Drugs to Know Exam 4 Flashcards

(90 cards)

1
Q

Somatropin

A
  • MOA: recombinant form of human GH
  • Uses: GH deficiency in children and adults and tx of children with genetic diseases associated with short stature
  • ADE: edema and hyperglycemia (d/t decreased affect of insulin)
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2
Q

Mecasermin

A
  • MOA: recombinant human IGF-1
  • Uses: pts with GH insensitivity who may be deficient in IGF-1
  • ADE: hypoglycemia (give within 20 min of food)
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3
Q

Octreotide

A
  • MOA: somatostatin analog that inhibits GH secretion
  • Uses: somatotroph adenomas
  • ADE: significant GI disturbances, gallstones, and cardia conduction abnormalities
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4
Q

Bromocriptine and Cabergoline

A
  • MOA: dopamine D2 receptor agonist that inhibits prolactin release, but can reduce GH at high doses
  • Uses: acromegaly and hyperprolactinemia
  • ADE: nausea, vomiting
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5
Q

Pegvisomant

A
  • MOA: binds to GH receptor and prevents the receptor dimerization
  • Uses: acromegaly
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6
Q

Tolvaptan and Conicaptan

A
  • MOA: vasopressin antagonist
  • Uses: hyponatremia
  • ADE: tolvaptan has significant risk of hepatotoxicity and liver failure
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7
Q

Levothyroxine (T4)

A
  • MOA: activation of nuclear receptors results in gene expression with RNA formation and protein synthesis
  • Uses: hypothyroidism
  • T1/2: 7 days
  • administer on an empty stomach
  • ADE: nervousness, heat tolerance, tachycardia, weight loss
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8
Q

Liothyronine (T3)

A
  • MOA: activation of nuclear receptors results in gene expression with RNA formation and protein synthesis
  • faster acting and shorter half life than T4 so multiple daily doses
  • Uses: myxedema coma (severe hypothyroidism)
  • ADE: greater risk of cardiotoxicity
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9
Q

Radioactive Iodine

A
  • MOA: destroy all or most of thyroid follicular cells, it is rapidly absorbed, concentrated in the thyroid and incorporated in to follicles.
  • Uses: treatment of thyrotoxicosis without surgery
  • Contraindications: pregnancy/breast feeding
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10
Q

Methimazole

A
  • thioamides
  • MOA: inhibits thyroid peroxidase –> prevents binding of iodide to tyrosine
  • Dosing: once daily
  • Contraindication: pregnancy
  • ADE: agranulocytosis, severe hepatitis, goiter
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11
Q

Lugol’s Solution and Potassium iodide

A
  • iodides
  • MOA: block release of T4 and T3, reduce size and vascularity of hyperplastic gland
  • Uses: preoperative prep for surgery, NOT for long term use
  • ADE: can cross placenta and can cause fetal goiter
  • Wolff-Chaikoff effect: iodine overload is accompanied by auto-regulatory inhibition of thyroid hormone release
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12
Q

Propylthiouracil

A
  • thioamides
  • MOA: inhibits thyroid peroxidase –> prevents binding of iodide to tyrosine
  • Dosing: 3 times per day
  • can be used in pregnancy
  • ADE: agranulocytosis, severe hepatitis, goiter
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13
Q

Jod-Basedow Phenomenon

A
  • iodine induced hyperthyroidism

- auto-regulation is absent and excess iodine increases thyroid hormone synthesis

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14
Q

Beta blockers and thyroid

A
  • inhibits peripheral conversion of T4 to T3

- uses: treatment of thyrotoxicosis

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15
Q

Glucocorticoids and thyroid

A
  • inhibits peripheral conversion of T4 to T3
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16
Q

Aspirin and NSAIDs and thyroid

A
  • decrease protein binding and cause an increase in free thyroid hormone
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17
Q

Amiodarone and thyroid

A
  • inhibits T4 to T3 by increasing plasma iodine

- note: can also cause hyperthyroidism

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18
Q

Prednisone, Hydrocortisone, Dexamethasone, and Fludricortisone

A
  • Glucocorticoids
  • hydrocortisone is tx of choice for Addison’s
  • Prednisone is safe in pregnancy bc not converted to active in fetus
  • ADE: hypertension, hypokalemia, hyperglycemia
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19
Q

