Pharmacology 8 Flashcards

Terms Definitions
Uncomplicated UTI
epilepsy prevalence
t1/2 (short/long)
Ethinyl estradiol
Miconazole (example)
ct4- microtubles
Endocrine (Glucocorticoids) MOA: Bind glucocorticoid receptors → ↑gluconeogenesis ↑glycogenesis ↑hormone-sensitive lipase ↑blood glucose ↓cytokines ↑vasoCX demarginalized PMNs ↓vitamin D → ↓Ca2+ absorption & ↑Ca2+ clearance & ↑bone resorption MET: Short-acting 4x anti-inflammatory SE: ↑susceptibility to infx Inhibits growth in kids Myopathy Osteoporosis Cataracts Adrenocortical atrophy Iatrogenic Cushing's TX: Addison's disease
AntiinfectiveCephalosporin - "Convenia"Cats and K9s over 4 mos, used for pyoderma, wounds, abcesses, 1x inj., lasts 7-14d, se: v/d, anorexia
Opiod analgesics
pg 313
inhaled anesthetic (halothane)
toxicity of methoxyflurane
Fluoroquinolone antibiotic

bactericidal inhibitor of topoisomerases; active against many gram−negative rods including E coli, H influenzae, Campylobacter, Enterobacter, Pseudomonas, Shigella.

CNS dysfunction, GI distress, superinfection, collagen damage (avoid in children and pregnant women). Interactions: caffeine, theophylline, warfarin
First−generation cephalosporin prototype

bactericidal beta−lactam inhibitor of cell wall synthesis. Active against gram−positive cocci, E coli, K pneumoniae, but does not enter CSF.

potential allergy; partial cross−reactivity with penicillins
Iron Dextran (Imferon)
ct1 - nitrosureases
Erythromycin and chloramphenicol interaction
Class: AntiviralAction: Kills suseptible viruses, antiviral.Side Effects: Encephalopothy changes, Seizures, DIC, hemolysis, leukopenia, hepatitis, vesicular eruption, angioedema, allergic reaction.Contraindications: allergyNursing considerations: Monitor for renal toxicity, dehydration, renal disease, mental condition.
Behavioral PharmAnti-Anxiety - Benzodiazepine "Ataivan"
haloperidol (Haldol)
Conventional (Typical) antipsychotics: Phenothiazines Haloperidol (Haldol) is a phenothiazine antipsychotic.
derived from opium poppy
naturally-occurring narcotic
mu receptor agonist
analgesia, euphoria, respiratory depression, physical dependence
Drugs ending with:
Pituitary hormone
Loop diuretic prototype

blocks Na+/K+/2Cl− transporter

high efficacy; used in acute pulmonary edema, refractory edematous states, hypercalcemia.

ototoxicity, K+ wasting, hypovolemia, increased serum uric acid
Gq stimulates _____
Phospholipase C
fosamax 70mg weekly bisphosponate
toradol tablets and ophth
Schedule III
High Abuse PotentialPrescription RequiredOpiates/Stimulants/Depressants/Anabolic Steroids
Glargine Insulin
EndocrineMOA: Peakless recombinant insulin that precipitates in neutral subQ tissuesMET: Ultra-long-acting Delayed onset of actionSE: 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: ype 1 diabetes
Cardiac Medication - Antiarrhythmic (or Antidysrhythmic)
Barb for anti-convulsant, chronic sedation , long acting
cyclophosphamide (Cytoxan)
Alkylating agents Cyclophosphamide (Cytoxan) is an alkylating agent used alone or in combination to treat a wide variety of cancers.
Cogwheel rigidity
rigidity in the extremities
Aminoglycosides, loop diuretics, cisplatin can lead to:
ototoxicity, nephrotoxicity
Cardiac drugs: sites of action
Type of drug?
alpha non-selective antagonist

broad spectrum agent; inhibits protein synthesis (50S); uses restricted to back− up drug for bacterial meningitis, infections due to anaerobes, Salmonella.

reversible myelosuppression, aplastic anemia, gray baby syndrome
Without p53, what happens?
mutations accumulate
MAO non selective inhibitor Depression
haloperidol, pimozide or ziprasodone. Tic treatment.
-Inhibition of bacterial folic acid synthesis--> inconsequentil to humans
-Dec sensitivity of target enzymes, increased PABA formation, use of exogenous folate
EndocrineMOA: GH lysine replaced by glycine → GH antagonistMET: PEGylated to ↑t1/2, ↓immunogenicity…but ↓affinity (8 AA substitutions fix that)SE: ↑hepatic aminotransferase (otherwise well-tolerated)Does not reduce size of GH tumor or lower GH levelsTX: Acromegaly
Adverse Effects of vasopressors
excessive vasoconstriction (peripheral ischemia & necrosis)
myocardial ischemia
GI SystemGI Ulcers - H2 Receptors"Pepcid"Blocks histamine receptors which decreases HCl secretions
tricyclic antidepression overdose
3c cardiotxicity convulsion coma
acetaminophen (Tylenol and others)
Nonopioid analgesics: NSAIDs-Nonsalicylates Acetaminophen (Tylenol) is a nonsalicylate, nonopioid analgesic used to relieve pain and reduce fever.
– Used mainly during induction only
	- Advantage: little pulmonary or cardiac effects
- Disadvantage: No analgesic effects (feel pain), post-op nausea, Adrenocortical suppression (decreased cortisol secretion)
Suspensions with oily substance in solvent
what is the antagonist of Nicotine?
It can cause bleeding,___________, and drug-drug interactions.
when is salmeterol used?
for asthma proph
Type of drug?
Anti-inflammatory mast cell stabilizer- asthma drug
H2 blocker prototype

used in acid−peptic disease.

