this glucocorticoid has a SHORT DOA, it’s the preferred medication for cortisol replacement - it’s MOA affects gene transcription (as all in it’s class) - which is it?
Hydrocortisone / Cortef
this glucocorticoid has an INTERMEDIATE DOA, with a potency of 4, which glucocortoid is this?
Prednisone / Deltasone
If given for > 3 weeks - TAPER*
this glucocortoid has a LONG DOA, it’s potency is 30, it’s FLUORINATED and a potent anti-inflammatory agent - name it
Dexamethasone / Decadron
this Sch. II, Cat. C narcotic is known for causing the side effect of RESPIRATORY DEPRESSION - which opioid analgesic is this?
Morphine / MS Contin
works on mu receptor
indicated for ACUTE MI due to peripheral dilation
this narcotic is 80X MORE POTENT than morphine. It comes in various delivery devices including a LOLLYPOP. As a category C pregnancy narcotic - which opioid analgesic is this?
Fentanyl / Duragesic
SE - Resp and CV depression
Grapefruit increases blood concentrations
This black box warning exists for which opioid agonist?
“Respiratory depression and death have occurred in children who receive ____ following tonsillectomy and or adenoidectomy due to ultra-rapid metabolizers wiht a CYP2D6 polymorphism”
Tylenol #3 - 30 mg codeine
Tylenol #4 - 60 mg codeine
Sch. II to V depending on codeine dose
What schedule is heroin?
No prescriptions may be written for Schedule I substances, and they are not readily available for clinical use
this centrally acting analgesic is used for moderate to severe pain - it’s MOA is important in that it acts centrally as a mild agonist in the mu opioid receptors and affects reuptake at noradrenergic and serotonergic systems - which drug is this?
Tramadol / Ultram
- nervous tremor has been reported with weaning
- no respiratory depression as seen in morphine and fentanyl
What’s an important side effect we should be aware of with this irreversible COX 1 and 2 inhibitor?
Aspirin / ASA
- do not give in children < 15-18 years of age
- causes swelling in the liver and brain - fatal
this NSAID is a COX 1 and 2 inhibitor (REVERSIBLE) - it’s initiated for migraine treatment in the pain phase - what is it?
Ibuprofen / Motrin, Advil
Indomethacin is the NSAID indicated for GOUT with SE of HA (random fact)
This was the first injectable NSAID that was a great fake until the narcotics users caught on.
This NSAID is a selective COX-2 inhibitor, decreasing the GI irritation normally associated with NSAID use - however, it does have an increased risk of CVD
Celecoxib / Celebrex
This NSAID is thought to have a strong CNS block (at the hypothalamus) of COX-3 inhibiting prostaglandin synthesis, it also weakly inhibits COX 1 and 2 in the periphery - which NSAID is this famous fever decreaser that we should, as NDs advise our patients to avoid.
Tylenol / Acetaminophen
Fever is our Friend Other fun Tylenol facts: DOA 4-6 hours, do not exceed 7g in 24 hrs. NEVER MIX WITH ETOH NAPQI - toxic metabolite
this is commonly injected for short-term pain relief and reduced swelling from inflammation of joints, tendors or bursa. It’s normally injected, but can be given PO, IM, IV and in a spray or topical formulation - what is this gout medication that works to decrease phospholipase A2 (effectively stopping arachidonic acid production)
This is a mitotic inhibitor used to treat ACUTE GOUT flares while also being an effective preventative. It does have the unfortunate side effect of peripheral neuropathy and in OD can cause ARF and hypovolemic shock - what is this gout drug?
All ACUTE gout TX are:
- Colchicine! (DOUBLE WHAMMY! It also prevents!)
this purine analog works as a xanthine oxidase inhibitor to treat prophylactically against gout - what is this medication that can cause Steven Johnson Syndrome as a rare, but not so awesome side effect
Allopurinol / Zyloprim
not used acutely, need 2+ weeks for it to be effective
SE - Steven Johnson Syndrome
This gout medication is a prophylactic agent. It works by increasing urinary excretion of uric acid (a uricosuric) by inhibiting the ORGANIC ANION TRANSPORTER - it is NOT used ACUTELY - what is it?
