Pharmacology exam 2 Flashcards

Terms Definitions
intrathecal
Intraspinal.
analeptics
doxapramstrychninetheophyllineaminophyllinetheobromine
buspirone
Buspar
Injections
Parenteral
CNS-->Ach-->Nicotinic-->NE-->Adrenergic
Sympathetic
Indocin
Anti-Inflammatory
afluzosin
xatrol
naproxen
naprosyn
pregabalin
lyrica
Triamcinolone
Endocrine (Glucocorticoids)MOA: Bind glucocorticoid receptors → ↑gluconeogenesis ↑glycogenesis ↑hormone-sensitive lipase ↑blood glucose ↓cytokines ↑vasoCX demarginalized PMNs ↓vitamin D → ↓Ca2+ absorption & ↑Ca2+ clearance & ↑bone resorptionMET: Intermediate-acting 5x anti-inflammatory 5x topicalSE: ↑susceptibility to infx Inhibits growth in kids Myopathy Osteoporosis Cataracts Adrenocortical atrophy Iatrogenic Cushing'sTX: Addison's Disease
atenolol/ chlorthalidone
Tenoretic
Sympathomimetics
p. 305
Isopto-Atropine
Atropine ophthalmic
Articaine
(E)
short-acting
RAPID ONSET
DENTISTRY
paclitaxel
ct4 taxane
Rifampin
TuberculosisMOA: inhibits mycobacterial DNA dep RNA polymeraseMET: Very lipid soluable (penetrates CNS), INDUCES CYP450 (↓ [ketoconazole, warfarin...])RES: decreased permeability or mutation in DNA dep RNA polySE: Red-orange color to secretions Rash Fever GI Flu-like syndromeTX: TB, prophylaxis against MAC, Leprosy, L. pneumophilia
Fenbendazole
AntiparasiticBenzimidazole - "Panacur"Kill slow, broad, interferes w. worm metabolism, taenia spp. only, GIARDIA
Analgesics/ Anesthetics
pg 312
Drug
Reversible AchE
competetive Alzheimer drug
galantamine
toxicity of sibutramine
htn
tachycardia
Nafcillin
Penicillinase−resistant penicillin prototype

used for suspected or known staphylococcal infections; not active against methicillin−resistant staphylococci.

Tox-
penicillin allergy
NPO
Nothing by mouth
bendroflumethiazide
thiazide pct diuretic
Citalopram
Selective Serotonin Re-uptake Inhibitor (SSRI). Used to treat depression.
Administration
oral, subcutaenous, IM, IV
Paroxetine
Behavioral PharmAntidepressant - SRI"Paxil"Used for OCD, aggression, phobias, separation anxiety
olig-
scanty; small or few
nalbuphine
synthetic narcotic
equipotent with morphine
parenteral use
lsee psychotomimetic effects than others
CV effects similar to morphine, can use in MI
MOA finasteride
5-alpha reductase blocker
What drug causes:
Interstitial nephritis
Methicillin
Diphenhydramine
Antihistamine H1 blocker prototype

used in hayfever, motion sickness, dystonias.

Tox-
antimuscarinic, anti−alpha, sedative
Name a proto-oncogene:
Ras p21
betaloc, lopressor
metoprolol (white, pink/blue)
Terazosin
Non-selective for alpha-1 subtypes.
Treats hypertension Less potent than prazosin and higher bioavailability (more water soluble). Half-life: 12 h. Increase dose slowly
eplerenone-what is it?
selective antialdosterone antagonist.does not have andronergic effects like spiranolactone.can cause hyperkalemia, severe arrhythmias, MI and angina
Ritalin,
Class: CNS stimulantAction: Promotes calmness in hyperkinesis, and prevents sleep.Side Effects: insomnia, nervousness, seizures, palpitations, tachycardia, abdominal pain, anorexia, decreased appetite, nausea, vomit, leukopenia, thrombocytopenia, thrombocytopenic purpura, erythema multiforme.Contraindications: Allergic, glaucoma, motor tics, family Hx, Tourette syndrome or Hx of marked anxiety, tension or agitaion, or within 14 days of taking MAO inhibitor.Nursing considerations: May precipitate Tourettes syndrome in children, Monitor closely, VS, CBC, platelets, differentials, s/s of hematologic toxicity.
Cardiac Medication - Antiarrhythmic (or Antidysrhythmic)
mexilitine
fexofenadine (Allegra)
H1-receptor blockers (Antihistamines) Fexofenadine (Allegra) is an H1-receptor blocker, or antihistamine, to reduce nasal congestion, sneezing, and tearing of the eyes.
What drug is a Gabapentin?
Neurontin
Drug reaction causing thrombosis?
oral contraceptives
mechanism of action of benztropine
antimuscarinic
Type of drug?
Lithium
Mood stabilizer
5HT-1a agonist
Bupivacaine
Long−acting amide local anesthetic prototype

greater CV toxicity than most local anesthetics
What is their percent effectiveness?
98-99%
losartan
angiotensin II receptor antagonist (AT1)
Etodolac
slightly more COX-2,intermediate half life, may cause less GI irretation, possible cardiovascular risks.
Moraxella catarrhalis DOC
-Co-trimoxazole
-Second or third generation Ceph
Terbutaline
AsthmaMOA: β2-agonists → Gs → ↑cAMP →bronchoRXAdmin: Metered dose inhaler Nebulizers SE: Anxiety, tremor, restlessness, ↑HR, hypokalemiaOTH: Albuterol is the most used Metered dose inhaler is most commonTX: Acute asthma attack
lipoproteins found in the bloodstream are often classified into four major groups based upon their relative density; the greater the proportion of lipid in the lipoprotein, the _____ the density.
lower
Silver Nitrate
SkinCausticsDestroy tissue @ site, proud flesh, warts, horn buds, may damage
desentisized quickly\nn or muscarinic or adrenergic receptor
nicotinic receptor
alteplase (Activase)
Thrombolytics Alteplase (Activase) is a thrombolytic.
– MAOb inhibitor, which breaks down dopamine
	- May be useful to slow disease progression
- Tyramine, doesn’t really cause the hypertensive episodes, probably because it is selective for only MAOb 

Entacapone
State of decreased anxiety and inhibitions
Sedation
infant
liver function and blood-brain barrier still immature
antifungal drug that acts on microtubules
griseofluvin
receptor selectivity for terbutaline
b2 > b1
Type of drug?
Zafirlukast
Anti-inflammatory leukotriene receptor antagonist- asthma drug
Abciximab
Monoclonal antibody to fibrin receptor (glycoprotein IIb/IIIa) on platelets

