Exam 1 - Drugs Flashcards
Aspirin (same for Salicylates?)
- 4 actions of aspirin
- Therapeutic uses
- 4 actions =
- analgesic
- anti-pyretic
- anti-inflammatory
- antiplatelet
- therapeutic uses
- suppress inflammation/arthritis
- analgesia
- reduce fever
- dysmenorrhea
- supress platelet aggregation
Aspirin
- Side effects
- Toxicity
- Side effects
- MOA = irreversibly inhibits COX
- GI: blocks protective prostaglandins
- blood: increases bleeding
- Uterus: decreases contractions
- Kidney: promotes retention
- Respiration: stimulates
- Toxicity
- GI-ulcers
- hypersensitivity
- overdose
- pregnancy
- Reye’s syndrome
- alcohol
Aspirin
- Drug interactions
- Poisoning
- Contraindications
- Interactions
- warfarin
- glucocorticoids
- alcohol
- ibuprofen
- Poisoning
- death from respiratory failure
- treat with ventilator
- Contraindications
- kidney problems
- preexisting bleeding disorder
- history of peptic ulcer/asthma
- pregnancy
Ibuprofen/Naproxen common names
- Ibuprofen
- Advil
- Motrin
- Nuprin
- Naproxen
- Aleve
- Naprosyn
Ibuprofen/Naproxen
- Mechanism
- Which lasts longer?
- 3 actions
- MOA = inhibits COX
- Ibuprofen has a shorter duration of action than naproxen
- 3 actions
- anti-inflammatory
- antipyretic (fever)
- analgesic
Ibuprofen/Naproxen
Therapeutic uses
- Therapeutic uses
- suppression of inflammation
- Rheumatoid arthritis
- Moderate pain
- fever
- Dysmenorrhea (best drug for this)
- Better tolerated NSAIDs
*** Naproxen only = bursitis/tendonitis
*** Ibuprofen = safe to use with anticoagulants
Piroxicam (aka Feldene)
I dont think we need to know this one
- MOA = inhibits COX
- antiplatelet like aspirin
- RA
- 9.5x higher risk for peptic ulcer and bleeding
Indomethacin: Stuff and common name
- Indomethacin (aka Indocin)
- MOA = inhibits COX
- Antiplatelet like aspirin
- Arthritis, bursitis, tendonitis, ductus arteriosus
* inhibits prostaglandin synthesis and inhibit urate phagocytosis
* initial treatment of gout
Celecoxib: Common name
uses
3 actions
- Celecoxib (aka celebrex)
- MOA = selective COX-2 inhibition
- OA and RA
- 3 actions
- anti-inflammatory
- anti=pyretic
- analgesic
*** NO PLATELET AGGREGATION
*** causes fewer GI ulcers than other NSAIDs
Acetaminophen
common name
MOA
what does it inhibit
actions
treating
- Acetaminophen (aka Tylenol)
- MOA = WEAK inhibition of COX
- Only able to inhibit prostaglandins in the CNS
- 2 actions
- analgesic
- antipyretic
- ****NOT an anti-inflammatory agent!
- Treating with acetaminophen
- does not cause GI bleeding
- rarely hypersensitivity
*** categorized as an analgesic
Ketorolac
common name
MOA
other stuff
- Ketoroloc (aka toradol) - only injectable!
- MOA = inhibits COX
- alternative for opioid analgesics
- LESS anti-inflammatory activity
Sulindac
Common name
other stuff!!
- Sulindac (aka Clinoril)
- Equipotent to aspirin
- closely related to indomethacin
- less potent/fewer adverse effects
DOAN’s and Ben-Gay
These are other salicylates. Same stuff as aspirin?
Doan’s = magnesium salicylate
Ben-Gay = topical
Methotrexate (type of DMARDs)
speed
side effects
use how often
- rapid acting
- side effects
- liver fibrosis
- bone marrow suppression
- administered once per week
Sulfasalazine (Azulfidine)
Type of DMARDs
treats?
slows?
side effects?
- treats inflammatory bowel disease
- retards progression of joint deterioration
- GI and rash
Leflunomide (Arava)
type of DMARDs
What does it do?
side effects?
