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50 drugs Flashcards
Anticonvulsant Drugs (3)
Phenytoin, Valproic Acid, Oxcarbazepine
Other Anticonvulsant Drugs (7)
Carbamazepine, Ethosuximide, Gabapentin, Topiramate, Pregabalin, Diazepam, Lorazepam.
Tricyclic Antidepressants (3)
Desipramine, Doxepin, Clomipramine
SSRI’s (3)
Fluoxetine, Escitalopram, Sertraline
SNRI’s-Serotonin Norepinephrine reuptake inhibitors (3)
Venlafaxine, Desvenlafaxine, Duloxetine
Atypical drugs (1)
Bupropion
MAOI’S-Monoamine oxidase inhibitors (1)
Phenelzine
Mood Stabilizers (1)
Lithium
Bipolar Disorder (2)
Valproate, Carbamazepine
Histamine-2 (H2) Receptor Antagonists (4)
Cimetidine, Ranitidine, Famotidine, Nizatidine
Proton (H+) Pump Inhibitors (PPI’s) (3)
Omeprazole, Esomeprazole, Lansoprazole
Acid Neutralizing Drugs (2)
Amphojel(AL(OH)3), Tums-CaCO3
Mucosal Protective Agents (3)
Sucralfate, Misoprostol, Bismuth subsalicylate
Drugs used to destroy the bacterium Helicobacterpylori. (Antibiotics) (3)
Clarithromycin, Metronidazole, Bismuth subsalicylate
Antihistamines H1 blocking drugs (5)
Chlorpheniramine, Diphenhydramine (1st gen), Loratadine, Cetirizine (2nd gen),Dimenhydrinate
Bronchodilators Beta 2 Adrenergic Receptor Agonists (2)
Albuterol (Short acting for acute “rescue” inhaler), Salmeterol (Long acting to “prevent” asthma COPD)
Bronchodilators Methylxanthines (1)
Theophylline
Bronchodilators (1)
Tiotropium
Bronchodilators Leukotriene Receptor Blockers (1)
Montelukast
Antiparkinsons Drug (3)
Levodopa (L-Dopa) Not used alone as a drug, Carbidopa, Amantadine
Antiparkinsons Drug Dopamine Agonists (1)
Pramipexole
Antiparkinson’s Drug MAO-B Inhibitors (1)
Selegiline
Antiparkinson’s Drug COMT inhibtors (1)
Entacapone
Antiparkinson’s Drug centrally acting antimuscarinic drugs (1)
Benztropine
Antipsychotic drug 1st Generation Low Potency (1)
Chlorpromazine
Antipsychotic drug 1st Generation High Potency (1)
Haloperidol
Antipsychotic 2nd Generation (3)
Olanzapine, Clozapine, Aripiprazole
Very good for tonic-clonic seizures, also used for generalized and partial seizures. May worsen absence seizures. Can cause gingival hyperplasia, can also be teratogenic.
Phenytoin-Anticonvulasant
Commonly used in all partial seizures and generilized seizures. Used for bipolar disorder. Can also be effecitve and preventing migraine headache. Increases GABA effects and blocks CA+ channels.
Valproic acid-Anticonvulasant
Anticonvulsant drug characteristics
Inhibits neronal excitability and and around seizure focus, prevents seizure development. Inhibits NA+ channels. Skin conditions are common, rash or other skin conditions. Can be teratogenic.
Effective with generally fewer adverse effects than traditional drugs. Is primarily used for partial seizures. Low plasma sodium, Stevens johnsons syndrome.
Oxcarbazepine-Anticonvulsant
Often used for generalized tonic-clonic seizures and is DRUG OF CHOICE for partial seizures. Also used to treat bi polar disorder and trigeminal neuralgia (shooting pains in face by trigeminal nerve). Has fewer side effects than phenytoin.
Carbamazepine-Other Anticonvulsant drugs
Drug of choice for absence seizures, not useful for other partial seizures and generalized seizures. Generally fewer adverse effects than other anti convulsants.
Ethosuximide-Other Anticonvulsants
Used with other drugs for partial seizures. Also used to treat neuropathic pain, migraine headache, and fibromyalgia.
Gabapentin-Other anticonvulsants-Newer
Useful for partial and gen seizures. Can also be used for migraine headache, weight loss, neuropathic pain, binge-eating disorder.
