Pharmacology Exam 3 Flashcards

Terms Definitions
valium
Diazepam
-lysis
breakdown
Elavil
nortriptyline
Pronestyl
Antiarrhythmic
Vicodin
Analgesic
alprazolam
xanax
floxetine
prozac
oxazepam
serax
propranolol
beta nonselective antagonist
Effexor XR
nefazodone
L-dopa/carbidopa
p. 307
Lopid
Antihyperlipidemic Agent
venlafaxine
effexor xr
robaxin OTC
methocarbamol
Pyramethamine
Malaria (folate inhib)MOA: Active against RBC forms Inhibit DHF reductase → ↓folate Coadmin: sulfa drugs (inh. DHP synthase = synergy)SE: GI PruritusTX: Malaria (p. falciparum)
Nystatin
AntiinfectivesAntifungals - "Panalog"Candidiasis, low tox, Polyene antif.
CBC
complete blood count
-zosin
alpha-1 antagonist. Prazosin
tx au toxicity
dimercaproli
succimer
penicillamine
Ethanol
Sedative−hypnotic

acute actions include impaired judgment, ataxia, loss of consciousness, vasodilation, and cardiovascular and respiratory depression. Chronic use leads to dependence and liver, cardiovascular, endocrine, gastrointestinal, hepatic, and nervous system pathology. Note: zero−order elimination kinetics
l or L
Liter
propofol
IV genreal anaestehic
Pentostatin
Mechanism: inhibits adenosine deaminase (ADA) accumulation of reactants toxic to lymphocytes
 
Side-effects: myelosuppression, nausea, vomitting, and neurotoxicity (somnolence, confusion, and coma)
 
Treatment: Hairy Cell, CLL, ATCLL, Waldestrom Macroglobulinemia
antimicrobials
agents (natural, synthetic, semi-synthetic) which kill or inhibit growth of microorganisms (pathogens)
Heparin adverse effects
Hemorrhage
Heparin-induced thrombocytopenia
Hypersensitivity reactions
indications of potassium
acid-base balance
Protein binding of Versed
94%
tx of benzo od
flumazenil
Ergotamine
Ergot alkaloid

vascular effect prototype, causes prolonged vasoconstriction, uterine contraction. Used in migraine, obstetrics
Antitussive
Prevents or relieves cough
metoprolol
betaloc (white), lopressor (pink,blue)
Aripiperazole
an atypical antipsychotic agent
Bethanechol
Mechanism: choline ester with quaternary ammonium group (poorly absorbed, low penetration of CNS); muscarinic receptor (M3) agonist, beta-methyl group gives selectivity for muscarinic group, parasympathetic effects
 
Treatment: promotes GI and urinary tract motility due to non-obstructive causes
 
Side effects: nausea, vomiting, diarrhea, salivation, sweating, cutaneous vasodilation bronchial constriction
Ke=Cl/Vd
What is the equation for pharmacokinetic behavior of a drug?
Lithium serum range
0.6 - 1.5
mannitol uses?
1_decrease IOP
2_decrease intracranial pressure
3_rhabdomyolysis
4_anuric state
Identify responsibility related to controlled substances
StorageDocumentationOrderingPrescriptionsDisposal/WastingLoss or theft
Adrenergic
Pertaining to the neurotransmitter norepinephrine
children
increased metabolism of some drugs
which drugs --> hemorrhagic cystitis
cyclophosphamide
ifosfamide
What drug causes:
SLE-like syndrome
"HIPP"
Hydralazine, Isoniazid(INH), Procainamide, Phenytoin
Norgestrel
Progestin

used in many oral contraceptives and Norplant implantable contraceptive
Spironolactone (Aldactone) class
potassium sparing diuretic
Ca channel block antiepi
ethosuximide, topiramate
Timolol
Treats hypertension, congestive heart failure migraine (prophylaxis), open-angle glaucoma, intraocular hypertension. Non-selective beta blocker; lipophilic, high CNS penetration.
Beclometasone
Inhaled corticosteroid, used in the treatment of asthma. Their mechanism of action involves decreased formation of cytokines, decreased activation of eosinophils and other inflammatory cells.
Mifepristone
Endocrine (PR & ER antagonist)MOA: Competitive binding to progesterone receptor & ↓prostaglandin dehydrogenaseMET: Inh. prog receptor & ↑PG → uteroCX Given w/misoprostol 2 days laterAlso blocks glucocorticoid receptorTX: Abortifacient Cushing syndrome
pharmacotherapeutics of tetracyclines
true broad-spectrum abx
currently rarely used against gram-pos or gram-neg pathogens but used for less common, more atypical infections
first line drug for Rocky Mountain spotted fever, other rickettsial infections, Lyme disease, many STDs, cholera, malaria, Traveler's diarrhea...
in PCN-allergic pts used to treat certain STDs, urinary & respiratory tract infections, meningitis
Diphenhydramine Benadryl
Dosage:25 to 50 mg IV/IMAntithistamineDef: blocks histamine release there by reducing bronchoconstrictorContra:Asthma and lower airway diseaseInd:Anaplyaxis,allergic reaction, dystonic recationsPre:May induce hypotension headache palpation tachycardia drowsiness or distrubed coordination sedation
which barbiturate is used for anesthesia induction
thiopental
passive absorbtion
drugs particles within the gastrointestinal tract are moved into body fluids by diffusion(movement from a higher concentration to a lower concentration)
Acetaminophin
Para amino phenol drug
MOA: Selective prostaglandin inhibition in the CNS (only)
Uses: helps to reduce pain, treat fever, no anti inflammatory effects. Not on platelet aggregation. No GI distress.
S/E: Rare at therapeutic doses
NI: Large doses over 4000mg can cause liver damage. It overloads the liver, causing hepatic necrosis, then liver failure. Different non-steroidals block at different points.
Organs of excretion
--Lungs
-Sweat and salivary glands
-Mammary glands
-Kidney
-Intestine
can you use epinephrine in closed-angle glaucoma
NO
which anti-epileptic drugs are 1st line in pregnancy and children
phenobarbital
Type of drug?
Selegiline
MAOI (selective for MAO-B)
Type of drug?
Guanethidine
Postganglionic sympathetic neuron blocker;
Inhibits release of NE into synapse
Clonidine
Alpha2 agonist

acts centrally to reduce SANS outflow, lowers BP.

