Drugs not in LANGE flashcards
Raltegravir, Elvitegravir
Integrase inhibitors – HIV drug
Inhibit HIV genome integration into host cell chromes by reversibly inhibiting HIV integrate
Toxicity: Increases creatine Kinase
Enfuvirtide
HIV drug
Binds gp41 – inhibits viral entry
Toxicity – skin reactions at site of injection
+ epenseive
- reserved for any drug resistant HIV strains
Maraviroc
HIV drug
Binds CCR-5 on surface of T cells/monocytes, inhibiting interaction with gp120
The problem: obviously can only be used in patients with functional CCR-5 receptor
Anidulafungin
Caspofungin
Micafungin
class: Echinocandins Antifungals
Mechanism: inhibit cell wall synthesis by inhibiting synthesis of beta-glucan
Clinical use: invasive aspergillosis, Candida
Toxicity = GI upset, flushing (via histamine release)
what are the 5 drug classes that can be used to treat glaucoma?
alpha agonists Beta blockers Cholinomimetics diuretics Prostaglandins (PGF-2)
What is the treatment for diverticulitis?
Metronidazole (anaerobes)
Fluoroquinolones (gram neg) or TMP-SMX
Cinacalcet
mechanism: Sensitizes Ca2+- sensing receptor (CaSR) in parathyroid
Clinical use: hypercalcemia due to primary or secondary hyperparathyroidism
Toxicity = hypocalcemia
Drugs that cause methemoglobinemia
Recall the methemoglobin – Fe3+ state (oxidized)
Nitrates Antimalarial drugs ( Primaqine, Chloroquine) Dapsone Sulfonamides Local anesthetics ( Lidocaine) metoclopimide
Drugs that can cause a long QT (cardiac)
ABCDE
anti-Arrythmics ( Ia, III) AntiBiotics (macrolides) Anti "C"ycotics (haloperidol) Anti Depressants ( TCAs) Anti Emetics (ondansetron)
How do you treat Torsades de pointes
Magnesium sulfate
How do you treat Wolff-Parkinson-White syndrome?
Procainamide - avoid beta blockers or calcium channel blockers ( can use class IA/C... others block AV node and facilitate passage through the accessory pathway.----> SVT
How do you treat atrial fibrillation?
Class IC or III anti-arrythmetics
What is the preferred treatment for atrial flutter?
catheter ablation
How do you treat an acute heart attack
- ABC
- MONA – morphine, O2 (if hypoxic), Nitroglycerine, Aspirin)
- Beta-blocker (but not if there is a sign of heart failure)
- Statin
- Anti-platelet – Clopidogrel/ticagrelor
- Anti-coagulant– heparin and enoxaparin
- K+> 4, Mg >2
- STEMI – CATH/ Fibrinolysis
- NSTEMI – Cath
What drugs decrease the oxygen demand of the heart?
- Beta blockers (decrease contractility & HR)
- Nitrates (decrease preload)
- ACE/ ARB ( decrease afterlood)
treatment for hair-pulling disorder (Trichotillomania)
Fluoxetine (SSRI) or Clomipramine (TCA)
Atomoxetine ( Strattera)
Norepinephrine reuptake inhibitor (SNRI)
ADHD - attention deficit hyperactivity disorder
Dextroamphetamine
(aka Adderall)
CNS stimulants
Cause release of catecholamines at the synaptic cleft
How do you treat intractable tics? (Tourette syndrome)
Behavioral therapy
Fluphenazine
Pimozide
Tetrabenzaine
Treatment of Bulimia Nervosa
(SSRI) Fluoxetine + psychotherapy
what is the treatment for DTs (Delirium Tremens)
Peaks 2-4 days after last drink
Benzodiazepines
What is used to treat alcoholic hallucinations
visual hallucination 12-48 hours after last drink
Long-acting benzodiazepines
chloridazepoxide, lorazepam, diazepam
Drug for Lyme disease or Rocky Moutain Spotted fever
Tetracyclines
Used to treat Giardia lamblia
Metronidazole
Treatment for gram negative rods in patients with renal insufficiency
Meropenem/ imipenem with TMPX, Dapsone then Pentamiine
Propholaxis in Aids patients against P. jirovecii pneumonia
Cilastatin
Used as prophylaxis against TB
Isoniazid
Which antibiotics are safe during pregnancy
Penicillins and aminopenicillins Piperacillin Cephalosporins Macrolides (erythromycin, azithromycin) Metronidazole (after 1st trimester) Nitrofurantoin
which medication inhibits dihydrofolate reductase
Enzymes plays role in pyrimidine synthesis
Methotrexate, Trimethoprim, pyrimethamine
which drug inhibits thymidylate synthase
Enzymes plays role in pyrimidine synthesis
5-FU
5- Fluorouracil
Inhibits nosine monophosphate dehydrogenase
Mycophenolate, Ribavirin
Inhibits PRPP amidotransferase
6-Mercaptopurine (6-MP) and it’s prodrug azathioprine
Etoposide
Inhibits eukaryotic topoisomerase
Treats cancer of the testicles and small cell lung cancer in combination with other medicines.