Topiramate-Other anticonvulsant drugs
Used as adjunct therapy for partial seizures, fibromyalgia and neuropathic pain and herpes zoster.
Pregabalin-Other anticonvulsant drugs
Benzodiazepines used I.V. for status epilpticus (2)
Diazepam
Lorazepam-Both Other Anticonvulsant drugs
Second choice drugs to treat depression (i.e. not drug of choice), generally safe and effective. Anti depressant effects take several weeks to develop. 1-2 months for max effects. Used for Bipolar, fibromyalgia, insomnia, ADHD. (3). Blocks neruonal reuptake pump for norepinephrine and serotonin. (This pump removes these monoamines from the synapse). Therefore more Norepineephrine and seratonin monoamine nerurotransmitters are available to activate NE and S pathways in brain. Side effects include-Sexual side effects, Anticholinergic effects (dry mouth, blurred vision, constipation, urinary retention, sedation, and orthostatic hypotension. (3)
Desipramine
Doxepin
Clomipramine-All are TCA’s.
Which drug can cause a “yawngasm?”
Clomipramine
Most widely used drugs in US. Effective in treating depression. Have fewer adverse effects than TCA’s. Takes several weeks to develop effects. A few months may be necessary for max antidepressant effects to occur. Other uses include: bipolar disorder, OCD, panic disorder, bulimia. These selectively block the neuronal reuptake of serotonin into nerves. Therefore, more S is available to activate S receptors and S pathways in brain. (3)
Fluoxetine
Escitalopram
Sertraline
All are SSRI’s
Similar effects to SSRI’s but not as well tolerated. Can cause nausea, constipation, fatigue, headache, insomnia, sex dysfunction, increased BP, withdrawal syndrome, suicidal thinking in children and adolecents (applies to this category and SSRIs for side effects. (3)
Venlafaxine Desvenlafaxine Duloxetine *All are SNRI's* Serotonin/Norepinephrine reuptake inhibitors.
Effective antidepressant and is well tolerated. Causes weight loss and increases sex desire. Also used to help patients quit smoking. Side effects include: anorexia, dry mouth, dizziness, insomnia, GI upset, weight loss, seizures.
Bupropion-Atypical drugs
These drugs are effective antidepressants but can have severe adverse effects which limits their use. Used when other ADep fail. May take several wks to before these drugs are effective, useful for atypical depression. These prevent metabolism of NE and S in nerve terminals. This results in more of these neurotransmitters released from nerves and increased stimulation of NE and S pathways in the brain. Side effects-Anxiety, CNS stimulation, mania, orthostatic hypotension, hypertensive crisis when used with drugs that increase norepinephrine or dietary tyramine. Antipsychotics are used for severe mania.
Phenelzine-MAOI’s
Monoamine oxidase inhibitors
Used for fluctuating mood. Mania, grandiose thoughts, and alternates with depression. Therapeutic index for this is low therefore measurement of plasma ________ levels are neessary to provide effective therapeutic ______ levels without excessive toxiccity. Low NA+, dehydration and NSAIDS can increase plasma ______ levels. Side effects-ECG changes, teratogenesis, polyuria, GI upset, sedation, hypotension, seizures, and coma.
Lithium-Mood stabilizers
Mood stabilizers include lithium and other drugs used as main treatment of bipolar disorder. They reduce mania and decrease symptoms, and decrease depression. _______ is often used. It may take weeks to see max effects of drug. Antidepressants may be used to control depression and antipsychotics used to control severe mania. Drugs are often used in combination. These (2) mood stabilizers _____ and _______ are anticonvulsant drugs also used to treat seizures. ______ has fewer adverse effects than lithium, but is somewhat less effective to control depression, bipolar relapse, and suicidal thoughts.
Valproate(one talked about in this question)
Carbamazepine
*Both for bipolar disorder, also used as anticonvulsants.
Uses-gastric ulcer, duodenal ulcer, gastric reflux, heartburn and indigestion. Relieves pain and eventually heals ulcers. Most effective given at bedtime. May take 4-12 weeks to heal ulcers. Adverse effects are mostly minor including, diarrhea, headache, nausea, vamiting, elevated risk of pneumonia, more adverse effects with ____ than other drugs. _____ enters the CNS and causes lethargy, confusion, restlessness, rarely impotence, also _____ inhibits metabolism of other drugs and can increase their plasma levels. MOA- These drugs block the H2 receptor subtype causeing a reduction of histamine stimulated acid release from gastric parietal cells. Also reduces basal acid secretion. (4)
Cimetidine (Talked about in question blanks)
Ranitidine
Famotidine
Nizatidine
*All are Histamine-2 (H2) receptor antagonists.
