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184 Cards in this Set
- Front
- Back
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What is best natural bronchodilator
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Epi
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Will steroids work in an acute asthma attack?
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No. They take too long
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How much drug is absorbed from inhalational routes?
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20-30%
|
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What is the #1 acute beta agonist?
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Albuterol
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Name 2 long term beta adrenergic agonists?
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Salmeterol and Formoterol
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Can you use Salmeterol to treat an acute asthma attack?
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No.
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Salmeterol-Fluticasone (advair) has what 2 classes of drugs?
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beta-agonist and corticosteroid
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beta 2 agonists are well known to cause tolerance, what can you do to prevent that?
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give them a break from them and corticosteroids are believed to restore the responsiveness.
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What is the #1 choie for status asthmaticus?
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Epinepherine
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Inhalational corticosteroids are known to cause changes in oropharyngeal microflora that may lead to what?
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infections like oral candidiasis
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Ipratropium (atrovent)is what class of drug?
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Anticholinergic bronchodilator
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Ipratropium (atrovent) works similar to what drug?
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atropine
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What is Tiotropium (spiriva) used to treat?
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COPD. Maintenance treatment of bronchospasm from COPD.
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When is thophylline given?
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treatment of acute exacerbations of reversible airway obstruction including status in patients who are not responding to first-line treatments
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What is the name for the OTC asthma treatment?
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Cromolyn Sodium (Crolom)
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How does cromolyn sodium work?
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Prevents the release of chemicals from mast cells.
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what is Montelukast (singular) used for?
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prophylaxis and chronic treatment of asthma. Can also be used for allergies.
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What type of drugs is Montelukast?
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Leukotrient antagonist and lipoxygenase inhibitors
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can Montelukast increase your LFTs?
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Yes
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What is Omalizumab (Xolair)?
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monoclonal antiobody directed against IgE.
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When would you prescribe Omalizumab?
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Highly refractory patients.
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What causes sedation in the H1 receptor antagonists?
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They cross the blood brain barrier
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Which have more sedating effects, 1st or 2nd generation H1 receptor antagonists?
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1st
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Why is there less sedating effects in the 2nd generation H1 antagonists?
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They have poor distribution in the CNS r/t to their poor lipid solubity
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All H1 receptor antagonists names end with?
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ine- example diphenhyrdamine, loratadine
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Name some 1st generation H1 receptor antagonists
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diphenhydramine (benadryl), dimenhydrinate (dramamine), hydroxyzine (atarax), promethazine (phenergan)
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which H1 receptor 2nd generation was withdrawn r/t cardiac problems?
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terfenadine (seldane)
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Of the 2nd generation H1 antagonists, which has the most sedating effects?
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Cetirizine (zyrtec)
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What are the clinical uses for H1 receptor antagonists?
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1- allergies of immediate type
2-sedative effect 3-cough preparations 4-prophylacitc motion sickness 5- N/V |
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What can happen if H1 receptor antagonists are administered with ketoconazole?
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increase and precipitate lethal arrythmias
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Which H1 antagonist is noted for it's OTC hypnotic effects?
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Diphenhydramine
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Name a H1 receptor antagonist that is used clinically for it's antiemetic effects?
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promethazine
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Which h1 antagonist has a dual mechanism of action that includes H1 receptor antagonism and it's ability to inhibit the release of histamine from mast cells?
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Azelastine (astelin)
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Name the only drug approved for pediatric patients >6 months old that is an H1 antagonist?
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Cetirizine (zyrtec)
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which h1 antagonist has been used in the treatment of anorgasmy r/t to SSRI?
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Cyproheptadine (periactin)
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Name the only bacteria that has been implicated in the spread of Cancer?
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H. Pylori- causesdevelopment of gastric adenocarcinoma and gastric B-cell lymphoma
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How do you treat H. pylori infection?
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triple therapy. Must include 2 atbx- amoxicillin, tetracycline, or metrondiazole plus a PPI. Tx for 14 days.