Tox:
rebound HTN if stopped suddenly
ETHOSUXIMIDE
Mechanism: Blocks T-type Ca channels in thalamic n. DOC in absence seizures. Safe in pregnancy. SE: dramatic GI distress.
Verapamil
Dysarthmia drug Ca blocker most effects on AV conduction
Varenicline
A nicotine agonist selective for alpha-4-beta-2 isoform of Nn that prevents many of the rewarding aspects of nicotine and can treat addiction.
Levetiracetam
Mech. unclear, used for partial seizures. SE: dizziness, somnolence, irritability, hallucinations, and psychosis.
vial
A small receptacle for holding liquid or pill medications.
Aminophylline (similar to theophylline) Acute, xanthine derivative
Class: BronchodilatorAction: Relaxing smooth muscle of the respiratory tract, increasing airflow, and vital capacity.Side Effects: arrythmias, headache, hypotension, IRITABLITY, nausea, PALPITATIONS, restlessness, urine retention, and VOMITING.Contraindications: Hypersensitivity to drug.Nursing considerations: monitor for toxicity, Vital signs.
Therapeutic Index
Ratio between a drug's therapeutic benefits and its toxic effects
Statins S/E
Rhabdomyolysis (break down of skeletal tissue), weakness and pain, abdominal cramps, elevated liver enzymes, interact with graprefruit
HPN with MI which antiHPN prefer?
B blocker
D-methamphetamine: Class of drug.
Cortical stimulant (amphetamine) *speedball/meth *has strong postictal depression
Durham-Humphrey Amendments
1. separated drugs into:LEGEND: Rx drugs & NONLEGEND: OTC drugsall legend must have warning2. Rules for dispensing legend drugs
Agonist
Has affinity (to locate receptor) and has intrinsic activity (to create changes in a cell). Creates 3 bonds with receptors to bind with receptor and changes occur within cell.

They attach to a receptor and stimulate the cell to act.
Laxative that absorb waters, leading to a softer stool
Bulk forming
Which induction agents are acids
Barbituates and Propofol
synapses
microscopic gap between neurons in a chain. can be electrical or chemical. neurotransmitter release and removal occurs here
This antibody drug targets the _______ on platelets.
Abciximab
uses of nitroglyceride
treats angina (decresae coronary asospasm)
CHF
HTN
Type of Drug?
Ethosuximide
Anti-epileptic drug
Blocks thalamic Ca channels
Tx of absence seizures(1st)
What can the diol-epoxide metabolites of benzo(A)pyrene induce?
Lung tumors
Corticosteroid interactions
diuretics that causes hypokalemia; ASA = increase GI problems; DM = hypoglycemia.
What is the NM receptor blocked by?
Turbocurarine
Pirenzepine
Blocks M1 receptors and blocks gastric acid secretion via blockade of ganglionic neuron.
Pentazocine mixed with what can produce heroine like effects?
Antihistamine tripelennamine
What is the most important property of an ideal drug?
Effectiveness
The BBB allows?
Liposoluble drugs (also cross the placenta) but not quarternary ammonium compounds
drugs to treat herpesvirus infections:
 
valacyclovir (Valtrex) 
valine ester of acyclovir
 
well-absorbed after oral admin, after which de-esterification releases free acyclovir; delivers higher blood levels of acyclovir w/ reduced dosing frequency (3-5x higher than oral acyclovir; comparable to IV acyclovir) - increased half-life & bioavail.
 
absorption not affected by food
 
can be used in preg (cat B) 
Valproic acid + derivativesfxn
Increases GABA @ higher concentrationsblocks sodim channels
This is a low concentration of drug required at a receptor.
Sensitivity
Side-effects of Vinblastine include….
VinBASTine BLASTs Bone Morraow, causing myelosuppression, as well as neurotoxicity and paralutic ileus.
antipsychotic activity of conventional APs
-improvement in positive symptoms, minimal improvement in negative and cognitive symptoms-variable onset time: 2-3 weeks until improvement and new evidence says within 24 hours-no tolerance to therapeutic effect (no decrease in efficacy on (+) symptoms)
4 catergories of laxatives
Bulk Forming, surfactant, stimulant, and osmotic
Synergism
The combined action of two drugs. The action is much stronger than the effects of either drug when administered separately.
What does the abbreviation stand for: qd or quaque die
every day
name three sympathomimetic drugs used to treat hypotension
epinephrine, norepinephrin, ephedrine
Diuretics are classified as carbonic anhydrase inhibitors, loop diuretics, thiazides, and K+-sparing diuretics. Which of these causes in increase in urine NaCl?
All of them!
Gq protein
H1, α1, V1, M1 & M3
Phospholipase C, PIP2, IP3(Ca) & DAG(protein kinase C)
what is the receptor preference for levalbuterol?
beta 2
Pharmacokinetics
study of process of phase of drug action.
thrombocytopenia
an abnormal decrease in the number of blood platelets.
Carcinosarcoma
A highly malignant tumor that has the appearance of both a carcinoma and a sarcoma.
What antibiotics are given for an appy?
cefoxitin or cefotetan
What can naloxone be used for?
treatment of morphine overdose
fusion inhibitors
after HIV binds to host cell surface, a conformational change occurs in the transmembrane glycoprotein subunit of the viral envelope, facilitating fusion of the viral & host cell membranes & entry of the  virus into the cell
 
fusion inhibitors bind to the glycoprotein subunit & prevent the conformational change 
Adverse effects of High-Ceiling (Loop) Diuretics
Hyponatremia, hypochloremia, and dehydration
 Hypotension, Loss of volume
Relaxation of venous smooth muscle
Hypokalemia, Ototoxicity
Hyperglycemia, Hyperuricemia
Use in pregnancy
Impact on lipids, calcium, and magnesium
Name the 2 Alpha-1 Adrenergic Blockers.
1 Prazosin 2 Terazocin
A drug effect that is uique to an individual; different than seen or expected in the population in gerneral is call a(n):
Idiosyncracy
Proton Pump Inhibitors
MOA: Converts active form in parietal cells; causes irreversible inhibition of the H+/K+. ATPase (enzyme – generated gastric acid). Therefore inhibits basal and stimulation of acid release (HCL). Blocks the last step of acid production. Can last up to 24hr. Single dose can decrease acid production by 99%.
S/E: less than 1%, headache
NI: Do not crush, best on empty stomach, impairs metab of many drugs (changes pH).
Drug distribution
The transport of a drug through the blood stream to various tissues of the body and ultimately to its site of action. Rate of distribution depends on the permeability of the capillaries to the drug molecule, cardiac output, and regional blood flow.
Beta-1 selective blockers = (A BEAM)
1) acebutolol
2) atenolol
3) betaxolol
4) metoprolol
5) esmolol (short acting)
Do loop diuretics cause acidosis or alkalosis?
Alkalosis, increases pH
toxicity associated wiht atypical antipsychotics
less EPS and anti-cholinergic effects
Clozapine --> agranulocytosis
What is the problem with using Garlic remedies?
drug-drug interactions
How many times must a med label be read before administering?
4X
drugs forming toxic interaction with immunosuppresants (5)
Erythromycin, Ketoconazole, Cimetine, Amphotericin B and grapefruit juice inhibit the metabolism by the liver and slow the clearance
Enter your front text here.
Enter your back text here.
How do the TCAs make it through the BBB?
Lipid soluble
disruptors of cell membrane permeability
increase the permeability of the bacterial cell membrane thereby permitting leakage of intracellular components to take place
 
differing ratios btwn sterol & phospholipid contents in mammalian & microbial cell membrane appear to be the basis  for the selectivity of these agents
 
considered bactericidal in their action since interference w/ the cell membrane results in the immediate death of microbes 
What type of receptors do Class II drugs effect?
B receptors (blocker)
Loxapine: Class of drug, use
D2 blockers - block dopamine receptors, diminishing psychosis, calming, can be used as antihistamines or thermostat *The D2 class is super calm from the Haloperidol, reading magaZINES, watching Priscilla THIO do TRIX, and eating LOX at PINE Springs Ranch
pharmacotherapeutics
is the study of how drugs are used in the treatment of disease.
Most recent major Federal Legislation affecting drug sales and use
Comprehensive Drug Abuse, Prevention, and Control Act (aka Contolled substance Act) of 1970
Isoproterenol =
b1 = b2 agonist - for asthma, AV block
why do patients taking L-dopa get arrhythmias
peripheral effects of dopamine
What cancer drugs have the SE of Hemorrhagic cystitis?
Cyclophosphamide & Ifosfamide
Partially prevented by mesna
Achieving therapeutic outcomes with antidepressant therapy is
subjecitve to patient; requires more communication
How does lithium work biochemically?
Increases rate of inactivation of biogenic amine neurotransmitters (norep. and serotonin) and so mech. is opposite effect of many antidepressant drugs. It also reduces the release of neurotrans. It can replace sodium and magnesium in the electrolyte pool
1 ACE inhibitor (Ramipril)
1 Prodrug – hepatic esterases convert it to ramiprilate
 