inhibits hepatic drug metabolism; antiandrogen effects. Less toxic analogs: ranitidine, famotidine, nizatidine
Calcium channel blockers AE
orthostatic hypotention, bradycardia
novolin 30/70, humulin 30/70
premix insulin, short/intermediate
Highly selective alpha-1 blocker but Non-selective for alpha-1 subtypes. Treat hypertension or BPH. Long half-life: 20 h and long duration of action. Bioavailability is similar to prazosin.
Centrally acting analgesic with unique dual MOA (Mu-receptor affinity and monoaminergic reuptake blockade) with equivalent analgesic relief to codeine, but less potent than acetaminophen-codeine/hydrocodone for dental or muscoloskel. pain. Lower potentia
is an anti-epileptic drug, used in tonic-clonics. May operate via a combination of potential mechanisms – sodium channel blocking, GABA action enhancement, and AMDA receptor blocking. It is used in similar circumstances to phenytoin.
Thyrotropin α
Endocrine (TSH)MOA: Binds TSH receptor → ↑cAMP → ↑iodide uptake & TH syn/secr'nTX: Dx residual thyroid carcinoma
treatment for depression
nonpharmacologic treatment 
cognitive behavioral therapy & interpersonal psychotherapy (best/first approach)
electroconvulsive therapy (ECT) (for those that don't respont to therapy/meds)
transcranial magnetic stimulation
vagus nerve stimulation (VNS)
deep brain stimulation (DBS)
complimentary therapieshypericum perforatum - St. John's wort
useful in depression of mild intensity
should not be used by pts taking SSRIs - both agents increase serotonin levels and could cause overdose
What is the receptor type on arterioles?
This drugs Pharmocodinetics include:* Active orally. Plasma half-life is about 3-4 hours* largely excreted unchanged by the kidney
Baclofen, (LIORESAL, prototype)
Harrison Narcotic Act
(1914)*established word narcotic and required a tax stamp on containers of narcotic drugs*required minimum standards of strength, purity of quality*dangerous drugs must be included on label
– Can be administered orally or by intermuscular injection; parenteral doses provide postoperative analgesia effects similar to opioids; max 5 days use due to renal insufficiency
Movement of solvent in solution from area of low to area of higher concentration
Carbachol =
direct ACh agonist - glaucoma (activate ciliary muscle, pupillary sphincter)
What is the antidote for iron toxicity/overdose
what are the symptoms of organophosphate poisoning
Excitation of skel muscle
moa azathioprine
interferes with metabolism and synth of nucleic acids
toxic to prolif wbc
Amphotericin B

polyene drug of choice for most systemic mycoses; binds to ergosterol to disrupt fungal cell membrane permeability.

chills and fever, hypokalemia, hypotension, nephrotoxicity (dose−limiting, possibly less with liposomal forms)
Which of the following antitussives is a DEA controlled substance?
Reduce cholesterol abs by 50%
Red LDL 18%, VLDL 5%
Inc HDL 3%
No serious AE
An NMJ blocker that is structurally similar to Ach. (it is a depolarizing agent). In some situations may cause rhambdomylosis (muscle breakdown).
Mucosal protectant with antibacterial activity against H. pylori
Colloidal Bismuth compounds
Class II antiarrhythmic drugs
block adrenergic receptors (beta blockers). Depresses phase 4 depolarization. Slows the heart rate and reduces contractility.(propanalol)
What does this abbreviation mean?
bid= twice a day
pharmacodynamics of PCNs:
bactericidal; interfere w/ cell wall synth. by inhibiting biosynthesis of cell wall mucopeptides
most effective on rapidly growing organisms
have virtually no untoward effec on human cells; safe in children, elderly, and during pregnancy (cat. B)
do not cross the BBB except when the meninges are inflamed 
in an acute asthma attack which group of drugs would you choose first?
name a bunch of benzodiazepines
diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide (all have ZZZ in them)
What is idiosyncratic effect
An abnormal or unexpected susceptibility to medication other than allergy, peculiar to one patient
injectable anesthetic agents, propofol, mechanism of action
-at hydrophobic domain-enhance gaba inibition-open cl channels-no effect on glycine or glutamate
MOA: Blocks action of Ach in VC. Reduces motion sickness by decreasing the sensitivity of the labyrinthine apparatus (stabilizes the ear). Used for vertigo.
S/E: r/t it being an anticholinergic drug. Dry mouth, const, and sedation.
NI: Increase fluids and monitor for dry mouth. Alt. is Scopolamine patch (better tolerated).
Define plasma-level profile
Describes the lengths of onset, duration, and termination of action, as well as the drug's minimum effective concentration and toxic levels.
What does the abbreviation stand for: Rx
receipt, take
What are the anti-TB drugs?
Rifampin, Ethambutol, Streptomycin, Pyrazinamide, Isoniazid (INH) -- RESPIre
what are the side effects of epinephrine treatment in glaucoma
mydriasis, stinging
which glaucoma drugs increase outflow of aqueous humor?
PGF2alpa (latanoprost)
Is there a safe exposure level to carcinogen?
ACE Inhibitors AE
1st dose hypotention, dry cough, hyperkalemia, renal failure, fetal injury,
What are the adverse reactions of evoxac?
Adverse reacions:
Sweating (19%), nausea (14%), diarrhea (10%), cardiac palpitations, eye pain , decreased visual acuity
Vancomycin absorption
Good tissue availability but not to CNS without inflamm. and probably not to bone.
is a biguanide which is used in the treatment of type II diabetes. It depresses hepatic glucose production.
Oxazepam is what kind of drug?
BDZ with intermed T1/2
inhibitors of bacterial cell wall synthesis
effective on "growing" bacteria that synthesize a peptidoglycan cell wall; should not be combined w/ bacteriostatic drugs 
 also inactive against organisms devoid of this structure (fungi, viruses, etc)
selectively interfere w/ the synthesis of the bacterial cell wall
bacterial cell walls are thicker & more rigid than the membranes of mammalian cells; they contain complex macromolecules that are formed via biosynthetic pathways which are absent from mammalian cells
block the cross-linking of peptidoglycan chains, which is the final step in bacterial cell wall synthesis, thereby producing deficiencies in the cell walls; interior of the cell is hypertonic, H20 enters the interior of the cell & causes lysis 
Heparin uses:
is it fast acting or slow acting?
pulmonary embolism
stroke evolving
massive deep vein thrombosis
Heparin is fast-acting.
This term is used to describe the increased tension often associated with certain musculoskeletal injuries and inflammation (e.g. muscle strain/tightness). It involves afferent nocieptive nput from damaged tissue which excites outflow of α motor neuron
Muscle spasms
active absorption
when a carrier molecule such as a protein or enzyme actively moves the drug across a membrane