Alpha-amanitin
Toxin
Found in Amanita phalloids (death cap mushrooms) and it inhibits RNA polymerase II (eukaryotes – recall prokaryotes only have 1 polymerase). Can cause SEVERE HEPATOTOXICITY if ingested.
Drugs that cause Disulfiram-like reactions
Metronidazole
Certain cephalosporins
Procarbazine (Hodgkin lymphoma)
1st generation sulfonylureas (tolbutamide)
Who are the low potency neuroleptics?
Chlorpromazine, Thioridazine
Who are the high potency neuroleptics?
Haloperidol Fluphenazine Loxapine Thiothixene Trifluoperazine
Who are the atypical antipsychotics?
olanzapine quetiapine Risperidone apipiprazole clozapine
Methylphenidate
Dextroamphetamine
Methamphentamine
- mechanism
- clinical use?
- toxicity?
Atypical antidepressant
Stimulates release of norepinephrine and dopamine into synaptic cleft
ADHD, narcolepsy, apetite control
toxicity: sedation, increase appetite, weight gain, dry mouth
Trazodone
- mechanism
- clinical use?
- toxicity
Atypical antidepressant
blocks 5-HT2 and alpha-1 adrenergic receptors
Primarly used for insomnia (works well with SSRIs and increases REM sleep)
Toxicity: sedation, nausea, PRIAPISM (painful persistent penile erection), postural hypotension
Bupropion
- mechanism
- clinical use?
- toxicity
Atypical antidepressant
increases NE and dopamine by inhibiting its uptake
Smoking cessation
Toxicity: stimulant effects (tachycardia, insomnia) – dont take drug before going to sleep
- headaches, seizures in anorexic or bulimic patients
benefit: NO SEXUAL SIDE EFFECTS
Nitrofuration
mechanism
Indication
SE
mechanism: bacteriocidal
Reduced by bacterial proteins to a reactive intermediate that inactivates bacterial ribosomes
* has to be in presence of bacteria to be active
Indication: UTI cystitis by E.coli or staph saprophyticus
SE: rarely nausea, HA, diarrhea
Safe in pregnancy
why should beta blockers not be used during cocaine intoxication
beta blockers can lead to severe hypertension from unopposed alpha 1 activation
How do you treat nephrogenic diabetes insipidus
Hydrochlorothiazide
Amiloride (lithium toxicity)
Indomethacin
Who are the short acting benzodiazepines?
“ATOM”
Alprazolam
Triazolam
Oxazepam
Midazolam
What are the drugs associated with Nephrotoxicity/ototoxicity
Vancomycin
Aminoglycosides
Loop diuretics
Cisplatin and Carboplatin
Mnemonic for treating testicular cancer:
“Eradicate ball cancer”
Etoposide
Bleomycin
Cisplatin
Or:
Etoposide
Ifosfamide
Cisplatin
Brimonidine
what is it used for?
receptor it targets?
mechanism?
Side Effects:
Glaucoma drug – FA 494
(alpha 2)
- decreases aqueous humor synthesis
Blurry vision, ocular hyperemia, foreign body sensation, ocular allergic reactions, ocular parities
Beta blockers that can be used in glaucoma?
Timolol, betaxolol, carteolol – Beta blockers
Decrease aqueous humor synthesis
No pupillary or vision changes
Mnemonic to see if beta blockers are specific for B1 or are non selective:
A- M selective against B1
N to Z is non selective
Carvedilol and labetalol are nonselective alpha and beta antagonists.
