Drug classes Flashcards
albuterol
SABA
Pirbuterol
SABA
terbutaline
SABA
Levoalbuterol
SABA
Ipratropium
Anticholinergic
Tiatropium
Anti-Cholinergic
Atropine
Anti Cholinergic
Prednison
Systemic Coticosteroid
Methylprednison
Systemic corticosteroid
Hydrocortison
Systemic corticosteroid
Prednosilone
Systemic corticosteroid
Fluticasone
ICS
Budenoside
ICS
Beclamethasone
ICS
flunisolide
ICS
Triancinolone
ICS
Salmeterol
LABA
Formoterol
LABA
Theophylline
Methyxanthine
Aminophylline
Methylxanthine
Zafirlukast
Leukotriene modifier
Montelukast
Leukotriene modifier
some efficacy in Migraine
Omiluzimab
anti IgE Ab
APAP
Centrally acting NSAID
Ibprofen
peripheral NSAID
Ketoprofen
NSAID
Naproxen
NSAID- dysmenorrheal
Etodolac
cox 2 preferential NSAID
Ketorolac
parenteral NSAID for analgesia
Oxaprosin
NSAID- long half life, anti inflammatory
piroxicam
NSAID- long half life, anti inflammatory
Nambumetone
NSAID- anti inflammatory
Sulindac
NSAID- anti inflammatory
diclofenac
topical NSAID
voltaren gel/ flexor patch
diclofenac
Misoprostol
protect GI against NSAIDs- PGEI analogue
TERATOGEN
Triad of findings with GI toxicity from NSAID use
perforated ulcer
obstruction
bleeding
Omeprazole
PPI- DOC for blocking GI symptoms of NSAIDs
Indomethacin
NSAID
Gout
Rofecoxic
COX-2 inhibitor
Valdecoxib
COX-2 inhibitor
Celebrex
COX-2 inhibitor- only one still on market
Tramadol
Central analgesic weak mu agonist SNRI DO NOT GIVE IF PT IS AT RICK OF SEIZURE NSAID alternative if pt has- hx PUD, renal insufficiency, HF, severe HTN, and opiod alt if pt has substance abuse problems
Capsacin
Substance P depletor
transderm lidocaine
block neuronal transmission?
Morphine
opiod- prototype, mu agonist
Meperidine
strong agonist
not recommended for long term use due to toxic metaoblite buildup
Short acting, IV
pupil dilation
Methadone
strong agonist
longer life controls withdrawal
Fentanyl
Meperidine like strong agonist Super strong fast on set short duration Patch formulation- 8-12 hours to get to therapeutic dose Anesthesia
Propoxyphene
more risk than benefit
methadone like moderate agonist
Codeine
Morphine precursor
used as antifussive w/o analgesia
Combined with APAP for analgesia
converted to morphine by CYP2D6 system
Naloxone
Tx for opiod OD
competitive mu agonist
can precipitate withdrawal in opioid addict
Oxymorphone
Morphine like agonist
Hydromorphone
Morphine like strong agonist
10x stronger than morphine
more respiratory depression but less nausea and constipation than morphine
Hydrocodone
Morphine like strong agonist, codeine derivative
similar efficacy to morphine
Oxycodone
Morphine like strong agonist, codeine derivative
similar efficacy to morphine
Pentazocine
mixed agonist- agonize pain but also antagonize at dif site
can precipitate withdrawal
Buprenorphine
mixed agonist- agonize pain but also antagonize at a dif site
long duration
metoclopramide
Tx nausea
Causes drug induced PD (bilateral and sudden)
Sinemet
CD/LD combo
DOC in PD
LD- precursor of DA crosses BBB and is decarboxylated
CD- inhibits peripheral DA decarboxylase
AE- nausea, orthostatic HypoTN, and hallucinations
CI- high protein diet
Wait to use in younger pts, may accelerate PD
Amantadine
Antiviral and Anti PD for dyskinesia
also used for tremor and drooling
DA agonists
cont stim @ DA receptors
AE toxic psychosis, sleep attacks (may or may not have prodrome), impulse control disorders
(overall worse CNS effects but better peripheral)
Use- early mild dz, young pts
CI- dementia
Bromocriptine
ergot derivative DA agonist
Pramipexole
DA agonist- non ergot derivative
mono tx or w/ LD
Rotigotine
non ergot derivative, available as transderm patch
Apomorphine
DA agonist- subq
used in advanced dz to break off spells but causes bad nausea. give with antinemics
Entacapone
COMT inhibitor used in PD as adjuct to LD tx to provide longer duration
causes diarrhea and urine discoloration
Selegilline
