Exam 4 Flashcards by Philip Wiener

Q

Prednisone

(Glucocorticoid - corticosteriod)

(Short-Med Acting)

A

Effect:
- PMN increase
- Lymphocyte/monocyte/granulocyte decrease
- Decrease response to Ag
- Decrease release of mediators (IL1,2, TNF-a, collagenase/elastase)
- Inhibit Phospolipase A2 and COX2
- liver activation
Use:
- allergic/hemato/collagen disorders
- hepatic/renal dz
SE:
- short = nothing; see SE card
- long = iatrogenic Cushing’s, osteoporosis, infection, ulcers

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Q

Methylprednisone

(Glucocorticoid - corticosteriod)

(Short-Med Acting)

A

Effect:
- PMN increase
- Lymphocyte/monocyte/granulocyte decrease
- Decrease response to Ag
- Decrease release of mediators (IL1,2, TNF-a, collagenase/elastase)
- Inhibit Phospolipase A2 and COX2
Use:
- allergic/hemato/collagen disorders
- hepatic/renal dz
SE:
- short = nothing
- long = iatrogenic Cushing’s, osteoporosis, infection, ulcers

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Q

Cyclophosphamide

(Prodrug - cytotoxic/antiprolif. T/B cell)

A

Effect:
- Alkylating agent, signal 3 inhib.
- Non-cell cycle spec
- Inhib B/T Cell (direct cytotox=immune supp.)
Use:
- RA
- Leukemia
SE:
- Short term = N/V
- Long term = Bone Marrow Supp. (leukopenia, thrombocytopenia, anemia)
- Derm (alopecia)

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Q

Azathioprine

(cytotoxic/antiprolif. T/B cell)

A

Effect:
- Antimetabolite, Signal 3 inhib.
- Cell-cycle spec
- Inhib T > B
Use:
- Renal Allotrasplant.
- RA (ADULT ONLY)
SE:
- Short term = N/V/D
- Long term = Bone Marrow supp. (leukopenia, thrombocytopenia, macrocytic anemia)
- Infections

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Q

Methotrexate

(cytotoxic/antiprolif. T/B cell)

A

Effect:
- Antimetabolite, Signal 3 inhib.
- Cell-cycle spec
- Inhibit B/T cell
Use:
- Crohn’s
- RA
- Leukemia
SE:
- N/V
- Bone Marrow Supp.
- Hepatox.

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Q

Mycophenolate Mofetil

(T-cell supp)

A

Effect:
- Inhib Purine synth, Signal 3 inhib.
- Inhibit B/T cell
Use:
- Kidney/Liver/Heart rejection
- combo w/ cyclosporine/cortico
SE:
- GI
- neutropenia
- infection

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Q

Cyclosporine

(T-cell supp)

A

Effect:
- Inhibit calcineurin and Signal 1
- T-cell supp.
Use:
- Kidney/Liver/Heart rejection
- w/ cortico/azathiprine
- RA
SE:
- Nephrotox
- HTN
- Embryotox

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Q

Muromonab-CD3

(Murine - T-cell supp)

A

Effect:
- Inhibit CD3R and Signal 1
- T-cell supp.
Use:
- Kidney/Liver/Pancreas/Heart rejection
SE:
- Fever/Chills
- Murine sensitivity

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Q

Lymphocyte Immune Globulin

(Horse - T-cell supp)

A

Effects:
- T-cell supp.
Use:
- Kidney rejection
SE:
- fever/chills
- horse sensitivity

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Q

Daclizumab

(Human - T-cell supp)

A

Effect:
- Inhibit IL-2R and Signal 3
Use:
- Kidney rejection
SE:
- GI dysfunction

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Q

RH_O Immune Globulin

(Human - Ab immunosupp.)

A

Effect:
- Supp immune response to Rh+ RBCs
Use:
- prevent erythroblastosis fetalis
SE:
- mild
- contra for Rh+ pts

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Q

Immune Globulin

(Human - Replacement tx)

A

Effects:
- increase passive immunity
Use:
- Hypogammaglobulinemia
- Prevent infections in HIV+
SE:
- mild

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Q

Interferon Beta-1b

(Immunomodulators)

A

Effects:
- Antiviral/Immunoregulatory
Use:
- MS (relapsing-remitting)
SE:
- Flu-like S/S
- depression/suicide
- injection site rxn

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Q

Interferon Gamma

(Immunomodulators)

A

Effects:
- activate phagocytic activity
- Ab-dependent cytotox.
Use:
- chronic granulomatous dz
- osteoporosis
SE:
- Flu-like S/S

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Q

Acetyl Salicylic Acid

(Salicylic Acid Deriv.)