Ketaconazole

A
  • inhibits glucocorticoid synthesis
  • Uses: cushing’s syndrome
  • ADE: fatigue, nausea, vomiting, HAs, mild liver dysfunction
  • low dose: decreases androgen synthesis
  • high dose: decreases all steroid hormone synthesis
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20
Q

Leuprolide

A
  • GnRH agonist –> will see initial surge of LH/FSH but will then turn off
  • short acting used for ovulation stimulation
  • sustained release formulations turn off GnRH and are used for prostate cancer, advanced breast cancer
  • ADE: hot flashes, gynecomastia, osteoporosis, decreased libido
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21
Q

GnRH antagonists

A
  • end in -relix
  • cause immediate drop in FSH and LH
  • Aberelix for metastatic prostate palliation
  • Degaralix - prostate cancer
  • Ganirelix and cetrorelix for ovulation induction to control timing for IVF
  • ADE: ovarian hyperstimulation syndrome - bloating, weight gain, dyspnea, venous thromboembolism, acute respiratory distress
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22
Q

Clomiphene

A
  • SERM (selective estrogen receptor modifier)
  • MOA: block estrogen receptors in pituitary to increase FSH and LH
  • Uses: induce ovulation
  • ADE: multiple follicular growth, thickening of cervical mucus, hot flashes, mood swings, ovarian hyper stimulation is rare
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23
Q

Tamoxifen

A
  • SERM
  • MOA: receptor antagonist in breast, agonist in endometrium and bone
  • Uses: treatment and prevention of hormone sensitive breast cancer, palliative care in metastatic breast cancer, prevents osteoporosis
  • ADE: higher risk of endometrial cancer, hot flashes, venous thrombosis, vaginal bleeding
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24
Q

