
|
AML
|
|
|
examples of nitrosureas
|
"you MUST not let the Nitro go to your head, or you'll do a strip tease- a sin!"
carmustine lmoustine semustine streptozacin |
|
|
uses for nitrosureas
|
brain tumors (incl. GBM)
|
|
|
uses of the -platins
|
Platinum treated BOLTs
breast ovarian lung testicular |
|
|
uses for busulfan
|
"I will bustle to treat my dark CaMeL"
CML |
|
|
adverse effects of busulfan
|
"I will bustle to treat my DARK CaMeL"
hyperpigmentation pulmonary fibrosis |
|
|
uses for rubicins
|
"MS. Hodgkin's will LOB the RED ball"
myeloma sarcoma Hodkin's lung ovarian breast |
|
|
uses for dactinomycin
|
"children ACT out"
rhabdomyosarcoma wilm's tumor ewing sarcoma |
|
|
MOA 6MP
|
blocks do novo purine synth, activated by HGPRTase
|
|
|
which 2 drugs work synergistically with each other to prevent DNA replicaion?
|
5-FU
MTX |
|
|
MOA MTX
|
blocks DHF reductase, preventing DHF --> THF
|
|
|
MOA 5FU
|
blocks thymidylate synthase (preventing dUMP --> dTMP)
|
|
|
which cancer agen has minimal myelosuppression?
|
bleomycin
|
|
|
leucovorin
|
folinic acid that can reverese some of the myelosuppression associated with MTX (doesn't do anything for 5FU myelosuppression)
|
|
|
"rescue agent" for 5FU
|
thymidine
|
|
|
which cancer agent --> macrovesicular fatty change in liver?
|
MTX
|
|
|
cancer agents that alkylate DNA
|
AL KEELED over when the BUS hit the PLATE the NIGHT he was on his CYCLE
Busulfan Platins Nitrosureas cyclophosphamide/ifosfamide |
|
|
which alkylating agent requires bioactivation
|
nitrosureas
|
|
|
uses for -phosphamides
|
"No Hodgkin's will see FOSSE with BO that smells like phospho"
non-hodgkin's breast ovarian |
|
|
which drugs intercalate in DNA?
|
3D
doxorubicin daunorubicin dactinomycin |
|
|
which cancer agents generate free radicals
|
"Wear red to show the bleeding of the free radicalS"
doxorubicin daunorubicin bleomycin |
|
|
which receptors are associaed with Gq
|
HAVe 1 M&M
H1 alpha 1 V1 M1, M3 |
|
|
which receptors are associated with Gi
|
MAD 2's
M2 alpha 2 D2 |
|
|
which receptors are associated with Gs
|
B1, B2, D1, H2, V2
|
|
|
major fxns of M2
|
decreases HR
|
|
|
major fxns of M3
|
increase exocrine gland secretion
|
|
|
major fxns of D1
|
relaxes vascular smooth muscle
|
|
|
major fxns of D2
|
modulates transmimtter release in brain
|
|
|
major fxns of H1
|
ubcreases basak abd bronchial mucus production, contraction of bronchioles, pruritis, pain
|
|
|
major fxns of H2
|
increase gastric acid secretion
|
|
|
major fxn of V1
|
constricts vascular smooth muscle
|
|
|
major fxn of V2
|
increas water permeability and reabsorption in CT of kidney
|
|
|
MOA hemicholinium
|
blocks the transport of choline into cholinergic neurons, blocking the production of ACh
|
|
|
MOA vesamicol
|
blocks the transporter that brings Acetyl CoA + Choline CHAT into vesicles
|
|
|
MOA botulinum
|
blocks the release of ACh vesicles
|
|
|
MOA metyrosine
|
blocks conversion of tyrosine into DA
|
|
|
MOA reserpine
|
blocks DA transporter into vesicles that form NE
|
|
|
MOA guanethidine
|
inhiits release of NorE from noraderenergic neurons
|
|
|
MOA amphetamine
|
increase release of NorE from vesicles
|
|
|
MOA pralodoxime
|
reactivates AChE after it's been inhibited by pesticides
|
|
|
treatment for salicylate OD
|
alkalinize urine
dialysis |
|
|
treatment of antimuscarinics OD
|
physostigmine salicyate
|
|
|
treatment of b-blocker od
|
glucagon
|
|
|
tx of digitalis od
|
stop dig
normalize K \lidocaine anti-dig Fab fragments Mg |
|
|
tx iron toxicity
|
deferoxamine (chelating agent)
|
|
|
tx fo lead poisoning
|
EDTA
dimercaprol succimer penicillamine |
|
|
tx of arsenic toxicity
|
dimercaprol
succimer |
|
|
tx hg toxicity
|
dimercaprol
succimer |
|
|
tx au toxicity
|
dimercaproli
succimer penicillamine |
|
|
tx cu toxicity
|
penicillamine
|
|
|
tx cn toxicyt
|
nitrite
hydroxocobalamin thiosulfate |
|
|
tx methemoglobin toxicity
|
methylene blue
|
|
|
tx CO toxcity
|
100% o2, hyperbaric pressure
|
|
|