A

pKa = 3.5 (acidic)
Abs favored in SI b/c large SA (even though not favored by kinetics)
Kidney excretion; if you increase urine pH = increase excretion
Effects:
- Irreversible COX 1/2 inhibition
Use:
- Analgesic
- Anitpyretic
- Antiinflamm
- Antirheumatic
- prevent A/V thrombosis
SE:
- GI - inhibit COX1 .: no PGs (protection) leads to S/S
- Tinnitus
- Heptic
- Renal ischemia due to PG inhibition
- Decrease Hct/Fe serum conc. + decrease RBC lifespan
- Hypersensativity - urticaria/angioedema
- Reye’s (children)
Rx Interactions
- protein bound
- anticoagulants
- corticosteroids
- NSAIDs

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Q

Diflunisal

(Salicylic Acid Deriv.)

A

Effects:
- Reversible COX1/2 inhibit
Use:
- Analgesic (acute/chronic mild-mod)
- Antiinflamm
- RA/Osteoarthritis
SE:
- Mild GI
- HA
- Renal
- Hypersensativity

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Q

Indomethacin

(Acetic Acid Deriv.)

A

Effects:
- Reversible COX 1/2 inhibition
Use:
- RA
- Osteoarthritis
- Tocolytic agent
SE:
- Severe GI
- Prolong Gestation
- Renal
- HA + aggrevated depression

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Q

Etodolac

(Acetic Acid Deriv.)

A

Effects:
- COX 2 > COX 1 inhibition
Use:
- RA
- Osteoarthritis
- Post op analgesia (6-8h)
SE:
- GI (Less severe)

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Q

Diclofenac

(Acetic Acid Deriv.)

A

Effect:
- Reversible COX1/2 inhibition
Use:
- RA
- Osteoarthritis
- Analgesia/Dysmenorrhea
SE:
- GI
- Dizziness + HA

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Q

Tolmetin

(Acetic Acid Deriv.)

A

Effect:
- Reversible COX1/2 inhibition
Use:
- JRA
- RA
- Osteoarthritis
SE:
- GI
- HA
- anaphylaxis

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Q

Ketorolac

(Acetic Acid Deriv.)

A

Effect:
- Reversible COX1/2 inhibition
Use:
- Mod-sev acute pain
SE:
- GI
- HA

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Q

Ibuprofen

(Proprionic Acid Deriv.)

A

Effect:
- Reversible COX1/2 inhibition
Use:
- RA
- Osteoarthritis
- Analgesia
- Dysmenorrhea
- Fever
SE:
- Mild GI
- Ocular dysfunction
- Rash/Dermatitis
- Contra: preggo/milking

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Q

Naproxen

(Proprionic Acid Deriv.)

A

Effects:
- Reversible COX1/2 inhibition
Use:
- JRA
- RA
- Osteoarthiritis
- Anagesia
- Dysmenorrhea
SE:
- Mild GI
- HA
- Hypersensitivity

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Q

Ketoprofen

(Proprionic Acid Deriv.)

A

Effects:
- Reversible COX1/2 inhibition
Use:
- RA
- Osteoarthritis
- Analgesia
- Dysmenorrhea
SE:
- GI - 30% of pts
- HA

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Oxaprozin | (Proprionic Acid Deriv.)

* Effects: * Reversible COX1/2 inhibition - Used Once daily * Use: * RA * Osteoarthritis * SE: * GI

Piroxicam | (Enolic Acid Deriv. - Oxicams)

* Effects: * Reversible COX1/2 inhibition * Use: * RA * Osteoarthritis * SE: * GI

Meloxicam | (Enolic Acid Deriv. - Oxicams)

* Effects: * Reversible COX 2 \> 1 inhibition * Use: * Osteoarthritis * SE: * GI

Nabumetone | (Non-acidic)

* Effect: * Reversible COX 2 \> 1 inhibition * Use: * RA * Osteoarthritis * SE: * GI * HA

Celecoxib | (COX-2 Inhibitor)

* Effect: * Selective COX 2 inhibition * Use: * Osteoarthritis * RA * dysmenorrhea * acute pain * familial adenomatous polyposis * SE (all minor): * GI (less than COX 1 inhibitors) * HA and dizziness * Respiratory * Rash * Sulfonamide allergy

Acetaminophen

* Effect: * analgesia (increase pain threshold) * weak COX1/2 inhibition * antipyresis via reg. @ hypothalamic heat-reg center * Use: * analgesia * antipyretic * Osteoarthritis * SE: * Heptotox * Nephrotox * Rash (minor)

Epinephrine | (Adrenergic Bronchodilator)