1 It binds to ATI inhibiting it binding with ACE; it also prevents ventricular remodeling in heart failure and decreases SNS activity 
beta adrenergic agonist bronchodilators are nonselective beta agonists, meaning they:
affect both B1and B2 receptors & A1 receptors
 
cause bronchodilation (from B2 stim.), cardiac stimulation (tachycardia & cardiac arrhythmias from B1 stim.), and vasoconstriction/elevation in BP (from A1 stim.) 
What is an example of a regulatory system?
 
Where are these found? 2
Baroreceptors
 
- Aortic arch
- Carotid artery
Name the 5 Muscarinic, Direct Stimulants.
1 Acetylcholine 2 Pilocarpine 3 Cevimeline 4 Carbachol 5 Bethenachol
What are the types of ligands that interact with receptors?


INCHILD: Ions, neurotransmitters, carbohydrates, hormones, immunoglobins, lipoproteins, and drugs.
What does the abbreviation stand for: SOS
si opus sit, if necessary
What should you watch out for when giving these drugs?
Hypersensitivity rxn (urticaria,severe pruritus); methicillin can cuase interstitial nephritis
which drug should be used in a glaucoma emergency
pilocarpine (direct ACh mimetic)
Niacin (Nicotinic Acid + Vit B3)
Dec VLDL by inhibit adipocyte lipolysis
Lowers VLDL, IDL, LDL
***Inc HDL 20%-50%
Flushing, liver inj, DM, gout, peptic ulcer/myopath w/ statins
Cell in the stomach that secretes histamine
Enterochromaffin-like cell (in the fundus)
drug interactions & adverse effects of prokinetic drugs (metoclopramide)
ETOH & other CNS depressants: increased sedation
phenothiazins: increased risk of EPS
anticholinergics & opiate analgesics: antagonize the therapeutic effect & decrease GI motility
most common adverse effects: drowsiness, restlessness, fatigue, diarrhea & EPS, particularly acute dystonic rxnsEPS usually subsides 2-3mo after d/c
other adverse effects: dizziness, visual disturbances, confusion, depression (b/c blocking dopamine receptors), insomnia, suicidal ideation, galactorrhea, gynocomastia
Name the 1 Nicotinic stimulant, and its use.
Nicotine - to overcome nicotine addiction
What is ACh and its function?
Acetecholine, which is a chemical that allows neurons to communicate with each other
Magnesium hydroxide overuse = ___________
diarhea; Mg = Must go to the bathroom
What are the two isoforms of the estrogen receptor?
alpha
beta
(tissue specific, but estradiol binds both)
2 main chemicals of the Eicosanoid groups
Prostaglandins and leukotrienes. 20 carbon essential fatty acids with 3-5 double bonds.
What are 8 patient factors affecting pharmocokinetics?
- weight and body composition- age- pregnancy- smoking- alcohol- liver function- kidney function- psychosocial factors
In general, what do ACE inhibitors do to the body?
Lower BP, Increase secretion of aldosterone
What is the effect of the following drugs: 1. Positive inotropic drugs 2. Beta blockers 3. Ace inhibitors 4. AII antagonists 5. Vasodilators and 6. Diuretics
1. Increases cardiac output. 2. Inhibit renin release. 3. Inhibit ACE 4. Inhibits effects of AngII including increasing the preload, increasing the afterload and remodelling. 5. Decrease the preload and afterload. 6. Decrease the preload and afterload
What are the three types of CHD that require prophylaxis?
1. Unrepaired Cyanotic disease, including shunts and conduits
2. Completely repaired heart with prosthetic valve for 6 months
3. Repaired CHD with defects at or near the site of the prosthetic valves
What is the drug of choice for atrial flutter? 2
- Propranolol (class II)
- Verapamil (class IV)
When are intermediate and long acting insulin agents given?
Typically given at bed time to mimic basal insulin output seen in normal individuals. NPH is intermediate acting. Lente and Ultralente are long acting.
What are the events of the last 3 decades?
*Explosion in development of new drugs 

*Molecular biology and the cloning of numerous receptors
What part of the heart is most likely affected by infective endocarditis?
The valves, although any part can be affected.
Demerol
meperidine
latero-
side
Ultram
oxaprozin
Aramine
Vasopressor
GU
Genitourinary
citralopram
celexa
risedronate
Actonel
dexamphetamine
dexedrin
Atropine
Cholinergic antagonist
promethazine
Phernergan Suppository
Chloramphenicol
p. 294
Isordil
Coronary Vasodilator
servent
salmeterol xinaforte
percocet
Acetaminophen & Oxycodone
Methylprednisolone
Pain and AntiinflammatoryGlucocorticoid - injectable, intermediate acting 12-36h
syndrome characteristics
-abscence-Lennox-Gastaut Syndrome-status epilepticus-age of onset-reponse to TM-prognosis
Herbal agents
p. 341
Antidote for Heparin?
Protamine
Echothiophate
Organophosphate cholinesterase inhibitor

less lipid soluble than most organophosphates; used in glaucoma
HDL
high density lipoprotein
Maclobemide
MAOAi selective, ant-depressant
Magnesium
Treatment: Digitalis induced arrythmias if hypomagnesmic or Torsades-de-Pointes in normomagnesic
Cardiac Medication - Antihypertensive
nicardipine
Imipramine
a tricylic for anti-depression
haloperidol
conventional, butyrophenones, high potency
antidote for benzodiazepines =
flumazenil
moa maprotiline
blocks NorE reuptake
Glipizide
glyburide
Oral hypoglycemics

second generation, very potent. Like other sulfonylureas, act by closing K channels in pancreatic B cells, causing depolarization and release of insulin.

