Pharmacology exam Flashcards

Terms Definitions
-azepam
benzodiazepine
Thiothixene
neuroleptic
peridone
Risperdal
AmitriptylineDesipramineNortriptyline
MAO-I
CLOZAPINE
(blank)
lioresal
baclofen
diazepam
valium
rivastigmine
exelon
-mab
monclonal atibiotics
akinesia
muscular paralysis
Antiviral chemotherapy
p299
Pyridostigmine
Cholinesterase inhibitor

long−acting (8 h) quaternary carbamate; used in myasthenia gravis
Sympathomimeticsterbutaline sulfate
Brethine
frusamide
loop diuretic
buccally
Inside the cheek
esmolol
beta1 selective antagonist
hydrochorothiazide use?
HPN
CHF
nephrolithiasis
nephrogenic DI
Produced ether
Valerius Cordus
MOA phenobarbital
increases GABA
Epinephrine
Adrenoceptor agonist prototype

product of adrenal medulla, some CNS neurons. Affinity for all alpha and all beta receptors. Used in asthma; as hemostatic and adjunct with local anesthetics; drug of choice in anaphylaxis
A yes/no response
Quantal
orphenadrine citrate
norflex otc
Cluvanic acid
Sulbactam
Tazobactam
-Penicillinase inhibitors
 
-Not ALL penicillinases are sensitive to these drugs
-MRSAs are resistant
Phenobarbital Anticonvulsant
Class: Anticonvulsant, sedative-hypnotic (barbiturate)Action: Prevents and stops seizure activity, promotes calmness and sleep.Side Effects: bradycardia, N/V, apnea, respiratory depression, erythema multiforme, Stevens-Johnson syndrome, angioedema.Contraindications: allergy, those with hepatic dysfunction, respiratory disease, dyspnea or obstruction, nephritis, or Hx of manifext or latent porphyria.Nursing considerations: NOT FIRST CHOICE, USUALLY USED IN COMBINATION WITH OTHER ANTICONVULSANTS. Assess prior, then monitor drug levels, CNS, don't abruptly stop, IM injection.
Ketamine
Nervous SystemDissociative - "Ketaject"w/ Diazepam, muscle rigidity, pupil dilation, eyes do NOT close, does NOT provide analgesia
Afterload
Systemic vascular resistance; increase afterload and increase b/p.Afterload is about pressure or resistance. If there is a link or narrowing in your garden hose, the volume will back up AND the output will drop.
Mycotoxins
Fungi and algae toxins
Pseudomembranous colitis (2)
clindamycin, ampicillin
What drug causes:
Hot flashes
Tamoxifen
Guanethidine
Postganglionic sympathetic neuron blocker

enters nerve ending by means of uptake−1 and is stored in the ending (effect reversed by TCAs, cocaine).

Tox-
severe orthostatic hypotension, sexual dysfunction
betaloc, lopressor
metoprolol (white, pink/blue)
guanithidine
Adrenergic neurone blocking agents-prevent NA post ganglionic release
intra-arterial
Injected directly into an artery.
Levothyroxine
Endocrine (Thyroid)MOA: Identical to endogenous T4 Converted to T3Intrx: steroids, tmxfn, opioid, 5-FU, phenytoin, CPZ, salicylate, benzos Contraind: adrenal insufficiencySE: Nervousness, arrhythmia, HTN, SOB, N/V, diarrhea, heat intolerance, ↓reproductive fxOTHER: ↑TBG in children & preggos → ↑doses required TX: Thyroid hormone replacement
contraindications of emetic agents:
cardiac dysfunction
hypersensitivity
depressed gag reflex
deep sedation
those in shock & coma
drug interactions:milk & activated charcoal may inactive ipecac
vegetable oil may delay absorption of ipecac
when given w/ carbonated bevs, abdominal distention may occur
Thrombolyticsfxm
breaks down already formed thrombusreestablishes blood flow
Documentation:
Record time, date, site, complications, test obtained and disposition of specimens Note clients reaction etc
Baclofen
Centrally acting skeletal muscle relaxant
__________ is a psychological condition that consists of irrational fear leading to avoidance.
Phobia
This drug depolymerizes microtubules, impairing leukocyte chemotaxis and degranulation, and used to treat acute gout
Colchicine
Type of drug?
Methyldopa
Central alpha-2 agonist
steady
administration has to equal elimination
Probenecid
Uricosuric

inhibitor of renal weak acid secretion and reabsorption in S2 segment of proximal tubule; prolongs half−life of penicillin, accelerates clearance of uric acid. Used in gout
desmethylimipramine
imipramine metabolite NA selective reuptake inhibitor
Mycophenolate mofetil
Inhibits inosine monophosphate dehydrogenase, which is needed for purine biosynthesis, and therefore it impairs proliferation of T and B lymphocytes.
Lymphocyte immune globulin
-Exogenous T-cell specific antibodies
-Allergic phenomena
Adalimumab
RA (DMARD) MOA: recombinant antibody against TNF-α receptor Admin: SubQ, usually w/ methotrexate SE: Headache, nausea, rash at injection site
Furosemide (Lasix)
Loop (High Ceiling) Diuretic

-give potassium supplement


SE - Transient Deafness, Photosensitivity
Fatty Acid Supplements
Pain and Antiinflammatory"DermCaps", "3V Caps"Skin and coat support, relief of pruritis, se: v/d, pancreatitis, incr. bleeding timesv
quinidine S/E
GIT upset, tinnitius,blurred vision, prolonged QRS and QT interval
An example of a beta blocker
Inderal
Depression- non-selective for type A and Bexcitiation: restlessness, irritability, agitation, sleep lossCentral and Peripheral anticholinergic, but less than TCAHypertensive crisis: fermented cheese + wine : E and NE release in periphery
SSRIs
Medication used to decrease stool firmenss and increase water content
Laxative
Which enzyme does disulfiram inhibit?
acetaldehyde dehydrogenase
Name some aminoglycosides?
Gentamicin, neomycin, amikacin, tobramycin and streptomycin
toxicity of trimethoprim
megaloblastic anemia
leukopenia
granulocytopenia

(TMP = treats marrow poorly)
Type of drug?
Terbutaline
Beta-2 agonist- asthma drug
Abciximab
Monoclonal antibody to fibrin receptor (glycoprotein IIb/IIIa) on platelets

Used to prevent clotting after coronary angioplasty
Urecholine AE
hypotention, tachycardia, HA, Seizure, asthmatic attack,
What are the contraindications for Ketorolac?
df
Latanoprost
Prostaglandin analog that can enhance uveosacral outflow and treat glaucoma.
Alpha-1 antagonist side-effects
Unexpected, unanticipated syncope (within 30-90 minutes of admin.), orthostatic hypotension, tachycardia, headache, depression, and priapism
Etanercept
binds Tumour Necrosis Factor (TNF) and blocks its interaction with cell surface receptors, thus preventing activation of subsequent inflammatory processes. It is used to treat inflammatory arthropathologies such as rheumatoid arthritis and Juvenile Idiopathic Arthritis.
What is a drug inducer?
Increases enzyme activity
Used for: BDZs
insomnia (hypnotic effect), anxeity (sedative effect), preanesthetic medabsence seizuresstaus epilepticussuppress dangerous sx of withdrawal from CNS depressants (esp ethanol)
contraindications and drug interactions of carbamazepine
h/o bone marrow suppression
hypersensitiity to the tricyclic antidepressents
taking monoamine oxidase (MAO) inhibitors
hepatic metabolism of carbamazepine is inhibited by several drugs; toxic symptoms may arise if the dose is not adjusted
OC: increased metabolism of estrogen - a decreased effectiveness of OC (all inducers of P-450 do this)
anticoagulants: decreased effectiveness (all inducers do this)
OXIDATIVE RXN:N-DealkylationCarbon group off Nitrogen
examples- codeine, imipramine, & theophylline
This drug has the following pharmacological actions:Decreases HR and cardiac output, decreases total coronary BF and O2 consumption,there is a gradual decrease in both systolic and diastolic FP in hypertensive pts., increase in airway resistance by
Propranolol (prototype)
Schedule III Drugs
*moderate potential for abuse*severe physical or psychological dependence*accepted medicinal usesex: paregoric dodeine combinations, seconal
– Alpha-2 adrenergic agonist in the CNS
	- Works on the presynaptic side to decrease release of excitatory neurotransmitters
	- Also decreases the excitability on the postsynaptic muscle
- Spinal cord injury, MS; less used in CVA b
Botulinum toxin
Bioassy
Test to ascertain a drugs availability in a biological model
This rodenticide has been off the market since 1979, less than 10 exposures yearly, it is an analogue of niacinamide that interrupts ox phos and intermediary metabolism.
Vacor
antidote for MERCURY, arsenic, gold =
dimercaprol, succimer
Clinical uses of Nifurtimox.
Chagas' disease, American trypanosomiasis (Trypanosoma cruzi).
What is the antidote for (TCA) Tricyclic Antidepressants toxicity/overdose
NaHCO3
MOA aminoglycosides
'cidal/static?
inhibits formation of initiation complex --> misreads mRNA
requires O2 for uptake, so won't work against anaerobes
'cidal
MOA actaminophen
reversibly inhibits cox (mostly in cns)
inactivated peripherally
Piroxicam
NSAID with longest duration of action (t1/2 about 40 h)
What is the most serious allergic reaction to penicillins?
anaphylaxis
What is the only skeletal muscle relaxant that will work directly on the skeletal muscle and is also used in patients with Malignant Hyperthermia?
Dantrolene
Donepezil
Another ChEI similar in features to tacrine, i.e., a noncompetitive, reversible ChEI, but with a high degree of selectivity for AChE in the CNS, and with minimal peripheral activity. Donepezil has a half-life around 70 hours, and some results suggest mild
2 mucosal protectants
Sucralfate and colloidal Bismuth compounds.
Summation
Two drugs that bothe have the same effect given together have double the effect (1+1=2)
60 gtt = __ tsp
60 gtt= 1 tsp
2 classifications of fungi