* Effect: * Bronchodilation * inhibit degranulation from mast cells * Use: * acute asthma attacks/asthmatic bronchospasms * anaphylactic reactions * SE: * CNS stimulation * Cardiac stimulation * tolerance/rebound bronchospasm

Isoproterenol | (Adrenergic Bronchodilator)

* Effect: * Bronchodilation * inhibit degranulation from mast cells * Use: * acute asthma attacks/asthmatic bronchospasms * anaphylactic reactions * SE: * CNS stimulation * Cardiac stimulation * tolerance/rebound bronchospasm

Metaproterenol | (Adrenergic Bronchodilator)

* Effect: * Bronchodilation * inhibit degranulation from mast cells * Use: * acute asthma attacks/asthmatic bronchospasms * anaphylactic reactions * SE: * CNS stimulation * Cardiac stimulation * tolerance/rebound bronchospasm

Albuterol/Levalbuterol | (Adrenergic Bronchodilator)

* Effect: * Bronchodilation * inhibit degranulation from mast cells * Use: * acute asthma attacks/asthmatic bronchospasms * anaphylactic reactions * SE: * CNS stimulation * Cardiac stimulation * tolerance/rebound bronchospasm

Salmeterol | (Adrenergic Bronchodilator)

* Effect: * Bronchodilation * inhibit degranulation from mast cells * Use: * acute asthma attacks/asthmatic bronchospasms * anaphylactic reactions * SE: * CNS stimulation * Cardiac stimulation * tolerance/rebound bronchospasm

Terbutaline | (Adrenergic Bronchodilator)

* Effect: * Bronchodilation * inhibit degranulation from mast cells * Use: * acute asthma attacks/asthmatic bronchospasms * anaphylactic reactions * SE: * CNS stimulation * Cardiac stimulation * tolerance/rebound bronchospasm

Pirbuterol | (Adrenergic Bronchodilator)

* Effect: * Bronchodilation * inhibit degranulation from mast cells * Use: * acute asthma attacks/asthmatic bronchospasms * anaphylactic reactions * SE: * CNS stimulation * Cardiac stimulation * tolerance/rebound bronchospasm

Theophylline | (Methylxanthine Bronchodilator)

* Narrow therapeutic window * Not used b/c of SEs * Effect: * bronchodilation * inhibit mast cell degranulation * inhibit PDE4 -\> increase cAMP in mast cell and smooth muscle * interact with adenosine receptors * Use: * oral in conjunction with other Rx for severe asthma * SE: * Mild: N/V, HA, insomnia, nervousness * Severe: arrhythmias, seizures

Aminophylline | (Methylxanthine Bronchodilator)

* Narrow therapeutic window * Not used b/c of SEs * Effect: * bronchodilation * inhibit mast cell degranulation * inhibit PDE4 -\> increase cAMP in mast cell and smooth muscle * interact with adenosine receptors * Use: * IV for severe asthma * SE: * Mild: N/V, HA, insomnia, nervousness * Severe: arrhythmias, seizures

Beclomethasone | (Corticosteroid)

* Effects: * antiinflammatory * inhibit leukocyte recruitment * inhibit synthesis/release of PGs, TXs, leukotrienes, PAFs, etc. * reduce cell mediated bronchial epithelial damage * slow acting * Use: * prophylactic NOT acute * SE: * Cataracts (inhaled steroids) * Cushing Syndome * Immunosuppression * Osteoporosis * Peptic ulcer * Growth suppression in kids (systemic use) * Hypothalamic-Pit axis suppression * Menstrual/repro problems

Flunisolide | (Corticosteroid)

* Effects: * antiinflammatory * inhibit leukocyte recruitment * inhibit synthesis/release of PGs, TXs, leukotrienes, PAFs, etc. * reduce cell mediated bronchial epithelial damage * slow acting * Use: * prophylactic NOT acute * SE: * Cataracts (inhaled steroids) * Cushing Syndome * Immunosuppression * Osteoporosis * Peptic ulcer * Growth suppression in kids (systemic use) * Hypothalamic-Pit axis suppression * Menstrual/repro problems

Triamcinolone | (Intermediate-acting Glucorticoid)

* Effects: * antiinflammatory * inhibit leukocyte recruitment * inhibit synthesis/release of PGs, TXs, leukotrienes, PAFs, etc. * reduce cell mediated bronchial epithelial damage * slow acting * no mineralcorticoid activity * Use: * prophylactic NOT acute * intralesional * allergic rhinitis * ophthalmic * bronchial asthma * oral ulcerative lesions * adrenocortical insuff, * DZ: derm, endocrine, GI, hem/neo, NS, nephro, rheumatic , resp, SLE * SE: * Cataracts (inhaled steroids) * Cushing Syndome * Immunosuppression * Osteoporosis * Peptic ulcer * Growth suppression in kids (systemic use) * Hypothalamic-Pit axis suppression * Menstrual/repro problems

