Pharmacology Exam 4 Flashcards

Terms Definitions
AntiinfectivesAminoglycosidesBirds, horses
Nolvadex tabs
p. 295
Coronary Vasodilator
phenylephrine (Pseudoephrine)
salmeterol xinaforte
acetaminophen & propoxyphene
Nervous SystemLocal Anestheticsantiarrythmia, rapid onset 5-10m, short duration 1-2 h
-loss of consciousness
tricyclic antidepressant. Amitriptyline
Antidote for TCA's?
Nonselective beta−blocker prototype

local anesthetic action but no partial agonist effect. Used in HTN, angina, arrhythmias, migraine, hyperthyroidism, tremor.

asthma, AV block, CHF
NSAID prototype

inhibits cyclooxygenase (COX) I and II irreversibly. Potent antiplatelet agent as well as antipyretic analgesic anti−inflammatory drug
Organophosphate insecticide cholinesterase inhibitor

pro−drug converted to malaoxon. Less toxic in mammals and birds because metabolized to inactive products
fl oz
fluid ounce
kaolin suspension
absorptive anti-diarrhoea
What is P.R.N.
As needed
Cardiac Medication - Antihypertensive
an SSRI for depression
Tiagabine (gabatril)
decreae GABA uptake
skeletal muscle resistant
blocks Ca release from SR
used with pts with spasticity
also treats malignant hyperthemia
no effect on Ach release
skeletal muscle resistant
blocks Ca release from SR
used with pts with spasticity
also treats malignant hyperthemia
no effect on Ach release
unique MOA
MOA buspirone
stimulates 5HT1a receptors

inhibitor of xanthine oxidase; reduces production of uric acid
auris dextra (right ear)
=triazole prevents ergosterol synthesis antifungal
TMP-SMX (trimethoprim and sulfonamide). Synergystic combination of sulfa drugs.
Non-Hodgkin's Lymphoma
CHOP - cyclophosphamide, 14-hydroxy-daunorubicin (doxorubicin), Oncovin (brand name for vincristine), prednisone
Binds to opiate receptor sites in the CNS thus alleviating pain. (all narcotics work this way)
Effective vs. pain but with lots of side affects such as:
Resper depress
N,V, D
blurred vision
EndocrinePheromonesBoar odor, used for heat detection in sows
selective aldosterone receptor blocker have no antiandrogenic effect
Muscarinic antagonists. Goes against what parasympathetic nervous system does. Used for: Preanesthetic ocular surgery and exams accelerate heart rate relax biliary tract smooth muscle & decrease tone and motility of intestinal smooth muscleantidote for muscarinic agonist poisoning
This system utilizes roman numerals
pure opioid antagonist

most commonly used opioid antagonist in vet med

parenteral use only (usually IV), slightly shorter acting than morphine
examples of typical antipsychotics
Drugs ending with:
Cardiac glycoside(+ inotrope)
Cardiac glycoside

half−life 168 h, excreted in the bile (partially as digoxin); subject to enterohepatic circulation. See digoxin
All toxic metabolites. First formaldehyde, then to formic acid. Causes respiratory failure, severe anion gap metabolic acidosis and ocular damage.
K sparing, aldosterone antagonist, diuretic
The unuseful Alpha-1 receptor agonist. Sometimes can treat hypotension and shock.
Science that studies, develops, and tests new drugs.
Azmacort Profilactic, Corticosteriod
Class: Anti inflammatory, immunosuppressant.Action: Improves breathing ability.Side Effects: Headache, sneezing, oral candidiasis, hypothalamic-pituitary-adrenal function suppression.Contraindications: With status asthmaticus, and allergy to any part of this drug.Nursing considerations: watch mucus membranes for fungal infections. Keep in haler clean, monitor drugs effectiveness.
example of extended-spectrum PCNs
piperacillin (Pipracil) IV/IM
Warafin drug interactions:
Drugs that...
increase/decrease anticoagulant effects, promote bleeding, Heparin, aspirin and acetaminophen
-some antibiotics can make you bleed (cephalosporin)
what type of antipsychotic is clozapine
facilitate NT release
-increase uptake of precursors-increase synthesis-increase uptake/storage into vesicles-increase release-slow destruction
MOA: Disrupt protein synthesis by binding to 30S ribosomal subunit in bacteria which causes a misread in the RNA/DNA. Genetic code misstep.
Broad spectrum: works best against aerobic gram – bacteria. Can work with some gram +. Does not cross the b/b barrier well.
TCA combination meds:

Limbitrol: Amitriptyline and chordiazepoxide

Triavil, Etrafon: Amitryptiline and perphenazine
what kind of drug is latanoprost
MOA lamotrigine
blocks voltage gated na channels
Type of drug?
Tx of addison's, inflammation, immune suppresion, asthma
True or False
Effector proteins are specific to certain G-Proteins
Where is aqueous humor made?
Posterior chamber
ct2 - antimetabolic prevents folate use
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
Synthetic guanosine analog that alters intracellular nucleotide pools and inhibits viral mRNA synthesis. Combined with peg-interferon 2A to treat chronic Hep. C. Aerosol in infants and children for RSV infections. Treat influenza A and B, parainfluenza
Drug mixed with a semisolid melting substance meant for administration by insertion in the vagina, rectum, or urethra.
How many Cytochrome P450 gene families are in humans?
cholesterol is necessary for ____
steroid biosynthesis: glucocorticosteroids, mineral ocorticosteroids, sex steroids
bile acids
cell membranes (so preg. women contraindicated) 
Animax and Panalog
Ear and Topical MedicationNystatin, neomycin, theostrepton, triamcinoloneAntiinfectives, aminoglycoside class, clean previous,caution in rupt. eardrums
drug used for neuroleptic pain?
1- tricyclic antidepreesion
2-carpamazepine(trigeminal neuralgia)
Succinylcholine: Class of drug, use.
Depolarizing/Non-competitive skeletal muscle relaxant - relax muscles for surgery *SUCCinylcholine gets STUCK to acetylcholine receptors
Sources of vit K
green vegetables, cabbage, cauliflower, fish liver oils, eggs, milk, meat, bacterial synthesis by normal intestinal flora
(Gluco S/E)