yeast: round, single celled facultative anaerobes that can live with or without oxygen
 

molds: filament-like, mutinucleated, aerobic microorganisms
 

mycotic infections: infections caused  by fungi; pathogenic fungi release mycotoxins
Four major categories of diuretics
High ceiling (loop)—(furosemide)
Thiazide—(hydrochlorothiazide)
Osmotic—(mannitol)
Potassium-sparing: two subdivisions:
Aldosterone antagonists (spironolactone) and Nonaldosterone antagonists (triamterene)
What are these drug's effects?
myocardial depression, respiratory depression, nausea/emesis, increase cerebral blood flow
What is an example of non specific mechanical?
Sunscreen
Indications of Vit D
metabolic bone disorderstreat minor burnschafed skindiaper rash
Aminoglycosides S/E & NI
S/E: 1. Ototoxicity, 2. nephrotoxicity, 3. neuromuscular rx and can lead to paralysis & resp. depression, 4. GI.
Relation b/w renal damage & increased BUN and creatine.
NI: Monitor BUN & creatine, changes in hearing; caution with nephro drugs; keep well hydrated to prevent renal damage. Cannot give IV w/ IV penicillin (the penicillin will inactivate the aminoglycoside.
Define summation
Also called the additive effect. Two drugs that both have the same effect are give together.
Effects of Alpha 2 receptors of GABA
Muscular relaxation
anxiolytic
tPA and urokinase promote the converson of ______ to ________ thereby increasing fibrinolysis.
plasminogen to plasmin
Toxicity using the OH DANG?
ototoxicity, hypokalemia, dehydration, allergy, nephritis interstitial, gout
MOA HCTZ?
block NaCl transport at the DCT
Enhanced Ca reaborption (because Na and Ca compete for ATP dependent reabsorption at DCT)
Name some targets of androgen action:
-testis
-penis
-prostate and seminiferous vesicles
-striated muscle
ect...
-CNS-aggressive behaviour
interactions with aminoglycosides
concurrent use with loop diuretics increases risk for ototoxicity. Can potentiate effects of warfarin toxicity. concurrent use w/neuromuscular block drugs mya prolong duration of action of neuromuscular blokade
Adverse reactions and contra-indications for decongestants
adverse
- rebound congestion (less with imidazoles), conjunctival reactions (follicular), mydriasis

contra-indications
- CVD, hyperthyroidism, diabetes
Physostigmine and neostigmine
Carbamyl ester linkage compounds which are hydrolyzed like ACh but more slowly, thus tying up the enzyme and allowing increased amounts of ACh to become available. Their effects last for 3-4 hours. Neostigmine is a quaternary agent, and does not cross th
Adrenaline
is a hormone that is also given as subcutaneous injection. It is the ‘fight or flight’ hormone, and has multiple effects throughout the body; including increasing heart rate, constricting blood vessels, and widening bronchi. It is injected during the early stages of anaphylaxis to prevent airway closure.
What is the formula for converting Celsius to Fahrenheit?
C= F-32
    1.8
drug interactions with thiazides
may increase blood glucose levels requiring higher doses of insulin & oral antidiabetic drugs
antihypertensive agents: potentiateaction of other antihypertensive drugs (synergistic) - good
digitalis: potentiate digitalis toxicity by inducing hypokalemia
lithium: increased serum lithium levels by redcing ints renal excretion (b/c use same channel)
anticoagulants (oral): decreased effect
ETOH & CNS depressants: increased sedation
Thiazide-Type Diuretics are taken ____ daily, and preferably in the _____?
once daily...in the morning
These drugs act on receptors that are activated by NE in smooth muscle, cardiac muscle and some glands.
Adrenergic drugs
What are the regulation of Medications
Drug StandardsDrug PurityDrug StrengthDrug QualityDrug EffcacyPlaceboOTC Medication
Cholinergic blocking agents (anticholinergics or parasympatholytics) - NI
Monitor heart rate, lung sounds, multiple drug interactions, assess for anticholin. overdose.

"Dry as a bone, red as a beat, blind as a bat, mad as a hatter".
How might metabolism increase toxicity?
by converting relatively safe compounds into forms that are toxic
What does the abbreviation stand for: o
no or none
What is the antidote Protamine used to treat
Heparin toxicity/overdose
People with low levels of N-Acetyl Transferase NAT are called ______ ________
Slow acetylators lo[NAT]
Drugs used to treat ulcers
Histamine 2 antagonists, Antacids, Proton pump inhibitors, Antipeptic agents, Prostaglandins
sodium bicarbonate
as antacid - neutralise acid attack on ulcers but no healing promotion too large/freq dose req
Two major cardiac effects of digoxin
Increase myocardial contractility (mechanical) and depolarize membrane (direct electrical) and increase vagal tone at SA and AV (indirect electrical)
Indomethacin
RA [Indocid] (COX 1 & COX 2 Inh) OTH: Very potent indole derivative SE: 30% have to discontinue (psychosis & hallucination) TX: RA, Chronic Inflammation, Acute Gouty Attacks
in an allergic rxn, histamine:
increases secretion of body fluids such as gastric, intestinal fluids and bronchial/salivary secretions
causes pain and itching w/ stimulation of sensory nerve endings
contracts bronchial smooth muscle
dilates cerebral blood vessels
causes vasodilation, which may lead to flushing and hypotension
increases capillary permiability causing edema in the nose, eyes, and throat
these systemic effects may lead to life-threatening anaphylaxis
three types of inhaled drugs for asthma
metered dose inhalers (MDIs)
dry-powder inhalers (DPIs)
nebulizers
Physostigmine: Class of drug, use.
Muscarinic, Indirect Stimulants - to treat atropine poisoning
This drug depolymerizes microtubules used to treat gout? Mechanism of this drug? Used for chronic or acute gout?
1. Colchicine 2. Destabilizing the microtubule lead Impairing leukocyte chemotaxis and degranulation - reduce inflammation and tissue destruction associated with gout. 3. Acute
Drug Enzyme Interaction
Interaction with a drug and an enzyme. Drugs can increase/decrease enzyme action to produce a reponse. A common one is ACE inhibitor.
What does the abbreviation stand for: U
unit, a dosage measure
what is the mechanism of risperidone
block 5-HT2 and dopamine receptors
MOA bile resins
binds cholesterol in the gut so they can't get to the hepatocytes
Which drug listed below can be administered as a nasal spray to treat a migraine attack?
sumatriptan (Imitrex), zolmitriptan (Zomig), dihydroergotamine (Migranal), and butorphanol (Stadol)
Bella Donna Alkaloids (2)
Atropine and scopalamine. (can cross the BBB)
3 types of generalized seizures
Tonic-clonic grand mal (loss of consciousness, prolonged duration), absence seizures (>10 sec, but can be 30-45sec with impaired consciousness, automatisms, and amnesia for the event), and myoclonic seizure (brief shock like contraction of muscle)
compare effectiveness of propoxyphene and codeine as well as abuse libaility
codeine is more effective but greater abuse potential
For which populations are ACEI's effective for heart failure/hypertension?
Black and White population; black population has higher incidence of hypertension.
This type of drug does not affect neuromuscular transmission nor does it change the electrical properties of skeletal muscle.
Dantrolene Sodium (Dantrim, prototype)
What factors are inhibited by heparin?
Inhibits factors from both intrinsic and extrinsic pathways including thrombin, Xa, IXa, XIa,XIIa,and kallikrein
Pyrethrins are? Pyrethroids are? What are these derivatives of and what is the MOA?
Pyrethrins are natural extracts and Pyrethroids are synthetic extracts. They are derivatives of the chyrsanthemum flower. They are lipophilic but rapidly metabolized. Their MOA is Na channel blockade.
what are the side effects of topiramate
sedation, mental dulling, kidney stones, weight loss
What are the main side effects of PTU and methimazole?
Skin rash
Agranulocytosis
Aplastic anemia
What can drugs combine with in addition to receptors?
enzymes, transport proteins, and nucleic acids
Descending inhibitory pathways do what and originate from where?
Modulate pain flow and the PAG
How is methadone superior to morphine?
oral absorption, larger T 1/2, lesser withdrawal sx
what are the advantages of phenobarbital
can be used in pregnant women, Crigler Najjar II
maximal electroschock seizure test (mice or rats)
-brief shock to brain through ear or corneal electrodes causes sz to test drugs which block tonic phase to see which drugs would be useful in human tonic-clonic seizures
Which alpha-agonists work for glaucoma?
1) epinephrine - not for closed angle, inc. outflow
2) brimonidine - dec. aqueous synthesis
What is the mechanism of action of glucocorticoids?
Binds to intracellular cytoplasmic receptors causing change in gene transcription and causing a physiologic response.
What are the EKG changes from class 3 antiarrhythmics?
Increase ERP
Increase QT interval
Describe the 3 components of the local anesthetic structure
lipophilic head, intermediate chain (an ester or amide), and hydrophilic tail (usually a tertiary amine...or secondary).
What does the term 'pharmacology' come from
greek words pharmakon and the suffix -ology
What does the abbreviation stand for: tid
ter in die, three times a day
Urecholine taken with Phenothiazide and Tricyclic antidepressnats (TCA) why?
to treat AE of these drugs such as bladder dysfunction, GI atony, Heartburn,
How are codeine and heroin related to morphine?
they are prodrugs that are converted into morphine
How to pee out something like amphetamines:
amphetamines are weak bases - need to acidify urine with ammonium chloride to increase clearance
What is so special about 1-acetylmethadol?
because it can be given as a depot and is structurally modified version of methadone, it is very long lasting and only needs to be admin. ever 2 or 3 days
where are the MAOs located in the body?
where the two nervous sys are: CNS and gut
versed
Midazolam
macro-
large
topiramate
Topomax
heparin
Aramine
Metaraminol
Clarinex
Antihistamine
phenytion
dilantin
mirtazapine
remeron
clonazepam
rivotril
Anaprox
naproxen sodium
diltiazem
Cardizem CD
Fluoroquinolones
p. 295
Levodopa
Dopar, larodopa
reminyl er
galantamine
oxeze
fomoterol fumerate
Clofibrate
Hypolipidemics (fibrates -TG)MOA: Bind PPAR-α+ RXR → ↓apoC-III & apoB & ↑lipoprotein lipase → ↓VLDL→ ↓LDL & ↑apoAMET: Half-life: 1.5 hours Highly albumin boundSE: GI disturbances Rash, myopathy, arrhythmia FatigueTX: HyperTAG DysbetalipoproteinemiaFC hyperTAG
L-Lysine
AntiinfectivesAntiviral - "Viralys"Herpes in cats
inhalational anesthesetics
halothaneisofluranesevofluranenitrous oxide
mixed opioid agonists/antagonists
butorphanol
buprenorphine
toxicity of enflurane
pro-convulsant
Flumazenil
Benzodiazepine receptor antagonist