Fluticasone

* Effects: * antiinflammatory * inhibit leukocyte recruitment * inhibit synthesis/release of PGs, TXs, leukotrienes, PAFs, etc. * reduce cell mediated bronchial epithelial damage * slow acting * Use: * prophylactic NOT acute * SE: * Cataracts (inhaled steroids) * Cushing Syndome * Immunosuppression * Osteoporosis * Peptic ulcer * Growth suppression in kids (systemic use) * Hypothalamic-Pit axis suppression * Menstrual/repro problems

Budesonide | (Corticosteroid)

* Effects: * antiinflammatory * inhibit leukocyte recruitment * inhibit synthesis/release of PGs, TXs, leukotrienes, PAFs, etc. * reduce cell mediated bronchial epithelial damage * slow acting * Use: * prophylactic NOT acute * SE: * Cataracts (inhaled steroids) * Cushing Syndome * Immunosuppression * Osteoporosis * Peptic ulcer * Growth suppression in kids (systemic use) * Hypothalamic-Pit axis suppression * Menstrual/repro problems

Mometasone | (Corticosteroid)

* Effects: * antiinflammatory * inhibit leukocyte recruitment * inhibit synthesis/release of PGs, TXs, leukotrienes, PAFs, etc. * reduce cell mediated bronchial epithelial damage * slow acting * Use: * prophylactic NOT acute * SE: * Cataracts (inhaled steroids) * Cushing Syndome * Immunosuppression * Osteoporosis * Peptic ulcer * Growth suppression in kids (systemic use) * Hypothalamic-Pit axis suppression * Menstrual/repro problems

Ciclesonide | (Corticosteroid)

* Effects: * antiinflammatory * inhibit leukocyte recruitment * inhibit synthesis/release of PGs, TXs, leukotrienes, PAFs, etc. * reduce cell mediated bronchial epithelial damage * slow acting * Use: * prophylactic NOT acute * SE: * Cataracts (inhaled steroids) * Cushing Syndome * Immunosuppression * Osteoporosis * Peptic ulcer * Growth suppression in kids (systemic use) * Hypothalamic-Pit axis suppression * Menstrual/repro problems

Cromolyn Sodium | (Mast Cell Stabilizer)

* Effect: * inhibit degranulation * Use: * prophylaxis of bronchial asthma in conjunction with other agents * rhinitis, conjunctivitis, GI allergies * SE: (rare) * throat irritation * cough * dry mouth * wheezing * HA * bronchospams * laryngeal edema * rash

Monteleukast | (Leukotriene Modulator)

* Effects: * Cysteinyl leukotriene receptor antagonist * Use: * oral * decrease frequency/severity of asthma attacks * Seasonal allergies

Zafirleukast | (Leukotriene Modulator)

* Effects: * Cysteinyl leukotriene receptor antagonist * Use: * oral * decrease frequency/severity of asthma attacks * Seasonal allergies

Zileuton | (Leukotriene Modulator)

* Effects: * 5-lipoxygenase inhibitor * Use: * oral * decrease frequency/severity of asthma attacks * 4x daily * SE: * Heptatotox * liver enzyme elevation

Ipratropium | (Antimuscarinic)

* Effect: * prevent Ach induced bronchospasm * Quarternary salt; poor abs .: few systemic effects * SE: * dry secretions

Tiotropium | (Antimuscarinic)

* Effect: * prevent Ach induced bronchospasm * COPD * SE: * dry secretions

Aclidinium | (Antimuscarinic)

* Effect: * prevent Ach induced bronchospasm * COPD * SE: * dry secretions

Advair Diskus | (Combo prep)

Salmeterol + Fluticasone

Combivent | (Combo prep)

Ipratropium + Albuterol

Symbicort | (Combo prep)

Formoterol + Budesonide

Dulera | (Combo prep)

Formoterol + Mometasone

Omalizumab | (Anti-IgE)

Diphenhydramine | (H₁ Antagonist - Sedating)

* Effect: * block H1 receptors * Use: * allergies * rhinitis * dermatitis * NOT bronchospastic conditions * antiemetic - vestibular system/CRTZ * antitussive * Sedation * SE: * dry secretions

Fexofenadine | (H1 Antagonist - Non-sedating)

* Effect: * block H1 receptors * Use: * rhinitis * dermatitis * NOT bronchospastic conditions * SE: * dry secretions