Tox-
hypoglycemia
Acetaminophen
Antipyretic analgesic

very weak cyclooxygenase inhibitor

not anti−inflammatory. Less toxic than aspirin but more dangerous in overdose (causes hepatic necrosis−antidote: acetylcysteine)
ac
ante cibum (before meals)
chlorpromazine
penothiazines, typical neuroleptic (psychosis) + H1, mACh, alpha1 antagonist
5 bacteriostatic antibiotics
Tetracyclines, macrolides
Procarbazine
(non-classic alkylating agent - polyfunctional alkylation)
 
"the pro car drives through DNA by Hodgkin and some one not related to Hodgkin"
 
Mechanism: causes chromatid and single strand DNA breaks inhibiting synthesis
 
Resistance: related to increase expression O6-alkylguanine-DNA alkyltransferase
 
Lasix
High Ceiling Diuretic
-give potassium supplement


SE - Transient Deafness, Photosensitivity
Domeboro
Skin - Topical MedicationsHypertonic solutions, draw out, magnesium sulfate
sargramostim
inrease both granulocyte and macrophage usd in bone marrow recovery
chorea
involuntary purposeless and rapid movements
Absorption through cheek and gum
Buccal
loperamide
misc. opioid agent (=Immodium)

used to tx diarrhea

avoid repeated use --> constipation
can cause profound sedation in certain dog breeds (collies, Australian shepherds, etc.)
MOA 5FU
blocks thymidylate synthase (preventing dUMP --> dTMP)
Drugs ending with:
-ane
Inhalational general anesthetic
Ex-Halothane
Isoproterenol
Beta1, beta2 agonist catecholamine prototype

bronchodilator, cardiac stimulant. Always causes tachycardia because both direct and reflex actions increase HR.

Tox-
arrhythmias, angina
ETHYLENE GLYCOL
Anti-freeze. Metabolized to Glycoaldehyde, Glycolic acid and Oxalic acid (toxic). Causes CNS depression, severe metabolic acidosis, deadly nephrotoxicity.
enoximone
PDE III inhibitors = ionotrope
Alfuzosin
Selective for alpha-1A in genitourinary tract (treats BPH (benign prostatic hyperplasia)) Half-life: 10 h. Not to be taken with grapejuice which inhibits (p450 isozyme CYP3A4 in the liver)
antacid
Drug that lessens or neutralizes acidity.
Prednisone Profilactic, Corticosteriod
Class: Antiinflammatory, immunosuppressant.Action: Relieves inflammation and reduces immunosuppression.Side Effects: Euphoria, insomnia, seizures, heart failure, thromboembolism, peptic ulceration, pancreatitis.Contraindications: with systemic fungal infection, and allergy to any part of this drug.
contraindications of PCNs
hypersensitivity & allergy
 
caution with severe renal insufficiency; doses should be adjusted 
verapamil drug interactions and toxicity
interactions:
digoxin
beta-adrenergic blocking agents
 
toxicity:
severe hypotension
bradycardia and AV block
V-tahcydysrhythmias
 
what kind of drug is latanoprost
prostaglandin
crossing bbb: pinocytosis
-endocellular inclusion-no lipid solubility needed-no need to fit transporter-rare in CNS
(Gluco S/E)

Glucose intolerance
Causes hypoglycemia. Monitor insulin.
Organophosphate Tx.
ABC's
Bronchorrea or excess oral secretions oxygenate and use atropine. Atropine only works at muscarinic sites. Also, intubate, using a nondepolarizing NM blocker. Circulation - IV fluids >2L or more due to diarrhea. Tx Seizures, gastric emptying if toxin ingested. Give antidote.
saw palmetto
GI distress, decreased libido, hypertension
MOA ethosuxamide
blocks ca channels in thalamus
Type of drug?
Beclomethasone
Glucocorticoid
Tx of addison's, inflammation, immune suppresion, asthma
Type of drug?
Edrophonium
Anti-cholinesterase
Short acting; for diagnosis of myasthenia gravis
Type of drug?
Scopolamine
Cholinergic antagonist- like atropine
Works on CNS- used on motion sickness
_____ like p-glycoprotein exist in cell membranes and only allow specific structures to pass
Transporters
What drugs are class 1A antiarrhythmics?
Procainamide
Disopyramide
Quinidine
Atenolol
Beta-1 blocker. Treats hypertension in elderly with systolic hypertension. Cardioselective; half-life: 6-7 h
Lithium can inhibit...
ADH, but are nephrotoxic.
brand name
Name copyrighted by the manufacturer for a particular version of a drug. Same as trade name.
Oxidations
Cytochrome P450 is linked to which Phase I reaction?
secondary hyperlipidemia
caused by other diseases and contributing factors:
 
endocrine disorders: DM, hypothyroidism (the most common metabolic cause), Cushing's syndrome (overprod. of cortisol by adrenals)
renal disorders: uremia, nephritic syndrome
hepatic disorders: primary biliary cirrhosis, acute hepatitis, hepatoma
autoimmune disorders: SLE
lifestyle: diet, low activity, obesity, stress, ETOH, smoking
medications: steroids, progestin, thiazide diurectics, loop diuretics, BBs w/o ISA 
Short Acting Insulin
EndocrineDiabetes Mellitus - "Humilin R"Clear, treats diabetic ketoacidosis, 15-30m onset, peak @ 2-4h, 8h duration
methyldopa
as clonidine alpha2 agonist used in RX of HPT
Define distribution.
Movement of drugs through the body
Define ionize
To become electrically charged or polar.
Basal ganglia
Where dopamine is made and stored.
Which drug name constitutes a description of a drug using the nomenclature of chemistry?
Chemical Name
Induction agent that can cause burst suppression at doses that do not cause profound hypotension
etomidate
adverse effects of neurolpetics
extrapyramidal effects: dyskinesia, dystonia, muscle tremors
higher doses --> catalepsy
hypotension
hypothermia
mild neg. inotropic effect
dec. seizure threshold
weak resp. depression, but can inc. resp. depression w/ other drugs
Antimicrobial Tx -- Mechanism of Action
p. 291
MOA acetazolamide
Carbonic anhydrase inhibitor
so it inhibits the reabsorption of HCO3- in PCT
also CA is in ciliary body of eye and in choroid plexus cells, so it decreases aqueous humor production and increases CSF production
Type of drug?
Phenylephrine
Alpha agonist (α1>α2)
Used for nasal decongestion
What carcinogen is responsible for a major proportion of lung cancer incidences?
Tobacco
Hamilton Rating Scale is used for
rating depression
Adenosine
A1 receptor agonist inhib ca channel, increase k permeability
Sodium Dantrolene
Produces muscle relaxation by blocking Ca2+ release from sarcoplasmic reticulum.
Heroin causes miosis by stimulating
Edinger Westphal nucleus
Ibuprofen
RA [Advil, Motrin] (COX1 & COX2 Inh) MET: Liver CYP2C8 Duration: Short (2hr) OTH: Low dose = analgesic (no anti-inflam) High dose = analgesic & anti-inflam SE: GI, rash, tinnitis, fluid retention kidney failure, hepatitis TX: RA, Chronic Inflammation
T 1/2: naltrexone
longer than naloxone (b/c oral administered)
drug/food interactions with thioamides
anticoagulants: action may be enhanced
lithium: simultaneous use may potentiate hypothyroidism
diuretics: increased K-losing effect
antidiabetic agents: incrased requirements for insulin & oral hypoglycemics
What is one of the most important factors that ↑ BP?
Endothelial cells
What enzyme catalyzes the production of Ach from Choline and Acetyl CoA? What enzyme hydrolyzes AcH release from their receptors?
Choline acetyltransferase. Acetylcholinesterase
Which cell type in the testis produces testosterone?
Leydig cells
opioid receptors
-μ1, μ2 (mu) for β-endorphins and endomorphins-δ1, δ2 (delta) for enkephalins-κ1, κ2, κ3 (kappa) for dynorphins
Parasypatholytic (Anticholergenic)
drugs or substance that blocks or inhibits actions of PNS
What are the Seratonin, 5HT-2A antagonist?

