B2 Drug Names Flashcards Preview

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Flashcards in B2 Drug Names Deck (247):
1

Ibuprofen

Reversibly inhibits Cox 1 and 2

2

Succinylcholine

Depolarizing NM blocker

3

Baclofen

Spasmalytic: GABA B agonist

increased K flow-->hyper polarization--> reduces release of excitatory NT

4

Simvastatin

Hypolipidemic: Competitive HMG-CoA reductase inhibitor (rate-limiting step of cholesterol synthesis) and induces high affinity LDL receptors--> reduces LDL levels

Toxicity = myositis and sometimes rhabdomyolysis (monitor creatine kinase) and hepatotoxicity (monitor liver enzymes)

Drugs that inhibit CYP enzymes will increase plasma concentrations of statins!!!

5

Cholestyramine

Bile Acid Binding Resin: Binds BA in intestine and forms complex that's excreted in feces.

Increased oxidation of cholesterol to BA in liver and increased # of LDL receptors--> decreased LDL levels and increased HDL

Toxicity: constipation, deficiency of fat-soluble vitamins (A, D, E, K)

May also delay or reduce the absorption of other oral medications (digitalis, warfarin)

CONTRAINDICATED in patients with hypertriglyceridemia

6

Gemfibrozil

HYPOlipidemic:

agonist at PPAR alpha and INCREASES the activity of LPL (esp in muscles and hepatocytes) --> hyperTG and reduces VLDL

Toxicity:
- GI symptoms
- myopathy
- cholesterol gallstones

Drug interactions: can displace other albumin-bound drugs like warfarin and sulfonyl ureas

7

D- Tubocurarine

Competitive Nm blocker

8

Bile acid binding resins are contraindicated in whom?

patients with hypertriglyceridemia

9

Tizanidine

alpha 2 agonist used as a spasmolytic --> decreases m tone without causing paralysis

10

pravastatin

Hypolipidemic: Competitive HMG-CoA reductase inhibitor (rate-limiting step of cholesterol synthesis) and induces high affinity LDL receptors--> reduces LDL levels

Toxicity = myositis and sometimes rhabdomyolysis (monitor creatine kinase) and hepatotoxicity (monitor liver enzymes)

Drugs that inhibit CYP enzymes will increase plasma concentrations of statins!!!

11

colestipol

Bile Acid Binding Resin: Binds BA in intestine and forms complex that's excreted in feces.

Increased oxidation of cholesterol to BA in liver and increased # of LDL receptors--> decreased LDL levels and increased HDL

Toxicity: constipation, deficiency of fat-soluble vitamins (A, D, E, K)

May also delay or reduce the absorption of other oral medications (digitalis, warfarin)

CONTRAINDICATED in patients with hypertriglyceridemia

12

Vecuronium

Competitive Nm blocker

13

Niacin

hypolipidemic: inhibition of VLDL synthesis and esterification of FA in liver --> decreased plasma LDL, VLDL and TG levels!

Toxicity:
- flushing
- itching (treated by aspirin or other NSAID)
- diarrhea
- hyperuricemia (gout)
- hyperglycemia

14

Using what drugs along with statins causes an increased risk of myopathy?

- amiodarone
- verapamil
- fibrates

15

Dantrolene

Tx malignant hyperthermia

inhibits release of Ca from SR during excitation/contraction coupling

also inhibits ryanodine receptor and Calcium channels in skeletal m

16

lovastatin

Hypolipidemic: Competitive HMG-CoA reductase inhibitor (rate-limiting step of cholesterol synthesis) and induces high affinity LDL receptors

--> reduces LDL levels

Toxicity = myositis and sometimes rhabdomyolysis (monitor creatine kinase) and hepatotoxicity (monitor liver enzymes)

Drugs that inhibit CYP enzymes will increase plasma concentrations of statins!!!

17

pancuronium

Competitive Nm blocker

18

colesevelam

Bile Acid Binding Resin: Binds BA in intestine and forms complex that's excreted in feces.

Increased oxidation of cholesterol to BA in liver and increased # of LDL receptors--> decreased LDL levels and increased HDL

Toxicity: constipation, deficiency of fat-soluble vitamins (A, D, E, K)

May also delay or reduce the absorption of other oral medications (digitalis, warfarin)

CONTRAINDICATED in patients with hypertriglyceridemia

19

How do you treat parities (itching) caused by Niacin?

aspirin or other NSAID

20

Gabapentin

spasmolytic

21

Fenofibrate

HYPOlipidemic:

agonist at PPAR alpha and INCREASES the activity of LPL (esp in muscles and hepatocytes) --> hyperTG and reduces VLDL

Toxicity:
- GI symptoms
- myopathy
- cholesterol gallstones

Drug interactions: can displace other albumin-bound drugs like warfarin and sulfonyl ureas

22

doxacurium

Competitive Nm blocker

23

Ezetimibe

HYPOlipidemic

reduces GI absorption of cholesterol--> reduces LDL and TG

Toxicity: diarrhea, abdominal pain

24

Vigabatrin

Anti-epileptic drug

MOA: irreversibly inhibits GABA transaminase (GTA)

25

Epinephrine

Bronchodilator (lasts 60-90m); rapid action

also used in anaphylactic shock (is a physiological antagonist)

Given Subcutaneous/Inhalation

--> tachycardia, arrhythmias

MOA: sympathetic stimulation of Beta2 receptor (adrenergic agonist)

A/E: skeletal m tremor, tachycardia, palpitations tolerance (short acting drugs)

26

Prednisolone

oral systemic corticosteroid

MOA: Has anti-inflammatory effects. Binds to an internuclear receptor and inhibits the transcription of genes that are responsible for producing cytokines. ESP interleukins

Use: severe chronic asthma

Chronic use can lead to Cushing's Disease

A/E:
- easy brushing
- adrenal suppression
- growth retardation
- increased bone catabolism--> osteoporosis

27

Rocuronium

Competitive Nm blocker

28

Tiotropium Bromide

Bronchodilator: given via inhalation; long acting (24h)

MOA: parasympathetic! Blockage of muscarinic receptors: anticholinergics

Blocks muscarinic receptors in large airways

frequently used in combo with salbutamol (DOC for people on beta blockers)

29

Tiagabine

Anti-epileptic drug

MOA: blocks GABA reuptake by blocking GAT (GABA transporter)

30

Isoproterenol

Bronchodilator

MOA: sympathetic stimulation of Beta2 receptor (adrenergic agonist)

