ED Pharmacology Review Flashcards

Terms Definitions
-ase
thrombolytic
Molidone
neuroleptic
alprazolam
Xanax
doxazosin
Cardura
Griseofulvin
p298
MEPERIDINE
(blank)
monocor
bisoprolol
phenytion
dilantin
valium
diazepam
-ipramine
tricyclic antidepressant
litho-
stone; calculus
Aspirin
p 330
Cyclophosphamide
Antineoplastic, immunosuppressive

cell cycle−nonspecific alkylating agent.

Tox-
alopecia, gastrointestinal distress, hemorrhagic cystitis, myelosuppression
Decongestantspsudoephedrine
Sudafed, Efidac
Theophylline
Methylxanthine, asthma
proprietary name
Trade name.
yohimbine
alpha2 selective antagonist
azathioprim
prodrug to 5MP
uses for albuterol
asthma
Rifampin
Antimicrobial

inhibitor of DNA−dependent RNA polymerase used in drug regimens for tuberculosis and the meningococcal carrier state.

Tox-
hepatic dysfunction, induction of liver drug−metabolizing enzymes (drug interactions), flu−like syndrome with intermittent dosing
lantus
long acting insuline
Neisseria meningitidis DOC
-Penicillin G
Ibuprofen
Class: Analgesic, antipyretic, antiinflammatoryAction: Relieves pain, fever, and inflammation.Side Effects: dizzy, drowzy, Headache, heart failure, peripheral edema, tinnitus, agranulocytosis, aplastic anemia, leukopenia, neutropenia, pancytopenia, thrombocytopenia, bronchospasm, Stevens-Johnson syndrome.Contraindications: Allery, nasal polyps, angioedema, and bronchospastic reactions to aspirin or other NSAIDs.Nursing considerations: Eveluate for relief of pain, renal hepatic function for long term use, Give with meals or mild.
meperidine
pure opioid agonist (=Demerol)effective analgesic, maintains much of potency when given POless constipating than morphine
ARSENIC ACUTE TOXICITY
GASTROINTESTINAL DAMAGE
mechanism of ipatropium is
antimuscarinic
What drug causes:
Coughing
ACE Inhibitors
Acetazolamide
dorzolamide
Carbonic anhydrase inhibitor diuretic

produces a NaHCO3 diuresis, results in bicarbonate depletion, and therefore has self−limited action. Used in glaucoma and mountain sickness. Dorzolamide is a topical analog for glaucoma
DDT
Insecticide

prevents inactivation of sodium channels, causes uncontrolled neuronal activity. Stored for years in body fat in mammals, birds, fish
How is flagyl metabolized?
Liver
maprotiline
slective uptake blockers, anti-depressant, NA uptake block
intramuscular
Injected deep into muscle tissue.
Trimethaprim sulfamethoxazole
Parasites (Pneumocystis carinii)MOA: Dihydrofolate reductase inhibitor, stops conversion of dihydrofolate to tetrahydrofolate.Admin: POSE: Rash, Dermatitis, Urticaria (esp. AIDS pts.) Stevens-Johnson syndrome GI Agranulocytosis, megaloblastic anemia (folate def. pts.), hemolytic anemia Headache DepressionOTH: most often combined with Sulfamethoxazole (sulfonamide - PABA analogue comp. inhibits dihydropteroate synthetase), synergisticTX: UTI's Pneumonia (P. carinii) Bacterial prostatitis Salmonella Shigella Gonorrhea Sinusitis/bronchitis Acute otitis media Toxoplasmosis (2nd line)
antidiarrheal drugs:
 
2. absorbents 
bismuth subsalicylate (Pepto-Bismol)
decreases fluid content in stool
has demulcent, astrigent & anti-inflammatory properties; action may have direct antimicrobial & antiviral effects
contains salicylates-contraindicated in kids (below 13) recovering from flu-type illnesses or chicken pox in which ASA is contraindicated (questionable assocation w/ Reye's syndome), in concomitant anticoagulant therapy, and in pts hypersensitive to ASA
adverse effects: gray-black tongue or stools & constipation
SNRI Duloxitine (Cymbalta)-ACTIONS/SIDE EFFECTS
ACTIONS:

inhibits serotonin/norepi @ all doses


liver met.


