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Human Disease and Therapeutics > Drugs - Midterm 2 > Flashcards

Drugs - Midterm 2 Flashcards

1
Q

hydrochlorthiazide

A

category: thiazide diuretic (anti-hypertensive drug)
mechanism: works on distal convoluted tubule to increase sodium and water excretion, which lowers blood volume.
side effects: hypokalemia (need to eat bananas); glucose intolerant
can be inhibited by NSAIDs under certain conditions.

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2
Q

chlorthalindone

A

category: thiazide diuretic (anti-hypertensive drug)
mechanism: works on distal convoluted tubule to increase sodium and water excretion, which lowers blood volume.
side effects: hypokalemia (need to eat bananas); glucose intolerant
can be inhibited by NSAIDs under certain conditions.

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3
Q

furosemide

A

loop diuretic (anti-hypertensive)
mechanism: works on the thick ascending limb to cause a larger increase in urine output (compared to thiazide diuretics). Also more potent and more side effects.
side effects: hypokalemia
can be inhibited by NSAIDs

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4
Q

bumetanide

A

loop diuretic (anti-hypertensive)
mechanism: works on the thick ascending limb to cause a larger increase in urine output (compared to thiazide diuretics). Also more potent and more side effects.
side effects: hypokalemia
can be inhibited by NSAIDs

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5
Q

spironolactone

A
  • aldosterone antagonist (anti-hypertensive)
  • mechanism: works on the collecting duct/tubule to block aldosterone and increase excretion of sodium and water. This drug is potassium sparing…which is why it is often combined with loop diuretics of thiazides. Not used with ACE inhibitors because it can cause worse hypokalemia.
  • side effects: head ache, diarrhea, hyperkalemia, electrolyte imbalance, fatigue, GI disturbance
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6
Q

amiloride

A
  • aldosterone antagonist (anti-hypertensive)
  • mechanism: works on the collecting duct/tubule to block aldosterone and increase excretion of sodium and water. This drug is potassium sparing…which is why it is often combined with loop diuretics of thiazides. Not used with ACE inhibitors because it can cause worse hypokalemia.
  • side effects: head ache, diarrhea, hyperkalemia, electrolyte imbalance, fatigue, GI disturbance
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7
Q

triamterene

A
  • aldosterone antagonist (anti-hypertensive)
  • mechanism: works on the collecting duct/tubule to block aldosterone and increase excretion of sodium and water. This drug is potassium sparing…which is why it is often combined with loop diuretics of thiazides. Not used with ACE inhibitors because it can cause worse hyperkalemia.
  • side effects: head ache, diarrhea, hyperkalemia, electrolyte imbalance, fatigue, GI disturbance
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8
Q

mannitol

A

osmotic agent/diuretic (anti-hypertensive)

mechanism: works on the thin descending limb

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9
Q

acetazolamine

A

diuretic (anti-hypertensive)

mechanism: carbonic anhydrase inhibitor that works in the renal glomerulus

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10
Q

propranolol

A
  • non-selective beta blocker
  • reduces peripheral vascular resistance and also reduces cardiac function (decreases HR, BP, and contractility to decrease O2 requirements)
  • tx: HTN, angina, arrhythmias
  • toxicity: asthma and acute heart failure

can also be used to treat hyperthyroidism: inhibits the conversion of T4 to T3

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11
Q

antenolol

A
  • beta 1 selective inhibitor
  • reduces peripheral vascular resistance and also reduces cardiac function (decreases HR, BP, and contractility to decrease O2 requirements)
  • tx: HTN, angina
  • less risk for bronchospasms
  • toxicity: asthma and acute heart failure
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12
Q

metoprolol

A
  • beta 1 selective inhibitor
  • reduces peripheral vascular resistance and also reduces cardiac function (decreases HR, BP, and contractility to decrease O2 requirements)
  • tx: HTN, angina, heart failure
  • less risk for bronchospasms
  • toxicity: asthma and acute heart failure
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13
Q