Used for gastric and duodenal ulcer and gastric reflux. Relieve pain and eventually weeks or months heal the ulcers. Effective given once a day only due to long duration. Side effects- Minor diarrhea, ab pain, n/v, elevated risk of pneumonia, bone fractures,and acid rebound. These drugs irreversibly inhibit the gastric parietal cell proton hydrogen, potassium, adenosine triphoshatase enzyme. This enzyme pumps protons out of the parietal cell adding acid to the gastric contents. By inhibiting the H+, K+, ATPase, these drugs reduce gastric acid secretion. (3)
Omeprazole
Esomeprazole
Lansoprazole
*All are Proton (H+) pump inhibitors (PPI’s)
Used sometimes in gastric and duodenal ulcer and gastric reflux. Common use in heartburn and indigestion. Produces effects within minutes. Relieves pain, less effect on healing of ulcer. Liquid preparation are most effective. Combinations of magnesium and aluminum antacids are often used. ___1___ has slow acting, long duration, and low potency. ____2_____ has rapid acting, long duration, potent. Adverse effects: chalky taste, liquid is inconvenient, can decrease absorption of some drugs, “with calcium-constipation and acid rebound”, Mg-diareaha, al-constipataion. MOA- Antacids have weak bases that combine chemically with gastric acid and raise the pH of the gastric contents. This reduces gastric acid formation and inhibits activity of the proteolytic enzyme pepsin this will lead to less mucosa digestion caused by acid and pepsin. The goal is to raise gastric pH. (2)
- Amphojel-Al(OH)3
- Tum-CaCO3
Both are acid neutralizing drugs
used for Gastric and duodenal ulcers. Relieves pain and promotes healing of ulcers. Taken 4x a day, oral suspension may be more acceptable. Adverse effects- uncommon (constipation, nausea, drowsiness). MOA- Is activated in an acid pH to form a gel that binds ulcer tissue where it acts as a barrier to acid and pepsin.
Sucralafate- Mucosal protective agents
Prevents gastric ulcers caused by nonsteroidal anti inflammitory drugs (NSAID’s), NSAID’s inhibit prostaglandin formation in the GI tract which can cause ulcers. Side effects- diarrhea is relatively common, abdominal pain, contracts the uterus and is contradicted in pregnancy. MOA- Is a prostaglandin E1 drug. THis drug decreases gastric acid, stimulates bicarbonate and mucous and increases gastrointenstinal mucosal blood flow.
Misoprostol
Mucosal protective agents
Used for gastric and duodenal ulcer. Effectiveness is limited. Used in combination with other drugs. Commonly used for heartburn and indigestion. Side effects-Black tongue and stool, tinnitus. MOA- Binds to ulcer tissue protecting ulcers from acid and pepsin. Inhibits the activity of pepsin. Also has antibacterial activity to kill the bacterium helicobater pylori.
Bismuth subsalicylate-Mucosal protective agents
Used for gastric and duodenal ulcers. Usually 2 or 3 antibiotics and a drug to reduce acid secretion are used for 2 weeks. Eradication of helicobacter pylori promotes healing of ulcers and reduces the chance of reocurrance of ulcer. Without antibiotics there is a 60-90% relapse rate compared to 15-20% relapse when anti biotics are used. Side effects-Most antibiotics often cause diarrhea, abdominal pain, nausea. MOA-Antibiotics and bismuth destroy helicobacter pylori. this bacterium is a gram neg rod that grows in an acid environment. This bacterium may produce toxins or play some other role in causing ulcers. (3)
Clarithromycin
Metronidazole
Bismuth subsalicylate
All are used to destroy the bacterium helicobacter pylori.” All are antibiotics
Side effects- 1st gen drugs have greater side effects than 2nd. 2nd gen side effects include- Sedation, antimuscarinic effects (dry mouth, blurred vision, urinary retention, decreased GI motility, CNS in children (insomnia, nervousness, tremors. CNS in elderly (dizziness, confusion, fatigue, incoordination). MOA- These drugs bind to H1 receptors and occupy the receptor. This prevents the binding of histamine to the H1 receptor. H1 receptor blockers do not block H2 histamine receptors. Some of these drugs also block muscarinic cholinergic receptors and therefore block responses caused by acetylcholine released from cholinergic nerves. (5)
- Chlorpheniramine-(1st gen)- Treatment of mild allergies(hay fever).