Hydantoins - NI
Monitor b/p, hydrate them, never d/c abruptly. Variety of dosing, may increase as a child grows. Don't mix IV with anything but normal saline. Monitor drug interaction.
The plasma drug level below which therapeutic effects will not occur
Minimum effective concentration
What does the abbreviation stand for: tsp
teaspoon (4-5 mL)
SLE-like syndrome (4). [mnemonic: it's not HIPP to have lupus]
hydralazine, INH, procainamide, phenytoin
Which gene is responsible for induction of 1A1?
Aromatic hydrocarbon response element
appropriate pain medications for RA
NSAIDS first, Corticosteriods, then MDARDS
taken into the body in a manner other than through the digestive canal.
Treatment of choice for chronic hepatitis C infection
Peg-interferon 2A and ribavirin.
Tubular secretion (active transport)
Where cells of the proximal tubule actively transport a wide variety of organic acids and bases from the plasma directly into the tubular fluid bypassing filtration?
Pharmacotherapeutics of anticholinergics:
appear to be more effective for lower airways
first line choice in the tx of COPD
dose: 2 puffs QID
intranasal spray is used for the tx of perennial rhinitis & rhinorrhea (allergies)
What is Preload? What is Afterload?
Preload: End-diastolic volume or end-diastolic pressure
Afterload: arterial pressure
D,l amphetamine: Class of drug, use.
Cortical stimulant (amphetamine) - treats ADD *ADderaL!!
Myelosuppression by methotrxate is reversible with what drug? How well is methotrexate transported across the BBB?
1. Leucovorin (folinic acid) rescue 2. Poorly - hence the importance of Leucovorin in high Methotrexate doses
How can antagonists affect cell function?
By blocking vitamins, decreasing fluids, and working with antibiotics.

By attaching to a receptor, they prevent somrthing else from attaching and causing an effect. Also called a blocker.
What does the abbreviation stand for: OS
oculus sinister, left eye
what are the side effects of nonselective alpha blockers
orthostatic hypotension, reflex tachycardia
MOA beta blockers in tx of glaucoma
decreases aqueous humor secretion
Dopaminergic drugs increase levels of______ in _____?
Increase levels of Dopamine in substantia nigra
IntraCerebroVentricular administration
Using PGE1 and 2 to increase body temp (NSAIDS and asprin can lower it)
You shouldnt drink what with antihistamines?
Grapejuice. (Metabolized by CYP3A4...can get lethal cardiac arrythmias with liver enzyme inhibitors)
Anatomical site of antipsychotic effects:
D2 receptors of frontal cortex and limbic structures
Calcium Channel Blockers do what?
Name the consequences of blockade
Prevent calcium ions from entering cells which decreases HR, contractility force and conduction velocity
Regulate contraction of vascular smooth muscle
(no significant effect on veins)
...on the heart:
SA/AV node
Coupling of cardiac calcium channels to beta1-adrenergic receptors
Name the 3 processes of renal excretion of drugs
* Glomerular filtration (water soluble and polar compounds)* Active tubular secretion (organic acids like penicillin)* Passive tubular reabsorption
Define biologic half-life
Time the body takes to clear one half of a drug.
Environent affects potential absorption
Water turbidity the nature of the clay ph of the water affect howa toxin settles in the water
Adverse effects of ACE-I Captorpil? Think CAPTOPRIL
C: cough, A: angioedema, P: proteinuria, T: taste changes, O: hypOtension, P: pregnancy problems like fetal renal damage, R: rash, I: increased renin, L: lower angiotensin. Also hyperkalemia.
What is the action of metformin?
It inhibits gluconeogenesis in the liver!
buspirone (Buspar) therapy/treatment
onset 2 - 3 weeks; PO; a scheduled medication not a PRN; and anxiolytic drug; no sedative or dependancy; no contrainindications except allergy
Why give someone nitroglycerin?
It causes nitric oxide to be produced and via cGMP relaxes vascular smooth muscle.
how would you treat neuroleptic syndrome?
as it results from over-suppression of D2, tx muscle rigidity with muscle relaxant and then with bromocriptine the D2 agonist
This is a combination of a drug with a receptor which results in a molecular change in the receptor which can trigger a chain of events leading to a response.
Drug-Receptor InteractionsDrug + Receptor --> Drug Receptor complex --> Response
Direct Acting Skeletal Muscle Relaxants - S/E & NI
S/E: Low risk of CNS S/E
NI: Effects may take up to 2 weeks to be seen. Can increase liver enzymes. Contains lactose. Monitor drug interactions; safety concerns.
what effect does atropine has on blood pressure?
promotes some cutaneous vasodilation by reflex mechanism

Note: Atropine has very little effect on the blood pressure if given alone
foods to avoid when takin tetracyclines
don't take with milk, iron, or antacids b/c it will inhibit absorption in gut
What is CYP P-450?
An enzyme that causes over 75% of the metabolism in the body (occurs in liver)
9. Differentiate the mechanism of action, indication for use, common adverse effects and nursing implications for Statins.
Indication for use – used to treat primary hypercholesterolemia and combined hyperlipidemia, and secondary prevention of coronary events. Mechanism of action- it inhibits HMG-CoA reductase which catalyzes cholesterol biosynthesis and increases HDL and decreases LDL, total cholesterol VLDL. Adverse effects- elevated liver enzymes and myopathies, muscle ache, joint ache, chabdomyolysis. Nursing implications- before therapy monitor liver function, evaluate patient for muscle soreness, avoid physical activity, monitor older adult who receives polypharmacy.   Identify core patient variables relevant to drugs that affect lipid levels.   Before starting drug therapy, patients should be treated with nonpharmacologic methods of controlling cholesterol and lipids, including dieting. Determine whether the patient is pregnant because lovastatin is in pregnancy category x drug. Check for drug interaction with older adults.
What do toxic levels of class IV drugs cause? 4
- Hypotension
- Aggravate CHF
- Heart block
- Negative inotropic effect
What does the abbreviation stand for: qid
quater in die, four times each day
Patient teaching for sleep aids
can be come addictive (need to use to be able to sleep)
describe the filtrate in the Bowman's capsule
free of proteins & blood cells but contains most LMW plasma components in about the same conc as are found in the plasmathese include: glucose, sodium bicarbonate, amino  acids, other organic solute, electrolytes (such as Na, K, Cl)
why are skeletal muscle relaxants not analgesic?
they are quaternary amines and must be administered IV. It doesn't cross the blood brain barrier or placenta.
What is an example of a therapeutic use of drugs?
-antibiotics to kill the bacteria that cause an infection.-Analgesics to contol the pain and inflammation of arthritis-Hormone replacement therapy for the symptoms of menopause
why prefer b blocker in Rx of HPN than alph blocker?
1_ no reflex tachycardia with b blocker.
2_no reflex increase in renine secretion.
seritonin syndrom
hyperthermia,myoclonus seizure
uses serotonin

