Pharm Flashcards
(450 cards)
1
Q
Bethanechol - MoA
A
Cholinomimetic - activates bladder and bowel smooth muscle; resistant to AChE
2
Q
Carbachol - clinical use
A
constricts pupil and relieves intraocular pressure in glaucoma
3
Q
Carbachol - MoA
A
Cholinomimetic - binds ACh receptor
4
Q
Methacholine - Clinical use
A
challenge test for asthma diagnosis
5
Q
Methacholine - MoA
A
cholinomimetic - stimulates muscarinic receptors in airway causing bronchoconstriction
6
Q
Pilocarpine - clinical use
A
stimulator of sweat, tears, and saliva
treats open angle and closed angle glaucoma
7
Q
Pilocarpine - MoA
A
Cholinomimetic - contracts ciliary muscle of eye (open-angle glaucoma), contracts pupillary sphincter (closed-angle glaucoma); resistant to AChE
8
Q
Rivastigmine/Donepezil - clinical use
A
alzheimer disease
9
Q
Rivistigmine/Donepezil - MoA
A
Anti-cholinesterase - increases ACh
10
Q
Edrophonium - clinical use/MoA
A
diagnosis of myasthenia gravis (improves symptoms by increasing ACh in synapse)
11
Q
Neostigmine - clinical use
A
Post-op and neurgenic ileus and urinary retention; myasthenia gravis, reversal of NMJ blockade
12
Q
Neostigmine - MoA
A
Anti-AChE - increases ACh
No CNS penetration
13
Q
Physostigmine - clinical use
A
anticholinergic toxicity (atropine overdose)
14
Q
Physostigmine - MoA
A
anti-AChE - increases ACh
Crosses BBB - CNS activity
15
Q
Pyridostigmine - clinical use
A
myasthenia gravis - long acting, increases muscle strength
16
Q
Pyridostigmine - MoA
A
anti-AChE - increases ACh
Does NOT penetrate CNS
17
Q
Cholinomimetic agents - contraindications
A
exacerbation of COPD, asthma, and peptic ulcers in susceptible patients
18
Q
Cholinesterase inhibitor poisoning
A
Organophosphates - irreversibly inhibit AChE
DUMBBELSS - diarrhea, urination, miosis, bronchospasm, bradycardia, excitation of skeletal muscle and CNS, lacrimation, sweating, salivation
Antidote - Atropine + Pralidoxime (given early - regenerates AChE)
19
Q
Atropine - clinical use
A
treat bradycardia and for ophthalmic applications (produces mydriasis and cycloplegia)
20
Q
Atropine - MoA and effects
A
Muscarinic antagonist: Eye - pupil dilations and cycloplegia Airway - decreases secretions Stomach - decreases acid secretion Gut - decreases motility Bladder - decreases urgency (cystitis)
21
Q
Atropine toxicity
A
Atropine Man - HOT as a hare (inc body temp due to dec sweating) DRY as a bone (dry mouth, dry skin) RED as a beet (flushed skin) BLIND as a bat (cycloplegia) MAD as a hatter (disorientation)
22
Q
Benzotropine - clinical use
A
Parkinson disease, acute dystonia
23
Q
Benzotropine - MoA
A
muscarinic antagonist (CNS)
24
Q
Glycopyrrolate - clinical use
A
parental: preop use to reduce airway secretions
Oral: decrease drooling, peptic ulcers
25
Glycopyrrolate - MoA
Muscarinic antagonist - GI/Respiratory
26
Hyocyamine/dicyclomine - clinical use
antispasmodics for IBS
27
Hyoscyamine/dicyclomine - MoA
muscarinic antagonist - GI
28
ipratropium/tiotroprium - clinical use
COPD and asthma relief
29
ipratropium/tiotropium - MoA
muscarinic antagonist - Respiratory
30
solifenacin/tolterodine - clinical use
reduce bladder spasms and urge urinary incontinence - overactive bladder
31
solifenacin/tolterodine - MoA
muscarinic antagonists - genitourinary
32
scopolamine - clinical use
motion sickness
33
scopolamine - MoA
muscarinic antagonist - CNS
34
Albuterol/Salmeterol - clinical use
Albuterol - acute asthma
| Salmeterol - long-term asthma/COPD control
35
Albuterol/Salmeterol - MoA
sympathomimetic - B2>B1 adrenergic agonist
36
Dobutamine - clinical use
heart failure (inotropic>chronotropic), cardiac stress testing
37
dobutamine - MoA
sympathomimetic - B1>B2,alpha adrenergic agonist
38
Dopamine - clinical use
unstable bradycardia, HF, shock
| inotropic and chronotropic alpha effects predominate at high dose
39
dopamine - MoA
sympathomimetic - D1=D2> beta > alpha adrenergic agonist
40
Epinephrine - clinical use
anaphylaxis, asthma, open-angle glaucoma
alpha effects predominate at high dose
41
epinephrine - MoA
sympathomimetic - beta > alpha adrenergic agonist
much stronger effect at B2-receptor than norepinephrine
42
isoproterenol - clinical use
electrophysiologic eval of tachycardia; can worsen ischemia
43
isoproterenol - MoA
sympathomimetic - B1 = B2 adrenergic agonist
44
norepinephrine - clinical use
hypotension (decreases renal perfusion)
45
norepinephrine - MoA
sympathomimetic - alpha1 > alpha 2 > B1 adrenergic agonist
Significantly weaker at B2 than epinepherine
46
Phenylephrine - clinical use
Hypotension (vasoconstrictor); ocular procedures (mydriatic); rhinitis (decongestant)
47
Phenylephrine - MoA
sympathomimetic - alpha 1 > alpha 2 adrenergic agonist
48
amphetamine - clinical use
narcolepsy, obesity, ADHD
49
amphetamine - MoA
indirect sympathomimetic general agonist
reuptake inhibitor
releases stored catecholamines
"turns on the faucet and blocks the drain"
50
cocaine - clinical use
vasoconstriction and local anesthesia
51
cocaine - MoA
```
indirect sympathomimetic - general agonist
reuptake inhibitor (blocks the drain)
```
52
cocaine - contraindications
do not give beta-blockers when suspected cocaine intoxications - can lead to unopposed alpha 1 activations -> extreme hypertension
53
ephedrine - clinical use
nasal decongestion, urinary incontinence, hypotension
54
ephedrine - MoA
indirect sympathomimetic - general agonist
| releases stored catecholamines
55
Clonidine - clinical use
hypertensive urgency, does not decrease renal blood flow
56
Clonidine - MoA
sympatholytic - alpha 2 agonist
57
Clonidine - toxicity
CNS depression, bradycardia, hypotension, respiratory depression, miosis
58
methyldopa - clinical use
HTN in pregnancy
59
methyldopa - MoA
sympatholytic - alpha 2 agonist
60
Methyldopa - toxicity
SLE-like syndrome, direct Coombs + hemolysis
61
Bethanechol - clinical use
postop ileus, neurogenic ileus, urinary retention
62
Phenoxybenzamine - clinical use
pheochromocytoma (preoperatively) to prevent catecholamine crisis (hypertension)
63
phenoxybenzamine - MoA
alpha blocker (irreversible)
side effects - orthostatic hypotension and reflex tachycardia
64
Phentolamine - MoA
alpha blocker (reversible)
side effects - orthostatic hypotension and reflex tachycardia
65
Phentolamine - clinical use
give to patients on MAI inhibitors who eat tyrosine rich foods
66
Mirtazapine - clinical use
anti-depressant
side effects - sedation, increased serum cholesterol, increased appetite
67
Mirtazapine - MoA
alpha 2 selective blocker
68
Prazosin, terazosin, doxazosin, tamsulosin (-osin) - MoA
Selective alpha 1 blocker
69