- &3. Loratadine and Cetirizine-(2nd gen)-Treatment of mild allergies (hay fever).
- Dimenhydrinate-Treatment of motion sickness
- Diphenhydramine (1st gen)-Used for sedation.
All of these are antihistamines H1 blocking drugs
Used for asthma. MOA- stimulate B2 adrenergic receptors that cause relaxation of bronchial smooth muscle. This dilates the bronchioles and increases lung airflow. Stimulation of B2-adrenergic receptor on mast cells inhibits release of histamine and other inflammatory mediators. Also used to relieve bronchoconstriction in other conditions. Side effects- Fewer SE when given with inhalation, use carefully in patients with Cardiovascular disease and the elderly, these drugs can worsen or cause tachycardia, palpitations, angina (B1) CNS stimulation including-anxiety, irritability, insomnia. Muscle tremor (B2) [2]
Albuterol-(Short acting for acute “rescue” inhaler)
Salmeterol (Long acting to “prevent” asthma COPD)
Both are Bronchodilators beta 2 adrenergic receptor agonists.
Used orally to prevent bronchoconstriction in ashtma. Limited use due to greater toxicity than other drugs. MOA-These drugs inhibit the enzyme phosphodisterase which destroys cAMP. Enzyme inhibition increases the amount of cAMP in bronchial smooth muscle cells which causes relaxation, bronchodilation, and increased pulmonary airflow. Plasma levels of ________ vary greatly among different people. Adverse effects-CNS effects, anxiety, restlessness, insomnia, n/v, arrhythmia’s convulsions, use cautiously in children, the elderly, and in patients with ulcer or cardiovascular disease.
Theophylline- Bronchodilators Methylxanthines
MOA- These drugs are muscarinic receptor blocking drugs that block the bronchoconstrictor action of actytlcholine. This causes bronchodialtion that can be helpful. Use-Inhaled to decrease bronchoconstriction in COPD and other lung diseases. Is poorly absorbed into the circulation so it has limited systematic effects outside the lung. Adverse effects- Dry mouth, irritation of upper airways,and GI upset.
Tiotropium-Bronchodilators
Use-Given orally for long term control and prevention of the symptoms of asthma. MOA-Leukotrienes are released from Mast cells and other immune cells. They cause bronchoconstriction by stimulating leukotriene receptors on the airways. Also promote airway inflammation which contributes to reduced air flow in asthma and other respitory diseases. These drugs block leukotriene synthesis of receptors to cause broncodilation and can reduce inflammatory responses of the airways. Adverse effects-Headache, upset GI, joint and muscle pain soreness, agitation, depression, suicidal thinking, insomnia, restlessness. (NOT first drug of choice)
Montelukast- Bronchodilators Leukotriene receptor blockers.
MOA-Dopamine does not cross the blood-brain barrier, ______ is transported into the brain and is converted to dopamine which stimulates dopamine receptors on GABA neurons in the corpus striatum. This results in improvement of motor symptoms. Side effects- “wearing off” effect, “on-off” phenomenon, n/v due to stimulation of the chemoreceptor trigger zone in the brain, head bobbing (dyskinesias) [2]
Levodopa(L-dopa)-Antiparkinsons drug.
NOT USED ALONE AS A DRUG.
Levodopa + Carbidopa (Antiparkinsons drugs)
Carbidopa inhibits decarboxylase in the periphery (intestine, liver, ect), less metabolism of levodopa occurs outside the brain and more levodopa (10%) is transported into the brain. Carbidopa itself does not enter into the brain. ADVANTAGE is the dose of levodopa is reduced by 70%, -less dopamine is made in the periphery so fewer adverse effects.
Use-First line drugs that can be sued alone in early, mild/moderate Parkinson’s, not as effective as levodopa, can be used as an adjunct with levodopa in more severe disease. MOA-Dopamine receptor agonists that directly stimulate dopamine receptors in the corpus striatum. Adverse effects-Nausea, dizziness, sleepiness, sleep attacks, constipation, weakness. In conjunction with Levodopa-Postural hypotension, dyskinesia, hallucinations, loss of impulse control.