kidney excretion


CONTRAINDICATED in Renal Dz. pts.


food delays absorption***unlike pharmacokinetics of SSRIs

SIDE EFFECTS:

n/v


dry mouth


constipation, diarrhea


insomnia, dizziness, somnolence


sweating


sexual dysfunction
Renewal order for narcotics
48 hours
What mechanism produces glucocorticoids in the body?
Negative feedback.
Analgesic effect of precedex
intense analgesia
Streptokinase and anistreplase both activate and Activator that increases convesion of plasminogen to plasmin.
Type of drug?
Risedronate
Bisphosphonate
Affinity for Hydroxyapatite; inhibits osteoclast activity
Norgestrel
Progestin

used in many oral contraceptives and Norplant implantable contraceptive
levothyroxine
eltroxin (cheaper less strengths), synthroid (more $, more strengths)
Potency
Drugs affinity for a receptor
Ciprofloxacin adverse rxns
-TENDON RUPTURE-Cartilage erosion
-NO PREGNANCY
Droperidol
GI Drug (antiemetic) MOA: D2 antagonist; Hist. antag; 5-HT antag SE: QT prolongation, Torsades TX: postoperative nausea/vomiting; antipsychotic
What protein gives rise to leu-enkephalin?
proenkephalin
Parasympathetic (PNS)
Rest and Digest; Decrease HRCHOLINERGIC (acetyle CHOLINE)
acetazolamide S/E
like dorzolamide can cause
1_m acidosis
2_hypokalemia
3_renal stone
4_hyperchloemia
Blood pressure & hypertensive categories: Stage 2 hypertension
>= 160/100
Characteristic of Mebivacaine
Short procedure, toxicity, levanordefrin
Alkalotic compund used to increase gastric enviornment's pH
Antacid
Drug reaction causing hepatitis? (this is a TB drug)
INH
what inhalation anesthetic DOES NOT cause malignanat hyperthermia?
N2O
MOA statins?
HMG-CoA reductase inhibitors
blocks formation of cholesterol from HMG-CoA
Type of drug?
Semustine
Cancer drug- Alkylating agent
Nitrosurea- used on brain tumors
Edetate (EDTA)
Chelating agent

used in lead poisoning.

Tox-
renal tubular necrosis
Corticosteroids indicaiton
menegitis, cerebral edema, exfolative dermatitis, thyroiditis, ulcerative colitis, asthma, COPD, organ transplant, leukemia
What are the contraindications for flagyl?
Pregnancy
Bethanechol
An AchE inhibitor that treats paralytic ileus more specifically than neostigmine.
Ciprofloxacin
Good antibiotic activity against gram negative (esp. pseudomonas)
Esomeprazole
proton pump inhibitor, used in the treatment of indigestion, and as part of ‘Triple therapy’ for stomach ulcers
Is an unbound drug active or inactive?
active
What does this abbreviation mean?
 
