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Pharm > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Aspirin (ASA)

A

1st Gen NSAID
Mech: IRREVERSIBLE inhibition of COX!
Effects: Suppress inflamm - COX 2
Analgesia - COX 2
Antipyretic - COX 2
Reduce plt agg - COX 1
SE: Kidney impairment, Gastric ulcers, Bleeding, stimulates breathing -> potential resp alkalosis
General: Reye’s syndrome (ASA not given to children!)
Acute Poisoning:
1. Resp alkalosis -> resp acidosis
2. Hyperthermia
3. Dehydration
4. Electrolyte imbalances
5. Coma

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2
Q

Ibuprofen (Advil, Motrin)
Naproxen (Naprosyn, Aleve)

A

1st Gen NSAIDs
Mech: REVERSIBLE inhibition of COX
Effects: Suppress inflamm - COX 2
Analgesia - COX 2
Antipyretic - COX 2
SE: Gastric Ulcers
Bleeding
Kidney impairment
General: DOES NOT PROTECT AGAINST MI/STROKE

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3
Q

Ketorolac (Toradol)

A

Mech: suppression of prostaglandin synthesis
Effects: equiv pain relief to opiates w/o resp depression, tolerance, and abuse!
Small anti inflamm effect
SE: Gastric Ulcers
Bleeding
Kidney impairment
General

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4
Q

Celecoxib (Celebrex)

A

2nd Gen NSAID (only one!)
Mech: selective inhibition of COX 2 “coxib”
Effects: anti-inflamm & pain relief w/ reduced gastric risk!
SE: GI ulcers
Increase risk of MI, stroke
General: given for chronic inflamm, long term use!
Less GI effects

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5
Q

Acetaminophen (Tylenol)

A

Mech: Inhibits COX in the CNS ONLY! concentration to CNS explains why no anti-inflamm
Effects: Analgesic, Antipyretic
SE: W/ Alc induces CYP450 -> increases prod of toxic metabolite, depletes glutathione (converts NAPQI to non-toxic metabolite)
General: Acetylcyesteine (Mucomyst) converts toxic metabolite into non-toxic (replenishes glutathione)

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6
Q

Sumatriptan (Imitrex)
Rizatriptan (Maxalt)
“-triptan”

A

Serotonin Receptor Agonists
Mech: Stim sero receptors on cerebral vessels -> vasoconstriction
Also stim receptors on sensory neurons ->reduced release of inflamm neuropeptides
Effects: Used for migraine relief
SE: 50% of pts experience “heavy arms” or chest pressure due to thoracic vasoconstriction
General: Must avoid in preg! Teratogenic!
Cautious w/ other vasoconstriction meds

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7
Q

Ergotamine (ergomar)
Ergotamine + caffeine (Cafergot)

A

Mech: same as -triptans
Effects: prolonged use can lead to physical dependence, S&S similar to migraine attack!
SE: very well tolerated
10% experience nausea
Ergotism w/ prolonged use (periph vasc ischemia) think cold, numb, headache, severe leads to gangrene
General: teratogenic! dont use w/ -triptans

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8
Q

Morphine (strong)
Codeine (mod to strong)

Other:
Fentanyl
Meperidine (Demerol)
Methadone (Methadose)
Hydromorphone (Dilaudid)
Oxymorphone (Opana)

A

Pure Opioid Agonists

Mech: Bind to & activate Mu & Kappa receptors
Effects: relieves mod to severe pain w/o influencing other senses or causing LOC
SE: Resp depression
Constipation
Urinary retention
Ortho HypoT
Emesis
Cough suppression
Overdose :
1. Coma
2. Resp depress
3. Pinpoint pupils
Tx w/ opioid antag & mech vent
General: oral doses must be MUCH higher than other routes.
should NOT be given with CNS depressants, anticholinergics, HypoT meds

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9
Q

Hydrocodone (Vicodin)
Oxycodone (OxyCotin)
Codeine

A

Mod to Strong Opioid agonists

Mech: Bind to & activate Mu & Kappa receptors
Effects: lower intensity than morphine
SE: same as morphine
General: Same as morphine

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10
Q

Methadone (Methadose, Dolophine)

A

Pure opioid agonist

Mech: stim Mu & Kappa receptors.
Longer half life 22hrs
No peak/troughs of pain
Effects: used for opioid maintenance therapy (for a person not ready to withdraw)
SE: dependence on opioids, resp depress & life threatening arrhythmias in large doses
General: Can ONLY be Rx by certified opioid Tx program!