Because it suppresses the immune system. Masks the s/s of infection. Need to monitor for infection.
This was the first system of medication measurement used by pharmacists and physicians
Precedex binds to this receptor site
alpha 2
clinical uses of neuroleptics
chemical restraint
preanesthetic meds (dec. dose of other meds)
rate of elimination of drug/[plasma drug] = ?
CL (Clearance)
clinical uses for polymyxins
resistant gram - infxs
Type of drug?
Beta agonist (β1>β2)
Used for shock & heart failure cardiac stress testing
What drug in mouthwash can prevent gingivitis?
Antipsychotics AE
lack or granulocytes (WBC), hemolytic anemia, Neuroleptic syndrome, tardivd dyskinesia, dystonia
ISMN Isosorbide Mononitrate
Long duration action nitrate Anti-Angina - tolerance high
a beta-1 adrenergic agonist, but the overall effect depends on the actions of two stereoisomers in the racemic mixture. Therefore, it has more inotropic than chronotropic effects at appropriate doses, the result of which is increased contractility and CO.
Paleospinothalamic tract
Projects to limbic structures and mediates emotional response to pain.
Gout (exact same as allo) MOA: Comp. inhibits xanthine oxidase ↓conversion of hypoxanthine → xanthine → uric acid MET: Metabolized to oxipurinol (active) Depletes purine precursors (5'-PRPP) SE: Maculopapular rash (pruritus) GI, hepatotoxicity Fever, hypersensitivity OTH: Not useful for acute gout attacks Inhibits kidney reperfusion injury TX: Chronic tophaceus gout
What protein gives rise to endorphins?
this is what we're trying to avoid; severe hypothyroidism; may lead to coma
What is the slow response to BP?
What is this based on?
Renin-angiotensin-Aldosterone system
Your body's set point: hormonal regulation
In general, what do Beta-1 Adrenergic Blockers do to the body?
Prevent bronchoconstriction
Fever is reduced by the inhibition of synthesis of which prostaglandin?
injectable anesthetic agents, barbiturates, mechanism of anesthetic action
-act at hydrophobic domains-enhance gaba's inhibition -can open cl channels-no effect on glycine or glutamine
Function of Diuretics
Reduce circulating blood volume by increasing amout of urine output. Reduces PRELOAD of the heart
What drugs inhibit seratonin reuptake?
Cocaine, dextromethorphan, meperidine, SSRIs, TCAs, Trazadone, Venlafaxine
Drugs causing gynectomastia (Inna, this is all you):
- spironolactone
- digitalis
- cimetidine
- chronic alcohol use
- ketoconazole
- estrogens (durr)
which beta blocker is used to treat glaucoma
What are some long acting glucocorticoids?
Bethamethasone and Dexamethsaone
Type of drug?
100 times more potent than morphine
What three drugs given together are used to treat H. pyloric-induced peptic ulcers?
bismuth subsalicylate-metronidazole-tetracycline (Helidac)
What is the MOA of megakaryocyte growth factors?
Increase thrombocytes
Biological half-life
The time required to metabolize or eliminate half the total amount of a drug in the body
Stage I of anesthesia
(analgesia) Drug admin. until consciousness lost, amnesia in later stage.
What is one of the only differences between generic and trade named drugs?
The binder
Clozapine is what kind of drug?
Atypical 2nd generation antipsychotic
pharmacodynamics of thiazolidinediones (glitazones)
lower glucose levels by increasing insulin sensitivity - increasing glucose uptake in muscle & adipose tissue & lowering hepatic glucose production
more powerful than metofrmin in increasing glucose uptake in muscles & adipose tissue but not as effective in lowering hepatic glucose production than metformin
What is the slow system mediated by?
- Renin production
Timolol: Class of drug, use
“All Beta” Adrenergic Receptor Blockers - treat hypertension or angina pectoris
Uses of vit B1
essential to normal functioning of the nervous system
Clearance rate
Rate of removal of the drug from circulation.
official name
Often the same as the generic name. This is the name listed in the US Pharmacopeia and the National Formulary which are used in research and for government regulated programs.
controlled drugs are
scheduled according to medical use and potential for abuse
what are the 2 functions of TxA2
platelet aggregation, vasoconstricion
which gout drugs are ued to treat acute gout
What do CYP450s do in phase I? phase II?
What are the adverse effects of megakaryocyte growth factors? (8)
Nausea and vomiting
Alpha-1 receptor agonists (3 useful ones)
Phenylephrine, oxymetazoline, and tetrahydrozoline (used in Visine) has relief of nasal cogestion and opthamic hyperemia
Can treat idiopathic hypercalciruia
hydrochlorothiazine (so they dont get renal calcium stones)
What BDZs are in the intermediate T1/2? (6-24hr)
temazepam, estazolam, lorzepam, oxazepam
pharmacotherapeutics of iodide products
rarely used as a sole therapy
most often used before surgery or in conjunction w/ a thioamide in thyrotoxic crisis (thyroid storm)
stable iodine is also used after radioactive iodine therapy to control symptoms of hyperthyroidism while radiation takes effect
not useful for long-term therapy b/c the thyroid ceases to respond to the drug after a few weeks
pts with prinzmetal angina DOC is?
Ca channel blocker esp nifidipine
Haloperidol: 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
pharmacological effects of opioids- biliary spincheter, ureter, bladder effects
-increase tone in biliary spincter (stone or biliary spasm, both cause pain, and opioid cause more tone and more pain, but high enough dose will block pain and allow passing)-increased tone in ureter and bladder neck cause urinary retention
When effects of a drug occur at the site of applicatoin this is called?
local effect
first-pass effect
when a drug is given orally, it is absorbed from the GI tract and carried to the liver for metabolism via portal circulation - some of the drug is metabolized in the liver
What does propanolol do the the PR interval?
Increases interval (beta-blocker)
Transformed cells may have which genes altered?
-growth factors
-gf receptors
-signal transduction
-transcription regulation
What is the MOA of ezetimibe?
Blocks GI uptake of cholesterol
Increases LDL receptors
Rifampin absorption and excretion
Oral admin. that decreases with meals or PAS acid. Excreted into bile, undergoes enterohepatic recirculation, eliminated in feces as a deacylated metabolite.
What is Maximum Efficacy/Effectiveness?
the largest effect that a drug can produce
cell-damaging proteins in pathogenic bacteria that cause infection:
released when the bacterial cell wall decomposes; they cause fever & are not affected by antibiotics (can be dangerous to the host)
What is the rate of dissociation of class 1C drugs?
What type of cell do they affect the most (firing)?
Normally firing cells
Describe the mechanism that converts angiotensinogen to Angiotensin II.
Angiotensin in the liver combines with Renin from the kidney --> Angiotensin I, which is converted in the lung by ACE --> Angiotensin II
How can the PNS be viewed?
As the housekeeper of the body.
What is the purpose of benzodiazepines?
Cause selective CNS depression, muscle relaxation, antianxiety, anticonvulsant, and sedative-hypnotic w/ some amnesia effects.
what are the 2 functions of PGI2
inhibition of platelet aggregation; vasodilation (Platelet Gathering Inhibitor)
Synergy effect
sum of 2 drugs is greater
1 + 1 = 3
Name the drugs for pain relief in order
codeine, morphine, meperidine, oxycodone, hyrdromorphone, fentanyl
why isn't urea used often?
can cross the BBB and cause rebound increase in ICP.high incidence of venous thrombosistissue necrosis with extravasation
B-blockers with ISA should not be used for...? (3)
angina pectoris, for cardiac protection during surgery, or after a MI
How does an antagonist work
It binds to a receptor, fits well enough to block any other normal response
Beside controlling b/p, what are beta 1 antagonist used to treat in emergency settings
SVT's anginas and also reduces recurrence od MI
work by directly or indirectly aiding the conversion of ___________ to __________, which cleaves ______ and ________ clots. tPA specifically coverts _______________ to plasmin
Directly or indirectly aid conversion of plaminogen to plasmin, which cleaves thrombin and fribrin clots. It is claimed that tPA specifically coverts fribrin-bound plasminogen to plasmin.
What can an excess of Vitamin D cause?
-increase in bone resorption
-activation of RANKL/osteoblasts
Rifampin can induce what liver enzyme?
P450 (so longer elimination rate for methadone, anticoag...etc.)
What is the formula for calculating gtt/min ?
gtt= amt solution (mL) x gtt factor
min                      time in minutes
What is drug interaction?
It is the action of one drug on a second drug creating an increased or decreased effect, a new effect or even an adverse reaction.
The advantage of this drug is that it is reliable, decreases incidence of ectopic pregnancy, decreases risk of pelvic infections, and regulates menses; however it also puts you in a hypercoagulable stat and may increase your trigylcerides, weight, and blo
Oral Contracpetices - syntheitc progestins/estrogen
Two of the more notable SSRI side effects
Transient weight loss from decreased food intake and decreased sexual libido/sexual function.
what is the mechanism of action of lithium
unknown; may be related to inhibition of phosphoinositol cascade
Is Thalidomide teratogenic in all organisms?
No! In rabbits it is, but not in mice!
Explain how blood flow can affect drug absorption
more rapid from sites where blood flow is high, blood containing newly absorbed drugs will be replaced rapidly by drug free blood, maintaining a large gardient, causing rapid absorption
What is the LD in humans, and the T 1/2 of strychnine?
LD in humans = 1-2mg/kg (50-100mg) and the T 1/2 = 10-16 hours, undergoes hepatic metabolism
AntiinfectivePenicillinPenicillinase resistant, narrow spectrum: staph, not widely used


