all pharm Flashcards
Decrease angiotensin II (potent vascoconstrictor) and have SE of angioedema (severe), acute RF, and persistent dry cough
Ace-Inhibitors (Lisinopril and Ramipril)
Lisinopril depletes
zinc
Alpha-2-agonist that decreases vasoconstriction and CO
Clonidine (AntiHTN)
Alpha-1-antagonist: decease NE; used to tx HTN and BPH
Doxazosin
Terazosin
Do not use these AntiHTN drugs with African Americans
ARBs (Losartan, Irbesartan, Valsartan)
Major ADR of ARBs
HYPERkalemia
Selective (B1) Antagonists
Atenolol
Metoprolol
Nonselective (B1 and B2) Antagonists
Carvedilol
Propanolol
Timolol
_______ BB crosses the BBB and has more SE
Propanolol
Which BB is commonly used in CHF?
Carvedilol
Which antihypertensive drugs are NOT 1st line for CHF?
CCB
CCB
Amlodipine
Diltiazem
Verapamil
Amlodipine depletes
Potassium
Verapamil depletes
Vitamin E
Potassium wasting diuretic that inhibits Na+ and Cl- at the ascending loop
Furosemide (Loop diuretic)
Furosemide SE
hypokalemia, ototoxicity, and nutrient depletion
Furosemide is CI in
allergy to sulfonamides
Potassium wasting diuretic that inhibits NaCl transporter in distal tubule
Hydrochlorothiazide (Thiazide diuretic)
Hydrochlorothiazide SE
hypokalemia and hyperglycemia
Hydrochlorothiazide is CI in
allergy to sulfonamides
Potassium sparing diuretics
Spironolactone Triamterene
Spironolactone and Triamterene are weak diuretics with SE of ______
HYPERkalemia
Aldosterone antagonist that works at the distal convoluted tubule
Sprionolactone
What does hydralazine do?
Antihypertensive (unknown MOA, peripheral vasodilation)
Major SE of NTG
HA
NTG C/I
Sildenafil (w/in 24 hrs)
Prophylactic vasodilator w/ a slower action than NTG
Isosorbide mononitrate
sympathomimetic with vasoconstriction via alpha-1 and bronchodilation via beta-2
Epinephrine (increases HR and contractility)
This antiarrhythmic has a narrow therapeutic window
Potassium chloride
Potassium chloride SE
Hyperkalemia
Sodium channel blockers
Class I anti-arrhythmics: Lidocaine and Flecainide
BBW for Class I anti-arrhythmics: Lidocaine and Flecainide
increased mortality*use as a last resort in hospital setting
Class II anti-arrhythmics
BB (-olol)
Potassium channel blockers
Class III anti-arrhythmics: Amiodarone
70% of pt on amiodarone have ADR, including:
pulmonary fibrosis, heart block, hypotension, hypo/hyperthyroidism, hepatotoxicity, coronary/skin deposits
Class IV anti-arrhythmics
CCB: Amlodipine, Diltiazem, Verapamil
anti-arrhythmics that inhibits N/K/ATPase
Digoxin (Class V)
Which anti-arrhythmics can be used for LHF (palliative) and A flutter, but must be monitored d/t narrow therapeutic window
Digoxin
Combining digoxin w/ diuretics increases the risk of
hypokalemia
fatigue, mm. weakness, agitation, anorexia, and yellow halos around vision are sx of _______ toxicity
Digoxin
Bile acid sequestrant used to tx T2DM, familial hypercholesterolemia and hyperlipidemia
Colesevelam
Colesevelam SE
wastes nutrients when bile is sequestered
Colesevelam C/I
bowel obstruction or TG > 500
Cholesterol absorption inhibitor
Ezetimibe
Ezetimibe C/I
active liver dz
fibrate drug used to tx triad of low HDL, high LDL, high TG (Type IV and V)
Gemfibrozil
Gemfibrozil interacts with
Warfarin and statins
Gemfibrozil SE
gallstones, elevated liver enzymes, enhances anticoagulants, myositis/rhabdomyolysis
HMG-CoA reductase inhibitors
Atorvastatin and Simvastatin
Statins interact with
fibrates and niacin
Statin SE
elevated LFT, myositis, rhabdomyolysis - d/c if pt has muscle pain
______ should always be given with statins
75-100 mg CoQ10
Best drug in anaphylaxis
Epinephrine
antitussive that suppresses cough reflex at source (i.e. anesthetizes respiratory passage)
Benzonatate (it’s actually an ester local anesthetic)
antitussive that works at cough center in medulla
Dextromethorphan
Which antitussive can cause serotonin syndrome?