- Slows formation of bone erosion
- well tolerated, benefits in 1 month
- stop lymphocyte activation
- side effects
- GI distress
- rash
- liver function
Entanercept (Enbrel)
- Anti-TNF drug (tumor necrosis factor)
- cytokines play a central part inflammation. TNF alpha stims release of cytokines
- side effects
- increase risk of infection
Prednisone
a steroid used to treat arthritis
Colchicine
- used to treat gout
- suppress different phases of leukocyte activation
- prophylaxis of recurrent episodes of gouty arthritis
- binds to tubulin
- troublesome diarrhea
Probenacid
- decreases the net reabsorption of uric acid by affecting the transport sites
- need large urine volume to minimize kidney stones
*decreases the pool of urate available for gout
morphine (everything but drug interactions and overdose)
- Principal alkaloid in opium
- Mu agonist
- does not reach brain quickly
- Lasts 4-5 hours
- relieves pain
- mental clouding
- orthostatic hypotension, constipation, pupil constriction, respiratory depression
- urinary retention
- emesis (vomiting)
- elevation of intracranial pressure
- tolerance and physical dependence
- ***only for patients with painful disorders and sharp stabbing pain
Morphine (drug interactions and overdose)
- Drug interactions
- alcohol
- barbiturates
- antihistamines-increase respiratory depression
- overdose
- ventilation and give opioid antagonist
Heroin
opioid agonist
gets into brain more rapidly than morphine
no evidence that heroin is more effective than morphine
high abuse potential
Codine
opioid agonist
mild to moderate pain
side effects limits the max tolerated
often used in comination with aspirin or acetaminophen
Oxycodone (OxyContin, Percocet)
opioid agonist
never achieve morphine like efficacy
schedule II drug
Meperidine (Demerol)
opioid agonist
shorter duration of action than morphine
forms a toxic metabolite that can accumulate
Fentanyl (sublimaze)
opioid agonist. Mu agonist
-100x more potent than morphine
short acting (1-1.5 hours)
synthetic heroin -> health professionals abuse
Tramadol (ultraam)
opioid agonist. weak Mu agonist
- mild to moderate pain
- may cause seizures
- useful in chronic neuropathic pain
Opioid antagoinists
- Naloxone (Narcon) = mu antagonist used to treat opioid overdoses
- Naltrexone (ReVia, Depade) = useful in the treatment of alcoholism
Opioid agonist-antagonist
-
Nalbuphine (nubain)
- moderate pain
- less side effects than agonist
- produces more psychotropic effects
- Opioid A-A
- agonist at kappa; antagonist at mu
- less powerful but also less addictive
Cromolyn sodium
-antihistamines
(Nasalcrom)
- stabilizes mast cells and prevents release of contents
- takes 2-3 weeks to be effective
- side effects
- burning
- itching
- sneezing
- coughing
Diphenhydramine
(benadryl)
- allergies
- anti-emetic (vomiting)
- available OTC
**first generation H1 blocker
Dimemhydrinate
- Motion sickness
- causes muscular weakness/drowsiness
*first generation H1 blocker
(Dramamine)
Fexofenadine
- Second generation H1 blocker
- allergies
- causes less drowsiness
- the active metabolite of Terfenadine so does NOT cause toxic cardiac effects like terfenadine
(Allegra)
Loratidine
- Second generation H1 blocker
- allergies
- less sedating
- once a day, extended release formulas
(Claritin)
Cimetidine
- H2 blocker
- inhibits cytochrome P450 metabolism of other drugs
- causes headaches, impotence (erectile dysfunction), and gynecosmastia (breast formation in males)
- better medications (this should not be used anymore)
(tagamet)
Ranitidine
- H2 blocker
- heart burn and gastric acid relief
- Zollinger-Ellison syndrome (can cause tumors to form?)
(Zantac)
Famotidine
- H2 blocker
- heart burn and gastric acid relief
- Zollinger-Ellison syndrome (can cause tumors to form?)
(Pepcid)
Aldosterone
Most potent mineralocorticoid
Bethanechol
- Muscarinic agonists
- Relieves urinary retention
- side effects
- hypotension
- excessive salivation/gastric acid secretion
- bronchoconstriction
Atropine
- Muscarinic Antagonist
- give this drug when they have muscarinic poisioning
Physostigmine (antilirium)
- Used in antimuscarinic poisoning
- inhibitor of AChE
- reversible
- crosses membranes
- Treats
- Atroprine poisoning
Neostigmine (Prostigmin) *
- Reversible AChE inhibitor
- MOA
- binds to cholinesterase preventing it from catalyzing breakdown of ACh
- treats
- Myasthenia gravis
Tubocurarine (Curare) *
- non-depolarizing neuromuscular blocking agents
- MOA
- competes with ACh to bind to nicotinicm receptors
- muscle relaxes etc.