prazosin

A
  • alpha 1 selective inhibitor
  • decrease peripheral resistance
  • tx: HTN
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14
Q

phentolamine

A
  • alpha 1/2 non-selective inhibitor

- tx: HTN

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15
Q

phenoxybenzamine

A
  • alpha 1/2 non-selective inhibitor

- tx: HTN

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16
Q

clonidine

A
  • alpha 2 agonist
  • centrally acting
  • tx: HTN
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17
Q

labetalol

A
  • beta 1/2 and alpha 1 antagonist

- tx: HTN

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18
Q

guanethidine

A
  • inhibits release of NE from sympathetic nerve endings (works by depleting NE stores)
  • tx: HTN
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19
Q

hydralazine

A
  • arteriole dilator (direct vasodilator)
  • hyperpolarizes smooth muscle by opening K+ channels
  • tx: HTN, heart failure
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20
Q

minoxidil

A
  • arteriole dilator (direct vasodilator)
  • hyperpolarizes smooth muscle by opening K+ channels
  • tx: HTN
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21
Q

diazoxide

A
  • arteriole dilator (direct vasodilator)

- tx: HTN

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22
Q

nitroprusside

A
  • arteriole dilator (direct vasodilator)

- tx: HTN

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23
Q

nitroglycerin

A
  • arteriole dilator (direct vasodilator)
  • tx: HTN, angina
  • administered sublingual
  • metabolized to nitric oxide –> increase cGMP –> relax smooth muscle and dilate cardiac vessels
  • volatile
  • available in long-lasting patches (8hr)
  • side effects: orthostatic hypotension, tachycardia, throbbing headache, tolerance
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24
Q

verapamil

A
  • calcium channel blocker
  • causes vasodilation (blocks contraction of smooth muscle), and reduces O2 demand, prolongs refractory time
  • tx: HTN, angina (prophylaxis), and arrhythmias
  • toxicity: cardiac depression and bradycardia, heart failure
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25
Q

dilitiazem

A
  • calcium channel blocker
  • causes vasodilation (blocks contraction of smooth muscle), and reduces O2 demand, prolongs refractory time
  • tx: HTN, angina, and arrhythmias
  • toxicity: cardiac depression and bradycardia, heart failure
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26
Q

captopril

A
  • ACE inhibitor
  • blocks angiotensin II
  • increases bradykinin (vasodilation)
  • side effects: dry cough or hyperkalemia if combined with K+ sparing drugs
  • tx: HTN, heart failure
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27
Q

mecamylamine

A
  • ganglion blocker (blocks sympathetic and parasympathetic NS
  • rare used due to serious side effects
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28
Q

mechanisms for anti-anginal drugs

A

vasodilation (increase blood flow and O2)

decrease O2 consumption

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29
Q

amyl nitrate

A
  • anti-anginal (nitrate)
  • crushed ampule and fumes are inhaled
  • side effects: orthostatic hypotension, tachycardia, throbbing headache, tolerance
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30
Q

nifedipine

A
  • calcium channel blocker
  • causes vasodilation (blocks contraction of smooth muscle), and reduces O2 demand
  • tx: HTN, angina (prophylaxis)
  • toxicity: cardiac depression and bradycardia, heart failure
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31
Q

treatments for lowering lipids or cholesterol

A
  1. non-drug (diet and exercise)

2. drugs (diet should still be managed, avoid pregnancy)

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32
Q

Lovastatin

A
  • “Mevacor”
  • statins - competitive inhibitor of HMG-CoA reductase to inhibit cholesterol synthesis
  • most effect on LDLs and some decrease in triglycerides –> reduces coronary events
  • toxicity: liver damage, weakness in skeletal muscles
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33
Q

Atorvastatin

A
  • “Lipitor”
  • statins - competitive inhibitor of HMG-CoA reductase to inhibit cholesterol synthesis
  • most effect on LDLs and some decrease in triglycerides –> reduces coronary events
  • toxicity: liver damage, weakness in skeletal muscles
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34
Q

