pharmy 3

Somatropin = recombinant GH

GHRH analog

Recombinant human IGF-1/IGF-3 complex

GH receptor antagonist

Somatostatin Analog

Dopamine Agonists

Human menopausal gonadotropins (hMG)

Purified FSH

Extracted and purified from urine (given IM)

GnRH analogs

GnRH Receptor Antagonists

Adrenocorticotropic Hormone Analog

Pharmacokinetics: Half life of 5 minutes

Oxytocin Antagonist

Released in response to rising plasma tonicity or falling BP

Vasopressin Antagonist

Stimulates/is required for gluconeogenesis (mostly) and glycogen synthesis in fasting state

Synthetic Glucocorticoids

Synthetic Corticosteroid (similar to Aldosterone), most commonly prescribed salt-retaining hormone

Mineralocorticoid Antagonist

Progesterone Antagonist: Antagonist at glucocorticoid and progesterone receptors

Corticosteroid Synthesis Inhibitor

Corticosteroid Synthesis Inhibitor (anti-androgen)

Corticosteroid Synthesis Inhibitor

Pharmacokinetics: Oral, IM, transdermal, and topical

Selective Estrogen Receptor Modulators (SERMs)

Selective Estrogen Receptor Downregulator (SERDs)

Aromatase Inhibitors, inhibit the conversion of androgens to estrogen

Inhibitor of P450 in gonadal steroid synthesis

Estrogen antagonist in the hypothalamus and anterior pituitary

Uses: Contraception (+/- estradiol), HRT (with estrogen), promote and maintain pregnancy, used in ovarian suppression, diagnosing endogenous estrogen secretion

Use: Substitution therapy in hypogonadism, increases bone density (osteoporosis), can increase muscle mass, use in aplastic anemia

Androgen Receptor Antagonists

5-α reductase inhibitors, inhibiting the conversion of testosterone to dihydrotestosterone

Anti-androgen

Rapid-acting Insulins

Short-acting Insulin

Intermediate-acting Insulin, also called Isophane Insulin

Long-acting Insulins

Ethanol: inhibits gluconeogenesis

Direct effects countering insulin: Epinephrine, glucocorticoids, atypical antipsychotics, HIV protease inhibitors

First-generation Sulfonylurea

First-generation Sulfonylurea

2nd Generation Sulfonureas

Meglitinides

Biguanide, 1st line treatment for DM Type 2

Thiazolidinediones (Glitazones)

α-Glucosidase Inhibitors (competitive inhibitors)

Glucagon-like Polypeptide 1 (GLP-1) Analog [Incretin Analog]

Inhibitor of DPP-IV

Synthetic Amylin Analog

Bile-acid Sequestrant

Uses: Severe Hypoglycemia, Radiology of the bowel (relaxes the intestine), β-blocker poisoning

Thyroid Hormones

Thioamides

-Used as a short-term inhibition of thyroid hormone synthesis (Wolff-Chiakoff Effect)--> after 10-14 days iodide effect escapes

Taken up and sequestered by the thyroid gland--> damage through emission of toxic β-particle

1)β-blockers--> Useful in controlling CVS effects, especially during the thyroid storm

Recombinant PTH (DNA analog)

Acts by activating steroidal nuclear receptor

Peptide Hormone

Phosphate binding drug used to prevent hyperphosphatemia in patients with chronic renal failure

Oral: Ca carbonate/citrate/lactate

MOA: Inhibit osteoclastic activity by disrupting the mevalonate pathway--> decreasing the osteoclast H+ ATPase

Activates the Ca2+ sensing receptors in parathyroid cells-- suppression of PTH synthesis and release

1) Fluoride--> Chronic exposure can lead to new bone synthesis which is denser, but brittle

Active elements: Flavonoids, polyacetylenes and caffeonyl conjugates

Combination of ephedrine + pseudoephedrine

Active component: Organic thiosulfinate, which is converted into allicin

Active constituents: Flavone glycosides and terpenoids

Active component: Ginsenosides

Active component: Silymarin (flavonolignans)

Active ingredients: Hypericin and hyperforin

Active components: photosterols, aliphatic alcohols, polyprenes, and flavanoids

Purified Nutritional Substance

Purified Nutritional Substance

Effects: Improves sleep onset, duration and quality--> used in sleep disorders and in those with jet lag

May possess analgesic, sedative and anti-inflammatory properties

Active compound: kavalactone

Step 1: Aspirin, Acetaminophen, NSAIDs

Morphine is the DOC for Breathlessness in end-of-life care

Poisoning: uncoupling of oxidative phosphorylation and disruption of normal cellular metabolism--> Impaired ability to generate ATP

Severe Cases: Fulminant liver failure--> Hepatic encephalopathy--> death

At high doses: Agitation, acute psychosis, HTN, tachycardia, TACHYARRHYTMIAS

Signs: Red as a beet (Skin flushed), Hot as a hare (hyperthermia), Dry as a bone (dry mucous membranes/lack of sweating), Blind as a bat (blurred vision, cycloplegia, pupillary dilation), Mad as a hatter (confusion, delirium) + Tachycardia