A/E: skeletal m tremor, tachycardia, palpitations tolerance (short acting drugs)

31

Ipratropium Bromide

Bronchodilator: given via inhalation; short acting, slower response

MOA: parasympathetic! Blockage of muscarinic receptors: anticholinergics

Blocks muscarinic receptors in large airways

frequently used in combo with salbutamol (DOC for people on beta blockers)

32

Levetriracetam

Anti-epileptic drug: treats GTC, simple partial seizures

MOA: binds to synaptic vesicular protein (SV2A) --> decreases synaptic release of glutamate

33

Hydrocortisone

IV systemic corticosteroid

MOA: Has anti-inflammatory effects. Binds to an internuclear receptor and inhibits the transcription of genes that are responsible for producing cytokines. ESP interleukins

Use: status asthmatics

Chronic use can lead to Cushing's Disease

A/E:
- easy brushing
- adrenal suppression
- growth retardation
- increased bone catabolism--> osteoporosis

34

DOC for asthmatics on beta-blockeres

Ipratropium Bromide in combo with Salbutamol

35

Albuterol

Bronchodilator: onset 5-15m

given via metered dose inhaler, nebulizer, oral tablet

MOA: sympathetic stimulation of Beta2 receptor (adrenergic agonist)

How: stimulates AC --> increase cAMP

Use: acute attacks and maintenance


A/E: skeletal m tremor, tachycardia, palpitations tolerance (short acting drugs)

36

Theophylline

BRONCHODILATOR

MOA: inhibition of phosphodiesterase--> increase cAMP

Narrow therapeutic margin (5-20; A/E above 25)--MONITOR serum levels to avoid toxicity!

Eliminated via CYP450

Slow-release form used to treat nocturnal asthma

Add on Rx where inhaled steroid plus beta agonist ineffective!

A/E:
CNS stimulant: insomnia, tremor, convulstions

heart: positive chronotropic and inotropic effect

Weak vasodilator
weak diuretic
anxiety
tachycardia
diuresis
vomiting
arrhythmia
shock

37

Felbamate

Anti-epileptic drug

MOA: Blocks NMDA (glutamate) receptors

38

Beclomethasone

Inhaled Corticosteroid. Used to treat Asthma. High topical and low systemic activity

MOA: Has anti-inflammatory effects. Binds to an internuclear receptor and inhibits the transcription of genes that are responsible for producing cytokines. ESP interleukins

A/E:
- dysphonia
- oropharyngeal candidia (brush teeth after puffing inhaler for prevention)
- sore throat

39

Terbutaline

Bronchodilator

MOA: sympathetic stimulation of Beta2 receptor (adrenergic agonist)

A/E: skeletal m tremor, tachycardia, palpitations tolerance (short acting drugs)

40

Zileuton

Leukotriene Synthesis Inhibitor: used in aspirin-induced asthma

MOA: Leukotriene Synthesis Inhibitor: 5-lipoxygenase inhibitor

A/E: Hepatotoxicity; elevation of liver enzymes must be monitored

41

Gabapentin

Anti-epileptic drug

MOA: Binds to presynaptic voltage-gated N type of Ca channel --> decreases synaptic release of glutamate

42

A/E associated with Theophylline

A/E:
CNS stimulant: insomnia, tremor, convulstions

heart: positive chronotropic and inotropic effect

Weak vasodilator
weak diuretic
anxiety
tachycardia
diuresis
vomiting
arrhythmia
shock

43

Formeterol

Bronchodilator

MOA: sympathetic stimulation of Beta2 receptor (adrenergic agonist)

A/E: skeletal m tremor, tachycardia, palpitations tolerance (short acting drugs)

44

Budesonide

Inhaled Corticosteroid. Used to treat Asthma. High topical and low systemic activity

MOA: Has anti-inflammatory effects. Binds to an internuclear receptor and inhibits the transcription of genes that are responsible for producing cytokines. ESP interleukins

A/E:
- dysphonia
- oropharyngeal candidia (brush teeth after puffing inhaler for prevention)
- sore throat

45

Pregbalin

Anti-epileptic drug

MOA: Binds to presynaptic voltage-gated N type of Ca channel --> decreases synaptic release of glutamate

46

Chlorpromazine

Phenothiazine typical antipsychotic

MOA: D2 receptor antagonist

Schizophrenia: reduce + symptoms

Toxicity:

Extrapyramidal syndrome: due to dopamine receptor blockade of the nigro-striatal pathway:
- acute dystonia
- akathisias (agitation, distress, restlessness)
- parkinson like symptoms

--> treated by benztropine, biperiden, trihexphenyl, diphenhydramine (anti-muscarinic drugs)

Tardive dyskinesias (occurs very late):
- oral/facial dyskinesias, muscle jerks, writhing lip muscles
- caused by relative cholinergic deficiency secondary to supersensitivty of DA receptors
- More common in pots taking typical antipsychotics
- Tx: switch patient to atypical drug (quetiapine or clozapine)

Neuroleptic Malignant Syndrome: rare but life threatening
- caused by rapid blockade of post synaptic Da receptors
- m rigidity, alterations in BP and HR, hyperthermia, muscle-type CK elevated
- Tx: IV dantrolene

Adrenoceptor blockade:
- orthostatic hypotension
- reflex tachycardia
- impotence
- inhibits ejaculation

Muscarinic blockade:
- dry mouth, constipation, blurred vision, tachycardia, urine retention

Hyperprolactinemia: weight gain

47

Montelukast

leukotriene receptor antagonist: Used as prophylaxis and chronic asthma treatment

Blocks bronchoconstriction, reduces edema, and decreases mucous production

MOA: competitively blocks LTD4, LTE4 receptors

48

Salmeterol

Bronchodilator: onset = 20, long-acting (DOA = 12h);

given via inhalation

Used for prophylaxis (prevents bronchoconstriction at night). NOT used for tx of acute asthma bc delayed onset!