Simvastatin

A
  • “Zocor”
  • statins - competitive inhibitor of HMG-CoA reductase to inhibit cholesterol synthesis
  • most effect on LDLs and some decrease in triglycerides –> reduces coronary events
  • toxicity: liver damage, weakness in skeletal muscles
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35
Q

Fenobrate

A
  • “Tricor”
  • fibrate drug
  • increases lipolysis in liver and muscles
  • reduces VLDL, modest effect on LDL, and moderate increase in HDL, reduces triglycerides
  • toxicity: GI symptoms
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36
Q

Niacin

A
  • nicotinic acid
  • decreases triglycerides and LDLs
  • side effects: flushing, tolerance develops
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37
Q

cholesteramine

A
  • bile acid binding agent
  • reduces absorption of bile acids and metabolites
  • side effects: constipation and bloating
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38
Q

exetimibe

A
  • inhibits intestinal sterol absorption

- reduces LDL

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39
Q

digitalis

A
  • positive ionotropic drug
  • increase intracellular Ca2+ and cardiac contractility –> increases blood ejection
  • side effects: premature depolarization (arrhythmias), ectopic beats, effects in all excitable tissues
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40
Q

milrinone

A
  • positive ionotropic drug
  • increase intracellular Ca2+ and cardiac contractility –> increases blood ejection
  • side effects: premature depolarization (arrhythmias), ectopic beats, effects in all excitable tissues
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41
Q

dobutamine

A
  • beta 1 agonist

- can cause arrhythmias

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42
Q

How can diuretics be used to treat heart failure?

A

they reduce salt and water retention which reduces venous pressure and decreases ventricular preload

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43
Q

Procainamide

A
  • Na+ channel blocker (slows action potential conductance)
  • tx: atrial and ventricular arrhythmias
  • side effects: can precipitate new arrhythmias
  • almost never the first choice
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44
Q

Quinidine

A
  • Na+ channel blocker (slows action potential conductance)
  • tx: atrial and ventricular arrhythmias
  • side effects: can precipitate new arrhythmias
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45
Q

Lidocaine

A
  • Na+ channel blocker (slows action potential conductance)
  • tx: atrial and ventricular arrhythmias (usually first choice for ventricular)
  • low toxicity
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46
Q

Amiodarone

A
  • prolongs the refractory period
  • tx: ventricular arrhythmias and atrial fibrillation
  • side effects: pulmonary fibrosis
47
Q

Rosuvastatin

A
  • “Crestor”
  • statins - competitive inhibitor of HMG-CoA reductase to inhibit cholesterol synthesis
  • most effect on LDLs and some decrease in triglycerides –> reduces coronary events
  • toxicity: liver damage, weakness in skeletal muscles
48
Q

heparin

A
  • anti-clotting agent, usually used in hospital setting
  • affects the INTRINSIC clotting pathway by binding to factor III –> inhibits thrombin
  • side effects: hemorrhage, allergic reactions, osteoporosis, bone fractures
  • neutralized by protamine binding
49
Q

enoxaparin

A
  • heparin fraction
  • heparin-like drug frequently prescribed to treat deep vein thrombosis
  • has fast onset (minutes)
50
Q

warfarin

A
  • “Coumadin”
  • anti-clotting agent
  • affects the EXTRINSIC clotting pathway (works through factor VIIa and leads to Xa)
  • antagonizes Vitamin K
  • side effects: hemorrhage, numbness, pain, headache, dizziness
  • oral warfarin is used for outpatient
  • need to watch amount of vitamin K in diet (leafy greens)
  • slow onset (the drug is used chronically)
51
Q

Dabigatran

A
  • “Pradaxa”
  • alternative drug for warfarin used to treat deep vein thrombosis
  • fewer side effects and more popular
  • affects PTT sensitive pathway, but has mechanism distinct form warfarin or heparin
  • used on outpatient basis
52
Q