Example is Prepac |
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Which H2 blocker has known SE of gynecomastia and galactorrhea?
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Cimetidine (tagamet)
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How do you recognize the H2 receptor blockers?
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they all have tidine
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If your patient has a problem with nocturnal acid secretion, which class of drug is best?
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H2 blockers. In all other situations, PPI's are better
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Name some H2 receptor antagonists:
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Cimetidine, famotodine, nizatidine (axid), and ranitidine
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which gastric acid regulating drug is contraindicated in pregnancy?
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Misoprostol (cytotec). It is a protaglandin analog. Causes uterine contraction and abortion.
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PPI have what MOA?
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they inhibit the H+/K+ ATPase pump. Proton pump inhibitors
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How do you recognize PPI's?
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they all end with razole
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name some PPI's
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Omeprazole (prilosec), esomeprazole (nexium), lansoprazole (prevacid),pantoprazole (protonix), rabeprazole (aciphex)
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Which medicaiton acts as a primer and sealer? It binds to injured tissue and forms a protective coating over ulcer
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Sulcrafalate (carafate)
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what is the main side effect of sulcrafalate?
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aluminum osteodystrophy
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What type of medication neutralizes an acid when given orally?
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antacids.
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why do antacids work better as a combinations of mag and aluminum hydroxide?
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because mag has a laxative effect and aluminum has a constipating effect, so they balance each other.
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Is mag hydroxide associated with milk alkali syndrome?
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yes
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What are metoclopramides three mechanisms of action?
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1- Dopamine receptor antagonist
2-inhibits 5-HT3 3-activation of 5-HT4 |
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what medication can be used in treating persistant hiccups?
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Metoclopramide
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What are the side effects of reglan?
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EPS, and induction of parkinsonism like effects
|
|
which antibiotics can increase gi motility?
|
Macrolides- erythromycing, clarithromycin, and azirthromucin
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How does dexamethasone produce antiemetic effects?
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blockade of prostaglandins
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How do H1 antagonists like benadryl produce antiemetic effects?
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acts on the vestibular afferents within the brainstem
|
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how do prochloperazine and promethazine produce entiemetic effects?
|
primarily by Dopamine antagonism at the chemoreceptor trigger zone. Also with antihistamine and anticholinergic effects.
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How do benzodiaepines produce entiemetic effects?
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through anticipatory vomiting. They work via their sedative amnesic and antianxiety effects. "too sleepy to vomit"
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Name some 5HT3 serotonin antagonists
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ondansetron (zofran), Granisetron (kytril) and Dolasetron (anzemet)
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How can you recognize 5ht3 receptor antagonists?
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all end in setron
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Is ondansetron good for PONV?
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Yes
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Do the 5HT3 antagonists work on central, peripheral, or both?
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both
|
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What does 5HT3 stand for?
|
serotonin
|
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What is dronabinol (Marinol) used to treat?
|
N/V-- It's marijuana. Also has an appetite stimulant
|
|
What is the safest laxative?
|
Bulk-forming. Psyllium-metamucil
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What is the down side to using diphenoxylate and difenoxin?
|
They are derivatives of meperidine.As an opiate, they can cause addiction.
|
|
What is added to diphenoxylate to prevent abuse?
|
Atropine.
|
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What drugs can be used for Traveller's diarrhea?
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Loperamide (immodium) and Diphenoxylare (Lomotil)
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Which is an OTC antidiarrheal that does not penetrate the CNS?
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Loperamide (immodium)
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What do you use to treat an opioid addiction?
|
an opioid. Methadone usually
|
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Which opiate can be considered a short acting anesthetic?
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fentanyl
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What is an opioid?
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class of drugs that included opiates, opiopeptins, and all synthetic and semiseynthetic drugs that mimic the action of opiates
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what is an opiopeptin?
|
endogenous peptides that act on opiod receptors
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What is an opioid agonist?
|
drug that activates some or all opioid receptrs and does not block any opioid receptor
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what is an opioid antagonist?