Used to prevent clotting after coronary angioplasty
Beta Blockers AE
bronchospasm (wheezing), bradycardia, hypotention, dizziness, fatigue, AV Block,
betamethasone
ectosone, betaderm - topical steroid medium potency
Vesamicol
Inhibits uptake of Ach into vesicles
Propofol
Most popular IV anesthetic, rapid onset and recovery, ambulate sooner, hypotension, respiratory depressant, ANTIEMETIC, and pain at injection site.
Simvastatin
is a HMG Co-A reductase inhibitor, used in the treatment of hypercholesterolaemia
Arginine Vasopressin
Endocrine (ADH) MOA: Binds V1a receptors → GI/vasoCX Binds V1b receptors → ↑ACTH Binds V2 receptors → ↑aquaporins V1 >> V2ADMIN: Nasal spray, subQ SE: VasoCX ↑GI muscle, ↑uterine muscle Desmopressin challenge: urine Osm should ↑50% w/central DI SIADH: Rx w/loop/demeclocycline Central diabetes insipidus TX: Dx central/nephro DI Post-op ileus...eso varices
propoxyphene is what kind of drug?
opiate agonist
primary anxiety disorder types:
generalized anxiety disorder
 
panic disorder
 
OCD
 
PTSD
 
social phobia 
What drives the conservation of sodium & water in the kidneys?
Aldosterone
These receptors bind to ACh and ______ with a higher affinity than nicotine.
Muscarinic
What factor does the OSPT check?
Factor VII
- Inhibitor of all cyclooxygenase activity (COX-1 and COX-2), also used for antipyretic and anticoagulant effects
Ibuprofen
Most wideley prescribed SSRI in US
Prozac (fluoxetine)
later symptoms of lead poisoning
memory problems,nausea,kidney problems,weight loss,constipation,weak wrist and ankles
Drug
used topically on the eys to produce a sustained miosis(pupilary constriction)
Echothiosphate
which seizure drug is used in Crigler-Najjar II
phenobarbital
MOA sibutramine
sympathommimetic 5HT and NorE reuptake inhibitor
Type of drug?
Flecainide
Class Ic antiarrhythmic
Na channel blocker
Most common target receptor
Single protein that spans membrane 7 times
G-Protein Coupled Receptor
Contraindications for anticholingeric drugs
-narrow angle glaucoma
-GI obstruction
-GU obstruction
-prostatic hypertrophy
Main Drug Classes for allergies
Decongestants
antihistamines
mast cell stabilizers
Anti-IgE monoclonal antibodies
anti-inflammatory drugs
Tubocurare
A competitive NMJ blocker that is eliminated by the kidneys and has a relatively long duration of action.
Atrial flutter
Atrial rate 250-350 (sawtooth pattern of P waves)
adverse reactions with Mannitol
pulmonary edema in CHF pts.hypovolemia, electrolyte disorders, plasma hyperosmolarity, renal ischemia may make tubules impermeable to mannitol
1 lb. = ____Kg.
1 lb. = 0.454 Kg.
adverse effects of aminoglycosides

ototoxicityrelated to high peak plasma levels& duration of txmay be irreversiblehas been known to affect fetuses in uteropts simultaneously receiving another ototoxic drug are at higher risksymptoms include: dizziness, tinnitus, vertigo, nystagmus, hearing loss

nephrotoxicity: limited if the drugs are administered for less than 5 days
at risk: infants, elderly, pts w/ preexisting renal impairment or those receiving concurrent nephrotoxic drugs
kidney damage may range from mild to severe acute tubular necrosis that can be irreversible


neuromuscular paralysis: may cause respiratory paralysis; pts w/ myasthenia gravis are particularly at risk as are those receiving anesthetics or muscle relaxants

allergic reactions: contact dermatitis is a common rxn topically
Name therapetuic agents that treat chronic stable angina:
organic nitrates
beta-blockers
calcium channel blockers
These drugs mimic the effect of stimulation of sympathetic nervous system.
Adrenergid drugs
An example of a Fibric Acid Derivative drug
Gemfribrozil (Lopid)
unclassified seizures
-does not fit into any other cateogory
Stimulating Beta 2 receptors
Lungs: bronchial dilation, relaxation of uterus, vasodilation, glycogenesis (increased blood sugar).
Inotropic drugs
Cardiology drug that affect force of contraction. How hard it contracts.
What does the abbreviation stand for: h or hr
hora, hour
Adverse effects of guanethidine?
orthostatic and exercise Hypotension, sex dysfxn, diarrhea
what is pralidoxime
antagonist used to regenerate active cholinesterase
What is the reversal of a vasectomy called?
vasovasotomy
Spironolactone (Aldactone) interactions
ACE Inhibitors = hyperkalemia; K suplements = hyperkalemia; lithium = increase lithium toxicity; NSAID's = reduced diuretic response; blocks aldestrone
What is in Percodan?
325 ASA + Oxycodone 5
Isoniazid toxicity
Hepatotoxicity. Rarely under age 20, but increases with age. Also greater in alcholics, pregnant women and in post-partum period. Peripheral neuropathy can also occur.
antiviral
Drug that stops or slows the spread of a virus.
Midazopam is what kind of drug?
BDZ with short T1/2
drug interactions with tetracyclines

oral contraceptives: may decrease in effectiveness
chelating agents (milk products, calcium, iron, magnesium-containing laxatives, most antacids): impaired absorption due to formation of insoluble ions; should be administered at least 2 hrs before or after any of these agents
cholestyramine/colestipol: decreased PO absorption of tetracyclines
concomitant use w/ PCN b/c bacteriostatic drugs (tetracyclines) may interfere w/ the bacterial effect of PCN
cimetidine: may decrease GI absorption of tetracyclines
digoxin: may increase levels of digoxin
tetracyclines should be admin. 1 hr before food or 2 hrs after meals w/ a full glass of water
define the 4 BP categories
normal 120/80
preHTN 120/80 - 139/89
HTN 140/90
stage 2 HTN when systolic an diastolic BP fall into different categories- >160/92
This adrenergic receptor is located in the heart and its effect is to increase its rate and force of contraction.
Beta one (β 1)
Schedule IV Drug
drug with limited abuse potential and accepted medical uses
Anti Inflammatory effects (increased doses) of glucocorticoids
1. Interferes with biosynthesis, storage, and release of substances assoc with inflammation such as histamines, kinases, prostaglandins
2. Stabilizes lysosomal membranes. Makes the cells strong and stable. Histamines and kinases stay inside the cell.
3. Decreases antibody formation
4. Decreases phagocytosis. Decreases WBC
5. Inhibits collagen deposits
6. Inhibits capillary dilation and permeability -- vasoconstriction, decreased blood flow, contents won't leak out.
Define synergism
Two drugs that both have the same effect are given together and produce a response greater than the sum of their individual responses; 1+1=3
What does the abbreviation stand for: tbsp
tablespoon (15 mL)
why does phenytoin cause megaloblastic anemia
causes decreased vitamin B-12
What does chlorine damage do to hair?
surface is bubbled
Normal value fot PT
11-13 seconds with therapeutic target of about 18 seconds (or 1.5 times control)
Schedule V drugs
Has lower abuse potential than class IV. Has accepted medical uses. May lead to physical or psychological dependence. Drug may or may not require a written prescription. Medications that contain limited amounts of certain opioid controlled substances.
2 drugs that can cause phenytoin toxicity by displacing it from being protein bound
Phenylbutazone or sulfonamides.
Glucuronidation, acetylation, thiopurine methyltransferase
What are the three phase II reactions that are pharmacogenetic variations?
Loop (high-ceiling) Diuretics
peak effect is much greater than that of other diuretics
most potent diuretics, producind the greatest vol of diuresis (urine prod) & the highest efficacy in mobilizing Na & Cl from the body
act primarily on thin ascending loop of Henle (the part of the nephron responsible for concentration urine)
increase water excretion by blocking reabs. of Na & Cl in loop of Henle; resulting in decreased osmolarity of the interstitial fluid surrounding the collecting ducts, which impedes the ability of the kidneys to concentrate urine; excretion of large amts of urine w/ high levels of NaCl result; increased secretion of K, Mg, Ca also
systemic heodynamic effects; by increasing venous capacitance, they reduce L Vent. filling pressure & relieve pulmonary edema if present
What are three uses of medical drugs?
1. Therapeutic 2. Preventative3.Diagnostic
Is the nonproprietary name considered the generic or trade name?
Generic, which we should know!!
Which factors require Vitamin K for activity?
II, VII, IX, X
Cholineregic medication for the eyes do what?
stimulate muscurinic receptors and cause MIOSIS (pupil constriction)and ciliary muscle contraction
What does lidocaine (xylocaine) do?
Used to treat ventricular tachycardia after cardiac arrest. Action 30-90 seconds post IV administration and 10 min post IM administration.
what is the action of phenylephrine
adrenergic agonist, alpha-1 > alpha-2
how is epi going to affect BP?