iodine−containing radiocontrast medium; also used in thyrotoxicosis. Reduces peripheral conversion of T4 to T3; may also reduce release of hormone from thyroid
(Side effects)
robaxin OTC
Hepatic encephalopathy DOC
beta2 selective agonist
Benzo for Sedation
Minimum effective concentration
Osteoporosis (2)
corticosteroids, heparin
Lincosamide antibiotic

bacteriostatic inhibitor of protein synthesis (50S); active against gram−positive cocci, B fragilis.

GI distress, pseudomembranous colitis
Synthetic corticosteroid

high mineralocorticoid and moderate glucocorticoid activity; long duration of action
orphenadrine citrate
norflex otc
(ARB) angiotensin II blocker
GlucocorticoidMOA: Bind glucocorticoid receptors → ↑gluconeogenesis ↑glycogenesis ↑hormone-sensitive lipase ↑blood glucose ↓cytokines ↑vasoCX demarginalized PMNs ↓vitamin D → ↓Ca2+ absorption & Ca2+ clearance & ↑bone resorptionAdmin: Inhaled SE: ↑susceptibility to infx Inhibits growth in kids Myopathy Osteoporosis Cataracts Adrenocortical atrophyIatrogenic Cushing'sTX: AsthmaDERMATOLOGYAnti-inflammatory AntimitoticSE: Skin atrophy, rosacea ↑IO pressure Cushing's syndrome, growth++Keloids, cystic acne, alopecia areata= triamcinolone injection
Pain and AntiinflammatoryOther Antiinflammatory - "Synotic"SE: garlic, burning, irritation, common in horses, carrier vehicle through skin for other drugs
FACTPhysiology of Neuromuscular Tranmission* Arrival of impulse* Opening of Ca 2+ channels* Release of ACh by exocytocis* Binding of ACh to nicotinic receptors* Muscle contraction
Loss of muscle movement
Ampicillin and amoxicillin
p. 291
Type of drug?
Thiazide diuretic

similar to erythromycin, but greater activity versus chlamydia and streptococci; long half−life due to tissue accumulation.

GI distress, but no inhibition of drug metabolism
Most commonly perscribed Sedative-Hypnotics
treats anxiety, panic attacks, phobias, OCD, PTSD, and sleep disorders.
Thienopyridine deravative aspirin like, anti-platelet
Cefaclor reaction
Serum sickness2nd gen ceph
Salicylic Acid
KeratolyticSolubilize cell surface protein debrisSE: Anaphylactic shock Irritation & inflammation Salicylism
originate from the Cephalosporium fungi
chemically related to PCNs: similar mech of activity, renal excretion & allergenicity
may be used as alternatives when pts are allergic to PCNs: 5-10% cross-over sensitivity

primarily are bactericidal & act on bacteria by interfering w/ bacterial cell wall  synthesis: bacterial cell walls weaken, swell & burst from increased osmotic pressure within the cell causing bacterial cell death
widely distributed in body fluids; some (not all) enter CNS; mostly eliminated by renal excretion
resistant to penicillinases but sensitive to other B-lactamases (i.e.cephalosporinases)
Glucosamine Sulfate/Chondroitin/MSM/ASU
Pain and AntiinflammatoryOther Antiinflammatory - "Dasequin"
pure opioid agonistsimilar to morphine, but 5x more potentless GI upset & vomiting than morphine in dogs
Benzoalternative agent, despite longer half-life more rebound seizures than Lorazepam
sedation, induction, and maintenance of anesthesia
hypnotic w/ no analgesic properties
fast recovery vs thiopental
CV & resp depression
This antimetabolite derivative of 6-mercaptopurine interferes with the metabolism and synthesis of nucleic acid, therefore toxic to proliferating lymphocytes
drugs for tb proph
INH alone
Antidote for Cyanide?
Nitrite, hydroxocobalmin, thiosulfate
Ergot alkaloid

used as prophylactic in migraine.

retroperitoneal and subendocardial fibroplasia
H2 Receptors
blood vessels*
GI parietal cells
mast cells (feedback inhibition)

distribution - gastric mucosa, cardiac muscle, mast cells, brain

postreceptor mechanism - Gs, increase cAMP
amounting to six in number.
3 nitrovasodilators
Nitroglycerin, isosorbie dinitrate, and isosorbide-5-mononitrate
(alkylating agent - causes DNA cross-linking)
estradiol linked to nitrogen mustard
mechanism: inhibition of microtubule formation 
treatment: prostrate cancer
What does this abbreviation mean?
SQ= subcutaneous
Transmembrane Receptor Protein
Intracellular enzymatic activity regulated by an extracellualr site
e.g. Lidocaine blocks Na+ channel hyperpolarizes can't depolarize for an action potential
Insulin binding to sugar
OXIDATIVE RXN:Aliphatic hydroxylationadding an OH group.
examples- ibuprofen, pentobarbital, and tolbutamide
dantrolene sodium
used to tx malignant hyperthermiadecreases Ca++ release from SR
loperamide (imodium)
-mu agonist-used for diarrhea-few other effects-abuse unlikely because poor oral absorption and not crossing bbb-not water soluble, don't give iv
SLUDGE Stands for
Salvation, Lacrimation, Urination, Defecation, Gastric motility, Emisis
Propofol's effect on baroreceptors
depression (no tachycardia)
Clinical uses of Chloroquine, quinine, mefloquine, atovaquone, proguanil.
which drugs are used totreat OCD
Type of drug?
Nalidixic acid
Inhibits DNA gyrase(topoisomerase II)
Blocks Ca2+ release from sarcoplasmic reticulum of skeletal muscle