Probenecid / Probalan
C/I with salicylates
Can increase blood levels of penicillin*
This PROPHYLACTIC migraine medication is a non-selective beta blocker - with this MOA, it has the unfortunate side effect of bronchoconstriction - what is it?
Propranolol / Inderal
This medication is used to treat migraine at the prodrome state. It’s a SEROTONIN AGONIST given PO/SQ or as a NASAL SPRAY* - with a rare side effect of serotonin syndrome - which commonly used medication is this?
Sumatriptan / Imitrex
works on 5-HT1B and D receptors
SE - Acute MI
This is used for the PAIN phase of MIGRAINE. It’s an opioid analgesic that comes in the convenience of a NASAL SPRAY - which medication is this?
Butorphanol / Stadol
This is an anti-emetic commonly used for migraine headaches - it’s a H1 histamine receptor antagonist that drops the seizure threshold while also causing EXTRAPYRAMIDAL effects of lip smacking, sticking out tongue, face and arm movements if given at high doses for too long - name this typical neuroleptic!
Prochlorperazine / Compazine
SE Extrapyramidal effects/Tardive Dyskinesia
this immune modulating medication works as an anti-metabolite and anti-folate - with an MOA of folate antagonism, it can cause side effects of pneumonitis and PULMONARY FIBROSIS. It’s used for autoimmune diseases - name it
Methotrexate / MTX
- if used for CA treatment, do not give folic acid
- Cat X for PREG
this immunosuppressant derived from soil fungus works by inhibiting T cells - making it an effective drug for prevention of organ transplant rejection - what drug is this?
Cyclosporine / Sandimmune
blood levels increase with grapefruit
this immunosuppressant from the macrolide class of antibiotics, extracted from soil microorganisms utilizes T cell inhibition to treat SEVERE ECZEMA - while being 100x more potent than cyclosporine - what is this medication targeting calcineurin
Tacrolimus / Prograf
This DMARD, recombinant DNA drug is used to treat severe RA and other AI disease by reducing the inflammatory response by anti-TNF alpha therapy - it does NOT help with IBD. Given SQ - what is this?
Enteracept / Enbrel
other anti-TNF DMARD that DOES work for UC/Crohns
Infliximab/Remicade** d/t APOPTOSIS (IV only)
this immunosuppressant is an anti-malarial as well, it blocks the activation of TLR on plasmacytoid dendritic cells. IT’s also an anti-spirochete - what is this drug that can cause possible corneal and macular damage therefore requiring dilated eye exams annually when used?
Hydroxychloroquine / Plaquenil
this anti-mitochondrial medication reduces inflammation by suppressing phagocytosis and lysosomal enzyme activity when taken up by macrophages - what is this medication commonly given to kiddos refractory to other treatment?
gold salts / auranofin
This antidepressant works by preventing breakdown of catecholamines in the CNS. When patients are using this (generally, it’s only RX’d in refractory patients) they must be careful to avoid these foods due to the increased risk of fatal HTN
- AVOID TYRAMINE CONTAINING FOODS
(all the good ones, wine, cheese, chocolate.. take all of those away and be sure another SE is increased depression)
this tricyclic antidepressant causes the side effects of dizziness, drowsiness, and the anticholinergic side effects that are opposite of sludge.. What is this medication used to treat major depression and bipolar disorder - with a potential for flu-like symptoms called “discontinuation syndrome”
Amitriptyline / Elavil
- cardiotoxic, prolongs QT interval
- 10X daily dose is toxic
this tetracyclic antidepressant works by inhibiting serotonin reuptake while being a partial antagonist effectively increasing serotonin levels in the synapse - what is it?
