Exam 4 flashcards Flashcards by Ben Archambeau

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

RHO 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 LI 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