Cetirizine | (H1 Antagonist - Non-sedating)

* Effect: * block H1 receptors * Use: * rhinitis * dermatitis * NOT bronchospastic conditions * SE: * dry secretions

Loratidine | (H1 Antagonist - Non-sedating)

* Effect: * block H1 receptors * Use: * rhinitis * dermatitis * NOT bronchospastic conditions * SE: * dry secretions

GLUCOCORTICOIDS | (Effects)

* 2 types of negative feedback on ACTH secretion * enhance Glc production * stim hepatic gluconeogenesis * decrease periph Glc utilization * increase proteolysis/AA release (periph/intestial tissues) * enhance FA mobilization/lipolysis/FA + glycerol release/choleserol synth * potentiate adrenergic VC on small vessels * decrease histamine release -\> decrease capillary perm. * increase plasma [Hb] * increase plasma RBCs, WBCs, PMNs * decrease eosinophils, basophils, monocytes, lymphocytes * induce lipocortin production -\> inhibits phospholipase A2 =\> decrease PGs/Leukotrienes * decrease inflamm mediator release

GLUCOCORTICOID - SE

* decrease gastric mucus barrier -\> bleeding/ulcers * Edema * Hyperglycemia * increased serum TAGs * hypokalema -\> arrhythmias * metabolic alkalosis * hypophosphatemia -\>mm weakness/cardiac dys/hemolysis * osteonecrosis (femoral head) * negative nitrogen balance * insomnia, inc appetite, nervousness, irritability, sleep change, psychotic episodes * growth supp. * myopathy (protein catabolism) * skin thinning + purpura * SCC/BCC * acne, alopecia, hypertrichosis, striae * Cushingoid features * inc IOP (decreased outflow) * enhanced ocular infections/perforations * cataracts * increase infection risk - reactivate TB * HPA supp. * Fetus - cross placenta = cleft palate, fetal renal hypoplasia

Hydrocortisone | (Short-Med Acting)

* GLUCOCORTICOID * Effect: * See Glucocorticoid effect card * strong mineralcorticoid activity * 1-2hr half-life * urine excretion * Use: * adrencortical insuff * anti-inflamm * relief of inflamm to corticosteroid responsive dermatoses * ulcerative colitis * SE: * See SE card

Dexamethasone | (Long-acting Glucocorticoid)

* Effect: * hepatic meta * no mineralcorticoid activity * 5+ hr half-life * urine/feces excretion * Use: * anti-inflamm * immunosupp. * Allergies * bacterial meningitis (before ABX) * collagen disorders (acute exacerbations) - SLE * idiopathic hemolytic anemia/ITP * Respiratory distress syndrome * conjunctivitis * otic inflammation * SE: * see SE card

Metyrapone (Glucocorticoid synth inhibitor + antagonist)

* Effect: * inhibits cortisol and aldosterone * Use: * hypersecretion of adrenalcorticoids

Ketoconazole (Glucocorticoid synth inhibitor + antagonist + Antifungal)

* Effects: * block all sterioid biosynthesis * Use: * Cushing's disease * antifungal * acts synergistically w/ metyrapone

Fludrocortisone | (mineralocorticoid agonist)

* Effect: * control renal excretion of cations * promote reabsorption of Na in distal tubules - maintain blood volume * increase Na/K ATPase * enchance K/H+ excretion * hepatic meta * urine/feces excretion * 30min half-life * Use: * aldosterone replacement * Adrenocortical insuff. - Addison's * SE: * hypokalemia * metabolic alkalosis * increase plasma volume * HTN/edema * convusions, HA, dizziness * acne, rash, bruising * growth supp. * HPA supp * hyperglycemia * peptic ulcer * mm weakness * cataracts

Spironolactone | (mineralocorticoid antagonist)

* Effect: * competes w/ aldosterone * increase Na/H2O excretion * conserve K/H+ * block aldosterone @ arteriolar sm * hepatic meta * 10 min half-life * Use: * manage edema from excessive aldosterone excretion * HTN * CHF * 1˚ hyperaldosteronism * hypokalemia * cirrhotic liver * SE: * Edema * drowsy, lethargy, HA, confusion, fever, ataxia, fatigue * rash, urticaria, hirsutism, eosinophilia * gynecomasta * hyperkalemia, hyponatremia, dehydration * amenorrhea, postmenopausal bleed * agranulocytosis * hepatotox * increased BUN

Doxylamine | (H1 Antagonist - Very Sedating)