OD
OD= right eye
thyroid replacement hormones
 
desiccated thyroid - armour, etwon & others 
naturally occuring thyroid hormone from thyroid glands or pigs or beef
contains both levothyroxine & liothyronine that possess all the actions of endogenous thyroid hormones
absorption is erratic & often incomplete when administered PO
average bioavailability 50-75%
most expensive form of therapy
Drug alone refers
specifically to chemical substances that are not used for their therapeutic, preventative, or diagnostic qualities
This drug decreses total peripheral resistance, induces postural hypotension, can cause reflex tachycardia and an increase in cardial output and can impair ejaculation of semen.
Phenoxybenzamine (prototype)
elimination
the removal of waste products of drugs fromt the body
- Therapeutic range: Acute episodes 1-1.4 mEg/L; Chronic 0.5-1.3 mEq/L
	- Side effects by level:
- <1.5: fine hand tremor, GI upset, muscle weakness, fatigue, memory and concentration problems
- 1.5-3: confusion, lethargy, ataxia, dysart
Traditional antipsychotics
Histamines
an endogenous substance that affects a wide variety of organs
Organophosphates Group 1?
Posphorylchlorines, X = Quartenary Nitrogen, used as weapons of war, MOA stimulates cholinergic receptors, acts as cholinesterase inhibitors
antidote for methanol poisoning =
FOMEPIZOLE, ethanol, dialysis
pts. receiving this medication are at most risk for: ______
bleeding
uses for phenobarbital
everything but absence and status
how microbes exhibit resistance
3 major mechanisms IAA
1)inactivation enzymes,2)decreased accumulation by decreased efflux or decreased uptake,3) decrease affinity
Which of the following drugs is classified as a macrolide?
erythromycin
Pharmacokinetics is regulated by which methods?
ADME:
Absorption (Input)
Distribution (Drug in Plasma)
Metabolism (Drug in tissue)
Excretion/Elimination (Output)
Cyclosporine, tacrolimus, and sirolimus toxicity
reversible nephrotoxicity (therefore you must monitor kidney function), neurotoxicity (seizures and tremor), vasoconstriction that may lead to hypertension, hyperlipidemia, hypercholesterolemia, hyperuricemia (may worsen gout) and transient hepatotoxicit
Triamterene
10x more potent than amiloride with shorter half life, converted to metabolite in liver, poorly soluble and may precipitate in tubules, patients are photosensitive.
Opioids
Agonist - derived from opium, act by decreasing the sensory neuron's ability to propagate pain impulses.
Antagonist - reverse the effects of opioids
Agonist-antagonist - decreases pain response without depressing respirations
Nonopioid analgesics - Salicylates like ASA, Nonsteroidal anti-inflamatory drugs (NSAIDS) like Ibuprofen and Paraaminophenol derivatives like Acetaminophen, affect the production of neurotransmitters.
Mechanism of action: bupropion
NE uptake inhibitor structurally related to amphetamines so it is a stimulant rather than sedative
adverse effects of monobactams
relatively nontoxic/safe; may cause phlebitis, skin rash, and occasionally abnormal liver function tests
Metabolic alkalosis Causes/Treatment
Causes: Excessive loss of gastric acid
 
Administration of alkalinizing salts
 
Treatment: Solution of sodium chloride plus potassium chloride
what is the clinical application of antipsychotics
schizophrenia, psychosis
midazolam + morphine
benzo/opioid combogiven IM as pre-med to dogs that can't be handled easily &/or are in painoften given to cats as alternative to ketamine (ex. w/ intracranial mass, etc.)
Sources of Vit B9
green leafy vegetables, milk, eggs,yeast, fortified breads & cereals
What is the antidote for Magnesium sulfate overdose?
Calcium gluconate
Vicodin and Tylenol w/Codeine are what schedule of drugs?
Schedule III
Can act as a direct GABA receptor agonist in very high doses without GABA being present
barbituates
what catecholamine is used to treat anaphylaxis
epinephrine ("EPI-pen")
contraindications of mannitol
CHF
pulmonary edema
anuria
severe renal failure
severe dehydration
How long does it take for spermatogenesis to cease in rats on hormonal contraception?
2 months
nizatidine (Axid)
newest drug in the H2 antagonists class, similar to ranitidine, IT DIFFERS FROM OTHERS, it is exc/kidneys, w/no 1st pass effect. Drug of choice for pt w/liver dysfunctions. ava in O form, CPEBM
Fibrates
Dec VLDL via inc LPL activity
Inc HDL 20-30%
Lowers TG***, VLDL, IDL, LDL
DDI w/ Statins, myopathy
Trimethaphan
A Nn ganglionic blocker. (of Ach type receptors and affects parasymp. and symp. so its rarely used)
Hydrocortisone
is a steroid hormone and is used to treat a variety of inflammatory diseases. It modulates DNA transcription by binding directly to DNA. It can be administered topically, orally, or intravenously.
2.204 lb. =  ____ Kg
2.204 lb. = 1 Kg.
adverse effects of loop diuretics

ototoxicity (transient w/ furosemide) - sign = ringing in ears

hyperuricemia/gout exacerbation: competes w/ uric acid for the renal & hepatic secretory systems, thus blocking its secretion from the body
acute hypovolemia/orthostatic hypotension
electrolyte depletion (hypocalcemia, hypomagnesemia, hypokalemia, hyponatramia, hypocholoremia)

