Pharmacology 3 Flashcards

Terms Definitions
Serotonin receptors
5HT1(a-f)5HT2(a-c)5HT3-5HT7
Most abundant amino acid neurotransmitter in the CNS
Glutamate
4 DA pathways
1) Nigrostriatal2) mesolimbic forebrain system3) mesocortical4) tuberoinfundibular
most neurons located in the subcortical area with few found in the cortex
Acetylcholine
Potassium sparing diruetics
spironolactone, blocks aldosterone receptors in collecting ducts and tubules (interphere with Na/K exchange), weak diuretics (use with thiazides)
How is GABA derived
decarboxilation of glutamic acid glutamic acid decarboxylace(GAD)Glutamic Acid-----------------> GABA Vit B6 (coenzyme)
Hypoxia
Deficiency in the amount of oxygen reaching body tissues
verapamil (calan)
calcium channel blocker, used for cardiac arrhythmias, angina, hypertension, decreases hearth work load (may cause N & C, diziness, less HR)
Thiazides
not as effective as loop diaretics (only 10% where loop is 20%, inhibit aldosterone (save K+)
mannitol
most effective, use of somotic force to pull fluid out (IV administration) for ICP and ARF, caution with hear problems (circulatory overload, bp)
give the entire catacholamine cascade including enzymes
tyrosine-->dopa-->Dopamine--> norepinephrine-->epinephrineenzymes:tyrosine hydroxylase, dopa decarboxylase, dopamine hyrdoxylase, and methyl transferase
pathway of serotonin inactivation
5HT---->5HIA----------->5HIAA MAO aldehyde dehydrogenasereuptake back to presynaptic is also a major pathway
Potassium administration
IV-> dilue and give slowly, NEVER RAPID PUSH = toxic arrhthmia
foods high in potassium
rainsins (dried fruits), strawberries, watermelon, cantaloupe, oranges, beets, greens, tomatoes, muchsrroms, beans, peas,turkey, fish, beef
what was the first neuropeptide dicovered, and how long is it
Substance P11 AA long
N1 and M1 have what functionN2 and M2 have what function
1-excitatory2-inhibitory
ACE Inhibitors (captoPRIL,enalaPRIL,lisinoPRIL)
uses: HTN, heart failure, MI (blok renin process, decrease BP and work load) (1) prevents vasoconstriction, (2) fluid loss
What are the 2 enzymes that metabolize catacholamines
MOA and COMT
functional role of cholinergic neurons in the CNS (4)
1) memory2) Motivation, perception, cognition3) Attention4) Fine motor function
nursing considerations for calcium channel blockers
monitor vitals (hold drug if HR
what makes peptide neurotransmitters distinct
synthesis takes place on ribosomes in cell body and directed by mRNA
How do Acidic AA neurotransmitters cause depolarizationWhat are they
increase Na conductance in the postsynaptic membrane (EPSP)Glutamate and Aspartate
calcium channel bockers (verapamil, nifedipine)
inhibit influx of calcium ions accross cell membranes (myocardial cells, vascular smooth muscles
Where is Gaba B foundAgonist and Antagonist of Gaba B
cerebellum and spinal cordbaclofen and phaclofen
Which 5HT receptory are excitatory and which are inhibitory
excit- 5HT2, 4, 6, 7inhib- 5HT1All are G protein coupled receptors
Name 2 neutral AA and what is there action
1) gamma aminobutyric acid (GABA)2) GlycineBoth are IPSPs causing hyperpolarization due to K or Cl conductance
-zine
antihistamine
Benztropine
ant-cholinergic
montelukast
Singulair
METHADONE
(blank)
bisoprolol
monocor
clonazepam
rivotril
diazepam
valium
-osin
alpha blocker
onco-
mass; tumor
Cephalosporins
p. 292
Cyclosporine
Immunosuppressant

antibiotic; inhibits interleukin−2 synthesis, suppresses T cells.

Tox-
HTN, hirsutism, nephrotoxicity (dose−limiting), seizures (in overdose). Not a myelosuppressant
Sympathomimeticsmetaproterenol sulfate
Alupent
Salbutamol
B2 agonist
sublingually
Under the tongue.
xylometazoline
alpha nonselective agonist
S/E of furasemide
hypokalemia
hypocalcemia
hyperuresemia
hypophosphatemia
sulf group sensitivity
ototoxicity (more with ethacrynic acid)
Ketamine
phencyclidine derivative
trance-like dissociative state
induction, sedation, and analgesia
profound analgesia & amnesia but little/no muscle relaxation
minimal respiratory depression
CV stimulation
class: physostigmine
indirect cholinomimetic
Neostigmine
Cholinesterase inhibitor prototype

quaternary nitrogen carbamate with little CNS effect
Cefoxitin
Second−generation cephalosporin