* Effect: * H1 competative antagonist * reduce severity of histamine stim: pain, itch, flare, VD, vasc perm increase, and congestion * NO inhibition of mediator release * NO reversal of anaphylactic bronchospasm * Use: * Allergies - Rhinitis, sneezing, wheezing, itchy eye/nose/throat, dermatitis * Cold - nasal irritation * Sedation * decrease resp sec * anticholinergic - parkinson's * SE: * anticholinergic * sedation, drowsy, confusion, amnesia, behavior change * paradoxic CNS stim (kids) * rash * interfere w/ allergy testing

Promethazine hydrochloride | (H1 Antagonist - Very Sedating)

* Effect: * H1 competative antagonist * reduce severity of histamine stim: pain, itch, flare, VD, vasc perm increase, and congestion * NO inhibition of mediator release * NO reversal of anaphylactic bronchospasm * Use: * Antitussive * Allergies - Rhinitis, sneezing, wheezing, itchy eye/nose/throat, dermatitis * Cold - nasal irritation * Antiemetic - motion sick/vert + N/V in preggo - vestibular system/CRTZ * Sedation * decrease resp sec * anticholinergic - parkinson's * SE: * anticholinergic * sedation, drowsy, confusion, amnesia, behavior change * paradoxic CNS stim (kids) * rash * interfere w/ allergy testing

Hydroxine | (H1 Antagonist - Very Sedating)

* Effect: * H1 competative antagonist * reduce severity of histamine stim: pain, itch, flare, VD, vasc perm increase, and congestion * NO inhibition of mediator release * NO reversal of anaphylactic bronchospasm * Use: * Allergies - Rhinitis, sneezing, wheezing, itchy eye/nose/throat, dermatitis * Cold - nasal irritation * Antiemetic - motion sick/vert + N/V in preggo * Sedation * decrease resp sec * anticholinergic - parkinson's * SE: * anticholinergic * sedation, drowsy, confusion, amnesia, behavior change * paradoxic CNS stim (kids) * rash * interfere w/ allergy testing

Dimenhydrinate | (H1 Antagonist - Sedating)

* Effect: * H1 competative antagonist * reduce severity of histamine stim: pain, itch, flare, VD, vasc perm increase, and congestion * NO inhibition of mediator release * NO reversal of anaphylactic bronchospasm * Use: * Allergies - Rhinitis, sneezing, wheezing, itchy eye/nose/throat, dermatitis * Cold - nasal irritation * Antiemetic - vestibular system/CRTZ * decrease resp sec * anticholinergic - parkinson's * SE: * anticholinergic * sedation, drowsy, confusion, amnesia, behavior change * paradoxic CNS stim (kids) * rash * interfere w/ allergy testing

Chlorpheniamine maleate | (H1 Antagonist - Sedating)

* Effect: * H1 competative antagonist * reduce severity of histamine stim: pain, itch, flare, VD, vasc perm increase, and congestion * NO inhibition of mediator release * NO reversal of anaphylactic bronchospasm * Use: * Allergies - Rhinitis, sneezing, wheezing, itchy eye/nose/throat, dermatitis * Cold - nasal irritation * decrease resp sec * anticholinergic - parkinson's * SE: * anticholinergic * sedation, drowsy, confusion, amnesia, behavior change * paradoxic CNS stim (kids) * rash * interfere w/ allergy testing

Meclizine | (H1 Antagonist - Sedating)

* Effect: * H1 competative antagonist * reduce severity of histamine stim: pain, itch, flare, VD, vasc perm increase, and congestion * NO inhibition of mediator release * NO reversal of anaphylactic bronchospasm * Use: * Allergies - Rhinitis, sneezing, wheezing, itchy eye/nose/throat, dermatitis * Cold - nasal irritation * Antiemetic - motion sick/vert - vestibular system/CRTZ * decrease resp sec * anticholinergic - parkinson's * SE: * anticholinergic * sedation, drowsy, confusion, amnesia, behavior change * paradoxic CNS stim (kids) * rash * interfere w/ allergy testing

Cimetidine | (H2 - Antagonist)

* Effect: * competative H2 antagonist - inhibit gastric acid sec. (response to vagal stim, gastrin, stress) * Use: * duo/gastric/stress ulcer * GERD * ZES * pre-op; dec aspiration damage * SE: * HA, dizzy, nausea, rash, itching (elderly w/ renal dz) * antiandrogenic - dec. libido, impotence, gynecomastia * cytopenias * increase [creatinine] * Drug interactions: inhibit hepatic microsomal drug enzymes and alter gastric pH

Ranitidine | (H2 - Antagonist)

