Pharm Flash Cards#2

Prostatin,

use inhaled albuterol, terbutaline, or metaproterenol before exposure

inhaled glucocorticoids, cromoyln sodium. Possible use oral theophylline and beta2 agonist.

oral glucocorticoids

there is up regulation and sensitivity of beta-receptors

Can be given up to 2 weeks systemically before cushingoid features.

Beclomethasone, fluticasone, and triamcinolone. AE include cough, dysphonia, oral thrust and infection

Cromolyn and Nedocromil, both interfer w/ Cl- channels

Beta2 agonist, works by increasing cAMP causing vasodilation (5 min will achieve 75% max effect). Members include albuterol, terbutaline, metaproterenol, and salmeterol. AE include tremor, anxiety, restlessness, tachycardia

salmeterol

Anticholinergic (Ipratropium and Tiotropium)

Tiotropium, requires just 1/day

Theophylline, phoshodiesterase inhibitor, has very low TI

Zafirlukast and Montelukast

use 1-2 hrs after meal b/c food affects absorption

Zileuton, used for noctural asthma, effects liver NZM's so not used much

Zileuton

omalizumab, given every 2-4 weeks subcut

inhaled beta2 agonist, ACh antagonist, corticosteroids systemically

inhaled corticosteroids, histamine release inhibitors, LT modifiers, long acting b-agonist, systemic corticosteroids, theophylline, and anti-IgE tx

oxygen

Cylomicrons (A-I, A-II, B-48, C, E); VLDL (B-100, C, E); LDL (B-100); HDL (A-I, A-II, C, E)

Mutation of LDL receptor

Defect in Apo E

↓total, ↓↓LDL, ↑HDL, ↓Triglycerides

Prego's and kids under < 8 y.o.

Lova, Simva, Prava, Fluva, Atorva, Rosuva-statin.

Pravastin

Rosuvastatin, metabolized by CYP2C9

Cholestipol, Colestipol, Colesevelam. They bind to bile-acid and stop there reabsorption. Can effect lipid-soluble drugs

Ezetimibe, given w/ statin, can cause liver failure

Niacin, flushing due to increase liver NZMs in blood

Niacin, increases HDL levels

Fibric acid derivatives (Gemfibrozil and Fenofibrate) are used to tx hypertriglyceridemia. AE: increase Liver NZMs, myositis, and Rhabdomyolysis, Gall stones

anti-thrombotic, vasodilatory, anti-inflammatory -> No CHF, CHD, high triglycerides

Prox tubules by absorption of HCO3

Increase aldosterone causes less Na and more K and H contents.

promotes the increase in volume, pressure, and Na retention

promotes the opposing effects to Renin

It increases thirst, levels of NE in synapse, aldosterone release, vasoconstriction, Na/H exchange

Excrete Na+, inhibits renin, vasodilation, and increase renal blood flow

metalloproteinase

Neseritide, IV, do not give to dehydrated pts

Stimulate Na reabsorption, Na/K exchange in DCT, H secretion in prox tubule

Mannitol given IV, acts as urine osmo agent. Can cause fluid overload (CHF, Pulm Edema) if decreased GFR

Acetylzolamide, needs to be 90% inhibitory to be effective. Can cause sulfonamide allergy.

Loop Diuretics (furosemide and torsemide), inhibits reabsorption of Cl in ascending loop. Toxicity includes allergic rxns, hypokalemia, hyponaturemia, hyperglycemia, hyperuricemia, and GI upset (sulfonamide)

Thiazide Duiretics (Chlorothiazide, Hydrochlorothiazide, Indapamide, and Chlorthalidone) Often used w/ loop diuretics

Renal failure (decreased GFR), hyperuricemia, hypokalemia, hyperglycemia, hypercholesteremia

Indapamide

Hydrochlorothiazide

Spironolactone and Eplerenone. CHF w/ hypokalemia, also reverse DM nephritis. Can cause hyperkalemia.

Amiloride and Triamterine. Can lead to hyperkalemia.

Spironolactone

Losartan and Valsartan. Used for HTN, K-retention, and reverse DM neph. Pregos.

Captopril, Lisinopril, Enalapril, Ramipril, and Quinapril

Dry cough and kills fetus

ACE inhibitors

Caffeine

Hypotension, Hyperosmolality, TCA, Morphine, and Nicotine

EtOH and phenytoin.

Causes vasoconstriction (V1), Glcogenolysis (V1), Antidiuresis (V2), and release of ACTH (V3).

V1 receptor is PLC. V2 receptors is cAMP.

Desmopressin

Pheochromocytoma and Renal Disease

Early is often asymptomatic, can have dizziness, tiredness, tachycardia. End organ damage by stroke in cerebral vessels, MI, Renal failure, and Pailledema

Minoxidil, opens K channel stabilizing membrane resting potential, which decrease excitability and contractility. Is long lasting and causes Na/Water retention. Causes hypertrichosis (hair growth).

Hydralazine, release NO which increases guanylate cyclase which relaxes VSM. Other AE include reflex tachy and increased renin

Diazoxide, which is similar to thiazide (opens K channels) but no diuretic activity

Sodium Nitroprusside, releases NO in VSM

Nifedipine, L-type VSM selective. Can cause edema and HA

Diltazem, may accelerate ventricular rate in presence of rapid arterial rate and AV-bypass

Verapamil, has greatest cardio-selection among Ca blockers (heart block). Avoid if pt is on b-blockers, WPW, aortic stenosis, or CHF.

Bepridil, used if b-blockers or Ca-blockers don't work. Can cause Torsades de Pointes.