HR?
nonselective so...
systolic will increase being controlled by a1
diastolic will decrease, being controlled by beta

HR will increase (b1)
Skeletal muscle relaxants ___ or ___ spasm.
lyse or destroy spasm(spasmolytics)
Drugs that may be used to supress immune sys (3)
Cyclophosphamide, Chlorambucil (alkylating agent), Methotrexate (antimetabolite)
What role does calcium concentration have in regulating the production of prostaglandins?
If calcium concentrations are low, then prostaglandins are formed from the arachadonic acid pathway via cyclooxygenase. If the calcium concentration is high, then leukotrienes are formed via the lipoxygenase pathway.
Pharmacotherapeutics / Indications of ACE inhibitors
mild to moderate HTN
management of HF and left ventricular hypertrophy; improve survival rates
beneficial in reducing progression of diabetic (& other) nephropathies (renoprotective)

recommended for a min of 6 mo after acute MI & def. w/ echo evidence of left ventricular systolic dysfunction
Furosemide (Lasix)- Mechanism of action, Pharmacokinetics, Therapeutic Uses
Mechanism of action: Acts on the ascending loop of Henle to block reabsorption
 
Pharmacokinetics: Rapid onset
 
Therapeutic Uses: Pulmonary edema, Edematous states, Hypertension
In general, what do Serotonin enhancers do to the body?
Elevate the mood, increase GI motility, vasoconstrict/dilate, increase sensitivity of pain receptors *I'm so happy I just poo-ed myself, but I'm crying because you poked me and I'm sensitive :(
enhancing cholinergic transmission in alzheimers: postsynaptic receptor agonists (musc and nic)
-stimulate M1, M3, Nic which enhances cholinergic activation (not M2 and M4)-several M1 agonists tried, trials now-nicotine helps at both pre and post cells
Why are barbituates used in cerebral ischemia
They decrease cerebral oxygen demand
What are the adverse effects of these two diueretics: hydrochlorothiazide, loop diuretics
1. Hypokalemia, hyperlipidemia, hyperuricemia, lassitude, hypercalcemia, hyperglycemia 2. Hypokalemia, met alk, hypotension, ototoxicity
ex of nondepolarizing NM blockign agent
anything with a "cur" in it
appropriate analgesic for mild to moderate pain and fever
NSAID's especially with inflamation or Tylenol for NO inflamation.
Subarachnoid block and most commonly used drug for it
Spinal anasthesia causing a temporary cord transection. (rapid onset) and tetracaine
Pharmacodynamics / Actions of beta blockers

interrupt adrenergic stim. to beta I or II receptors by competing w/ NE for available beta receptor sites
blockage of beta I/II receptors causes decrease in inotropy & chronotropy
stroke vol. and venous return decreased
those that inhibit beta II receptors cause vasodilation in skeletal muscles' arterioles
In summary, BBs decrease BP and block adrenergic receptor sites in herat muscle and conduction system, decreasing HR & reducing the force of the heart's contractions, resulting in lower demand for oxygen
Name the three specific types of enteral drug administration that avoid first-pass biotransformation.
1 Sublingual 2 Buccal 3 Rectal
How does sinemet treat Parkinson's?
It has levodopa and carbidopa in it. Carbidopa inhibits decarboxylases making levodopa more available in CNS.
mechanism of action of benzodiazpines
facilitates GABA by binding to site on GABA receptor --> inc. affinity of GABA for receptor & vice versa --> GABA produces inc. in chloride conductance
which drugs --> photosensitivity
Amy played Tetris on her cell phone in the sun

amiodarone
sulfonamides
tetracycline
What is the difference between a direct acting and indirect acting cholinergic agonist?
Direct: direct stimulation by binding the Ach receptor site

Indirect: breaks down acetocholinesterase
What are the three major oxidative systems?
1. Oxidative mechanisms of white cells cause killing of bacteria and produce oxidative damage to normal cells2. Prostaglandin production (Induced)3. Peroxynitrite production (Induced)
what happens if you give barbiturates to a patient in alcohol-induced coma or DT's
they might DIE!! Because of additive effect of barbiturates and alcohol --> respiratory depression
Which amino acid is needed to make NE?
Tyrosine (--> dopa --> dopamine --> NE)
What are the two mechanisms of arrhythmias?
1. Formation: pacemaker is not working or an ectopic pacemaker is present

2. Conduction: delay is due to a block or another problem
What are the steps in the Enzymatic Synthesis of Catecholamines?
Tyrosine > Dopa > Dopamine > Norepinephrine > Epinephrine
What are some other benefits of 3rd gen?
better activity against gram neg bugs resistant to beta-lactam drugs. Ceftazidime for Pseudomonas and ceftriaxone for N. gonorrhea
Where are the ganglia located in the Sympathetic nervous system?
usually close to the spinal cord so that preganglionic axons are short and the postganglionic axons are long.
What to do if a drug was given late?
Put actual time on MAR, most agencies require report or form because it can be a drug error
Dilantin
phenytoin
-megaly
enlargement
phenidate
Concerta
Desoxyn
Methamphetamine
Dulcolax
Laxative
rizatriptan
maxalt
sertraline
zoloft
alprazolam
xanax
phenoxybenzamine
alpha nonselective antagonist
amlopidinen/ benazepril
Lotrel
Isoniazid
p. 296
Verapamil (Calan)
Antiarrhythmic
robaxin OTC
methocarbamol
methocarbamol
robaxin OTC
Ibandronate
Endocrine (Calcium Homeostasis) Bisphosphonates (pyroPO4 analogs) Bind OH-apatite → ↓osteoclasts ↑bone massAbsorbed IV much better than PO PO: take w/full glass of waterSE: Hypocalcemia, hypophosphatemia Upper GI distressTX: Paget's Dz Osteoporosis Malignancy ↑Ca2+
Ciprofloxacin
AntiinfectivesQuinolones - "Cipro"Broad, gm-/+, cidal, very fast acting, seizures w/NSAIDS, articular damage w/ young/pregs
methohexital
barbiturateultra-short acting anesthetic agent often used in sight hounds b/c it does not depend on redistribution to fat to reverse effect
pure opioid antagonists
naloxone
naltrexone
diprenorphine
class fluphenazine
typical antipsychotic
Fluoxetine
Antidepressant

serotonin selective reuptake inhibitor (SSRI) prototype. Less ANS adverse effects and cardiotoxic potential than tricyclics.