MAO-B inhibtor that loses selectivity at higher dose
CI in meperideine
adjunct to LD so can use lower dose
or Monotx in early dz
Rasagilline
MAO-D inhibitor that is not selective
CI in meperideine
adjunct to LD so can use lower dose
or Monotx in early dz
Trihexyphenidyl
Anticholinergic
AE are severe in elderly
used in younger pts to manage tremor
Benztropine
Anticholinergic
AE are severe in elderly
used in younger pts to manage tremor
Triptans- MOA
5HTB agonism- vasoconstriction
5HT1D presynaptic inhibition- inhibits inflammatory neuropeptide rls from trigeminal nerve
5HT1D- stimulations- prevents pain transmission from trigeminal nuclei
Chlorpromazine
Triptan- antiemetic and analgesic
CI in CAD
AE med overuse rebound HA, serotonin syndrome
DO not use w/ ergots
Prochlorperazine
Triptan- IV, oral PR formulas
CI CAD
AE med overuse rebound HA, serotonin syndrome
do not use with ergots
Promethazine
triptan- lower rade of extrapyramidal problems compared to prochlorperazine
best one
CI in CAD
AE medication overuse HA, serotonin syndrome
DO not use with ergots
Propranolol
beta blocker for prophylactic use in migraine HA
caution in pts w/ asthma, COPD, Hx of depression or PVD
DOC in prophylaxis and great for pts w/ co morbid conditions ie HTN, post MI, panic disorders
used less frequently than others b/c crosses BBB
gradually inc dose
Atenolol
betablocker used in prophypactic migraine tx
caution in pts w/ COPD, asthma, Hx of depression or PVD
DOC for prophylaxis and great in pts with HTN, post MI, or panic disorder
use if pts cant tolerate CNS effects of propranolol
gradually inc dose
Nadolol
betablocker used in migraine prophylaxis
caution in pts w/ asthma, COPD, hx of depression, or PVD
DOC for prophylaxis and great in pts w/ HTN, post MI, or panic disorder
gradually inc dose
nortryptilline
TCA
better tolerated b/c 2nd gen
can cause: sedation, weight gain, arhymia, dementia
reduces frequency and severity of migraine and tension HA
Ideal in migraine pts w/ comorbid- depression, insomnia, or neuropathic paiin
Desiprammine
TCA
AE- sedation, weight gain, prolonged QT, dementia
better tolerated b/c 2nd gen
dec frequency and severity of migraines and tension HA
ideal for pts in migraine with comorbid- depression, insomnia, or neuropathic pain
Amitriptyline
1st gen TCA clinically shown to work for migraine but high AE
AE: sedation, weight gain, prolonged qt interval, dementia
1st gen so not tolerated as well as 2nd
dec frequency and severity of migraines and tension HA
great for migraine pts w/ comorbid depression, insomnia, or neuropathic pain
Imipramine
TCA - 1st gen so not tolerated as well as 2nd
AE: sedation, weight gain, prolonged qt, and dementia
reduce severity and frequency of migraine and tension HA
great in pts with comorbid depression, panic disorders, or neuropathic pain
Valproate and Depakote
antiepileptic that reduces neuronal firing and enhances GABA
can cause significant weight gain
cat D in pregnancy
ideal for migraines in epileptics or bipolar disorder (RAPID CYCLERS/ MIXED MANIA0
Verapamil
CCB- used to dec frequency of migraines
only after BB, TCAs, and valproate have failed
Topiramate
Shows efficiency in 1st month
looks similar to DA
causes cognitive dysfunction and language
BUT also causes weight loss
Riboflavin
prevent migraines, safe during pregnancy but takes 2 weeks
Gabapentic
best tolerated antiepilectic drug
estrogen gel
start 2 days bfr menstral HA
Botox for migraines
can reduce migraines with injection
ACE/ ARB
show reduced migraine frequency
Fluoxetine
SSRI- long t1/s, DOC for MDDduring preg, most activating,
OCD
Citalopram
SSRI- least activating
Paroxetine
SSRI- DONT USE IN PREG, short t1/2 beware of withdrawal GAD OCD PTSD
Sertaline
SSRI
OCD
PTSD
Fluvoxamine
SSRI
OCD
Escitalopram
SSRI
GAD
SSRI
inhibit presmpatic 5HT Reuptake, down regulate receptors 5HT2 agonism
AE- transient jitters, insomnia, diarrhea, and anxiety.