tx of methanol od
|
ethanol
dialysis fomepizole |
|
|
tx of ethylene glycol od
|
etoh
dialysis foempizole |
|
|
tx of opiod toxicity
|
nalaxone
naltrexone |
|
|
tx of benzo od
|
flumazenil
|
|
|
tx of ca od
|
NaHCO3
|
|
|
tx of heparin toxicity
|
protamine sulfate
|
|
|
tx of warfarin toxicity
|
vitamin k
ffp |
|
|
x tpa toxicity
|
aminocaproic acid
|
|
|
tx streptokinase toxicity
|
aminocaproic acid
|
|
|
sx of iron od
|
fever
sweating abdominal pains diarrhea cyanosis weakness |
|
|
examples of insulin drugs (and give duration of action)
|
lispro (short)
insulin (short) NPH (intermediate) lente and ultralente (long acting) |
|
|
clinical uses of insulin analogs
|
DM I
life-threatening hyperkalemia (insulin increases K entry into cells) stress induced hyperglycemia |
|
|
examples of 1st generation sulfonylureas
|
tolbutaminde
chlorpropamide |
|
|
examples of 2nd generation sulfonylureas
|
glyburide
glimepiride glipizide |
|
|
MOA sulfonylureas
|
when glucose enters the cell, the ATP level rises
high ATP:ADP closes K channel this causes Ca influx --> insulin release these drugs enoucrage this process by closing k channels (basically stimulates the release of endogenous insulin) |
|
|
uses of sulfonylureas
|
DM II
reqires some islet cell fxn, so useless in DM I |
|
|
toxicity associated with sulfonylureas (1st gen)
|
diulfuram effects
|
|
|
toxicity associated with 2nd generation sulfonylureas
|
hypoglycemia
|
|
|
examples of biguanides
|
metformin
|
|
|
MOA metformin
|
unknown, but might decrease gluconeogenesis, increase glycolysis and decrease serum glucose levels
|
|
|
clinical use of metformin
|
can be used in pts without islet cell fxn
|
|
|
adverse effects of metformin
|
lactic acidosis
|
|
|
MOA glitazones
|
incresaes target cell response to insulin
|
|
|
clinical use for glitazones
|
DM II
|
|
|
toxicity associated with glitazones
|
weight gain
edema hepatotoxicity |
|
|
examples of alpha-glucosidase inhibitors
|
acarbose
miglitol |
|
|
MOA alpha-glucosidase inhibitors
|
inhibits intestinal brush border alpha-glucosidases
delays sugar hydrolysis and glucose absorption decreasesd post-prandial hyperglycemia |
|
|
clinical use of alpha glucosidase inhibitors
|
DM II
|
|
|
MOA orlistat
|
inhibits pancreatic lipase
|
|
|
clinical use of orlistat
|
obesity management
|
|
|
toxcicity of orlistat
|
gi discomfort
steatorrhea reduced absorption of fat soluble vitamins ha |
|
|
MOA sibutramine
|
sympathommimetic 5HT and NorE reuptake inhibitor
|
|
|
uses of sibutramine
|
short term and long term obesity management
|
|
|
toxicity of sibutramine
|
htn
tachycardia |
|
|
uses of GH
|
GH deficiency
turner's syndrome |
|
|
uses of somatostatin
|
acromegaly
carcinoid gastrinoma glucagonoma |
|
|
uses of octeroitide
|
(aka somatostatin)
acromegaly carcinoid gastrinoma glucagonoma |
|
|
uses of adh
|
pituitary DI
|
|
|
MOA propylthiouracil
|
inhibits organification and coupling of thyroid hormone synthesis
decreased peripheral conversion of T4 --> T3 |
|
|
Which drugs block peptidoglycan cross-linking
|
Cephalosporin
-cillins -nam/-nem |
|
|
which drugs block peptidoglycan synthesis?
|
"I will backtrack in my van or on my cycle to find my peppy synth"
bacitracin vancomycin cycloserine |
|
|
which drugs block bacterial/fungal cell wall synth
|
polymyxins
|
|
|
which drugs disrupt fungal cell membranes
|
amphotericin b
nystatin -azoles |
|
|
which drugs block NT synth
|
"Try my cell phone - I blocked the New Cleo"
Sulfonamides trimethoprim |
|
|
which drugs block DNA synth
|
"TOPless DANcing Queen" (insert abba song here... :)
Topoisomerase Quinolones |
|
|
which drugs block mRNA synth
|
"the Rif-Raf RAN around the block"
rifampin |
|
|
Which drugs block protein synth at the 50S subunit?
|
"There are MICE IN LINE to see 50 year-old GRANdma make MACRoni and CHLORide"
-mycins linezolid -gramins macrolides chloramphenicol |
|
|
which drugs block protein synth at the 30S subunit
|
"I MEAN NO harm, but you are playing TETRIS at 30 years old!"