MOA: sympathetic stimulation of Beta2 receptor (adrenergic agonist)

A/E: skeletal m tremor, tachycardia, palpitations tolerance (short acting drugs)

49

Lamotrigine

Anti-epileptic drug: treats GTC, simple partial seizures

MOA: prolongs inactivation of Na channels, presynaptic voltage gated N type of Ca channel --> decreases synaptic release of glutamate

50

Fluticasone

Inhaled Corticosteroid. Used to treat Asthma. High topical and low systemic activity

MOA: Has anti-inflammatory effects. Binds to an internuclear receptor and inhibits the transcription of genes that are responsible for producing cytokines. ESP interleukins

A/E:
- dysphonia
- oropharyngeal candidia (brush teeth after puffing inhaler for prevention)
- sore throat

51

Extrapyramidal syndrome and treatment

Extrapyramidal syndrome: due to dopamine receptor blockade of the nigro-striatal pathway:
- acute dystonia
- akathisias (agitation, distress, restlessness)
- parkinson like symptoms

--> treated by benztropine, biperiden, trihexphenyl, diphenhydramine (anti-muscarinic drugs)

52

Neuroleptic Malignant Syndrome and treatment

Neuroleptic Malignant Syndrome: rare but life threatening
- caused by rapid blockade of post synaptic Da receptors
- m rigidity, alterations in BP and HR, hyperthermia, muscle-type CK elevated
- Tx: IV dantrolene

53

Zonisamide

Anti-epileptic drug: tx myoclonic seizures

MOA: block high frequency firing via action on Na channels

54

Zafirlukast

leukotriene receptor antagonist: Used as prophylaxis and chronic asthma treatment

Blocks bronchoconstriction, reduces edema, and decreases mucous production

MOA: competitively blocks LTD4, LTE4 receptors

55

Triamcinolone

Inhaled Corticosteroid. Used to treat Asthma. High topical and low systemic activity

MOA: Has anti-inflammatory effects. Binds to an internuclear receptor and inhibits the transcription of genes that are responsible for producing cytokines. ESP interleukins

A/E:
- dysphonia
- oropharyngeal candidia (brush teeth after puffing inhaler for prevention)
- sore throat

56

Benztropine

anti-muscarinic drug used to treat Extrapyramidal syndrome:

due to dopamine receptor blockade of the nigro-striatal pathway:
- acute dystonia
- akathisias (agitation, distress, restlessness)
- parkinson like symptoms

57

Tardive dyskinesias and treatment

Tardive dyskinesias (occurs very late):
- oral/facial dyskinesias, muscle jerks, writhing lip muscles
- caused by relative cholinergic deficiency secondary to supersensitivty of DA receptors
- More common in pots taking typical antipsychotics
- Tx: switch patient to atypical drug (quetiapine or clozapine)

58

Typical Anti-psychotics:

end in "-zine" and haloperidol

59

Haloperidol

Typical Anti-psychotic;

used to treat touter's syndrome and to reduce + symptoms in Schizophrenia

MOA: D2 receptor antagonist

60

Sodium Cromoglycate

Inhaled mast cell stabilizer used in prophylaxis of asthma, allergic rhinitis, allergic conjunctivitis

MOA: inhibits degranulation of mast cell by trigger stimuli

61

Biperiden

anti-muscarinic drug used to treat Extrapyramidal syndrome:

due to dopamine receptor blockade of the nigro-striatal pathway:
- acute dystonia
- akathisias (agitation, distress, restlessness)
- parkinson like symptoms

62

Sumatriptan

5HT1 receptor agonist

MOA: 5HT1D agonist

Use: acute migraine attack

63

Bromocriptine

Ergot Alkaloid that acts in the CNS

used to treat hyperprolactinemia and parkinson's disease

64

Fluphenazine

Phenothiazine typical antipsychotic

MOA: D2 receptor antagonist

Schizophrenia: reduce + symptoms

Toxicity:

Extrapyramidal syndrome: due to dopamine receptor blockade of the nigro-striatal pathway:
- acute dystonia
- akathisias (agitation, distress, restlessness)
- parkinson like symptoms

--> treated by benztropine, biperiden, trihexphenyl, diphenhydramine (anti-muscarinic drugs)

Tardive dyskinesias (occurs very late):
- oral/facial dyskinesias, muscle jerks, writhing lip muscles
- caused by relative cholinergic deficiency secondary to supersensitivty of DA receptors
- More common in pots taking typical antipsychotics
- Tx: switch patient to atypical drug (quetiapine or clozapine)

Neuroleptic Malignant Syndrome: rare but life threatening
- caused by rapid blockade of post synaptic Da receptors
- m rigidity, alterations in BP and HR, hyperthermia, muscle-type CK elevated
- Tx: IV dantrolene

Adrenoceptor blockade:
- orthostatic hypotension
- reflex tachycardia
- impotence
- inhibits ejaculation

Muscarinic blockade:
- dry mouth, constipation, blurred vision, tachycardia, urine retention

Hyperprolactinemia: weight gain

65

Nedocromil

mast cell stabilizer used in prophylaxis of asthma, allergic rhinitis, allergic conjunctivitis

MOA: inhibits degranulation of mast cell by trigger stimuli

66

trihexphenyl

anti-muscarinic drug used to treat Extrapyramidal syndrome:

due to dopamine receptor blockade of the nigro-striatal pathway:
- acute dystonia
- akathisias (agitation, distress, restlessness)
- parkinson like symptoms

67

Buspirone

5HT1 Receptor Agonist

MOA: 5HT1A agonist

Use: anxiolytic drug; DOC for generalized anxiety

68

Pergolide

Ergot Alkaloid acting in the CNS

Used to treat hyperprolactinemia

69

Thioridazine

Phenothiazine typical antipsychotic

Causes retinal deposits-->browning of vision

Prolongs QT interval--> ventricular arrhythmias (patients taking enzyme inhibitors or other drugs that prolong QT interval)

MOA: D2 receptor antagonist

Schizophrenia: reduce + symptoms

Toxicity:

Extrapyramidal syndrome: due to dopamine receptor blockade of the nigro-striatal pathway:
- acute dystonia
- akathisias (agitation, distress, restlessness)
- parkinson like symptoms

--> treated by benztropine, biperiden, trihexphenyl, diphenhydramine (anti-muscarinic drugs)

Tardive dyskinesias (occurs very late):
- oral/facial dyskinesias, muscle jerks, writhing lip muscles
- caused by relative cholinergic deficiency secondary to supersensitivty of DA receptors
- More common in pots taking typical antipsychotics
- Tx: switch patient to atypical drug (quetiapine or clozapine)

Neuroleptic Malignant Syndrome: rare but life threatening
- caused by rapid blockade of post synaptic Da receptors
- m rigidity, alterations in BP and HR, hyperthermia, muscle-type CK elevated
- Tx: IV dantrolene