active against a wide spectrum of gram−negative bacteria including anaerobes (B fragilis). Does not enter the CNS
humalog
rapid acting insulin
Enterobacteriaceae DOC
-Ertapenem
-2nd gen ceph
Amoxicillin
Class: AntibioticAction: Kills suseptable bacteria.Side Effects: Seizures, N/V/D, agranulocytosis, thrombocytopenia purpura, leukopenia, allergic reaction.Contraindications: allergicNursing considerations: Ask about allergy to Penicillins, monitor for side effects.
Propanolol
Nervous SystemAdrenergic BlockingBeta BlockerHeart, used for HCM, arrythmias
theobromine
methylxanthine (weak analpetic)in chocolate
ARSENIC CHRONIC TOXICITY
SKIN/LIVER CANCER
-cycline
antibiotic, protein synthesis inhibitor. Tetracycline
Drugs ending with:
-caine
Local anesthetic
Ex-Lidocaine
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
metoprolol
betaloc (white), lopressor (pink,blue)
quetiapine
dibenzazepine derivatives, atypical neuroleptic
excrete
To separate out and expel.
Sulfadoxine
Malaria (Sulfonamide)MOA: Blockade of folic acid synthesisAdmin: used w/ Pyrimethamine (also folate inh)TX: Malaria (chloroquine-res. P. falciparum)
antiemetic drugs:
 
serotonin receptor antagonists 
ondansetron (Zofran)
 selectively block central & peripheral serotonin receptors, producing an antiemetic effect
most effective antiemetics for highly emetogenic chemo drugs

can be used for postoperative n/v
onset of action: 30min PO; IV route:1-3min; duration of action for PO drugs is 4-24hrs; peak is 30-90min
HA-common side efect; may require analgesic for relief
Atypical Antidepressants DRUG NAMES

Buproprion (Wellbutrin)


Mirtazipine (Remeron)


Nefazodoen/Trazodone (Desyrel)
3 domains of learning are
cognitiveaffectivepsychomotor
Drug safeguards
1. Post-marketing surveillance
2. Watchdog org.
3. Agencies

1980 gov't estab safeguards to protect unborn fetus; rating system estab
Which BZD have active metabolites
Diazepam
Midazolam
what are phenoxybenzamine and phentolamine used for
pheochromocytoma
Type of drug?
Sulfamethoxazole
Sulfonamide
PABA antimetabolites inhibit dihydropteroate synthase
Type of drug?
Levothyroxine
Thyroid hormone replacement
Acyclovir
Antiviral

inhibits DNA synthesis in herpes simplex and varicella zoster. Requires activation by viral thymidine kinase (TK− strains are resistant).

Tox:
behavioral effects and nephrotoxicity (crystalluria), but not myelosuppression
symbicort
budesonide with long acting fomoterol
Used to treat status elipticus
Diazepam
Echinocandins (-fungin)
-Mechanism
-Uses
-Inhibit D-glucan synthesis: inhibit cell wall synthesis
-Useful in pts with resistant aspergillosis and candidiasis
 
-NO nephrotoxicity
 
Ultralente Insulin
EndocrineMOA: Excess zinc (produces large crystals) in acetate bufferMET: Long-actingSE: Hypoglycemia (Counter-reg. often impaired) Mild: juice/glucose Severe: glucagon ~ Allergy (insulin or protamine) ~ Insulin resistance (IgG) ~ LipohypertrophyOTH: Insulin requirements ↑ during 2nd half of pregnancy ~ If impaired renal fx: ↓insulin clearanceTX: Type 1 Diabetes
What protein gives rise to dynorphins?
prodynorphin
Leuprolide
EndocrineOther - "Lupron"Used to treat adrenal endocrinopathy in ferrets, used to treat inappropriate egg laying in birds
muromonab
used in kidney transplant against allograft rejection
alpha 2 stimulation
Regulates transmitter release. Decreases NE. Blocks sympathetic stimulation.S/E: Hypotension, headache, fatigue.
3 Parts
Aromatic nucleus, linkage, amino group
Antipsycotic drugs are also known as
Neuroleptic
Which cholinoreceptor blocker is used for motion sickness?
scopolamine
Other toxicity?
neuropathy, NH3 toxicity, sulfa allergy
uses of carbechol
glaucoma
pupillary contraction
release of intraocular pressure
Type of drug?
Salmeterol
Beta-2 agonist- Asthma drug
Ethacrynic acid
Loop diuretic

not a sulfa derivative.