used to reverse CNS depressant effects of benzodiazepines (overdose or when used in anesthesia)
PSS
Physiologic Saline Solution
prilocaine
amide local anaestegesics
Glycopyrrolate
Mechanism: quaternary amine
Treatment: decrease oral secretions, decrease GI spasms, treats peptic ulcers, prevents bradycardia during surgical procedures
Side effects: same as all muscarinic antagonists
Common beta blockers
-olol
 
 
carvedilol (Coreg)
 
metoprolol (Lopressor, Toprol-XL) 
Organophosphates
AntiparasiticsNeurotoxic to parasite, hooks, rounds whips, high risk!
terminal autoreceptors
inhibit NT relase
Thiopental half life
11 hours
tx streptokinase toxicity
aminocaproic acid
inscription
drug name and dose
Ibuprofen
NSAID prototype

short duration. Inhibits cyclooxygenase (both I and II) reversibly. Used in arthritis, dysmenorrhea, muscle inflammation.

Tox-
peptic ulcer, renal damage
Ferrous Sulfate (Fer-in-sol, slow-Fe)
Antianemics/Iron
budesonide
nasal rhinocort, pulmicort inh
FTY720
Sphingosine 1-phosphate receptor (SIP-R) agonist. Reversibly sequesters lymphocytes in the lymph nodes and Peyer’s patches and keeps them out of circulation so that the graft is protected from T cell-mediated attack.
Glaucoma
diphenhydramine is contraindicated in a narrow angle __________.
Diflucan (Fluconazole)
Class: AntifungalAction: Hinders fungal growthSide effects: headache, N/V/D, abdominal pain, hepatotoxicity, anaphylaxisContraindications: Hypersensitiver to drug or any of it's components.Nursing considerations: Assess prior to drug therapy and reassess regularly, periodically monitor liver function, GI and hydration.
Cardiac Medication - Antiarrhythmic (or Antidysrhythmic)
lidocaine
S/E of rosiglitazone?
hyoglycemia
hyperTG(wt gain)
oedema
heparin (Heplock)
Parenteral anticoagulants Heparin (Heplock) is a parenteral anticoagulant.
Administer to top of skin
Topical
Drug
Quaternary amine
synthetic
better oral
Pyrodostigmine
Drug
Quaternary amine
synthetic
better oral
similar to Neostigmine
MOA carbamazepine
increases na channel inactivation
Type of drug?
Zileuton
Anti-inflammatory leukotriene synthesis inhibitor- asthma drug
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
define [ Urticaria ] =
Hives
fentanyl
short acting mu agonist opoid
Warfarin
Coumadin, Jantoven, Marevan, and Warfarin and is an anticoagulant.
Azathioprine
RA (DMARD) MOA: Converted to thioinosinate; Cytotoxic to B/T lymphocytes; Competitive inhibition of inosinate S phase inhibitor MET: Low dose used for prophylaxis SE: Toxicity may limit chronic use OTH: Myelosuppression Coadministration w/allopurinol is toxic (azatioprine broken down by xanthine oxidase) TX: RA, Crohn's, Ulcerative Colitis, Transplant Rejection
common beta adrenergic agonist bronchodilators:
Epinephrine
 
Ephedrine (generic)
 
Isoproterenol (affects B1 & B2 receptors; no affiity w/ A receptors) 
Cerenia
GI SystemEmetics - Centrally acting (CRTZ)For motion sickness, vomiting, SE: swelling at injection site
pergolide
dopamie used in Rx of hyperprolactenemia
sibutramine (Meridia)
Anorexiants Sibutramine (Meridia) is a serotonin reuptake inhibitor prescribed as an appetite suppressant, or anorexiant.
All prescriptions should be written with which system?
Metric
dextromethorphan
pure opioid agonist

devoid of all opioid properties except ANTITUSSIVE effect
ipatropium is used to treat
asthma, COPD
clinical uses for aminopenicillins
"ampicillin/amoxicillin HELPS kill enterococci"
H. influenza
e. coli
Listeria monocytogenes
Proteus mirabilis
Salmonella
Enterococci
What drug causes:
Atropine like side effects
Tricyclics
Ticlopidine
clopidogrel
Newer antiplatelet agents. Used to prevent strokes, postangioplasty occlusion.
antidepressant therapy AE
suicide, and increased depression
clonidine
alpha 2 selective agonist hence decreases [NA]
Buspirone HCl
treats generalized anxiety disorders and in anxiety with depression, slow onset of action may require weeks of treatment. May act by affecting serotonin 5-HT-1A or the dopamine receptor.
Estrogen containing contraceptives can produce...
Thrombi (white)
Loperamide
is an antidiarrhoeal agent. It acts through the opioid receptor to inhibit peristalsis and prolong transit time.
Amphoterecin B
Anti-fungal MOA: polyene; binds to ergosterol and forms pores w/in memb Admin: IV, intra-thecal (fungal meningitis), topial (candidiasis) MET: poor absorption from GI, excreted in bile RES: replace ergosterol with other precursor sterols SE: Renal Impairment (80% experience ↓ GFR and changes in tubular function) Renal Tubular Necrosis Hypotension Fever chills Hypochromic normocytic anemia CNS TX: Systemic mycosis (Candida, Histoplasma, Cryptococcus, Aspergillus, Coccidioides, Mucor)
Narcotic Antagonists
Are antidotes for overdoses of narctoic analgesics.
They have a higher affinity for opiate receptor sites than narcotics, thus blocking their binding.
gastroesophageal reflux disease:
 
tx in infants 
physiologic GER (infancy):smaller, more freqeunt feedings
more frequent burping
positioning (up at 30 degrees)
thickening of feedings (some advise adding rice cereal to formula); will eat less volume
elemental formula (simple amino acids to baby doesn't need gastrin to break down anything into amino acids); very expensive and not sure if it's necessary

only 10% of babies won't correct this by 18yrs old
infliximab
monoclonal AB against TNF used in Rheum arthrities,crhons disease
What molecules in the living organism do drugs bind to?
Receptors
Loading dose
initial drug dose administered to rapidly achieve therapeutic levels
Antagonist
Drug combines with receptor but fails to produce an effect itself. It prevents an agonist from illiciting a response (prevents it from happening). Has affinity but not intrinsic activity.
Drug used to treat MYASTHENIA GRAVIS
Neostigmine (Prostigmin)
3 factors that change context sensitive half life
metabolism
lipid solubility
clearance
trade name
designated and patented by the manufacturer - amoxil, trimox, zoloft, etc.
Buffalo hump, moon facies, truncal obesity, muscles wasting, thin skin, easy bruisability, osteoporosis, adrenocortical atrophy, peptic ulcers characterize what syndrome?
Cushing's Syndrome
contraindication of digoxin
hypokalemia
2nd/3rd degree heart block
WPW who develop a-fib --> increased impulses through accessory pathway --> VF
Type of drug?
Digoxin
Cardiac glycoside for heart failure
Blocks Na/K pump which increases Na/Ca pump leading to increased Ca & therefore contractility
When a dose response curve plateau's it has reached maximum ______
efficacy
define [ Anaphylaxis ] =
sensitivity to drugs
Which drugs damage or inhibit synthesis of cell membrane?
Polymyxins
Amphoterecin B
Sotalol
The only beta blocker that delays ventricular repolarization and is effective for maintenance of sinus rhythm in cases of chronic atrial fibrillation.
5 inhalation agents anesthetics
Halothane, enflurane, isoflurane, desflurane, sevoflurane
Vancomycin-type and uses?
a glycopeptide antibiotic that impairs cell wall synthesis. Reserved for treatment of resistant species. Given IV for systemic infrctions,but can be given orally for C-diff colitis.
PHysical dependance: nonBDZ sedative/hypnotics
major physical dependence and withdrawal can be lethal
some infections take the form of minor illnesses, others result in a life-threatening condition called ____, causing widespread vasodilation and multiorgan system failure (shock)
sepsis
MAOIs ACTIONS