Cyp Methyl
Cyproheptadine and Methylsergide
Phenoxybenzamine =
irreversible a1 & a2 blocker - pheochromocytoma
latanoprost is used to treat what eye disease
glaucoma
What is the toxicity of insulin?
Hypoglycemia and hypokalemia
What drug causes:
Cutaneous flushing
Niacin, Calcium channel blockers, adenosine, vancomycin
Which of the following is not a mechanism by which bacteria develop antibiotic resistance?
metabolism
What is a high LDL level?
Over 160 mg/dL
Chemical Name
The exact designation of a chemical structure as determined by the rules of chemical nomenclature. ex. ethyl 1-mehtyl-4phenylisonipecotate hydrochloride
Nalbuphine HCL
Mixed opioid, when given IV is equipotent to morphine and is 5X pentazocine with less psychomimetic effects (more MOR antagonist activity)
Anthracyclines
Drug Interactions
1. how to increase clearance?
2. how to increase metabolism?
3. inhibitors of P-gp ?
1. Heparin binds and forms insoluable aggregate increasing clearance of drug
2. drugs that increase hepatic microsomal enzyme activity (ie barbituates)
3.cyclosporine 
 
perphenazine is what kind of drug (what level potency)?
intermediate, classical antipsychotic
adverse effects of biguanides
most common GI problems: metallic taste in mouth, mild anorexia, nausea, abdominal discomfort & diarrhea; usually transient & reversible
should be discontinued for 48hrs after any radiologic procedure involving IV admin. of iodinated contrast material; should be withheld in any pts undergoing major surgery
rare problem: lactic acidosis
7.) Postmarketing surveillance
Gather and analyze voluntary reports of adverse effects submitted by health care professionals.
In the GI tract, where are most drugs absorbed?
Duodenum
Define parenteral roure
Delivery of a medication outside of the gastrointestional tract, typically using needles to inject medication into the circulatory system or tissues.
Therapeutic drug level
drug level is between MEC and MTC.
Cumulative action
Occurs when a drug is administered in several doses, causing an increased effect.
phase 1 clinical trials
15-20 healthy volunteers - watching absorption, metabolism, excretion, toxicity
Most common resistance mechanism for sulfonamides.
Altered enzyme (bacterial dihydropteroate synthetase), decrease uptake, or increase PABA synthesis.
which class of drugs is used to treat alcohol w/d
benzos
Name 4 DNA repair mechanisms:
1) Mismatch repair
2) Nucleotide excision repair
3) Base excision repair
4) Recombination repair system
What are the adverse effects of erythropoietin? (6)
Pure RBC aplasia
ostealgia
hypertension
CHF
cancer
thrombosis
Botulism toxin blocks what?
Ach release at the presynaptic membrane. (Binds synaptobrevin of SNAP-25 involved with Ach vesicles)
How do oralanticoagulants work?
They inhibit hepatic synthesis of several clotting factors. Dont affect fibrinolysis.
Mechanism of action: barbituates (low and high dose)
low dose: potentiate GABAergic transmissionhigh dose: promote Cl-influx trhough GABA gated channels independently of GABA.
nucleoside reverse transcriptase inhibitors
antiretroviral (NRTIs) 
prevents viral DNA f rom replication; active inhibitors of reverse transcriptase - decrease or prevent HIV replication in infected cells
exert a virustatic effect against retroviruses (drug mimics one of the nucleosides that the virus wants, so DNA prod is inactive)
b/c of rapid mutation, the virus is a constantly moving target, thus the therapeutic response decreases w/ long-term usage, particularly in the later stage of the disease
resistant strains can be transferred between individuals
another factor that contributes to loss of drug efficacy includes incrased viral load resulting from a reduction in immune mechanisms
name drugs work on NE reuptake
cocain , tricyclic antidepresion
Captopril, Enalapril, Lisinopril, Ramipril, Benazepril: Class of Drug, use
ACE Inhibitors - Lower BP, increase secretion of aldosterone *ACE the class in aPRIL
pharmacological effects of opioids- respiratory depression
-decreased rate and depth of respiration-cause of death in overdose-no air hunger because opioids block intrinsic drive (give Oxygen with pressure)-direct depression of brainstem respiration centers and depression of responsiveness-can be beneficial to decrease hyperpepnia
The standard 3mL syringe is calibrated in ?
Tenths of a mL
phase 3 clinical trials
10-15,000 people with disease - do benefits outweigh the risks? Leads up to the FDA approval.
What type of antiarrhythmic is encainide?
Class IC (includes flecainide, encainide, propafenone)
What does LH regulate?
Where does it act?
-steroid synthesis
-induces synthesis of FSH receptor

Theca cells (layer around developing oocyte)
What are the 3 sources for cholesterol?
diet
blood
liver makes its own
tetracycline mech. of resistance
Found on transposons and plasmids. Efflux pumping. Some produce a proteing that binds to the ribosome and blocks tetracylcine action. (Tigecycline not affected by these two types)
What is the Minimum Effective Concentration?
plasma drug level which below, therapeutic effects will not occur.
nursing management for osmotic diuretics
ensure infusion is given through a filter (can cause precipitate otherwise)
What AP phase do class IV drugs effect?
 
How do class IV drugs effect conduction?
Phase 4: slows depolarization
 
Slows AV node conduction
In general, what does an intracellular skeletal muscle relaxant do to the body?
Prevents calcium release from the Sarcoplasmic Reticulum, so no depolarization occurs *used for spastic disorders and malignant hyperthermia
Dopaminergic Drugs - Def & MOA
Def: It's a combination drug, carbidopa-levodopa.

MOA: It diffuses levodopa into the CNS, where it is converted into dopamine. It balances dopamine and Ach.
What does the abbreviation stand for: IVPB
IV piggyback, secondary IV line
Drug of choice for Pneumocystis carinii pneumonia.
TMP-SMX (drug of choice), aerosolized pentamindine.
Term for when a single nucleotide in the sequence is altered
SNP single nucleotide polymorphism

