H1: Antihistamine - 1st gen: diphenhydramine, cholorpheniramine, promethazine --> highly sedatin - 2nd gen: fexofenadine, loratidine, cetirizine H2: Gastric

6 - OTC & Pharmacogenetics Flashcards by G V

OTC drugs containing sympathomimetic (phenylephrine - decongestant) should be avoided in?

Hypertension

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Aspirin should not be used in a child with?

Viral fever (Reye’s Syndrome)

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H1 and H2

H1: Antihistamine
- 1st gen: diphenhydramine, cholorpheniramine, promethazine –> highly sedatin

2nd gen: fexofenadine, loratidine, cetirizine

H2: Gastric

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Misuse/Abuse Effects: Dextrometorphan (Antitussive) contains

Aluminum hydroxide (an antacid) that causes constipation

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Misuse/Abuse Effects: High Doses of Caffeine

Rebound Headache

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Misuse/Abuse Effects: Long term use analgesics

Interstitial nephritis

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Nasal decongestants: Drugs and Effects

Stimulates alpha receptors (vasospasm)

Oxymetazoline
Phenylephrine
Pseudoephedrine

Effects: Rebound congestion and increased BP

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NSAIDs: Drugs and Effects

Ibuprofen
Aspirin

Impair the hypotensive/antihypertesnive effect of ACEIs by blocking bradykinin mediated vasodilation

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Antitussives: Drugs and Effects

Codeine (opioid anaol)
Dextromethorphan

**Causes sedation
Addiction

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Antihistamines: Drugs and Effects

Chlorpheniramine
Cetirizine (less sedation)
Diphenhydramine

Sedation

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Prescription Plant Drugs (3)

Atropine
Digoxin
Morphine

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Saw Palmetto

BPH

5-Alpha reductase inhibitor

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St. John’s Wort

Antidepressant
Anti-viral and anti-cancer

Enhances serotonin
Induces CYP-450

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Ginkgo

Alzheimer’s /Dementia
Antioxidant
HTN

Intermittent claudication

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Echinacea

Common cold
Bacterial, Viral, & Fungal

Enhances interleukin

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Melatonin

Jet lag and insomnia

Serotonin effects

Inhibits LH Surge and decreases sperm count

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Ephedra

Weight loss & congestion

Sympathomimetic

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Ginseng

Mental and physical enhancer

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Garlic

Anti-hyperlipidemic - Heart disease and cancer

Inhibits HMG-CoA reductase
Acts like ACE Inhibitors

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Mixing garlic with anti-platelet drugs (e.g. Aspirin or Warfarin) OR any other HYPERtensives leads to what?

Hypotension

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Dehydroepiandrosterone

Anti-aging - SLE

Androgen precursor

Kava

Anxiety

Enhances GABA

Feverfew

Migraine

Decreases leukotrienes and prostaglandins

Milk thistle

Liver disease
Mushroom poisoning

Antioxidant

Coenzyme Q10

Hypertension Myopathy Angina Antioxidant

Glucosamine

Osteoarthritis Major part of connective tissue and cartilage

Serotonin (5HT) Receptors: Buspirone (+5HT1A)

GAD

Serotonin (5HT) Receptors: Sumatriptan (+5HT1D)

Migraine

Serotonin (5HT) Receptors: Olanzapine *(-5HT2A)

Atypical Antipsychotic Typical antipsychotic: D2 inhibitor

Serotonin (5HT) Receptors: Cyprohepatadine *(-5HT2)

H1-Blocker

Serotonin (5HT) Receptors: Ondansetron *(-5HT3)

Antiemetic for cancer therapy

Malignant Hyperthermia: Cause from Drugs and Onset

Succinylcholine Volatile anesthestics Onset: within MINUTES

Malignant Hyperthermia: Treatment

Dantrolene - inhibits calcium from SR

Serotonin Syndrome: Cause from Drugs and Onset

Combo of 2 SSRIs: SSRIs, MAOI, Linezolid, Triptans, St. John's, Ginseng, LSD Onset: Within HOURS

Serotonin Syndrome: Treatment

Benzodiazepines

Neuroleptic Malignant Syndrome: Cause from Drugs and Onset

D2-blocking antipsychotics (haloperidol) Onset: 1-3 DAYS

Neuroleptic Malignant Syndrome: Treatment

IV Diphenhydramine (which also blocks muscarinic receptors) Botulenum Dantrolene

Pharmacogenetics: Defined

Study of how an individual's genetic inheritance affects the body's response to drugs

Pharmacogenetics: Latest Technology (2)

1. Reverse genetics | 2. Genotype to phenotype

Pharmacogenetics: Clinical Practice

Adjusting doses based on genetic testing

Genetic Polymorphisms: Clinical Significance

Substitution of a single base pair by another When found in the population at frequency of >=1% SNP

Genetic Polymorphisms: Succinylcholine

Prolonged respiratory paralysis Butyrylcholinesterase defect

Genetic Polymorphisms: Isoniazed

SLE and High incidence of peripheral neuritis Slow acetylators

Genetic Polymorphisms: Procainamide and Hydralazine

SLE Slow acetylator

Genetic Polymorphisms: 6-Mercaptopurine

Increased BMS From TPMT defect

Genetic Polymorphisms: 6-Mercaptopurine

Increased BMS From TPMT defect

Genetic Polymorphisms: CYP2D6

Tamoxifen - poor metabolizer High risk of relapse in breast cancer patients

Ultra Rapid Metabolizers

Nortryptiline (antidepressant) Saudi Arabians

Genetic Polymorphisms: CYP2C9*3

Warfarin toxicity

Genetic Polymorphisms: UGT1A1*28

Gilbert's Syndrome (hyperbilirubinemic disease) e.g. Irinotecan

Genetic Polymorphisms: CYP2C9 Poor Metabolizers (2)

1. Warfarin toxicity - bleeding | 2. Phenytoin - nystagmus, ataxia