Drugs Flashcards
Levothyroxine
T4, DOC for chronic hypothyroidism/euthyroid goiter
abused for weight loss
(Liothyronine is T3 and has a shorter half life)
Hydrocodone
Patients w/ hx of depression or family hx of substance abuse higher risk of abuse
Contraindicated + alcohol, parenteral, asthma, COPD, used w/ other CNS depressants, coma, cor pulmonale , hypoxemia, obesity, pulmonary, disease, respiratory insufficiency, scoliosis, sleep apnea, status asthmaticus.
Neonatal withdrawal: irritability, high-pitched crying, tremor, vomiting, diarrhea, failure to gain weight, abnormal sleep pattern. –tx w/ methadone
Amoxicillin
orall
administered w/ beta-lactamase inhibitor clavulinic acid
more bioavailable than oral ampicillin and more stable in gastric acid than penicillin
for otitis media, bronchitis, sinusitis, H. pylori eradication
Lisinopril
contraindicated in pregnancy–potential for oligohydramnios from decreased renal function and fetal death
for htn, CHF, post-MI, Diabetic nephropathy
slower onset and longer DOA than captopril or enalapril
Esomeprazole
proton pump inhibitor for GERD and synergistic effect w/ abx for H. pylori tx
also for gastrinomas, stress induced gastritis, and PUD
form covalent bonds with H/K/ATPase–irreversible inactivation
Induce P450–>avoid use with clopidogrel
risk of -diarrhea -pseudomembranous colitis -vitamin B12 deficiency -hip fractures -pneumonia (lack of acid doesn't kill GI bugs which are refluxed/aspirated and cause pneumonia) -dementia -CKD -Risk of exacerbating SLE -long QT syndrome (hypomagnesemia) Rebound acid hypersecretion
Atorvastatin
HMG-CoA reductase inhibitor
Hypercholesterolemia, hypertriglyceridemia, homozygous familial hypercholesterolemia
reduces LDL cholesterol, ApoB, Triglycerides; increases HDL
upregulates LDL receptors int he hepatocytes because decreases production and increases cholesterol scavenging
CONTRAINDICATIONS:
- Acute liver disease or impaired liver function
- Alcoholism, cholestasis, hepatic disease, hepatic encephalopathy
- Pregnancy: vertebrae malformations
SE:
- Myopathy (proximal weakness)
- Monitor those with DMII on statins
- diarrhea
- arthralgia
- elevated hepatic enzymes
Simvastatin
For the treatment of hypercholesterolemia, hyperlipoproteinemia, and/or hypertriglyceridemia, primary hypercholesterolemia (heterozygous familial and nonfamilial) or mixed dyslipidemia (hypertriglyceridemia, dysbetalipoproteinemia) hyperlipoproteinemias.
CONTRAINDICATED: -Hepatic impairment (elevates transaminases) -Monitoring w/ renal Impairment -Monitor in DMII
SE: A fib myopathy constipation gastritis edema infection abd pain
Clopidogrel
Irreversibly blocks ADP receptor on platelets
blackbox: CYP2C19 metabolism–>poor effect on those with poor CYP2C19 metabolism (contraindicated w/ omeprazole/esomeprazole)
For pts w/ recent ischemic stroke (TE prevention), unstable angina/acute STEMI, kids w/ Kawasaki (in conjunction w/ aspirin)
Notable SEs:
TTP
Montelukast
PO Leukotriene D4 antagonist
add-on prophylaxis for asthma, allergic rhinitis (this is after corticosteroids have not provided adequate coverage)
won’t reverse status asthmaticus
Rosuvastatin
longer half life of the statins
CONTRAINDICATIONS: hepatotoxic myopathy (especially when used with amiodarone or verapamil) will be increased by CYP3A4 inhibitors/competitors
Grapefruit juice can increase bioavailability of some statins
Metoprolol
beta 1 selective (cardioselective) adrenoceptor blocking agent, at higher levels also some beta-2 activity (bronchial/vascular) effects)
for
CONTRAINDICATIONS:
- Bradycardia