Tox-
CNS stimulation, seizures in overdose
BSA
Body Surface Area
Benztropine
Mechanism: muscarinic receptor antagonist; tertiary amine
Treatment: Parkinsons, acute dystonia caused by antipsychotic meds
Side effects:increased thirst, impaired speech, etc.
common ACE inhibitors
"-pril"
 
lisinopril (Zestril) 
Diuretic adverse effects
HypovolemiaAcid-base imbalanceElectrolyte imbalances
Sulfonamides
b-static totally synthetic, antagonist with plasma protein (PABA)
Wave of quiet wakefulness
Alpha
tx of ca od
NaHCO3
otc
safe,self limited conditions,fda
reg.
Allopurinol
Antigout

inhibitor of xanthine oxidase; reduces production of uric acid
Lidocaine HCI (Xylocaine HCI)
Antiarrhythmic
humulin R
short acting insulin
Acebutolol
Treats hypertension, arrhythmias. Cardioselective with ISA, half-life: 3 h. Beta-1 blocker.
Zyloprim
A trade name for allopurinol.
enflurane
nonflammable fluorinated ethyl methyl ether
can cause changes in EEG (seizure activity)
only 2% metabolized
G Proteins
Transmembrane receptor protein stimulates a GTP binding cell surface detects, activates G protein stimulates an enzyme OR ion channel and 2nd messenger (cAMP, IP3, CA2+)
hydralazine
arteriolar dilatation through NO.
use in Rx mod to sever HPN.
This antimetabolite derivative of 6-mercaptopurine interferes with the metabolism and synthesis of nucleic acid, therefore toxic to proliferating lymphocytes
azathioprine
Tinctures
Prepared using alcohol extract process
Drug
metabolized by CYP2D6 and CYP3A4
long lasting
Donepezil
Drug
metabolized by CYP2D6 and CYP3A4
long lasting
limited effect with Alzeimer's cognition
fewer liver side effects
uses for edrophonium
to dx MG
Type of drug?
Prazosin
alpha-1 selective antagonist
Botulinum
Toxin

enzyme produced by Clostridium botulinum; interacts with fusion/docking proteins to block release of acetylcholine vesicles
Digitoxin (Crystodigin, Digitaline)
Cardiac Glycosides: "Cardiotonics"
streptomycin
aminoglycoside, AB prevents codon-anticodon regoition mRNA-tRNA nonsense protein formed
Pralidoxime
A nucleophilic drug pralidoxime (2-PAM) is used to reverse nicotinic effects associated with organophosphate exposure. (Similar to atropine effects)
Verapamil
Calcium channel blocker, thus reducing the influx of calcium into the smooth muscle cell and preventing contraction. Used to treat angina, hypertension, and SVT arrhythmias.
Metoclopramide
GI Drug (Prokinetic Agent) MOA: Increases Peristalsis (via 5HT-3 Ach release), anti-nausea anti-emetic; D2 antagonist in the chemoreceptor trigger zone in CNS, 5-HT3 antagonist/5-HT4 agnoist (high dose) SE: Tardive Dyskinsea, Agranulocytosis, Neuroleptic-malignant Syndrome; restlessness, drowsiness, lassitude TX: Antiemetic, prokinetic
interactions with theophylline:
cimetidine, erythromycin, oral contraceptives, quinlones --> increased theophylline levels
cigarette/marijuana smoking, phenytoin, phenobarbital, rifampin --> decreased theophylline levels
concurrent use w/ B2 agonists causes additive effects
Triple Antibiotic
Eye MedicationsNeomycin, polymixin B, bacatracinTriple A, broad, gm-/+, antibax
which B blocker has B1 selectivity?
atenolol
acebutalol
metoprolol
Bleomycin, Dactinomycin
____intercalates DNA strands and induces free radical fromation which causes strand breaks
Noncompetitive Antagonist
Inhibits the agonist response regardless of concentration. Irreversible. Combines with a different part of the receptor and inactivates the receptor. Exists for the lifetime of the cell.
When chemical equivalence drugs absorb at the same rate and to the same extent they are?
Bioavailablity
cocaine
local anesthetic (ester)

only one to cause vasoconstriction
What vitamin prevents neurotoxicity
Vitamin B6 (pyridoxine)
uses of octeroitide
(aka somatostatin)
acromegaly
carcinoid
gastrinoma
glucagonoma
P450 Inducer or Inhibitor:
Grapefruit Juice
P450 Inhibitor
Ranitidine
H2 blocker

like cimetidine but less inhibition of hepatic drug metabolism; no antiandrogenic effects
SSRI's OTC interactions
don't take with antitussives
colestipol
bile binding resin, prevent uptake less cholesterol uptake
Tyramine
An indirect acting symptahomimetic. If it is not quickly broken down by MAO (i.e. with use of MAOI or taken IV) it displaces NE from extravesicular sites and competes with its uptake, thus increasing NE in the synapse.
Felbamate
Useful in controlled or poorly controlled seizures. Can cause aplastic anemia and sever hepatitis at high rates. NMDA antag., increased GABA, effective in MES, and PTZ tests.
Sulfasalazine
RA (DMARD) MOA: Bacteria split azo bond → 5-ASA (& sulfapyridine) → ↓ inflammation MET: 75% reaches colon 5-ASA = active metabolite Sulfapyridine = SEs SE: Nausea, vomiting Headache Allergy OTH: Can cause ↓ folate absorption TX: RA, Ulcerative colitis (85%) Colonic Crohn's Dz
Demerol (not a prototype)
Narcotic
Preferred for preggers
CSS II
clinical presentation of gastroesophageal reflux disease
heartburn, acid regurgitation, epigastric pain = most common
others: belching, dysphagia, odynophagia, cough, hoarseness, nausea, noncardiac chest pain, respiratory complaints: asthma, chronic sinusitis

alarm symptoms: serious damage may have already occurred if the followin are present:dysphagia: difficulty w/ swallowing
bleeding: vomiting blood or having tarry, black BMs
choking: sensation of acid refluxed into the windpipe causing SOB, coughing, or hoarseness
weight loss
cyclosporine MOA?
bind to cyclophilin which reduce calcineurin (cytoplasm phosphatase)then decrease T cell transcription factor
Does the small intestine more readily absorb weak acids, weak bases, or both?
Both
Adverse Effect
general term for undesirable and potentially harmful drug effect
Nicotinic N
Found in postganglionic receptor of PNS/SNS. Stimulation causes nerve impulses.
Drugs used to treat and prevent abnormat cardiac rhythms
Antidysrhythmics
Described nitrous oxide and produced it
Joseph Priestly
adverse effects
*any* undesired response to a drug
Clomiphene's side effects include:
Hotflashes, ovarian enlargment, multiple simultaneous pregnancies, visual disturbances
4Rs of rifampin
RNA polymerase inhibitor
Revs up microsomal p450
Red/orange body fluids
rapid resistance if used alone
Type of drug?
Disopyramide
Class Ia antiarrhythmic
Na channel blocker
Describe the G-Protein Cycle
G-Protein binds Ra
Conformation change- GDP dissociates
GTP binds to G-protein
alpha subunit dissociates with GTP(from beta,gamma)
alphaGTP binds effector proteins
GTP phosphorylated to GDP and G-protein reassociates
define [ Abuse ] =
Misuse of drugs
What is the brand name for Pyridostygmine?
Mestinon
carboprost tromethamine
PGF2α analog , used as above.
H3 receptors
(histamine) Mostly presynaptic in the brain (H1 and H2 are postsynaptic). They reduce transmitter release (histamine, norep., dopam., 5-HT, and Ach)
Capecitabine
given orally and is converted to 5-FU by three enzymes  Treatment: refractory breast or colon cancer
Mechanism of action: BDZs
positive allosteric modulators of GABA-operated chloride channels. Straddles the alpha and gamma subunit. Increaes the frequency at which chloride channels are opened by GABA sothat they increase synaptic inhibition (but they NEED GABA)
antifungal agents: 
 