Dextromethorphan (it is C/I to use MAO-I w/in 14 days of dextromethorphan)
Opioid antitussive(s)
Codeine
Hydrocodone
Mucolytic, expectorant
Guaifenesin
1st generation anti-histamines that cross BBB and cause sedation
Diphenhydramine
Hydroxyzine
Promethazine
2nd generation anti-histamines that do not cross BBB (thus do not cz sedation)
Cetirizine
Fexofenadine
Loratadine
Dose of diphenhydramine during anaphylaxis
50 mg IM
The anti-histamine _____ is used as an anxiolytic
Hydroxyzine
The anti-histamine _______ is used as an antipsychotic
Promethazine
Antihistamines that are used for allergies/asthma are ____ antagonists
H1
Loratadine SE
QT prolongation
sympathomimetic nasal spray (mostly alpha-adrenergic)
Phenylephrine (decongestant)
sympathomimetic decongestant (alpha and beta)
Pseudoephedrine
Pseudoephedrine C/I
MAO-I (HTN crisis)
Decongestants
Phenylephrine (nasal spray), Pseudoephedrine, Epinephrine
mast cell stabilizer that inhibits histamine release
Cromolyn sodium
Albuterol onset is ___ and lasts ____
onset: 15 min lasts: 3-4 hrs
Albuterol C/I
MAO-I, TCA, sympathomimetic
Long-acting B2 agonist that lasts 12-24 hr
Salmeterol (usu. used in combo w/ glucocorticoids)
Salmeterol C/I ______ and ADR _____
C/I: acute asthmaADR: prolonged QT
Salmeterol BBW
may increase asthma-related death
Inhaled steroids
Fluticasone, Mometasone, Beclomethasone, Budesonide
leukotriene antagonist used for prophylaxis and maintenance of persistent asthma, aspirin-induced asthma, and exercise-induced asthma
Montelukast
Montelukast SE
Churg-strauss syndrome, hypereosinophilia
antimuscarinic bronchodilator that inhibits ACh in smooth muscle of respiratory tract and is used for maintenance therapy in COPD
Tiotropium bromide
antimuscarinic bronchodilator that is shorter acting
Ipratropium bromide
Procoagulant that stimulates factors II, VII, IX, X
Vitamin K1
drug that inhibits ADP-induced platelet aggregation and is often used in pt that are aspirin intolerant
Clopidogrel
drugs that inhibits COX and inhibits platelet aggregation
Aspirin
Aspirin increases which drug?
Phenytoin (seizure drug)
Aspirin C/I
kids < 12 y/o (Reye’s syndrome) and G6PD deficiency
inhibits synthesis of vitamin K-dependent factors but has no effect on established thrombus
Warfarin
has a narrow therapeutic window and requires monitoring of PT/INR
Warfarin
Drugs that can increase effects of Warfarin
Acetaminophen, Androgens, BB, Corticosteroids, Omeprazole, Phenytoin
xanthine derivative that reduces blood viscosity and is used in intermittent claudication and peripheral vascular dz
Pentoxifylline
Factor X inactivator that binds anti-thrombin III to prevent conversion of fibrinogen to fibrin (intrinsic pathway)
Heparin
Low molecular weight heparin (factor X inactivator)
Enoxaparin
Factor Xa inactivator that inhibits platelet activation and fibrin clot formation
Rivaroxaban
direct thrombin inhibitor that inhibits free and fibrin-bound thrombin
Dabigatran
Iron chelator used to tx chronic iron overload, hemochromatosis, routine transfusions
Deferoxamine
chelator of mercury, gold, arsenic
DMPS
chelator of mercury, lead, antimony, and arsenic
DMSA (oral version of DMPS so it has less severe ADR)
chelator of lead, mercury, iron; also acts as anti-coagulant in blood tubes
Edetate calcium disodium (EDTA)
chelator of copper and other heavy metals; used to tx Wilson’s dz
Penicillamine
drug used in anemia of chronic dz because it stimulates erythropoiesis
Epoetin alfa
Antibacterial classes that inhibit cell wall synthesis
Penicillins, Glycopeptides, Cephalosporins
Antibacterial classes that inhibit protein synthesis
Tetracyclines, Macrolides, Lincosamides, Aminoglycosides
Antibacterial classes that inhibit DNA synthesis
Fluoroquinolones
Antibacterial classes that inhibit RNA synthesis
Synthetase inhibitors (Mupirocin), Monoxycarbolic acid agents (Rifaximin, Nitrofurantoin)
Antibacterial classes that act as PABA analogue/dihydrofolate reductase inhibitors
Sulfamethoxazole-trimethorpim
B-lactam drug used to tx dental abscesses, recurrent rheumatic fever, recurrent strep cellulitis in lymphedema but has SE of anaphylaxis and black hairy tongue
Penicillin G/VK (i.e. natural penicillin)
synthetic B-lactam drugs that are 1st choice for uncomplicated ENT infx
Ampicillin, Amoxicillin, Amoxicillin + clavulanate
What is clavulanate?