Tox-
like furosemide but does not increase serum uric acid.
Corticosteroid contraindication
cataracts, glaucoma, DM(elevates blood glucose), PUD(peptic ulcer disease), mental health problems
What are the contraindications for Diflunisal?
.
Metopolol
Beta 1 blocker. Treats hypertension First cardioselective agent; short half-life:
3-4 h
At higher dose which atypical anti-psychotic can produce Parkinsonian like side effects
Risperidone
Carbamazepine
is an anti-epileptic drug which is similar in structure to the tri-cyclic anti-depressants. It is a sodium channel blocker (same mechanism of action as valproate and phenytoin).
Does an agonist activate or unactivate receptors?
activate
which barbituate is esp good at inducing microsomal enzymes?
phenobarbital
drug interactions with mood stabilizing agents (lithium)
antipsychotics, carbamzepine, diuretics, indomethacin, ibuprofen, methyldopa, pheytoin:  increased toxic effects of lithium
Benzodiazepines: life-threatening hypothermia
Haldol: severe encephalopathic symptoms such as parkinsonism, dyskinesia, and dementia
neuromuscular blockers: prolonged effects of these
sympathomimetics: reduced pressor effects
urinary alkalinizers (antacids, caffeine, NaCl, sodium bicarb) - decreased effects of lithium
OXIDATIVE RXN:O-DealkylationCarbon group off Oxygen
examples- Codeine, dextromethacin, and indomethacin
This drug is used in Hypertensive crises, peripheral vascular disease (e.g. Raynaud's phenomenon), and Paraplegics to contol autonomic hyperreflexia.
Phenoxybenzamine
Schedule V Drugs
*limited abuse potential*abuse may lead to limited physical or psychological dependence*accepted medicinal usesex: small amounts of narcotics(codeine) used as antitussives or antidiarrheals
Barbituates sedative-hynotic
Older class of drugs, small therapeutic indexpotentiates GABAhigher doses can release glycine (inhibitory transmitter
Drug that best demos the class's common properties and illustrates its particular characteristics
Prototype
How many phases are associated with acetamenophen toxicity?
4
Ephedrine =
releases stored catecholamines - for nasal decongestion, urinary incontinence, hypotension
Drug of choice for syphilis.
Benzathine penicillin G.
how is mannitol administered?
parenterally (poorly absorbed PO)
NSAIDS
And said: "I be napping in Keto"
ibuprofin
naproxen
indomethacin
ketorolac
Captopril
ACE inhibitor prototype

used in HTN, diabetic renal disease, and CHF.

Tox:
hyperkalemia, fetal renal damage, cough ("sore throat")
An all-inclusive effect on the whole body is also called a(n)______ effect.
systemic
Efficacy
How big a response the drug elicits
Busiprone side-effects
Side effects associated with buspirone include palpitations, tachycardia, GI distress, pupillary constriction, and increased blood pressure in patients being treated with monoamine oxidase inhibitors (MAOIs).
Principal cells
In collecting tubules are responsible for Na+, K+, and H2O transport. (affected by aldosterone and ADH)
Synergism
Two drugs having the same effect given together produce a response greater then the sum of the two (1+1=3)
_____mL= 1 fl. oz.
30 mL= 1 fl. oz.
Subclass of PCNs:
 
natural PCNs/narrow spectrum 
penicillin G (prototype drug, PO/IV/IM)
 
penicillin V (penVeeK) (PO only, less potent)
 
penicillin G procaine (crysticillin A.S.) (IM only, releases PCN over period of 4-24 hrs; used for desensitizing allergic pts)
 
penicillin G benzathine (bicillin L-A) (IM only; long-acting repository form; produces low, but sustained blood levels of PCN for as long as 4 wks)
 
all natural PCNs work the same way but differ in route of  admin & stability to gastric acid
 
broad spectrum: gram pos organisms the most (strep, staph)-the most effective; gram neg; gram pos anerobes
 
susceptible to inactivation of B-lactamases (penicillinases) 
 
Hypomagnesemia prevention and treatment
Magnesium gluconate and magnesium hydroxide Magnesium sulfate
Tolerance does not develop to __________and ______
miosis and constipation
benzodiazepines to tx seizures
orally ineffective in dogstolerance to anticonvulsant properties can develop over timemost potent elevator of seizure threshold: facilitates GABAdiazepam: used in cats that are refractory to phenobarb (don't give orally)clonazepam: not metab. by liver microsomal enzymes (no active metabolites), longer half life, doesn't cause hepatic necrosis
Indications of Vit B9
megaloblastic & macrocytic anemia, prevention of neural tube defects in the fetus
3 routes of drug administration
1. Enteral
2. Parenteral
3. Topical
Define tachyphylaxis
A rapidly occuring tolerance to a drug
Three conditions that methohexital may be used for
ECT
Cardioversion
Seizure foci mapping
what is dobutamine used to treat
shock, heart failure
Hydrochlorothiazide is a thiazide diuretic that inhibits the reabsorption of ----- in the ---- tubule
NaCl; early distal tubule
uses for lithium
bipolar
blocks relapse and acute manic events
What is a highly important component of toxicology?
Risk Assessment
ranitidine (Zantac)
longer acting and more potent then cinetidine, met/liver, exc/urine, ava in O, P forms, CPEBM, Not associated w/antiadrenergic adverse effects
Antianxiety Drugs: Benzodiazepines
List examples
Valium, Librium, Ativan, Xanax, Klonopin
Anticholinergics that can treat overractive bladder (3)
tolterodine, trospium, and oxybutynin
Colchicine
is used to treat gout. It prevents the activation and release of inflammatory mediators from neutrophils.
1 gm = ____ grains
1 gram = 15 grains
drug interactions with loop diuretics

digitalis: increased risk of digitalis toxicity; increased risk of electrolyte imbalances that can trigger arrhythmias (b/c hypokalemia)