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a drug that blocks some or all opioid receptors
|
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what is a mixed agonist-antagonist?
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a drug that activates some opioid recetpors and blocks others
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name the opiod receptors
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mu 1 and 2, delta, and kappa.
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which opioid receptors contribute to analgesia at both spinal and supraspinal levels and to respiratory depression?
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mu and delta
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which opioid receptros contribute to spinal analgesia only and play a role in the sedative effects of opioids?
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kappa
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where does the endogenous opioid enkephalin work?
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delta
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where does the endogenous opioid dynorphin work?
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kappa
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where does the endogenous opioid beta endorphin work?
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mu
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what are the 8 clinical effects of opioids?
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1- analgesia
2- sedation and euphoria 3- resp. depression 4- antitussive actions 5- n/v 6- constipaiton 7- smooth muscle effects 8- miosis |
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What is tolerance?
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"need more"
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what is depenence?
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psychologic and physical need or dependence for the drug. Appreciated when it is acutely withdrawn
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what are the 6 clinical uses of opioids?
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1-analgesia
2- cough suppression 3- diarrhea 4- acute pulmonary edema 5- anesthesia 6- opioid dependance |
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are opioids like morphine agonists or antagonists?
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agonists
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name the opioid antagonists?
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naloxone and naltrexone (give for etoh dependance)
|
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what are the 3 clinical uses of NSAIDS?
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1- analgesia
2- antipyretic 3- anti-inflammatory |
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how do NSAIDS cause gi ulcers?
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they block cox1 which block protaglandins. Prostaglandins are GI protective
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what are the s/s of ASA toxicity?
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tinnitus, vertigo, hyperventilation, and respiratory alkalosis. Very high doses can lead to dehydration, hyperthermia, coma and death
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Which NSAID can be used as a suppository in pedi's for fever?
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diclofenac (voltaren)
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Name some NSAIDS?
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ibuprofen, indomethacin, ketorolac, naproxen, ketoprofen, diclofenac, piroxicam, nambumetone (relafen)
|
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which NSAID is the only systemic anypyretic?
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ketorolac
|
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which NSAID has the longest anti-inflammatory effects?
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Naproxen
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Name the only selective cox2 inhibitor still on the market?
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celecoxib (celebrex)
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can you give celebrex to patients with a sulfa allergy?
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No. They contain sulfa. Vioxx was the only one without sulfa
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how do you recognize selective cox2 inhibitors?
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they end with coxib
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Does tylenol have anti-inflammatory effects?
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No. It is a central cox inhibitor, does not have any peripheral effects.
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What are tylenols toxic effects at therapeutic effects?
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very negligible. At high does it can have a potent heatotoxin.
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TCA block the reuptake of which 2 neutortransmitters in the neuron?
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norepi and serotonin
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|
T or F
TCA's work by blocking the uptake of norepi and serotonin which leads to increased concentrations in the synaptic cleft and that causes the antidepressant effect |
True
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How long does it take for the TCA's to work once treatment is started?
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2 weeks
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Which TCA is useful in the treatment of bedwetting in children?
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Imipramine
|
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what are some clinical indications of use for TCA's
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depression, panic disorders, OCD, enuresis, chronic pain, bulemia, and ADHD
|
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if your patient experiences sedation after starting TCA's, how long should you tell them it will last?
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2-3 weeks
|
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what are some adverse effects of TCA's?
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anticholinergic type: blurred vision, dry mouth, urinary retention, constipation. Also cardiac stimulation, othostatic hypotension, reflex tachy, sedation
|
|
Name some TCA's
|
imipramine (toranil), amitriptyline (elavil), doxepin (sinequan),
|
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how can you recognize a TCA?
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they end with amine or yline except for doxepin
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what is the difference between an SSRI and a TCA?
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THey have same mechanism, except everything is reuptaken except serotonin by the SSRI
|
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What are some benefits to SSRI's vs TCA?
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less adverse effects. Specifically less anticholinergic effects, and fewer cardiac effects
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what are some clinical uses of SSRI?