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11
Q

Pentazocine (Talwin)
Butorphanol (Stadol)

A

Agonist-Antagonist Opioids

Mech: Mu antagonist, Kappa agonist
Effects: used for mild to mod pain
SE: less severe than pure opioid SE’s
Limited resp depress
Can increase CV workload = chest pain
General: could see withdraw symptoms if also taking pure opioid agonist becus Mu are being blocked!

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12
Q

Buprenorphine (Suboxone)

A

Agonist-Antagonist Opioid

Mech: Mu partial agonist (suppresses craving), Kappa antagonist
Effects: used for opioid maintenance therapy (1/day dosing)
SE: lower risk of resp depress
General: can be prescribed in PCP office !

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13
Q

Naloxone (Narcan)

A

Opioid antagonist

Mech: competitive antagonist at opioid receptors, blocks opioid agonists
Effects: used for opioid overdose, life saving med! Lasts ~20min (book says 1hr)
Used post-op to break sedation
Used for neonatal resp depress
SE:
General: can induce withdrawal symptoms if given to someone w/ opioid dependence

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14
Q

Procaine (Novocain)
Lidocaine (Xylocaine)

A

Local Anesthetics

Mech: Block Na channels & prevent propagation of action potential
Block sensory & motor neurons
Effects: duration of anesthesia dependent on blood flow in region.
Often admin w/ Epi for vasocon = longer effect
SE: CNS excitation (seizure inducing)
Suppresses myocardium excitability = reduced conduction/heart block
General: Most of these SE not seen when admin SQ.
If given subdural during delivery, could reach baby!

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15
Q

Propofol (Diprivan)

A

Most widely used IV Anesthetic!

Mech: promotes release of GABA (keeps suppressing nerve impulse)
NO ANALGESIC EFFECT!
Effects: induction & maintanence of anesthesia, sedation while on mech vent
SE: profound resp depress!
HypoT
Risk for bacterial infection! Store 72
General: cannot be out unrefrigerated for >6hrs!
educate pt on green urine!

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16
Q

Etomidate (Amidate)

A

General Anesthetic

Mech: binds to GABA receptor & increases sensitivity to GABA
Effects: potential hypnotic used for induction of general anesthesia
NO ANALGESIC ACTION
SE: transient apnea!
HypoT
Electrolyte disturbances
General:

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17
Q

Ketamine (Ketalar)

A

General Anesthetic

Mech: Antagonizes NMDA receptor (Ca Channel)
Effects: used often for burn dressing changes
Produces state of “dissociative anesthesia”
SE: ~12% pts experience hallucinations post-op
General:

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18
Q

Cortisone
Hydrocortisone
Betamethasone (Celestone)
Dexamethasone (Decadron)
Prednisone (Deltasone)
Methylprednisolone (Medrol)

A

Glucocorticoids

Mech: Increase glucose levels, inhibit protein synthesis, mobilize fat (moon face, buffalo hump) , Mimic aldosterone = Na/water retention, K excretion
Inhibit prod of inflamm mediators
Suppress prolif of leukocytes
Effects: Tx Rheumatoid arthritis, SLE, IBD, allergic reactions, asthma, dermatology, suppression of transplant rejection
SE: CHAOS
Cushing’s syndrome (moon face/buffalo hump, fluid retention/HTN)
HypoK
Adrenal insufficiency if quick withdrawal
Osteoporosis
Suppressed immune system
General: Roid rage!
pt should be tapered off of steroid to avoid adverse effects!