Lithium: excretion reduced, increased tox. risk
reduction of the hypoglycemic effect of oral antidiabetic drugs (which reduce sugar levels), possible result in hyperglycemia

antihypertensive agents: potentiate action

Salicilates:decreased elimination of salicilates, increased risk for toxicty (b/c takes excratory sites)
Side effects of thiazide treatment:
hypokalemia, their efficacy is diminished in patients with renal insufficiency, Use with caution in severe renal disease and severe hepatic disturbances
The therapeutic uses of this drug include:* Spasticity associated with lesions of the spinal cord including traumatic injuries resulting in paraplegia and quadriplegia* Spasticity associated with disease of the spinal cord e.g. demyelination
Baclofen, (LIORESAL, prototype)
1.Carmustine and Streptozocin are part of what group? 2. Name two other drugs in this group? 3.Drug mechanism of action? Treatment of what tumors?
1. Nitrosoureas (alkylating agent) 2.lomustine, semustine, 3. Alkylates DNA after bioactivation and can cross the BBB and treats brain tumors (glioblastoma multiforme)Nitrous bomb for the head!
Synergistic effects
2 or more unlike drugs are used together and the sum is greater than either drug alone. 1 + 1 = 3.
When drug is held under the tongue and absorbed
Sublingual
What does the abbreviation stand for: tbsp
tablespoon (15 mL)
what is the action of terbutaline
adrenergic agonist, beta-2 >beta-2
What is the term for "down regulation" where the initial agonist response is largest, followed by desensitization and a recovery time
Tachyphylaxis

receptors are dynamic
Biotransformation: chemical change of drug
Biotransformation: chemical change of drug
use dependent Na channel block epileptics
carbmazepine, phenytoin, Valproate, Lambrogine
Significance of Eubacterium lentum
Can convert digoxin to inactive metabolites. Treat with antibiotics.
Who's the biggest pimp of all transport system carriers?
P-Glycoproteins AKA multidrug transporter protein, because they help out in so many ways.
Classes of lipoproteins:
 
VLDL 
produced in the liver to transport TGs & cholesterol to the tissues
how are mast cell stabilizers given?
 
what is a popular mast cell stabilizer?
spin inhaler (capsule w/ powder)
MDI
solution for nebulizer
 
Tilade (nedocromil)
This is an all-or none response to a drug and relates to the frequency with which a specified dose of a drug produces a specific response in a population.
Quantal Response
List some therapeutic lifestyle changes that are recommended by NCEP
decrease intake of fats and cholesterol, decrease weight, increase physical activity, increase fiber, increase plant sterols.
Loading dose
1st dose to get level to MEC (large dose to reach therapeutic level).
What does the abbreviation stand for: qs
quantum satis, sufficient quantity
What do class 1B antiarrhythmics do to the AP duration?
Decrease AP duration
MAO cholinomimetics in tx of glaucoma
increased outflow of aqueous humor
From what two organs are most drugs eliminated?
kidney and liver
Where would you find alcohol dehydrogenase? Where would you find aldehyde dehydrogenase?
Hepatic cytosol. Hepatic mitochondria.
2 drugs that can not be administered with nevirapine
Rifampin and ketoconazole.
What side fx does meperidine lack compared to morphine?
less spasmogenic, less constipation and urine retention, doesn't inhibit coug
Diazepam Valium antianxiety hypnotic anticonsulsant sedative
Siezures: 5 to 10mg IV/IMAnixiety:2 to 5mg IV /IMPre Med:5 to 10mg IVSedative and skeletal muscle relexant decrease tremors and seizures,pain cardioversionInd siezures anxiety premed cardioversionContra hypersensitivity shock coma low vitals alcholism OB pts neonatesPrecautions: Depression hepatic and renal impairment addiction very ill pts copd short half life
NE release from the synaptic vesicles diffuses across the synaptic cleft and binds to __________ or ___________.
postsynaptic receptors or target cells
What are three consequences of Training Stress Syndrome
• Stop eating• Gastric ulcers• Tie up
D = Disability, Dstick
Altered Mental Status examples?

Low Blood Sugar examples?
Altered Mental Status = Sleepy, comatose, Agitated as seen with PCP, Hallucinating which can be seen with benadryl. These can be measured on the glasgow coma scale.