ex: A-T instead of C-G
What four types of bacteria are most likely to cause infective endocarditis?
1. Strep
2. Staph
3. Enterococcus
4. fastidious gram - coccobacillary forms
mechanism of action of thiazide diuretics
inhibit reabsorption of Na+ and Cl- ions in the cortical portion of the loop, the loo of Henle, proximal and distal renal tubules
The ACCOMPLISH study found that:
It shows that some patients do better on an ACE inhibitor plus calcium channel blocker, than on an ACE inhibitor plus thiazide
What is peak
The time it takes for a drug to reach it maximum therapeutic response
Sometrem and Somatropin are use to treat?
Dwarfism and is a growth hormone
Clinical uses of Amphotericin B.
Used for a wide spectrum of sytemic mycoses. Cryptococcus, Blastomyces, Coccidioides, Aspergillus, Histoplasma, Candida, Mucor (systemic mycoses). Intrathecally for fungal meningitis; does not cross blood-brain barrier.
What effect does St.-John's Wart have on CYP3A?
induces it (higher metabolism of drugs)
Propranolol and atenolol for hypertension.
Treat mild or moderate HT, used in combination with others
What special considerations by the nurse are taken when administering liquid iron?
The nurse should use a straw to administer liquid iron to avoid staining the patient's teeth.
What is an additive response?
When two or more like drugs are used together to produce an effect, the outcome is the sum of each individual effect 1+1=2
How is this drug different from furosemide? And how does that affect its use?
Although both have the same action, ethacrynic is a phenoxyacetic acid derivative not a sulfonamide. Therefore use this drug when you are allergic to sulfa.
Dapsone (and it is useful against 3 pathogens)
Another sulfa drug. Useful against mycobacteria, LEPROSY and Pneumocystis carinii (a fungus).
what is the order of loss of sensation?
pain first, then temp, then touch, then pressure
Is there fluoride in the water in Montreal?
No! Although in many other cities there is!
What was the first american law to regulate drugs
Federal Pure Food and Drug Act of 1906
What is a sign in phase 1 that you have hepatotoxicity?
If you have vomiting within 8-10 hours of ingestion than this is a sign of hepatotoxicity.
Benadryl
diphenhydramine
Lovastatin
Mevacor
Vytorin
Omeprazole
CLOMIPRAMINE
(blank)
IFA
?
tiotropium
spiriva
xatrol
afluzosin
lidocane
xylocaine
selegiline
MAOb inhibitor
-triptyline
TCA (amitriptyline)
class amitriptyline
tca
agit
shake, stir
sennas
Senokot (laxitive)
-vir
anti-viral, protease inhibitors
dobutamine
beta1 selective agonist
Hydantionsfxn
blocks sodium channels
nitroglycerin
Nitrostat subl tabs
-olol
beta antagonist. Propranolol
Pralidoxime
Acetylcholinesterase regenerator

very high affinity for phosphorus in organophosphates
Aspirin
NSAID prototype

inhibits cyclooxygenase (COX) I and II irreversibly. Potent antiplatelet agent as well as antipyretic analgesic anti−inflammatory drug
Mepivacaine
(A)
int-acting
rapid onset
LEAST VASODILATORY
Important Benzos
Diazepam(Valium),Alprazolam,Xanax), Chlordiazepoxide (Librium),Flurazepam (Dalmane),Triazolam (Halcion),Flunitrazepam (Rohypnol—Roofies),Midazolam (Versed)
Cosyntropin
Endocrine (ACTH)MOA: CRH (hypothalamus) → ACTH (ant. pituitary) → cortisol & aldosterone & sex hormonesTX: Dx adrenal insufficiency
Neutersol
EndocrineOtherAdministered to puppy testicles to induce infertility, does NOT stop testosterone production
ototoxicity drugs?
aminoglycoside
vancomycine
ethacrynic acid
– Catechol-O-Methyl Transferase (COMT) inhibitor	- Blocks conversion of Levodopa to inactive form in the periperal tissues
	- May help on/off phenomenon with levodopa
	- SEs: initial increase in dyskinesia, N/V/D, orange urine, hall
Desflurane
Hexamethonium (ganglionic blocker) blocks -------- receptors.
Nicotinic.
Type of drug?
Methicillin
Penicillinase-resistant penicillin
Anistreplase (APSAC)
Thrombolytic

bacterial streptokinase complexed with human plasminogen. Longer acting in body than other thrombolytics (rt−PA, streptokinase, urokinase).

Tox:
bleeding, allergy to streptococcal protein
Antihistamines and Decongestantsclemastine
Tavis Allergy
montelukast
leukotriene LTD4 receptor antagonist
Drugs that cause hematopoietic toxicity
-Antivirals
-Chloramphenicol
-Sulfonamides
Metformin
Endocrine (Biguanide) MOA: ↓ gluconeogenesis ↑insulin-stimulated GLUT4 trafficking to membrane ↑cAMP-act. protein kinase (Increase tissue sensitivity to insulin) MET: Not significantly metabolized 90% oral dose gone in 24 hours Half-life: 2 hours Low potency SE: Lactic acidosis (Even less with 2nd generation) Cardiovascular disorders OTH: Do not cause hypoglycemia (even at high doses) ↓TAG, ↓cholesterol, ↓LDL, ↑HDL Weight loss & ↓BP TX: DOC Type 2 Diabetes (Obese)
example of monobactams
aztreonam (Azactam) IV/IM
Nitrous Oxide
Nervous SystemInhalantUsed in combination with other gases to speed induction
FACTParasympathetic system* When Ach is released from nerve terminals, it diffuses across the synaptic cleft to bind to postsynaptic receptors on target cells* Receptors for ACh (Cholinergic receptors or cholinoceptors) are broadly subd
.
AED to treat migraine
valproate, gabapentin
allopurinol
anti-gout
inhibits xanthine oxidase at both purine sythesis steps
competitive (low dose) and noncompetitive (high dose) inhibition
hypersensitivity, blood dycrasias
is mivacurium depolarizing or nondepolarizing?
nondepolarizing
which drugs block bacterial/fungal cell wall synth
polymyxins
Type of drug?
Protirelin
Synthetic Thyrotropin-releasing hormone
Aminoglutethimide
Nonsteroid inhibitor of steroid synthesis

reduces conversion of cholesterol to the hormone precursor, pregnenolone. Used in metastatic breast cancer
Garlic
Lowers cholesterol, cv disease, arteriosclerosis - Anticoagulant - Highly distributed
Propylthiouracil
thioureylenes, inhibit iodination of tyrosine residues + precent T4->T3 conversion
Fomivirsen
Antisense oligonucleotide (1st FDA approved gene therapy). Injected directly into the eye. Treats CMV retinitis in HIV patients non responding to other drugs. DONT GIVE TO PATIENTS WHO HAVE TAKEN CIDOFOVIR IN PAST MONTH.
2 pt= ___qt
2 pt= 1 qt
treatment approaches for PUD
eradicating H.pylori infection
reducing secretion of gastric acid or neutralizing the acid after it is released
providing agents that protect the gastric mucosa from damage
Levadopa
for parkinsons, crosses BBB then converted to DA by dopa decarboxylase
Fexofenadine/Loratadine
H1 Blocker (2nd generation) *Prevent normal histamine reaction
treatment of vascular dementia
-hydergine- questional efficacy-AntiChE and memantine are used with efficacy as seen in AD-prevent stroke and icerebrovascular arterosclerosis
Which induction agents would you decrease your dose with in low protein states
Precedex
____acts like an alkylating agent, x-linking via hyrdolysis of Cl and platinum; used to treat testicular, bladder, lung carcinomas
Cisplatin
MOA sildenafil
inhibits cGMP phosphodiesterase --> increased cGMP --> maintains smooth muscle relaxation in corpus cavernosum
--> increased blood flow and erection
Type of drug?
Lincomycin
50S protein synthesis inhibitor
Where is cholesterol metabolized to synthesize vitamin D?
-skin
-liver
-kidney
Autonomic Pathway PSNS
Preganglionic neurons are long
Postganglionic neurons are short
Guanethidine
A false neurotransmitter and indirect acting sympathomimetic that is actively transported into neurons by NET and can have a reserpine-like effect producing neurotransmitter depletion in the sympathetic nervous system. used to treat severe hypertension bu
Sulfonamides
-Bactericidal to G+ and G--Group A strep-Escherichia coli-Pseudomonas-StaphUSED FOR INFECTIONS IN CHILDREN AND AIDS PTS
The induction of which proteins regulates the inflammatory process?
CytokinesAdhesion FactorsChemokinesEnzymes
zero order
Nonlinear elimination is onlly for ____ ____ drugs.
second-generation cephalosporins
preg. category B
cover the same organismsas first-generation; less active against gram-pos but w/ increased activity against gram-neg organisms, including H. influenza, M. catarrhalis, S.pneumoniae
CO is dertmined by:
 