Used in muscle spasm (cerebral palsy, multiple sclerosis, cord injury) and in emergency treatment of hyperthermia caused by malignant hyperthermia, malignant neuroleptic syndrome, and serotonin syndrome
Which CYP450 converts codeine to morphine?
Heart disease, Lowers BP & cholesterol
(Ambien) is a BZ-1 selective benzodiazepine agonist which enhances GABA-mediated inhibition, although it is structurally unrelated to the benzodiazepines. It is an effective hypnotic agent, similar to the benzodiazepines used for this purpose, and is usef
Effective hypnotic. (Nefazodone is a structural analog that works better as an antidepressant) Relatively side-effect free, but not a good antidepressant. Priapism can occur. Possibly spontaneous orgasms too.
Cephalosporins mechanism
-Interfere with cell wall synthesis--> inc aytolytic enzymes-Bactericidal
Dextromethorphan is used to suppress a ______________ cough.
Used for: TCAs
unipolar (major) depression, panic disorderadjunctive tx in chronic pain, sleep disorders, OCD (clomipramine only)
atipical bacteria
no cell wall
include mycoplasma and chlamydia 
Where is ACE mainly found?
in the lungs
what glaucoma should epinephrine NOT be used for
closed-angle glaucoma
Cholesterol-Synthesis Inhibitors (statins)
(Most effective)MOA: Interferes with cholesterol synthesis. Inhibits hepatic HMG COA reductase (enzyme), causes hepatocytes to synthesize more LDL receptors, therefore more LDL is removed from the blood.Lowers: primarily LDL, also decreases VLDL, increases HDL.Use: Decrease LDL cholesterol (dose dependent). Effects are seen in 2 weeks, full effects in 4 weeks.S/E: Few: GI, headache, rashNI: Check LGTs. Admin in the evening.
complex partial seizures
-35% -attacks have confused behavior-impaired/loss of consciousness-automatisms-start as simple partial, psychic or sensory seizures
Osmotic diuretics
Not used for hypertension. Decreases intracranial pressure.
MOA: Increases osmolarity of the plasma. Pulls water into the vascular space so that it can be excreted.
Uses: Decreases intracranial and cerebral pressure.
S/E: Fluid and lyte imbalance, headache, nausea, vomiting.
NI: Monitor neuro status.
The enhancement of one drug's effects by another drug.
Phenergan to Morphine
True or false. Osmolality controls the distribution and movement of water between body compartments.
What is the antidote for copper, arsenic, gold toxicity/overdose
which barbiturate is commonly used as an IV anesthetic?
Type of drug?
Glitazone- DM treatment
↑ insulin sensitivity
what is the duration of arformoterol?
12 hour
What drugs are considered class 3 antiarrhythmics?
Isosorbide Isordil
NitratesNitrites. Are esters of nitrous or nitric acid. Relief of cardiac induced chest discomfort, relaxation of smooth muscle tissue. Venous and arterial dilation leads to reduced cardiac demand.
Alpha-methyl DOPA. Released as a false neurotransmitter and stimulates NTS alpha-2 receptor to reduce symp. output. Treats MODERATE hypertension.
is a steroid hormone. Used as an anti-inflammatory/immunosuppressant in a variety of diseases.
Membrane Proteins
What control the influx of essential nutrients, ions (and certain drugs) and the efflux of toxins and certain drugs?
adverse effects of Niacin:
flushing, itching, burning sensation common due to prostaglandin release (histamine); diminshed by aspirin (ASA) 30 min before dosing 
GI problems
Atypical antipsychotic S/E(Drug of choice for Schizophrenia)
Leukopenia and agranulocytis, osteoporosis, decreased libido, weight gain, do not cause EPS
S/E of flecainide?
suuden death so limitted use
Aromatic hydroxylation: Is this reaction Phase I or Phase II? Is it Non or Microsomal? Is it Hydrolysis, Reduction, or Oxidation?
Phase I, Non-microsomal, Oxidation
words part meanings: pharmacokinetic
pharmac/o= drugkinetic= pertaining to motion or movement
Cholinergic crises
Caused by overdosage of cholin. drug. Give atrapene for overdose.
this is one tenth of the base unit
B subunit
allows toxins to travel inside the cell
nerve fiber
an axon together with a myelin sheath
Clinical uses of Amantadine.
Prophylaxis for influenza A; Parkinson's disease.
which drugs block DNA synth
"TOPless DANcing Queen" (insert abba song here... :)
_____ ______ gives an idea about safety of a drug
Therapeutic index
Which of the following medication is least likely to be used to treat or stop an acute asthma attack?
cromolyn sodium
Muscle Relaxants
Act to relieve pain associated with skeletal muscle spasms
Activates beta 1 and beta 2 receptors, but no effect of alpha. The beta activity underlies its cardiovascular effects with positive inotropic and chronotropic effects that lead to an increased cardiac output, but decreased cardiac efficiency and increase
4 locals that are esters
Cocaine, procaine (novocaine), tetracaine, and benzocaine.
Facilitiated Diffusion
What type of drug transport is the carrier-mediated process in which there is no input of energy, and therefore, enhanced movement of the involved substance is down an electrochemical gradient?
Pathophysiology of Angina Pectoris
simply bad oxygen economics
there's an imbalance between oxygen supply and demand
in normal heart, when demand goes up, coronary blood flow increases, so there is an increased supply of oxygen to meet metabolic needs of the myocardium
in the heart w/ coronary arteries that are obstructed by plaques (or arteries that have vasospasm) when oxygen demands go up, supply isn't always capable of keeping up
Name the 5 types of Transmembrance Signaling
hint (GILTR 2)
Ion Channel (ligand-gated)
Lipid Soluable Ligand
Transmembrance Receptor Protein
2nd Messengers
Fluoxetine, sertraline, paroxetine, citalopram are what class of drugs?
pg 311 SSRI's for endogenous depression
What is pharmacology?
A science that studies drug effects within a living systemcentral focus is to improve the quality of life
a seizure is
-a brif episode of abnormal brain functino and one or more of the following: change in consciousness; sensory, psychic or autonomic disturbances; behavior change; loss of muscle tone; convulsions-msost have EEG evidence of excessive and hypersynchronous dischange of cerebral cortical neurons-need excessive glutaminergic excitation, not enough gaba inhibition, or a combo