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19
Q

Bismuth subsalicylate (Pepto-Bismol)

A

Mech: believed to disrupt bacterial cell wall
Effects: Can be used w/ amox to Tx H. Pylori
Used for diarrhea due to anti-secretory effect
SE: Grey/black stool, black tongue (harmless)
General:

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20
Q

Famotidine (Pepcid)
Cimetidine (Tagamet)
“-idine”

A

Histamine2 receptor antagonists

Mech: Blocks H2 receptors exclusively! No affect on H1 (allergies)
Normally H2 receptor provides cAMP to Proton-Pump to secrete stomach acid.
Effects: used for GERD, gastric/duodenal ulcers, Zollinger Ellison syndrome (hypersecretion of HCL from tumor)
SE: most common w/ Cimetidine
Anti-androgen effects (gynecomastia, reduced libido) not assoc w/ famotidine
CNS effects (confusion)
Pneumonia (buildup of bacteria in stomach)
General: Cimetidine inhibits CYP450 !

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21
Q

Misoprostol (Cytotec)

Analog of prostaglandin E1

A

Prostaglandin receptor antagonist
Mech: stim prostaglandin receptors on parietal cells to suppress prod of gastric acid
Effects: prev of gastric ulcers assoc w/ long use of NSAIDs
SE: Diarrhea, abdominal pain
Vaginal spotting or dysmenorrhea
General: contraindicated in preg women! Stim uterine contractions!

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22
Q

Omeprazole (Prilosec)
Esomeprazole (Nexium)
Pantoprazole (Protonix)

A

Proton Pump Inhibitors

Mech: Pro-drug that is activated in parietal cells of stomach. Inhibits the proton pump!
greater acid suppression than H2RAs!
Effects: lowers stomach acid, GERD & ulcers
SE: Very uncommon, headache, diarrhea, pneumonia by changing oral pharynx flora inhibiting acid secretion.
Rebound hypersecretion if quick cessation of PPI
General: Reduced acid secretion can influence absorption of anti-retrovirals

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23
Q

magnesium hydroxide (Milk of Magnesia)
Aluminum hydroxide/Magnesium hydroxide combo (Maalox)

A

Antacids

Mech: Alkaline compounds react w/ gastric acid to produce neutral salts
Raises stomach pH
Effects: Reduces destruction of gastric lining, reduces pepsin acitivity
SE: Usually affect the colon.
Milk of Mag causes diarrhea
Maalox can cause constipation
General:

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24
Q

Sucralfate (Carafate)

A

Mucosal protectant

Mech: NO ACID REDUCTION
Acts as a physical barrier!
In acidic environments converts to a gel that coats the stomach and adheres to ulcers
Effects:
SE: No known serious SEs
General: won’t be effective if taking an antacid. If stomach isn’t acidic, won’t convert to a gel

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25
Q

Magnesium Hydroxide (Milk of Magnesia)
Polyethylene glycol (MiraLax)
Lactulose

A

Osmotic Laxatives

Mech: poorly absorbed salts or carbs that pull water into intestines
Softens fecal mass
Feces expand & stretch colon
Stimulates peristalsis
Effects:
SE: Loss of water, nausea, flatulence, Mg Hyd contraindicated in renal failure pt due to risk of tox (hyperMag)
General:

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26
Q

Psyllium (Metamucil)

A

Bulk-forming laxative

Mech: acts like natural fiber, swells in water, transforms into a gel, softens stool & increases bulk, swelling stretches colon stems peristalsis
Effects: laxative
SE: Rare, constipation & impaction if GI motility is interrupted
General: PT SHOULD DRINK FULL GLASS OF WATER!

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27
Q

Docusate sodium (Colace)

A

Surfactant laxatives

Mech: lowers surface tension of stool, allows water into stool, inhibits reabsorption of water from colon
Effects: laxative
SE: Rare
General: PT SHOULD DRINK FULL GLASS OF WATER!