miconazole/clotrimazole/terconazole
greates use as a topical tx:
 
tinea corporis (ringworm)
tinea cruris (in inguinal area)
tinea pedis (athlete's foot)
vulvovaginal candidiasis (yeast infection)
 
miconazole & clotrimazole available OTC
 
side effects: itching & burning 
SSRIs ACTIONS
1. block reuptake of serotonin leading to increased conc. in the synaptic cleft
2. two wks. - intial mood improvement
3. 12+ wks. - max. benefits felt
4. 40% do NOT respond, so try different drug
5. does NOT produce mood changes in normal individuals
This is the study of the interaction of chemicals with biological systems.
Pharmacology
diphenoxylate with atropine (Lomotil and others)
Antidiarrheals Diphenoxylate with atropine (Lomotil and others) is an antidiarrheal.
pharmacokinetic factors of opioids
-well absorbed orally, but bioavailability varies due to first pass-high lipid soluble opioids are well absorbed through nasal, buccal, and skin (therapeutic and abusive routes, also smoking)-also im, sc, iv, intrathecal/epidural (CSF/subarachnoid space or fatty tissue to act on spinal cord but no higher CNS effects
Function of Class IC
Decreases Conduction velocity through atria nad ventricles as well as Bundle of His and Perkinjie network
Agonist
Drugs that bind to a receptor and cause a physiological response.
Name the vein on the lateral, anterior forearm or elbow.
Cephalic
where are microtubules found
cilia, flagella, mitotic spindles, neuronal axons (slow axoplasmic transport)
Type of drug?
Infliximab
Monoclonal Ab to TNF-alpha
Tx of crohn's & RA
what is the receptor preference for arformoterol?
beta 2
what can help protect GI system when on long term NSAID therapy
Cytotec
GTN (Glyceral Trinitrate)
Anti-angina, NO, decrease TPR, dilate collateral, treats coronary spasm
Serotonin syndrome
From combination of SSRIs (or SNRIs) and triptans or MAO-Is. Can produce symptoms of hyperthermia, muscle rigidity, myoclonus, altered mental status, and death.
uses for loop diuretics
edema r/t renal, hepatic,or cardiac dxtx increased ICP, pulmonary edemadifferential diagnosis of acute oliguria+++have little use for chronic HTN
The four drugs that will inhibit CYP450 are?
Cimetidine (GURD)Ketoconazole (antifungal)Erythromycin (antibacterial)Chloramphenicol (antibacterial)
drugs used to treat herpesvirus infection
herpesvirus family:
herpes simplex virus type 1 (cold sore) & 2 (genital)
varicella-zoster virus
cytomegalovirus (CMV)
epstein-barr virus (mono) 

Actions of aldosterone
 Regulation of blood volume and blood pressure Pathologic cardiovascular effects
(heart remodeling)
Name the 2 indirect adrenergic receptor blockers.
1 Reserpine 2 Bretylium
crossing bbb: passive diffusion
proportional to lipid solubility and amount non-ionized, mw <500
Onset of action
The interval between time of drug administration and the first sign of effect.
Cholinergic drugs
A drug or other substance that causes effects like those of the PNS. This is done by stimulating the nicotnic and muscarinic receptors. Drugs that inhibit or block nicotinic and/or muscarinic receptors is knows as anticholenergic drugs, blocking the PNS also.
Drug reaction causing hot flashes?
tamoxifen - selective estrogen receptor modulator, for E/P receptor positive breast cancers
Furosemide also works by?
abolishes hypertonicit y of medulla, prevent concentration of urine. Increase Caexcertion. Loops Lose calcium
when is cromolyn used
asthma proph, ineffective during acute asthma attack
What is a side-effect of accutane?
It is a teratogen!
diuretic AE
dose related above 25 mg - electrolyte imbalances (hypokalemia, hypercalcemia, elevated lipids, elevated glucose, elevated uric acid)
Disulfiram (function)
Drug used to support the treatment of chronic alcoholism by producing an acute sensitivity to alcohol. It blocks the enzyme acetaldehyde dehydrogenase
VKORC1 gene
It affects vitamin K production and if present requires lower drug doses of warfarin in a patient.
1 mo - 2 years
During which developmental stage is the average metabolism reached? 
drug interactions with aminoglycosides
additive renal toxic effects are noted if they are given w/ other nephrotoxic agents
loop diuretics will increased ototoxicity chance
will increase the effects of neuromuscular blocking agents
synergistic effect w/ PCNs
inactivation occurs when they are mixed in the same IV sol'n w/ PCNs
What is the drugs of choice for ventricular fibrillation? 2
- Epinephrine
- Lidocaine
What is the largest molecular size that can diffuse across capillary membranes (in Angstroms and in Kilodaltons)?
30 Angstroms, 60 Kilodaltons
Drug distribution
pasage of a drug from the blood to the tissues and organs of the body
Make up of peripheral Sys.
Everything else except brain and spinal column and nerves that start and end in brain and spinal column
Hemicholinium is an anticholinergic that works by:
inhibiting transport of choline into presynaptic nerve --&gt; no ACh can be made
specifically, which drugs are used to treat Parkinson's
Bromocriptine, Amantadine, Levodopa, Selegiline, Antimuscarinics (BALSA)
What is DHEA used for?
Herbal agent used for symptomatic improvement in females w/ SLE or AIDS
buspirone (Buspar) interactions
with MAOI risk of elevated HTN; must stop MAOI 14 days prior to takin Buspar
Sulfa drugs resistance mech.
Mutated genes for target enzymes, high levels of expression of enzymes, newly transferred genes with resistant enzymes, altered uptake and efflux. Resistance on chromosomes and plasmids.
Risk factors for surgical wound infections?
microbiology of the surgical site, presence of an established infection, the risk of contaminating sterile tissue during surgery, and perioperative events.
major property of beta blockers:
 
possession of intrinsic sympathomimetics activity (ISA) 
classified as beta blockers but have some beta-agonistic properties (very mildly stim. both beta I & II receptors; their intrinsic effects are not as strong as those of full-agonists)
 
mimic symp. NS
 
produce bronchoconstriction only at extreme high doses
 
do not induce bradycardia to the degree that full antagonists do (do not decrease resting HR) & cause minimal disruption of lipid & CHO metab.
4.) PHASE 3 of clinical studies
Obtain statistical evidence of drug safety and efficacy.Are conducted to compare the safety and efficacy of the IND with that of another substance or treatment approach. Employs a larger group of subjects, 100s or even 1000s ppl large. Phase 3 are often double blind and placebo controlled. Phase three trials often involve crossover studies in which the pt's recieve one medication of placebo for a period of time and then are switched, after a washout period, to the other medication or placebo. A clinical study is topped if an IND has been found to cause a significant increase in rate of mortality or serious toxicity.
Can succinylcholine be reversed by neostigmine?
NOT initially, but after it biotransforms to succinylmonocholine, which is like pancuronium, it can be reversed by neostigmine
ancillary drugs- induction agents, goal
assure a rapid and pleasant induction into surgical anesthesia
What does the abbreviation stand for: SOS
si opus sit, if necessary
what is the clinical application of clozapine
schizophrenia positive and negative symptoms
how is toxic hepatic damage from acetaminophen treated
moa?
n-acetylcysteine - it regenerates glutathione
What is the MOA of HMG-CoA reductase inhibitors?
Block sterol ring biosynthesis
Increase LDL receptors
Decrease VLDL release
Levodopa's course to become dopamine
Crosses BBB and is decarboxylated by I-aromatic acid decarboxylase (AADC) to be dopamine.
what is a major determinant of diuretic potency?
site of action within the nephron
Describe the two mechanisms that get rid of Norepinephrine from a postganglionic fiber.
1 Reuptake into the preganglionic neuron 2 Breakdown by MAO or COMT
Whay should Lovastatin be administered in the evening?
Because that is when most cholesterol synthesis occurs.
How does resistance to Vanco occur?
D-ala D-ala is replaced with D-ala D-lactate which vanco does not block
A ______ mutation results when a SNP causes a stop codon to be inserted
Nonsense