* Effect: * competative H2 antagonist - inhibit gastric acid sec. (response to vagal stim, gastrin, stress) * Use: * duo/gastric/stress ulcer * GERD * ZES * pre-op; dec aspiration damage * SE: * HA, dizzy, nausea, rash, itching (elderly w/ renal dz) * Drug interactions: inhibit hepatic microsomal drug enzymes and alter gastric pH

Famotidine | (H2 - Antagonist)

* Effect: * competative H2 antagonist - inhibit gastric acid sec. (response to vagal stim, gastrin, stress) * Use: * duo/gastric/stress ulcer * GERD * ZES * pre-op; dec aspiration damage * SE: * HA, dizzy, nausea, rash, itching (elderly w/ renal dz) * Drug interactions: inhibit hepatic microsomal drug enzymes and alter gastric pH

Nizatidine | (H2 - Antagonist)

* Effect: * competative H2 antagonist - inhibit gastric acid sec. (response to vagal stim, gastrin, stress) * Use: * duo/gastric/stress ulcer * GERD * ZES * pre-op; dec aspiration damage * SE: * HA, dizzy, nausea, rash, itching (elderly w/ renal dz) * Drug interactions: inhibit hepatic microsomal drug enzymes and alter gastric pH

Scopolamine

* Transderm prep - prevents some SEs * Effects: * antimuscarinic * act on vestibular system * Use: * vertigo and motion sickness * SE: * anticholinergic * sedation, confusion, amnesia

Prochlorperazine | (phenothiazine)

antiemetic

Metoclopramide

* Effect: * DA antagonist @ CRTZ * increase GI tone and motility * increase tone of lower eso sphincter * Use: * antiemetic - chemo/radiation * GERD * preop - aspiration vomitus * SE: * sedation * extrapyramidal motor dys

Ondansetron | (5-HT3 antagonist)

* Effect: * depress CRTZ * inhibit seratonin med aff input to GI * Use: * antiemetic - chemo and postop N/V * SE: * drug interaction - hepatic enzyme meta * HA * Constipation

Granisetron | (5-HT3 antagonist)

* Effect: * depress CRTZ * inhibit seratonin med aff input to GI * Use: * antiemetic - chemo and postop N/V * SE: * drug interaction - hepatic enzyme meta * HA * Constipation

Dronabinol | (THC)

* Use: * antiemetic - chemo * SE: * sedation * confusion * disorientation * Loss of control * altered sensation * paranoia * pyschosis * Munchies! - good and bad

Aprepitant

* expensive * Effect: * P/neurokinin receptor (NK1) antagonist * inhibit gastric motility and fxn * Use: * antiemetic - chemo * SE: * well tolerated

Opioid - Codeine/Hydrocodone

* Use: * most effective antitussive * lower dose than analgesic * SE: * sedation * light headedness * confusion * nausea * dizzy * constipation * Abuse potential - dependence

Dextromethorphan

* Non-opiod * Effect: * block NMDA receptors in cough center * Use: * antitussive - mild/mod * lower abuse potential than codeine * SE: * Mild: sedation, dizzy, confusion

Benzonatate

* Effect: * local anesthetic - desens. receptors in airway * some effect @ cough center * Use: * antitussive * SE: * Mild: constipation, nasal congestion, nausea, drowsy, rash

Guaifenesin | (Expectorant)

* Effect: * irritate GI -\> activate reflexes -\> increase mucus in airway * Use: * antitussive

Acetylcysteine | (Mucolytic)

* Effect: * break mucus plug * disrupt disulfide link -\> decrease viscosity * Use: * antitussive * following: surgery, tracheotomy, severe bronch., emphysema * Acetaminophen antidote

Hydroxychloroquine sulfate | (Non-biologic DMARD)

* Effect: * rapid GI abs * Half-life: 6-7d * deposit in tissues (eyes, brain, liver, spleen, lung, kidney, heart) * Use: * 2nd-line for moderate RA w/ methotrexate * SLE * Antimalarial * SE: * Ocular Tox * pigmentation/psoriasis * Contra: Preggo * hypersensativity

Sulfasalzine | (Non-biologic DMARD)

* Effect: * Immunosupp. * CT affinity * High conc. in liver/intestines * Use: * RA w/ hydroxychloroquine + parentral gold + methotrexate * Chronic ulcerative colitis * SE: * reversible neutropenia * Anorexia * HA * vomiting * gastric distress

Leflunomide | (Non-biologic DMARD)

* Effect: * inhibit pyrimidine synth * inhibit dihydroorotate dehydrogenase * Use: * RA (adult) * SE: * Diarrhea * elevated ALT/AST * immunosuppression * rash/alopecia

Etanercept | (Biologic DMARD)

