Exam 2 Flashcards
What is the major effect of all NSAID’s?
Decrease synthesis of prostaglandins by inhibiting cycle oxygenate
What do Prostaglandins do in the body?
1) Enhance inflammatory process
2) Increase renal blood flow
3) protects the GI mucosa
MOA of COX-1
Gastroprotective effects
MOA of COX-2
Produces proinflammatory mediators
Problems associated with acute toxicity:
1) GIT symptoms = MC (Dyspepsia)
2) Renal effects = 2nd MC
Treatment for acute overdose:
1) Secure airway
2) Activated Charcoal
3) Transport
MOA of Salicylate Toxicity:
1) Inc. metabolic rate
2) inc. O2 consumption
3) inc. CO2 formation
4) inc. heat production
5) inc. glucose use
6) depletion of hepatic glycogen
Clinical features of salicylate toxicity
- nausea/vomiting
- tachypnea
- tinnitus
- metabolic acidosis
Why is Acetomenophen toxicity worse in alcoholics?
Due to introduction of Hepatic Microsomal Enzyme Systems
Vitamin A Acute Toxicity clinical features:
- Pseudotumor Cerebri
- Tired/Irritable
- Hair Loss
- Hepatomegaly
Chronic Vitamin A toxicity clinical features
- bone pain
- visual disturbances
- fatigue, but difficulty sleeping
- dry skin/hair loss
- elevated Alk Phos
- Periosteal calcification
Vitamin D toxicity clinical features
- Hypercalcemia
- Weakness
- Headache/Fatigue
- ST Calcificaton
- Polyuria/Polydipsia
- nephrocalcinosis
Vitamin C toxicityClinical features:
- Urinary calculi
- elevated Estradiol (when taking birth control)
- Inc. iron absorption
- Diarrhea, Nausea, Craming
When is increased iron absorption dangerous?
In patients with Hemochromatosis
Functions of Histamine
1) Mediates all Allergic responses
2) Regulates Gastric acid secretion
3) CNS neurotransmitter
Function of H1 Antihistamine
Stimulation…
1) constricts bronchioles
2) Dilates peripheral vasculature
3) inc. vascular permeability
Function of H2 Antihistamine
1) Regulates Gastric acid secretion
In the CNS, H1 & H2…
Modulate…
1) Arousal
2) Thermoregulation
3) Neuroendocrine functions
Function of H3 Antihistamine
1) Presynaptic regulator of histamine synthesis and release
What are H1 receptor blockers?
1) Reversible & Competitive
2) Inhibit H1 receptors
3) Competitive inhibitors of Muscanaric receptors
4) Block sodium channels disrupting cortical neurotransmission
Antihistamine Toxicity clinical features
1) Sedation
2) Headache
3) Dry Mouth
4) Nausea
5) Menstrual Pain (Allegra)
What are H2 receptor blockers used to treat?
Heartburn
Clinical indications to use an H2 receptor blocker
1) Brady/tachycardia
2) confusion
3) agitation
4) delirium
5) Seizures
Examples of H2 receptor blockers
1) Tagamet
2) Zantac
3) Pepcid
4) Axid
Example of H1 receptor blockers
1) Benadryl
2) Unisom
3) Chlor Trimeton
4) Atarax
5) Claritin
6) Allegra
7) Zyrtec
Macrolides Antibiotic toxicity effect:
Gastric Irritation
Chloramphenicol Antibiotic toxicity effect:
Aplastic anemia
Tetracyclines Antibiotic toxicity effect:
1) Photosensitivity
2) Renal Tubular Necrosis
Fluroquinolones Antibiotic toxicity effect:
Disrupt Cartilage synthesis
Low dose caffeine toxicity clinical features:
1) Nervousness
2) Insomnia
3) Abdominal pain
High dose caffeine toxicity clinical features:
1) Vomitting
2) Myoclonus
3) Myocardial irritability
4) Seizures
Clinical features of chronic caffeine toxicity
1) Irritability
2) Insomnia
3) Anxiety
4) Chronic abdominal pain
5) CVD
6) Fibrocycstic disease
FDA regulation of herbal medicines
Little to none…
In many herbal products the active ingredient __________.
“Is not known”
Definition of Infusion
Herbs steeped in water (like tea)
Definition of Decoction
Plant soaked then boiled in water (extracts more)
Definition of Tincture
Herb extract prepared by steeping in 25% mix of alcohol & water
Definition of Syrup
Herb extract prepared in honey or sugar
Definition of Compress
Cloth pad soaked in hot herbal extract and applied to painful area
Definition of Poultice
Similar to compress, but entire herb is applied to area
Definition of Emmenagogue
Herb that induces or increases menstrual flow
Definition of Carminative
Herb that reduces or prevents flatulence
MC use f herbal medicine is…
Herbal teas
What is “Folk” medicine?