intermediate half-lifesedative-hypnotic
class phenylzine
Antihyperlipidemic Agent
robaxin OTC
reminyl er
common mucolytic:
acetylcystine (Mucomyst)
RenalOsmoticLimit tubular reabsorbtion, draw water in, give drug slowly, rare SE, exert pressure on kidneys
ethinyl estradiol/ norethindrone
Asthma drugs
p 326
Drugs ending with:

unknown mechanism; recently withdrawn but new evidence suggests efficacy in preventing restenosis of coronaries after angioplasty.

causes arrhythmias
United States Pharmacopeia
ditropan(xl), oxytral patch
Endocrine (3rd Generation 19-nortestosterone derivative Progestin) MOA: diffuses into cell, binds to PR between cytoplasmic and nuclear domains, forms homo- and hetero-dimers, which bind to response elements similar to glucocorticoids. The only role of the progestin component of combination oral contraceptives is to protect endometrium from estrogen-induced hyperplasia & cancer SE: (Less androgen activity with 3rd gen.) ↑fat deposition & weight gain Acne Menstrual abnormalities Uterine cramps Hirsutism (androgenic preps) ↑risk of breast cancer TX: Oral contraceptive Suppress gonadotropins
like acetazolamide
used in
2_metabolic acidosis
3_acute motion sickness
Climara transdermal system
Conjugated Estrogens
pure opioid antagonist

control crib biting in horses
reverse carfentanil-induced immobilization

long duration of action
oral or parenteral use
MOA gabapentin
increases GABA release
Cardiac glycoside prototype

positive inotropic drug for CHF, half−life 40 h; renal excretion; inhibits Na+/K+ ATPase, also a cardiac parasympathomimetic.

