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Flashcards in Pharm Deck (79):
1

Dronabinol (THC isomer)

antimemetic after chemo and to increase appetite in AIDS pts

2

Methadone

long-acting oral opiate; used in long-term Tx of heroin addiction and for maintenance; also given in opioid withdrawal

3

Naloxone + buprehorphine

partial opioid agonist; long-acting like methadone but with fewer withdrawal symptoms; naloxone is not active orally--> withdrawal only if injected--> decreases abuse potential

4

Naltrexone

long-acting opioid antagonist; used for relapse prevention once detoxified; also used for alcohol addiction

5

disulfiram

conditions to obstain from alcohol use

6

IV vitamin B1

Tx for WErnicke-Korsakoff syndrome (ass with periventricular hemorrhage/necrosis of mamillary bodies

7

Mirtazapine

Tx of depression with insomnia

8

typical antipsycotics include; mech; ADEs

Haloperidol + -azine drugs;
all block D2 R--> increase in cAMP;
used for positive symptoms of schizophrenia, psychosis, Tourettes, acute mania.
Highly lipid soluble;
EXTRA-pyramidal ADEs; decrease in prolactine--> galactorrhea; block muscarinics--> dry mouth, constipation; block alpha1--> hypotension; H Rs--> sedation
NMS; tardive dyskinesia

9

Tx of EPS from typical antipshychotics

Benztropine; diphenhydramine

10

NMS

neuroleptic malignant syndrome - due to use of antipsych; rigidity, myoglobinuria, autonomic instability, hyperreflexia. Tx: D2 agonist (bromocriptine), dantrolene

11

High potency antipsych

Haloperidol, Trifluoperazine, fluphenazine--> EPS

12

low potency antipsych

chlorpromazine and Thioridazine--> no EPSP but anticholinergic and antiadrenergic, and antihistaminorgic ADEs

13

NMS and tardive dyskinesia (stereotypical oral-facial movement) ass with use of

Haloperidol

14

NMS --> think FEVER

fever; encephalopathy, vitals unstable, enzymes elevated; rigidity of muscles

15

chlorpromazine ass with ADE

Corneal deposits

16

thioridazinea ass with ADE

reTinal deposits

17

EPS evolution (four 4's)

4day- acute dystonia; 4 day- akathisia (restlessness); 4 wk- parkinsonism; 4 mo--> tardive dykinesia

18

atypical antipsych (less sedation and EPS)

It's atypical for OLd CLOSets to QUIEtly RISPER from A to Z:
olanzapine; clozapine; quetiapine; risperidone; aripiprazole; ziprasidone.
Used for schizo (+and-), OCD, bipolar, anxiety, depression, mania, tourettes.

19

alanzapine and clozapine lead to

weight gain

20

Clozapine ADE

agranulocytosis--> requires weekly WBC monitoring; seizures

21

Risperidone ADE

increase in prolactine--> lactation, gynecomastia, decrease in GnRH, LH, FSH--> irregular menstruation and infertility

22

Ziprasidone ADE

QT prolongation

23

Lithium ADEs

LMNOP:
lithium side effects:
movement- tremor
nephrogenic diabetes insipidus (ADH antagonist)
hypothyroidim
pregnancy problems - fetal cardiac defects (Ebstein anomaly is a congenital heart defect in which the septal leaflet of the tricuspid valve is displaced towards the apex of the right ventricle of the heart), malformation of great vessels;
excreted by kidneys; most reabs in proximal convoluted tubule following Na reabs; narrow therpeutic window

24

Buspirone

slow onset of action - 2 weeks; used in generalized anxiety; stimulates 5-HT1a; no ineraction with alcohol; no major ADEs

25

SSRIs

fluoxetine, paroxetine, sertraline, citalopram;
GI; sexual dysfunction;
SEROTONIN SYNDROME

26

serotonin seyndrome

any drug that incr 5-HT (MAOinh, TCA, SSRIs, SNRIs)- hyperthermia, confusion, seizures, myoclonus, CV collapse, flushing, diarrhea. Tx: cypraheptodine