Unrefined products derived from local plants, animals or minerals as a treatment for disease.
Use for Aloe:
1) Laxative
2) Cathartic effects
3) Psoriasis/Seborrhea
4) Skin Burns
Use for Bilberry (Huckleberry, Blueberry):
1) Atherosclerosis
2) PVD
3) lipid-lowering
4) anti-inflammatory
5) night vision/visual acuity
Use for Black Cohosh
1) alternative to Hormone Therapy
2) Menopausal/Dysmenorrhea/Prementrual
Use for Chamomile
1) Sleep
2) anti-peptic/pyretic
3) antibacterial/fungal
4) antispasmodic
Contraindication for using Chamomile
Allergy to Ragweed (contact dermatitis)
Use for Cascara Sagrada (Fletcher’s Castoria)
1) Constipation
2) Gallstones
3) Liver problems
Use for Cheyenne Pepper
1) Topically for anti-inflammatory for arthritis
Use for Chinese parsley, Coriander, Cilantro
1) cooking
2) Chelating agent
3) Inc. Hg, Pb & Al excretion from the body
Use for cranberry fruit
1) prevent & treat UTI/Kidney stones
2) Diuretic
3) antiseptic
Use for Echinacea
1) Upper respiratory viral infections
2) immune stimulant
3) promote healing
What can Echinacea interfere with?
Immunosuppressive therapy
Use of Feverfew Leaf
Prophylactic prevention of…
1) migraine/headaches
2) fever
3) arthritis
4) mentrual problems
Use of Ginger
1) prevent & treat motion sickness
2) appetite stimulant
3) arthritis
4) cold symtoms
No not use Ginger in patients with…
Cholelithiasis
Health benefits of Ginger Tea List: (11)
1) Motion sickness/STOMACH DISCOMFORT
2) dec. inflammation
3) asthma
4) circulation
5) mentrual discomfort/fertility
6) immunity
7) relieve stress
8) cough & cold
9) cancer
10) Alzheimer’s
11) Weight loss
Use for Ginkgo root:
1) Vasodilator
2) Cerebral insufficiency
3) dementia/memory enhancement
4) sexual dysfunction due to antidepressant use
Use of Asian Ginseng (Panay ginseng)
1) respiratory, digestive & CNS stimulant
2) Fatigue
3) Ulcers
4) Lowers cholesterol
5) immunostimulatory agent
6) cope with stress
Use of Goldenseal root
1) Common cold & URI
2) bacteria & inflammation
3) immune stimulant
4) infectious diarrhea
Use of hawthorn (Crataegus monogyna)
1) Cardiac function (HR & blood flow to heart) (dec. BP)
Use of Kava Root
1) anxiety
2) insomnia
3) promote relaxation
Why is Kava root no longer available in the U.S.?
Live issues
Use of Milk Thistle (Silybum Marianum)
1) prevent/cure liver disease
2) protects cell membrane
3) Scavenges harmful Oxygen radicals in the liver
Use of Saw Palmetto (Serenoa Repens)
1) Benign Prostatic Hyperplasia
2) Enlarged prostate
Use of Red Yeast Rice Extract
1) Lowers total cholesterols, LDL’s & triglycerides
[Marketed as Cholestin]
Do not take Red yeast Rice Extract with…
1) Alcohol
2) Zantac
3) selected antibiotics
[blocks metabolism] -> [produces GABA analog]
Use of St. John’s Wort (Hypericum Perforatum)
1) Depression/Anxiety
2) CT swelling
3) Menopausal neurosis
4) wound healing
Use of Tea Tree
Antiseptic &Antimicrobial applied to the Skin
Use of Valerian Root:
1) Anxiety
2) Insomnia (sedative)
What is L-Tryptophan?
- Essential amino acid
- Precursor for Serotonin
What can L-Tryptophan Treat?
1) Insomnia
2) depression
3) PMS
Caution when taking Pennyroyal:
Liver Damage & may cause abortion
Caution when taking Senna
Electrolyte Loss
Caution when taking White Willow Bark
Reye’s Syndrome
Caution when taking Wormwood:
Neurological Symtoms
Mandrake is used to treat…
1) Ovarian cancer
2) Sedative
3) Hallucinogen
4) Purgative, Emetic & Analgesic
Do not give Mandrake to…
Pregnant women
Thorn Apple tea is used to treat…
1) Asthma
2) boils
3) piles
4) cancer
Burdock root tea is used to treat…
1) Psoriasis & Eczema
2) Gout
3) Sores
4) Cancer
5) Skin Diseases
6) Arthritis
Burdock Root Tea is a ___________ and a _____________.