Adrenoceptor blockade:
- orthostatic hypotension
- reflex tachycardia
- impotence
- inhibits ejaculation

Muscarinic blockade:
- dry mouth, constipation, blurred vision, tachycardia, urine retention

Hyperprolactinemia: weight gain

70

Ketotifen

ORAL mast cell stabilizer used in prophylaxis of asthma, allergic rhinitis, allergic conjunctivitis

MOA: inhibits degranulation of mast cell by trigger stimuli

71

diphenhydramine

anti-muscarinic drug used to treat Extrapyramidal syndrome:

due to dopamine receptor blockade of the nigro-striatal pathway:
- acute dystonia
- akathisias (agitation, distress, restlessness)
- parkinson like symptoms

72

Tegaserod

5HT4 Receptor Agonist

Use: IBS with constipation (stimulated release of ACh, increasing gastric motility)

73

Trifluoperazine

Phenothiazine typical antipsychotic

MOA: D2 receptor antagonist

Schizophrenia: reduce + symptoms

Toxicity:

Extrapyramidal syndrome: due to dopamine receptor blockade of the nigro-striatal pathway:
- acute dystonia
- akathisias (agitation, distress, restlessness)
- parkinson like symptoms

--> treated by benztropine, biperiden, trihexphenyl, diphenhydramine (anti-muscarinic drugs)

Tardive dyskinesias (occurs very late):
- oral/facial dyskinesias, muscle jerks, writhing lip muscles
- caused by relative cholinergic deficiency secondary to supersensitivty of DA receptors
- More common in pots taking typical antipsychotics
- Tx: switch patient to atypical drug (quetiapine or clozapine)

Neuroleptic Malignant Syndrome: rare but life threatening
- caused by rapid blockade of post synaptic Da receptors
- m rigidity, alterations in BP and HR, hyperthermia, muscle-type CK elevated
- Tx: IV dantrolene

Adrenoceptor blockade:
- orthostatic hypotension
- reflex tachycardia
- impotence
- inhibits ejaculation

Muscarinic blockade:
- dry mouth, constipation, blurred vision, tachycardia, urine retention

Hyperprolactinemia: weight gain

74

Omalizumab

Mast Cell Stabilizer used in prophylaxis of asthma

MOA: inhibits binding of IgE to mast cells and prevents the release of mediators (humanized monoclonal ab to human IgE

75

Clozapine

Atypical antipsychotic

MOA: 5-HT2 and D4 receptor antagonist, weak D2 affinity

Schizophrenia: reduce + symptoms and GREATER effect on negative symptoms

Causes agranulocytosis; weekly blood counts required

Toxicity:

Extrapyramidal syndrome: due to dopamine receptor blockade of the nigro-striatal pathway:
- acute dystonia
- akathisias (agitation, distress, restlessness)
- parkinson like symptoms

--> treated by benztropine, biperiden, trihexphenyl, diphenhydramine (anti-muscarinic drugs)

Neuroleptic Malignant Syndrome: rare but life threatening
- caused by rapid blockade of post synaptic Da receptors
- m rigidity, alterations in BP and HR, hyperthermia, muscle-type CK elevated
- Tx: IV dantrolene

Adrenoceptor blockade:
- orthostatic hypotension
- reflex tachycardia
- impotence
- inhibits ejaculation

Muscarinic blockade:
- dry mouth, constipation, blurred vision, tachycardia, urine retention

76

Drug to treat Tourette's

Haloperidol (typical antipsychotic)

77

Drug to treat manic episode in bipolar disorder

olanzapine and aripiprazole

78

Neurolept anesthesia

Droperidol + fentanyl + NO

79

Aripiprazole

Atypical antipsychotic

MOA: partial agonist at D2

Schizophrenia: reduce + symptoms; manic episode in bipolar disorder

Toxicity:

Extrapyramidal syndrome: due to dopamine receptor blockade of the nigro-striatal pathway:
- acute dystonia
- akathisias (agitation, distress, restlessness)
- parkinson like symptoms

--> treated by benztropine, biperiden, trihexphenyl, diphenhydramine (anti-muscarinic drugs)

Neuroleptic Malignant Syndrome: rare but life threatening
- caused by rapid blockade of post synaptic Da receptors
- m rigidity, alterations in BP and HR, hyperthermia, muscle-type CK elevated
- Tx: IV dantrolene

Adrenoceptor blockade:
- orthostatic hypotension
- reflex tachycardia
- impotence
- inhibits ejaculation

Muscarinic blockade:
- dry mouth, constipation, blurred vision, tachycardia, urine retention

80

Glucocorticoids

histamine release inhibitors

MOA: IgE dependent release

81

Antipsychotic that causes emesis and MOA

prochlorperazine

due to DA receptor blockade at the chemoreceptor trigger zone

82

Nedocromil

histamine release inhibitors

MOA: mast cell stabilizers--> prevents degranulation of mast cells

use: allergic asthma, allergic rhinitis, allergic conjunctivitis

83

Asenapine

Atypical antipsychotic

MOA: 5-HT2 and D4 receptor antagonist; weak D2 affinity

Schizophrenia: reduce + symptoms

Toxicity:

Extrapyramidal syndrome: due to dopamine receptor blockade of the nigro-striatal pathway:
- acute dystonia
- akathisias (agitation, distress, restlessness)
- parkinson like symptoms

--> treated by benztropine, biperiden, trihexphenyl, diphenhydramine (anti-muscarinic drugs)

Neuroleptic Malignant Syndrome: rare but life threatening
- caused by rapid blockade of post synaptic Da receptors
- m rigidity, alterations in BP and HR, hyperthermia, muscle-type CK elevated
- Tx: IV dantrolene

Adrenoceptor blockade:
- orthostatic hypotension
- reflex tachycardia
- impotence
- inhibits ejaculation

Muscarinic blockade:
- dry mouth, constipation, blurred vision, tachycardia, urine retention

84

Ketanserine

5HT2 Receptor Antagonist

MOA: 5HT2 and alpha receptor blocker

Use: topical preparation for glaucoma

85

Ergonovine

Ergot Alkaloid acting on the uterus

used to treat postpartum hemorrhage, IM

86

Cromolyn sodium

histamine release inhibitors

MOA: mast cell stabilizers--> prevents degranulation of mast cells

use: allergic asthma, allergic rhinitis, allergic conjunctivitis

87

Olanzapine

Atypical antipsychotic

MOA: 5-HT2 and D4 receptor antagonist; weak D2 affinity

Schizophrenia: reduce + symptoms; manic episode in bipolar disorder

Toxicity:

Extrapyramidal syndrome: due to dopamine receptor blockade of the nigro-striatal pathway:
- acute dystonia
- akathisias (agitation, distress, restlessness)
- parkinson like symptoms

--> treated by benztropine, biperiden, trihexphenyl, diphenhydramine (anti-muscarinic drugs)

Neuroleptic Malignant Syndrome: rare but life threatening
- caused by rapid blockade of post synaptic Da receptors
- m rigidity, alterations in BP and HR, hyperthermia, muscle-type CK elevated
- Tx: IV dantrolene

Adrenoceptor blockade:
- orthostatic hypotension
- reflex tachycardia
- impotence
- inhibits ejaculation

Muscarinic blockade:
- dry mouth, constipation, blurred vision, tachycardia, urine retention

88

Beta 2 receptor agonist

histamine release inhibitors

89

theophylline

histamine release inhibitors

MOA: phosphodiesterase inhibitor

90

Olanzapine

5HT2 Receptor antagonist used to treat schizophrenia

91

Ergotamine

Ergot Alkaloid acting on the uterus and on the BV

used to treat postpartum hemorrhage, IM

also used to treat acute migraine

92

Gi receptor 2nd messengers

decreased cAMP

93

Risperidone

Atypical antipsychotic

MOA: 5-HT2 and D4 receptor antagonist; weak D2 affinity

Schizophrenia: reduce + symptoms

Toxicity:

Hyperprolactinemia (along with typical anti-psychotics) and weight gain

Extrapyramidal syndrome: due to dopamine receptor blockade of the nigro-striatal pathway:
- acute dystonia
- akathisias (agitation, distress, restlessness)
- parkinson like symptoms

--> treated by benztropine, biperiden, trihexphenyl, diphenhydramine (anti-muscarinic drugs)

Neuroleptic Malignant Syndrome: rare but life threatening
- caused by rapid blockade of post synaptic Da receptors
- m rigidity, alterations in BP and HR, hyperthermia, muscle-type CK elevated
- Tx: IV dantrolene

Adrenoceptor blockade:
- orthostatic hypotension
- reflex tachycardia
- impotence
- inhibits ejaculation

Muscarinic blockade:
- dry mouth, constipation, blurred vision, tachycardia, urine retention

94

Lithium Carbonate

Inhibits the recycling of PIP2 --> depletion of 2nd messengers DAG and IP3

Used to treat acute mania or bipolar disorder (2-3 weeks for onset)

Prophylaxis of bipolar disorder when given with TCA

Low therapeutic index so plasma levels need to be monitored.

Contraindicated in pregnancy!

A/E:
- nausea
- vomiting
- diarrhea
- fine tremors
- polydipsia
- Nephrogenic DI (tx: amiloride)
- benign, reversible thyroid enlargement

Toxicity: confusion, drowsiness, ataxia, severe tremors

95

Gq receptor 2nd messengers

increased IP3 and DAG

96

Gs receptor 2nd messengers

increased cAMP

97

Alternate drugs to lithium

Carbamazepine and valproic acid

can be used alone or as adjuncts with lithium

98

Ziprasidone

Atypical antipsychotic

MOA: 5-HT2 and D4 receptor antagonist; weak D2 affinity

Schizophrenia: reduce + symptoms

Toxicity:
Prolongs QT interval--> ventricular arrhythmias (patients taking enzyme inhibitors or other drugs that prolong QT interval)

Extrapyramidal syndrome: due to dopamine receptor blockade of the nigro-striatal pathway:
- acute dystonia
- akathisias (agitation, distress, restlessness)
- parkinson like symptoms

--> treated by benztropine, biperiden, trihexphenyl, diphenhydramine (anti-muscarinic drugs)

Neuroleptic Malignant Syndrome: rare but life threatening
- caused by rapid blockade of post synaptic Da receptors
- m rigidity, alterations in BP and HR, hyperthermia, muscle-type CK elevated
- Tx: IV dantrolene

Adrenoceptor blockade:
- orthostatic hypotension
- reflex tachycardia
- impotence
- inhibits ejaculation

Muscarinic blockade:
- dry mouth, constipation, blurred vision, tachycardia, urine retention

99

Treatment for nephrogenic DI

Amiloride

100

H1 receptor type

Gq: increased IP3 and DAG

101

H2 receptor type

Gs: increased cAMP

102

H3 receptor type

Gi: decreased cAMP

103

H4 receptor type

Gi: decreased cAMP

104

H1 receptor located which organ

BV--> vasodilation--> decreased BP (by releasing NO)

bronchoconstriction --> features of anaphylaxis

H1 = increased IP3 and DAG

105

H2 receptor located in which organ

stomach --> stimulates gastric secretion

H2 = increased cAMP

106

H3 receptor located in which organ

presynaptic: brain, myenteric plexus, other neurons

H3 = decreased cAMP

107

H4 receptor located in which organ

eosinophils, neutrophils, CD4+ T cells
H4 - decreased cAMP

108

Cyproheptadine

5HT2 antagonist used to treat carcinoid tumors

109

Methysergide

Ergot Alkaloid acting on BV used to treat carcinoid tumor

110

NSAIDS used to treat acute migraine

- aspirin
- diclofenax
- ketorolac
- ibuprofen
- naproxen

All used to treat Mild or Moderate Migraine

111

Diphenhydramine

first generation H1 receptor antagonist

Use: allergic reactions, anaphylactic reactions
- and in treating drug-induced EPS
- anti-emetic action: motion sickness

A/E: sedation, peripheral and central anti-muscarinic actions, adrenoreceptor blocking actions.

112

Ondansetron

5HT3 receptor antagonist

MOA: central antiemetic action

Used to control vomiting associated with chemo

113

Drugs used to treat mild or moderate migraine

NSAIDS or Acetaminophen

114

Drugs used to treat moderate or severe migraine:

Ergot Alkaloids: Ergotamine; Ergotamine + Caffeine;

Triptans: Sumatriptan (all end in -triptan)

NSAIDs (aspirin, diclofenax, ketorolac, ibuprofen, naproxen)

Neuroleptics: Chlorpromazine and haloperidol

115

Chlorpheniramine

first generation H1 receptor antagonist

Use: allergic reactions, anaphylactic reactions
- and in treating drug-induced EPS
- anti-emetic action: motion sickness

A/E: sedation, peripheral and central anti-muscarinic actions, adrenoreceptor blocking actions.