Prazosin, terazosin, doxazosin, tamsulosin (-osin) - clinical use
urinary symptoms of BPH, PTSD (prazosin)
hypertension (NOT tamsulosin)
side effects - first dose orthostatic hypotension, dizziness, headache
70
Beta blocker effects - Angina
decrease heart rate and contractility, resulting in decreased O2 consumption
71
Beta blocker effects - MI
decrease mortality (metoprolol, carvedilol, bisoprolol)
72
beta blocker effects - SVT
decrease AV conduction velocity - class II antiarrhythmics (esmolol and metoprolol)
73
Beta blocker effects - hypertension
decrease CO, decrease renin secretion
74
Beta blocker effects - HF
decrease mortality in chronic HF
75
Beta blocker effects - glaucoma
Timolol - decreases secretion of aqueous humor
76
Beta blocker - toxicity
impotence, cardiovascular adverse effects (bradycardia, AV block, HF), CNS effects (seizures, sedation, sleep alterations), dyslipidemia (metoprolol), asthma/COPD exacerbations
77
B1 selective antagonists (B1>B2)
acebutolol, atenolol, esmolol, metoprolol
78
Non-selective Beta antagonists
pindolol (partial agonist), propranolol, timolol
79
Non-selective alpha and beta antagonists
carvediol and labetalol
80
Antihypertensive therapy - primary HTN
thiazide diuretics, ACE-I, ARBs, dihydropyridine calcium channel blockers
81
antihypertensive therapy - HTN w/ HF
diuretics, ACE-I/ARBs, beta-blockers, aldosterone agonists
82
antihypertensive therapy - diabetics
ACE-I, ARBs - protective against diabetic nephropathy
Calcium channel blockers, thiazide diuretics, beta-blockers
83
antihypertensive therapy - pregnancy
methyldopa (alpha-agonist), hydralazine, labetalol, nifedipine
84
Dihydropyridine calcium channel blockers - clinical use
(Amlodipine)
HTN, Angina (including Prinzmetal), Raynaud phenomenon
85
Dihydropyridine calcium channel blockers - MoA
(Amlodipine)
block voltage dependent calcium channels - decreased intracellular calcium - decreased muscle contractility (vascular smooth muscle)
86
Dihydropyridine calcium channel blockers - toxicity
(amlodipine)
| reflex tachycardia, gingival hyperplasia
87
non-dihydropyridine calcium channel blockers - MoA
Diltiazem and verapamil
block voltage dependent calcium channels - decreased intracellular calcium - decreased muscle contractility (heart) - decreases CO
88
non-dihydropyridine calcium channel blockers - clinical use
diltiazem and verapamil
HTN, angina, atrial fibrillation/flutter
89
non-dihydropyridine calcium channel blockers - toxicity
verapamil - hyperprolactinemia, constipation, AV block
90
hydralazine - clinical use
severe HTN, HF
safe during pregnancy; administer w/ beta blocker to prevent reflex tachycardia
91
hydralazine - MoA
increases cGMP - smooth muscle relaxation
vasodilates arterioles > veins
decreases afterload
92
hydralazine - toxicity
compensatory tachycardia (contraindicated in angina, CAD), fluid retention, headache, angina
Lupus-like syndrome in slow-acetylators
93
Nitroprusside - clinical use
hypertensive emergency
94
Nitroprusside - MoA
increases cGMP via direct release of NO - dilation of arterioles and veins
95
Nitroprusside - toxicity
cyanide toxicity - releases cyanide
96
Fenoldopam - clinical use
hypertensive emergency
97
Fenoldopam - MoA
dopamine D1 receptor agonist - coronary, peripheral, renal, and splanchnic vasodilation
decreases BP, increases natriuresis
98
Nitrates - nitroglycerin, isosorbide dinitrate and mononitrate
MoA
vasodilate by increasing NO in vascular smooth muscle - increased cGMP and smooth muscle relaxation
dilate veins >> arterioles - decreases preload
99
Nitrates - nitroglycerin, isosorbide dinitrate and mononitrate
Clinical use
angina, acute coronary syndrome, pulmonary edema
100
Nitrates - nitroglycerin, isosorbide dinitrate and mononitrate
toxicity
reflex tachycardia (treat with beta blockers), hypotension, flushing, headache
101
HMG-CoA reductase inhibitors (statins) - MoA
inhibit conversion of HMG-CoA to mevalonate (cholesterol precursor)
102
HMG-CoA reductase inhibitors (statins) - lipid profile effects
decrease LDL >>> TG = VLDL
| increase HDL
103
HMG-CoA reductase inhibitors (statins) - toxicity
hepatotoxic - increased LFT
| myopathy when used with fibrates or niacin
104
Bile acid resins (cholestyramine) - MoA
prevent intestinal reabsorption of bile acids - liver uses cholesterol to produce new bile acids
105
Bile acid resins (cholestyramine) - lipid profile effects
decreases LDL
| slightly increases HDL and TG
106
Bile acid resins (cholestyramine) - toxicity
GI upset, decreased absorption of other drugs and fat-soluble vitamins
107
Ezetimibe - MoA
prevents cholesterol absorption at the small intestine brush border
108
Ezetimibe - lipid profile effects
decreases LDL
109
Ezetimibe - toxicity
rarely increases LFT, diarrhea
110
Fibrates (gemfibrozil) - MoA
upregulate LPL - increase TG clearance
| Active PPAR-alpha to induce HDL synthesis
111
Fibrates (gemfibrozil) - lipid profile effect
decrease TG>>>LDL, increase HDL
112
Fibrates (gemfibrozil) - toxicity
myopathy (inc risk w/ statins)
| cholesterol gallstones
113
Niacin (B3) - lipid profile effect
decreases LDL>TG
| increases HDL
114
Niacin (B3) - MoA (lipids)
inhibits lipolysis in adipose tissue; reduces hepatice VLDL synthesis
115
Niacin (B3) - toxicity (lipid-lowering agent)
red, flushed face (due to inc PG) - decreased by taking NSAIDS
hyperglycemia, hyperuricemia
116
Cardiac glycosides (digoxin) - MoA
inotrope
directly inhibits sodium-potassium ATPase - indirectly inhibits sodium-calcium exchange - increases intracellular calcium - + inotropy
Indirect - stimulates vagus nerve - decreases HR
117
Cardiac glycosides (digoxin) - clinical use
HF, atrial fibrillation
118
Cardiac glycosides (digoxin) - toxicity
cholinergic - nausea, vomiting, diarrhea, blurry vision, arrhythmias, AV block
hyperkalemia - poor prognosis
Factors increasing toxicity - renal failure, hypokalemia, verapamil, amiodarone, quinidine
119
Cardiac glycosides (digoxin) - antidote
slowly normalize potassium, cardiac pacer, anti-digoxin Fab fragments, magnesium
120
Quinidine - MoA
Class IA antiarrhythmic - blocks open/active sodium channels (phase 0)
increases APD and ERP in ventricular AP (decreases slope of phase 0)
increases QT interval (prolongs repolarization - phase 3)
121
Procainamide - MoA
Class IA antiarrhythmic - blocks open/active sodium channels (phase 0)
increases APD and ERP in ventricular AP (decreases slope of phase 0)
increases QT interval (prolongs repolarization - phase 3)
122
Disopyramide - MoA
Class IA antiarrhythmic - blocks open/active sodium channels (phase 0)
increases APD and ERP in ventricular AP (decreases slope of phase 0)