PR is determined by:
CO: 
HR
contractility
venous return
blood volume
 
PR:
arteriolar constriction
what antimuscarinic is used to treat Parkinson's
benztropine
Name some components of NSAIDS.
Non-steroidal anti-inflammatory agents, have all 3 actions: analgesic, anti-pyretic, anti-inflammatory, all were originally prescription drugs *motrin-ibuprofen and Aleve
injectable anesthetic agents, ketamine, use
-minor surgery, diagsnotic procuedures-not so much for induction-vet med
What is the most important human glucocorticoid?
cortisol
Entral route
Drugs administered along any portion of GI tract.
What does the abbreviation stand for: a (or 'ante')
before
What is the antidote for antimuscarinic/anticholinergic agents toxicity/overdose
physostigimine salicylate
what types of seizure is ethosuximide inidcated for
absence
benefit of propofol
less post-op nausea than thiopental
Type of drug?
Glipizide
2nd gen. Sulfonylurea
Increase insulin release(closes K channel→ Ca influx →cell depolarization)
what is the duration of formoterol?
12 hours
What is another clinical use of potassium sparing diuretics?
Hyperaldosteronism
cholinergic
Of or pertaining to the effects produced by the parasympathetic nervous system or drugs that stimulate or agonize the parasympathetic nervous system
Sertraline
An SSRI that produces less akathisia than fluoxetine and does not inhibit P-450 system.
Tiagabine
Used as an adjunct to treat partial seizures. Enhances the action of GABA by preventing re-uptake into the pre-synaptic neurons.
lipid soluble
Substrates of a CYP oxidation reaction must be
______ ______?
 
a. water soluble
b. lipid soluble
Right HF
can result from left HF which eventually increases the burden on the R heart and may cause it to fail as well
causes must hterefore include all of the left HF (less blood ejected to pul. circ, so back up into systemic circ)
pure right HF is rare (usually due to R ventricular infraction or pulmonary disease)
pulmon. disorders that relsut in PVR impose a high afterload against which the RV must pump; the resultant RV hypertrophy (called cor pulmonale) may progress to right ventricular failure as the lung disease worsens
RHF is characterized by systemic venous congestion, which may maifest w/ jugular vein distention, hepatomegaly, spenomegaly & peripheral edema
physiologic reflux
 
 
vs.
 
 
pathologic reflux 

physiologic reflux: reflux that does not compromise health or well-being (the usual cause in infancy) - if baby is not gaining weight, the it could be a problem

pathologic refulx: reflux associated w/ esophagitis, growth failure, respiratory disease, apnea, or psychosocial dysfunction
manifestation of chronic organophosphate
peripheral neuropathy and demylination
Cyclobenzaprine: 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
entry route peripheral capillaries
-endothelial cells are gap junctions-hydrophilic drugs pass through water filled gaps-lipophilic drugs penetrate by passive diffusion through endothelial cells
What is the antidote for Bethanecol?
Anticholinergic blocking agent.
SLUDGE is the acronym for side effects of what type of drugs?
Cholergenics
AN SMR=150
INDICATES THAT 50 PERCENT ARE AT GREATER RISK
medication orders require
clients full name
generic and/or trade name
dose
route
frequency
date, time, sig of prescriber
refills -- scheduled medications (schedule II not refillable)
Calcium enters cardiac cells through which channel?
Voltage-gated calcium channel
MOA etanercept
recombinant form of TNF receptor that binds TNF-alpha
various types of pharmaceutical preps
natural source ex opium
How do third-generation cephalosporins differ from earlier cephalosporins?
improved activity against gram-negative bacteria
What classes is amiodarone in?
1, 2, 3, 4
Trimethaphan
A Nn ganglionic blocker. (of Ach type receptors and affects parasymp. and symp. so its rarely used)
2 congeners of phenobarbital
Mephobarbital, primidone (metab. to pheno. and PEMA, but may be superior to pheno.)
Phase II
 
*conjugation: synthetic reactions with addition of another molecule
Which phast of metabolism is conjugation in?
Nursing Management / Implications for ARBs
same as ACE inhibitors
physiological responses to gastrointestinal dysfunction:

Halitosis: foul smelling breath; may indicate periodontal or oral infectious process

dysphagia: difficulty swallowing; may result from mechanical problem (e.g. neoplasm, surgery) or occur secondary to neurologic damage or dysfunction (e.g. CVA)

Odynophagia: painful swallowing; important marker for infection or disease

Pyrosis (heartburn): burning sensation usually in midsternal area caused by reflux of gastric contents into esophagus

dyspepsia (ingestion): feeling of discomfort during digestive process, or inability to digest food secondary to GI disorder

anorexia: loss of appetite, common complaint associated w/ GI disease; causes can include: neoplastic process ,anxiety, pain, depression, infection, or constipation

satiety: feeling of fullness, at times beyond the point of satisfaction

malabsorption: inability to absorb nutrients secondary to GI disorder or surgery

altered bowel sounds: indicate passage of air/fluid in GI tract; diminished or absent after abdominal surgery or hyperactive/high pitched as a result of hypermotility of GI tract

melena: black or tarry stools indicating presence of blood
What are heterocyclics?
pg 312 2nd and 3rd generation antidepressants with varied and mixed mechanisms of action. Used major depression.
What is hypotonic
A fluid with lower mineral ratio: brings fluid into cells
Glutamate NMDA receptor antagonists in alzheimers: memantine (namenda)
-slow down excitotoxicity in alzheimers to slow disease and heal hurt cells-uncompetitive NMDA receptor antagonist (channel blocker is frequency dependent)-possible reduction in excitotixicity but little effect at normal activity level-SE: none important, can use with AChE inhib-efficacy: no shown effect with AChE inhib-no NMDA antagonist SE because of lower affinity-moderate to severe alzheimer's slows the rate of decline but effect is modest
Describe generalized seizures?
Involves bith hemispheres of the brain and is described in terms of visible motor activity
4 components of the peripheral compartment
muscles, skin, fat, bone
mechanisms of action of seizures
seizure focus activated, seizure discharge from focal area may synchronize w/ other neurons & propagate to surrounding areas of brain

dec. GABA activity & inc. glutamate activity important
Clinical use of Acyclovir.
HSV, VZV, EBV. Mucocutaneous and genital herpes lesions. Prophylaxis in immunocompromised patients.
clinical uses for clindamycin
treats anaerobic infections (above the diaphragm)
What is a classic example of a drug that is eliminated by a zero-order pharmacokinetic process?
alcohol
Cholinergic-Blocking do what?
block or inhibit the actions of acetylcholine in the PSNS