Dstick is a bedside dextrose check for low blood sugar. Low blood sugar can be a reason for altered mental status, causes can also be oral hypoglycemics, sulfonylurias and insulin overdose
These type of drugs used to decrease pH in the stomach.
antacids….duh….jk. (I was instructed to make a question of every word)
What are some indications for using glucocorticoids?
Inflammation, allergies, asthma, and replacement therapy for adrenocortical insufficiency and CAH.
Which of the following drugs is used to treat influenza A or influenza B?
rimantadine, zanamivir, and oseltamivir
2 drugs that inhibit stomach ADH
Aspirin and cimetidine (also competes with P450 hepatic metabolism)
Give examples of unintended activation of different receptor subtypes?
Beta-1 adrenergic Rs are expressed in the heart and lead to increased HR and contractionBeta-2 adrenergic Rs are mainly in the airways and SM cells and lead to relaxation & dilationBeta-receptor antagonists (Beta-blockers) are often targeted to Beta-1 to help Tx angina or HF BUT some beta-blockers are not soo selective and thus give bronchoconstriction too
what happens to L-dopa after it crosses the BBB
converted to dopamine by dopa decarboxylase
enhance b-amyloid destruction and/or removal from CNS: passive immunizatino against b-amyloid
-raise antibodies in mice and give to humans-mice are genetically modified to give human antiboies-theory- give less encephalitis
What drugs can have atropine-like (anticholinergic) reactions?
a lot...but in this section they wanted "TCAs" especially amitriptyline
What are the contraindications of glyburide?
Because it is a sulfonylurea, it cannot be used in pregnant women becuase it can cross the placenta and deplete insulin from the fetal pancreas.

2. Also contraindicated in renal or hepatic insufficiency because its accumulation can lead to hypoglycemic episodes.
Is it better to have a one or two way block?
Two way
Why does tolerance of sodium nitroprusside not develop?
Activation is catalyzed by a different nitric oxidase than nitroglycerin.
Drug and medicine can be thought of as
any nonfood chemical substance that affects the mind or the body.
How is acetaminophen Tx carried out?
put levels measured over 4 hours on the Rumack nonogram to measure what Tx. is necessary. If less than 3-4 hours since exposure give AC, if extended release and over 3-4 hours than give AC, otherwise you use NAC either the 72, 48 or 21 hour protocol.
Carbidopa reduces amount of _____ ____ to do what?
Reduces amount of levodopa needed to reach therapeutic level in brain
What is the difference btw On & Off-target adverse effects?
The former binds to the intended receptor but at inappropriate conc.
Explain why all drugs that work on GABA are synergistic
they all work on different receptor sites
Why might St. John’s wort be bad for HIV pts?
It induces CYP3A4 which reduces the therapeutic levels of Indinavir
Iptratropium
Asthma (mAch-antag) MOA: mACh receptor antagonist → ↓Gi → ↑cAMP & ↓PLC → bronchoRX Admin: dry powder inhalation TX: Chronic bronchitis Limited in asthma
escitalopram
lexapro
Thiazide
hydrochlorothiazide
Aciphex
Famotidine
MIVACURIUM
(blank)
Parasympatholyticsipratropium/albuterol
Combivent
DuoNeb
inderal
propanolol
alprazolam
trizolobenzodiazepines-depression
xylocaine
lidocaine
Antidepressants
pg 311
Noradrenergic
uses norepinephrine
Phenoxybenzamine
Alpha−blocker prototype

irreversible action. Used in pheochromocytoma
Combivent (Albuterol/Atrovent)
Corticosteroids
robaxin OTC
methocarbamol
Isoniazid
-Antituberculotic agent
-Inhibits mycolic acid synthesis
 
-Peripheral neuritis
-Hepatotoxicity
-Hemolysis
epinephrine
alpha nonselective agonist
Metamucil
Bulk forming laxative
milk thistle
viral hepatitis
Cocaine
Indirectly acting sympathomimetic

blocks amine reuptake into nerve endings. Local anesthetic (ester type). Marked CNS stimulation, euphoria; high abuse liability.

Tox-
psychosis, cardiac arrhythmias, seizures
detrol, detrol la
tolterodine
-ine
reverse transcriptiase inhibitors, antihistamines
Omalizumab
Asthma (antibodies)MOA: Monoclonal anti-IgE antibodyOTH: Allowed lower doses of ICS & ↓hospitalizations & ER visitsTX: Asthma (maintenance)
H1
Pain and Antiinflammatory AntihistamineInflammation, motion sickness
FACTQuantal ResponseThe construction of a quantal dose-response curve requires that data be obtained from many individuals. The smallest dose that will produce a quantal response is not the same for all members of a population.
.
Robinol
antisecretory, decreases GI secretions.
mechanism of tropicamide is
antimuscarinic
Type of drug?
Piperacillin
Anti-pseudomonal penicillin
Atropine
Cholinergic Blocking
-blocks PSNS, s/e mimic SNS
-Decrease oral and respiratory secretions
-treatment of bradycardia, peptic ulcer, and IBS
5'-fluorouracil
inhib enz -> dTMP
Vancomycin
-Glycopeptide: inhibits elongation of peptidoglycan chain
-Only effective against G+ bacteria
-Bactericidal
 