photosensitivity (always w/ sulfa drugs!!)
neg. effect on lipid profile (decrease HDL, increase LDL)
Patients who develop symptomatic bradycardia with other ß-blockers may want to switch to a B-blocker with what intrinic activity?
A B-blocker with intrinsic sympathomimetic activity (ISA), which does not cause a decrease in heart rate at rest
This type of drug will bind and stay there, causing continuous contraction, flaccid paralysis
Depolarizing
Name two cell cycle Nonspecific oncologic drugs?
alkylating agents and antibiotics
Pancreatic Enzymes MOA & SE
Uses: Digestant, replaces oxogenous exocrine pancreatic juices (in Cystic Fibrosis). Aids in the digestion of starches, fats, & protein in absorption in the small intestine.
MOA: Replacement therapy.
S/E: Increased doses – abd. Cramping, nausea, diarrhea
when the drug must be absorbed into the bloodstream before it can be distributed to a distant location
systemic effect
What does the abbreviation stand for: stat
statim, at once
Clinical uses of Mebendazole / thiabendazole.
Nematode/roundworm (e.g., pinworm, whipworm) infections.
which beta blockers are beta-1 selective
acebutolol, betaxolol, esmolol, atenolol, metaprolol (A BEAM of beta-1 blockers)
True or False
SNP's are inherited and cannot be caused by the environment
True

can be geographical/ethnic
What are the adverse reactions for dopaminergic drugs
nervousness,anxiety,HA,blurred vision, arrhthymias
ceph/cef- begining = cephalosporin e.g cephotaxime
inhibits transpeptidase prevents peptodoglycan wall of bact forming
Where is erythropoeitin made?
In peritubular interstitial cells of the kidney.
What is Toxic Concentration?
the Plasma level at which toxic effects begin
Major risk factors (exclusive of LDL cholesterol) that modify LDL goals:
 
(5) 
cigarette smoking
 
hypertension (BP >= 140/90 or on hypertensive meds)
 
low HDL cholestertol (<40)
 
family history of premature CHD (CHD in male first degree relative <55yrs; CHD in female first degree relative <65yrs)
 
age (men >45yrs; women >55yrs) 
long acting beta 2 agonist asthma med:
how long does it last?
for which type of asthma?
salmeterol, serevent
 Lasts 12 hours
For mild/moderate asthma ONLY!!! Not for acute attacks!
This drug interfere with release of Ca 2+ from sarcoplasmic reticulum in skeletal muscle.
Dantrolene Sodium (Dantrim, prototype)
Potassium Sparing Diuretics
The degree of diuresis is small. It's used as an adjunct to loop or thiazide diuretics. Balances the potassium.MOA: Blocks aldosterone in the distal tubule.Uses: Also for edema. Primarily for fluid in the belly (ascites).S/E: Can cause hyperkalemia, arrythmias.NI: Monitor for hyperkalemia.
Nitrofurantoin (Macrodantin) - MOA &amp; Spectrum
MOA: Not fully understood. Interferes with carbohydrate metabolism. Blocks acetyl Coenzyme A. Needed for CHO metabolism.