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depression, bulimia, OCD, anorexia, panic disorders, pain from diabetic neuropathy and PMS
|
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which anti depressant class is used to treat diabetic neuropathy and pms pain?
|
SSRI
|
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name some SSRI's?
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desyrel, prozac, serzone, paxil, celexa, zoloft, effexor.
|
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What are some adverse effects male patients may have with SSRI and how can you treat it?
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loss of libido, delayed ejaculation, and anorgasmia. Treat with peri-actin
|
|
name some MAO inhibitors?
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Nardil, marplan, and parnate
|
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which class of antidepressant function by inhibiting the "safety valve" and therefor irreversibly permitting neurotransmtter molecules to escape degradtion therefore excess will accumulate in the presynamptic neuron.
|
mao inhibitors
|
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which class of antidepressants are restricted r/t severe dietary interactions?
|
mao inhibitors
|
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what are the clinical uses for mao inhibitors?
|
depressed patients who do not respond to other tx or who have anxiety. also good for phobias and atypical deptression.
|
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which 2 classes of drugs should never be given at the same time because of a life threatening interaction?
|
MAO inhibitors and TCA
|
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how long apart should MAO inhibitors and TCA's be given?
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6 weeks
|
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what foods does your patient on MAO inhibitors need to avoid?
|
tyramine containing. cheeses, chicken liver,beer and red wines.
|
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is lithium an antidepressant?
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NO
|
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what is the clinical use for lithium?
|
manic-depressive patients and in the treatment of manic episodes
|
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what are some side effects with MAO inhibitors?
|
drowsiness, orthostatic hypotension, blurred vsion, dry mouth, dysuria, and constipation
|
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what are the consequences of taking an MAOI and consuming tyramine?
|
headache, tachycardia, cardiac arrythmias, stroke, HTN, nausea
|
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what is a common side effect of beta agonists?
|
muscle tremors and tachycardia
|
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name a weak opiate?
|
propoxyhene (darvocet)
|
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name some moderately strong opiates
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hydrocodone, codeine, oxycodone
|
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name some strong opiates
|
morphine, methadone, meperidine, and fentanyl
|
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which opiate doesn't cause miosis and why?
|
demerol. its a muscarinic blocker
|
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what opiates are commonly used to treat coughs?
|
codeine and dextromethhorphan
|
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what opiates are commonly used to treat diarrhea?
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diphenoxylate and loperamide
|
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what opiate is typically used to treat pulmonary edema?
|
morphine
|
|
hypnosis
|
induction of sleep
|
|
anesthesia
|
loss of consciousness associated with absence of response to pain
|
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what is the drug of choice for status epilepticus?
|
valium
|
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what are the 5 effects of benzos?
|
anxiety reduction, sedative and hypnotic, anterograde amnesia, anticonvulsant, and muscle relaxing
|
|
what benzo is good for panic disorders?
|
alprazolam
|
|
name 4 clinical uses of benzos?
|
1- anxiety disorders,
2- muscular disorders 3-seizure disorders 4- sleep disorders |
|
what benzo is good for insomnia because it dec. sleep induction time and number of awakenings therefore increasing duration of sleep?
|
flurazepam (dalmane)
|
|
do benzos provde anesthesia?
|
no
|
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do benzos provide analgesia?
|
no
|
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what are some adverse effects of benzos?
|
drowsiness and confusion, ataxia
|
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what patient population should you use benzos cautiously in?
|
liver disease or patients taking other CNS depressants
|
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does zolpidem (ambien) cause more or less daytime cognitive impairment than benzos?
|
less
|
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name some nonbenzo sedative/hypnotics?
|
Buspirone, hydroxyzine, zolpidem
|
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what is the antagonist to benzos?
|
flumazenil
|
|
what are some therepeutic uses of barbs?
|
anesthesia, anticonvulsant, anxiety
|
|
what are some adverse effects of barbs?