function might not be altered if it is not at the binding site
Ephedrine (affects in bronchials and eyes. What receptors?)
It acts like amphetamine to stimulate alpha and beta receptors to release NE and can cause a hypertensive episode. Produces bronchial relaxation (beta-2) and mydriasis without cycloplegia (alpha-1).
How can you promote therapeutic effects?
Inform the patiend of the nature and time course of expected beneficial effects
Differentiate side effect from toxic effect.
Side effect is any effect other than the intended effect, while toxic effect is a side effect that is undesirable.
what test must be done weekly on patients taking clozapine
WBC count because of potential agranulocytosis
What is the MOA of class 1B antiarrhythmics?
Block activated and inactivated sodium channels (rapid kinetics) WEAK
What is cardiac output dependent on?
- HR
- How much blood goes thru each pump <- how much goes in (filling pressure) + how much goes out (resistance)
T/F: misoprostol is a PGE2 analog and increases the production and secretion of gastric mucous barrier.
False: misoprostol is a PGE1 analog and it increases the production and secretion of gastric mucous barrier.
What should you do if you cannot read a physician's handwriting?
We should call the physician for clarification before administering the drug
what happens if 2 drugs compete for protein-binding sites?
one drug will be displaced due to lack of adequate binding spots and therefore have a higher serum level - could be a big problem
Ancef/Kefzol
cefazolin
Doxazosin
Cardura
Tiazac
lisinopril
feverfew
migraine
BROMOCRIPTINE
(blank)
mEq
milliequivalent
levodopa/carbidopa
sinemet
rivastigmine
exelon
benzodiazepinesfxn
increase GABA
Celebrex
Cox2 Inhibitor
class clomipramine
tca
Nitrobid
Coronary Vasodilator
Ibuprofen
motrin, advil
Phenytoin (function)
Antiepileptic.
common aminoglycoside
gentamicin (Garamycin)
Aminophylline
RespiratoryBronchodilator - MethylxanthineFound in chocolate/caffiene, cardiac stiumulation/bronchodilation, SE: GI, tachycardia, arrythmias, ataxia
Yasmin
Norelgestroin/ ethinyl estradiol
-operidol
butyrophenone (neuroleptic). Haloperidol
Type of drug?
Fluoxetine
SSRI
Norfloxacin
Fluoroquinolone antibiotic

inhibits bacterial DNA gyrase; active against many urinary pathogens including E coli, H influenzae, Klebsiella, Enterobacter, Pseudomonas, Serratia.

Tox-
see ciprofloxacin
MIC
minimum Inhibitory Concentration
morphine sr
ms contin
Promethazine
GI Drug (antiemetic) MOA: Block H1 receptor → ↓ histamine act. Allergies Motion sickness; Has Sedation Antiparkinsonian effects Anti-cholinergic effects Anti-serotonergic effects alpha receptor blocking Local anesthetic effects SE: Strong sedation! Ototoxicity (newborns or ABX) TX: Allergies MOTION SICKNESS (anti-chol./anti-5HT) Sedation
Cardiac Medication - Antihypertensive
enalopril
procainamide S/E
1_SLE like syndrome
2_hematotoxicity(thrombocytopenia )
CVS effect
methotrexate
Rheumatrex tabs, Trexall tabs
fentanyl
pure opioid agonist

anesthetic adjunct in dogs
patches: control of chronic pain (absorption can be unreliable)
toxicity of venlafaxine
stimulant effects
sedation
nausea
constipation
increased BP
Prazosin
terazosin
doxazosin
Alpha1−selective blockers

used in HTN.

Tox-
first−dose orthostatic hypotension
au
Aures Unitas (both ears)
nedocromil
anti-allergenic drug, for asthma
Metabolism of heparin follows...
zero-order
Naftifine
Anti-fungal (topical) MOA: inhibits squalene epoxidase blocking Ergosterol synthesis Admin/TX: creams for tinea cruris and corporis
common fibric acid derivative:
gemfibrozil (Lopid)
Melatonin
EndocrineOtherUsed to improve early breeding/ovulation in sheep/goats
cefoperazone
3ed generation cephalosporine and doesnt cross BBB
opioids
any agent (natural, semi-synthetic, or synthetic) with morphine-like activity
Pyrethrins/Pyrethroid Tx.
Decontamination of Skin
Activated Charcoal
Treat Allergic RXN
Benzos for seizures or neurologic Sx, follow with phenytoin
A-tocopheryl (Vit. E) useful for parasthesias
what does L-dopa stand for
levodopa
toxicity of maprotiline
sedation
orthostatic hypotension
Type of Drug?
Benztropine
Parkinson's Tx
Antimuscarinic; improves tremor &amp; rigidity
Disopyramide
Group IA antiarrhythmic

used for ventricular arrhythmias.

Tox-
strong antimuscarinic; may cause CHF
cc
cubic centimeters (same as ml)
tamoxifen
perifer oestrogen receptor antgomist for breast cancer E
Prazosin
Treats mild to moderate hypertension.
What are the long acting anti-inflammatory steroids?
dexamethasonebetamethasone
Secretion
What is an important excretory mechanisms for drugs and foreign chemicals, and includes transport proteins for both organic cations and anions at the level of the proximal tubules?
contraindications of sulfonylureas
hypersensitivity
severe hepatic & renal impairment (measured by increased creatine in circ due to decreased excretion in urine)
DM type 1
complications of DM type 2 (severe infections, major surgery, trauma, coma)
not intended to use during pregnancy, lactation, or by children
interact w/ drugs that potentiate the effects of sulfonylureas and probenecid & ETOH
Atypical Antidepressants Buproprion (Wellbutrin)/ACTIONS/SIDE EFFECTS
ACTIONS:

unknown action site


short 1/2 life


requries more than 1 per day dose or use extended release


decr. cravings for nicotine

SIDE EFFECTS:

dry mouth


sweating


tremor


incr. dose = seizures
FACTBinding of Drugs to Plasma proteins* Many drugs are bound to plasma proteins, usually albumin* Drugs bound to plasma proteins are pharmacologically inactive* Binding occurs in a reversible fashion and is in dynamic equilibrium
.
Define bioequivalence
Relative therapeutic effectiveness of chemically equivalent drugs.
What neurotransmitter is decreased in Parkinson's?
Dopamine.
measurement of accumulation
context sensitive half life
Myelosuppression by 5-FU is ______
Not reversible
which tCA is used for OCD
clomipramine
Type of drug?
Guaifenesin
Expectorant- removes excess sputum
Type of drug?
Ibutilide
Class III antiarrhythmic
Potassium channel blocker
Which enzyme converts testosterone to estradiol?
aromatase
BNDD
Bureau of Narcotics and Dangerous Drugs
prochlorperazine
D2 antagonist at chemoreceptor trigger zone (floor 4th ven), crosses BBB therefore may -> dystonia
Phentolamine
Short-term control of hypertension and pheochromocytoma. Competitive alpha (1 & 2) receptor antagonist. Similar to phenoxybenzamine on cardiovascular system.
Ulcerative colitis
Relapsing inflamm. condition affecting variable lengths of colon (diarrhea and bleeding)
Assay
Test that determines the amount and purity of a drug
Pharmacology
The study of substances that interact with living systems through chemical processes.
common mast cell stabilizer:
cromolyn sodium (Intal)
 
excellent; available as metered nasal spray, capsules for inhalation, nebulization solution, aerosol & oral form 
advserse effects related to vasodilation
postural hypotension
relflex tachy
expansion of blood volume
what MAOI is used to treat Parkinson's
selegiline
adverse effects of neurolpetics
extrapyramidal effects: dyskinesia, dystonia, muscle tremorshigher doses --> catalepsyhypotensionhypothermiamild neg. inotropic effectdec. seizure thresholdweak resp. depression, but can inc. resp. depression w/ other drugs
dementia: etiology
-caused by 60 disorders-80-90% is caused by alzheimers or cerebrovascular disorders (vascular dementia)-also from brain trauma, brain tumor, infections, exogenous toxins, metabolic disorders, neurodegenerative disorders, anoxia
Influenza
Caused by the influenza virus, which spreads from infected persons to the nose or throat of others.
Define side effect
Unintended response to a drug
What does the abbreviation stand for: os
mouth
Clinical use of Ribavirin.
RSV (respiratory syncytial virus).
effects of inhaled anesthetics
myocardial depression
respiratory depression
n/v
increased cerebral blood flow
decreased cerebral demand
Type of drug?
Daunorubicin
Cancer drug- Intercalates DNA
Also generates free radicals
Where are H2 receptors found?
in the stomach
LORAZEPAM(ATIVAN)
Mechanism: Bind to GABAa BZ binding site to increase frequency of chloride channel opening. No GABA mimetic activity.
Uses: Status epilepticus(IV), preop sedation.
Metabolized "Out The Liver" to non active compounds
Trazodone
5ht reuptake inhibitor + 5HT2 receptor antagonist, anti-depressant
Sulfanilamide
Sulfa antibiotic analog of PABA that binds dihydropteroate synthetase. This causes non functional analogs of folic acid to be produced and thus folic acid levels fall.
Tetracyclines adverse effects
-GI: due to broad spectrum--> resistant organisms energe
-Bone and teeth chelation= NO PREGNANCY
-Liver damage
-Photosensitization
-Allergy
Dexedrine ( Dextroamphetamine Sulfate)
Class: CNS StimulantAction: Helps prevent sleep and calms hyperactive children.Side Effects: Insomnia, restlessness, arrhythmias, cardiomyopathy.Contraindications: allergy, if taken within 14 days of MAO inhibitor, hyperthyroidism, glaucoma, advanced arteriosclerosis, Hx drug abuse.Nursing considerations: Obtain Hx, monitor growth in children, sleep pattern, excessive stimulation, give at least 6 hours prior to bedtime. Could become dependent with long term use.
Superinfection S/S
Suspect this if pt develops diarrhea or recurrent fever.  May also have stomatitis and/or monilial vaginitis.
adverse effects of hydantoins
common: ataxia, nystagmus & alterations in extraoccular movements, diplopia, slurred speech, stuttering, trembling of hands - occur when serum levels are above 20
GI: constipation, n/v/d

cosmetic (may affect compliance):gingival hyperplasia, hirsutism, nystagmus, rash, coarsening of facial features
serious: arrhythmias, seizures, leukopenia, thrombocytopenia, abnormalities in vit D metabolism, teratogenic (produces fetal hydantoin syndrome, which is characterized by prenatal growth/mental deficiences; also incrase incidence of congenital malformations such as cleft palate)
What drugs shifts the AP this way?
 
Class 1A
Is this performed in animals or man? Small doses to determine safety
Man
antagonist
drug that binds to its recptor and prevents other drugs or substances from producing an effect
mechanisms of action
attach receptor in membrane, block conduction of impulse, prevent action potential, decrease sodium ion uptake, decrease polarization, excitability
Anatagonist
Drug that binds to receptor sites that do not initiate the expected response
Drugs that cause QRS widening, ie. non antiarrhythmics.

Car, Coc, Chlor, Anti thio meso, Di Di Pro Beta
Carbamazepine
Cocaine
Chloroquine
Antipsychotics (thioridazine/mesoridazine)
Digoxin
Diphenhydramine
Propoxyphene
Beta-Blockers
Drug
Quaternary amine
synthetic
blocks AchE
augments GI, urinary function
Neostigmine
Drug
Quaternary amine
synthetic
blocks AchE
augments GI, urinary function
direct action against nAchR
good for myasthenia gravis
reverses the effects of curare poisoning
poor oral absorption
what drug has the same mechanism as amphetamine
ephedrine
toxicity of acetaminophen
how?
hepatic necrosis
a metabolite of acetaminophen depletes glutathione and forms toxic tissue adducts in liver
Type of drug?
Botulinum
Autonomic drug
Blocks the release of ACh vesicles from nerve terminal of cholinergic nerves
vWhich drug or drug combination is correctly paired with its DEA control schedule?
diphonoxylate-atropine (Lomotil)--C-V
What are the secondary causes of high triglycerides?
diabetes
alcohol
estrogens
Idiosyncrasy
An abnormal or peculiar response to a drug
Indapamide
Acts like a thiazide, 20X more potent than hydrochloro., with long half life (totally eliminated by liver)
What organ is the major player in drug excretion?
kidneys
Oxazolidinone
Nursing Implications
1 - used to treat vancomycin resistant infections, MRSA, community/hospital acquired pneumonia,
and complicated skin infections.
2 - IV form must be protected from light
3 - side effects = diarrhea, nausea, vomiting, HA
4 - may cause thrombocytopenia if used long time
5 - taken with/without food
6 - Avoid foods high in tyramine - aged cheese, smoked/dried meat, red wine, sauerkraut, soy sauce
7 - Inform md if taking anti-HTN, cold remedies, or decongestant
types of neurotransmitters
over 50 chemical signal molecules have been identified in the nervous system
six signal compounds are most commonly involved in the actions of therapeutic drugsNE and E
ACh
dopamine
serotonin (5-HT)
glutamate
gamma-amminobutyric acid (GABA)

each of these binds to a specific family of receptors
cholinergic (ACh-transmitter) & adrenergic (NE & E-transmitters) are the primary signals in the autonomic nervous system
What phase does fast sodium channels open -> Na enters cell?
 
What phase does slow calcium channels open -> Ca enters cell?
 
What is the voltage that calcium channels open?
 
What phase does potassium channels open -> K exits cell?
 