Carbachol
muscarnic and nicotinic receptor agonist.
M3 receptor
Drugs that cause SLE
Hydralazine Procainamide Isoniazid Minocycline Quinidine
What is the treatment for Wilson’s disease
low ceruloplasmin
tx: penicillamine
What is the anti protozoan therapy for toxoplasmosis
Pyrimethamine
What is the anti-protozoan therapy for trypanosome brucei
suramin and melarsoprol
What is the anti-protozoan therapy for T. cruzi
nifurtimox
What is the anti-protozoan therapy for leishmaniasis
Sodium stibogluconate
What are the anti-louse therapies
Permethrin (blocks Na+)–> neurotoxicity
Malathion (AchE i)
Lindane (blocks GABA) —> neurotoxicity
To treat Scabies and Pedicures and Pthirus (lice)
who are the agents used as antihelminthic therapy
Mebendazole, pyrantel pamoate, ivermectin, diethylcarbamazine, praziquantel
treatment of Von Willebrand disease
Desmopressin – analog of vasopressin/ADH – it is known that it increases vWF release from endothelial cells.
however, severe vWF deficiency will not respond to desmopressin
what is the treatment for gestational diabetes if light exercise and diet have failed?
Insulin – does not cross the placenta
how is hypoglycemia treated in medical setting vs. non medical setting
In medical setting – IV dextrose (glucose)
In non medical setting – intramuscular glucagon
treatment of central DI?
Intranasal desmopressin acetate
Hydration
Treatment for nephrogenic DI?
- HCTZ (1st line) – causes patient to become dehydrated: makes PCT work harder and so it reabsorbs more water so that by the time filtrate hits distal tubal, it is already a little more concentrated
- Indomethacin (blocks prostaglandin, decrease renal blood flow, inhibit urine output)
- Amiloride ( blocks Na+ channels that lithium use to enter principle cell) – lithium induced DI.
- hydration
Treatment for SIADH?
Fluid restriction IV hypertonic saline (NaCl > 0.9%) Conivaptan Tolvaptan Demeclocycline
Drugs that can cause seizures
- Bupropion (antidepressant – especially bolemic/ anorexic)
- Clozapine (antipsychotic at high doses)
- Isoniazide ( anti-TB, give pyridoxine)
- Ciproflaxin (antibiotic)
- Imipenem (antibiotic)
treatment for ADHD?
- names and mechanism
stimulants : Methylphenidate, dextroamphetamine, methamphetamine
mechanism: increase catecholamines in the synaptic cleft, especially NE and Dopamine
treatment for alcohol withdrawal
long-acting benzodiazepines
(chlordiazepoxide, lorazepam, diazepam_
treatment for bipolar disorder
- Lithium ( mood stabilizer)
- Valproic acid
- Atypical antipsyhcotics
treatment for Bulimia
SSRIs
treatment for Depression
SSRIs
treatment for generalized anxiety disorder
SSRIs, SNRIs
Treatment for obsessive compulsive disorder
SSRIs, clomipramine (tricyclic antidepressant - block reuptake of NE and 5-HT - serotonin)
treatment of panic disorder
SSRIs
Venlafaxine (SNRI)
benzodiazepines
treatment of PTSD
SSRIS
Venlafaxine (SNRI)
treatment of Schizophrenia
Atypical antipsychotics (olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone)
Treatment for social phobias
SSRIs, beta-blockers
Tourette Syndrome
Antipsychotics (fluphenazine, pimozide)
tetrabenazine
Clonidine
drugs with antimuscarinic effects:
Atropine TCA H1 antagonists neuro-eleptics Anti-parkinson meds
= flushing and myadriasis
who are the mood stabilizers? Are they used in combination with anything else?
Lithium
Valproate ( Valproic Acid)
carbamazepine
Plus an atypical antisychotic (olanzapine)
treatment for essential tremors
nonspecific beta-adrenergic antagonist (like propranolol)
essential tremor is believed to be inherited as an autosomal dominant
Drug given for ALS
“Lou needed riLUzole”
Riluzole – decreases presynaptic glutamate release
treatment for bedwetting
Desmopressin
Treatment for night terrors and sleepwalking
benzodiazepines