|
drowsiness, impaired concentration, mental sluggisness, addiction, poinsoning
|
|
what is the barb used to treat young children with recurrent febrile seizures?
|
phenobarbital
|
|
name 2 methylxanthines?
|
caffeine and theophylline
|
|
what is the moa of methylxanthines?
|
translocation of extracellular calcium, inc cAMP and cGMP, blockade of adenosine receptors (causes excitation)
|
|
what is the most widely used licit or legal drug?
|
nicotine
|
|
what is nicotines mechanism of action?
|
ganglionic stimulation by depolarizetion. At very high doses it causes ganglionic blockade
|
|
what is the mechanims of action of cocaine?
|
blockade of norepi, serotonin, and dopamine re-uptake. Poentiates nad prolongs the CNS actions of these catecholamines. This produces the intense euphoria.
|
|
what triggers the vicious cycle of craving for cocaine?
|
depletion of dopamine
|
|
what are some actions of cocaine?
|
fight or flight, pupillary dilation, tachycardia, HTN
|
|
amphetamine's MOA?
|
releasing intracellular stores of catecholamines. It blocks MAO, so high levels of cetecholamines are readily released into synaptic spaces
|
|
what are some effects of amphetamines?
|
increased alertness, decreased fatigue, depressed appetite, and insomnia, Seizures with high doses
|
|
what amphetamine is given to treat ADHD?
|
ritalin
|
|
LSD- MOA?
|
serotonin agonist. This causes sympathetic nervous system activation,
|
|
what are some effects of LSD?
|
hallucinations and mood alterations, pupillary dilation, htn, inc. body temp and goose bumps
|
|
what medications can be used to block the hallucinatory action of LSD?
|
haldol and other neuroleptics
|
|
What is PCP's MOA?
|
inhibits the reputake of dopamine, serotonin, and norepi. Also has antiocholinergic, but with inc. salivation
|
|
what type of drug is the date rape drug rohypnol?
|
benzo. It's other name is flunitrazepam
|
|
what is a tonic clonic seizure
|
grand mal
|
|
what is an absence seizure?
|
petit mal
|
|
which anti-seizure drug also has antiarrythmic properties?
|
dilantin
|
|
what is dilantin's MOA?
|
stabalizes neuronal membranes or stops depolarization by decreaseing the influx of sodium ions. Suppresses repetitive firing of neurons
|
|
what type of seizures is dilantin used in?
|
tonic clonic, partial, and status epilepticus
|
|
what are some adverse effects of dilantin?
|
nystagmus and ataxia, gingival hyperplaxia, coarsening of facial features, confusion, hallucinations, drowsiness.
|
|
should dilantin be given to pregnant women?
|
No- causes fetal hydantion syndrome- cleft palate, cleft lip, and congential heart disease. If mom is unresponsive to other tx it's better to keep her on this than have anoxic episodes for the baby during a seizure
|
|
What is tegretol's MOA?
|
reduce the propogation of abnormal impulses by slocking sodium channels, thereby inhibiting the generation of repetitive action potentials
|
|
which antiseizure drug can cause severe liver toxicity?
|
tegretol
|
|
which anti-seizure drug is used to treat trigeminal neuralgia?
|
tegretol
|
|
which anti-seizure drug resembles phenobarbital structurally and in it's anticonvulsant activity?
|
primidone (mysoline)
|
|
what is the most effective drug for treating myoclonic seizures?
|
valporic acid
|
|
what is the first choice for absence seizures?
|
zarontin
|
|
which antiseizure drug is an analogue of GABA?
|
Gabapentin (neurontin)
|
|
which anti-seizure drug blocks GABA uptake which causes enhanced inhibitory effects?
|
Tiagabine (Gabatril)
|
|
which anti-seizure drug is a chemical relative to fructose?
|
Topiramate (topomax)
|
|
what is topiramate MOA?
|
blocking sodium channels, increased GABA, and blockade of glutamate receptros
|
|
which antiseizure drug was designes to irreversibly inhibit GABA transaminase.
|
Vigabatrin
|