Abciximab

A
  • glycoprotein inhibitor used to prevent clot formation in patients with unstable angina.
53
Q

Bivalirudin

A
  • “Abjiomax”
  • anti-clotting agent
  • thrombin inhibitor
  • rapid acting and inhibits circulating thrombin
54
Q

Rivaroxaban

A
  • “Xarelto”
  • anti-clotting agent
  • oral factor Xa inhibitor
  • rapid onset and shorter half-life than warfarin
55
Q

Streptokinase

A
  • thrombolytic
  • anti-clotting agent
  • can recanalzie an occluded coronary artery by dissolving the clot.
56
Q

Aspirin

A
  • cox 1 inhibitor that has anti-platelet effects
57
Q

drugs to stop bleeding

A

vitamin K or pure clotting factors

58
Q

drugs/factors that increase RBC production or decrease anemia

A

B12 and folic acid
iron
erythropoietin

59
Q

insulin Lispro

A
  • “Humalog”
  • rapid-onset insulin, early peak action, 4 hr duration
  • taken immediately before a meal
60
Q

crystalline zinc insulin

A
  • 30 min. onset, peak in 2-3 hr, lasts 5-8 hr
  • “Humulin R” = fast acting
  • the zinc helps to delay onset and lengthen duration
61
Q

NPH (neutral protein hagedorn)

A
  • intermediate acting insulin
  • insulin linked to protein called protamine (delayed absorption and onset after injection)
  • onset 2-5 hr, duration 4-12 hr
  • often mixed with shorter acting insulins
62
Q

insulin glargine

A
  • long acting sustained insulin, no peak/valleys

- good for background insulin

63
Q

insulin detemir

A

long-acting insulin good for background

64
Q

T/F insulin can be effectively administered PO

A

False, it is administered subcutaneously

65
Q

side effects of too much insulin

A 
Hypoglycemia, which leads to:
- tachycardia
- sweating
- tremors
- hunger
- confusion
- seizures
- coma
Also see local irritation and subdermal atrophy at injection sites.
66
Q

T/F insulin is usually given to type II diabetics as a first choice to manage glucose levels

A

False; insulin is given to type II diabetics if glucose levels cannot be managed with oral hypoglycemic drugs first

67
Q

tolbutamide

A
  • “Orinase”
  • 1st generation sulfonylurea
  • block K+ channels which in turn increases Ca2+ influx and increases insulin release from beta cells
  • bind to plasma proteins in the blood for transport (can be dislodged by other drugs that bind at the same site)
  • side effects: hypoglycemia, weight gain
68
Q

glipizide

A
  • 2nd generation sulfonylurea
  • block K+ channels which in turn increases Ca2+ influx and increases insulin release from beta cells
  • less protein binding
  • side effects: hypoglycemia, weight gain
69
Q

glitinides

A
  • “Prandin”
  • sulfonylurea
  • block K+ channels which in turn increases Ca2+ influx and increases insulin release from beta cells
  • side effects: hypoglycemia, weight gain
70
Q

metformin

A
  • biguanides (tx of diabetes); also metformin-glucophage?
  • very popular
  • decrease glucose production in liver and increase efficiency of insulin binding
  • no effect on insulin production in the pancreas
  • insulin-sparing (does not provoke hypoglycemia when used alone)
  • may prevent some of the CVS effects of type II DM
  • side effect: GI irritation, don’t use in alcoholics
71
Q

Sitagliptin

A
  • “Januvia”
  • DPP-4 inhibitor
  • slows inactivation of incretin hormones –> stimulates insulin synthesis and release (by prolonging the effects of GIP and glucagon-like peptide 1)
  • reduces glucagon activity leading to less hepatic glucose production and release
72
Q

Acarbose

A
  • tx of diabetes
  • alpha-glucosidase inhibitor
  • slows digestion/absorption of starch disaccharides from small intenstines (may help to prevent type II DM)
  • side effects: GI irritation and bloating, flatulence!
73
Q