Diuretic; Diaphoretic
Mormon Tea is used to treat…
1) Asthma
2) Diarrhea
3) Stimulant to control Hay fever
4) Adrenal Stimulant
Drug interactions with Ginkgo Biloba:
1) Aspirin
2) NSAID’s
3) Warfarin
4) Heparin
Drug interactions with Ephedra
Caffeine or other stimulants
Drug interactions with Feverfew:
1) Anticoagulants
2) Pregnancy
Drug interactions with Garlic:
1) Warfarrin
2) Aspirin
3) May inhibit clotting
Drug interactions with Kava Kava
Benzodiazepines
Drug interactions with St. John’s Wort:
Antidepressants
Drug interactions with Licorice:
BP Medications
Drug interactions with Ginseng:
1) Digitalis
2) MAO Inhibitors
3) Avoid w/ Antidepressants
MOA of Carboxylic Acids (Acetylsalicylic Acid, Aspirin, White Willow Bark):
Inhibits PROSTAGLANDIN SYNTHETASE found in the Cyclooxygenase pathway
Toxicity of Aspirin Clinical Features
1) Tinnitus
2) Metabolic acidosis
3) ulcers
4) Leads to Reye’s Syndrome
Examples of Carboxylic Acids:
1) Acetylsalicylic Acid
2) Aspirin
3) White Willow Bark
Examples of non-opiate/non-anti-inflammatory analgesics:
Acetomenophin (Tylenol, Tempra)
Examples of Propionic Acids:
1) Ibuprofen (Motrin, Advil)
2) Ketoprofen (Orudis)
3) Fenoprofen (Nalfon)
4) Naproxen (Aleve)
MOA of Propionic Acids:
- Block PROSTAGLANDIN SYNTHETASE
- Accumulate in synovial fluids
- Long lasting effects
MOA of Acetic Acids:
Toxicity of Acetic Acids
What effect do Glucocorticoids have on the HPA Axis?
Hypothalamus: release CRH
Ant. Pituitary: release ACTH
Adrenal Cortex: release Glucocorticoids
MOA of Gluccorticoids:
Block formation of Arachidonic Acid
(Prevent PHOSPHOLIPASE A2 to form Arachidonic acid to stop inflammation)
Glucocorticoids promote…
Gluconeogenesis from non-CHO sources
Glucocorticoids effects on the liver:
1) inc. amino uptake
2) inc. glycogen deposition
3) inc. blood glucose to stimulate insulin release
4) Cause glycosuria > 200mg
Cushing Syndrome can be caused by:
Taking glucocorticoid drugs or a functional adenoma
(ACTH would be lower in Cushing’s)
Glucocorticoids effects on muscle/catabolism:
1) inc. amino acids release from muscle
2) Inhibit protein synthesis
3) Catabolic effect on: lymph, CT, muscle, skin, bone
Glucocorticoid Effects on Bone:
1) Catabolic- > Osteoporosis
2) Decreased Osteoblastic activity
Glucocorticoid Effect on RBC components & WBC’s:
Neutrophils: increase
Lymphocytes: decrease
Monocytes: Inhibit ability to turn into macrophages
Eosinophils: decrease
Platelets: Increase
Chemotaxis of all WBC’s: decrease
Glucocorticoids effects on:
1) Macrophages
2) Lysosomal Membranes
3) Fibroblasts
4) Collagenase
5) Phagocytes
M -> Dec. ability to phagocytize bacteria
L -> Stabilize
F -> Inhibit growth
C -> Potentiate
P -> long-term leads to suppression
Effects of Glucocorticoids on:
1) Capillaries
2) Vessels
3) Histamine
4) ACTH
5) Gastric Acid & Pepsin
C -> Dec. permeability
V -> vasoconstriction
H -> Dec. release
ACTH -> Dec. release
G & P -> inc. release in stomach
Effects of Glucocorticoids on TSH release:
Decreases, so patients present similar to hypothyroidism: Depression, mood swings, weight gain, cold intolerance
Effect of Glucocorticoids on Sodium & Potassium:
Na: Retention
K: Depletion
Conditions treated with Glucocorticoids: (12)
1) RA
2) Lupus
3) Inflammatory Bowel Disease
4) Allergic Conditions
5) Asthma
6) Skin Disorders
7) Neoplasm (lymphocytic leukemia, lymphoma Roma, hodgkin’s)
8) Surgical Graft’s
9) Preterm Labor
10) Shock
11) Cerebral Edema
12) Bell’s Palsy
Glucocorticoids combined with NSAID’s can cause…
Severe GIT disturbances and risk of ulceration
Components that aid in the production of Peptic Ulcer Disease
Duodenal > Peptic
H. PYLORI (infection) & NSAIDS (COX-1)
Examples of H2 Receptor Antagonists:
1) Tagamet (prototype)
2) Pepcid
3) Axid
MOA of H2 Receptor Antagonists:
Decrease HCl in the stomach
Metabolized in liver
Excreted in the Urine. (Tagamet excreted in bile)
Clinical Indications for H2 Receptor Antagonists:
1) Dyspepsia
2) Heartburn
What do Proton Pump Inhibitors do?