Loss of K, Acidosis, Adenosine release, depletion of high energy phosphates

50%

80%

First in subendocardium then moves out to the epicardium

To restore oxygen supply and demand balance, not the relief of anginal pain

Dipyridamole and Adenosine, effect known as coronary steal

Venous pooling, reduces preload, decrease CO and myocardial oxygen consumption, and relieves ischemia

Nitroglycerine, sublingual

Venodilation, This is the isosorbide dinitrate form.

Amyl Nitrate

Tolerance can develop thus causing rebound ischemia and avoid if pt is on PDE-5 inhibitors

Increased preload, increased afterload, sinus/AV tachycardia, reduced contractility

It inhibits Na/K pump, which increase Na cytosolic, which decrease Na-Ca exchange, which increase Ca cytosolic, thus increase contraction force, increase para reflex, thus decrease AV node conduction and increase PR segment.

To tx CHF and AF. It increases force of contraction independent of preload and afterload

Slurring of ST segment and Prolongation of PR segment

Look for changes in elctrolyte balance (K low and Ca high)

Lidocaine and replace electrolytes

Amrinone and Milrinone, they are positive inotropic agent that inhibit PDE-3.

Thrombocytopenia (reversible), GI idsturbances, vent arrhymias

Nifedipine

Increase HR, size, vasoconstriction, contractility, sympathetic tone, HTN, and HF.

Occurs at rest. ST elevation(transmural ischemia). Tx by prevent spasm.

Occurs w/ exertion or emotion. ST depression(subendocardial ischemia). Tx by reduced oxygen demand.

Should not extend for more than 12-16 hrs of any 24 hr period

Systolic hypotension

~ 20 mins

20 - 30 mins

Reduction of myocardial blood flow

subendocardial ischemia

Transmural ischemia

NA+ and Ca++

Rapid and regular rhythm; ventricular HR is regular but is too rapid to allow ventricular filling

Rapid and irregular; ventricular HR is also rapid and irregular but vent rate is slower than w/ atrial flutter this both CO and exercise tolerance are reduced. Conduction through AV node is slower and more likely to block.

Ventricular Prematures

Na+ pump inhibitors, voltage dep block

Quinidine and Procainamide, they have mild depression of conduction w/ fast HR by directly depressing AV node

Lidocaine and Mexiletine, there is no change in conduction except at high HR

V-fib acute, Digitoxin OD, post MI V-fib. Give IV, quick metabolism.

Propafenone and Flecainide, they markedly slow conduction and prolong QRS interval at all HRs

Class Ia, they may increase HR and decrease CO tus worsen HF

Quinidine

Procainamide

Tocainide

Beta1 blockers

Used for depression AV nodal conduction in pts w/ AF and/or prevent Vfib during 2 yrs following myocardial.

Blocks K channels

Ibutelide and Dofetilide

Amiodarone, used for VF pts then lidocaine. It increase PR, QRS, and QT duration.

Amiodarone

Class Ia and III agents

Sotalol, has little CNS effects

Ca++ L-type channels, rate and voltage dep blockade. Thus they decrease membrane potential.

Only during systole

Verapamil and diltrazem

Verapamil and B-blockers

Adenosine, given as bolus and last just seconds

transient dyspnea and flushing

Digoxin (more polar, given orally or IV, fast onset, renal excretion) Digitoxin (more lipid, given orally, slow onset, liver metabolism)

Disorientation, delerium, visual yellow halos, and rarely convulsions. Gynecomastia and hypersensitivity can occur.

Dopamine (low doses increase myocardial contractility, given IV, useful in acute severe failure for its positive inotropic action, also increases RBF). Dobutamine (stim alpha and beta in both heart and blood vessels but selectively stims cardiac B receptors to produce inotropic action, given IV, causes fewer arrhythmias)

Heparin, it activates ATIII, which forms complex w/ serum protease

protamine

Osteoporosis, thrombocytopenia, and reocclusion once withdrawn

Enoxapirin, it rarely produces thrombocytopenia as it does not bind to platelet factor 4, it also has less osteoporosis RF, and can be given to prego's.

Fondaparinux, binds selectively to ATIII and inhibits only factor Xa. It is not inactivated by protamine. There is no binding to platelet factor 4.

2, 7, 9, and 10. Protein C and S too.

Can be procoag and produce Venous thrombosis and necrosis of intestines an dbreasts tissue

Lipirudin, a direct inhibitor of thrombin, it binds 1:1 to thrombin.

INR (PT) for venous thrombosis(-1.5), AF (-2), and aortic valve replacement (-3)

aPTT

Aspirin

It prevents K-aggregation thus inhibits CF synthesis

Clopidogrel, prevents GP Iib/IIIa receptor activation by ADP

Abciximab

325 mg/2 days or 81 mg/day

Eptifabatide and Tirofiban, used for acute coronary syndrome in cath lab

Cilostazol, which is used for intermittent claudication. Avoid if pt has CHF

Abciximab, eptifabatide, and tirofiban

Clopidogrel

Acutely (Abciximib, eptifibitide, tirofiban) Chronic (clopidogel)

Cilostazol

t-PA and streptokinase

Streptokinase

t-PA

Converted from ferric to ferrous iron, a process which requires ascorbic acid

Ferritin and Hemosiderin (insoluble, ferritin w/ no shell)

GI irritation

desferoxamine

Aliskiren

Constricts efferent arterioles in glomerulus, stims Na/H exchange, and causes vasoconstriction

Conivaptan

thiazide

loop

Prazosin

Doxazosin

Salmeterol

hypokinesis

Inhale amyl nitrate

verapamil and diltiazem

adenosine and dipyridamole, used to dx CAD.

Problem of blood coagulation/platelet aggregation on top of stenosis and artherosclerosis. Tx w/ anticoagulants

Fluticasone