Spectrum: Broad. Increasedeffectiveness against E. Coli. Therapeutic levels/effects only found in urine, local effect. Increases excretion rate.
What does the abbreviation stand for: pc
post cibum, after meals
What would happen if you used rifampin alone?
get rapid resistance
differences between amiloride and triampterene?
MOA similar, but triampterene has shorter t1/2
What is the drug of choice in treating malabsorption syndrome due to panceratic insufficiency?
pancrelopase (Creon-10)
How does acetaminophen kill your liver?...and at what dose?
OD depletes the anti-oxidant glutathione, which conjugates with the metabolic intermediate of acetaminophen before final metabolism and excretion of the drug.
Glutathione depletion leaves the highly reactive intermediate present, which can result in s
6 protease inhibitors used in HAART therapy
Atazanavir, Indinavir, Ritonavir, Lopinavir, Nelfinavir, and Amprenavir.
Cytotoxic alkylating agents (CA chemo) also damage normal RBC progenitors thus ...?
Toxic to bone marrow -> AML
Insulin - Regular insulin,Humula Hormone
Dosage:5 to 10 units IV/IM/SCDef:is a natuarlly accuring protein that promotes that uptake of glucose by the cellsInd:hyperglycimea,Diabetic comaContra:Hypersensitvity hypoglycemiaPre: none
how is L-dopa different from dopamine
L-dopa can cross the blood-brain barrier, dopamine cannot
In racetrack terminology the term bleeder is used for a horse with what problem?
EIPH - Exercise induced pulmonary hemmorhage
What are the main toxicities of Mirtazapine?
Sedation which leads to coma
what are the chronic toxicities of phenytoin
gingival hyperplasia in children, peripheral neuropathy, hirsutism, megaloblastic anemia, malignant hyperthermia (rare)
Where is bethamethasone used?
Used in preterm labor to induce fetal lung surfactant synthesis
Which of the following drugs may be used to treat tuberculosis?
isoniazid (Laniazid, Nydrzid), rifampin (Rifadin. Rimactine), ciproflozacin (Cipro), and rifapentine (Priftin)
3 drugs that may cause alcohol flush reaction by inhibiting ALDH
Metronidazole, cephalosporins, and oral hypoglycemic agents.
Explain two chronic effect of drug toxicity?
A) Dopamine receptor antagonists for schizophrenia can result in tardive dyskinesia (due to increased no. of receptors)B) Hormone replacement therapy (HRT) can lead to endometrial CA (due to continued activation of estrogen receptors)
How are narcotic analgesics used? Examples?
Morphone and fentanyl are used with CNS depressant during general anesthesia.
enhancing cholinergic transmission in alzheimers: musc autoreceptor antagonist
-M2 and M4 inhibit ACh released so block them to release more ACh-need good affinity for M2 and M4 without blocking M1 an M3-need specificity-resonable but no current trials
What are toxicities of atropine? (laundry list of anticholinergic effects)
raise body Temp, rapid pulse, dry mouth, dry flushed skin, cycloplegia, constipation, disorientation, acute angle-closure glaucoma in old ppl, urinary retention w/BPH, hyperthermia in babies
What is the main side effect of metformin?
It causes anion-gap metabolic acidosis.
What effect does hyperkalemia cause on the heart?
Decrease in excitability (lower AP height, slower conduction)
How to terminate reentrant activity in fast response and slow response cardiac tissues
Block delayed rectifier K+ currents and calcium channel blockers or B-blockers.
What are diuretics? What are the two major applications?
Drugs that increase urinary output
 
Two major applications
Treatment of hypertension
Mobilization of edematous fluid, which prevents renal failure
What is phase 4 of acetamenophen toxicity?
Phase 4: 4-14 days - Surviving patients show complete resolution of hepatic dysfunction.
Levodopa does not cross the blood brain barrier. T/F
False, levodopa does cross the blood brain barrier. Dopaminergic drugs do not cross the blood brain barrier.
FDA classification of drug use by pregnant women are?
A - Research done and no risk (includes methyldopa ???)B - Animal studies have been done to show either no effect or adverse effect BUT studies on humans if available dont show any riskC - Animal studies show adverse effects or are not done at all AND there are not human studiesD - Research shows risk to fetus but there is still utilityX - Not to be used at all (includes thalidomide and retinoic acid)
What are two things that can happen as delayed effects from organophosphates?
Intermediate syndrome - Weakness after initial improvement (1-4 days), Bulbar, respiratory and proximal muscle weakness which resolves in 2-3 weeks. This may be due to inadequate pralidoxime presence.

OPIDN - Organophosphate induced delayed neuropathy - Occurs 1-3 weeks out, Parasthesias then distal flaccidity, agent-specific, Possible Inhibition of neuronal target esterase
What are the effects of pH on drug absorption?
A) The protonated form (uncharged) of a weak acid is the more liposoluble formB) The unprotonated form (uncharged) of a weak acid is the more liposoluble form
What is the issue with the bile route of excretion?
Some drugs can be reabsorbed into the blood through the intestine, which could substantially prolong a drug's sojourn in the body.
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