similar to that of TCSa and SSRIs


delayed several weeks
This is a drug that activates a receptor in order to elicit a response.
Agonist
psyllium mucilloid (Metamucil and others)
Laxatives: Bulk-forming Psyllium mucilloid (Metamucil and others) is a bulk-forming laxative.
antinociceptive system
-off shoots in spinal cord active opioid cell and they fire on presynaptic cell to inhibit (lower NT)and fire on postsynaptic cell to hyperpolarize in spinal cord-off shoots on the way to the cerebral cortex activate opioid cell which inhibits GABA cell (take away tonic inhibition) which then allows more 5HT and NE transmission which lowers amount of NT released and hyperpolarizes receiving cell-PAG- activates LC and NRM- LC- NE-NRM- 5HT
Ascites
Excess fluid in the space between the membranes lining the abdomen and abdominal organs (the peritoneal cavity). This is typically caused by liver disease.
Efficacy
A drugs capacity to bring about its desire effect.
Name the vein on the medial, anterior forearm.
Basilic
what drug is used to treat malignant hyperthermia
dantrolene
uses of bethanechol
activates bladder and bowel smooth muscle (used post-op for ileus adn urinary retention)
A group of drugs that provide sufficient pain suppression necessary for surgical procedures via general inhibition of the cns
General anesthetics
what does acetylcysteine do
prevents hepatoxic metabolites of tylenol from forming which prevents hepatoxicity
beta-carboline beta-CCE
inverse bezo GABAa binding site -> convulsions axiety
How are neuroleptics involved with weight gain?
Medullary-periventricular and incerto-hypothalmic systems help regulate ingestive behaviors...so weight gain occurs if they are blocked.
What is the gold standard in anti-inflammatory drugs?
The anti-inflammatory steroids.
Mechanism of action for methylxanthines
stimulate CNS by competitive inhibition of CNS adenosine receptors (A1 and A2). A1 inhibits transmitter release via K channels and is located pre- and post synaptically
subclass of PCNs:
 
extended-spectrum PCNs (antipseudomonal) 
SPECTRUM: less effective against the typical Pen G spectrum & ineffective against staphylococci; gram-neg coverage includes: pseudomonas, enterobacter, klebsiella
 
important in treating serious gram-neg bacteria; often used in combo w/ aminoglycosides 
Drug interactions Spironolactone [Aldactone]
Thiazide and loop diuretics
Agents that raise potassium levels
Define an antagonist.
Drugs that interact with the receptor to inhibit the action of an agonist without producing any effect themselves.
increase NT in cleft
-block uptake in presynaptic or perisynaptic cells-decrease destruction in cleft
Direct Acting Skeletal Muscle Relaxants - Uses & MOA
Uses: Relief of muscle spasm/spasticity. Treatment of malignant hyperthermia.
MOA: Direct effect on skeletal muscle fibers. Interfers with release of Ca from the SR. Decreases the ability of the muscle to contract.
Define efficacy
A drug's ability to cause the expected response.
Which cholinoreceptor blocker is used for asthma and COPD?
ipratropium --> prevents bronchoconstriction
How does it work?
inhibits folic acid pathway by blocking dihydrofolate reductase which humans have as well
uses for -phosphamides
"No Hodgkin's will see FOSSE with BO that smells like phospho"

non-hodgkin's
breast
ovarian
What toxins are in daffodils?
What do they do?
-lycorine
-galanthamine
-bind acetylcholiresterase
-calcium oxalate crystals irritate mucous membrane
MAOI food interactions
high tyramine foods - aged mature cheeses, smoked or pickled meats, aged or fermented meats, yeast, red wines, Italian broad beans
Beta-2 agonists for treating asthma (5)
Metaproterenol (treats obstructive airway disease and acute bronchospasms), salmeterol (longer acting and used with corticosteroid via nebulizer), formoterol (faster acting than salmeterol with a similar half-life of 12 hours), terbutaline (treat obstruct
3 Adverse effects of amiloride
Hyperkalemia, NSAIDs, and nausea; vomitting; diarrhea; leg cramps; headache; dizziness.
Zero order kinetics
 
(aka saturation kinetics)
What type of kinetics is characterized by a constant amount of change per unit time?
adverse effects of macrolides
erythromycin is considered one of the safest abx; hypersensitivity rxns are rare

GI distress: most common w/ E-mycin (21%) > clarithromycin (10%) > azithromycin (5%)
superinfections
How do the mechanisms used to regulate BP usually effect BP? 
By elevating it
N, O, or S-dealkylation: Is this reaction Phase I or Phase II? Is it Non or Microsomal? Is it Hydrolysis, Reduction, or Oxidation?
Phase I, Microsomal, Oxidation
What are some contraindications for corticosteroid use?(7)
– Diabetes mellitus– Pre-existing catabolicconditions– Bacterial or fungaldisease– Ocular viral infections– Growth in young animals– Pregnancy– Delays wound healing
Most common types of medications used to treat glaucoma is
Beta blockers and cholineregics
what types of seizures is carbamazepine indicated for
simple and complex partial, tonic-clonic
What is Kava used for?
Herbal agent used for chronic anxiety
hematopoietic agent: epotein alpha (Epogen) action
stimulates RED blood cells; indication = chemo induced leukopenia
ACE inhibitors shouldnt be used during
pregnancy (none of the trimesters)
uses for thiazide diuretics
given orally for the initial tx of essential hypertension+works well with other agents+treats diabetes insipidus-helps kidneys to regognize ADH+treat hepercalcemia+Iv formulation (Chlorothiazide) use to help mobilize edema fluid r/t renal, hepatic, and cardiac dysfunction
Therapeutics for angina are directed to:
 (2)
 
 
and can be accomplished  by:
(3) 
increased supply (coronary blood flow) & decreased demand (reduced myocard. O2 requirements)
 
 
 
decreasing HR and/or contractility
decreasing afterload (arterial pressure)
decreasing preload (cardiac filling) 
Therapeutic use of drugs
drugs are used to control, improve, or cure symptoms, conditions, or diesases of a physiological or pshychological nature.
Clozapine: Class of drug, use.
SDA - block serotonin AND dopamine receptors, diminishing psychosis, calming, can be used as antihistamines or thermostat *SDAs QUiETly whISPER “OLANZA!” when they are locked in the CLOSET and PINE for their #2,3,4, and 5 personalities
how to avoid side effects of AED
-titrate slowly-also monitor serum levels
What is the SC method of administration?
Subcutaneous. Needle inserted quickly with a slight withdraw to make sure a blood vessel has not been hit. Site of injection: upper arm, thights, abdomen or fat pads. Needle size: 25 to 27 gauge x 1/2 to 5/8 inch, Volume= .5 to 1.5 ml. (ex. epinephrine, insulin, heparin, vaccines)
What is the mechanism of TCA?
block reuptake of NE and 5HT
adverse effects of busulfan
"I will bustle to treat my DARK CaMeL"

hyperpigmentation
pulmonary fibrosis
What is the MOA of amiodarone?
Blocks potassium, calcium and sodium channels

Blocks beta receptors

Blocks peripheral conversion of T4 to T3
Where are B12 and folate each absorbed?
Distal ileum and proximal jejunum.
Nursing management for loop diuretics
admin in AM to avoid voiding at noc
recommend diet high in K (bananas, orange juice)
take w/ food
avoid sun exposure
report ototoxicity
Define margin of safety.
The amount of a drug that can be safely given.
Recombinant Cytokine- sargamostim is used for?
Recovery of Bone Marrow (it is a granulocyte-macrophage colony stimulating factor)
What is Melatonin used for?
Herbal agent used for Jet lag & insomnia
2 major advantages of non-acetylated salicylates over salicylates.
Lack renal toxicity and dont cause NSAID asthma.
What does ionized mean and how does it effect absorption?
With a charge; LESS absorption
Why is it better to plot dose-intensity relationships on logarithmic scales instead of arithmetic (From the book)?
Arithmetic scales are hard to compare to each other, and often the intensity rises so fast it is impossible to determine the exact ED50
_____ cells are predominatly found in the antrum and _________ cells are predominatly found in the fundus.
Gastrin cells are predominant in the antrum and parietal cells are predominant in the fundus.
How much folic acid to pregnant women require?
300 to 400 units per day
what happens over time if Albuterol is used too much?
it becomes less effective and a corticosteroid is needed to restore effectiveness
What is the mechanism of action of corticosteroids?
inhibits the synthesis of virtually of cytokines-->inactivates NF-KB, the transcription factor that induces the production of TNF-a, amonth other inflammatory agents.
What is the effect of food given with most medications?
Coats the stomach and reduces gastic upset
what is the effect of muscarinc antagonist on the eye?

name one antagonist
Muscarinic antagonists cause
pupillary dilation (mydriasis) that may be useful
during eye examination.

tropicamide
what is the effect of muscarinc antagonist on the eye?