sexual dysfunction
serotonin syndrome
SSRI- withdrawal- anxiety, electric shock feeling flu
Take time to work (takes a few weeks to down-regulate the postynaptic beta receptors)
DOC- in MDD, Panic disorder, OCD
TCA
SNRI, alpha adrenergic agonist, H1 receptor agonist, anticholinergic AE- CARDIAC TOXICITY- TORSADES DE POINTES othrostatic HypoTN, weight gain, anticholinergic sexual dysfunction 5HT syndrome w/ other antidepressants lowers seizure threshold low risk teratoginicity OD can kill- tx with NaHCO3 CI- CAD, seizure disorders
TCA uses
antidepression
chronic pain
migraine HA
atypical depression
MAO-Is
inhibit breakdown of biogenic amines
AE
TERAOTOGENIC
wine and cheese rxn (tyrammine OD, HTN crisis –> hemorrhagic stroke)
orthostatic hypoTN, weight gain, anticholinergic
sexual dysfunciton
serotonin syndrome
MAO-Is drug interactions
serotonin syndrome- meperdine, tramadol, dextromethorphan
fever, HTN, delirium- meperidine, sympathomimetics, phenylephrine,
MAO- USES
atypical depression (weight gain, sleeping, inc sensitivity to rjxn) WAIT 2 WEEKS WHEN SWITCHING TO AN MAOI FROM ANOTHER DRUG
Isocarboxacid
MAOI
Phenelzine
MAOI
Tranylcypromine
MAOI
Venlafaxime
SSRI @ low dose
SNRI @ high dose
avoid in uncontrollable HTN
used in depression, GAD
Duloxetine
SNRI at all doses
DIABETIC NEUROPATHY, GAD
watch for liver toxicity
Nefazodone
SNRI and blocks 5HT2A (ELIMINATES ANXIETY, INSOMNIA, AND SEXUAL DYSFUNCTION)
used for depression, anxiety, insomnia
AE- sedation, GI, dry mouth, constipation
drug interactios and deadly hepatic failure
Trazodone
SSRI and blocks 5HT2A (RI and antagonist) as well as H1 and alpha 1
AE- orthostatic hypotn, sedating, PRIAPRISM
use- use w/ SSRI to counter insomnia (“trazodoze”)
Buproprion
NE and DA reuptake inhibitor- same MOA as cocaine
AE- anorexia, psychosis, HA, insomnia, psychomotor activation
AE- inc seizures and inc sexual function
can also cause weight loss
DO NOT GIVE TO PTS WITH SEIZURE HX, ANXIETY, OR BULIMIA
used for depression, quit smoking
Mirtazapine
Sleep, sex, food antidepressant
antagonizes presynaptic alpha 2 to inc NE release also blocks 5HT2, 3 and H1
used for- comorbid anxiety, reduced sexual dysfunciton, and has a low potential for OD
AE- agranulocytosis, weight gain, sedation
BZD
inc frequency of GABA channel opening
has ceiling effect
AE- ataxia, sedation, anterograde amnesia, resp depression, paradoxical excitement, aggression NO NYSTAGMUS
BZD use
short term while waiting for SSRI to kick in
long term in pts with anxiety disorder and somatic symptoms
insomnia, acute mania, akasthesia, RLS, seizures, EtoH detox
taper b/c withdrawal can be deadly
CI in EtoH and Narcotic ingestion
BZD tolerance
to euphoria but not anxiolytic effects
Lorazepam
BZD- short acting- met is glucronidation better in elderly and liver
Oxazepam
BZD- short acting- met is glucoronidation, better in elderly and liver dz
Diazepam
BZD- long acting and most lipophillic
Temazepam
BZD- least lipophillic
Clorazepate
BZD- long acting
Chlodiazepozide
BZD- long acting
Flumazenil
ccompetitive to BZD @ GABA A
AE- can precipitate withdrawal in BZD dependent individuals
Buspirone
partial agonist @ presynaptic 5HT1A
scheduled med GAD, sleep apena, substance abuse, h/o of BZD tx
AE- HA, N, dizziness, nervousness, SLOW ACTING
AE are mild
used in GAD esp if pt has hx of substance abuse, sleep apnea, or hx of falls
Clonazepam
BZD- scheduled basis for panic disorder
alprazolam
BZD- assoc w/ withdrawal and seizures
Clomipramine-
TCA with strong seratonergic component good for OCD
OCD tx
if using SSRI- use higher dose than depression
clomipramine
also need CBT
PTSD tx
SSRI (paroxetine, sertaline), MAOI, TCA
BZD or alcohol after event make it worse
antipsychotic or anticonvulsant can help
betablockers can help
SAD tx
SSRI, MAOI
specific phobia tx
CBT
performance anxiety
beta blocker
LI
DOC in Bipolar disorder- prevents relapse of mania and depression (mania more than depression) and dec suicide rates.
1-2 weeks to see effect- use adjuncts until then (antipsychotics or benzos)
AE- tremor, psoriasis, weight gain, acne, hypothyroidism, nephrogenic diabetes, bad for kidneys.
LI- actue intoxication
seizures, arrhythmias permanan neurologic impairment, kidney damage, maintain adequate Na ad fluid levels.
LI- drug interactions
anything that dec GFR–> inc of serum levelsNSAIDs, ACE, ARB, HCTZ
LI-CI
prenancy
Li- baseline lab tests
CBC SCr Thyroid urinalysis electrolytes
Li- monitor lab tests
Li levels
CBC
SCr/ BUN
TSH
carbamazapine/ oxcarbazepine
antiepileptics for when Li/ Valproate fail
Lamotrigine
blocks voltage gated Na channels to block glutamate and aspartate
2 mnth sto get therapeutic dose
AE- rash
Used to prevent depression but use with Li
SSRI in bipolar disorder
careful about using dont want to throw them into mania, make sure they are on a mod stabilizer first
bipolar disorder and preg
use atypical antipsychotics- they are fast acting