Rosiglitazone

A
  • “Avandia”
  • drug class: Thiazolidinediones
  • reduces insulin resistance especially in muscles and fat cells by increasing GLUT-4 expression
  • tx: type II DM
74
Q

Glucagon

A
  • used to treat severe hypoglycemia associated with diabetes drugs
  • produced in alpha cells of pancreas
  • increases gluconeogenesis
75
Q

Phentermine

A
  • amphetamine used to as an appetite suppressant/weight loss drug
  • inhibits norepinephrine and dopamine uptake
  • side effects: weight loss, dry mouth, hypertension, palpitation
  • interactions with sympathomimetics (including the epi in local anesthetics), MAOIs, SSRIs, and CNS stimulants
76
Q

Topiramate + phentermine

A
  • “Qsymia”
  • anti-convulsant (anti seizure drug)
  • weight loss drug
77
Q

Orlistat

A
  • lipase inhibitor that decreases fat absorption in the intestines
  • weight loss drug
78
Q

Belviq

A
  • “Lorcaserin”
  • 5HT2 agonist
  • suppresses appetite in the hypothalamus
79
Q

Propylthiouracil (PTU)

A
  • tx: hyperthyroidism (Grave’s disease)
  • drug class: thiomides
  • inhibit thyroid peroxidase reaction and blocks the synthesis of thyroid hormone
80
Q

Lugol solution

A
  • tx: hyperthyroidism
  • drug class: Iodides
  • inhibits thyroid hormone release
81
Q

Radioactive iodine

A
  • tx: hyperthyroidism

- destroys thyroid parenchyma

82
Q

synthroid or levothroid

A
  • thyroid replacement therapy for hypothyroidism
  • “Levothyroxine” (T4)
  • “Liothyronine” (T3)
83
Q

denosumab

A
  • “XGEVA”
  • tx: osteoporosis
  • antibody to osteoclast-stimulating protein “RANK”
  • blocks osteoclast number and activity
84
Q

teraparatide

A
  • “Forteo”
  • tx: osteoporosis
  • a recombinant form of parathyroid hormone segment which selctively activates osteoblasts and stimulates new bone formation
85
Q

Estrogens/estrogen modulators for treatment of osteoporosis…

A
  • prevents bone loss in early postmenopausal period

- should be used in combo with progestin to prevent venous thrombi in postmenopausal women

86
Q

Ibandronate

A
  • “Boniva”
  • bisphosphonate
  • tx: osteoporosis
  • suppress activity of osteoclasts and inhibit bone resorption
  • interferes with boney repair after surgery esp. in jaws –> MRONJ
87
Q

Alendronate

A
  • “Fosamax”
  • bisphosphonate
  • tx: osteoporosis
  • suppress activity of osteoclasts and inhibit bone resorption
  • interferes with boney repair after surgery esp. in jaws –> MRONJ
88
Q

primary uses and side effects of glucocorticoids

A
  • use - rapid and dramatic anti-inflammatory effects (suppress leukocytes and cytokines, topical can inhibit histamine release and skin thinning)
  • loss of muscle mass/muscle weakness
  • thinning of skin
  • impaired wound healing
  • osteoporosis
  • diabetogenesis (increased blood glucose with increased insulin release as a result)
  • peptic ulcers
  • catabolic/anti-anabolic effects
89
Q

Hydrocortisone

A
  • short to medium acting glucocorticoid
  • uses: allergic reactions, inflammatory bowel disease, ARDS, dermatitis
  • used to treat Addison’s disease (daily dose with an increase during stress, need to combine with a salt-retaining hormone)
90
Q