calcium overload arrhythmias, GI upset
Succimer (DMSA)

dimercaptosuccinic acid; used to chelate lead and arsenic
every (q8h, q12h, etc)
v selective V2 agonist
Are herbal supplements considered drugs?
Dobutamine (Dobutrex) 
synthetic catecholamine causing selective adtivation of B1 receptors only
Liothyronine sodium
EndocrineHypothyroidism - T3Less effective than T4
compatitive inhibitor non selective alpha antagonist
sources of vit B1
pork products
List Routes of medication administration
Paraenteral (any med route other than alimentary canal)
which one blocks NE reuptake
MOA albuterol
B2 agonist, --> bronchodilation
Type of Drug?
Nitrous oxide
Inhaled anesthetic
Ergot alkaloid

used as prophylactic in migraine.

retroperitoneal and subendocardial fibroplasia
"6" Rights
Patient, Medication, Dose/Amount, Route/Method, Technique, Time
neucleoside analogue antiviral inhbits viral polymerase
Essential hypertension
Idiopathic hypertension (unknown causes)
-Beta blockers
prevent adrenergic receptors from being stimulated, it slows heart rate, depresses AV conduction, decreases cardiac output, reduces systolic and diastolic blood pressure, which decreases oxygen demand thereby decreasing angina.
What route of drug administration cannot be used with people on anticoagulants?
somogyi phenomenon
morning rebound hyperglycemia; occurs in response to nocturnal hypoglycemia w/ excessive insulin administration
clues: erratic plasma glucose & urine ketone values; symptoms of nocturnal hypoglycemia (night sweats, nightmares, low serum glucose 2 to 3 am), weight gain in presence of heavy glycosuria 
Aldosterone Antagonists adverse effects



Menstrual irregularities


Deepening of the voice
Thy study of the absorption, distribution, metabolism and excretion of drugs.
a chemical substance (natural or synthetic) that "affects the processes of the mind or body".
(eye drops) Primarily used for glaucoma. Stimulates muscarinic receptors which *stimulate miosis and contracts ciliary muscle which changes the focus of the lense, reduces intraocular pressure.
S/E: localized: burning, itching, blurred vision.
Are posionous because they contain Galanthamine (anticholinesterase) that affects the nervous system
It is also an excellent insecticides
can a patient become benzodiazepine dependent
uses for TCAs
major depression
bedwetting (imipramine)
OCD (clomipramine)
What neurotransmitter?
Parasympathetic preganglionic nerves
Acetylcholine on nicotinic receptors
Type of drug?
Cholinergic agonist
Treats Acute glaucoma
Can you compare oral contraceptive drugs to delivery doses?
bis in die (twice per day)
O-ethyltyrosine susitute
V1+ V2 angtagonist AVP antag
Azathioprine (IMURAN)
purine antimetabolite used in combination with corticosteroids, effects T cells more than B cells, anti inflammatory, for arthritis and inhibits rejection of transplantation.
Treats opioid overdose and treats alcohol dependence with no liver toxicity.
Drug that lowers blood sugar or increases insulin sensitivity.
the unbound fraction
Glomerular filtration will filtrate what part of the drug?
Classification of antitussives:
opioid agents & nonopioid agents 

opioid agents: codeine, hydrocodone (Hycodan): CNS effect on the cough center

nonopioid agents: dextromethorphan (Benylin DM, Pertussin ES): CNS effect; benzonatate (Tessalon): local anesthetic
Loop diuretics have basically the same side effects as thiazides plus the possibility of ______ from intravenous furosemide
used in breast cancer (monoclonal ab against erb b2
benzodiazepine/opioid combos
(+): sedation, dec. anxiety, intense analgesia, amnesia, minimal autonomic effects, NO extrapyramidal effects(-): resp. depression (easily reversed w/ opioid antagonist)
uses of Iron
essential component of blood hemoglobin, used in antibody formation, stored in bone marrow
What is the flu season?
November to April
The study of drugs in humans
Clinical pharmacology
What system is affected by poliomyelitis?
GI tract
cons of halothane
hypotension d/t dec. myocardial contractility
significant hepatic biotransformation (hepatotoxic metabolites)