116

beta blocker used in prophylaxis of migraine

propranolol

117

TCA used in prophylaxis of migraine

amitriptyline

118

Alosetron

5HT3 receptor antagonist used to treat IBS with diarrhea

119

Promethazine

first generation H1 receptor antagonist

Use: allergic reactions, anaphylactic reactions
- and in treating drug-induced EPS
- anti-emetic action: motion sickness

A/E: sedation, peripheral and central anti-muscarinic actions, adrenoreceptor blocking actions.

120

Ca Channel Blocker used in prophylaxis of migraine

flunarizine and verapamil

121

SSRIs used in prophylaxis of migraine

Fluxoetine

122

Anti-convulsant used in prophylaxis of migraine

sodium valproate

123

Serotonergic antagonist used in prophylaxis of migraine

cyproheptadine

124

Alprostadil

Eicosanoid; Type: PGE1

Use:
- cyanotic heart diseases: keeps DA open
- impotence

125

Hydrozyzine

first generation H1 receptor antagonist

Use: allergic reactions, anaphylactic reactions
- and in treating drug-induced EPS
- anti-emetic action: motion sickness

A/E: sedation, peripheral and central anti-muscarinic actions, adrenoreceptor blocking actions.

126

misoprostol

Eicosanoid; Type: PGE1

Use:
- NSAID-induced peptic ulcers
- combined with mifepristone (antiprogestin) --> induce abortion

127

Loratidine

second generation H1 receptor antagonist

NON-sedating!

Use: allergic reactions, anaphylactic reactions

128

Dinoprostone

Eicosanoid; Type: PGE2

Use: cervical ripening, abortifacient

129

fexofenadine

second generation H1 receptor antagonist

NON-sedating!

Use: allergic reactions, anaphylactic reactions

130

Carboprost

Eicosanoid; Type: PGF2a

Use: cervical ripening, abortifacient

131

cetirizine

second generation H1 receptor antagonist

NON-sedating!

Use: allergic reactions, anaphylactic reactions

132

Cimetidine

H2 receptor antagonist

MOA: competitive blockade of H2 receptors

- Inhibits p450
-causes gynecomastic bc blocks androgen receptors at hich doses

Uses:
- duodenal and gastric ulcer
- drug/stress induced ulcer
- GERD
- esophagits
- ZE syndrome
- dyspepsia
- heartburn

133

PGE2 synthesis blocker used to treat dysmenorrhea

NSAIDs

134

Latanoprost

Eicosanoid; Type: PGF2alpha

Use: glaucoma

135

ranitidine

H2 receptor antagonist

MOA: competitive blockade of H2 receptors

Uses:
- duodenal and gastric ulcer
- drug/stress induced ulcer
- GERD
- esophagits
- ZE syndrome
- dyspepsia
- heartburn

136

azelastin

second generation H1 receptor antagonist

NON-sedating!

Use: allergic reactions, anaphylactic reactions

137

epoprostenol

Eicosanoid; Type: PGI2

Use: pulmonary hypertension

138

famotidine

H2 receptor antagonist

MOA: competitive blockade of H2 receptors

Uses:
- duodenal and gastric ulcer
- drug/stress induced ulcer
- GERD
- esophagits
- ZE syndrome
- dyspepsia
- heartburn

139

5HT1A receptor
a) distribution
b) post-receptor mechanism

a) hippocampus, raphe nuclei
b) Gi: decreased cAMP

140

5HT1D receptor
a) distribution
b) post-receptor mechanism

a) cranial BV
b) Gi: decreased cAMP

141

5HT2A receptor
a) distribution
b) post-receptor mechanism

a) platelets, smooth muscle, CNS
b) Gq: decreased IP3, DAG

142

5HT3 receptor
a) distribution
b) post-receptor mechanism

a) area pastrami, sensory and enteric nerves
b) Na+/K+ ion channels

143

5HT4
a) distribution
b) post-receptor mechanism

a) NS and myenteric neurons, smooth muscle
b) Gs: increased cAMP

144

NO breakdown inhibitor

Sildenafil

145

NO donors

nitrates and sodium nitroprusside

146

used to treat diarrhea

diphenoxylate and loperamide

147

used to treat chronic malignant pain

via patches/lollipop

Fentanyl (or -fentanil derivatives) with droperidol

148

drugs used to precipitate opioid withdrawal

nalbuphine and pentazocine

149

Filgrastime

used to treat neutropenia caused by anti-cancer drugs

150

used to treat thrombocytopenia caused by anticancer drugs

IL-11 aka Oprelvekin

151

used to treat OD on fibrinolytic agents

aminocaproic acid-->
inhibits plasminogen activation

152

dipyridamole

phosphodiesterase III inhibitor

153

Flunitrazepam

used for date rape

154

sargramostim

used to treat neutropenia caused by anti-cancer drugs

155

drugs used to treat status epilepticus

via high dose IV

Phenobarbital, diazepam/lorazepam

156

Partial agonists at 5HT autoreceptors

buspirone and propranolol

157

fulmazenil

antagonizes effects of Zolpidem, Eszopiclone and Zaleplon

158

Ramelteon

agonist at melatnonin receptors

159

seizures caused by local anesthetics are treated by

Diazepam

160

Drug that inhibits xanthine oxidase

allopurinol

161

Methotrexate MOA

inhibits DHF reductase (inhibits folate metabolism)

So it's cytotoxic to immune cells

162

Azathioprine

purine anti-metabolite = immunosuppressor

163

Highly selective COX-2 inhibitors end in.... and are used to treat

-coxib

ie Celecoxib, Valdecoxib, Etoricoxib

Used to treat osteoarthritis and RA

164

Etanercept

monoclonal Ab against TNFalpha

highly effective and used to treat RA (s a disease-modifying RA drug)

165

Sulfasalazine

Disease-modifying RA drug

risk of allergic rxn if patients allergic to sulfur

5-aminosalycilic acid = anti-inflammatory active metabolite

166

N-acetylcysteine

Drug used to treat acetaminophen

MOA: replenishes glutathione stores in liver

Early symptoms of hepatic damage: nausea, vomiting, diarrhea, abdominal pain.