Function of Class IB
Increase repolariztion where as IA DECREASES repolarization
Kind of metabolism in which a constant fraction of a drug is eliminated
first order
Symptoms of protease inhibitor toxicity.
GI intolerance (nausea, diarrhea), hyperglycemia, lipid abnormalities, thrombocytopenia (indinavir).
What does AT stand for?
A = Aminoglycosides (streptomycin, gentamicin, tobramycin an damikacin. And T = Tetracyclines
What cancer drugs have the SE Pulmonary fibrosis?
Busulfan & Bleomycin
Which of the following drugs is an example of a selective 5-HT receptor agonist?
sumatriptan (Imitrex)
a small adhesive patch or disk, which contains a drug, that may be applied to the body near the treatment site
transdermal system
Isoniazid neuropathy due to...
Relative pyridoxine deficiency. More likely to occur in slow acetylators and patients with predisposing conditions like malnutrition, alcoholism, diabetes, AIDS, and uremia. It promotes pyridoxine excretion. (reversed by pyridoxine administration)
half-life and dosing of macrolides (e-mycin, clarithromycin, azithromycin)
Clarithromycin has longer half-life than e-mycin and is given BID (also has less GI intolerance) azithromycin has the longest half-life and can ge given 1X/QD-useful in treating MAC inpatients with HIV
Calcium Channel Blockers (CCBs)
Ca ions play important role in excitation and contraction of cardiac and vascular smooth muscle; contraction takes place when extracellular Ca enters cells through channels in membrane
CCBs act to reduce influx of Ca into cell, which results in relaxation of vascular smooth muscle, dilation of coronary arteries/arterioles, and reduction of myocardial O2 consumption
What are some of the factors effecting absorption?
Bioavailability, Concentration, Circulation, Surface Area, Route of Administration
This type of drug reduces skeletal muscle strength by interfering with excitation-contraction coupling in the muscle fiber
Dantrolene Sodium (Dantrim, prototype)
Do drugs create new responses?
No they just modify existing responses
Direct acting cholinergic agonists
--works directly on the Nicotinic and Muscarinic (primarily) receptors.
--Uses: to treat atonic bladder or bowel, galucoma
S/E: mimics PNS stimulation. If you increase the dosage you increase the s/e.
What is the antidote for carbon monoxide toxicity/overdose
100% oxygen, hyperbaric oxygen
which asthma drug blocks a phosphodiesterase
what is the net result?
cAMP levels are raised
What can folate possibly prevent?
neural tube defects in deloping fetuses
-also may prevent colorectal cancer
What should you be worried about when you prescribe pilocarpine?
Cardio changes
Visual blurring
Pulmony spasms/bronchitis
beta blockers
Antocholinergic drugs can antagonize pilocarpine reactions
Neurons of the PAG innervate...
Serotonergic neurons of median raphe nucleus and noradrenergic neurons of locus coeruleus (which both moderate spinal chord interneurons relaying to the ascending pathway) (enkephalin is also involved here)
How is buspirone different from BDZs?
doesn't use GABA channelslacks BDZ side effects (sedation)free of tolerance/dependence/withdrawalless effective tx severe anxietylacks sedative/ataxic, anticonvulsant, or muscle relaxant effectsno "rebound" anxiety upon withdrawal
pharmacotherapeutics of sucralfate
used to protect the wall of the GI tract from ulceration or injury from excess acid (hyperacidity)
to prevent or treat ulcer disease & used for short-term tx (up to 8wks) of duodenal & gastric ulcers
contraindicated in kidney impairment b/c Al is not removed via the impaired kidneys or dialysis
what is the clinical application of lithium
mood stabilizer for bipolar disorder
Name some of the sites for excretion.
Kidneys-primary organs, GI tract, sweat and salivary glands, mammary glands, hemodialysis and peritoneal dialysis
What are the 2 major advantages of the oral route
convenient and inexpensive
__________and ________ are two major corticosteroids used for treatment of what kind of asthma?
Beclomethasone and prednisone are 1st line therapy for chronic asthma
What is a positive side of insecticides/pesticides?
-better crop yield
-less disease (malaria)
Mechanisms of resistance for macrolides
Methylation of ribosomes to block drug binding and efflux pumping.
1. oral
2. sublingual
3. buccal
4. Rectal
What are the 4 ways of enteral administration?
How many classes of antiarhythmic drugs are there?
What are the classes?
- Class 1(A, B, C): sodium channel blockers
- Class II: B blockers
- Class III: potassium channel blockers
- Class IV: calcium channl blockers
Explain why nicotinic acid can cause vasodilation and flushing.
This is attributed to histamine release.
What is sublingual administration and what are the benefits of using this route?
Tablet placed under the tongue for absorption or dissolution. Will access the circulatory system without passing through the liver or being affected by gastric or intestinal enzymes.
What is the main effect of ezetimibe?
decrease serum LDL (a cholesterol absorption inhibitor)
define [ Dispense ] =
prepare drugs and give drugs at a later time
2-10% of population have SNPs that inactivate CYP2C9 which causes
lower warfarin clearance, lower dose requirements, and increase the risk of bleeding complications
precautions & drug interactions of thyroid replacement hormones
elderly - need much lower doses to prevent excessive cardiac stimulation
variability in bioavailability among brands
drug interactions:Ca, aluminum-based antacids, iron preps & bile acid sequestrants interfere w/ levothyroxine absorption from the stomach; they must be spaced about 4 hrs apart
antidiabetic drugs & digitalis: decreased effectiveness of these drugs
aspirin, phenytoin: enhanced action of thyroid hormone
Why are infants especially sensitive to drugs?
because the liver does not develop its full capacity to metabolize drugs until one year
which cancer agents generate free radicals
"Wear red to show the bleeding of the free radicalS"