alters Ca++ movements
1. intearctions w/ aminoglycoside Abs, Ca channel blockers --> severe CV depression
2. can produce malignant hyperthermia (esp. in pigs), caused by failure of Ca uptake in SR
Bronchoconstriction is mediated by _________ and ___________
Ach and adenosine
For each drug reaction, give the pharmacological agents responsible. The number of drugs you should list are given in parentheses. You could also quiz yourself in reverse by going down the list of drugs on the right.
MOA isoproterenol
B1=B2 so, innervates bronchial smooth muscle and causes bronchodilation
What neurotransmitter?
Somatic nervous system acting on skeletal muscle
Acetylcholine on nicotinic receptors
Which hormone plays an effect on libido?
asses for ? with Loop diuretic
electrolyte imbalances
=a Quinolone AB, inhibits DNA syn/rep, by inhibiting DNA gyrase resulting in supercoiling of DNA + topoisomerase
Sulfa drug analog of dihydrofolic acid that binds bacterial dihydrofolic acid reductase and blocks formation of folic acid.
Glycopeptides vs beta-lactam antibiotics
-Glycopeptides sterically inhibit the addition of subunits to peptidoglycan backbone
-Beta-lactams prevent the cross-linking reaction transpeptidation
Salmeterol (Serevent) acute, beta adrenergic
Class: BronchodilatorAction: Improves breathingSide Effects: Headache, ventricular arrhythmias, nasopharyngitis, bronchospasm, worsening of asthma, anaphylaxis.Contraindication: If hypersensitive to drug.Nursing considerations: Assess respiratory status prior and thereafter. Not for acute bronchospasm.
Name the preferred Antianginal drug type for people of African descent.
Calcium Channel blockers
pharmacotherapeutics of benzodiazepines
suppress seizure activity by producing GABA - inhibitory neurotransmitter
management of status epilepticus, severe recurrent seizures & ETOH withdrawl seizures
parenteral diazepam & lorazepam - drugs of chice in treating status epilepticus
What drugs shifts the AP this way?
Class 1C
Albuterol/Terbutaline/Metaproterenol: Class of drug, use
Beta 2 Adrenergic Stimulants - treats bronchoconstriction due to asthma/emphysema
generic name
nonproprietary, or common, name of a drug
What is pharmacokinetics?
*The study of the absorption, distribution, metabolism, and excretion of drugs.

*What the body is doing to the drug
These receptors causes vasodialation and brochodialation
Beta 2 adrenergic receptors
What is a drug that inhibits seratonin metabolism?
Which cholinoreceptor blockers act on the GU system to reduce urgency and bladder spasms?
Methscopolamine, oxybutin, glycopyrrolate
what is the function of carbidopa
peripheral decarboxylase inhibitor
toxicity of nsaids
renal damage
aplastic anemia
GI distress
What drug causes:
Tardive dyskinesia
Antipsychotics(more likely w/ typical antipsychotics)
Tardive dyskinesia- involuntary movements of the facial muscles & tongue
In what percent of asthma patients is there an allergic component?
What are the risk factors for atherosclerosis?
high cholesterol
low exerecise
infectious agents
Therapeutic index
A measurement of the relative safety of a drug. It is a ratio of the lethal dose in 50 of lab animals over the effective dose in 50 of a similar population. The closer to 1, the greater the danger in administering the drug to human being.
Acts like a thiazide, 10X more potent and longer half-life than hydrocholoro.
What is metabolism?
the way the body alters the drug
(transcutaneous electrical nerve stimulation)
applies electrical currents to skin areas over nerves causing release of natural endorphin and interferes with pain impulse conduction
types of depressive disorders:
Dysthymic Disorder 
onset of depressive symptoms less discreet and acute, the experience more chronic in nature
greatly underdiagnosed; characterized by chronic mild-to-moderate depression lasting about 2 hrs or longer (1yr in kids)

other depressive disorders: substance-induced depressive disorder, season affective disorder, bipolar disorder, postpartum depression, atypical depression
What are "class V" drugs?
- Adenosine (Adenocard)
- Magnesium sulfate
concentration effect
only seen w/ high conc. of nitrous oxidewhen higher conc. of anesthetic gas is inhaled, FA (& therefore Fblood), inc. at a slightly greater rate than if a lesser conc. were inhaled
endogenous opioids (endopioids), act as
-act as NT and neuromodulators
What systems control blood pressure?
1. ANS
2. Renin angiotensin Aldosterone System
3. Endocrine. Release of epinephrine and NE from the adrenal medulla causes sympathetic stimulation.
How do you diagnose organochlorines?
History is most important
Chlorinated hydrocarbons are radiopaque
Gas Chromatography for confirmation, no correlation derived for levels and effect.
drug selection and dosage
best drug, least side effects, individualized dosage
name the enzyme that liberates AA from the cell membrane
phospholipase A2
clinical uses for penicillinase resistant penicillins?
S. aureus (except for MRSA)
What is the steroidogenesis pathway?
cholesterol --> progesterone --> testosterone --> estradiol
Which drug should be used for an acute iron toxicity?
2 types of depression
Reactive(related to an adverse life event and is about 60%) and biologically derived (without a precipitating event...25% unipolar and 15% bipolar).
What part of the brain are the dopamine pathways involved with addiction in?
Nuclus accumbens
Mechanism of action: Modafinil
similar to amphetamine in that it releases NE and 5HT but it also has a large activation of the wake-promoting histaminergic system
indications for atypical (2nd generation) antipsychotics:
pts experiencing first episode of psychosis or pts w/ no avaiable hx concerning response to antipsychotics
List as many as you can.
morphine, fentanyl, codeine, heroin, methadone, meperidine, dextromethorphan
cons of phenobarbital for tx of seizures
polyphagia --> wt. gainPU/PDhepatotoxicityw/ chronic use:altered bone metabolisminc. metabolism of other drugs using liver microsomal enzymesblood dyscrasiasinc. liver enzymes
pharmacological effects of opioids- prurtits
-itching-usually in injection and not oral dose-release histamine from mast cell-also vasodilation, flushing, and sweating -due to spinal mechanisms
Define onset of action
The time from administration until a medication reaches its minimum effective concentration.
cons of phenobarbital for tx of seizures
polyphagia --> wt. gain

w/ chronic use:
altered bone metabolism
inc. metabolism of other drugs using liver microsomal enzymes
blood dyscrasias
inc. liver enzymes
Side effects of Atropine.
Increase body temp, rapid pulse, dry mouth, dry/flushed skin, disorientation, mydriasis with cycloplegia, and constipation. "Atropine parasympathetic block side effects: Blind as bat, Red as a beet, Mad as a hatter, Hot as a hare, Dry as a bone."
What are ecological studies?
Incidence of a disease in one geographical area compared to another.
What are the clinical uses of erythropoietin?
renal failure
bone marrow disorders
2nd anemia
following antiviral drug therapy
myelosuppressive chemotherapy
Streptomycin and MOA
1st line TB drug. Unknown MOA. Treats M TB, M avium complex, M kansaii (other M are resistant). Poor penetration into cells.
What is drug clearance?
volume of fluid clearing out of the body. same as excretion
adverse effects of NNRTIs:

most common = rash, which can be benign or life-threatening, may be associated w/ fever, conjunctivitis, blistering, oral lesions & muscle/joint pain
HAs, fatigue, drowsiness, n/v/d
anemia & neutropenia (very low WBCs) may also occur
may be given with or without food
pt should withold drug and notify precribing heath care provider immediately when rash occurs
DOC in emmergency HPN
nitroprosside but should be less than 12-24hr.
Where does that take place?
Primarily in kidney but also in lungs, GI tract, skin, liver
Most common side effects of direct acting skeletal muscle relaxants.
Weakness, malaise, fatigue, GI upset
1st line treatment for lead poisoning =
dimercaprol, EDTA, succimer for kids
Clinical application / action of Pyridostigmine.
Myasthenia gravis. / Increase Ach; increase strength.
What are cross-sectional studies?
Test if a certain group is more susceptible to a certain condition. e.g. golf green tenders
The vascular effects of the muscarinic agents are mediated through...
M3 receptor stimulation with subsequent activation of the Gq-PLC-IP3 pathway resulting in calcium mobilization and Ca++-calmodulin production and release of endothelium derived relaxation factor (EDRF), which is now known to be nitric oxide (NO).
1 Diuretics (Thiazides)
1 Used most often in hypertension to decrease BP; Acts on cells in the renal tubule to promote diuresis (Na/H2O excretion), can decrease BP 10-15 mmHg
1 These act on the distal convoluted tubule, they block the Na/Cl cotransporter (out of the lumen) so NaCl can’t be reabsorbed and is lost in the urine (K+ may also be lost) 
which is more potent?  histamines or leukotrienes?
Leukotrienes are 100-1000 times more potent and have a longer effect.
What are 2 components of drug pooling?
plasma protein binding and tissue binding
What is the objective of drug therapy?
to provide maximum benefit with minimum harm
what classes of drugs are used to treat glaucoma
alpha agonists, beta blockers, cholinomimetics, diuretics, prostaglandins (*mnemonic -- treating glaucoma is easy as ABCD)
Do DNA mutations occur equally in the genome?
No!! There are "hot spots"
Drug interaction between TCAs and other drugs
MAOIs (bad for heart), CNS depressants (anti-psychotics, narcotics, alcohol, barbs and benzos), guanethidine (block its anti-hypertensive effects) and enhances sympathomimetic effects.
When can you replace a trade drug with a generic drug?
When the two preparations’ conc.-time plots are superimposable then they are said to be bioequivalent
What are some varibles that affect absorption?
Nature of cell membrane, blood flow to site of administration, solubility of drug, ph, drug concentration, drug form and route
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
2 things MAO inhibitors may effect
Both type A (metabolizes NE and 5-HT) and type B (metabolizes DA) or just be selective for type A.
determinants of tension of gas in alveoli (FA)
rate of delivery of gas TO alveoli: 1. tension of anesthetic gas in inspired gas (FI)2. minute volumerate of removal of gas FROM alveoli:1. cardiac output2. blood solubility (Fblood)*
what do you do if PTT shows Heparin OD
stop drip and administer protamine sulfate
What is the purpose of rapid injection?
To limit the dilution of iodine by the cardiovascular system
What is the rule for dosage sizes for Peds?
Always do dose by weight, Mg per Kg per day (divided doses), BSA is the most preferred if possible!
943 mg=
INH generic
Diabinese generic
Nursing Management
Valsartanblood pressure
ug or mcg
dispense as written
hour of sleep
Epipen/epinepherine implications
close observation
valium (antiepileptics)stabilize neurons and keep them from becoming hyperexcited adn generating excessive nerve impulses to adjacent neuronsindicaiton: status elileptics (seizure that doesnt stop)dont use with pregnancy or alcoholdrowsinesstoo many interactions to mention, take blood
 morphine like drugs
Common Expectorants
Guaifenesin (Robitussin)
brand name:Marcaine

xylidine derivative

the only long acting LA, 90-180 min pulpal, 4-9 hours soft tissue- great for post op pain and/or long procedures
able to be long duration bc it has a stronger bind in the Na+ channel

