2ND HALF DRUGS ONLY - Disease, class and mechanism

Question 1

Clonidine

Answer 1

Treatment: hypertension (also withdrawal of sedatives and opioids - treat autonomic symptoms)

class = a2 agonist

mechanism: decrease NE in CNS - decrease SNS - decrease CO and PVR

Question 2

Metoprolol/Propanolol

Answer 2

Treatment: hypertension, heart failure, angina, arrhythmias

class = Beta blockers

mechanism: block B1 in heart = decreased CO, block B1 in kidneys = devrease PVR

overall decrease in O2 demand for heart

Question 3

Prazosin

Answer 3

Treatment: hypertension

Class = a1 antagonist

mechanism: block a1 on arteries - vasodilation

Question 4

Sodium nitroprusside

Answer 4

Treatment: hypertension

Class = NO donor/vasodilator

Mechanism: donate NO - increase cGMP - vasodilation

Question 5

Verapamil

Answer 5

Treatment = hypertension, arrhythmias, angina

Class = Ca2+ channel blocker/vasodilator

Mechanism: block Ca2+ from getting into BV cells → vasodilation

decreases O2 requirment for heart

Question 6

Enalapril

Answer 6

Treatment: hypertension, heart failure

Class = ACE inhibitor

Mechanism: Blocks ACE from making AG II and from cleaving bradykinin → vasodilation

Question 7

Losartan

Answer 7

Treatment: hypertension, heart failure

Class = AT1 receptor blocker

Mechanism: Binds AT1 → prevents effects of AG II → vasodilation

Question 8

Hydrpchlorothiazide

Answer 8

Treatment: hypertension, heart failure

Class = Diuretic (thiazide)

Mechanism: Inhibits NaCl transport in DCT → less water and Na+ being removed from urine (decreased BV)

Question 9

Furosemide

Answer 9

treatment: hypertension, heart failure

Class = Diuretic (loop)

Mechanism: Inhibits co-transporter of Na+, K+ and Cl- in loop of Henle → inhibits NaCl transport → ↓BV

Question 10

Nitroglycerin

Answer 10

Treatment: Angina, heart failure

Class = vasodilator/NO donor

Mechanism: Nitrate converted to NO → ↑cGMP → vasodilation

Question 11

Digoxin

Answer 11

Treatment: heart failure

Class = cardiac glycoside

Mechanism: inhibits Na+/K+ ATPase → ↑Na+ inside cell → ↑intracellular Ca2+ → ↑cardiac contractility

(indirect effect = improves circulation → baroreceptor → increase PSNS)

Question 12

Quinidine

Answer 12

Treatment: Arrhythmias

Class = Na+ blocker

Mechanism: Blocks open Na+ channel → ↓Na+ influx into cell → ↓ conductance and excitation

Question 13

Lidocaine (CVS treatment)

Answer 13

Treatment: Arrhytmias

Class = Na+ blocker

Mechanism: Blocks open Na+ channel → ↓Na+ influx into cell → ↓ conductance and excitation

Question 14

Amiodarone

Answer 14

Treatment: Arrhythmias

Class = K+ blockers

Mechanism: Block K+ from leaving cell → prolong refractory period of AP

Question 15

Donepezil

Answer 15

Treatment: Alzheimer’s

Class = AChE inhibitor

Mechanism: ↓breakdown of ACh → ↑ACh levels in CNS

Question 16

Haloperidol

Answer 16

Treatment: Schizophrenia, Psychosis

Class = D2 > 5HT2A antagonist (antipsychotic)

Mechanism: Binds D2 receptor in the cortex and limbic system → ↓cAMP → ↓DA activity

Treats positive symptoms of schizophrenia but makes negative symptoms worse

Question 17

Olanzapine

Answer 17

Treatment: Schizophrenia, Psychosis

Class = 5HT2A > D2 antagonist (antipsychotic)

Mechanism: Binds and blocks 5HT2A receptor → ↓serotonin activity → increase DA release in cortex but not lymbic system → alleviate negative symptoms of schizophrenia

Question 18

L-dopa

Answer 18

Treatment: Parkinsons

Class = Dopamine precurssor (D2 agonist)

Mechanism: L-dopa converted to dopamine in the nigrostriatal portion of the brain → temporarily improves motor symptoms

Question 19

Ronipirole

Answer 19

Treatment: Parkinsons

Class = D2 agonist

Mechanism: Binds D2 receptor → mimics dopamines effects → improve motor symtoms of parkinsons

Question 20

Selegiline

Answer 20

Treatment = Parkinsons

Class = MAO inhibitor

Mechanism: Binds and inhibits MAO →↓breakdown of DA → ↑DA levels in the brain

Question 21

Benztropine

Answer 21

Treatment: Parkinsons

Class = Antimuscarinic drug (ACh blocker)

Mechanism: Binds M/N receptor → ↓ACh activity in the brain to balance ACh and DA levels

Question 22

Lithium

Answer 22

Treatment: Bipolar dissorder

Class = mood stabilizer (antidepressant)

Mechanism = decrease IP3 and DAG precursors - effects M, a1 and 5HT2A receptors)