Propranolol is most toxic-->blocks Na+ channels at high doses and is lipophilic (CNS effects)

Effects: Depress SA automaticity and slow AC node conduction, reduce CO and BP

Normal Action: Antagonists at muscarinic receptors, are α-blockers (vasodilation/hypotension), and have quinidine-like depressant effects (blockade of fast Na+ channels) which slow conduction and depresses cardiac contractility

Signs: Severe HTN reactions with tyramine-containing foods/drugs (aged cheese, red wine, phenylpropanolamine, ephedrine)

Hyperthermic Disorder seen in patients who use Anti-psychotic agents (dopamine agonists)

Mild/moderate overdose: Lethargy, SMALL PUPILs, BP/pulse rate decreased

Treatment: Glucose bolus + IV OCTREOTIDE

Colorless, tasteless, odorless, and nonirritating gas

Treatment: IV DEXTROSE (glucose), THIAMINE (for Wernicke-Korsakoff syndrome), and correct electrolyte balance

Metabolized into formaldehyde and FORMIC ACID (toxic)

Used in heat exchangers, coolents, antifreeze formulations, industrial solvents and hydraulic brake fluids

Normal Action: Cholinesterase Inhibitors

Rodenticide

Common in plastic/jewelry manufacturing, burning of wool/silk, consumption of cassava root or apricot seed

From industrial exposure, lead-containing paint chips (children)

Toxicity (increasing order): Organic arsenicals < pentavalent aresenic < trivalent arsenic < arsine

Found in the industries such as battery, thermometer, and barometer

Acute iron toxicity: Vomiting, GI bleeding, lethargy, and GRAY CYANOSIS

MAOIs: Increase levels of NE, serotonin, and dopamine

TCAs: Block SERT and NET in addition to α-adrenergic, muscarinic, histamine, and 5-HT receptors

SSRIs: specifically inhibit serotonin uptake

SNRIs

Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs): inhibits uptake and increases release

5HT2 Antagonist and (general) Reuptake Inhibitors (SARIs)

Noradrenergic and Specific Serotonergic Anti-depressants (NASSA)

Use: Prophylactically for manic-depressive episodes and in treatment of manic episodes

Valproate/Carbamazepine are commonly used

Classical Antipsychotics

Atypical Antipsychotics

Sedatives--> NON-LINEAR dose-response curve

Sedatives--> LINEAR dose-response curve

Non-benzodiazepine Benzodiazepine Receptor Agonists

5-HT1A PARTIAL Agonist, Anxiolytic

Agonist at MT1/MT2 Melatonin Receptors

Older Sedative-Hypnotics

Hydroxyzine: Antihistamine with antiemetic activity

Anti-muscarinics used to treat parkinsonism

Precursor of dopamine

Nonergot Dopamine Agonists

Nonergot Dopamine Agonist

Nonergot Dopamine Agonist

Selective and irreversible inhibitor of MAO-B (which selectively metabolizes dopamine)

Selective and irreversible inhibitor of MAO-B (which selectively metabolizes dopamine)

Catechol-O-Methyltransferase Inhibitors (COMT)

Antiviral drug used for Parkinson's Disease

DOC for Simple/Complex Partial and Secondarily Generalized tonic-clonic seizures: Carbamazepine, Oxacarbazepine, Lamotrigine, Phenytoin

Anti-epileptic

Anti-epileptic

Anti-epileptic

Anti-epileptic

Anti-epileptic

Anti-epileptic

Anti-epileptic

Anti-epileptic

Anti-epileptics

Methylxanthines

MOA: Inhibits DOPAMINE, NE, and serotonin uptake

MOA: Increase release of catecholamines, weak inhibitors of MAO, possible direct catecholaminergic agonists on the brain

Actions: ganglionic stimulation by depolarization (low doses) and ganglionic blockade at high doses

Opioids

9-Tetrahydrocannabinol produces most of the effects

MOA: Agonist effects at the 5-HT2 receptors in the CNS

1st used as an anesthetic

Actions: Fosters feelings of empathy and intimacy without impairing intellectual capacities

Inhalants including gasoline, paint thinner, lighter fluid, glue and degreasers

Inhaled Anesthetic, Gas

Inhaled Anesthetics, Volatile Halogenated Hydrocarbons

AD phenomenon triggered by exposure to volatile inhalation anaesthetics and depolarizing skeletal muscle relaxants (succinylcholine)

Diazepam, Lorazepam, and MIdazolam

Common IV Anesthetic used for induction/maintenance of anesthesia

IV Anesthetic

IV Anesthetic

Reasons: Amnesic effects, prevention of salivation and bronchial secretions, protection of heart form bradycardia caused by inhalational agents and neuromuscular blockers

Ester Local Anesthetics

Amide Local Anesthetics

Non-Depolarizing Neuromuscular blockers Benzylisoquinolines

Non-Depolarizing Neuromuscular blockers Ammonio Steroids (contain esters hydrolyzed in the liver)

Depolarizing Neuromuscular Blocker

Diazepam: Facilitates action of GABA at GABAa receptors

Dantrolene and Botulism

Used for relief of ACUTE muscle spasm