B-lactamase inhibitor (added to B-lactam drug Ampicillin)
Are the synthetic penicillin drugs (ampicillin, amoxicillin, and amox + clavulanate) safe in Pg?
Yes
glycopeptide drugs that is IV only and used to tx MRSA
Vancomycin
Cephalosporins
Cefdinir CefuroximeCeftriaxoneCephalexin
10-15% of pt that are hypersensitive to penicillins will also reach to ________
Cephalosporins (cefdinir, cefuroxime, ceftriaxone, cephalexin)
Cephalosporins (cefdinir, cefuroxime, ceftriaxone, cephalexin) tx
cellulitis
broad-spectrum antibiotics that can have ADR of photosensitivity and tooth discoloration/bone effects in kids < 8
Tetracyclines (minocycline, doxycycline)
_________ antibiotics should be taken on an empty stomach, where as ______ antibiotics should be taken with food
Empty = tetracyclinesFood = macrolides
Are macrolides safe in pregnancy?
Yes (Cat. B)
Macrolides
“-romycin”
Azithromycin
Clarithromycin
Erythromycin
alternative antibiotic for people w/ penicillin allergy
Clindamycin
antibiotic that is used topically for acne
Clindamycin
Clindamycin ADR
C. diff super infx (pseudomembranous colitis)
topical aminoglycoside antibiotic used for ocular infx
Gentamicin
1st line drug for UTIs
Ciprofloxacin and Levofloxacin (Fluoroquinolones)
Ciprofloxacin and Levofloxacin BBW
tendon rupture
Ciprofloxacin and Levofloxacin C/I
< 18 y/o (can arrest growth plate)
topical antibiotic for MRSA and impetigo
Mupirocin
Monoxycarbolic acid agent used to tx SIBO, traveler’s diarrhea, IBS, hepatic encephalopathy
Rifaximin
“everything inhibitor” used to tx acute uncomplicated UTIs
Nitrofurantoin
Nitrofurantoin C/I
G6PD deficiency, lactation, and 3rd trimester of Pg (can cz hemolysis of newborn)
Give _____ with Sulfamethoxazole-trimethorpim
Folate
Sulfamethoxazole-trimethorpim SE
photosensitivity and megaloblastic anemia
Sulfamethoxazole-trimethorpim interactions
OCPs
Triple Antibiotic Ointment
Bacitracin + Neomycin + Polymyxin B B: inhibits cell wall synthN: aminoglycosidePB: cell wall permeability
Triple Antibiotic Ointment SE
allergic contact derm and SNHL (neomycin)
Neomycin SE
permanent SNHL (aminoglycoside drug)
Anti-tuberculosis drugs
Isoniazid and Rifampin Note: use both drugs together for active infx
can be used to tx latent and active TB but is also hepatotoxic
Isoniazid
Rifampin SE
red tears/saliva/urine, hepatotoxic
anti-fungals that penetrate into all body fluids
Fluconazole and Ketoconazole (Triazoles)
Fluconazole and Ketoconazole interactions
Warfarin, phenytoin, others
Anti-fungal used for onychomycosis
Terbinafine
Terbinafine SE
hepatotoxic, SJS, neutropenia
anti-fungal that disrupts cell wall formation and only works topically (even in GI it works as topical agent)
Nystatin
Malaria prophylaxis
Hydroxychloroquine
anti-helminthic drugs that destroy microtubules and block glucose uptake
Albendazole and Mebendazole
topical application for lice, ticks, mites; 1st line tx scabies
Permethrins
anti-parasitic for roundworms, lice, scabies
Ivermectin
anti-protozoel for anaerobic infx, C. diff, H. pylori ulcers, BV, trichomonas, and giardia
Metronidazole
Metronidazole C/I
EtOH (disulfiram rxn)
guanosine analogue that inhibits viral DNA polymerase and tx actively replicating HSV
Acyclovir and Valacyclovir
reverse transcriptase inhibitor; drug accumulates in all dividing cells
Zidovudine
Parkinson’s drugs that can also tx Influenza A
Amantadine (no longer recommended for influenza A)