-Useful in treating G+ infections in penicillin allergy patients
 
-OTOTOXIC and NEPHROTOXIC
-"Red man" syndrome
Repaglinide
Endocrine (Meglitinides)MOA: Bind SUR receptors associated w/ ATP-sensitive K+ channels (diff. sitefrom sulfonylureas) → ↓K+ current → ↑insulin secretion MET: Metabolized by liver Half-life: 1 hourSE: Hypoglycemia Weight gainOTH: Used for post-pran hyperglycemiaTX: Type 2 diabetes
superinfections
drug therapy, particularly w/ broad-spectrum antimicrobials or combo of agents can lead to alterations of the normal microbial flora of the upper respiratory, GI, GU tracts, permitting the overgrowth of opportunistic organisms (esp. fungi or resistant bacterial strains)
Synovi G3
Pain and AntiinflammatoryOther antiinflammatory - Glucosamine, MSM, Fatty AcidsNutraceutical, maintenance/repair cartilage/synovial fluid
local anesthetics
esters: cocaine, proparacaineamides: lidocaine, bupivacaine, mepivacaine
Benzofirst line agent to break/terminate active seizure
Diazapam
Fentanyl
short acting opioid, adjunct
rapid onset
profound analgesia w/ incomplete amnesia and no skeletal muscle relaxation
is tubocurarine depolarizing or nondepolarizing?
nondepolarizing
proph against endocarditis with surgical/dental procedures
penicillins
Type of drug?
Methacholine
Cholinergic agonist
Causes bronchioconstriction when inhaled; used for asthma challenge test
Oral antihistamines- strongly sedating (SS)PD
promethazine
diphenhydramine
one
a single person or thing:
Antihistamine that inhibits cytochrome P-450 system
Cimetidine
Melphalan
(alkylating agent - causes DNA cross-linking)
phenylalanine mustard used for multiple myeloma
30 mg= ____grain
30 mg= 1/2 grain
Henderson Hasselbach for acidic:
 
for basic:
Acidic: Ionized/Unionized
 
 
Basic: Unionized/Ionized
What is the normal BP?
Lower than 120/80
loperamide
misc. opioid agent (=Immodium)used to tx diarrheaavoid repeated use --> constipationcan cause profound sedation in certain dog breeds (collies, Australian shepherds, etc.)
isoflurane
-less side effects than enflurane-no seizures-number 1 in US
Antihistamines
drugs that arrest histamines by blocking its receptors
Benzo with most potent amnistic properties
lorazepam
____is an estrogen receptor mixed agonist/antagonist that blocks the binding of estrogen to ER+ cells.
Tomoxifen/Raloxifene
which drugs are ssris?
paroxetine
fluoxetine
sertriline
citalopram
Type of drug?
Clarithromycin
Macrolide
50S protein synthesis inhibitor
Glucagon
Hormone product of pancreatic A cells

Increases blood sugar via increased cAMP
The various general anesthetics produce varying degrees of muscle relaxation; usually muscle relaxation has to be further enhanced by using neuromuscular blocking agents.
Muscle relaxation.
Dicyclomine (Bentyl)
Cholinergic Blocking
-used to manage IBS, spastic colons, mucous colitis.
Analgesic/anti-pyretic and anti-inflamm. dosages of aspirin
600 mg/4h and 3.2g/d
Leucovorin
(Citrovorum factor or folinic acid) May be used to reverse the effects of methotrexate by bypassing blocked DHFR.
Erythromycin vs clarithromycin vs azithromycin drug interactions
Erythromycin= Clarithromycin> Azithromycin
Tolterodine (oxybutynin, darifenacin)
Mechanisms: muscarinic antagonist, M3 selectivity, tertiary amine
Treatment: T+D for urinary incontinence adults, O relieves bladder spasm after urologic surgery
Side effect: xerostomia (cotton mouth; less with D)
What are the non selectie MAOIs?
phenelzine, tranylcypromine
contraindications of quinolones/fluorquinolones
contraindicated in pregnancy, during lactation & in kids under 18 yrs of age (can cause cartilage erosion)
 