Trazodone / Desyrel
- treats anxiety, sleep and ED
This SSRI* decreases serotonin uptake at presynaptic cleft - it’s used for major depression and OCD - What is it?
Fluoxetine / Prozac
- NSAIDs may increase risk of GI bleed
- Serotonin Syndrome (agitation, ataxia, tremor, etc)
- ok’d for use in children
Paxil is SSRI not ok for kids
This SNRI* is indicated when the depression is accompanied by peripheral neuropathy and fibromyalgia - with a black box warning of increased risk of suicidal thinking in 18-24 year olds with MDD and other psychiatric d/o’s
Duloxetine / Cymbalta
C/I with heavy alcohol use
This NDRI* with some nicotinic receptor antagonism is used to treat depression as well as aid in smoking cessation - what is it?
Bupropion / Wellbutrin
This antipsychotic (typical neuroleptic) can cause PARKINSONIAN symptoms, extrapyramidal SE such as tardive dyskinesia and can increase prolactin - what is the D2 R blocker?
Chlorpromazine / Thorazine
this typical neuroleptic is a H1 receptor ANTAGonist - indicated mostly as an anti-emetic to decrease nausea and vomiting - what it is?
Prochlorperazine / Compazine
- 10-20X more potent than Chlorpromazine w/o Parkinsonian SE
this typical neuroleptic is indicated for ACUTE AGITATION BEHAVIOR - by working chiefly as D2 dopaminergic R blockers - Vitamin H
Haloperidol / Haldol
- Parkinsonian SE*
- Neuroleptic Malignant Syndrome
this atypical neuroleptic can cause acute psychosis if withdrawn too quickly from therapy. It has the unfortunate side effect of WEIGHT GAIN and hyperglycemia, DM and stroke (in the elderly). What is this dopamine, serotonin blocker?
Respiradone / Risperdal
Olanzapine/Zyprexa is the other atypical that causes stroke in elderly
This short-acting non-benzo hypnotic is used for initiating sleep for those with insomnia - what is it?
Zolpidem / Ambien
this melatonin AGonist, sedative hypnotic works by binding MT1 and MT2 receptors, with no GABA binding effect (therefore not an anxiolytic) - what drug is this
Ramelteon / Rozerem
this benzodiazepine ANTAGONIST (ie ANTIDOTE) reverses CNS depression caused by benzo overdose - what is this drug that need to be administered every 1-2 hours with increased risk of withdrawal syndrome?
Flumazenil / Romazicon
- remember, charcoal does not work in benzo OD unless alcohol is involved or other charcoal sensitive agents
This barbituate is an anticonvulsant that is cat D for pregnancy, and only given if life-threatening condition - what is this?
Primidone / Mysoline
Phenobarbital is a known metabolite of primidone
This benzodiazepine is indicated for STATUS EPILEPTICUS - however, Lorazapam is commonly used in place of it due to a longer half life - which second choice drug is this?
Diazepam / Valium
- works on voltaged gated Cl channels
This is a LONG ACTING benzo with marked abuse potential and the ability to decrease IQ in children
Clonazepam / Klonopin
this anticonvulsant has the unfortunate side effect of GINGIVAL HYPERPLASIA and NYSTAGMUS - with a SLOW ONSET and LONG half-life - name this seizure prophylaxis drug
Phenytoin / Dilantin
- Ethosuximide/Zarontin (absence seizure drug)
this anticonvulsant also causes the unfortunate side effect of GINGIVAL HYPERPLASIA as well as LUPUS LIKE SYNDROME - it’s indicated for ABSENCE seizures and can increase phenytoin levels dt liver metabolism - what is it?