increases QT interval (prolongs repolarization - phase 3)
123
Quinidine - clinical use
Class IA antiarrhythmic - blocks open/active sodium channels (phase 0)
atrial and ventricular arrythmias, re-entrant and ectopic SVT and VT
124
Procainamide - clinical use
Class IA antiarrhythmic - blocks open/active sodium channels (phase 0)
atrial and ventricular arrythmias, re-entrant and ectopic SVT and VT
125
Disopyramide - clinical use
Class IA antiarrhythmic - blocks open/active sodium channels (phase 0)
atrial and ventricular arrythmias, re-entrant and ectopic SVT and VT
126
Quinidine - toxicity
Cinchonism (headache and tinnitus)
thrombocytopenia
torsades de pointes due to long QT
127
Procainamide - toxicity
Reversible SLE - like symptoms (slow acetylators)
thrombocytopenia
torsades de pointes due to long QT
128
Disopryamide - toxicity
Heart failure
thrombocytopenia
torsades de pointes due to long QT
129
Lidocaine - MoA
Class IB antiarrhythmic - blocks inactive sodium channels (phase 0)
decrease slope of phase 0 and shorten AP duration
preferentially affect ischemic or depolarized purkinje and ventricular tissue
130
Mexiletine - MoA
Class IB antiarrhythmic - blocks inactive sodium channels (phase 0)
decrease slope of phase 0 and shorten AP duration
preferentially affect ischemic or depolarized purkinje and ventricular tissue
131
Lidocaine - clinical use
acute ventricular arrhythmias (post-MI)
| digitalis induced arrythmias
132
Mexiletine - clinical use
acute ventricular arrhythmias (post-MI)
| digitalis induced arrythmias
133
Lidocaine - toxicity
least cardiotoxic antiarrhythmics
CNS stimulation - seizures; CNS depression; CV depression
134
Mexiletine - toxicity
least cardiotoxic antiarrhythmics
CNS stimulation - seizures; CNS depression; CV depression
135
flecainide - MoA
Class IC antiarrhythmic - blocks fast sodium channels (phase 0)
decreases slope of phase 0, significantly prolongs ERP in AV node and accessory bypass tracks
No effect of ERP in purkinje and ventricles; minimal effect on AP duration
136
Propafenone - MoA
Class IC antiarrhythmic - blocks fast sodium channels (phase 0)
decreases slope of phase 0, significantly prolongs ERP in AV node and accessory bypass tracks
No effect of ERP in purkinje and ventricles; minimal effect on AP duration
137
Flecainide - clinical use
SVTs, including atrial fibrillation
| last resort in refractory VT
138
Propafenone - clinical use
SVTs, including atrial fibrillation
| last resort in refractory VT
139
Flecainide - toxicity
pro-arrhythmic (post-MI) - sudden death
140
Propafenone - toxicity
pro-arrhythmic (post-MI) - sudden death
141
Class II antiarrhythmics
Beta blockers!
Esmolol (cardioselective)
metoprolol, propranolol, atenolol, timolol, carvedilol
142
Class II antiarrhythmics - MoA
Beta blockers
decrease SA and AV nodal activity by decreasing cAMP and calcium currents
suppress abnormal pacemaker activity by decreasing slope of phase 4 (prolonged depolarization)
143
Class II antiarrhythmics - clinical use
SVT, ventricular rate control in atrial flutter and atrial fibrillation
144
Class II antiarrhythmics - toxicity
impotence, exacerbation of COPD/asthma, CV effects (bradycardia, AV block, HF), CNS effects (sedation, sleep alteration)
may mask symptoms of hypoglycemia
145
Amiodarone - MoA
Antiarrhythmics - Class III (mimics I,II,III,IV) - potassium channel blocker - slows phase 3 - prolongs repolarization
increases AP duration, increases ERP, increases QT
146
Ibutilide - MoA
Antiarrhythmics - Class III - potassium channel blocker - slows phase 3 - prolongs repolarization
increases AP duration, increases ERP, increases QT
147
Sotalol - MoA
Antiarrhythmics - Class III - potassium channel blocker - slows phase 3 - prolongs repolarization
increases AP duration, increases ERP, increases QT
148
Dofetilide - MoA
Antiarrhythmics - Class III - potassium channel blocker - slows phase 3 - prolongs repolarization
increases AP duration, increases ERP, increases QT
149
Amiodarone - clinical use
atrial fibrilation, atrial flutter, VT
150
Sotalol - clinical use
atrial fibrilation, atrial flutter, VT
151
Ibutilide - clinical use
atrial fibrilation, atrial flutter
152
Dofetilide - clinical use
atrial fibrilation, atrial flutter
153
Amiodarone - toxicity
pulmonary fibrosis (check PFTs)
hepatotoxicity (check LFTs)
hyperthyroidism (Check TFTs)
acts as hapten - blue/grey skin deposits - photodermatitis
neurologic effects
constipation
CV effects - bradycardia, heart block, HF
154
Class IV antiarrhythmics
verapamil, diltiazem
calcium channel blockers - block slow calcium channels - slow rise of AP (phase 0) and prolong repolarization (phase 3)
decrease conduction velocity, increase ERP, increase PR
prevent nodal arrhythmias, rate control in atrial fibrillation
155
Adenosine
antiarrhythmic - increases potassium efflux - hyperpolarizes the cell and decreases intracellular calcium (Gi coupled - decreases cAMP)
diagnose/abolish SVT
Very short acting
156
Aspart, glulisine, lispro - MoA
rapid acting insulin - bind insulin receptor (tyrosine kinase)
Liver: increases glucose stored as glycogen
Muscle: increases glycogen, protein synthesis; increases potassium uptake
Fat: increases TG storage
157
Detemir, glargine - MoA
long acting insulin - bind insulin receptor (tyrosine kinase)
Liver: increases glucose stored as glycogen
Muscle: increases glycogen, protein synthesis; increases potassium uptake
Fat: increases TG storage
158
Metformin - MoA
biguanide - mechanism unknown
increases glycolysis, peripheral glucose uptake (insulin sensitivity)
decreases gluconeogenesis
159
Metformin - clinical use
oral - first line therapy for T2DM
cause modest weight loss
can be used in pts w/o islet cell function
160
Metformin - toxicity
GI upset, lactic acidosis (contraindicated in renal insufficiency)
161
Chlorpropamide, tolbutamide - MoA
first gen sulfonylureas
close potassium channel in beta-cell membrane - cell depolarizes - insulin release via calcium influx
162
Chlorpropamide, tolbutamide - clinical use
first gen sulfonylureas
stimulate release of endogenous insulin in T2DM.
Requires some islet cell function to work (not for T1DM).
163
Chlorpropamide, tolbutamide - toxicities
first gen sulfonylureas
risk of hypoglycemia (renal failure)
disulfiram-like effects
164
Glimepiride, glipizide, glyburide - MoA
2nd gen sulfonylureas
close potassium channel in beta-cell membrane - cell depolarizes - insulin release via calcium influx
165
Glimepiride, glipizide, glyburide - clinical use
2nd gen sulfonylureas
stimulate release of endogenous insulin in T2DM.
Requires some islet cell function to work (not for T1DM).
