7 -Meds and Pharm Flashcards
Do not pass through liver (no 1st pass metabolism)
Sublingual and rectal drugs
Absorption based on lipid solubility through epidermis
Skin absorption
Absorption restricted to non-ionized lipid-soluble drugs
CSF absorption
Largely responsible for binding drugs
Albumin
Drugs that will displace unconjugated bili from albumin in newborns
Sulfonamides (Bactrim, Sulfasalazine)
Causes kernicterus (brain damage) in newborns
Sulfonamides (Bactrim, Sulfasalazine)
Drug types (2) stored in bone
Tetracycline and Heavy metals
Constant amount of drug eliminated regardless of dose
0 (zero) order kinetics
Drug amount eliminated proportional to dose
1st order kinetics
Time for a drug to reach steady state
5 half lives
Amount of drug in body divided by amount in plasma/blood
Volume of Distribution
Drugs with high volume of distribution have higher concentrations in extravascular or intravascular compartment?
Extravascular (eg fat tissue)
Fraction of unchanged drug reaching systemic circulation known as
Bioavailabilityq
Drug level at which desired effect occurs in 50% of pts
ED50
Drug level at which death occurs in 50% of pts
LD50
Decline in potency with continued use
Tolerance
Effect at an unusually low dose
Hyperactive
Tolerance after only a few doses
Tachyphylaxis
Dose required for effect
Potency
Ability to achieve results without untoward effect
Efficacy
Responsible for drug metabolism
Smooth ER (Liver), P450 system
Demethylation, oxidation, reduction, hydrolysis metabolism phase
Phase 1
Metabolism Phase for glucuronic acid and sulfate attached to for water-soluble metabolite
Phase 2
Product of phase 2 metabolism that’s usually inactive and ready for excretion
water-soluble metabolite
INHIBITORS of P450
MAMA bit (inhibit) VICK'S FACE MAOIs Amiodarone Metronidazole Alcohol (acute/binge-drinking)
Verapamil Isonaizid Cimetidine Ketonzaole 'Sulfonamides
Flagyl
Allopurinol
Ciprofloxacin
Erythromycin
INDUCERS of P450
CRAP GPS induces WAR Carbamazepines Rifampin Alcohol (Chronic) Phenytoin
Green and leafy veggies
Phenobarb
Smoking
WARfarin
Most important organ for eliminating most drugs
Kidneys
How do the kidneys eliminate most drugs (2 ways)
Glomerular filtration
Tubular secretion
Water soluble drugs, more likely to be eliminated unaltered
Polar/Ionized Drugs
Fat soluble drugs, more likely to be metabolized before excretion
Nonpolar/Non-ionized Drugs
Negatively birefringent crystals that cause gout; End production of PURINE metabolism
Uric Acid
Gout affecting big toe joint
Podagra
Anti-inflammatory gout drug; binds TUBULIN and inhibit chemotaxis of WBCs
Colchicine
NSAID gout drug; inhibits prostaglandin synthesis (reversible COX)
Indomethacin
Xanthine oxidase inhibitor gout drug; blocks xanthine from forming uric acid
Allopurinol
Gout drug increasing renal secretion of uric acid
Probenecid
Gout drugs (4) and which for acute, which for chronic
I CAP the AC Indomethacin Colchicine Allopurinol Probenecid
Acute - Colchicine
Chronic - Allopurinol
Binds bile acids in gut forcing body to resynthesize bile acids from cholesterol; can bind vitamin K, causing bleeding tendency
Cholestyramine
Lipid lowering drug that can cause liver dysfunction and rhabdo
HMG-CoA reductase inhibitors (Statins)
Lipid lowering drug that can cause flushing (Tx with ASA); inhibits cholesterol synthesis
Niacin
Prokinetic GI drug that inhibits dopamine receptors; increase gastric and gut motility
Metoclopramide (Reglan)
Prokinetic GI drug that binds and activates motolin receptor
Erythromycin
Prokinetic GI drug that acts as ANTAgonist to mu-opioid receptor
Alvimopan
GI drug that slows gut motility; AGONIST to mu-opioid receptor
Loperamide
GI drug that slows gut motility; AGONIST to opioid receptor and inhibits muscarinic receptors
Lomotil (Atropine/Diphenoxylate)
Antiemetic GI drug that inhibits dopamine receptors
Promethazine (phenergan)
Antiemetic GI drug that acts centrally to inhibit serotonin receptors
Ondansetron (zofran)
GI drug that is proton pump inhibitor; blocks H/K ATPase in stomach PARIETAL CELLS
Omeprazole
GI drug that blocks H2 receptors; decrease stomach acid
Cimetidine/Ranitidine
GI drug that acts as somatostatin analogue; decrease gut secretions
Octreotide
Cardiac drug that inhibits Na/K ATPase; increase myocardial Ca
Digoxin
Cardiac drug that is inotrope, slows AV conduction and NOT cleared with dialysis
Digoxin
Side effects of amiodarone (3)
Pulmonary fibrosis
Hypothyroidism
Hyperthyroidism
Used to treat torsades
Magnesium
Cardiac drug that causes transient interruption of AV node
Adenosine
Cardiac drug shown to be best single agent to improve survival in pts with CHF and prevent CHF after MI
ACE inhibitor
Cardiac drug that can prevent progression of renal dysfunction in pts with DM and HTN
ACE inhibitor
Cardiac drug shown to be best single agent to improve survival after MI
Beta-Blockers
Cardiac drug that is an acetylcholine antagonist, INCREASES heart rate
Atropine
Analogue of GnRH and LHRH
Leuprolide
Alpha-adrenergic receptor antagonist; BPH
Tamsulosin
PGE1 derivative; protective prostaglandin used to prevent peptic ulcer disease
misoprostol
Antipsychotic, inhibits dopamine receptors
Haldol
Most common side effect of iodine contrast
Nausea
ASA poisoning causes what metabolic conditions (2, it switches)
1st - respiratory alkalosis
2nd - metabolic acidosis