Raloxifene

A
  • SERM
  • MOA: partial estrogen agonist in bone
  • Uses: prevention and treatment of osteoporosis in postmenopausal women
  • can be used to prevent but not treat breast cancer
  • ADE: hot flashes, venous thrombosis
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25
Fulvestrant
- SERD - MOA: pure estrogen receptor antagonist in all tissues - Uses: treatment of women with breast cancer that have developed resistance to tamoxifen - ADE: vasodilation (hot flash), headache, anti-estrogenic effects (osteoporosis) - no risk of venous thrombosis or endometrial cancer
26
Anastrazole
- aromatase inhibitor - indicated in postmenopausal women - Used in treatment of breast cancer - ADE: fatigue, arthralgia, increased risk of fx - no risk of uterine cancer or venous thromboembolism
27
Finasteride
- 5-a reductase inhibitor - Uses: treatment of symptoms resulting from benign prostate hyperplasia - **pregnant women should not take - ADE: decreased libido, erectile dysfunction, gynecomastia, risk of harm to exposed fetus
28
Bicalutamide
- androgen receptor antagonist - used to prevent initial flare from leuprolide - treatment of metastatic prostate cancers
29
Two predictable effects of increasing insulin:
- risk of hypoglycemia (beta blockers mask all symptoms except sweating) - risk of weight gain
30
Lispro, Aspart and Glulisine
- rapid acting exogenous insulin - MOA: forms weak hexamers which dissociate quickly into monomers - short duration of about 4 hrs - given just before or up to 15 min after meal, skip meal skip dose
31
Regular insulin (Humulin, Novolin)
- short acting - MOA: binds to insulin receptor and is structurally similar to endogenous insulin + Zn+. Forms hexamers which slowly dissociate into monomers to delay absorption - duration about 6-8 hrs - give about 30 min before meal, skip meal skip dose
32
NPH
- intermediate insulin - MOA: bound to protamine which needs to be cleaved before active - duration of 12-18 hrs - used for basal control, usually given with rapid or short acting for meal time control
33
Insulin glargine and insulin determir
- long acting, peakless insulins - glargine - precipitates - determir - attached to FA - two should not be mixed in same syringe and must be given as separate injections
34
Chlorpropramide and Tolbutamide
- 1st gen sulfonylureas - MOA: inhibit K channel causing Ca influx and insulin release - must eat on time - ADE: disulfram like rxn, hypoglycemia, SIADH, weight gain - caution in hepatic and renal failure --> increased risk of hypoglycemia d/t decreased clearance
35
- Glyburide
- 2nd gen sulfonylurea - MOA: inhibit K channel causing Ca influx and insulin release - must eat on time - ADE: hypoglycemia, weight gain - caution in hepatic and renal failure --> increased risk of hypoglycemia d/t decreased clearance
36
Repaglinide
- MOA: inhibits K channel causing Ca influx and insulin release - very rapid onset, take with meals (skip meal skip dose) - ADE: hypoglycemia increased with renal failure, weight gain
37
Metformin
- MOA: decrease hepatic glucose production and increase insulin mediated peripheral glucose uptake --> does NOT promote insulin secretion - 100% excreted by kidneys - Use: initial drug in most T2DM - affects fasting glucose more than post prandial - advantages: no weight gain, no hypoglycemia - ADE: lactic acidosis** in CHF, renal failure, alcohol abuse (reduce dose if GFR < 45, stop if < 30), also GI distress - CI: DKA, metabolic acidosis, renal failure
38
Pioglitazone
- thiazolinediones - MOA: insulin sensitizers, enhance sensitivity at peripheral targets, increase expression of GLUT4 - advantages: improves HDL, no hypoglycemia - disadvantages: takes 6 weeks for max effect ADE: edema, weight gain - CI: CHF
39
Acarbose
- MOA: reversible inhibitor of alpha-glucosidase enzyme which decreases the digestion of carbs - taken at beginning of meals - uses: postprandial hyperglycemia - advantages: skip meal skip dose, no weight gain - ADE: GI distress - CI: IBD. colonic ulceration, intestinal obstruction - DI: to treat hypoglycemia use glucose rather than sucrose
40
Exenatide
- MOA: GLP-1 receptor agonist, increases post prandial insulin release and suppresses glucagon release - use: adjunct in T2DM - advantages: weight loss - ADE: pancreatitis - CI: gastroparesis - DI: DPP-IV inhibitors
41
Sitagliptin
- MOA: inhibits DPP-4 enzyme to increase GLP-1 and increase insulin concentration - uses: T2DM - ADE: pancreatitis, delayed gastric emptying - risk of hypoglycemia with SFU's - CI: renal failure
