7. Medicines and Pharm Flashcards
What drugs are bound by albumin
Warfarin and PCN are 90% bound
s/e of sulfonamide
Displace unconjugated bilirubin from albuin in newborns causing kernicterus
What drugs are stored in bone
Tetracycline
heavy metals
O order kinetics
Constant amount of drug is eliminated regardless of dose
1st order kinetics
drug eliminated proportional to dose
How long does it take a drug to reach steady state?
5 half lives
Volume of distribution
amount of drug in the body divided by amount of plasma/blood
- high VOD means high concentrations in vascular compartment (fatty tissue) compared to intravascular
Bioavailability
Fraction of unchanged drug reaching systemic circulation
- 100% for IV
- Oral usually less (PO cipro is 100%)
ED50
drug level at which desired effect occurs in 50%
LD50
drug level at which death occurs at 50%
Tachyphylaxis
Tolerance after only a few doses
Phase 1 metabolism
Demethylation, redox, hydroxylation
Phase 2 metabolism
Glucuronic acid and sulfates attached to form water soluble metabolite
P450 inhibitors
Cimetidine Isoniazid Ketoconazole Erythromycin Cipro Flagyl Allopurinol Verapamil Amiodarons MAOi Disulfuram
P450 inducers
Cruciform vegetables ETOH Cigarette smoke Phenobarb Barbiturates Dilantin Theophylline Warfarin
Colchicine
MOA: Binds tubulin and inhibits chemotaxis of WBC
Use: Acute gout attack
Indomethacin
MOA: NSAID, reversible cinhibitor, blocks uric aox inhibitor, inhibit PG synthesis
Use: Acute gout attack
Allopurinol
MOA: XO inhibits, inhibits UA production from xanthine
Use: Chronic gout
Probenecid
MOA: increases renal secretion of UA
Use: Chronic gout
Cholestyramine
MOA: binds bile acids in gut forcing body to resyntheize using cholesterol
Use: lipid-lowering agent
S/E: binds vit K causing bleeding
Statis
MOA: HMG coa reductase inhibitors
Use: lipid-lowering agent
S/e: Liver dysfunction, rhabdo
Niacin
MOA: inhibits CE syntheesis
Use: lipid-lowering
s/e: flushing (tx with ASA)
Metoclopramide
Reglan
MOA: inhibits dopamine receptors
Use: increase gastric/gut motbility
Erythromycin
MOA: binds and activates motilin receptor
Use: increase gastric/gut mobility
Alvimopan
MOA: anatongist to mu-opinoid receptor
Use: post op ileus
Loperamide
MOA: mu-receptor agonist
Use: slows gut motility
Lomotil
Dephnoxylate/atropine
MOA: opidoid receptor agonist
Use: slows gut motility
Promethazine
Phenergan
MOA: inhibitos dopamine receptors
Use: anti-emetic
s/e: TD (Tx w/ diphenhydramine)
Ondansetron
Zofran
MOA: Central acting ser rec inhibitor
Omperazole
MOA: blocks H/K ATPase in he stomach parietal cells
Cimetidine
MOA: H2 receptor blocker
Use: decrease stomach acid
Ranitidine
MOA: H2 receptor blocker
Use: decrease stomach acid
Octreotide
MOA: SS analgoue
Use: decrease gut secretions
Digoxin
MOA: inhibits Na/K ATPase and increase Ca
Effects: Decreases AV node, inotrope
S/e: mesenteric ischemia, hypokalemia, yellow vision, arrythemia
- not cleared with dialysis
Amiodarone
MOA: anti-arrythmic
Use: Acute atrial and ventrail arrythmia
s/e: pulmonary fibrosis, hypo/hyper thyroidism
Mg
Use: torsades de pointes and ventricular tachycardia
Adenosine
MOA: Interupts AV node
ACEi
Inhibit ACE
Use: best single agent to improve survival with CHF
s/e: precipitate RF if RAS
Beta blocker
MOA: block beta receptors
Use: best single agent to improve survival after MI
- reduce risk of MI and afib post op
S/e: don’t start a BB w/in 24h of surgery in a new user
Atropine
MOA: Acetylcholine antagonist
Use: increases HR
Metyrapone
MOA: Inhibits adrenal steroid synthesis
Use: Adrenocortical CA
Aminoglutethimide
MOA: Inhibits adrenal steroid synthesis
Use: Adrenocortical CA
Leuprolide
MOA: analogue of GnRH and LHRH that inhibits release of LH/FSH for pituitary (paradoxic effect)
Use: metastatic prostate CA
Tamsulosin
MOA: alpha antagonist
Use: BPH
NSAIDS
MOA: non selective cox inhibitor
S/E: inhibit PG synthesis and lead to less mucus and bicarb secretion and more acid production
- gastritis, ulcers, GI bleeding
- renal insufficiency 2/2 constriction of renal afferent arteriole
Celeoxib
MOA: NSAID with selective cox2 inhibition
S/E
- fewer gi s/e
- increase r/o CV event
Misoprostol
MOA: PGE1 derivative, protective PG sed to prevent peptic ulcer disease
- Use: patients on chronic NSAIDS
Haldol
MOA: Inhibits dopa receptorts
Use: Anti-psychotic, agitation in elderly
- s/e: EPSx (tx w/ benadryl), qt prolongation
Furosemide
MOA: loop diuretic
s/e: metabolic alk, hypoK, ototoxic
Spironolactone
MOA: aldo inhibitor
s/e: metabolic acid, hyperK
Infliximab
Remicade MOA: TNF-alpha Ab Use: IBD S/e: TB reactivation, CHF, new infection - no effect on wound healing
ASA poisoning
Sx: tinnitus, HA, n/v
- Initially: respiratory alkalosis (increased ventilation)
- Later: metabolic acidosis (compensation + drug effect)
Gadolinium
S/E: nausea, acute renal failure, nephrogenic fibrosis
Iondine contrast
S/e: nausea, dyspnea
Tx for tylenol overdose
N-acetlycysteine
S/e of ergot
Retroperitoneal fibrosis
Tx w/ prednisone
Drugs not safe with pregnancy
- Methimazole: cretenism
- ACE-: congential malformation, RF
- Coumadin: CNS and skeletal defect (x BBB)
- ASA: Increase miscarriages
- Tylenol: Increase miscarriages
s/e of Nitroprusside
Metabolized into NO and cyanide causing CN toxicity
tx: amyl nitrate