166
Glimepiride, glipizide, glyburide - toxicity
2nd gen sulfonylureas
risk of hypoglycemia (renal failure)
167
Pioglitazone, rosiglitazone - MoA
Glitazones/thiazolidinediones
increase insulin sensitivity in peripheral tissue
binds to PPAR-gamma nuclear transcription regulator
168
Pioglitazone, rosiglitazone - clinical use
Glitazones/thiazolidinediones
mono- or combined therapy for T2DM
169
Pioglitazone, rosiglitazone - toxicity
Glitazones/thiazolidinediones
weight gain, edema
hepatotoxicity, HF, increased risk of fractures
170
exenatide, liraglutide - clinical use/MoA
GLP-1 analogs - T2DM
increase insulin
decrease glucagon
171
exenatide, liraglutide - toxicity
GLP-1 analogs - T2DM
nausea, vomiting, pancreatitis
172
linagliptin, saxagliptin, sitagliptin - clinical use/MoA
DPP-4 inhibitors - T2DM
increase insulin
decrease glucagon
173
linagliptin, saxagliptin, sitagliptin - toxicity
DPP-4 inhibitors
mild urinary or respiratory infections
174
pramlintide - clinical use/MoA
amylin analogs - T2DM, T1DM
decrease gastric emptying
decrease glucagon
175
pramlintide - toxicity
hypoglycemia, nausea, diarrhea
176
canagliflozin - clinical use/MoA
SGLT-2 inhibitors - Type 2 DM
block reabsorption of glucose in PCT
177
canagliflozin - toxicity
SGLT-2 inhibitors
glucosuria, UTIs, vaginal yeast infections
178
acarbose, miglitol - clinical use, MoA
alpha-glucosidase inhibitors - T2DM
delayed carbohydrate hydrolysis and glucose absorption - decreased postprandial hyperglycemia
179
propylthiouracil - MoA/clinical use
block thyroid peroxidase, inhibiting the oxidation of iodide and then organification (coupling) or iodine - inhibition of thyroid hormone synthesis
Blocks 5-deiodinase - decreases peripheral conversion of T4 to T3
hyperthyroidism; can be used in pregnancy
180
methimazole - MoA/clinical use
block thyroid peroxidase, inhibiting the oxidation of iodide and then organification (coupling) or iodine - inhibition of thyroid hormone synthesis
Hyperthyroidism
181
propylthiouracil - toxicity
skin rash, agranulocytosis, aplastic anemia, hepatotoxicity
182
methimazole - toxicity
skin rash, agranulocytosis, aplastic anemia
can cause aplastic crisis - teratogenic
183
Levothyroxine, triiodothyronine - MoA
thyroid hormone replacement
184
Levothyroxine, triiodothyronine - toxicity
tachycardia, heat intolerance, tremors, arrhythmias
185
ADH antagonists - clinical use
SIADH, block action of ADH and V2-receptor
186
desmopressin
central DI
187
oxytocin - clinical use
stimulates labor, uterine contractions, milk let-down
controls uterine hemorrhage
188
somatostatin (otreotide) - clinical use
acromegaly, carcinoid syndrome, gastinoma, glocagonoma, esophageal varices
189
Demeclocycline - MoA
ADH antagonist
190
Demeclocycline - clinical use
SIADH
191
Demeclocycline - toxicity
nephrogenic DI, photosensitivity, abnormalities in bones and teeth
192
glucocorticoids - MoA
metabolic, catabolic, anti-inflammatory, immunosuppressive effects mediated by glucocorticoid response elements, inhibition of phospholipase A2, inhibition of transcription factors (NF-KB)
193
glucocorticoids - clinical use
Addison disease
inflammation
immunosuppression
asthma
194
glucocorticoids - toxicity
```
iatrogenic cushing syndrome
adrenal insufficiency (with abrupt stop)
```
195
Cinacalcet - MoA
sensitizes calcium sensing receptor in PTH glands to circulating calcium - decreases PTH
196
Cinacalcet - clinical use
hypercalcemia due to primary or secondary hyperparathyroidism
197
Cinacalcet - toxicity
hypocalcemia
198
valproic acid - clinical use
all types of seizures except status epilepticus
bipolar disorder
myoclonic seizures
199
valproic acid - toxicity
GI, rare but fatal liver toxicity (measure LFTs), neural tube defects, tremor, weight gain
200
gabapentin - MoA
inhibits high voltage gated calcium channels
| GABA analog
201
gabapentin - clinical uses
simple and complex seizures
postherpetic neuralgia
peripheral neuropathy
202
phenobarbital (seizure) - MoA
increases GABAa action
203
phenobarbital (seizure) - clinical use
simple, complex, tonic-clonic seizures
| first line in neonates
204
phenobarbital (seizure) - toxicity
sedation, tolerance, dependance, cardirespiratory depression
induces CYP450
205
topiramate - MoA
blocks sodium channels, increases GABA action
206
topiramate - clinical use
simple, complex, tonic-clonic seizures
| migraine prevention
207
topiramate - toxicity
sedation, metal dulling, kidney stones, weight loss
208
Lamotrigine - MoA
blocks voltage gated sodium channels
209
Lamotrigine - clinical use
all seizure types except status epilepticus
210
Lamotrigine - toxicity
Stevens-Johnson syndrome (titrated slowly)
211
levetiracetam - MoA
unknown - may modulate GABA and glutamate release
212
levetiracetam - clinical use
simple, complex, tonic-clonic seizures
213
Tiagabine - MoA
increases GABA by inhibiting reuptake
214
Tiagabine - clinical use
simple and complex seizures
215
Vigabatrin - MoA
increases GABA by irreversibly inhibiting GABA transaminase
216
Vigabatrin - clinical use
simple and complex seizures
217
Barbiturates (general) - MoA
Phenobarbitol, pentobarbitol, thiopental, secobarbital
facilitate GABAa action by increasing DURATION of chloride channel opening - decreases neuronal firing
218
Barbiturates (general) - clinical use
sedative for anxiety, seizures, insomnia, induction of anesthesia (thiopental)
219
Barbiturates (general) - toxicity
respiratory and CV depression
CNS depression
induces CYP450
contraindicated in porphyria
220
benzodiazepines (general) - MoA
facilitate GABAa action by increasing FREQUENCY of chloride channel opening.