167

Salicylism and treatment

vomiting, tinnitus, decreased hearing, vertigo,

Reversible when treated with sodium bicarbonate

When higher doses of Aspirin are given

168

Quinidine

Class 1A anti-arrhythmatic-->these drugs slow conduction, cause prolonged QT interval

Primary: blocks voltage sensitive Na channels
Secondary: block inward rectifier K channels

binds to inactivated Na channels and prevents Na influx. slowing upstroke of Phase O

Toxicity:
- cinchonism: blurred vision, tinnitus, headache, disorientation and psychosis
- syncope
- prolonged QT
- torsades de pointes

169

Flecainide

Class 1C anti-arrhythmatic

170

Amiodarone

Class III anti-arrhythmatic

Block voltage gated K channel and diminish outward current during repolarization --> prolongs AP

Tx: refractory SVT and VT

Toxicity:
- thyroid dysfunction (affects peripheral conversion of T4-->T3)
- interstitial pulmonary fibrosis (pt needs routine CXR)
- corneal microdeposits
- blue-skin discoloration "surf skin"
- hepatotoxic (monitor liver enzymes)

171

Digoxin

decrased AV node conduction-->enhances vagal tone

use: Atrial Fibrillation and flutter

Toxicity: ectopic ventricular beats

used IV in emergencies

172

Sotalol

Class III anti-arrhythmatic

has strong anti-fibrillary effects in ischemic myocardium--> long-term therapy to decrease the rate of sudden death post-MI.

Prolongs both depolarization and duration of AP--> lengthens ERP

173

Magnesium

interferes with Na/K ATPase, Na channels, K channels, Ca channels

Used to treat Torsades de points (QT prolongation syndrome)

given slowly by IV and used with extreme caution!

174

Procainamide

Class 1A anti-arrhythmatic

Metabolism by acetylation to NAPA which PROLONGS DURATION OF AP (has properties of class III drugs)

Toxicity:
- reversible Lupus-like syndrome (in slow-acetylators)
- asystole
- ventricular arrhythmias
- depression
- hallucination
- psychosis

175

Adenosine

Decreases conduction velocity--> prolongs refractory period--> decreases SA and AV nodal activity by stimulating adenosine receptors

Toxicity: flushing, sedation, dyspnea

Used in IV for acute attacks due to its short half-life

176

drug that causes pulmonary fibrosis

amiodarone

177

drug that causes smurf skin

amiodarone

178

DOC in PSVT and AV nodal arrhythmias

Adenosine

179

Adenosine antagonists

Theophylline and caffeine

180

anti-arrhythmatic contraindicated in patients with cardiac failure

Dispyramide

Class 1A (slows conduction, prolongs QT interval) used to treat ventricular arrhythmias

181

H2 blockers

end in -tidine (cimetidine, ranitidine, famotidine, nizatidine)

Competitive inhibition

182

PPIs

end in -prazole (omeprazole, pantoprazole, lansoprazole, rabeprazole)

IRREVERSIBLY inhibit H/K atpase pump

183

Side effects of Sodium bicarbonate and calcium carbonate

bloating and metabolic alkalosis

184

drug interactions with antacids

tetracycline, fluroquinolones, iron salts

antacids decrease their absorption

185

Drug that causes blackening of stool, tongue and dentures

colloidal bismuth subsalicylate (ulcer protector, coats ulcer base)

186

Drugs used in triple therapy

2 antibiotics and a PPI for 14 days

amoxycillin
clarithromycin
tetracycline
metranidazole/tinidazole

187

Rifampicin

CYP inducer

188

CYP inhibitors

- cimetidine
- SSRIs
- ketoconazole
- macrolie antibiotics
- fluoroquinolones
- HIV protease inhibitors
- grapefruit juice

189

Sucralfate

Ulcer healing drug

polymerizes at Ph

190

barbiturates and phenytoin

CYP inducers

191

Leucovorin

foiling acid = active form of folic acid

192

Drugs that cause folate deficiency

- methotrexate
- phenytoin (CYP inducer and anti-convulsant)
- sulfonamides (antibiotics)
- INH
- OCPs

193

When do you give EPO?

anemic of chronic renal failure, chemotherapy or AIDs (i.e. zidovudine)

194

How do you treat acute iron poisoning

deferrioxamine (iron chelating agent)

195

factors that decrease Fe absorption

antacids, phosphate, phylates, tetracyclines and food

196

factors that increase Fe absorption

acids, amino acids, meat

197

When do you use folic acid

megaloblastic anemia, pregnancy

198

when do you use VB12

megaloblatic anemia, pernicious anemia

199

Meperidine

Opioid agonist

used to treat heroin withdrawal and pain of terminal cancer

causes tachycardia because of antimuscarinic action.

Also causes serotonin syndrome when combined with MAOIs (i.e. selegine rasagiline)

SS = muscle rigidity, myoclonus, diarrhea

also the exception, does NOT cause biliary colic

200

Treatment for opioid toxicity

Naloxone (rapid action) and Naltrexone

201

Buprenorphine

used in opioid dependence

202

LMWH all end in ....and MOA

LMWH all end in "-parin" (enoxaparin, dalteparin, tinzaparin)

Selectively inhibits Xa, less effect on thrombin

given subcutaneously. less side effects than heparin and better bioavailability

203

Hirudin

Anti-coagulant: Direct Thrombin Inhibitor

MOA: direction binds to thrombin and inhibits the downstream effects

used instead of heparin for anticoagulating patients with heparin-induced thrombocytopenia

204

Protamine

basic compound used to neutralize heparin

Toxicity: bleeding, thrombocytopenia, osteporosis

205

Anticoagulant that is Contraindicated in pregnancy

Warfarin

206

lepuridin

Anti-coagulant: Direct Thrombin Inhibitor

MOA: direction binds to thrombin and inhibits the downstream effects

used instead of heparin for anticoagulating patients with heparin-induced thrombocytopenia

207

Treatment for Warfarin toxicity

stop the drug, Vitamin K, fresh frozen plasma

Toxicity: bleeding, skin necrosis (rare)

208

Warfarin MOA

interferes with normal gamma carboxylation of VitK dependent clotting factors (including 7) by inhibiting Vit K epoxide reductase

given orally

209

Sinemet

DRUG used to treat Parkinsons DOPA preparation containing Carbidopa and levodopa

Carbidopa inhibita dopa decarboxulase --> increase L-dopa amounts in the brain

reduces symptoms of parkinson esp bradykinesia

210

bivalirudin

Anti-coagulant: Direct Thrombin Inhibitor

MOA: direction binds to thrombin and inhibits the downstream effects

used instead of heparin for anticoagulating patients with heparin-induced thrombocytopenia