What h
Phase 0
 
Phase 2
 
-40 mV
 
Phase 3
 
Repolarization
 
effects of alpha-2 agonists
increases potency of other anasthetic drugssedation/hypnosisanalgesiamuscle relaxation
injectable anesthetic agents, ketamine, MOA
-no action on reticular formation, acts on cerebral cortex, limbic system, and spinal cord-inhibits glut by high-affinity binding to PCP site on the NMDA
What effect does Lopid (Fibric Acid Derivative) produce?
moderate hyperglycemic effect
RANGE OF TOXICITY, SALICYLATES:
Therapeutic Serum Levels?
Home Treatment-Accidental?
Mild?
Moderate?
Severe?
Therapeutic Serum Levels = 10-30
Home Tx-Accidental = 150
Mild = 150-300
Moderate = 300-500
Severe = &gt;500
drug therapy in children
dosage based on weight
oral route preferred
for IM administration, use thigh
childproof containers
never refer to it as candy!
NSAIDs, Acetaminophen and COX-2 inhibitors block which arachadonic acid pathway enzymes
NSAIDs-non-selectively block COX-1 and COX-2, acetaminophen doesn't block COX-1 or COX-2, but instead it may block COX-3 in found in the brain, COX-2 inhibitors block COX-2
MOA class IA anti-arrhythmics?
increased AP duration
increased ERP
increased QT interval
Which of the following is an OTC expectorant available in caplet, capsule, liquid, syrup, tablet, and sustained-release forms?
guaifesesin (Mucinex)
What is the MOA of dofetilide?
Blocks rapid potassium channels
4 miscellaneous antibodies used as anticancer therapy
Trastuzumab, Rituximab, Cetuximab, Bevacizumab.
Venlaxafine
is an SNRI. It is used in treatment of depression, but can have severe withdrawal effects
Name two drugs that cause pulmonary fibrosis?
Amiodarone (antiarrhythmic) & Bleomycin (chemotherapeutic agent)
extrapyramidal side effects of antipsychotics
 
(75-80% of pts, both high and low potency) 
acute dystonia (onset 1-5 days)spasm of muscles of tongue, face, back
tx with benadryl

parkisonism (onset 5-30 days)bradykinesia, tremor, gait, "pill rolling"
tx with benadryl

akathisia (onset 5-60 days)resless,compulsive, anxiety
tx w/ reduced dose ore switch to low-potency drug

tardive dyskinesia (onset month-yrs)oral-facial dyskinesias
tx w/ prevention (can be irreversible)
what is neuroleptic malignant syndrome
a side effect of antipsychotics; rigidity, autonomic instability, hyperpyrexia
third level drugs used to tx seizures
felbamate (dogs)gabapentin (dogs, cats)
general mechanisms of AED
1- prevent the development of seizure foci or cause foci to go to a non-pathological state (no drugs do this)2- decrease the excitability in the seizure focus to prevent or reduce abnormal discharge
Define prodrug (parent drug)
Medication that is not active when administered, but whose biotransformation converts it into active metabolites.
2nd gas effect
occurs when a 2nd gas (ex. 1% halothane) is inspired w/ 75% nitrous &amp; 24% O2

conc. effect produced by 75% N2O not only concentrates O2, but also halothane --&gt; inc. rate of movement of halothane from alveolar air to pulm. blood --&gt; faster induction
which catecholamines are agonists to beta-1 adrenergic receptors
EPI, NE, Isoproterenol, dopamine, dobutamine
Explain the mechanism of retinoids:
RA binds RAR, activates genes, activates caspases, causes apoptosis (exact pathway unknown)
What type of drugs are considered class 4 antiarrhythmics?
Calcium channel blockers
Verapamil &amp; Diltiazem
Adverse metabolic effects of acetazolamide
Loss of bicarbonate causes metabolic acidosis
unionized
To get a drug into the body it must be relatively...?
 
a. ionized
b. unionized
nursing considerations of acyclovir (Zovirax)
advise the pt absorption is unaffected by food
 
these drugs can only manage the disease; they can neither cure it nor keep it from spreading to others
 
promote condom use during sex & abstinence while lesions are present
 
instruct pt to report redness or pain in the eye; herpes eye infections can lead to blindness 
 
adverse effects: relatively safe & well tolerated:
IV - renal dysfunction & neurotoxicity
PO - diarrhea & HAs
topical - local irritation 
what is the clinical application of clozapine
schizophrenia positive and negative symptoms
Why is this important?
- it determines how much of the drug is released (if 98 % is bound, only 2% is active)- It cannot be metabolized when bound
Dosage - Gluco

Alternate day therapy
Given a dose every other morning; usually prior to 9AM, mimicing the body's steroid production.

This is a good method because it:
1. Reduces risk of adrenal insuff.
2. Reduces risk of s/e.
3. In children reduces risk of bone retardation.
(May have flare-up or symptoms on day 2)
Which beta-blockers work for glaucoma? (3)
1) timolol (non specific)
2) betaxolol (b1)
3) carteolol
* dec. aqueous secretion
Why are toxicities particularly important to monitor in patients taking INH?
INH half-lives are different in fast versus slow acetylators!
How can potential teratogens be tested?
1. epidemiological studies
2. in vivo (2 species, during development)
3. in vitro (whole embryo/embryonic stem cells)
Albumin mostly binds what kinds of drugs? and alpha-1acid glycoprotein mostly binds?
Acidic ones. Basic ones.
What is the theraputic objective of drug therapy?
To provide maximum benefit with minimum harm
Which pts cannot receive neupogen?
bone marrow cancer pts b/c it will help the cancer grow.
Name the 5 components of the nursing process?
1. Assessment2. Nursing diagnosis3. Planning4. Implementation5. Evaluation
Explain why highly lipid-soluble drugs are absorbed more rapidly than drugs whose lipid solubility is low
lipid soluble drugs can readily cross the membrances that separate them from the blood
what is the clinical use and toxicity?
adjunctive agent to L-dopa for Parkinsons. May enhance adverse effects of L-dopa
How can you evaluate the safety of a drug (2)?
-Therapeutic index (LD50/ED50)
-Safety margin (LD01/ED99)
What do antipsychotics do in regards to prolactin?
Block D2 receptors of anterior pituitary that prevent tubero-infundibular system release of prolactin. Results in hyperprolactinemia (breast development and gallactorrhea.
What is the difference btw carcinogenesis and teratogenesis?
The former leads to CA while the latter leads to congenital malformations
Why is the antiplatelet activity of aspirin long lived?
Aspirin binds to the COX receptors irreversibly, thus preventing binding to these receptors for the life of the platelet.
What is its mechanism and where does it work?
reversibly inhibits cox, mostly in CNS. Inactivated peripherally.
2 ways that drugs effective against partial seizures work
Prolonge inactive state of Na+ channel (increase refractory period) and incrase activity of GABA (Increase GAD activity, decrease GABA-T, or affect GABA-A)
What is the mechanism of action?
Thw term given to the means by which drugs change a function of tissues or organs, drug-receptor interactions, drug-enzyme interactions, non-specific
What is the MOA of osmotic diuretics?
Cannot be absorbed or secreted so they pull water out
what is the &quot;rule of 4&quot; with EPS side effects from antipsychotic drugs
evolution of EPS side effects: 4 hours -- acite dystonia, 4 days -- akinesia, 4 weeks -- akasthesia, 4 months -- tardvie dyskinesia
what is the effect of low dose Ach given IV?
When a low dose of ACh is given I.V., it is metabolized quickly by the
plasma cholinesterases and the only pharmacologic actions observed are on
the vascular system. The fall in blood pressure causes the baroreceptor reflex to increase sympathetic tone to the heart, and thus a reflex tachycardia.
/ 443
Term:
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