decrease REM sleep
most have long half-life and active metabolites
221
short-acting benzodiazepines
alprazolam, triazolam, oxazepam, midazolam
| higher addictive potential
222
benzodiazepines - clinical use
anxiety, spasticity, status epilepticus (lorazepam/diazepam), alcohol detox (DTs), night terrors, sleepwalking, general anesthetic, hypnotic
223
benzodiazepines - toxicity
daytime drowsiness assoc w/ ataxia and falls
dependence, additive CNS depression w/ EtOH
Treat OD with flumazenil
224
Zolpidem, Zaleplon, Eszoplicone - MoA
non-benzo hypnotics
act via BZ1 subtype of GABA receptor
225
Zolpidem, Zaleplon, Eszoplicone - clinical use
insomnia
226
Zolpidem, Zaleplon, Eszoplicone - toxicity
ataxia, headache, confusion
decreased dependence
short duration (rapid liver metabolism)
227
Malignant hyperthermia
due to inhaled anesthetics + succinylcholine = fever and sever muscle contractions
antidote = dantrolene
228
Thiopental - IV anesthetic
high potency, high lipid solubility, rapid entry into brain and rapid redistribution to muscle/fat
decreases cerebral blood flow
229
Midazolam - IV anesthetic
benzo - short-acting
may cause severe post-op respiratory depression and decreased BP (treat w/ flumazenil); anterograde amnesia
230
Ketamine (anesthetic)
IV arylcyclohexylamine - PCP analog that acts as dissociative anesthetic
blocks NMDA receptors
increases cerebral blood flow
231
Propofol (anesthetic)
IV - used in ICU for sedation
Potentiates GABAa
rapid induction, good for short procedures
less post-op nausea than thiopental
232
local anesthetics (esters and amides) - MoA
block sodium channels by binding receptors on inner portion of channel - prefer activated channels, so most effective in rapidly firing neurons
pain>temp>touch>pressure
small myelinated > small unmyelinated > large myelinated > large unmyelinated
233
succinylcholine - MoA
depolarizing neuromuscular block
strong ACh receptor agonist - produces sustained depolarization and prevents muscle contraction
selective for motor (nicotinic) receptors
234
succinylcholine - phase I blockade
prolonged depolarization - no antidote
| potentiated by cholinesterase inhibitors
235
succinylcholine - phase II blockade
repolarized but blocked - ACh receptors are available but desensitized
antidote is cholinesterase inhibitors
236
succinylcholine - toxicity
hypercalcemia, hyperkalemia, malignant hyperthermia
237
Tubocurarine, atracurium, pancuronium, etc
non-depolarizing neuromuscular blocking drugs
competitive ACh antagonists
reverse blockage with neostigmine (give w/ atropine to prevent muscarinic effects), edrophonium, and cholinesterase inhibitors
238
Dantrolene - MoA
prevents release of calcium from SR of skeletal muscle
239
Dantrolene - clinical use
malignant hyperthermia and neuroleptic malignant syndrome (antipsychotics)
240
Baclofen - MoA
activates GABA B receptors at spinal cord - induces skeletal muscle relaxation
241
Baclofen -CLINICAL USE
back pain/muscle spasms
242
cyclobenzaprine - MoA
centrally affecting skeletal muscle relaxant
| structurally similar to TCAs - similar anticholinergic side effects
243
cyclobenzaprine - clinical use
muscle spasms
244
L-Dopa - MoA
increases level of dopamine in brain (dopamine precursor)
| crosses BBB and is converted by dopa decarboxylase to dopamine
245
Carbidopa - MoA
peripheral Dopa Decarboxylase inhibitor - allows more L-Dopa to enter CNS and limits peripheral side effects
246
L-Dopa - toxicity
arrhythmias from increased peripheral formation of catecholamines
long term - dyskinesias following administration, akinesia between doses ("on/off" phenomenon)
247
Selegine - MoA
selectively inhibits MAO-B increasing the availability of dopamine
248
selegiline - clinical use
adjunctive to L-Dopa in parkinson; may enhance adverse effects of L-Dopa
249
Tolcapone/Entacapone - MoA
COMT inhibitors - block peripheral conversion of L-Dopa to 3-O-methyldopa
Tolcapone - also central COMT inhibitor and blocks conversion of dopamine to 3-MT in CNS
250
Bromocriptine - MoA
dopamine agonist (ergot) (parkinson disease)
251
pramipexole, ropinirole - MoA
dopamine agonist (non-ergot) (parkinson disease)
252
Amantadine - MoA
increases dopamine release and inhibits reuptake
(Parkinson disease)
also used as antiviral - influenze and rubella
253
Benzotropine - MoA
antimuscarinic that improves tremor and rigidity in parkinson disease
curbs excess cholinergic activity
254
Memantine
NMDA receptor antagonist - helps prevent excitotoxicity (mediated by calcium)
Alzheimer Disease
dizziness, confusion, hallucinations
255
Tetrabenazine and reserpine - MoA/clinical use
inhibit vesicular monoamine transporter (VMAT) - limits dopamine packaging and release - decrease dopamine availability
Huntington disease
256
Haloperidol - MoA/clinical use
D2 receptor antagonist - Huntington
257
Sumatriptan - MoA
5-HT-1B/1D agonists
inhibit trigeminal nerve activation
prevent vasopeptide release
induce vasonstiction
258
Sumatriptan - toxicity
coronary vasospasm - contraindicated in Prinzmetal angina or CAD
mild paresthesia
259
leuprolide - MoA
GnRH analog
| pulsatile = agonist; continuous = antagonist
260
leuprolide - clinical use
pulsatile - infertility
| continuous - prostate cancer, uterine fibroids, precocious puberty
261
estrogens (ethinyl estradiol, DES, mestranol) - clinical use
hypogonadism or ovarian failure, menstrual abnormalities, HRT
men - androgen-dependent prostate cancer
262
clomiphene - MoA
selective estrogen receptor modulator
antagonist at estrogen receptors in hypothalamus - prevents normal feedback inhibition and increases the release of LH and FSH from pituitary, stimulating ovulation
263
clomiphene - clinical use
stimulates ovulation - infertility due to anovulation
264
tamoxifen - MoA
selective estrogen receptor modulator - antagonist at breast; agonist at bone/uterus
265
tamoxifen - clinical use
treat/prevent recurrence of ER/PR + breast cancer
266
raloxifene - MoA
selective estrogen receptor modulator - antagonist at breast/uterus; agonist at bone
267
raloxifene - clinical use
osteoporosis
268
anastrozole/exemestane - MoA
aromatase inhibitors
269
anastrozole/exemestane - clinical use
ER + breast cancer in post-menopausal women
270
progestin - MoA
bind progesterone receptors - decrease growth and increase vascularization of endometrium
271
progestin - clinical use
oral contraceptives, endometrial cancer, abnormal uterine bleeding
272
mifepristone - MoA
competitive inhibitor of progestins at progesterone receptors
273
mifepristone - clinical use
termination of pregnancy (co-admin w/ misoprotol - PGE1)
274
oral contraceptives
estrogen and progestins inhibit LH/FSH - prevents estrogen surge - prevents LH surge - no ovulation
progestins - thicken cervical mucus and inhibit endometrial proliferation
275
terbutaline, ritodrine - MoA
B2 agonists that relax the uterus
276
terbutaline, ritodrine - clinical use
decrease contraction frequency in women during labor
277
danazol - MoA
synthetic androgen that acts as partial agonist at androgen receptors
278
danazol - clinical use
endometriosis, hereditary angioedema
279
testosterone, methyltestosterone - MoA
agonists at all androgen receptors
280
testosterone, methyltestosterone - clinical use
hypogonadism, promotes development of secondary sex characteristics, stimulates anabolism to promote recovery (post-burn/injury)
281
Finasteride - MoA
5a-reductase inhibitor
282
Finasteride - clinical use
male pattern baldness, BPH
283