use w/ caution in those w/ CNS disorders or predisposed to seizures
 
use w/ caution in pts w/ known prolongation of the QT interval, pts w/ uncorrected hypokalemia & those receiving class 1A antiarrhythmics 
Causes of Hyperkalemia
Severe tissue trauma
 Untreated Addison’s disease
 Acute acidosis
 Misuse of potassium-sparing diuretics
 Overdose with IV potassium
what type of seizure are benzodiazepines indicated for
status epilepticus
An example of Angiotensin II receptor antagonist
Avapro
AED drug interactions
-induce or inhibit CYP450-change binding -PD interactions, in CNS-and specific interactions
What's an example of a Cholesterol-Synthesis Inhibitors (statins) drug?
Lovastatin, Simvastatin
Antibiotics
Used to tx local or systemic infection. Kill or suppress growth of microorganisms.
What does the abbreviation stand for: cap
capsule
What is the antidote N-acetylcysteine used to treat?
Acetaminophen toxicity/overdose
All of the above actions are ------synaptic
PRE
uses of thiopental
induction of anesthesia
short surgical procedures
Type of drug?
Metyrosine
Autonomic drug
Blocks the conversion of tyrosine to dopamine (on it's way to become NE) in noradrenergic nerves
what is the brand name of metaproterenol?
alupent
Which antiarrhythmics cause an increase in QRS duration?
1A and 1C
First-pass metabolism
The initial biotransformation of a drug during passage through the liver from the portal vein that occurs before the drug reaches the general circulation
Side-effects of hydralazine
Tachycardia, fluid retention, edema, headache, nausea, lupus-like syndrome.
Amlodipine
is a calcium channel blocker and thus is used to treat heart failure and cardiac dysrhythmias.
Henderson-Hasselbach Equation
Which equation shows the influence of ionization on drug absorption?
ezetimbe (Zetia)
only drug in the class
 
approved for use by itself or together w/ statins in pts w/ high cholesterol to reduce LDL cholesterol and total cholesterol
 
mechanism: selectively blocks intestinal absorption of exogenic cholesterol; localizes & appears to act at the brush border of the small intestine; inhibits the absorption of cholesterol, leading to a decrease in the delivery of intestinal cholesterol to the liver
 
as an add-on: increases HDL (4%), decreases LDL (30% when used w/ a statin), decreases TGs (11%) 
Anticoagulants considerations
same time every day, assess for bleeding, transition from Heparin to Coumadin, both taken for 2-3 days, avoid ASA or NSAIDS
what role of B blocker in prinzmetal angina?
C/I
Oxidative Deamination: Is this reaction Phase I or Phase II? Is it Non or Microsomal? Is it Hydrolysis, Reduction, or Oxidation?
Phase I, Microsomal, Oxidation
Define summation
Also called the additive effect. Two drugs that both have the same effect are give together.
Pancreatic Enzymes NI
NI: Sensitive/allergy to pork (it’s made from pork) Eff. Treatment: decreased stools, decreased diarrhea. Take as prescribed, do not change brands, take with meals. Careful with powder as it can irritate skin. Enteric coated to decrease b/d in the stomach.
Example: Viokase, Pancrease.
To convert to a smaller unit you must
Multiply
Sources of exposure from pollution
air water and soil
pharmacotherapy
the use of drugs to prevent, diagnose, or treat signs, symptoms, and disease processes
Mechanism of action of Amantadine.
Blocks viral penetration/uncoating; may buffer pH of endosome. Also causes the release of dopamine from intact nerve terminals. "Amantadine blocks influenza A and rubellA and causes problems with the cerebellA."
MOA 6MP
blocks do novo purine synth, activated by HGPRTase
True or False
A higher Kd (dissociation constant) means there is a greater affinity
False
Lower Kd=Greater affinity
What is the only neuromuscular blocker that acts via a depolarizing mechanism?
succinylcholine (Quelicin)
Aceteminophen Overdose and long-term large dosage use causes what?
hepatic necrosis and neprophathy
side effects of sympatholytics(a-2 agonist like clonidine)
dry mouth, dizziness, constipation,sedation and impotence.
Bupivacaine is toxic how?
More cardiotoxic than other locals.
plasma concentration - increase
 
time of elimination - increase
In nonlinear elimination if you increase the dose, what will happen to the plasma concentration?
 
to the time of elimination?
Pharmacodynamics of Niacin:
reduces plasma VLDL by inhibiting VLDL synthesis in liver
 
reduces LDL by 15-25%
 
increases HDL by 25-30% 
 
reduces triglycerides by 50% 
Explain Up/Down Regulation.
The body's response to drugs via creating more or less receptors. (e.g. a person on B-blockers a long time they will eventually no longer work as well)
which dopamine agosts are used to treat Parkinson's
L-dopa/carbidopa, bromocriptine, pramipexole, ropinirole, amantadine
How are drugs classified?
By their Therapeutic or Pharmacologic classification
Tramadol (ultra)
-weak mu agonist, inhibit 5HT and NE reuptake (codeine, propoxyphene), helps antinociceptive pathway-for moderate to severe pain-low but increasing abuse potential
Drugs of Class II (Beta Blockers)
Propanalol (Inderal), Acebutolol (Sectral), Esmolol (Brevibloc)
Amount of time it takes to remove one half of a drug from the plasma
Half-time
Used to treat colon cancer and other solid tumors, basal cell carcinoma (topically)
5-Fluorouracil (5-FU)
EKG effect of Class III antiarrhythmic?
Increased PR & QT
What is the least sedating OTC antihistamine and the only one approved by the FDA for cold symptoms?
clemastine (Tavist Allergy)
Treat VLDL + LDL?
Fibrate or Statins (atorv/simv best) or Niacin
or Statins + Zetia
or Statins + Niacin/Fibrate
**Resins CI - raise VLDL
**DDI Statin + Gemfib
2 common antibiotic resistance mechs of beta-lactams.
Mutant transpeptidases and beta-lactamase.
What 2 drug types least affect the NMJ?
PCN and Cephalosporin
major property of beta blockers:
 