Inhibit the pumping Hydrogen ions into stomach to combine with Cl to make HCl Acid.
Examples of Proton Pump Inhibitors:
1) Prilosec (prototype)
2) Nexium (2nd generation Prilosec)
3) Prevacid (biggest competitor)
MOA of Sucralfate (Carafate)
Works in an acid environment; lays down a protective coating
Side Effects of Mylanta/Maalox:
- Constipation
- loose stools
Examples of Antacids:
1) Milk of Magnesia
2) Amphogel
3) Tums, Roland’s
4) Mylanta, Maalox
MOA of Antacids:
Immediately neutralize the acids that are already there
MOA of Fecal Softeners (Mineral Oil):
Blocks absorption of water which allows water to be retained in the bowel
Examples of Irritant Laxatives:
1)Castor Oil
2) Cascara Sagrada (Flether’s Castoria)
3) Senna
MOA of Irritant Laxatives:
Stimulant to the bowel
MOA of Bulk Laxatives (Citrucel):
Non-digestible fiber that has been ground into powder form
MOA for Saline Laxatives (epsom salts, Mg Citrate, Fleet Enema):
Have a lot of electrolytes, so act as a diuretic to draw fluid into bowel
Examples of Antidiarrheal OTC medications:
1) Pepto Bismol
2) Kaopectate
3) Imodium-AD
4) Donnagel
MOA of Pepto Bismol
Binds to toxins in the bowel, producing a dark stool
MOA for Kaopectate:
Binding agent that thickens the stool (flour to gravy)
MOA for Imodium:
1) Slows down longitudinal peristalsis
2) Inc. Intersegmental peristalsis to absorb more water
3) Inc. transit time
Prescription Meds for Diarrhea containing Opiates:
1) Lomotil
2) Paregoric
Examples of bronchodilators:
1) Albuterol
2) Metaproterenol
3) Terbutaline
4) Ephedrine
MOA of Bronchodilators
Beta 2 Agonists that affect smooth muscle to relax the respiratory tree
Clinical Indication for using Bronchodilators (Beta 2 agonists)
Asthma attacks
Side effects of Bronchodilators (Beta 2 agonists)
Can stimulate B1 receptors in the heart -> inc. HR
Examples of Methylxanthines:
1) Theophylline (Theodur, Slo-Phyllin)
2) Aminophylline
MOA of Methylxantines:
Affect PHOSPHODIESTERASE causing inc. cyclic AMP which relaxes smooth muscle
Clinical indications fro Methylxantines:
Take routinely to prevent asthma attacks and when you have an asthma attack it is much milder
MOA of Cromones:
Stabilize mast cell membranes to block the release of HISTAMINE
MOA of Inhaled Steroids
Catabolic steroids that minimize inflammation around your respiratory tree
MOA of Mucolytics (n-acetyl-cysteine)
Minimize accumulation of mucus from mucous membranes & breaks down mucus being secreted
Clinical Use for Mucolytics (n-acetyl-cysteine)
Used as the only treatment for Tylenol overdose
Examples of antihistamine H1 receptor blockers:
1) Benadryl (prototype)
2) Claritin
3) Allegra
4) Zyrtec
MOA of Antihistamine H1 receptor blockers:
Basophils release histamine & act against rhino RRROA
Side effects of antihistamine H1 receptor blockers
1) Drowsiness/sedation
2)) drying agents
Examples of nasal decongestants:
1) Sudafed (prototype)
2) Afrin
3) Dristan
4) Ephedrine
MOA of Nasal Decongestants:
Alpha 1 stimulators causing Vasoconstriction
Do not give Nasal Decongestants to:
1) Hypertensive Patients
2) Prostate issue patients
3)can become addictive/dependant
Examples of Expectorants:
1) Guaifenesin (Robitussin)
2) Iodine (PotassiumIodine)
MOA of Expectorants:
Thin out mucus secretions by adding ions so it expels
Side effects of Expectorants:
None
Examples of Antitussives:
1) Dextromethorphan (non-narcotic)
2) Codeine (narcotic) -> natural extract
3) Hydrocodone (Narcotic) -> controlled substance
MOA of Antitussives:
Used to suppress a cough, (suppress centrally in the Medulla)
Side-Effects of Antitussives:
1) Non-Addicting
2) Sedating effects
3) Constipation
OIC stands for:
Opiate Induced Constipation
Doxylamine =
Antihistamine
Pseudoephedrine =
Decongestant
Guaifenesin =
Expectorant
Dextromethorphan =
Cough Suppressant
Acetaminophen =
Pain Reliever