flutamide - MoA
nonsteroidal competitive inhibitor at androgen receptors
284
flutamide - clinical use
prostate carcinoma
285
ketoconazole - MoA
inhibits 17,20-desmolase - inhibits steroid synthesis
286
ketoconazole - clinical use
PCOS - reduction of androgen symptoms
can cause gynecomastia and amenorrhea
287
spironolactone - clinical use
PCOS - reduction of androgen symptoms
can cause gynecomastia and amenorrhea
288
spironolactone - MoA
inhibits steroid binding, 17a-hydroxylase, and 17,20-desmolase
289
tamsulosin - MoA
alpha-1 agonist - selective for alpha 1A,D receptors in prostate
inhibits smooth muscle contraction
290
tamsulosin - clinical use
BPH
291
sildenafil, vardenafil, tadalafil - MoA
inhibit PDE-5 - increases cGMP, smooth muscle relaxation in corpus cavernosum
increases blood flow and penile erection
292
sildenafil, vardenafil, tadalafil - toxicity
headache, flushing, dyspepsia, cyanopsia
life-threatening hypotension in pts taking nitrates
293
minoxidil - MoA
direct arteriolar vasodilator
294
minoxidil - clinical use
androgenetic alopecia; severe refractory hypertension
295
Burkitt Lymphoma
increased C-myc activity
| t(8,14)
296
CML
BCR-ABL translocation (9,22)
| increased tyrosine kinase activity
297
Heparin - MoA
activator of antithrombin - decreases thrombin and factor Xa
| short halflife
298
Heparin - clinical use
immediate anti-coag for PE, acute coronary syndrome, MI, DVT
use during pregnancy (does NOT cross placenta)
Monitor with PTT
299
Heparin - toxicity
bleeding, HIT, osteoporosis, drug-drug interactions
Rapid reversal - protamine sulfate (negatively charged - binds positively charged heparin molecules)
300
Heparin - LMWH
enoxaprarin, dalteparin - act more on factor Xa
better bioavailability, longer half-life
can be administered subcutaneously w/o lab monitoring
Not easily reversible
301
Fondaparinux
direct Xa inhibitor
302
Heparin-induced thrombocytopenia
development of IgG antibodies against heparin-bound platelet factor 4 (PF4)
antibody-heparin-PF4 complex activates platelets - thrombosis and thrombocytopenia
STOP heparin, do NOT give coumadin
303
argatroban, bivalirudin, dabigatran
direct thrombin inhibitors - use in pts with HIT
304
Warfarin - MoA
interferes with gamma carboxylation of Vit-K dependent clotting factors (2,7,9,10,S,C)
increases PT
305
warfarin - clinical use
chronic anti-coagulation
cannot use in pregnant women
follow PT/INR
306
Warfarin - toxicity
bleeding, teratogen, skin/tissue necrosis, drug-drug interactions
early transient hypercoag - small vessel microthrombi (necrosis)
VitK - reversal
rapid reversal - fresh frozen plasma
307
Apixaban, rivaroxaban - MoA
direct factor Xa inhibitors
308
Apixaban, rivaroxaban - clinical use
treat/prophylax - DVT, PE, stroke (in pts with a.fib)
309
Apixaban, rivaroxaban - toxicity
bleeding - no reversal agents
310
Thrombolytics - MoA
alteplase, reteplase, streptokinase, tenecteplase
directly or indirectly aid conversion of plasminogen to plasmin
plasmin cleaves thrombin and fibrin clots
increase PT and PTT, no change in platelet counts
311
thrombolytics - clinical use
alteplase, reteplase, streptokinase, tenecteplase
early MA, early ischemic stroke, severe PE
312
thrombolytics - toxicity
alteplase, reteplase, streptokinase, tenecteplase
bleeding - contraindicated in pts w/ bleeding, history of intracranial bleed, recent surgery, severe HTN
treat toxicity w/ aminocaproic acid (inhibits fibrinolysis)
313
Aspirin - MoA
irreversibly inhibits COX-1 and COX-2 by covalent acetylation
increase bleeding time, decrease TXA2 and prostaglandins
no effect on PT and PTT
314
Aspirin - clinical use
antipyretic, analgesic, anti-inflammatory, anti-platelet
315
aspirin - toxicity
gastic ulceration, tinnitus (CN VIII), acute renal failure (chronic use), interstitial nephritis, upper GI bleeding
OD - initially causes hyperventilation and respiratory alkalosis, transitions to metabolic mixed acidosis-respiratory alkalosis
316
ADP receptor inhibitors - MoA
clopidogrel, prasugrel, ticagrelor (reversible), ticlopidine
inhibit platelet aggregation by irreversibly blocking ADP receptors
prevents expression of GP IIb/IIIa on platelet surface
317
ADP receptor inhibitors - clinical use
acute coronary syndrome, coronary stenting
decrease incidence or recurrence of thrombotic stroke
clopidogrel, prasugrel, ticagrelor (reversible), ticlopidine
318
ADP receptor inhibitor - toxicity
clopidogrel, prasugrel, ticagrelor (reversible), ticlopidine
neutropenia - ticlopidine!
TTP
319
Cilostazol, dipyridamole - MoA
phosphodiesterase III inhibitor - increases cAMP in platelets resulting in inhibition of aggregation
vasodilators
320
Cilostazol, dipyridamole - clinical use
intermittent claudication, coronary vasodilation, prevention of stroke/TIA, angina prophylaxis
321
Cilostazol, dipyridamole - toxicity
nausea, headache, flushing, hypotension, abdominal pain
322
GP IIb/IIIa inhibitors - MoA
abciximab, eptifibatide, tirofiban
bind GP IIb/IIIa on activated platelets and prevent aggregation
323
GP IIb/IIIa inhibitors - clinical use
unstable angina, percutaneous transluminal coronary angioplasty
abciximab, eptifibatide, tirofiban
324
GP IIb/IIIa inhibitors - toxicity
abciximab, eptifibatide, tirofiban
bleeding, thrombocytopenia
325
meningitis in newborns
group B strep (gram + cocci, beta-hemolytic, catalase -, bacitracin resistant)
E. coli (gram - rods, lactose fermenter, metallic green on EBM)
listeria (gram + rods, tumbling motility)
326
meningitis in children (6mo-6yrs)
S. pneumo (lancet shaped diplococci, gram+, alpha hemolytic, bile soluble)
N. meningitidis (gram - diplococci, ferments maltose)
H.influenzae B (gram - coccoid rods, grow on chocolate agar or w/s.aureus)
Enteroviruses
327
meningitis - adults (6 yrs-60yrs)
S.pneumo (lancet shaped diplococci, gram+, alpha hemolytic, bile soluble)
N. meningitidis - #1 in teens (gram - diplococci, ferments maltose)
Enterovirus
HSV
328
meningitis - 60+ yrs
S.pneumo (lancet shaped diplococci, gram+, alpha hemolytic, bile soluble)
gram negative rods
listeria (gram + rods, tumbling motility)
329
methylphenidate, dextrophetamine, methamphetaine - MoA
CNS stimulants - increases catecholamines in the synaptic cleft, especially NE and dopamine
330
methylphenidate, dextrophetamine, methamphetaine - clinical use
ADHD, narcolepsy, appetite control
331
Antipsychotics - neuroleptics - MoA
haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine (haloperidol + -azines)
block D2 receptors - increases cAMP
332
antipsychotics - neuroleptics - clinical use
schizophrenia, psychosis, acute mania, Tourette syndrome, huntington
333
anti-psychotics - neuroleptics - toxicity
High potency (Trifluoperazine, fluphenazine, haloperidol) - neurologic side effects (extrapyramidal symptoms)
Low potency (chlorpromazine, thioridazine) - non-neuro side effects (anticholinergic, antihistamine, alpha 1 blockade effects)
chlorpromazine - corneal deposits
thioridazine - retinal deposits
Haloperidol - NMS, tardive dyskinesia
334
neuroleptic malignant syndrome
rigidity, myoglobinuria, autonomic instability, hyperpyrexia
"FEVER - Fever, Encephalopathy, Vitals unstable, Enzymes elevated, Rigidity"
treat w/ dantrolene, D2 agonists
335
tardive dyskinesia
oral-facial movements - long term antipsychotic use ( 4 mo)
336
extrapyramidal system effects
treat with benztropine or diphenhydramine
4 hr - acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4 day - akathisia (restlessness)