Ethosuximide / Zarontin
this anticonvulsant, atypical analgesic affects N-type Ca channels and is specifically indicated for POST-HERPETIC NEURALGIAs as well as migraines
Gabapentin / Neurontin
- can be added to monotherapy in anticonvulsants where monotherapy is goal
This anticonvulsant decreases excitatory effects of glutamate and aspartate - it’s used for partial seizures as well as treatment of BIPOLAR TYPE I disorder - name this sucker
Lamotrigine / Lamictal
works by decreasing effects of glutamate and aspartate (excitatory)
This is the first line therapy for Parkinsons
- definitive tx
- generally combined with Sinemet to increase bioavailability of this dopamine precursor to CNS by blocking conversion peripherally
this is the second line therapy for Parkinsons, with additional indications for PROLACTIN SECRETING ADENOMAS
Bromocriptine / Parlodel
SE - pulmonary fibrosis (also TX this)
This antiviral is indicated as third line therapy for Parkinsons, but also for INFLUENZA A tx, it antagonizes NMDA receptors diminishing dopamine reuptake - what is this?
Amantadine / Symmetral
- sadly, only good for approx. 6 mo of treatment
This fourth line medication for Parkinson’s is especially indicated for TREMOR and DROOLING - it’s side effects are the most desired - as an anticholinergic - it can dry the mouth. However, it also causes constipation, hallucinations, psychosis.. What is this palliative tx?
Benztropine / Congentin
SE - Toxic Psychosis (antidote with Physostigmine)
This drug is a synthetic replacement of T4, used commonly for hypothyroidism - long term use can increase risk of CVD and osteoporosis (therefore take caution when dosing in 65 yrs +) which drug is it?
effective in 6-8 weeks (steady state levels)
SE - CVD, Osteoporosis
This drug, if given before cortisol replacement in Addisons - can be fatal - what is it?
Thyroid replacement before Cortisol can be fatal!
What are the equivalencies of Levo to Armour to Cytomel?
Thyroid USP/Armour - 60mg
Levothyroxine - 100mcg
this synthetic T3 replacement is used for hypothyroid, however have increased risk of what?
increased risk of CVD and OSTEOPOROSIS
this thioamide is 10x more active than PTU - blocking T4 to T3 conversion in the CNS, used to treat HYPERthyroid and given IV admin for thyroid storm - what is it and what side effect is a huge problem with this medication (also making is C/I in pregnancy)
Methimazole / Tapazole
** DO NOT DOSE LONGER THAN 6-12 months **
This thioamide works mostly by blocking PERIPHERAL conversion of T4 to T3 - it is generally NOT used for thyroid storm
Propylthiouracil / PTU
Cat D for pregnancy - only use if benefits outweigh risks
With this hyperthyroid treatment - which works by large doses blocking release of thyroxine from the thyroid gland - has benefits that last 2-3 weeks without the SE of HYPERKALEMIA - which element is this?
Iodine / Super Saturated Potassium Iodine (SSKI)
This biguanide works by decreasing hepatic glucose production and has the potential to cause B12 deficiency as well as lactic acidosis - but for a pharmaceutical? It’s a badass diabetes drug and generally first line for type II - what is it?
Metformin / Glucophage
metformin hydrochloride (500mg)
T PO bid ac
this second line therapy for diabetes works by stimulating intact beta cells to release insulin - it can cause weight gain, cat C for pregnancy and becomes ineffective in 5-10 years - which drug is this and when is it strictly contra-indicated?
(first generation sulfonylurea)
CI in SULFA ALLERGY*
this meglitinide - ie a non-sulfonylurea secreagogue binds ATP sensitive K channels stimulating beta cells to release insulin - what is this medication?
Nateglinide / Starlix
SE hypoglycemia and WEIGHT GAIN
this thiazolidinediones helps to improve insulin sensitivity in muscle and fat while decreasing hepatic glucose production - it takes 6-14 weeks to be effective - what is this?
Rosiglitazone / Avandia
NOT ok to use with INSULIN
however, it’s sister glitazone ACTOS is approved with insulin
This TZD is expensive and can cause CHF as a side effect - what is this?