27

cypraheptodine

5-HT2 antagonist; Tx of serotonin syndrome - hyperthermia, confusion, seizures, myoclonus, CV collapse, flushing, diarrhea. Tx: cypraheptodine

28

venlafaxine, duloxetine

SNRIs;
both for depression;
venlafaxine- generalized anxiety and panic disorders
duloxetine- diabetic peripheral neuropathy
ADEs: BP elevation, nausea, sedation

29

TCAs

-tryptiline; -ipramine; doxepin and amoxapine;
Clomipramine- OCD
ADEs:
alpha1 block--> postural hypotension; anticholinergic- tachycardia, urinary retention, dry mouth (>in amytryptiline (3) than nortryptiline - secondary); --> use nortryptilin in elderly.
Convulsion, Coma, Cardiotoxicity; repiratory depression; hyperpyrexia.
For cardio toxicity: NaHCO3.

30

MAO inhibitors

nonselective inhibition leads to increased levels of amine neurotransmitters
MAO Takes Pride In Shanghai:
Tranylcypromine
phenelzine
isocarboxazid
selegline (selective MAO-B)
ATYPICAL DEPRESSION, anxiety, hipochondriasis

31

MAO inhibitos are contraindicated with

Tyramine- wine and cheese--> hypertensive crisis;
SSRIs, TCAs, St, John Wart, meperedine, dextromethorphan- to prevent serotonin syndrome.

32

somatostatin analog

used to treat acromegaly; decr in GH and TSH

33

bromocriptine

DA R agonist--> inhibits prolactine secretion--> Tx. prolactinoma

34

*somatotropine - GH

secreted from ant pituitary; stim linear growth and muscle mass through IGF-1/somatomedin secretion (insulin-like growth factor); diabetogenic- increases insulin resistance.

35

desmopressin

ADH analog; tx of central DI

36

ketoconazole

inhibition of CHolesterol to pregnelone conversion by cholesterol desmolase (1st step in cholesterol metabolism)

37

propylthiouracil

inhibits peroxidase and 5'-deiododinase (no T4 to T3 conversion, MIT and DIT coupling, oxidation and organification of iodide)

38

Methimazole

inhibits peroxidase only (not 5'-deiododinase)

39

spironolactone

used in primary and secondary hyperaldosteronism

40

primary and secondary adrenal insuff
Addison's disease

chronic primary: atrophy or destruction of adrenal--> no hormone production from all three division of cortex (doesn't affect medulla)--> increased ACTH production--> increased MSH production--> hyperpigmentation.
secondary---> decrease in pituitary ACTH production--> no hyperpigmentation.

41

Watterhouse-Friderichsen syndrome

primary adrenal insuff due to adrenal hemorrhage ass with N. meningitis septicemia, DIC, and endotoxic shock

42

Tx of thyroid storm

Propranolol, Propilthyouracil, Prednisolone;
massive stress-ind release of catecolamines--> fever, delirium, coma, death due to tachycardia; +/- elevated ALP due to increased bone turnover

43

DI Tx (central and nephrogenic)

central: hydration and DDAVP- ADH analog;
nephrogenic: hydration + HCTZ, indomethacine, amiloride

44

cyclophosphomide

alkylating agent; used to Tx Hodgkin's lymphoma; may lead to SIADH (+/-cerebral edema, seizures)

45

SIADH Tx

fluid restriction (low serum Na); IV HYPERtonic saline;
conivaptam, tolvaptam, (vaptam drugs are vasopressin R antagonists); demeclocycline (teracycline antibio)

46

zero-order kinetics

PEA - phenytoin, ethanol, aspirin (PEA is round shaped like 0); constant amount of drug eliminated per unit time--> doesnt depend on drug concentration; target plasma concentration Cp decreases linearly.

47

urine pH affects drug elimination

weak acids- phenobarbital, MTX, aspirin - trapped in basic urine--> Tx overdose with bicarbonate (alkalise);
weak bases - amphetamine- trapped in acidic environment--> Tx with ammonium chloride.