more potent and less toxic than other amides
slightly longer onset time than lidocaine
infiltration, block, peridural
available as 0.5% with 1:200,00 epi
one and one half
Humulin N route
sub q
What is selective MAOIs?
what is fosamax
Alendronate sodium
bisphosphonate,regulator of bone metabolism
Complication of insulin therapy
immunogenic insulin resistance 
Itraconazole AEs
elevated LFTs
Elevated TGs
antipsychotic(literally, affecting the nerves)
which atypical psychotherapeutic causes altered glucose metabolism, DM, inc. appetite and wt gain?
which antibiotic contains phenylalanine and thus should not be used in those with PKU?
1/2NS-0.45 NaCL
osmolality: hypotonic (154 mOsm/L)uses: promotes renal function. free water, sodium, and chloride; preferable to 0.9% NS for electrolyte restoration of Na & Cl; reduces serum osmolality; hyperosmolar diabetespotiental complications:hypernatremia, fluid overloadm incompatibilities:amphotericin Bmannitol
Lanoxin/digoxin action
slows and strengthens heart
benzotropine mesylate/cogentin
cogentin (anticholinergics)too much ACh can cause muscle tremors and muscle rigidity (cogwheel rigidity), therefore anticholinergics help block AChused as a antidyskinetic agents to treat muscle tremors and rigidityconfusion, cant pee, cant see, cant spit, cant shit, dilated pupilsinteraction: additive CNS effect, therapeutic effects of anticholinergics decrease with antacids
Non ASA Nonsteroidal anti-inflammatory medications
works at muscular level
Infections disease caused by mycobacterium tuberculosis[pulmonary TB] (typically affects the lungs), may occur in other organs (extrapulmonary TB), TB infection refers to asymptomatic, latent infection, occors between 10-15 mil ppl in US. It's activated when immune system isnt strong.
what does Acyclovir treat?
some Epstin-Barr
DOC for HSV encephalitis
most commonly used to treat genital herpes
chemical used to diagnose,treat,or prevent disease
Opiod addiction
overdosepointpoint pupils, respiratory depression, coma
withdrawl"cold turkey" gooseflesh, lacrimation, perspiration, rhinorrhea (very runny nose), irritabilty, nausea, vomiting, tachycardia, and chills
Identifying an addict:specific drug requests (misprounces name)
claims allergy to everything else
cx tx appt, avoids tx to remove cause of pain and reason for needing opoids
complains of unusual pain after any tx
goes from dentist to dentist
claims low pain threshold
Valium (diazepam) 
antianxiety, anticonvulsant, skeletal muscle relaxant, central acting**controlled substance schedule IV** Use direct rather than IV drip. BenzodiazepinePotentiates action of GABA, in limbic system; enhances presympathetic inhibition. Uses: anxiety, acute alcohol withdrawal, adjunct in seizures disorders, preoperatively as a relaxant, skeletal muscle relaxation, rectally for acute repetitive seizures. Side effects: drowsiness, dizziness, orthostatic hypotension, blurred vision, ECG changes, tachycardia, neutropenia, respiratory depression. Nursing considerations: Assess BP, resp; blood studies; degree of anxiety; for alcohol withdrawal symptoms; for seizure control and type; hepatic studies; IV site for thrombosis or phlebitis; mental status; physical dependency, withdrawal symptoms; suicidal tendencies. Continuous infusion is NOT recommended.
which 2 traditional psychotherapeutics come in a depot formulation?
Anticonvulsant for Bipolar disorder. Calcium channel blocker. Used for fibromyalgia.
most medications are excreted by the?
Which chemotherapy agent permits safe administration of high doses of methotrexate by allowing normal cells to produce thymidylate?
Many NSAIDs work by inhibiting synthesis of _______.
Ritalin/methylpenidate ed
take last dose before 6pm
What is MAOI?
monoamine oxidase inhibitor: phenolzine/nardil
reduce anxiety w/o causing sleep
cns depressent
shouldnt use longer than 14 days
Types of insulin
rapid acting
intermediate acting
long acting 
pyrantel pamoate is used to treat:
combining alcohol with benzodiazepines produces:
respiratory depression
combining benzos with other CNS depressants including alcohol can increase risk of addiction
solutions that create osmotic pressure by dissolved ion movement.
study of drugs's alterations during its trip through the body as it is absorbed, distributed, bound to or localized in tissues, biotransformed, and excreted
Erythromycin, Clarythromycin, Azithromycin
Macrolide AntibioticsInhibit protein synthesis in microorganisms. Mainly for pneumonia, STDs, sinusitis, etc.Side effects: GI problems, nausea.
ingredients permitted to vary from generic and trade name drugs are called _____ ingredients.
inert (inactive)
Essential hypertension is diagnosed as:
No known cause
Prostaglandins are _______ to inactive products at their site of action.
Rapidly metabolized
EES/erythromycin nursing implication
no dairy - ca+ interferes.
action of ASA
inhibits Cox 1 & 2
barbiturate interactions
Alcohol and other CNS depressants cause severe CNS depression that may lead to death.
Alcohol is the only way to O/D on barbiturates 
what are the SEs of ethionamide?
peripheral neuropathies
optic neuritis
the study of drugs and their interactions with the body
condition where pt has an enzyme disfunction that is  exaserbated by barbiturates and lead to build of products that the pt cannot break down.
Occurs when irritating drugs such as KCl are being infused, esp, when superficial veins are uses or/and med is infused too rapidly or is inadequately diluted. If this occurs, check for tension, gently move the hub of the needle to see if pain decreases, and/or change the rate of flow, change to larger vein.
Can stabilize mood in patients with bipolar disorder 
what can you use haloperidol for?
alcohol-induced psychoses
Huntington's chlorea
which tetracycline can be used to treat acne in a topical or oral formulation?
find the term for:use of many prescribed and OTC drugs at the same time
A cancer drug effective in eliminating growing cancer cells will exert the least effect if the cell is in the:
G0 phase
Which of the following drugs is used in the treatment of Alzheimer's disease that exerts its action by blocking NMDA receptors for glutamate?
Antivert/meclazine HCL when to take
1 hr before exposure
What are atypical or newer antipsychotics?
clozaril adn zyprexa
limit for ASA& tylanol
4grams or 4000mg daily limit
Pharmacodynamics/action of Dopaminergic agents
increase dopamine levels in the CNS
Stimulate dopamine receptors in the brain
Inhibit dopamine breakdown in neurons 
Oseltamivir and Zanamivir are effective against what?
Influenza A and B
what is the most significant toxic effect of Amp B?
Renal damage
movement of a solute in a solution from an area higher concentration to an area of lower concentration
dental uses of benzodiazepines
**mentioned in test 2 review 
primarily to reduce preop anxiety
downside- pts cannot drive themselves so they need to find a ride
Osmotic pressure
is the amount of hydrostatic pressure needed to move particles and fluids in and out of vascular volume.
which opioid is used to treat chronic pain, cancer pain, opioid withdrawl (including heroin) and neuropathic pain?
which is the only atypical agent to outperform perphenazine in terms of patient discontinuation?
when the action of one drug increases the effect of the second drug its called:
What does the DEA do?
regulates the manufacturing and dispensing of potentially abused drugs
The drug of choice for treatment of absence (petit mal) seizures is
Ethosuximide (Zarontin)
D5LR - 5% dextrose and LR
osmolality: hypertonic (524 mOms/L)Uses: sever dehydration, hypovolemia, replace ECF loss, shock, mild acidosis (lactate ions metabolized to bicarbonate by liver, diabetic ketoacidosis, salicylate overdose, 9kcal/L (lactate), calories from dextrose
what are the the two opioids
analgesics-morphine sulfate and meperidine HCl/demerol
how is Carbamazepine (Tegretol) used
Management generalized tonic clonic seizures
Used in combination with phenytoin in clients who require polytherapy 
the drugs used to treat worms are all taken ___________.
onset of action
the time from administration until a medication reaches its minimum effective concentration
tx of opiod addiction
substite oral opiod for injectable (methadone) with gradual withdrawl
"cold turkey"
methadone mtc-
naltrexone (Trexan)- blocks action of opiod
Nitrous oxide (Laughing Gas
most common gaseous anesthetic agent used. Usually administered in combo with O2. Colorless, odorless and nonirritating. Equivalent to 10 mg morphine sulfate. Weak and generally used in combination with another anesthetic. O2 should be used for several minutes after to prevent hypoxia. Cylinders are always blue. Not explosive.
is risperidone, olanzepine or clozapine more potent? which has the most EPRs?
potency risperidone and olanzepine then clozapine
least to greatest EPRs clozapine, then olanzepine then risperidone
what is pharmacodynamics?
the study how drugs produce thier effects in the body to result in a pharmacologic response
Warfarin differs from heparin because:
It decreases synthesis of clotting factors
what does plaquenil do?
slow acting for RA