4 weeks - bradykinesia (parkinsonism)
4 months - tardive dyskinesia
337
atypical antipsychotics
olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone - atypical for Old CLOZets to Quietly RISPER from A to Z
338
atypical antipsychotics - MoA
olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone
not completely understood - varied effects on 5-HT2, dopamine, and alpha and H1 receptors
339
atypical antipsychotics - clinical use
olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone
schizophrenia - positive and negative symptoms
bipolar, OCD, anxiety, depression, mania, tourette
340
atypical antipsychotics - toxicity
olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone
fevers EPS and anticholinergic effects that neuroleptics; all prolong QT interval
Olanzapine/clozapine - significant weight gain
Clozapine - agranulocytosis (weekly WCB monitoring)
Risperidone - increase prolactin - decreases GnRH, LH, FSH - irregular menstruation
341
Lithium - clinical use
mood stabilizer for bipolar
blocks relapse and acute manic events
treats SIADH
342
Lithium - toxicity
LMNOP - Movement (tremor), Nephrogenic DI, hypOthyroidism, Pregnancy problems
causes Epstein's anomaly in newborns if taken during pregnancy
excreted by kidneys - reabsorbed in PCT with Na+; Thiazide use can cause lithium toxicity
343
Buspirone - MoA
stimulates 5-HT1A receptors
344
Buspirone - clinical use
GAD
does not cause sedation, tolerance, addiction
takes 1-2 weeks for effect
does NOT interact with alcohol
345
SSRIs
Fluoxetine, paroxetine, sertraline, citalopram
346
SSRI - MoA
Fluoxetine, paroxetine, sertraline, citalopram
5-HT specific reuptake inhibitors
takes 4-8 wks for effect
347
SSRI - clinical use
Fluoxetine, paroxetine, sertraline, citalopram
depression, GAD, panic disorder, OCD, bulimia, social phobias, PTSD
348
SSRI - toxicity
Fluoxetine, paroxetine, sertraline, citalopram
fever than TCAs
GI distress, SIADH, sexual dysfunction
serotonin syndrome - w/ any drug that increases 5-HT
349
serotonin syndrome
hyperthermia, confusion, myoclonus, CV instability, flushing, diarrhea, seizures
treat w/ cyproheptadine (5-HT2 receptor antagonist)
350
SNRIs
venalfaxine, duloxetine
351
SNRIs - MoA
venalfaxine, duloxetine
inhibit 5-HT and NE reuptake
352
SNRIs - clinical use
depression
venalfaxine - GAD, panic disorder, PTSD
duloxetine - peripheral diabetic neuropathy
353
SNRIs - toxicity
venalfaxine, duloxetine
increased BP, stimulant effects, sedation, nausea
354
TCAs
amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine
355
TCAs - MoA
amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine
block reuptake of NE and 5-HTq
356
TCAs - clinical use
amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine
depression, OCD (clomipramine), peripheral neuropathy, chronic pain, migraine prophylaxis
357
TCAs - toxicity
amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine
Tri-C: Convulsions, Coma, Cardiotoxicity (arrhythmia due to inhibiting Na+ channel conduction) - use NaHCO3 to prevent arrhythmias
respiratory depression, hyperpyrexia, confusion and hallucinations in elderly due to anticholinergic effects
sedation, alpha 1 block (postural hypotension), atropine-like effects (amitriptyline > nortriptyline), prolong QT
358
MAO-I
Tranylcypromine, phenelzine, isocarboxazid, selegiline (selective MAO-B)
359
MAO-I - MoA
Tranylcypromine, phenelzine, isocarboxazid, selegiline (selective MAO-B)
increase amine neurotransmitters (NE, 5-HT, dopamine)
360
MAO-I - clinical use
Tranylcypromine, phenelzine, isocarboxazid, selegiline (selective MAO-B)
atypical depression, anxiety
361
MAO-I toxicity
Tranylcypromine, phenelzine, isocarboxazid, selegiline (selective MAO-B)
hypertensive crisis (w/ ingestion of tyramine) CNS stimulation
contraindicated w/ SSRIs, TCAs, St. John's wort, meperidine, dextromethorphan - prevent serotonin syndrome
362
bupropion - MoA
atypical antidepressant
smoking cessation
increase NE and dopamine (unknown mechanism)
363
bupropion - toxicity
stimulant effect (structurally similar), headache, seizures in anorexic/bulimic pts, no sexual side effects
364
Mirtazapine- MoA
alpha 2 antagonist - increases release of 5-HT and NE
potent 5-HT2 and 5-HT3 receptor antagonist
atypical antidepressants
365
mirtazapine - toxicity
sedation, increased appetite, weight gain, dry mouth
366
trazodone - MoA
blocks 5-HT2 and alpha 1 receptors
367
trazodone - clinical use
atypical antidepressant - primarily for insomnia (high dose for anti-depressive effect)
368
trazadone - toxicity
sedation, nausea, priapism (trazaBONE), postural hypotension
369
Cluster A personality disorders
"Weird" - odd or eccentric, inability to develop meaningful social relationships, no psychosis, genetic association with schizophrenia
Paranoid "Accusatory"
Schizoid "Aloof"
Schizotypal "awkward"
370
pervasive distrust and suspiciousness; projection is major defense mechanism
paranoid personality disorder (cluster A)
371
voluntary social withdrawal, limited emotional expression, content with social isolation
schizoid personality disorder - cluster A
372
eccentric appearance, odd beliefs/magical thinking, interpersonal awkwardness
schizotypal personality disorder - cluster A
373
cluster B personality disorders
dramatic, emotional, erratic
generic association with mood disorders and substance abuse
"Wild" (Bad to the Bone)
Antisocial, borderline, histrionic, narcissitic
374
disregard for and violation of the rights of others, criminality, impulsivity
antisocial PD - cluster B
M>>F; must be >18 w/ history of conduct disorder
375
unstable mood and interpersonal relationships, impulsivity, self-mutilation, boredom, sense of emptiness
borderline PD - cluster B
F>>M
splitting = major defense mechanism
376
excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with apperance
histrionic PD - cluster B
377
grandiosity, sense of entitlement, lacks empathy and requires excessive admiration, often demands the best and reacts to criticism with rage
narcissistic PD - cluster B
378
cluster C personality disorders
"worried" anxious or fearful; genetic association with anxiety disorders
Cowardly - avoidant
compulsive - Obsessive-compulsive
clingy - dependent
379
hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others
avoidant PD - cluster C
380
preoccupation with order, perfectionism and control; ego-syntonic
obsessive-compulsive PD - cluster C
381
submissive and clingy, excessive need to be taken care of, low self-confidence
dependent PD - cluster C
| often stuck in abusive relationships
382
alcohol intoxication
emotional lability, slurred speech, ataxia, coma, blackouts
serum GGT - sensitive indicator of alcohol use
AST >> ALT
383
Alcohol withdrawal
tremor, tachycardia, HTN, malaise, nausea, DTs
384
Delirium tremens
life threatening alcohol withdrawal that peaks 2-4 days after last drink
autonomic hyperactivity (tachycardia, tremors, anxiety, seizures)
5-15% mortality rate
treat w/ benzos
alcoholic hallucinations - 12-18 hrs after last drinks
385
opioid intoxication
euphoria, respiratory and CNS depression, decreased gag reflex, pinpoint pupils, seizures (OD)
treat w/ naloxone or naltrexone
386
opioid withdrawal
sweating, dilated pupils, piloerection, fever, rhinorrhea, diarrhea, yawing, nausea, cramps
treat w/ long-term support, buprenorphine, methadone
387
barbiturate - intoxication
low safety margin - marked respiratory depression
| treat by managing symptoms (increase BP, assist respiration)
388
barbiturate withdrawal