48

flumazenil

competitve inhibitor of BNZ on GABA receptors

49

ketamine

noncompetitve antagonist of glutamate on NMDA Rs

50

Phenoxybenzamine

irreversible competitive anatgonist of NE on alpha-Rs

51

morphine vs buprenorphine

full agonist vs partial agonist at opioid mu receptors

52

narrow therapeutic window/low therapeutic index drugs

TI=median toxic dose/median effective dose;
digoxin, lithium, theophyline, warfarin

53

QISS and QIQ until you are SIQ of Super Qinky Sex

G protein coupling of:
alpha1, alpha2, beta1, beta2, M1, M2, M3, D1, D2, H1, H2, V1, V2.

54

metyrosin

inhibits tyrosine to DOPA conversion

55

reserpine

inhibits DA to NE conversion

56

Cocaine, TCA, amphetamine

prevent NE reuptake; amphetmaine also promotes NE release

57

bretylium, guanethidine

inhibit NE release

58

hemicholinium

inhibits choline from interacting with acetyl-CoA to produce Ach

59

vesamicol

prevents Ach packaging into presynaptic vesicles

60

botulinum

cleaves SNAREs--> prevents vesicle with Ach binding to the membrane --> prevents Ach release

61

bethanechol

Achomimetic; resistant to AchE; activates bladder and bowel smooth muscle in postoperative or neurogenic ilius and urinary retention

62

carbacol

CARBon copy of Ach; Tx: glaucoma, pupillary constriction, and relief of intraocular pressure

63

methacholine

challenge test for asthma; stimulates M Rs in airways

64

pyridostigmine

indirect cholinergic agonist; inc enodogenous Ach; incr strenght; LONG acting; Tx for myastenia gravis

65

physostigmine

like pyridostigmine BUT crosses BBB

66

Tx of alzheimers

donepezil, rivastigmine, galantamine- incr endogenous Ach

67

edrophonium

used to be used for myasthenia gravis Dx (now antiAch-R Ab); extremely SHORT acting; incr endogenous Ach

68

Pilocarpine

you sweat, drool, and cry on your PILlow--> stimulation of sweat, tears, and saliva; Tx of open and closed angle glaucoma (contracts pupillary sphincter and ciliary muscles of the eye respectively)

69

cautions with cholinergic drugs

COPD, asthma exacerbations; PUD

70

anticholinesterase inhbitor poisoning (aka too much Ach)

DUMBBELSS; with organophosphates--> in farmers; Tx: atropine (competitve inhbitor) + pralidoxime (regenrate AchE)

71

benztropine

muscarinic antagonist; Park my Benz-- Tx of Parkinsons

72

atropine, homatropine, tropicamide

eye--> cycloplegia and mydriasis; muscarinic antagonist;
atropine blocks DUMBBeLSS (not Excitation of skeletal muscles and CNS because those are nicotinic Rs);
decr in airway secretion, acid secretion in the stomach, motility, urgency in cystitis; used to treat bradychardia

73

scopolamine

motion sickness; muscarinic antagonist

74

ipratropium, tiotropium

COPD and asthma; muscarinic antagonist

75

oxybutynin, darifenacin, solifenacin, tolterodine, fesoterodine, trospium

muscarinic antagonist; reduce urgency in mild cytitis, reduce bladder spasm

76

glycopyrrolate

muscarinic antagonist; parenteral to reduce airway secretion before surgery; oral- drooling and ulcers

77

anticholinergic toxicity

incr in body temp (due to decr in sweating); dry, flushed skin, rapid pulse, dry mouth, cycloplegia, constipation, disorientation; angle-closure glaucoma (in elderly- mydriasis), urinary retention in men with prostate hyperplasia, hyperthermia in infants

78

Jimson weed

gardner's pupil - mydriasis du eto plant alkaloids

79

insulin drugs

rapid acting insulin: Lispro, Aspart, Glulisine;
short acting: regular insulin
intermidiate acting: NPH
long-acting: Glargine, Detemir