42
Canagliflozin
- MOA: inhibits SLGT-2 to decrease reabsorption of glucose in the PCT - use: T2DM - ADE: hypovolemia, hypotension, hyperkalemia - CI: renal failure
43
Glucagon
- use: treat severe hypoglycemia (in unconscious pts), overdose of beta blockers
44
Dextrose
- treat hypoglycemia if pt is on an alpha-glucosidase inhibitor (arcabose)
45
Octreotide
- MOA: long acting somatostatin analog that blocks release of inulin and glucagon - uses: insulinomas
46
Diazoxide
- MOA: opens K channels and decreases insulin release - uses: insulinomas - ADE: opens K channels in cardiac and smooth muscle leading to cell hyperpolarization and vasodilation --> hypotension
47
Acyclovir
- anti-herpesvirus - MOA: phosphorylated intracellularly by viral kinase to become inhibitors of viral DNA synthesis - oral: genital herpes and adult varicella-zoster - IV: herpes encephalitis, neonatal herpes, serious herpes or varicella ADE: nausea, diarrhea, HA, renal toxicity or neurological effects - don't give with other nephrotoxic agents
48
Docosanol
- topical fusion inhibitor - prevents entry into cells and subsequent replication - apply within 12 hrs of prodrome to reduce sx by 18 hrs
49
Cidofovir
- inhibitor and alternative substrate for viral DNA polymerase --> completely inhibits DNA synthesis - phosphorylation is independent of viral enzyme - ADE: dose dependent proximal tubular nephrotoxicity - must administer with probencid
50
Foscarnet
- inhibits DNA, RNA, reverse transcriptase without requiring activation by phosphorylation - broad spectrum - ADE: nephrotoxicity, hypocalcemia
51
Oseltamivir (Tamiflu)
- competitively and reversibly interacts with active enzyme site to inhibit viral neuraminidase resulting in clumping of newly released virions - flu a and b - early administration is crucial - replication peaks at 24-72 hrs
52
Entecavir
- guanosine analog that competitively inhibits all 3 functions of hep B DNA polymerase - ADE: exacerbation on discontinuation, lactic acidosis, hepatomegaly --> monitor liver function
53
Interferon therapy (pegylated interferon alpha)
- 2 is for hep B and C - 2b is for hep C - increases protein kinase which inhibits protein synthesis - efficacy is enhanced by ribavirin - ADE: flu-like sx, neutropenia
54
Ribivirin
- used in combo with interferon - guanosine nucleotide analog - ADE: VERY TOXIC pts should not conceive children for 6 months after stopping and healthcare workers exposed may have effects (HA, conjunctivitis, rhinitis, nausea)
55
Simeprevir
- tx for HVC genotype 1 in combo with peginterferon and ribivirin - protease NS3/4A inibitor - dont give with CYP3A4 inducers - ADE: anemia, hepatotoxicity, fatigue
56
Daclastasvir
- NS5A inhibitor that affects replication and viral assembly - tx of HCV
57
Ledipasvir
- NS5A inhibitor that affects replication and viral assembly - tx of HCV - very expensive
58
Ombitasvir
- NS5A inhibitor that affects replication and viral assembly - tx of HCV
59
Sofosbuvir
- nucleotide polymerase inhibitor resulting in chain termination - hep C - administration with amioderone is not recommended d/t symptomatic bradycardia and fatal cardiac arrest
60
Dasabuvir
- non-nucleoside polymerase inhibitor that prevents viral replication - less potent, best for genotype 1 - primarily used as an adjunct
61
Ritonavir
- protease inhibitor used in HIV that is used off label as a pharmacokinetic booster bc it is a strong CYP3A4 inhibitor
62
Raltegravir
- integrase strand transfer inhibitor | - ADE: increase in creatine kinase, insomnia, HA, diarrhea, nausea
63
Maraviroc
- MOA: binds to host cell CCR5 receptor to block binding of viral gp120 - tropism testing required to ensure virus uses the CCR5 receptor - substrate of CYP3A4 - ADE: URI, hepatotoxicity, hypotension, MI
64
Abacavir
- nucleoside reverse transcriptase inhibitor, competitive inhibition, require phosphorylation, require host kinases - less active as single agents that other classes - useful in resistant strains - ADE: mitochondrial toxicity, lactic acidosis, hypersensitivity
65
Tenofovir
- nucleotide reverse transcriptase inhibitor, competitive inhibition, require phosphorylation, require host kinases - ADE: mitochondrial toxicity, lactic acidosis,
66
Zidovudine
- nucleoside reverse transcriptase inhibitor, thymidine analog, competitive inhibition, require phosphorylation, require host kinases - ADE: mitochondrial toxicity, lactic acidosis, insulin resistance. dyslipidemia, bone marrow suppression