delirium, life-threatening CV collapse
389
benzos - intoxication
greater safety margin than barbiturates
ataxia, minor respiratory depression
treat with flumazenil
390
benzos withdrawal
sleep disturbance, depression, rebound anxiety, seizure
391
amphetamine intoxication
euphoria, grandiosity, pupillary dilation, agitation, insomnia, arrhythmias, tachycardia, anxiety
392
amphetamine withdrawal
anhedonia, increased appetite, hypersomnolence, existential crisis
post-use crash: depression, lethargy, weight gain, headache
393
cocaine intoxication
impaired judgement, pupillary dilation, hallicinations, paranoid ideations, angina, sudden cardiac death
treatment: alpha blockers, benzos (NOT beta blockers)
394
cocaine withdrawal
hypersomnolence, malaise, severe craving, depression/suicidality
post-use crash: depression, lethargy, weight gain, headache
395
caffeine intoxicatoin
restlessness, increased diuresis, muscle twitching
396
caffeine withdrawal
lack of concentration, headache
397
nicotine intoxication
restlessness
398
nicotine withdrawal
irritability, anxiety, craving
treatment: nicotine patches/gum/etc, bupropion, varenicline
399
varenicline
partial nicotinic receptor agonist - decreases nicotine w/d symptoms and decreases reward from nicotine
400
PCP intoxication
belligerence, impulsivity, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium, seizures
treatment: benzos, rapid-acting anti-psychotic
401
PCP withdrawal
depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep
402
LSD intoxication
perceptual distortion, depersonalization, anxiety, paranoia, psychosis, flashbacks
403
Marijuana intoxication
euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, social withdrawal, increased appetite, dry mouth, conjunctival injections, hallucinations
404
marijuana withdrawal
irritability, depression, insomnia, nausea, anorexia
peak w/in 48 hrs (may last 5-7 days)
405
methadone
long-acting oral opiate for heroin detox and maintenance
406
naloxone
antagonist - must be injected (not orally bioavailable)
407
buprenorphine
opiate partial agonist
408
naltrexone
long-acting opiate antagonist used for relapse prevention once detoxed from heroin
409
HIV therapy
HAART
2 nucleoside reverse transcriptase inhibitors + 1 protease inhibitor OR integrase inhibitor OR non-nucleoside reverse transcriptase inhibitor
410
protease inhibitors
-navir (Navir tease a protease)
```
atazanavir
darunavir
fosamprenavir
indinavir
lopinavir
ritonavir
saquinavir
```
411
protease inhibitors - MoA
-navir
assembly of virons depends on viral protease (pol gene) - PI prevents maturation of new viruses
412
protease inhibitors - toxicity
hyperglycemia, GI intoleraqnce, lipodystrophy
indinavir - nephrotoxicity, hematuria
contraindicated w/ rifampin (CYP inducer)
413
nucleoside reverse transcriptase inhibitors
```
abacavir
didanosine
emtricitabine
lamivudine
stavudine
tenofir
zidovudine
```
414
nucleoside reverse transcriptase inhibitors - MoA
competitively inhibit nucleotide binding to reverse transcriptase and terminate DNA chain
all need to be phosphorylated to be active EXCEPT tenofovir
zidovudine - general prophylaxis and during pregnancy
415
Nucleoside reverse transcriptase inhibitors - toxicity
```
bone marrow suppression (reversed with G-CSF and EPO)
peripheral neuropathy
lactic acidosis (except tenofovir)
anemia (zidovudine)
pancreatitis (didanosine)
```
416
non-nucleoside reverse transcriptase inhibitors
delvirdine
efavirenz
nevirapine
417
non-nucleoside reverse transcriptase inhibitors - MoA
bind to reverse transcriptase in a different site from NRTIs
| do not require phosphorylation
418
non-nucleoside reverse transcriptase inhibitors - toxicity
rash, hepatotoxicity
vivid dreams - efavirenz
only use nevirapine in pregnancy
419
raltegravir - MoA
integrase inhibitors - inhibits HIV genome integration into host chromosome by reversibly inhibiting HIV integrase
420
raltegravir - toxicity
integrase inhibitor
increases creatine kinase
421
enfuvirtide - MoA
fusion inhibitor - binds gp41, inhibiting viral cell entry
causes skin reaction at injection site
422
maraviroc - MoA
fusion inhibitor - binds CCR5 in surface of T cells/monocytes
inhibits interaction with gp120
423
H2 blockers (GI) - MoA
cimetidine, ranitidine, famotidine, nizatidine
reversible block of H2 receptors - decrease H+ secretion by parietal cells
424
H2 blockers (GI) - clinical use
cimetidine, ranitidine, famotidine, nizatidine
peptic ulcer, gastritis, mild esophageal reflux, zollinger-ellison
425
H2 blocker (GI) - toxicity
cimetidine, ranitidine, famotidine, nizatidine
cimetidine - inhibits CYP450; antiandrogenic effects, crossed BBB and placenta
cimetidine and ranitidine - decrease renal excretion of creatinine
426
proton pump inhibitors - MoA
omeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole
irreversible inhibit H+/K+ ATPase in parietal cells
427
PPI - clinical use
omeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole
peptic ulcer, gastritis, esophageal reflux, zollinger-ellison
428
PPI - toxicity
omeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole
C.diff infection, pneumonia
decreased serum Mg with longterm use
429
bismuth, sucralfate - MoA
binds to ulcer base - physical protection; allows HCO3 to reestablish pH gradient in mucosa
430
bismuth, sucralfate - clinical use
ulcer healing, travelers diarrhea
431
misoprostol - MoA
PGE1 analog - increases production and secretion of gastric mucous barrier (mucus and bicarb)
decreases acid production
432
misoprostol - clinical use
prevention of NSAID inducted peptic ulcers
maintain PDA
induction of labor (off label); abortifacient
433
misoprostol - toxicity
diarrhea
434
octreotide - MoA
long acting somatostatin analog, prohibits actions of splanchnic vasodilatory hormones
435
octreotide - clinical use
acute variceal bleeds, acromegaly, VIPoma, carcinoid tumors
436
octreotide - toxicity
nausea, cramps, steatorrhea
437
antacids - MoA
neutralize protons in gut
| alter gastric and urinary pH; delay gastric emptying
438
antacids - toxicity
all can cause hypokalemia
Aluminum hydroxide - constipation, hypophosphatemia, prox. muscle weakness, osteodystrophy, seizures
Calcium carbonate - hypercalcemia, rebound acid, chelates other drugs (tetracycline)
Magnesium hydroxide - diarrhea, hyporeflexia, hypotension, cardiac arrest
439
sulfasalazine - MoA
combo of sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory)
activated by colonic bacteria
440
sulfasalazine - clinical use
Ulcerative colitis, Crohn disease (colitis component)
441
sulfasalazine - toxicity
malaise, nausea, sulfonamide toxicity, reversible oligospermia
442
odansetron - MoA
5-HT3 antagonist, decreases vagal stimulation
| powerful anti-emetic (central acting)
443
odansetron - clinical use
post-op and cancer anti-emetic
444
odansetron - toxicity
headache, constipation, prolonged QT interval
445
metoclopramide - MoA
D2 receptor antagonist
increases resting tone, contractility, LES tone, motility
does NOT influence colon transport time
446
metoclopramine - clinical use
diabetic and post-op gastroparesis, anti-emetic
447
metoclopramine - toxicity
parkinsonian effects, tardive dyskinesia
| restlessness, fatigue, drowsiness, depression, diarrhea
448
orlistat - MoA
inhibits gastric and pancreatic lipase - decrease breakdown/absorption of dietary fats
449
orlistat - clinical use
weight loss
450
orlistat - toxicity
steatorrhea, decreased absorption of fat soluble vitamins