1 Vasodilation by Ca++ channel blockers (nifedipine, diltiazem, verapamil)
1 Nifedipine acts primarily on VSM cells; diltiazem and verapamil act on heart cells AND VSM cells
1 Blocks Calcium channels in vascular smooth muscle (or heart) and does not allow calcium to enter the cell; if the calcium concentration does not rise inside the cell there will be no contraction = relaxation 
Antihistamines should not be used in patients with?
Astham due to the effevt of increased secretions
1 ACE inhibitors (Captopril, Enalapril – prodrug; metabolized to enaliprilate)
1 Used to decrease BP by getting rid of Na and H2O
1 Inhibit angiotensin converting enzyme (ACE) so that ATI can’t be converted to ATII = less ATII = decreased Na and H2O in the body, vasodilation; ACE also inactivates bradykinin, so ACE inhibitors = increased bradykinin = vasodilation 
Drugs enter body by : [ Sublingual ]
Drugs enter body by :[ Sublingual ]
cubic centimeter
supp., suppos
hydrophilic base
PSNS Liver
Ditropan (XL)
Cefotaxime (Antibiotic)
Terbinafine(Systemic Antifungal)
pulmicort respules
Effexor XR
Toprol XL
Muscle Relaxant
valproate sodium
(Muscle Relaxant)
Escitalopram oxalate
Nasacort AQ
oiint., ung.
ointment, unguent
acts against viruses.
slow, extended release
Insulin aspart
Novolog/Rapid Acting
Gentamicin (Systemic Antibacterial)
Depakote ER
divalproex sodium
Alpha I Blocker
Divalproex Sodium
Depakote ER
unexpected response to drug
Broadspectrum, antibiotic>
bacterio static against many gram- &gram+ organisms
bacteriocydal in Urinary system> useful for UTIs
central nervous system stimulant
after food, after meals
Butorphanol (Opioid Analgesic, C-IV)
Benicar HCT
hctz. + olmesartan
Benicar HCTZ
olmessartan & HCTZ
Triamcinolone acetonide
Mechanism: synthetic corticosteroid with increased (GC) topical activity; DOA: 12-36 hours
Treatment:  Useful in dermatology (anti-inflammatory)
NMDA receptor antagonists - Alzheimer’s Disease
prevents convulsions (abnormal brain activity).
The pharmacy staff delivers intravenous meds only to the floor at the beginning of each shift.
Is capreomycin static or cidal?
Drospirenone + Ethinyl Estradiol (21)
short acting stimulant: Methylphenidate
Methylin, Ritalin
Ortho Evra
ethinyl estradiol & norelgestromin
substance occuring naturally in the body
Tripelennamine (PBZ)
First gen H1 blocker
Mildly sedative
ipratropium - Atrovent
Anticholinergic bronchodilator - Asthma (off-label), COPD
location fro preparing and dispensing drugs; also the study of preparing and dispensing drugs.
- Migraines, arthritis pain
- inhibits PhospholA, PLT serotonin release
- S/E: withdrawal syndrome (insomnia, joint pain); menstrual irreg; avoid prior to surg
Regarding the card system, each patient has a set of cards for routine med.
Between chloroquine and quinine, which drug is more effective if the bug is sensitive to both?
What is the DOC for giardiasis?
How are arterial thromboses treated?
Aspirin, Clopidrogel
Acetaminophen MOA
inhibits prostaglandin synthesis at the CNS
hydrocodone and acetaminophen
Analgesic, Schedule 3 (CIII)
p (has a line over the p)
Before initiating therapy with a nonselective B-blocker, the nurse should assess the patient for the presence of: a) HTN b) Liver disease c) Pancreatitis d) Chronic Bronchitis
Chronic Bronchitis
Famotidine (Pepcidine, Pepcid)
H2 blocker
Mechanism: does not interfere with hepatic drug metabolism pathway, most potent (12hrs), OTC
bupropion - Wellbutrin
aminoketones - Depression, sexual dysfunction
slows the uptake of androgens or interferes with their binding in tissues.
- long acting insulin analog(2-5h on, 18-24 h dur)
- sort of depot insulin, single shot provides flat level of response
Only medications being kept within the console can be profiled by the system.
Enteric coated tablet
dissolves in intestines like aspirin
Which TB drug shows good activity against resistant organisms and has no cross resistance w/ other TB drugs?
Which NNRTI causes bad dreams and shows teratogenicity in non-human primates?
SNS Urinary tract
relax bladder detrusor (inhibit urination) contract sphinctors
Blind end of nephron where fluid (water and solutes from plasma) move from capillaries into Bowman's capsule (lumen of nephron)
Percussion is a respiratory therapy often used in what lung disease
cystic fibrosis
Tolcapone (Tasmar)
PO, for Parkinsons, ADVERSE: liver damage and deaths from liver failure; can cause dark urine and other symptoms of liver failure; anorexia, abdominal tenderness, jaundice, clay-colored stools.
action of two drugs given together is the sum of their individual actions
phentolamine (Regitine) & prazosin (Minipress) are key drugs in what category?
Alpha Blockers (Adrenergic blockers)
Cyclizine (Marezine)
Meclizine (Antivert)
First gen H1 blocker
Treatment: antiemetic
Erythromycin (Action and contraindication)
Inhibits bacterial growth protects baby's eyes from gonorrhea at birth. Not for those allergic, or taking pimozide, or have hepatic disease.
- RL step: cholesterol to pregnolone
- Glucocorticoids: Cortisol (21C), ZF
- Mineralcorticoids: Aldosterone (21C), ZG
- Adrenal Androgens: DHEA (19C), ZR
Endogenous Corticosteroids
Please select the class of meds that have severe Ototoxicty from the choices. a.Penicillins, b.Aminoglycosides, c.Sulfoamides, or d.Macrolides
powder does not dissolve in the base and must be shaken before use
What type of antiretroviral drug is enfuvirtide?
fusion inhibitor
What is the DOC for onchocerca (also known as river blindness)?
Class III Anti-arrhythmic drugs
Increases action potential duration (APD)
A ____________ is obtained when the drug is applied in the immediate area where its effect is desired
local effect
drugs that increase LES pressure
tetracycline, NSAIDs, ASA, bisphosphonates, iron, quinidine, KCL
Opioid Analgesics - side effects
Sedation, Nausea, vomiting, constipation, respiratory depression, hypotension
biotransformation kinetics
v=vmax*[C]/Km when there is low concentrationv= vmax when there is a high concentrationmajor purpose is to allow for excretion
inhaled insulin - Exubera
Rapid-acting insulin - Type 1-2 diabetes mellitus
Nelfinavir (Viracept) Action and contraindication)
Produces immature noninfectious virus, prevention of AIDS progression. NO grapefruit, Do not use if receiving ergot derivatives, not for pregnant women, or if presense of carcinogen EMS. No grapefruit. Use barrier contraceptives, conflict with oral.
What is Pharmacodynamics?
Study of biologic effects produced by chemicals, the site at which and mechanism by which the biologic effects are produced ; the fate of a chemical agent in the body: its absorption, distribution, elimination, and the factors which influence the safety and effectiveness of an agent.
Which of the following medications should never be taken with any form of Alcohol?
a.flagyl, b.allegra, c.tetracycline, quinine?........a is correct "flagyl"
Per 1993 CDC classification, pts in what HIV stage should be offered anti-retro viral therapy?
symptomatic (AIDS) phase
What are the steps of hemostasis?
Vasoconstriction, Platelet plug, Coagulation
State relations between L and ml
1 L = 1000ml
Maalox/Mylanta (with simethicone)
Mg + Al salts (physical mixture, antacid + antiflatulence)
Acetaminophen with Codeine Phosphate
Tylenol with Codeine, Phenaphen with Codeine
Schedule IV for Controlled Substances
Lower potential for addiction - examples: phenobartital, diazepam
Drugs that block the sympathetic nervous system are adrenergic BLOCKERS. Thus you will have all the same as the _______________ nervous system. explain....
Parasympathetic. Adrenergic Blocking Drugs will elicit Parasympathetic Nervous System activities in the body (vasodilation, decreased HR, decreased BP, bronchoconstriction, increased GI/GU motility, miosis)
Nursing actions to reduce bacterial resistance