name one antagonist
“red as a beet, dry as a bone, blind as a
bat, mad as a hatter”]
phenergan
Promethazine
Aspirin/dipyridamole
Aggrenox
enalapril
Vasotec
Imipenem/cilastatin
p.293
Aldoril
Antihypertensive
dil
dilute
olanzapine
zyprexa
trazadone
desyrel
Terramycin
AntiinfectiveTetracyclineOpthalmic oint.
Groups
Esters, Amides
Aminoglycosides
p. 294
Peritrate
Coronary Vasodilator
sectral, monitan
acebutalol
methocarbamol
robaxin OTC
Common decongestant:
pseudoephedrine (Sudafed/Novafed)
Oxytocin
EndocrineUterine ContractilityInduces contractions
Norgestimate/ ethinyl estradiol
Ortho-Cyclen
Arachidonic acid products
p.325
Drugs ending with:
-azole
Antifungal
Ex-Ketoconazole
Pralidoxime
Acetylcholinesterase regenerator

very high affinity for phosphorus in organophosphates
sid
once per day
Finasteride
TrichogenicMOA: Blocks 5α-reductase → inhibits conversion of testosterone → DHTAdmin: oralSE: ↓libido Ejaculation disorders Eretctile dysfunctionPregnant women should not be exposed (hypospadias)TX: Androgenic Alopecia
Cardiac Medication - Antihypertensive
quinapril
HPT + BPH
ALPH blocker
triamcinolone aerosol
Azmacort inhalatino aerosol
meperidine
pure opioid agonist (=Demerol)

effective analgesic, maintains much of potency when given PO
less constipating than morphine
2nd line anti-tb drug
cycloserine
Amiloride
K+−sparing diuretic

blocks Na+ channels in cortical collecting tubules
qid
four times per day
ethinyloestradoil
Oestrogen ag contracept, HRT,
7 anti-metabolites
Methotrexate, 6-thioguanine, 6-mercaptopurine, 5-fluorouracil, capecitabine, cytarabine, gemcitabine
What is N.K.A.
No Known Allergies
Barbiturates Side Effects
Lethargy
Nausea & vomiting
diarrhea
constipation
respiratory depression
hypotension
bradycardia
thrombocytopenia
Etodolac
Pain and AntiinflammatoryIndole Acetic Acid Derivative -"Etogesic" Osteoarthritis in K9, analgesic, antiinfl. SE: anorexia, v/d, lethargy
nafreline
as leuprolide is GnRH analogus
Indications of vit B1
malabsorption, alcholism
Catecholamines
Naturally occurring and synthetic adrenergic drugs.
Ex: Epinephrine, Dopamine, Isoproterenol, and Dobutamine
ginko
GI distress, anxiety, insomnia, headache, and antiplatelet actions
toxicity of trazadone
sedation
nausea
priapism
postural hypotension
Type of drug?
Propoxyphene
Opioid
Metabolite is cardiotoxic
Metoprolol
Beta1−selective blocker

used in HTN and for prevention of post−MI sudden death arrhythmias
Tranquilizer
reduces mental tension and anxiety
stilboestrol
non-steroidal synthesic oestrogen for hormone dependent cancer
Rifampin
Semisynthetic analog of rifamycin, first line Mycobacteria and TB (some atypical and leprosy) drug. Binds beta subunit of bacterial DNA-dependent RNA polymerase (inhibits synthesis).
-Nitrates
dilate vascular smooth muscle and both venous and arterial vessels. Venous dilation decreases returning flow, and arterial dilation reduces systemic vascular resistance and arterial pressure.
lipoproteins
What plasma proteins transport drugs that are lipid soluble?
iodine products
not frequently used
potassium iodide (SSKI)
strong iodine solution (Lugol's solution)
 giving iodides would seemto exacerbate s/s of hyperthyroidism
giving iodides in large doses actually decreases release of thyroid hormone
also, iodides decrease the vascularity & size of the thyroid gland
Aldosterone Antagonists  drug interactions
 Inhibitors of CYP3A4
 
    Drugs that raise potassium levels

     Caution when combined with lithium
These drugs pharmacological actions include: ^ HR, v in gastrointestinal motility, relaxation of smooth muscles of the bronchioles, urinary bladder, circular muscle of the iris and ciliary muscle and mydriasis, v in secretions from salivary sweat and lac
Anticholinergic Drugs
toxicology
the scientific study of poisons, their actions, their detection, and the treatment of conditions produced by them.
MTC
Minimum toxic concentration. This is where we see the first signs of toxicity.
Lindane is effective for what specifically
LICE
This drugs inhibits xanthine oxidase decreasing the conversion fo xanthine to uric acid
Allopurinol
uses of tacrolimus
immunosuppression following organ transplant
What neurotransmitter?
Sympathetic preganglionic nerves
Acetylcholine on nicotinic receptors
Type of drug?
Oxybutin
Cholinergic antagonist- like atropine
Works on GU system- reduces urgency in cystitis & bladder spasms
Where is lead found?
-airborne
-gasoline (formerly)
-house paint (formerly)
-lead pipes
-pottery (certain countries)
What drugs are considered HMG-CoA reductase inhibitors?
Statins
methylcellulose
to add bulk to faeces anti0constipation
Short acting,higher potency benzos
alprazolam, triazolam, oxazepam
Etomidate
Rapid onset, loss of consciousness, quick recovery, minimal cardiovascular and respiratory depression, NO ANALGESIA, hih incidence of nausea and vomitting, painful injection.
antibacterial
Drug that stops or slows bacterial growth
Glucuronidation
 
*donor: UDP-glucornonic acid
Which phase II reaction is quantitatively most important and is a pharmacogenetic variation?
contraindications of glucocorticosteroids:
no significant drug interactions
 
no significant contraindications
 
contraindicated in the primary tx of status asthmaticus (b/c/ not immediate onset) 
____ are no longer recommended for initial treatment of uncomplicated hypertension?
B-blockers
S/E of methyldopa
coombs test positive
-CNS depression
-oedema
clinical uses of alpha-2 agonists
preanesthetic agentchemical restraintselectivity: xylazine < detomidine < medetomidineduration: detomidine longest
sources of B3
meats, legumes, enriched grains, peanuts
What kind of agent is Carafate?
cytoprotective agent
By what metric parameters is dosage strength referred
milligrams
What system is affected by salmonellosis?
GI tract
clinical uses of alpha-2 agonists
preanesthetic agent
chemical restraint

selectivity: xylazine &lt; detomidine &lt; medetomidine

duration: detomidine longest
____is an alkylating agent acivated by liver that covalently x-links DNA at guanine N-7, and is used to treat non-hodgkin's lymphoma, breast/ovarian carcinomas
cyclophosphamides
MOA glitazones
incresaes target cell response to insulin
Gi protein
M2, α2 &amp; D2
Decreased adenyl cyclase, cAMP &amp; proein kinase A
What are the phases of hair growth?
-anagen
-catagen
-telogen
monoxidase OTC interactions
don't take with antihistamines, decongestants, and antitussives
Polymyxins
binds to lipopolysacaride wall of GRAM -VE bact, increases permeability, no longer selective
4 common combinations of penicillin with a beta-lactamase inhibitor
piperacillin-taxobactam, ampicillin-sulbactam, amoxicillin-clavulanate, and ticaricillin-clavulanate.
Short acting barb used for local anesth.
Pentobarbital
Menotropin
Endocrine (hMG)MOA: Used for LH & FSH activity MET: IM OTH: Derived from urine of postmenopausal womenTX: Male infertility Female infertility
Normal Digoxin Levels are what?
.5 to 2 ng/ml
atypical antipsychotic drugs:
 
limitations of the traditional antipsychotics: 
inadequate response in 20-40% of pts
relapse reate of about 35%/yr
lack of impact upon neg symptoms very high
incidence of side effects
Why are K channel blockers/class III drugs used?
Improves survival
Theophylline: Class of drug, use.
Cortical stimulant (Methylxanthine)- *strongest at bronchodilating, diuresis, and cardiac stimulation
Where in the ovary is progesterone produced?
Corpus luteum
What is a receptor?
Component of cell (cellular macromolecule or assembly of macromolecules) that interacts witha drug or an endogenous molecule to initiate a chain of biochemical events leading to an observed biological effect.
Orogastric/nasogastric
OG/NG used as an oral route for medications when a tube is already in place
Organophosphats Group 3?
Cyanide or Halogen, except fluorine, cyanophosphates: Tabun
The adrenal medulla has ___ ACh receptors that respond to sympathetic/parasympathetic stimulation.
nicotinic; sympathetic
What the most famous floroquinolone?
Ciprfloxacin (treatment for Anthrax)
major fxns of D2
modulates transmimtter release in brain
What drug causes:
Hemolysis in G6PD-deficient pts
Sulfonamides, Isoniazid(INH), aspirin, ibuprofen, primaquine, nitrofurantoin
What is the rate-limiting factor for drug distribution?
blood flow
Which drugs cause a hypokalemic metabolic acidosis?
Loop &amp; Thiazides
Cumulative Action
The effect that occurs when several doses of a drug are administered or when absorption occurs more quickly than removal by excretion or metabolism or both
Part of brain that nicotine activates
Mesoaccumbens dopamine system
What is a noncompetitive antagonist?
Decreases maximal response achieveavke with an agonist
ASA Side Effects
1 - Inhibits platelet aggregation.
2 - Can cause GI bleed.
3 - Can cause kidney failure/damage
parmacotherapeutics of MAOIs
tx of major depression unrelieved by TCAs, SSRIs, or miscellaneous agents; although MAOIs are considered to be as effective as other antidepressants, they are not the drug of first choice for major depression due to their potential adverse and hazardous effects
What are the class IV drugs?
- Verapamil
- Diltiazem (Cardiezem)
mechanisms of action of seizures
seizure focus activated, seizure discharge from focal area may synchronize w/ other neurons & propagate to surrounding areas of braindec. GABA activity & inc. glutamate activity important
injectable anesthetic agents, ketamine, abuse
-special K-more abused now than before-liquid- oral or evap and snort, smoke-high psychological dependence but rare phsycial depedence-less negative effects from using ketamine vs PCP
Beta 1 stimulation
Cardiac: increase heart rate, force of contraction, and velocity of the A-V node.