Question 23

Imipramine

Answer 23

Treatment: depression

Class = TCAs (antidepressant)

Mechanism: prevent NE and serotonin reuptake

Question 24

Fluoxetine (PROZAC)

Answer 24

Treatment: depression

Class = SSRI (antidepressant)

Mechanism: prevent serotonin reuptake

inhibits CYP2D6 which metabolizes sevral drugs (TCAs, haloperidol, B-blockers) - avoid Fluoxetine if taking one of these drugs

Question 25

Bupropion

Answer 25

Treatment: depression Class: atypical antidepressant Mechanism: inhibits reuptake of DA and NE inhibits CYP2D - avoid bupropion if taking drugs metabolized by this

Question 26

Phenelzine

Answer 26

Treatment: depression (only use if TCA not effective) Class = MAO-inhibitor Mechanism: prevent metabolism of NE, Serotonin and dopamine

Question 27

Diazepam

Answer 27

Treatment: anxiety Class = benzodiazapie (sedativehypnotic) Mechanism: Binds GABAA at allosteric site → ↑frequency of Cl- channel opening in presence of GABA → inhibit many neurons in the brain

Question 28

Phenobarbital

Answer 28

Treatment: anxiety Class = Barbituate (sedativehypnotic) Mechanism: Binds GABAA at allosteric site → ↑frequency of Cl- channel opening with or without presence of GABA →inhibit many neurons in the brain High doses can also inhibit NMDA and inhibit Na+ and Ca2+ channels

Question 29

Ethanol

Answer 29

Treatment: anxiety Class = alcohol Mechanism: ↓NMDA activation, ↑GABAA activation + decrease membrane excitability

Question 30

Fentanyl Morphine Heroin

Answer 30

Treatment: analgesics - abused drug for users seeking euphoria, tranquility and sleepiness Class = opioids Mechanism: Presynaptic = ↓Ca2+ → ↓release of NTs Postsynaptic = ↑K+ influx → inhibition of postsynaptic neurons (longer refractory period)

Question 31

Methadone

Answer 31

Treatment: manage opioid withdrawal Class = long-acting opioid agonist Mechanism: same as opioids, but effect not as intense + longer duration of action

Question 32

Amphetamine

Answer 32

Treatment: abused drug for users seeking alertness and euphoria Class = stimulant Mechanism: increase NE, dopamine and serotonin release

Question 33

Cocaine

Answer 33

Treatment: abused drug for users seeking alertness and euphoria, topical local anesthetic Class = stimulant Mechanism: prevent NE, dopamine and serotonin reuptake

Question 34

LSD

Answer 34

Treatment: abused drug for users seeking visual illusions and visual distortion Class = hallucinogen Mechanism: 5HT-2A receptor agonist

Question 35

PCP

Answer 35

treatment: abused drug for users seeking visual illusions and visual distortion Class = hallucinogen Mechanism: NMDA antagonist

Question 36

Marijuana (THC)

Answer 36

Treatment: anxiety + abused drug for users seeking euphoria, relaxation and sleepiness Class = cannabinoid Mechanism: binds and activate CB1 receptor - decrease glutamate or GABA release

Question 37

Chlorpromazine

Answer 37

Treatment: premedication - sedative + neuroleptic Class = Phenothiazines (D2 antagonist) Mechanism: Block D2 receptor in brain → sedation and reduced agitation

Question 38

Dexmedetomidine

Answer 38

treatment: premedication - sedative (with some analgesia) Class = a2 agonist Mechanism: Bind a2 at presynaptic neurons → opens K+ channels and suppress Ca2+ influx → inhibit NT release → sedation, analgesia, hypotension and relaxation

Question 39

Midazolam

Answer 39

Treatment: premedication - sedative/anxiolytic (+amnesia properties) Class = benzodiazepine Mechanism: Binds allosteric site on GABAA → facilitates GABA binding → opens Cl- channel → inhibits excitation → reduce anxiety, muscle relaxation, amnesia, sedation

Question 40

Naloxone

Answer 40

Treatment: opioid overdose Class = Mu receptor antagonist Mechanism: bind and block Mu receptors - competitive inhibition of opioids

Question 41

Thiopental Sodium

Answer 41

Treatment: induction agent Class = barbituates Mechanism: Bind GABAA → inhibit dissociation of GABA from receptor → keep Cl- channel open → inhibit AP

Question 42

Propofol

Answer 42

Treatment: induction agent (+sedative) Class = propofol Mechanism: Facilitates effect of GABA at its receptor → keeps Cl- channel open →inhibits AP

Question 43

Ketamine

Answer 43

Treatment: induction agent Class = Phencylidines Mechanism: Main: blocks NMDA receptor Minors: inhibits GABA receptor → closes Cl- channel Stimulates sigma receptors → dysphoria

Question 44

Isoflurane Sevoflurane

Answer 44

Treatment: inhalent anesthetic Class = inhalents Mechanism: Facilitate interaction of GABA with GABAA → inhibit APs

Question 45

Procaine Bupivicaine

Answer 45

treatment: local anesthesia Class = Na+ channel blocker Mechanism: Block Na+ channel → blocks pain at low concentrations and blocks movement at high concentrations