- side effects
- respiratory paralysis
- hypotension
Catecholamines (list drugs)
- Epi
- NE
- Isoproterenol
- Dopamine
- Dobutamine
*not orally
*cannot cross BBB
Non-catecholamines (drugs list)
- Ephedrine
- Phenylephrine
- Terbutaline
*given orally
*Can cross BBB
Epinephrine (Adenalin, EpiPen)
- Receptors
- alpha 1 & 2
- Beta 1 & 2
- for
- anaphylactic shock, delay absorption of anesthetics, hemostasis, overcome AV heart block, pupil dilation, asthma
- Catecholamine
Isoproterenol (Isuprel)
- Receptors
- beta 1 & 2
- for
- AV heart block, asthma, bronchospasm
- Catecholamine
Dopamine (intropin)
- Catecholamine
- binds
- dopamine, alpha 1, beta 1
- for
- heart failure, shock, acute renal failure
Terbutaline (brethine)
- non-catecholamine
- binds
- beta 2
- for
- asthma, delay of preterm labor
- side effect
- tremor
Ephedrine
- Noncatecholamines
- receptor
- alpha 1 & 2
- beta 1 & 2
- Mixed drug
- for
- nasal congestion
- narcolepsy
Prazosin (minipress)
- Alpha-adrenergic antagonist
- receptor
- alpha 1
- for
- hypertension
- BPH
- side effect
- orthostatic hypotension
Phentolamine (regitine)
- alpha-adrenergic antagonists
- receptors
- alpha 1 & 2
- for
- pheochromocytoma
- side effects
- same as prazosin
Propranolol (inderal)
- Beta-adrenergic antagonist
- receptors
- beta 1 & 2
- for
- hypertension
- angina
- MI
Metoprolol (lopressor)
- beta-adrenergic antagonist
- receptor
- Beta 1
- for
- hypertension
- asthma or diabetes & angina or MI
*** asthma person cannot use a beta 2 blocker!! So use this!
Reserpine
- adrenergic neuron-blocking agent (indirect?)
- what it does
- suppresses NE synthesis
- and displaces NE from vesicles
- hypertension
Clonidine (Catapres)
- Centrally acting alpha 2 agonist
- MOA
- activates a2 receptors to decrease transmitter release
- for
- hypertension and severe pain
Methyldopa (aldomert)
- centrally acting alpha 2 agonist
- same MOA as clonidine
- activates a2 receptors to decrease transmitter release. except must be converted to methyl-NE
- for
- hypertension
Phenylephrine
- Non catecholamine
- activates alpha 1
- for nasal decongestion
Furosemide (Lasix)
- High ceiling loop diuretic
- most effective
- loop of henle
- MOA
- blocks Na+ and CL-
- reabsorbs K+
- adverse effects
- dehydration
- hypotension
- hypokalemia
- ototoxicity (start to lose hearing)
Hydrochlorothiazide (hydroDIURIL)
- Thiazide diuretic
- MOA
- blocks Na+ and Cl-
- reabsorbs K+
- does
- elevates uric acid and glucose
- adverse effects
- dehydration
- hypotension
- hypokalemia
- not in pregnancy
Spironolactone (Aldactone)*
- Potassium sparing diuretic
- modest increase in urine production
- decrease K+ secretion
- Aldosterone*
- action
- retains potassium
- excretes sodium
- adverse effects
- HYPERKALEMIA****
Triamterene (Dyrenium)*
- potassium sparing diuretic
- modest increase in urine production
- decrease in K+ excretion
- non-aldosterone *
- MOA
- direct inhibitor of potassium/sodium exchange
- **quicker
- adverse effects
- HYPERKALEMIA***
Mannitol
- Osmotic diuretic
- creates osmotic force as undergoes min reabsorption
- uses
- intracranial pressure
- intraocular pressure
- adverse effects
- edema
(osmitrol)
Hydrocortisone
- glucocorticoid
- similar to cortisol
- also has mineralocorticoid properties
- generally safe
Fludrocortisone
- Only mineralcorticoid available for replacement therapy.
- treats
- addison’s
- hypoaldosteronism
- congenital adrenal hyperplasia