Teaching> complete Rx>do not treat viral infection w/ ABX
Discard unused ABX
Aseptic technique
Governmental agency having the legal responsibility for enforcing proper dug manufacture and clinical use.
Food and Drug Administration (FDA)
Which of the following meds is fastes acting thyroid hormone replacement? a.Synthroid, b.Levoxyl, c.Armour Thyroid, d.Cytomel
d.Cytomel is correct.
What is a common AE associated w/ all NNRTIs?
maculopopular rash
How does atropine treat bradycardias?
Blocks acetylcholine's action on heart rate to increase HR
State relations between Kg and Gm/G
1 Kg = 1000 Gm/G
What are important things to teach your patient on Dilantin?
Appropriate birth control alternatives, Seizures caused by abruptly stopping meds, Urine discoloration is normal, Remind about importance of dental check-ups, inform them that alcohol decreases the effectiveness of phenytoin
What is Flagyl used for?
drug of choice for Clostridium difficile and AAPC, also used for gynecologic infections
Blocking alpha adrenergic receptors will lead to what?
Well, w/o being blocked the alpha receptors helped the sympathetic nervous system, but now when they are blocked they mimic the parasympathetic nervous systems effects: Vasodilation, Decreased Blood Pressure and Constriction of the Pupil (Miosis).
Describe route of administration inhalation
rapid absorption of gases and vapors due to:-high pulmonary blood flow-low diffusional distance from avelous to blood-route for localized delievery of drugs with actions in pulmonary tissue
Why should isoniazid never be used as monotherapy against TB?
resistance develops too rapidly
What are indirect adrenergic agonists?
Drugs that act indirectly to increase concentration of noradrenaline (NA) in the synapse by inhibiting reuptake or causing release
What is Status epilepticus?
When a seizure lasts for longer than 20 minutes
What is Simvastatin ( Zocor )?
It is a HMG-CoA Reductase Inhibitors, commonly referred to as "statins." (our other key drug in this category is atrovastatin ( Lipitor ). They are considered a first-line therapy for the treatment of high cholesterol. HMG-CoA Reductase is a chemical made in our bodies that helps the liver produce cholesterol. Statins get in the way of that process, thus reducing the amount and frequency of cholesterol being produced.
Urine pH affect on drug excretion
weak acids excreted more readily in alkaline urine; weak bases excreted more readily in acidic urine
What is the MOA of rifampin?
binds RNA Pol beta subunit and inhibits RNA synthesis
What is a platelet plug?
Temporary block of a break in vessel wall
Tegretol is considered a unique CYP450 inducer...why?
Tegretol will increase the metabolism of other drugs AND itself
How can aminoglycoside toxicity be detected?
By monitoring peak and trough levels. If the trough is elevated then the patient is toxic.
What are some of the physiochemical properties of drug molecules?
Small MW..stability in vitro and in vivosolubillity in H2O and oil3-D structureionizable groups
What are the responsibilities of the pharmacy technician on Medication Rounds? (6)
Delivering meds to nursing floor, new meds placed in designed area, discontinued meds are to be retrieved and returned to be credited
What are symptoms associated with TEN and how are they treated?
Blisters and skin sloughing and the prescriber will immidiately stop AED!
Where are most of the alpha-receptors located?
The ARTERIOLES, the GI & GU sphinters, the muscles of the eyes & skin.
What is one downfall of the PIs?
does not affect early stages of HIV-1 replication cycle
What is the only drug route for Lidocaine?
always given IV.. it works really fast & it is usually given in an emergency situation
What are the 2 routes to overcome the first-pass effect of nitrates?
1.Sublingual - fast acting but short duration of action
2.Patch - transdermal delivery with slow release over 10-12hrs but tolerance develops so must be used intermittently
List one form of birth control that is not an oral contraceptive the Patch or the Ring? State the mechanism of action.
Withdrawal. The woman can make this more effective by combining with the calendar method to determine most fertile time and obstaining for sexual intercourse.
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