- Heart block more than 1st degree
- Cardiogenic shock/heart failure
SE:
Rebound tachycardia/angina
Dyslipidemia
Drug-Drug interactions:
Reserpine/Calcium channel blockers
Escitalopram
2nd gen SSRI
Prolonged QTC
Citalopram
SSRI
SE:
sexual dysfx
QTc prolongation
p450 CYP3A4 and 2C19 inhibitors
avoid abrupt withdrawal
Azithromycin
Macrolide: anti 50s (binds 23S rRNA of the 50s ribosomal subunit)–>blocks translocation of tRNA and thereby inhibits protein synthesis
resistance: methylation of rRNA near Erith’s binding site
outpatient tx of RTI, Atypical pneumonia (Legionella, chlamoydophila, mycoplasma pneumonia), STDs (Chlamydia, Neisseria); GM+ cocci strep infections in pts w/ penicillin allergy, moraxella
Less likely to affect the QT interval than clarithromycin/erythromycin
longer half life than clarithromycin
SE:
Eosinophilia, prolonged QT syndrome, Acute cholestatic hepatitis in pregnancy, induces peristalsis
Albuterol
Beta -2 agonist
aka salbutamol
also: terbutaline, metaproterenol, (isoproterenoll is nonselective)
stimulation of adenylate cyclase leading to closing of calcium channels
–>relaxation of smooth muscles
Hydrochlorothiazide
calcium sparing diuretic, acts on the NaCl transporter
USE
calcium
nephrolithiasis, idiopathic
hypercalciuria,
nephrogenic diabetes insipidus
osteoporosis
SE hypokalemic metabolic alkalosis hyponatremia hypercalcemia hyperglycemia hyperlipidemia hyperuricemia (avoid in pts w/ gout) SULFA allergy contraction alkalosis
Metformin
Biguanide: decreases hepatic gluconeogenesis and decreases postprandial glucose levels, might inhibit complex 1 of respiratory chain
also: increases insulin sensitivity, increase glycolysis, decreases serum glucose levels
no hypoglycemia or weight gain!!
CONTRAINDICATED IN:
Renal failure: check kidney function
SE:
Lactic acidosis
Sertraline
SSRI (Zoloft)
for depression, anxiety, OCD, social anxiety disorder, PMDD, premature ejaculation, vascular headaches
SE
sexual dysfunction, diarrhea, sleep, serotonin syndrome, risk of suicide in younger than 25
CONTRAINDICATED WITH
MAO inhibitor
Ibuprofen
COX-1 and COX-2 inhibitor–>decreases formation of thromboxanes and prostaglandins
for: analgesia, antipyretic, anti-inflammatory, for niacin-induced red and flushed face
(indomethacin used to close the PDA)
SE
Interstitial nephritis
renal ischemia (decrease prostaglandinE2, I2–>vasoconstriction of afferent arteriole–>renal papillary necrosis
asplastic anemia
gastric ulcers and bleeding (decrease in PGE2 and PGE1 results in decreased gastric mucosal protection)
pill-induced esophagitis
Zolpidem
GABAa agonist at the same location as Benzes but not a benzo
for sleep, this is ambient
Furosemide
Loop: blocks NKCC
For edema assoc w/ CHF, cirrhosis of liver (ascites), renal disease, nephrotic syndrome in adults and peds
Injection: adjunctive therapy for acute pulmonary edema
CONTRAINDICATIONS
- Bladder emptying disorders
- Lithium bc of reduced lithium clearance
- Use w/ ACE inhibitors, ARBs
- NSAIDs
SE Interstitial nephritis (Sulfa drug) Rapid injection=Tinnitus/ototoxic Hypoproteinemia w/ aminoglycoside/ethacrynic acid/etc hypokalemic metabolic alkalosis
Furosemide binding to albumin reduced in elderly
Gout
activation of SLE
Trazodone
5HT2A Receptor antagonist,
alpha 1 receptor antagonist
moderate H1 antagonism–>sedation
For sleep mainly
SE
Sedation
Orthostatic Hypotension
Valsartan
ARB (no increase in bradykinin)
for brown people/those w/ hereditary angioedema who can’t tolerate ACE-I
SE
hyperkalemia
decreased GFR
hypotension
CONTRAINDICATION
It’s a teratogen!!!