capacity to block alpha-adrenergic receptors (alpha I) 
nonselective beta blocking along with alpha I selective blockage, w hich results in peripheral vasodilation rather than the vasoconstriction that occurs w/ the other beta blockers
 
used in tx of HTN or CHF b/c:
reduction of symp. activity & improvement of diastolic dysfunction by prolonging diastolic filling time
 
beta-blockers are contraindicated in tx of  acute CHF; they are only used when the pt is hemodynamically stable
Antiplatet considerations (dose 325 mg)
monitor CBC, Avoid ASA and NSAIDS
The following are exp of what type of drug:Tubocuraruine, Gallamine, Vacuronlium, atracurium
Nondepolarizing blocker
What is iatrogenic ?
a term used to describe illness caused by the medical profession
What happens when proteins are taken with levodopa?
They compete with levodopa.
Methyl mercury
is the more common build up in the environment
What is the antidote for lead toxicity/overdose
CaEDTA, dimercaprol, succimer, penicillamine
what are the different classes of drugs that treat asthma?
nonspecific beta agonists
b2 agonists
methylxanthines
muscaranic antagonists
cromalyn
corticosteroids
antileukotrienes
What is tyramine's mechanism of action?
releases extra neurotransmitter, which is not broken down b/c of MAO
What is Evoxac used for?
Evoxac = cevimeline
Used to treat xerostomia
Brown Sequard syndrome
Resection of half of the spinal chord (contralateral loss of temp and pain and ipsilateral loss of 2 point discrim, vibrat., and propriocep.)
Used for: Flumazenil
A BDZ antagonist, it can be used to reverse sedative effects of BDZReverse BDZ overdose
nursing considerations for prostoglandin (misoprostol)
no dose reduction is suggested for pts w/ renal impairment or older pts, unless dose is not tolerated
admin ac & ghs w/ food to prevent GI discomfort &diarrhea
avoid admin w/ Mg-containing antacids, which may increase incidence & severity of diarrhea
advise pt w/ childbearing potential to avoid pregnancy & use effective contraception
What toxicity mactches the following drugs 1. Halothane 2. Methoxyflurane 3. Enflurane 4. Rare
1. Hepatotoxcity 2. Nephrotoxicty 3. Proconvulsant 4. Malignant hyperthermia
Why do we use nursing diagnoses?
Nanda nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable
Name two organs in the body where drugs must cross a cell membrane
blood brain barrier, placenta
What are the indications for Albuterol and Salmetrol, respectively?
Albuterol- use during acute exarcebation, Salmetrol- long-acting agent for prophylaxis
What is a safer alternative to DDT that uses the same mechanism of action?
Pyrethroids (more easily metabolized)
Lithium is maximally effective in what types of patients?
Ones with less severe illnesses.
Vd - Volume of distribution
What is the variable that relates the toal drug concentration in the body to the plasma concentration?
What are the 2 major causes of arrhythmias?
 
 
1) Abnormal automaticity (spontaneous AP\depolarization of phase 4)
2) Abnormal impulse conduction -> retrograde conduction from block or reentry
What happens after renin is released?
It stimulates AI, ACE transforms it into AII, which causes vasoconstriction and aldosterone to be released, which causes Na and H2O to be reabsorbed which increases b/p.
What effects can occur as a result of barium?
constipation, intestinal obstruction, ulceration, and perforation as a result of impaction of the colon
What are the side effects of clofibrate?
Incease LFTs and cause myositis (Clofibrate is a "Fibrate")
H2 antagonists--adverse effects & drug/drug interactions
AE of GI:diarrhea or constipation. CNS effects: dizziness or headace. Drug/drug---warfarin (anticoagulants), alcohol
2 things loss of Cl- does
Stimulates H+ secretion (from type A intercalated cells) and inhibit bicarb. secretion in type B intercalated cells.
nursing considerations with iodide products
dilute the drug in full glass of H20, fruit juice, or milk & admin after meals
monitor weight, pulse, and thyroid status
instruct pt to avoid aspirin & products containing iodine: iodized salt, shellfish & OTC cought medicine
When do we use a leading zero?
to emphasize the decimal pint for fractional amounts less than 1
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
What are the three ways to cross the cell membrane?
- Channels and pores- Transprot system- Direct penetration
How many types of Beta adrenergic receptors are there and where are they located
B1- Heart and kidneys, B2- Lungs, GI, Liver, vascualr smooth muscles,uterus, and skeletal muscle B3- Fat Cells
Are generic products and brand names therapeutically equivalent?
99% of the time, they are exactly the same except for the binder and it could effect the absorption
Drugs enter body by : [ Rectal ]
Drugs enter body by : [ Rectal ]
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Term:
Definition:
Definition:

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