211

Benzodiazepenes

end in "-azepam" "-azolam" or Chlordiazepoxide

212

Barbiturates

end in "-barbital" or thiopental

213

Bromocriptine

Used to treat Parkinson's

Dopamine receptor aconist--> increases dopamine levels


used for hyperprolactinemia

toxicity: nausea vomiting, postural HYPOtension and dyskinesia

214

argatroban

Anti-coagulant: Direct Thrombin Inhibitor

MOA: direction binds to thrombin and inhibits the downstream effects

used instead of heparin for anticoagulating patients with heparin-induced thrombocytopenia

215

Drugs that displace the protein binding of warfarin

aspirin, phenytoin, sulfonamides

216

drugs that inhibit the metabolism of warfarin

- CYP inhibitors (cimetidine, SSRIs, ketoconazole, macrolide AB, fluoquinolones, HIV protease inhibitors, grapefruit juice)
- antifungals

217

drugs that decrease Vitamin K production

antibiotics, cephalosporins

218

drugs that induce metabolism of warfarin

CYP inducers: barbiturates, rifampicin, phenytoin, glucocorticoids, chronic alcohol use, carbamazepine

219

Which anticoagulant is used for immediate anticoagulation

Heparin (activates antithrombin III; inactivates clotting factors in intrinsic pathway)

Toxicity: bleeding, thrombocytopenia, osteporosis

220

pramipexole

Used to treat Parkinson's

Dopamine receptor agonist-->increase dopamine levels

agonist at D3 receptor. Considered 1st line drug bc fewer side effects

toxicity: nausea vomiting, postural HYPOtension and dyskinesia

221

MAO-B inhibitor

Used to treat Parkinson's

end in -giline (selegiline, rasagiline)

Inhibition of enzymatic degradation of dopamine--> increased dopamine

use with Levodopa

can cause serotonin syndrome when combined with SSRIs or TCAs

Toxicity: insomnia, HYPOtension, GI distress, mood chnages,

When used with meperidine: agitation, delirium, death

222

COMT-inhibitor

Used to treat Parkinson's

Inhibition of enzymatic degradation of dopamine--> increased dopamine

end in -capone (entacapone, tolcapone)

Entacapone: doesn't cross BBB, peripheral effects only, preferred bc Tolcapone causes hepatic damage

Toxicity: dyskinesias, postural HYPERtension

223

Drug that may activate malignant melanoma

Levodopa (used to treat parkinson. Dopamine precursor)

also contraindicated in psychotic patients and those with angle-closure glaucoma

224

Amide Local Anesthetics

- Lidocaine (surface anesthetic)
- Bupivacaine (most cardiotoxic -->arrhythmias)
- mepivacaine
- etidocaine
- prilocaine (can cause black urine)

all are hepatic metabolized

225

Esther Local Anesthetics

- cocaine (DON'T give with EPI, causes vasoconstriction-->HTN, and used in nasal surgeries)
- procaine (short t 1/2)
- tetracaine
- benzocaine (surface anesthetic

226

Anti epileptics that block Na channels

- phenytoin
- carbamazepine
- topiramate
- phenobarbitone (also enhances GABA transmission
- valproic acid (also enhances GABA transmission and blocks T channels in the Thalamus)
- lamotrigine (also blocks gluamine receptors)
- Topiramate

227

DOC to treat GTC

phenytoin or Carbamazepine

228

Anti epileptics that Enhances GABA transmission

- phenobarbitone
- valproic acid
- diazepam
- clonazepam
- Vigabatrin (inhibits GABA transaminase)
- Tiagabine (interferes with GABA re-uptake)
- Topiramate
- Gabapentin (interferes with GABA reuptake)

229

Anti epileptics that block T channels

valproic acid, Ethosuximide, Valproate

230

DOC to treat simple partial and complex partial seizures

phenytoin, carbamazepine, valproate

231

DOC to treat absent seizures

Valproate, Ethosuximide, Clonazepam

232

DOC to treat febrile convulsions

diazepam

233

DOC to treat status epilepticus

Diazepam, lorazepam, phenytoin

234

DOC to treat bipolar disorder

Carbamazepine, valproate

235

DOC to treat seizures that develop after IV administration of lidocatine

Diazepam

also used to cause skeletal muscle relaxation

236

Temezepam

BZD used to treat insomnia

Works by increasing the frequency of GABA-mediated chloride channel openings

237

Alprazolam

BZD used to treat panic and phobias

Works by increasing the frequency of GABA-mediated chloride channel openings

238

IV anesthesia

diazepam, midazolam, lorazepam

Works by increasing the frequency of GABA-mediated chloride channel openings

239

ozazepam

BZD used to treat insomnia

Works by increasing the frequency of GABA-mediated chloride channel openings

240

Preferred agents to treat insomnia that cause no cognitive impairment

zolpidem
zolplone
eszopiclone

work by stimulating specific BZD receptors

241

Thiopentone

barbiturate used to induce GA

works by prolonging the duration of GABA-mediated chloride channel openings

242

Carbamazepine toxicity

- diplopia
- ataxia
- increased ADH secretion (dilution hyponatremia)

Carbamazepine = antiepileptic, and CYP enzyme inducer

243

Phenobarbitone toxicity

Phenobarbitone = antiepileptic and CYP enzyme inducer

- sedation
- drowsiness
- mood changes

244

valproic acid toxicity

= antiepileptic and CYP enzyme inhibitor

- neural tube defects
- hepatotoxicity in children

245

Phenytoin toxicity

= antiepileptic and CYP enzyme inducer

- gingival hyperplasia
- hirsutism
- nystagmus
- megalobalastic anemia
- osteomalacia
- teratogenia
- ataxia
- vertigo
- drowsiness

246

side effects of typical antipsychotics

- M block = dry secretions, constipation
- alpha block = postural hypotension, inhibition of ejaculation, reflex tachycardia
- H2 block = sedation
- D2 antagonism = hyperprolactinema (amenorrhea, galactorrhea, gynecomastia and impotence)
- D2 antagonism in nigrostriatal = EPS

247

order of sensitivity of nerve fibers to LAs

Type B and C > Type A

small unmyelinated fibers are more sensitive to the block