Aminoglycosides tetracyclines |
|
|
MOA penicillin
|
it binds to penicillin binding proteins
blocks the cross-linking of peptidoglycan activates autolytic enzymes |
|
|
uses for penicillin
|
gram + cocci and rods
GNR spirochetes |
|
|
which penicillins are the penicillinase resistant?
|
"Penny resisted NApkins and CLOX when I MET her"
Nafcillin dicloxacillin methicillin |
|
|
clinical uses for penicillinase resistant penicillins?
|
S. aureus (except for MRSA)
|
|
|
why are penicillinase resistant penicillins resistant to penicillinase
|
bulikier R group
|
|
|
how is MRSA resistant to methicillin
|
altered penicillin binding protein target site
|
|
|
adverse reaction to methicillin
|
interstitial nephritis
|
|
|
examples of aminopenicillins
|
ampicillin
amoxicillin |
|
|
what is clavulanic acid
|
penicillinase inhibitor
|
|
|
clinical uses for aminopenicillins
|
"ampicillin/amoxicillin HELPS kill enterococci"
H. influenza e. coli Listeria monocytogenes Proteus mirabilis Salmonella Enterococci |
|
|
anti-pseudomonal drugs
|
"Take Piper in the Car, Sue"
ticarcillin piperacillin carbenicillin |
|
|
MOA cephalosporins
|
same as penicillins, less susceptible to penicillinases
|
|
|
uses for 1st generation cephalosporins
|
PEcK
Proteus E coli Klebsiella |
|
|
uses for 2nd generation cephalosporins
|
HEN PEcKS
H. flu Enterobacter Neisseria Proteus E. coli Klebsiella Serratia |
|
|
examples of 1st generation cephalosporins
|
"You FAILed the FIRST PHASE"
cefazolin cephalexin |
|
|
examples of 2nd generation cephalosporins
|
"Wait a SECOND! You SEE, FOX FUR is a FACt"
cefoxitin cefuroxime cefaclor |
|
|
3rd generation cephalosporins
|
"If you are THIRsty, try a FOTO TAZER"
Cefotaxime Ceftazidime ceftriaxone |
|
|
clinical uses of aztreonam
|
klebsiella
pseudomonas serratia (GNR only, nothing against gm + or anaerobes) |
|
|
who is given aztreonam
|
penicillin allergic pts
pts w renal insuff that can't tolerate aminoglycosides |
|
|
what is cilastatin?
|
inhibits renal dihydropeptidase I
always administered with imipenem |
|
|
clinical uses for imipenem/meropenem?
|
gram + cocci
GNR anaerobes #1 for enerobacter |
|
|
toxicity of imipenem, meropenem
|
gi distress
rash seizures (all occcur at high plasma levels) |
|
|
MOA aminoglycosides
'cidal/static? |
inhibits formation of initiation complex --> misreads mRNA
requires O2 for uptake, so won't work against anaerobes 'cidal |
|
|
which drugs are aminoglycosides?
|
"Mean GNATS canNOT kill anaerobes"
Gentamicin Neomycin Amikacin Tobramycin Streptomycin |
|
|
toxicity of aminoglycosides
|
"Mean GNATS canNOT kill anaerobes"
Nephrotoxicity (esp if used with cephalosporin) Ototoxicity (esp w/ loop diuretic) Teratogen |
|
|
Uses for tetracyclines
|
VACUUM THe BedRoom
V. cholera Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Tularemia H. Pylori Borrelia Burgodorferi Rickettsia |
|
|
MOA tetracyclines
'cidal/static? |
binds 30S and prevents attachment of aminoacyl RNA
static |
|
|
foods to avoid when takin tetracyclines
|
don't take with milk, iron, or antacids b/c it will inhibit absorption in gut
|
|
|
which tetracycline is fecally eliminated?