67
Zidovudine
- nucleoside reverse transcriptase inhibitor, thymidine analog, competitive inhibition, require phosphorylation, require host kinases - ADE: mitochondrial toxicity, lactic acidosis, insulin resistance. dyslipidemia, bone marrow suppression - *generally used during labor and delivery to prevent transmission to the fetus and given to newborn for 6 wks*
68
Efavirenz
- non-nucleoside reverse transcriptase inhibitor, binds directly to HIV-1 reverse transcriptase and do not require host enzyme activation - mixed CYP3A4 inducer/inhibitor - ADE: *teratogenic*, skin rash, GI upset, CNS effects
69
Didanosine
- nucleoside reverse transcriptase inhibitor | - ADE: mitochondrial toxicity, lactic acidosis, pancreatitis, peripheral neuropathy
70
Darunavir
- protease inhibitor to prevent HIV mature form - CYP3A4 substrate - ADE: hyperglycemia, lipodystrophy (buffalo hump), hepatotoxicity, GI intolerance
71
Ritonavir
- protease inhibitor - CYP3A4 inhibitor - used as a booster - ADE: hyperglycemia, lipodystrophy (buffalo hump), hepatotoxicity, GI intolerance
72
Delavirdine
- non-nucleoside reverse transcriptase inhibitor, binds directly to HIV-1 reverse transcriptase and do not require host enzyme activation - CYP3A4 inhibitor - skin rash, GI upset
73
Cobicistat
- CYP3A4 inhibitor not active against HIV used to boost levels of other drugs
74
General ART
- 2 NRTI + protease inhibitor OR NNRTI
75
Latanoprost
- prostaglandin analog - MOA: PGF2a analog that lowers IOP by facilitating aqueous outflow through accessory uveoscleral outflow - caution: macular edema, bacterial keratitis - ADE: may cause pigmentation of the iris, eyelash changes - often first line therapy
76
Timolol and Betaxolol
- beta blocker - MOA: inhibit the production of aqueous humor by decreasing intracellular cAMP - Uses: glaucoma - ADE: bradycardia, heart failure, depression, blurred vision, burning sensation
77
Acetazolamide, Dorzolamide, Brinzolamide
- CA inhibitor - MOA: reduces formation of bicarb and reduces fluid transportation to decrease IOP - Uses: glaucoma - ADE: allergic reactions (sulfonamide related), abnormal taste, burning in eye, conjunctivitis
78
Dipiverfin (B2) and Brimonidine (A2)
- sympathomimetic - MOA: decreases IOP by increasing uveoscleral outflow via beta 2 - ADE: hyperemia, systemic effects
79
Pilocarpine
- cholinergic agonist - MOA: stimulates muscarinic receptors which increase outflow of aqueous fluid - CI: cardiac failure, parkinson's, peptic ulcer disease - ADE: clouding of corneal stroma, retinal detachment - not commonly used
80
Cyclopentolate
- muscarinic antagonist - MOA: causes mydriasis and paralysis of accommodation - uses: angle closure glaucoma d/t anterior lens displacement, and to visualize internal structures of the eye
81
Phenylephrine
- sympathomimetic agent | - MOA: alpha agonist that causes mydriasis
82
Dexamthasone and Prednisolone
- glucocorticoid - MOA: anti-inflammatory - uses: post operatively, age-related macular degeneration, do not use more than a week ADE: cataracts, secondary infection, secondary open angle glaucoma, increase in IOP (all from long term use)
83
Olopatadine
- antihistamine
84
Antimuscarinic toxidrome
- fever, tachycardia, mydriasis, cycloplegia, flushing, dry skin, agitation, hallucinations, constipation - antidote: physostigmine - will not cause a change in BP
85
AChE inhibitors toxidrome
- increased BP, muscle fasciculations leading to paralysis, diaphoretic, pale, hyperkalemia - atropine and pralidoxime
86
Insulin and potassium
- insulin shifts potassium into cells so can cause hypokalemia
87
Insulin and potassium
- insulin shifts potassium into cells so can cause hypokalemia
88
Iron
- antidote: deferoxamine - sx: acute - necrotizing gastroenteritis, n/v, bloody diarrhea, shock, metabolic acidosis, hepatotoxicity - iron is radiopaque - some pts get sx from immune response to antidote --> histamine release and vasodilation
89
Lead
- antidote: BAL (dimercaprol), calcium disodium EDTA (after levels are lowered), succimer - increased delta-ALA excreted in urine, less heme produced - sx: fatigue, abdominal pain, anemia - sources: paint, plumbing, imported food packaging, moonshine
90
Cyanide
- nitrate, sodium thiosulfate, hydroxocobalamin - sx: HA, nausea, dyspnea, metabolic acidosis, hypotension, syncope, bitter almond odor - suspect when: sudden collapse in lab, fire victim, artificial nail remover, *peach pit*, prolonged nitroprusside - want to induce methemoglobinemia with sodium nitrite