tx influenza A and B; prevents release of virus
Oseltamivir
tx chronic HBV and HCV
interferon-a-2
alkylating agent used to tx metastatic testicular and ovarian tumors and adv bladder CA
Cisplatin
Cisplatin BBW
renal toxicity, myelosuppression, ototoxicity
alkylating agent used to tx leukemia, lymphoma, and many other CA
Cyclophosphamide
anthracycline drug used to tx Kaposi’s sarcoma, ovarian CA, multiple myeloma
Doxorubicin
Doxorubicin SE
life-threatening heart damage
Doxorubicin C/I
cardiac dz
drug used to tx Her-2+ breast CA
Trastuzumab
Trastuzumab BBW
fatal heart/lung problems and fetal harm
folic acid antagonist used to tx many CA and to induce abortion
Methotrexate
anti-microtuble drug used to tx Hodgkin’s, testicular CA, and Kaposi’s sarcoma
Vinblastine (IV only)
Vinblastine is derived from
Vinca rosea (periwinkle)
aromatase inhibitor used reduce serum estradiol in breast CA pt post-surgery and for METS
Anastrozole
GnRH analogue; testosterone antagonist used to tx metastatic prostate CA
Bicalutamide
Bicalutamide C/I
women, pregnancy (X)
GnRH analogue; suppression of ovarian/testicular steroidogenesis for prostate CA, endometriosis, uterine fibroids
Leuprolide
mitotic inhibitor that binds tubulin and affects rapidly dividing cells
Paclitaxel
drug used to tx advanced ovarian CA, non-small cell lung CA, ovarian/breast CA METS unresponsive to 1st line drugs
Paclitaxel
pyrimidine analogue use to tx many CA
5-Fluorouracil
5-Fluorouracil is used topically to tx
BCC
SERM used prophylactically for postmenopausal osteoporosis
Raloxifine
SERM that competes with E2 for E-receptor proteins and is used to tx E+ CA
Tamoxifen
Tamoxifen BBW
uterine malignancies, stroke, PE
cytokine inhibitor; circulating receptor fusion protein used to tx RA, jRA, PsA, AS, plaque psoriasis
Etanercept
Etanercept BBW
incr risk of serious infx and CA
TNF-a inhibitor used to tx inflammatory dz (RA, PsA, IBD)
Adalimumab
Adalimumab BBW
incr risk of serious infx and CA
Infliximab BBW
incr risk of serious infx and CA *can also cz HF, pancytopenia, and demyelinating dz
Cytokine/TNF inhibitors
Etanercept, Adalimumab, Infliximab
DMARD used to tx SLE and RA
Hydroxychloroquine
DMARD used to tx CA, RA, severe psoriasis, ectopic pg (abortifacient)
Methotrexate
DMARD used RA (also a copper chelating agent)
Penicillamine
DMARD used to tx IBD and RA that is C/I in people with sulfonamide/salicylate allergy
Sulfasalazine
JAK inhibitor used to tx RA when it’s refractive to methotrexate
Tofacitinib*new on NPLEX
Tofacitinib BBW
incr risk of serious infx and CA
used for prophylaxis during organ transplant and for dry eyes
Cyclosporine
transplant drug that has BBW of incr risk of serious infx and CA
Tacrolimus
drug used to tx leprosy and multiple myeloma
Thalidomide
Thalidomide C/I
pregnancy (X)
4x stronger than cortisol and longer acting than hydrocortisone
Prednisone
non-selective COX inhibitor used to tx fever, pain, inflamm, and platelet agg
Aspirin
Salicylism
dose-dependen reversible vertigo, vomiting, tinnitus, hearing loss (aspirin toxicity - max dose = 4g)
Diclofenac gel
non-selective COX inhibitor for inflammation; NSAID
non-selective COX inhibitor that decreases cartilage synthesis
Ibuprofen
Ibuprofen interacts with
Aspirindo not combine
Indomethacin
non-selective COX inhibitor for inflammation
non-selective COX inhibitor use for moderate-severe pain only; IV or IM
Ketorolac
Ketorolac C/I
use > 5 days and in peds