Kidney: release of renin.

S/E: tachycardia, arrythmias, increase b/p, HTN, increase angina.
What drugs act as serotonin receptor agonist?
buspirone, LSD-Lysergic Acid
pregnancy drug category C
adverse effects reported in animal fetus; information in humans is not available
Mechanism of action of Griseofulvin.
Interfers with microtubule function; disrupts mitosis. Deposits in keratin-contianing tissues (e.g. nails).
which drug is used to treat myoclonic seizures
valproic acid
What are two important principles in drug evaluation?
1. double-blind
2. randomization
What is a normal LDL level?
Less than 100 mg/dL
Describe the peptidoglycan link between chains
3rd unit (meso-diaminopimelic acid) binds to the 4th unit (D-alanine) of another chain. The 5th unit (also is D-alanine) is cleaved for this.
Valproic acid and sodium valproate
Broadly effective anti-convulsant that can treat partial, absence, gen. ton-clon, myoclonic, and atonic seizures. Affects Na+ channels and increases GABA levels (facil. GAD activity, inhibits GABA-T, and inhibits T-type Ca2+ channel). MAY HAVE FATAL HEP
mechanism of action: sibutramine
inhibits NE and 5HT uptake therefore enhances satiety and thermogenesis
adverse effects of mood stabilizing agents (lithium)
CNS:
mild: hand tremors, fatigue, muscle weakness, lethargy

moderate: coarse hand tremors, confusion, incoordination, increased lethargy, muscle hyperirritability

severe: ataxia, slurred speech, fasciculation, extrapyramidal symptoms, blurred vision, seizures, coma

CV: ECG changes and hypotension
GI: anorexia, nausea, vomiting, diarrhea, increased thirst, gastritis, increased salivation, indigestion, flatulence, taste distortion, salty taste in mouth
GU: polyuria
renal: albuminuria, oliguria, glycosuria, hyperkalemia
derm: pruritus, rash, thinning of hair, acne, cutaneous ulcerations
endo: hypothyroidism, hyperglycemia, hyperparathyroidism, nephrogenic diabetes insipidus
EENT: worsening of cataracts, eye irritation
most pts experience some adverse effects from admin of lithium, but toxicity usually depends on dose and length of therapy; development of toxic symptoms is gradual; usually starts from nausea, gastric upset, fine tremors, urinary frequency
What does Ketamine (PCP analog and an arylcyclohexylamine) do?
dissociative anesthetic. Cardiovascular stimulant. Causes disorientation, hallucination, bad dreams. Increases cerebral blood flow.
2nd gas effect
occurs when a 2nd gas (ex. 1% halothane) is inspired w/ 75% nitrous & 24% O2conc. effect produced by 75% N2O not only concentrates O2, but also halothane --> inc. rate of movement of halothane from alveolar air to pulm. blood --> faster induction
pharmacological effects of opioids- antitussive effect
-depresseion of cough reflex by action in the "cough center" in the medulla-at doses lower than that needed for analgesia-involves receptors not yet characterized
Define drug antagonism
The effects of one drug blocks the response to another drug.
metabolism of local anesthetics
esters: shorter half life d/t rapid hydrolysis by plasma &amp; liver cholinesterases
amides: hydrolyzed by liver microsomal enzymes (DO NOT USE w/ liver dz)
Clinical application / action of Echothiophate.
Glaucoma. / Increase endogenous Ach.
What is toxicology?
The study of the nature and mechanisms of adverse effects.
What is the normal total cholesterol level?
less than 200 mg/dL
Ethambutol and how does it work?
1st line mycobacterial bacteriostatic agent. Inhibits mycobacterial arabinosyl transferase enzymes, encodes embCAB operon that is involved in polymerization of arabinoglycn (needed for mycobacterial cell). Used against most TB strains.
What is the first-pass effect?
Refers to the hepatic inactivation of certain oral drugs. If the capacity of the liver to metabolize a drug is extremely high, that drug can be completely inactivated on its first pass through the liver.
nursing management for amphotericin B
dose varies w/ severity of infection, so no optimum dosage schedule is established
 
therapy must continue for weeks to ensure effectiveness
 
when amphotericin B is  reconstituted, it may be added to 5% D5W; the infusion solution must contain no preservatives or electrolytes; saline should not be used to flush the amphotericin B IV line
 
do not use an in-line filter, but when it is unavoidable, the pore diameter should be no less than 1micro. or the amount of the drug the client receives will be less
 
protect IV solutions from light exposure, particularly when given over 8 hrs; drug should be infused slowly over a min of 6 hrs; long term therapy usually requires placement of central line
 
premedicate the pt w/ acetaminophen, diphenhydramine & glucocorticosteroids to lessen fever & chills
 
monitor for renal dysfunction, phlebitis 
what assesstement need for pts on procainamide?
hematological assesstment like cbc regulary
Why does a bottle need vented tubes?
To let air in (vacuum)
3 Principles of pharmacology
1. Drugs do not confer any new function on a tissue or organ, they only modify existing functions.
2. Drugs in general exert multiple actions rather than a single effect.
3. Drug action results from a physiochemical interaction between a drug and a functionally important molecule on the body.
What do you give in cholinesterase poisoning?
atropine (muscarinic antagonist) + pralidoxime (regenerate AChE)
neuromuscular blocking drugs are used for
muscle paralysis in surgery or mechanical ventilation
What is a cohort study?
-Study of a group of individuals exposed to a chemical over time, compared to a control group.
-Can be prospective/retrospective.
4 drugs that induce the P450 system accelerating clearance of certain drugs
Phenobarbital, steroid hormones, rifampin and St. John's wort
  St. John’s Wort (Natural Health Product) – Hypericum perforatum
  Used in depression, axiety, exhaustion, neuralgia, OCD, HIV/AIDs, hepatitis C, migraine headache, insomnia
 
It has 2 active ingredients: Hyperforin and Hypericin. It interacts with many neurotransmitters to produce its effects 
Regulation of blood pressure by the
renin-angiotensin-aldosterone system by  two ways:
 Constricts renal blood vessels Acts on the kidney to promote
retention of sodium and water and excretion of potassium
How can ethnicity change the effect of drugs?
Different ethnic groups can have enzyme deficiencies that change the reaction to drugs.
Names under which drugs are marketed?
Trade names or proprietary or brand names
which beta blocker also blocks alpha receptors
labetalol (all others are spelled &quot;olol&quot;)
What kinds of things can lead to false outcomes of epidemiological studies (3)?
-selection bias: group non-representative of the population
-information bias: subjects misclassified
-confounding factors: other elements not taken into consideration
Lincosamine MOA and spectrum of activity
Block protein synth. at 50S rib. subunit. Gram pos. and some protozoa, but no gram negatives.
What plasma proteins are drugs bound to?
Acidic drugs are bound to albumin; Basic drugs are bound to alpha-1-acid glycoprotein. NB these drugs (sulfonamides) can displace endogenous substances such as unconjugated bilirubin thus leading to bilirubin encephalopathy in newborns. In adults Warfarin has a small therapeutic window and thus causes bleeding if too much are made free.
What is the diffference between side effects and adverse reactions
The severity. Some side effects are nauseousness, constipation, adverse reactions can be fatal
The action of NE and DA is terminated by --------- and ----------.
Reuptake, diffusion (different than for Ach).
What other receptor does clonidine act at?
Imidazoline found in the brain stem area of NTS.
What are the two normal functions of Beta-1 receptors?
1 Increase heart rate 2 Increase contractile force
Which of the following is a symptom of alcohol withdrawal?
nausea and vomiting, delirium tremens (DTs), hallucinations, and sweating
Lead is more harmful to kids or adults
Kids are more harmful to the effects of lead
Drugs enter body by : [ Vaginal ]
Drugs enter body by : [ Vaginal ]
Cordarone
amiodarone
Simvastatin
Zocor
Progestin
Levothyroxine
AMITRIPTYLINE
(blank)
IP
intraperitoneal
ipratropium
atrovent
timoptic
timolol
fluoxitine
SSRI drug
Reverses BZDs
Flumazenil
class citalpram
ssri
aa
of each
pantoprazole
Nexium (PPI)
-statin
cholesterol lowering agent
brimonidine
alpha2 selective agonist
Warfarin works on___
K+
Necon
drospirenone/ ethinyl estradiol
antihypertensive drugs
pg 315
Chlorpheniramine maleate (example)
Chlor-Trimeton
Hemicholinium
Inhibits choline uptake
Testosterone cypionate
Endocrine (Androgens)Esterified Testosterone Der.MOA: Anabolic - increase in overall body growth, muscle mass, and red blood cell production. Androgenic - growth of the larynx and skeleton, development of facial hair, darkening of the skinMET: IM depot every 2 weeksSE: Behavioral effects - excessive rage or hostility; Increased LDL/HDL ratio; Stunted growth due to premature closure of the epiphyseal plates; Women - hirsutism, depression of menss, acne, and clitoral enlargement; Males - decreased spermatogenesis, gynecomastia, acne, testicular atrophy, prostatic hypertrophyTX: Replacement therapy in male hypogonadism. Growth in pre-pubertal boys
DOC for bipolar Disorder
lithium
Oxzepam
OTL, short-intermediate 1/2 lifesedative-hypnotic
apomorphine
misc. opioid agents
strong dopaminergic agonist

emetic of choice in dogs
give conjunctivally (or SQ)
Type of drug?
Olanzapine
Atypical Antipsychotic
Atropine
Muscarinic cholinoceptor blocker prototype

lipid soluble, CNS effects.