aka anticholinergics
How are clonidine side-effects different from alpha methyl DOPA?
Clonidine doesnt interfere with dopaminergic function so much (dont get depression), less orthostatic hypotension, more serious withdrawal effect (shorter half-life and receptor up-regulation), rebound hypertension to the point of crisis.
13. Differentiate the mechanism of action, indication for use, methods of administration, common adverse effects of, key points for patient education, and nursing implications for Calcitriol.
-Vitamin D; management of hypocalcemia and resultant bone disese in patients undergoing chronic renal dialysis. -Major contraindications: Hypercalcemia, hypervitaminosis D, malabsorption syndrome, and decreased renal function. - Most common adverse effects: weakness, headache, somnolence, nausea, vomiting, dry mouth, constipation, muscle or bone pain, and metallic taste. - Most serious adverse effect: chronic hypercalcemia can lead to generalized vascular calcification, nephrocalcinosis, and other soft tissue calcification. -Maximizing therapeutic effects: Patients with normal renal function taking calcitriol should maintain adequate fluid intake and avoid dehydration; periodically monitor serum calcium, phosphate, magnesium, alkaline phosphatase, and 24-hour urinary calcium and phosphate,  especially in hypoparathyroid and dialysis patients. -Minimizing adverse effects: Maintain serum calcium levels between 9 and 10 mg/dl. - Most important patient education: Adequate dietary calcium is necessary for a clinical response to vitamin D therapy; compliance with dosage instructions, diet, and phosphate-binder use, and calcium supplementation is essential; avoid use of nonprescription drugs, including magnesium-containing antacids.
Name the 5 types of diuretics.
Thiazide and Thiazide-like
Loop or high-ceiling
Osmotic
Carbonic anhydrase inhibitor
Potassium-sparing
What is First Order Clearance?
A known/predicted amount is eliminated per unit of time. (e.g 50% hour)
what types of seizures is phenobarbital indicated for
simple and complex partial, tonic-clonic
What is hypertonic
A fluid with a higher mineral ratio: takes fluids out of cells
Misc approaches to treating Alzheimers: ginko biloba
-herb available without and Rx-long history of folkuse to increase memory and mental alertness in both normals and those with dementia-likeconditions.-EGb 761.-clinical trials in prevent and treat-chochrane shows effective like AChE inhibitor but support is lacking-unknown MOA, may be antioxidant
How do you Tx. Vacor toxicity?
Niacinamide and insulin for hyperglycemia
Most common resistance mechanism for macrolides.
Methylation of rRNA near erythromycin's ribosome-binding site.
What is the action of oxytocin?
Stimulates smooth muscle contraction in the uterus, cervix, and myoepithelial cells.
What is coriolos fungus marketed for?
cancer adjuvant therapy
--no clinical trials!!!
Interaction Types
Addition - 1+1 = 2
Synergism - 1+1 = 3
Potentiation - 0+1 = 2
Antagonism - 1+1 = 0
4 ways endothelial cells prevent clotting
negative transmural electric charge, release plasminogen activators, release thrombomodulin (activates protein C (coagulation factor inhibitor), release PGI2.
half-time OR biological half-life
What equals the time required for 50% of the drug remaining in the body to be eliminated?
nursing considerations for lithium
admin PO in both liquid and tablet form (also sustained-released)
instruct pt to never double dosage if a dose is missed but contact physician immediately for instructions
take w/ meals/milk
with normal renal function, 10-12 days may be required for lithium to be completely clear of body
advice pt to carry medicalert card
what drugs can be used for status epilepticus
phenytoin, benzodiazapines (diazepam, lorazepam)
Discuss ASSESSMENT-the first part of the nursing process.
Initial step-appraisal of a pt's condition (ongoing process) that involves gathering and interpreting data.i.e. contraindications, allergies, drug-drug, drug-food, alcohol use, caffeine etc
Function of Class Ib Sodium Channel Blockers include
Increasing repolarization rate and reduce automicity in ventricular cells
mechanism of action of barbiturates
low doses: facilitates GABA by binding to site on GABA receptor (separate site from benzos)

higher doses (anesthetic):
decreases presynaptic release of NTs
blocks postsynaptic action of excitatory NTs
GABA-mimetic effect
what is the effect of cholinesterase inhibitors on succinylcholine neuromuscular blockade?
phase I: cholinesterase inhibitors potentiates the blockade phase II: cholinesterase inhibitors reverse the blockade
When do PAHs become carcinogenic?
after they are metabolized by p450 enzymes to form reactive diol epoxides that form DNA adducts
Drug used in TB treatment in HIV
Rifampin.(gives similar response to that seen in HIV-free TB patients.
If you need less mg of a drug to get a response is that drug less or more potent?
More
What happens when you activate β1 receptors? 2
- ↑ heart tempo(intrinsic pace) in pacemaker cells on SA node
- ↑ force of contraction
- ↑ stroke volume
Explain a category B for pregnancy.
Animal studies have shown no adverse effect, no well-controlled studies in preg. womenor-animal studies have shown adverse effect-but studies in preg women have not
What is the Mnemonic for TCA?
T = Tremor
C = Cardiovascular
A = Anticholinergic
what are the side effects of beta blocker treatment in glauzoma
no pupillary or vision changes
What is common about the mechanism of action of antifungal drugs?
Antifungals interfere with the synthesis of ergosterol, a building block for fungal cell membranes.
What anticonvulsant should pregnant women not take?
Valproic acid. It can cause birth defects: Spina bifida, cardiovascular, orofacial, and digital defects.
common long-acting beta 2 agonist:
 
salmeterol (Serevent) 
onset of action: 30 min; peak about 3 hrs; duration 12 hrs (12 hr half-life)
administered via inhaler
poorly absorbed into circ. via the lungs; w/ chronic use, it is detected in the serum at very low levels
large doses via inhalation (12-20 normal) have been associated w/ prolongation of the QT interval, which has the potential for producing ventricular arrhythmias
approved for use in kids 4yrs + ; elderly may require lower doses
headaches and cough = common side effects (well tolerated)
alpha 1 adrenergic blocking agents - NI
Careful with other drugs affecting the SNS (ie, caffeine), OTC drugs, assess for safety; give med with meals to decrease GI upset.
What can be used to treat thyroid storm?
Iodine because it inhibits the iodination of tyorisine. After several weeks, however, the thyroid gland will nto respond to iodide treatment, so this agent is used only in short term therapy. Also can use PTU because it blocks peripheral conversion of T4 to T3.
2 reasons why atrial cells repolarize faster than ventricular
Transient outward current (phase I) is larger in atrial and atrial cells are under the influence of vagal tone.
FDAMA - Food & Drug Admin. Modernization Act
- allows fast tracking of drugs for serious illness- reqs. 6 months notice before a drug is discontinued- established clinical trial database for drugs- informs of OFF-LABEL uses- incentives for pediatric drug researc
% of drugs that are substrates of CYP2D6
15-30%. Dictates whether someone will be a poor or good metabolizer. (i.e. Antipsychotics (especially fluoxetine) inhibit and codeine needs converting to morphine)
What is the requirement for germ cell maturation?
10X more [T] in tubules than in circulation
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Term:
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