in confirmed RA only
 to reduce remission
 for limited time-only for 6 mo
Overview of Nursing Management for Narcotics
assess resp status (resp depression)
Drowsiness and sedation
Narcotics stimulate the chemoreceptor trigger zone
be alert for physical or psychological depenendence
Narcotics lower bp
They obsucre diagnosis of acute abdominal condition 
Dose depends on pain, response and pt size
Often prescribed PRN
Analgezia is more effective if given regularly around the clock
Oral drugs go through 1st pass effect 
What is ribavirin indicated for?
the treatment of hospitalized infants and young children with severe LRT infections due to respiratory syncytial virus
ONLY RSV infections
sodium potassium pump
neuron normally has more Na on the outside and more K on the inside. 
an action potential makes a rapid influx of Na to the inside of the neuron → nerve fires.
Then K enfluxes out of the neuron. The pump lets the Na out and the K back in, returning neuron to its resting potential.
rate of nitropress 
initial rate is .3 mcg/kg/min and max rate is 10 mcg/kg/min
how should you take azithromycin?
on an empty stomach
food reduces absorption by 50%
1 g (mg to g move three spaces to the left.)
Entacapone (Comtan), Tolcapone (Tasmar), and Selegilne (Elaepryl) are used to treat Parkinson's disease. These agents share which one of the following mech's of action:
They inhibit enzymes of COMT and MAO that break down dopamine
what types of organisms is nitrofurantoin effective against?
gram + and gram -
broad spectrum
Which local anesthetic is the only LA that causes vasoconstriction?
all others are vasodiliating
are less sedating drugs more effective at treating withdrawn patients than more sedating drugs?
no, they are the same
a generic name can be recognized by being: (3)
1.lower cased2.usually hard to pronounce3.sometimes in parenthesis
An example of an antibacterial agent used as a means of prophylaxis would be:
An antibiotic used before dental surgery
local anesthetic effects on the CVS
Local anesthetics can have a direct effect on cardiac muscle when used IV for antiarrhythmic agents
block cardiac sodium channels
depress abnormal cardiac pacemaker activity, excitability, and conduction
depresses strength of contractions and produce arteriolar dilation which leads to hypotention
which infections do natural penicillins cover?
gram +, gram - cocci, most anaerobes and spirochetes
Cytotoxic drugs are not the drugs of first choice for immunosuppression because they:
Are toxic to all proliferating cells
Mechanism of action of local anesthetics
**mentioned in test 2 review
LA ↓ permeabilty of the cell to Na+.
It binds to the receptor on the Na channel and blocks Na from adhering.
LA must be in it's ionized lipophilic form (RN) to cross the cell membrane. 
Then it must be in it's nonionoized, hydrophylic  (RNH+) form to bind once in the cell. 
When injected into tissue:
pKa determines how much will be in base and salt forms.
At 7.4 25% is RN and permeates into the nerve.  
Some of the RNH+ will be left behindcontinues to convert to RN and permeate the  nerve
diffuses and is absorbed by blood vessels and soft tissue at the injection site.

Once inside the nerve the RN reequilibrates. RNH+ competes with Ca for binding sites. The Ca is what lets the Na in, so no Ca=no Na. No Na no action potential.
Problems with ergot alkaloid use in HAs
chronic use can lead to status migrainus
degradation can lead to vasodilation and HAs
when is it best to take oxymorphone?
who should not take it?
on an empty stomach (50% more is released w/ food)
kids, those with mod-sev hepatic disease
what is an official name for a drug?
usually is the trade name and are listed in UNITED STATES PHARMACOPEDIA-NATIONAL FORMULARY (USP-NF)
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