* Effect: * Bind TNF a/b; inhibit receptor binding * mod TNF dependent activities * Use: * RA * JRA * combo w/ methotrexate * SE: * hypersensativity * discontinue in pt w/ sepsis/infections

Infliximab | (Biologic DMARD)

* Effect: * Neutralize TNF-a NOT b * inhibit TNF-a dep activities * Use: * RA * Crohn's * combo w/ methotrexate * SE: * hypersensativity * immunosupp. * infection * HACA Abs

Levothyroxine | (Hypothyroidism)

* Effect: * T4 converted to T3 in periph. * increase dose for preggos or pts on estrogen tx * Use: * hypothyroidism

¹³¹I | (Hyperthyroidism)

* Effect: * thyroid uptakes radioisotope -\> damages tissue * Use: * Hyperthyroidism * thyroid cancer * SE: * low cancer risk * contra: nursing mommies

Propylthiouracil | (Hyperthyroidism)

* Effect: * inhibit iodination reactions (3rd step) * Inhibit iodotyrosines (4th step) * does not inhibit release of preformed T3/T4 * block T4-\>T3 conversion: periph effects before T3/T4 depletion * Use: * hyperthyroidism * good for preggos - more protein binding * SE: * Rash * arthralgia * heptatotox - minor/reversible * Agranulocytosis - fatal * vasculitis - rare * lupus rxn - rare

Methimazole | (Hyperthyroidism)

* Effect: * inhibit iodination reactions (3rd step) * Inhibit iodotyrosines (4th step) * does not inhibit release of preformed T3/T4 * Use: * hyperthyroidism * periph effects before T3/T4 depletion * SE: * Rash * arthralgia * heptatotox - minor/reversible * Agranulocytosis - less than PTU * vasculitis - rare * lupus rxn - rare

KI (Lugol's Solution) | (Hyperthyroidism)

* Effects: * 5% iodine + 10% K * competative uptake of Iodine * inhibit hormone synth (block 1st step) * inhibit release of preformed hormone (6th step) * Use: * radioactive disaster * conjunction w/thionamides * temporary effects * thyroid storm tx * SE: * Rash * salivary gland swelling * metallic taste * sore teeth

Alendronate | (Osteoporosis, Paget's)

* Effects: * inhibit bone resorption w/o impairing mineralization * Use: * Paget's - last for mos, good pain reduction * osteoporosis - increased bone density/decrease fractures * SE: * GI distress * esophageal erosion * take w/ large glass of H2O + sit upright for 30 min

Risedronate | (Osteoporosis)

* Effects: * binds hydroxyapetite in bone - decrease turnover * Use: * Paget's - increase bone density * osteoporosis * SE: * GI distress * esophageal erosion * Take w/ large glass H2O + sit upright for 30 min

Ibandronate | (Osteoporosis)

* Effects: * decrease bone turnover * Use: * 1x/mo dose * osteoporosis * SE: * GI distress * Esophageal erosion * high dose - constipation, flu-like S/S, extremity pain

Zoledronic Acid (Osteoporosis, Hypercalcemia, Paget's)

* Effects: * very potent osteoclast inhibitor * Use: * IV - 1x/y * SE: * fever * N/V/D * constipation * GI pain * osteonecrosis of jaw

Teriparatide | (Osteoporosis)

* Effects: * PTH - increase osteoblast activity -\> increase Ca deposition * increase bone formation in spine and femoral neck * Use: * osteoporosis * SubQ injection, 1x/d, expensive * SE: * osteosarcoma * nausea * dizziness * leg cramps

Raloxifene | (Osteoporosis)

* Effect: * selective estrogen receptor modulation - bone agonist and breast/uterus antagonist (no cancer risk) * Use: * osteoporosis * postmenopasual women * SE: * venous thromboembolism

Calcitriol | (Osteoporosis, Hypoparathyroidism)

* Effects: * potent VitD metabolite - increase Ca abs and decrease Ca/phos excretion * decrease bone resorption * promote osteoblast precursor cell recruitment * Use: * osteoporosis - decrease fractures * hypoparathyroidism * No kidney/liver activation

Calcitonin | (Hypercalcemia, Paget's)

* Effects: * inhibit osteolysis (decrease serum Ca) and increase Ca excretion * from salmon or human * Use: * hypercalcemia * Paget's * postmenopausal osteoporosis * SE: * well tolerated * rash * vomit * facial flushing (salmon version b/c of Ab against salmon)

Pamidronate | (Hypercalcemia)

* Effect: * bisphosphonate substitute - decrease bone turnover * Use: * hypercalcemia of malignancy * decrease bone pain/fracture in MM and metastatic breast cancer * injection; expensive * SE: * Nausea * anorexia * leukopenia * injection site rxn