|
doxycycline (can be used in renal failure)
|
|
|
toxicity of tetracyclines
|
photosensitivity
gi discomfort discoloration of teeth inhibits bone growth in kids |
|
|
contraindications of tetracyclines
|
pregnancy
|
|
|
what drug can act as a diuretic in SIADH
|
demeclocycline (ADH antagonist)
|
|
|
examples of macrolides
|
the MACRO WREATH's CLARity is EZ to see
Erythromycin Clarithromycin Azithromycin |
|
|
MOA macrolides
cidal/static? |
blocks protein transloation by binding to the 50S ribosomal subunit
|
|
|
clinical uses for macrolides
|
URIs
pneumonia STDs gm + cocci (for pts allergic to penicillin) Mycoplasma Chlamydia Legionella Neisseria |
|
|
toxicity of macrolides
|
GI discomfort
acute cholestatic hepatitis eosinophilia skin rash increases serum [] theophylline and oral anti-coagulants |
|
|
MOA chloramphenicol
cidal/static? |
binds 50S, inhibiting peptidyl transferase
static |
|
|
clinical uses for chloramphenicol
|
meningitis
|
|
|
toxicities associated with chloramphenicol
|
anemia
aplastic anemia gray baby sndrome |
|
|
what causes gray baby syndrome
|
premature infants lack UDP gluuronyl transferase
|
|
|
MOA clindamycin
cidal/static? |
blocks peptide bond formation at 50S ribosomal subunit
static |
|
|
clinical uses for clindamycin
|
treats anaerobic infections (above the diaphragm)
|
|
|
toxicity of clindamycin
|
c. diff overgrowth
fever diarrhea |
|
|
MOA sulfonamides
cidal/static? |
PABA antimetabolites inhibit dihydropterate synthase
static |
|
|
clinical uses for sulfonamides
|
gram +/-
nocardia chlamydia |
|
|
which sulfonamide can be used to treat simple uti's
|
triple sulfa
|
|
|
toxicity associated with sulfonamides
|
hypersensitivity
hemolysis with G6PD deficiency tubulointerstitial nephritis kernicterus in infants displaces other drugs from albumin |
|
|
MOA trimethoprim
static/cidal? |
inhibtits bacterial dihydrofolate reductase
static |
|
|
clinical use of trimethoprim
|
used in combo with sulfamethoxaole
treats recurrent uti's, shigella, salmonella, PCP |
|
|
toxicity of trimethoprim
|
megaloblastic anemia
leukopenia granulocytopenia (TMP = treats marrow poorly) |
|
|
examples of fluorquinolones
|
-floxacins
|
|
|
MOA fluoroquinolones
cidal/static? |
inhibits topoisomerase II (DNA gyrase)
cidal |
|
|
toxicity associated with fluoroquinolones
|
gi upset
superinfections skin rashes h/a dizziness cartilage damage bone pain tendonitis, tendon rupture (adults) myalgia and leg cramps in kids "fluoroquinolones hurt attachments to your bones" |
|
|
contraindications of fluoroquinolones
|
pregnant women
children |
|
|
MOA metronidazole
static/cidal? |
forms toxic metabolites in bacterial cell
cidal |
|
|
clinical uses for metronidazole
|
anti-protazoal
GET GAP on the METRO Giardia Entamoeba Trichomonas Gardnerella vaginalis Anaerobes H. PYLORI treats anaerobic infx below the diaphragm (as opposed to clindamycin, which treats them above the diaphragm) |
|
|
toxocitiy of metronidazole
|
disulfiram like rxns with etoh
h/a metallic taste |
|
|
MOA polymyxins
|
bind to cell membranes of bacteria and disrupt osmotic properties
act like detergents |
|
|
clinical uses for polymyxins
|
resistant gram - infxs
|
|
|
toxicity associated with polymxyins
|
neurotoxicity
acute renal tubular necrosis |
|
|
1st line anti-TB drugs
|
INH-SPIRE
streptomycin pyrazinamide isoniazid rifampin ethambutol |
|
|
2nd line anti-tb drug
|
cycloserine
|
|
|
drugs for tb proph
|
INH alone
|
|
|
MOA INH
|
decreased synth of mycolic acid
|
|
|
toxicity of INH
|
hemolysis in G6PD deficiency
neurotoxicity (prevent with B6) hepatotoxicity SLE-like syndrome INH = Injures Neurons and Hepatocytes |
|
|
MOA rifampin
|
inhibits DN Adependent RNA polymerase
(the rif-raf RAN around the block) |
|
|
uses for rifampin
|
m. tb
delays resistance to dapsone when treating leprosy meningococcal proph proph in contacts of children with HiB |
|
|
4Rs of rifampin
|
RNA polymerase inhibitor
Revs up microsomal p450 Red/orange body fluids rapid resistance if used alone |
|
|
meningococcal proph
|
rifampin (drug of choice)
minocycline |
|
|
gonorrhea proph
|
ceftriaxone
|
|
|
proph in a pt with h/o repeated uti's
|
tmp-smx
|
|
|
proph against PCP
|
tmx-smp (drug of choice)
aerosolized pentamide |
|
|
proph against endocarditis with surgical/dental procedures
|
penicillins
|
