6.4 - Pharmacology

Question 1

Benzodiazepines

Indications
MOA
Adverse effects

Answer 1

Anti-anxiety medications
- Ex: Diazepam

Indications: Anxiety

MOA
- Facilitate binding of GABA (inhibitory neuron) to GABA receptors

Adverse Effects:
- SEDATION
- Tolerance & dependence
- GI discomfort

Decreased HR & RR

Question 2

Barbiturates

Indications
Adverse effects

Answer 2

Indications: seizure disorders, anxiety, insomnia

Adverse effects:
- SEDATION
- Sleep

Question 3

Antidepressants

What drugs are commonly used for antidepressants?
MOA
Adverse effects

Answer 3

Selective serotonin reuptake inhibitors (SSRIs)
Tricyclics
Monoamine Oxidase inhibitors

MOA:
- Increase aminergic transmission
- Aminergic = dopamine, NE, serotonin

Adverse Effects:
- Tricyclics - sedation
- Monoamine - restlessness, CNS excitation, irritability, agitation
- SSRIs - insomnia

Question 4

What drug may be used for Bipolar disorder?

Adverse effects

Answer 4

Lithium

Adverse effect: lithium retention –> seizures, coma, fatal episodes

Question 5

What medication is commonly used for Parkinson disease?

MOA
Adverse effects

Answer 5

Levodopa

MOA:
- Converted to dopamine when it crosses the blood-brain barrier

Adverse Effects:
- Dyskinesia, athetoid movements
- TOLERANCE

Question 6

What medications are commonly used for skeletal muscle relaxants?

Indications
Adverse effects

Answer 6

Indications: skeletal muscle spasms / tightness, spasticity

Meds:
- Cyclobenzaprine
- Baclofen
- Botulinum Toxin (localized injection)

Adverse effects:
- Cyclobenzaprine - tolerance, dependence, sedation
- Baclofen - drowsiness, fatigue, confusion

Question 7

Opioids

Examples
Indications
Adverse effects

Answer 7

Ex:
- MORPHINE
- Fentanyl
- Oxycodone
- Hydrocodone

Indications: Severe pain

Adverse Effects:
- DEPENDENCE
- Tolerance
- Sedation
- DEPRESSED RESPIRATION
- Orthostatic hypotension
- Constipation, GI distress

Question 8

What drug should be used if suspecting an opioid overdose?

Answer 8

Naloxone (Narcan)

Question 9

NSAIDs

Examples
Indications
MOA
Adverse Effects

Answer 9

Examples:
- Aspirin (acetylsalicyclic acid)
- Ibuprofen
- COX-2 inhibitor Celecoxib

Indications: mild to moderate pain

MOA:
- Inhibit prostaglandin, which initiates the inflammatory response

Adverse Effects
- GI problems
- GI ulcer

Question 10

Acetaminophen

Brand name?
Comparison to NSAIDs
Adverse effects

Answer 10

Acetaminophen = Tylenol

Indications: mild to moderate pain; fever

Comparison:
- NO ANTI-INFLAMMATORY EFFECTS
- Less analgesic effect than NSAIDs
- No GI tract irritation

Adverse Effects:
- HEPATOTOXICITY

Question 11

What medications are commonly used for RA?

Answer 11

NSAIDs - “first line of defense”
Corticosteroids
Methotrexate (DMARD)

Question 12

Corticosteroids

Examples
Indications
Adverse Effects

Answer 12

Ex: Cortisone, dexamethasone, hydrocortisone

Indications:
- Extremely effective anti-inflammatory agent

Adverse Effects:
- Long-term use –> Cushing’s syndrome
- Catabolic effect on muscle, tendon, bone
- HTN
- Diabetes
- Muscle wasting

Question 13

DMARDs

Most common example
Indications
Adverse effects

Answer 13

Methotrexate

Indications: RA

Adverse Effects:
- Varies
- GI distress, n/v

Question 14

What is Methotrexate sometimes referred to as?

Answer 14

“Gold therapy”

Question 15

Diuretics

Examples
MOA
Adverse Effects

Answer 15

Ex:
- Lasix
- Diuril
- Aldactone

MOA: increase formation and excretion of urine

Adverse Effects:
- Hypovolemia
- Orthostatic hypotension
- Electrolyte imbalance

Question 16

Nitrates (Nitroglycerin)

MOA
Adverse Effects

Answer 16

Vasodilation –> increased BF to heart & decreased BP (TPR) –> decreases stress on heart

Adverse Effects:
- Orthostatic hypotension
- headache

Question 17

What cardiac medications are commonly prescribed?

Answer 17

Beta blockers
ACE inhibitors
CCBs

Question 18

Beta Blockers

Examples
MOA
Adverse effects

Answer 18

ex: “-lols”

MOA:
- Block beta-adrenergic receptors –> reduces binding of E & NE –> reduces sympathetic input
- Decreases HR
- Decreases contractility of heart

Adverse Effects:
- Fatigue
- Orthostatic hypotension
- Decreased HR response to exercise

Question 19

ACE Inhibitors

Examples
MOA
Adverse effects

Answer 19

“-prils”

MOA:
- Inhibit angiotension-converting enzyme –> inhibits the conversion of angiotension I to angiotension II
- Promote vasodilation –> decreases BP

Adverse Effects:
- Hypotension
- Fatigue
- Dizziness
- Cough (annoying, but not life-threatening)

Question 20

Calcium Channel Blockers

Examples
MOA
Adverse effects

Answer 20

Ex: amlodipine, nifedipine, verapamil

MOA:
- Black calcium entry into the cell
- Vasodilation & reduced HR

Adverse Effects:
- I’m assuming orthostatic hypotension

Question 21

Cardiac glycosides

Examples
MOA
Adverse effects

Answer 21

Ex:
- Digoxin, digitoxin, digitalis

MOA: “fewer, but better beats”
- Inhibit sympathetic NS
- Increase myocardial contraction force
- Slows sodium-potassium pump

Adverse effects:
- GI distress
- ARRHYTHMIAS
- Drowsiness, fatigue

Question 22

What are anticoagulants used for?

Examples of this med

Answer 22

Clots in the venous system

Heparin, warfarin (coumadin)

Question 23

What are antithrombotics used for?

Examples

Answer 23

Clots in the arterial system

Aspirin

Question 23

What are thrombolytics used for?

Answer 23

To break down the clot

Question 24

Statins

Examples
Indications
MOA
Adverse Effects

Answer 24

ex: Lipitor

Indications: hyperlipidemia

Adverse effects:
- Myalgias
- Rhabdomyolysis

Question 25

What medication is commonly used for the management of diabetes?

MOA

Answer 25

Metformin

• Inhibits gluconeogenesis by the liver

Question 26

Describe the expected time frames for peak effects of rapid-acting vs long-acting insulin

Answer 26

Rapid-acting = peak effect 2-4 hrs

Long-acting = peak effect 5-24 hrs