Tox:
&quot;red as a beet, dry as a bone, mad as a hatter,&quot; urinary retention, mydriasis
LSD
Lysergic acid diethylamide, &quot;Acid&quot;

semisynthetic ergot derivative; orally active; hallucinogen
q
every (q8h, q12hr, etc)
busulphan
Ct1 - nitrous mustard
Cyclosporine
-Mech
-Uses
-Toxicity
-T-cell inhibition by inhibiting calcineurin
-Transplant pts; autoimmune pts
-HTN, renal toxicity
-Gingival hyperplasia
 
MORE toxic than tacrolimus
Lomotil
GI Drug (antidiarrheal) MOA: diphenoxylate & atropine; diphenoxylate is a derivative of meperidine, an opiate which slows down GI tract through actions of peripheral mu-opiod receptors; and atropine prevents OD (with anti-emetic qualities) Contraindicated: Diphenoxylate/atropine allergy; jaundice; diarrhea to do Membranous Collitis, antibiotic trx, or diarrhea due to enterotoxin prod. bacteria Dx Interactions: Sedatives, Barbs, Benzos, Antidepressants, MAO-I's TX: Diarrhea
parasites
single-celled or multicelled organisms that depend on a host for food & a protective environment
 
most common parasitic infections, such as tapeworm infestation, occur in the intestines 
Potassium Bromide
Nervous SystemAnti-SeizureOld school, used with Phenobarbitol
These drugs are AKASympatholyticAdrenergic blocking drugs
Adrenergic antagonists
simple partial seizure
-10%-no consciousness impairment-focal motor, autonomic, psychic, or sensory symptoms
colchicine
relieves acute gouty inflammatory attacks, prophylactic also
inhibits granulocyte migration
GI, renal, and CV problems
which anti-epileptic drug is teratogenic
phenytoin
MOA trimethoprim
static/cidal?
inhibtits bacterial dihydrofolate reductase
static
Type of drug?
Alendronate
Bisphosphonate
Affinity for Hydroxyapatite; inhibits osteoclast activity
Cholestyramine
colestipol
Bile acid−binding resins

sequester bile acids in gut and divert more cholesterol from the liver to bile acids instead of circulating lipoproteins.

Tox:
constipation, bloating; interfere with absorption of some drugs
Corticosteroids (inhaled and intranasal)flunisolide
Aerobid
Nasalide, Nasarel
venlafaxine
SNRI, seritonin noradrenaline reuptake inhibitors
Fomepizole
An alcohol dehydrogenase inhibitor approved for treating ethylene glycol poisoning. (use hemodialysis also)
2nd generation cephalasporins?
cefaclor, cefonacid, ceforinide, cefoxitin, cefuroxime, loracarbef, (cefamandol and cefotetan have MTT which can increase risk for bleeding)
What does this abbreviation mean?
 
mcg
mcg= microgram
contraindications of hydantoins
contraindicated in hypersensitivity reactions, bradycardia & severe kidney & liver disease
caution in elderly
caution in pregnancy pts: congenital defects (if status epilepticus, no other choice)
multiple drug/food interactions, check when administering
Thiopental
Barb, for anesthesia, ultra short acting
Metoprolol/Acebutolol/Atenolol/Esmolol: Class of drug, use
Beta-1 Adrenergic Blockers - treat hypertension or angina pectoris
AED SE
-cerebellar effects- inention tremor, nystagmus, atacxic gait, dilopia, hyperreflxia-seizure-SE unique to each agent
**Drug Efficacy**
Effectiveness. Maximum response or effect achieved when the dose-response curve reaches its plateau.
Which induction agents cause an increase in CMRO2 and CBF
Ketamine
Aspirin acts by inhibiting production of ________ that in turn inhibits glycoprotein expression in activated platelets.
TxA2
MOA probenecid
inhibits resorption of uric acid
Type of drug?
Sildenafil
Inhibits cGMP phosphodiesterase→ vasodilation
Tx of ED
Type of drug?
Nifedipine
Calcium channel blocker
Vasodilator only (no AA activity like the other calcium channel blockers)
Antidote for Arsenic?
Dimercaprol, succimer &amp; penicillamine
Which CYP450 is induced by ethanol?
2E1
Echinacea
Stimulates the immune system - unpleasant taste
Antagonists
Agents designed to inhibit or counteract the effects of other drugs or undesired effects caused by normal or hyperactive physiological mechanisms
Pindolol
Treats hypertension in patients with bradycardia. Non-selective beta blocker, partial ISA
First generation Cephalosporins
-Good G+ coverage (cocci)-E coli-Klebsiella pneumoniae-Proteus mirabilis
What physiolgical mechanisms are regulated by COX-II?
InducibleInflammatory systemProduces large amounts of prostaglandinsIncreases pain and increases pain perception
8 ml/min/decade
How much does creatinine clearance decrease per decade after age 30?
Bowman's capsule
layer of epithelial cells surrounding the glomerular capillaries; it collects newly formed untrafiltrate that is passed to tubules
 
connects with the first portion of the proximal tubule into which the filtrate flows 
Hyperkalemia Consequences
Disruption of the electrical activity of the heart
what enzyme convertes L-dopa to dopamine
dopa decarboxylase
Where does metabolism take place?
Mainly in liver
morphine
-full mu agonist prototype (most used opioid in the world)-drug of choice for terminal cancer pain because available and cheap and works-25% F-morphine-6-glucuronide is an active metabolite on my receptors with a long half life, it accumulates and gives most of the opioid activity in long term use-can be IV, IM for fast relief
(Gluco)

Effects on CHO metabolism
Increases blood sugar/glucose levels.
Mucokinetic drugs
Used to move respiratory secretions, mucus and sputum along the tracheobronchial tree.
What does the abbreviation stand for: SC, SQ
subcutaneous
Recombinant Cytokine- gamma interferon is used for?
Chronic Granulomatous disease
which anti-epileptic drugs can cause diplopia
carbamazepine, phenytoin
side effects of arylcyclohexamines
bad dreams
CV stimulation
disorientation
hallucinations
increased cerebral blood flow
Type of drug?
Leuprolide
GnRH analog; ↑gonadotropin release when used in pulsatile fashion; ↓release when used continuously
what is the brand name of levalbuterol?
xopenex
Which glaucoma drug is a muscarinic agonist?
Pilocarpine
Drug
Any substance taken by mouth, injected into a muscle, blood vessel, or cavity of the body, or applied topically to treat or prevent a disease or condition
Pyrazinamide resistance
Mutations in pncA (blocks drug conversion to active form or decreases drug uptake)
Nitrous Oxide
is used for maintenance of anaesthesia and for analgesia. It induces opioid release.
Phase II
During which phase are the metabolites rendered physiologically inactive?
Contraindications / Cautions of Phosphodiestarase inhibitors
hypersensitivity reactions
used w/ caution in arrhythmias, past MI, thrombocytopenia
lifestyle modifications for GER
diet modificationsavoid food that aggrevate symptoms (peppermint, chocolate, citrus juice, tomatoes, coffee, smoking, ETOH, fatty foods, spicy foods, onions) - activate gastrin pathway
avoid eating 2-3hrs before bed
avoid large meals & quantities of liquid