Pioglitazone / ACTOS
this alpha-glucosidase inhibitor interferes iwth hydrolysis of CHO at the brush border - delaying glucose absorption - what is this drug that must be given STRAIGHT GLUCOSE if OD’d
Acarbose / Precose
This DPP-4 inhibitor cannot be combine with insulin because it’s MOA involves increasing insulin secretion - what is this medication?
Sitagliptin / Januvia
this bisphosphonate both prevents and treats osteoporosis by inhibiting osteoCLAST activity, however it has a shitty side effect of ESOPHAGITIS - what is this
Alendronate / Fosamax
- must take without food, while remaining upright x30-60 mins to reduce risk of esophagitis
2 others TREAT osteoporosis
- Calcitonin / Miacalcin
this synthetic hormone used to treat osteoporosis by inhibiting osteoCLAST activity - is given as a NASAL SPRAY
Calcitonin / Miacalcin
2 others TREAT osteoporosis
this human monoclonal antibody treats osteoporosis by targeting RANKL (protein promoting bone removal via osteoclasts)
Denosumab / Prolia
other RANKL drug
- Teriparatide/Fortea - synthetic PTH, increases RANKL expression while increasing calcium availability (like PTH)
What’s the recommended dosage of vitamin D for infants?
this synthetic progestin can be used to chemically castrate sex offenders within days at high doses - what is this hormone replacement therapy that can also increase LDL and risk of DVT?
Medroxyprogesterone / Provera
cannot use for >2years if contraceptive - increases risk of osteoporosis.
This synthetic spironolactone can be used to treat premenstrual dysphoric disorder (PMDD)
Drospirenone / YAZ
This device is a combination of estrogen and progestin that is worn for 3 weeks, with 1 week off to allow for menstruation - what is this?
This is a copper IUD
how long is the Mirena (levonorgesterel - long acting progestin) active? what dose is in this IUD?
5 year effective
52mg LNG initially, secretes 20mcg/day
Liletta is the SAME
Skyla - effective 3 yrs, 13.5mg LNg, 14mcg/day
how effective is this emergency contraceptive that is progestin only and suggested to be used within 72 hours of unprotected sex
Plan B / Ella
selective progesterone receptor modulator
this progestin antagonist can be used in the first 2 mo of pregnancy as an abortant (initiating labor) - what drug is this?
Mifepristone / mifeprex
given with misoprostol (prostaglandin antagonist) can use 200mg instead of 600mg
this SERM is used for infertility - it binds E receptor sites in the brain increasing GnRH which increases LH and FSH secretion - stimulating ovulation
Clomiphene / Clomid
this sex hormone suppressant works as a SYNTHETIC ANALOG to GnRH effectively interrupting production of T and E - given SQ/IM - this drug is used to treat prostate cancer or precocious puberty
Leuprolide / Lupron
this type II ALPHA REDUCTASE INHIBITOR limits the conversion of T to it’s active form DHT - making it an anti-androgen - it’s effective for BPH but also alopecia.. what is this>
Finasteride / Proscar / Propecia
- TERATOGENIC - women, beware! Do not touch, do not sniff, do not hang out with!
Viagra - increases NO which leads to increased cGMP activation allowing for SM relaxation and vasodilation - ta-da! Erection! What enzyme does it inhibit?
this anticholinesterase is used to TX alzheimers, but can be used in autistic children to increase their vocabulary and expressive language
Donepezil / Aricept
Centrally acting, 100% bioavailable PO
this anticholinesterase is most beneficial for patients with aggressive disease progression of dementia and hallucinations - what is it and what additional enzyme is blocked that makes it so effective for hallucinations - also - it’s so damn convenient with it’s PATCH administration.. You don’t even know you’re being treated!
Rivastigmine / Exelon
- inhibits BUTYRYLCHOLINESTERASE
this dementia medication works on the NMDA receptor by modulating the Ca influx and decreasing excitability of the neuron - what is this?