cortisone

A
  • short to medium acting glucocorticoid

- uses: allergic reactions, inflammatory bowel disease, ARDS, dermatitis

91
Q

prednisone

A
  • short to medium acting glucocorticoid

- uses: allergic reactions, inflammatory bowel disease, ARDS, dermatitis

92
Q

dexamethasone

A
  • long-acting glucocorticoid

- uses: allergic reactions, inflammatory bowel disease, ARDS, dermatitis

93
Q

ketoconazole

A
  • inhibits adrenal steroid synthesis

- tx: Cushing’s disease

94
Q

Metyrapone

A
  • selective inhibitor of cortisol/corticosteroid synthesis
  • tx: osteoporosis and Paget’s disease (can block osteoblastic bone formation and inhibit vit. D-stimulated intestinal absorption of calcium)
95
Q

albuterol

A

beta-2 agonist
“reliever”
rapid onset and 4-6 hr effects
MOA = directly relaxes airway smooth muscle and causes bronchodilation; also decreases microvascular leakage

96
Q

salmeterol

A

beta-2 agonist
“reliever”
slower onset than albuterol, 12 hr effectiveness
MOA = directly relaxes airway smooth muscle and causes bronchodilation; also decreases microvascular leakage

97
Q

fluticasone

A

inhaled steroid
MOA = anti-inflammatory effects reduce bronchial reactivity
side effects = nose bleeds; sores in nose, mouth, and tongue that don’t heal; increased oral infections (candidiasis)
[oral steroids such as prednisone are last resort]

98
Q

theophylline

A 
methylxanthine drug (tablet or inhaler)
MOA = phosphodiesterase inhibitor that increases cAMP and relaxes airway smooth muscle
side effects = headaches, nausea, anxiety, sleep problems
uses = add-on controller; monotherapy for mild asthma; combined with corticosteroids to reduce steroid doses and side effects.
99
Q

ipratropium

A

anti-muscarinic
MOA = reverses the contraction of smooth muscle and reduces mucous secretions from vagal activity
uses = back-up to beta-2 agonists
slow onset

100
Q

montelukast

A

“Singulair”
leukotriene modifier
MOA = block leukotriene-binding receptor
uses = for prophylaxis and for patients that have trouble with inhaled therapies

101
Q

cromolyn

A

inhibits releases of inflammatory mediators such as histamine
for prophylactic use only

102
Q

omalizumab

A

monoclonal antibodies
inhibit IgE binding to mast cells preventing the release of inflammatory mediators
very expensive
only for severe non-responsive asthma

103
Q

tiotropium bromide

A

“Spireva”
Treatment of COPD
long-acting bronchodilator

104
Q

pharmacological treatment of COPD

A
  1. tiotropium bromide - long-acting vasodilator
  2. salmeterol - longer acting beta-2 agonist
  3. Theophylline + glucocorticoids

Typically, responses are not as good as with asthma.

105
Q

oseltamivir

A

“Tamiflu”
MOA = prevents separation of virus particle from cell receptors –> stops viral spread; early treatment is essential
decreases duration by 1-2 days and reduces severity
effective for both influenza A & B.

106
Q

diphenhydramine

A

“Benadryl”

anti-histamine

107
Q

chlorpeniramine

A

anti-histamine

108
Q

epinephrine (for allergy)

A

potent reversal

vasoconstriction and reduces fluid in the lungs so breathing improves and swelling reduces.

109
Q

anti-smoking medications

A

nicotine replacement therapy
bupropion (Zyban; Wellbutrin) - antidepressants
varenicline (Chantix) - stimulates selective nicotine receptors to reduce craving

110
Q

bupropion

A

“Zyban”
“Wellbutrin”
anti-depressants
anti-smoking

111
Q

varenicline

A

“Chantix”
stimulates selective nicotine receptors to reduce craving
anti-smoking

112
Q

pharmacological treatment of kidney stones

A

hydrochlorothiazide - thiazide diuretic; reduces calcium in the urine
sodium bicarbonate - alkalinizes urine
allopurinol - reduces uric acid excretion; also used to gout

113
Q

Common treatments for UTIs

A

Trimethoprim-sulfamethoxazole
amoxicillin + clavulanic acid (resistant bacteria can be a problem)
ciprofloxacin (expensive)

Human Disease and Therapeutics (11 decks)

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