Pramipexole-Antiparkinson’s drug dopamine agonists.
Use-Second line drug, less effective than levodopa or dopamine agonists, effects diminish over time, primarily used for levodopa induced dyskinesias. MOA- Causes release of dopamine from dopamine nerves in the striatum, is also an antiviral drug. Adverse effects- CNS effects-confusion, anxiety, antimuscarinic effects-blurred vision, dry mouth, urinary retention, livedo reticularis(purple network discoloration of skin)
Amantadine-Antiparkinson’s drug
Use-1st line drugs, used alone in early parkinsons, usually used with levodopa, prolongs the effectiveness of levodopa, decreases fluctuations in motor control and “off” times. MOA-Irreversibly inhibits (MAO) type B in the brain. This enzyme inactivates dopamine in the striatum. With these drugs less dopamine is inactivated and the effects of levodopa are enhanced. Adverse effects-insomnia, enhanced adverse responses to levodopa, dyskineias, hallucinations. May also be dangerous to use with other drugs that increase monoamine neurotransmitters. (Can cross blood brain barrier)
Selegiline-Antiparkinson’s drug MAO-B inhibitor
Use-Second line drug, used only with levodopa, prolongs the half-life of levodopa and decreases “wearing off.” Another drug “tolcapone” not as safe and is used when other drugs fail. Adverse effects-Inhibits catechol-O-methyl transferase(COMT) in the GI tract, liver ect. This inhibits breakdown of levodopa and more levodopa is available for a longer time in blood. Thus, more levodopa enters into the brain. Adverse effects- Diarrhea, nausea, constipation. (related to levodopa: postural hypotension, dyskinesia, hallucinations, sleep disorders, loss of impulse control. -Tolcapone can cause liver damage.
Entacapone-Antiparkinson’s drug COMT inhibitors.
Use-Third line drugs, used to control mild symptoms of parkinsonism in younger patients, less effective than levodopa and other drugs, but generally less adverse effects, limited use. MOA- Excessive stimulation of GABA nerves by cholinergic nerves in the striatum contributes to disordered motor function in parkinsonism. Blocking muscarinic receptors on GABA nerves inhibits cholinergic stimulation of those nerves. Adverse effects-Dry mouth, blurred vision, constipation, tachycardia, CNS effects-confusion, delusions, depression, more severe adverse effects in the elderly.
Benztropine -Antiparkinson’s drug centrally acting antimuscarinic drugs.
Use-Less use than 2nd generation drugs. Effective within days but full effects may take weeks. Used for acute episodes of psychosis and used chronically to prevent psychotic episodes. These drugs are more effective in reducing the positive symptoms of schizophrenia and less effective in treating the negative symptoms. Treatment is not curative(cure), but symptoms are reduced. All of these drugs have similar antipsychotic effects but they differ in adverse effects. MAO- 1st gen/conventional drugs, anti psychotic effects are due to blockade of D2 type dopamine receptors in the brain. These drugs also block receptors for the neurotransmitters norepinephrine, acetylcholine, histamine, which is responsible for many adverse effects of these drugs. Adverse effects-Sedation due to blocking histamine receptors in brain, anticholinergic (antimuscarinic) effects, orthostatic hypotension, serious arrhthmias with some drugs, neurolepti malignant syndrome, extra pyramidal effects. [2]
Chlorpromazine-1st gen-Low potency
Haloperidol-1st gen-High potency
Both are antipsychotic drugs
Use-2nd generation agents are most commonly used antipsychotic drugs. They are equally effective compared to 1st generation drugs but are more expensive. Also used for bipolar disorder. Adverse effects- low likelihood of extrapryamidal effects, drowsiness and sedation, orthostatic hypotension, anticholinergic (antimuscarinic effects)- dry mouth, blurred vision, urinary retention, constipation, tachycardia, metabolic effects: weight gain dsylipidemia, risk for diabeties, cardiovascular mortality, arrhythmias. [3]
Olanzapine & Clozapine-2nd gen-Antipsychotic
Aripiprazole-2nd gen-Antipsychotic- Used as a “dopamine stabilizer” and acts as a partial agonist. It is safer than other drugs but less effective. Used for psychosis and as an add on, therapy with antidepressants for major depression. (Abilify)