avoid medications that lower lES tone or decrease motility
elevate head of bed
curtain smoking & ETOH intake
avoid stooping & bending
do not exercise immediately after eating
avoid tight-fitting clothing
reduce weight, if overweight
interlukine 11
icrease in platelat formation used in thrombocytopenia
Carisoprodol: Class of drug, use.
Centrally-acting skeletal muscle relaxant - anti-anxiety, to relax emotions *The CENTER for RELAXATION is handing out DIAZEPAM, putting on a show at the ORPHEUM, and CHARISmatically selling motorCYCLES by Mercedes-BENZ
main target of drugs in CNS
-receptors-pumps and transporters-enzymes
- Kappa agonist and mu antagonist or partial agonist&#10;- Less respiratory depression&#10;- Less addiction (potentially)&#10;- More psychotropic effects &#8211; hallucinations and vivid dreams&#10;- Better for moderate to severe pain&#10;Butorphanol&#10;
ANTAGONIST
These receptors cause peripheral vasoconstriction, mild bronchoconstriction, and stimulation of metabolism
Alpha 1 adrenergic receptors
RR=175
INDICATED THAT THERE IS A 75% INCREASE IN RISK
systemic effects of drugs
travels through multiple body systems
name 3 alpha-1 selective adrenergic blockers
prazosin, terazosin, doxazosin
drug interactions assicated with maois
b-blockers
ssri
(--&gt; both cause seratonin syndrome)
agonist drugs
receptors that have high affinity and efficacy
Which of the following anticonvulsants is also used to treat manic episodes in bipolar mood disorders?
valproic acid (Depakene)
What type of glaucoma occurs in patients who use inhaled and topical corticosteroids?
Open angle
Lignocaine
Aka lidocaine. A local sometimes used with EPI for dental procedures or minor surgeries.
4 OTC histamine H1 receptor antagonists
Chlorpheniramine, diphenhydramine (benadryl), fexofenadine (allegra), loratadine (claritin).
CYP2D6
Which CYP do a number of people not have?
Adverse Effects of ARBs
less potential for cough (not completely absent)
less potential for hyperkalemia
Dizziness
Diarrhea
GI upset
Kidney impairment
inflammatory disorders
always made worse by the use of tobacco & ETOH; avoiding these substances is part of the treatment for any GI disorder
yohimbine
alpha 2 blocker used in RX of postural HPT, impotence
What is pharmacodynamics?
- mechanism of the drug action - How the drug affects the body
AED second generation SE
-less SE-not more effective, but better compliance causes better effectivity-developed with mechanisms in mind (GABA)
Drug s used for ADH deficiency are
Vasopressin, desmopressin, lysepressin
How do you combat tachycardia when giving barbituates
predose with narcotic
blood solubility &amp; induction/recovery
LOW blood solubility:
fast induction &amp; recovery

HIGH blood solubility: slow induction &amp; recovery
Calicium carbonate= hypercalcemia and (increase/decreased) acid
causes hypercalcemia and increased acid.
clinical uses for macrolides
URIs
pneumonia
STDs
gm + cocci (for pts allergic to penicillin)
Mycoplasma
Chlamydia
Legionella
Neisseria
What class of drugs used to treat hypertension, angina, cardiac arrhythmias, and migraine headaches is contraindicated in asthma patients?
beta blockers
D5W
5% dextrose in water
-why 5%? if u put something in blood stream where the osmolality is low, the RBC will pull it into the cell and it will explode or if its too high they'll shrivel up. 5% is isotonic.
8 classes of inhibitors of bacterial protein synthesis
Aminoglycosides, tetracyclines, oxazolidinones, macrolides, streptogramins, lincosamides, chloramphenicol, and mupirocin
6.    (52/9) IDENTIFY KEY POINTS FOR PATIENT & FAMILY EDUCATION FOR INSULIN THERAPY, ORAL HYPOGLYCEMIC AGENTS, HOME GLUCOSE MONITORING & RECOGNITION OF S&S OF HYPOGLYCEMIA.
a.    Insulin therapyi.    Eat prescribed diet after insulin dosingii.    Don’t take any OTC drugs including herbs & alcoholiii.    Exerciseiv.    Stress might change insulin requirements b/c hormones released during stress are antagonistic to insulin.v.    Learn to measure own blood glucose level- monitor periodically (before meals & bedtime) and regular insulin is given according to degree of glucose detected.vi.    Perform aseptic technique, select appropriate type of insulin, mix insulin properly (if necessary), administer correctly by SC, rotate sites, store carefully.vii.    Replace needles to reduce risk for infections.b.    Oral hypoglycemic agents    i.    S&S of hypoglycemia  treat w/ small amount of carbohydrates (hard candy, OJ or teaspoon of sugar)1.    Irritability2.    confusion3.    nervousness4.    weakness5.    hungerii.    Alert to S&S of out of control diabetes1.    Hyperglycemia- persistency by indicate a need to adjust glyburide dose or some other aspect of the therapeutic regimen.2.    polydipsia3.    polyphagia4.    polyuriaiii.    Avoid alcohol & OTC drugsiv.    Provide w/ oral & written info about the amount & timing of dosages.
What is the effect of a negative chronotropic action?
Decreases heart rate
disorders of digestion & absorption
disorders of digestion & absorption affect the stomach and small intestine, hindering the body's ability to break down food & absorb essential nutrients
gastritis, peptic ulcer disease, gastroenteritis  (stomach flu), malabsorption syndrome, stomach cancer & cancer of the small intestine are disorders
ulcerative colitis and regional enteritis (Crohn's disease) are considered disorders of digestion/absorption as well as elimination

risk factors: genetic predisposition, stress, administration of certain drugs, use of tobacco
why do patients taking L-dopa get arrhythmias
peripheral effects of dopamine
So to teach you have to asses
- readiness to learn- physiological status- previous knowledge- cognitive ability to learn- support system (family)
Misc approaches to treating Alzheimers: prednisone
-no data on prevention-recent well controlled prospective study in patients with ADusing a low dose of prednisone for one year found no effect on symptoms or the rate ofcognitive decline. However, the dose used may well have been subtherapeutic. On the other hand, AD patients can’t tolerate larger doses. So glucocorticoids not a likely future treatment.
What are examples of drugs that cause the anticholinergic toxidrome?
Diphenhydramine, Tricyclic Antidepressants, Atropine, Jimson Weed
Mechanism of action of Nystatin.
Binds to ergosterol, disrupting fungal membranes.
How can rats be treated to cease spermatogenesis?
T + E2
What is the clinical use of class 1C antiarrhythmics?
Supraventricular tachycardia
PVC
Torsades de Pointe
End of SA/AV nodal tissue phase 3 where drugs that prolong this causing more repolarization begin to reset sodium channels. You get early after depolarization arrythmias that can degenerate to ventricular fibrillation.
the mean concentration of the drug during the dosing interval
Since the plasma concentration fluctuates during fixed rate, multiple dose regimens, the Steady state concentration (Css) now represents what?
radioactive iodine: 131 I
b/c the thyroid gland avidly takes up iodine, a dose of radioactive iodine can ablate thyroid tissue, which results in permanent reduction of thyroid activity
destroys thyroid tissue, through induction of acute radiation thyroiditis & chronic gradual thyroid atrophy; acute radiation thyroiditis usually occurs 3-10 days after tx; chronic thyroid atrophy may take several years to appear
what types of seizures is lamotrigine indicated for
simple and complex partial, tonic-clonic
Why do you need blood samples
- to aid in making diagnosis- to monitor effect of therapy- to monitor course of a disorder
How does Neostigmine work
Blocks the degradation of ACh and help increase muscle stregnth
3 ways anticonvulsants inhibit seizures
1. dec. excessive discharge of seizure focus
2. inc. seizure threshold required for discharge
3. dec. spread of discharge to surrounding neurons

most drugs work by 2 &amp; 3
What are tetracyclines used for?
VACUUM your Bed Room -- Vibrio cholerae, Acne, Chlamydia, Ureaplasma, Urealyticum, Mycoplasma pneumoniae, Borrelia burgdorferi, Rickettsia, tularemia
What are the NOAEL and the LOAEL?
no observed adverse effect level
lowest observed adverse effect level
Rivastigmine and Galantamine
Two more ChEIs similar in most ways to donepezil and without the liver complications of Tacrine, have also been recently introduced for treating Alzheimer's.
What is Relative Potency?
Hiw much a drug must be given to achieve the desired response
What are the 2 things used to determine BP?
- Cardiac output
- Peripheral vascular resistance
What are some side effects of NSAIDS?
Nausea or vomiting, cramps, diarrhea, gas, possibly ulcers and GI bleeding
How do you differentiate between the anticholinergic toxidrome and the sympathomimetic toxidrome? In regards to skin exam and bowel sounds?
SKIN EXAM
Anticholinergic = Dry and flushed
Sympathomimetic = Diaphoretic

BOWEL SOUNDS
Anticholinergic = Decreased
Sympathomimetic = Normal
what are the side effects of valproate
GI distress, rare by fatal hepatotoxicity, neural tube defects (spina bifida)
Which statement regarding linezolis (Zyvox) is incorrect?
It should be stored in clear glass containers.
6 adverse side effects to anticancer drugs
Bone marrow, digestive tract, hair root, gonads, impaired healing, and fetus (teratogenesis).
What is the desirable level for total cholesterol?
 
 
what is the optimal level for LDL cholesterol? For diabetics?
 
 
What are the lowest healthy levels of HDL cholesterol for men and women? 
200 mg/dL
 
<100 mg/dL ; <70 mg/dL
 
<40 mg/dL is too low for men; <50 mg/dL is too low for women 
What 3 factors affect drug administration?
1. The degree of blood flow
2. Binding of the drug to protein
3. Drug/protein complex
Why is the importance of metformin?
It actually lowers weight, so it is considered the hardcore drug of choice in newly diagnosed type II diabetes. And it does NOT produce allergy to sulfa drugs.
Why are Asians lightweights with alcohol?
They have a ADH B2 subunit that oxidizes ethanol faster than normal producing more acetaldehyde. Also a genetic variant of ALDH with low activity.
If you give 15 mg of carprofen to a 15 kg dog is it a reasonable assumption that you should give 1mg to a 1 kg turtle?
Hell No!! EXTRAPOLATION BETWEEN SPECIES IS NOTRECOMMENDED!!!!!
Time of onset for tardive dyskinesia and types of movements involved
6 months to many years (usually late developing) and ballisms, choreoform and athetoid movements that are essentially irreversible and associated with increased mortality and morbidity.
What is the mechanism of action of DDT?
Open Na+ channels in insects so they cannot close = neurotoxicity
Bind to alpha subunit
Insect Na+ channel more susceptible than human Na+ channel
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Term:
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