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28
Q

Disacodyl (Dulcolax, Feen-a-mint)
Senna (Senokot)
Castor Oil

A

Stimulant Laxatives

Mech: stim intestinal motility, increase secretion of water & electrolytes into colon
Effects: laxatives
SE: Dependency, proctitis (inflamm of the anus) typically only seen w/ repeated use
General:

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29
Q

Ondansetron (Zofran)

A

Antiemetic

Mech: exerts effect by block serotonin in the pathway to the vomiting center
Effects: anti-nausea
SE: dizziness, risk for arrhythmia (Torsades de pointes)
General:

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30
Q

Metoclopramide (Reglan)

A

Antieme*tic & Prokinetic

Mech: Suppresses emesis by blocking serotonin AND dopamine in emesis pathway.
Also enhances effect of ACh in upper GI tract (increases upper GI motility)
Effects:
SE: usually only w/ high dose & prolonged use
Tardive dyskinesia & possible neuroleptic malignant syndrome (NMS, v similar to malignant hyperthermia)
Sedation
General:

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31
Q

Scopolamine (Scopoderm)

A

Antiemetic

Mech: Blocks muscarinic receptors on pathway to vomiting center
Effects: Used for motion sickness!
SE: anti-cholinergic effects (dry mouth, constipation, blurry vision)
General:

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32
Q

Meclizine (Antivert)
Dimenhydrinate (Dramamine)

A

Antiemetic

Mech: Blocks histamine receptors on pathway to vomiting center
Also blocks muscarinic receptors to a lessor degree
Effects: Used for motion sickness!
SE: Anti-cholinergic & ant-histamine SE’s
General:

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33
Q

Sulfasalazine (Azulfidine)

A

5-aminosalicylates

Mech: Reduces inflamm by suppressing prostaglandin synthesis by inhibiting COX
Effects: Used for Tx of acute IBS attack
SE: Nausea, fever, rash
General:

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34
Q

Budesonide (Entocort)
Prednisone (Deltasone)

A

Glucocorticoids

Mech: Inhibits protein synthesis, inhibits synth of chem mediators (prosta, Leuko, histamine)
Effects: anti-inflamm, reduce swelling (decreases vasodilation), reduces pain
SE: usually only in long term use or high doses CHAOS, psychologic disturbances
General:

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35
Q

Infliximab (Remicade)
“-mab” = Mono-clonal antibody

A

Immunomodulators

Mech: Binds to & neutralizes TNF-a , reduces inflamm
Effects: IV Admin only!
SE: Immunosuppression increases risk of infection, infusion reaction risk!
General: Tell pt to report sore throat or fever!

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36
Q

Adalimumab (Humira)

A

Immunomodulator

Mech: Binds to & neutralizes TNF-a, reduces inflamm
Effects: SQ ADMIN
SE: Risk of infection, injection site reaction
General: Tell pt to report sore throat or fever! Pt edu on how to admin SQ injection

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37
Q

Cyclosporine (Neoral, Sandimmune)

A

Immunomodulator

Mech: Suppresses prod of interleukens & other cytokines, reduces prolif of B and cyto T cells
Effects: Used to prevent organ transplant rejection
SE: increased risk of infection, nephrotoxicity
General: tell pt to report sore throat or fever

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38
Q

Heparin
unfractionated heparin

A

Mech: increases the activity of anti-thrombin! -> inactivates thrombin & factor Xa
Works very quick!
Effects: Admin parenteral ONLY!
Best for venous thrombi
Good for conditions that require rapid response (PE, DVT, MI)
Doesn’t cross placenta or BBB preferred in preg
SE: Hemorrhage!! (Dark stools, lumbar/abdominal/pelvic pain), spinal/epidural hematoma
Heparin-induced thrombocytopenia (prod of abs against heparin-plt complex)
General: PROTAMINE SULFATE IS ANTIDOTE!!
Admin slow IV push
1mg neutralizes 100u heparin
Monitor aPTT labs
Normal Essex
Therapeutic 1.5-2.5x normal (60-80sec)

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39
Q

Enoxaparin (Lovenox)
“No Xa”
Low molecular weight heparin

A

Mech: Neutralizes factor Xa better! Increases the activity of anti-thrombin resulting in less thrombin & Xa. Fast acting!
Effects: Long half-life (only admin 1-2x/day)
Good for DVT prev post op or Tx of estab DVT
Given prophylactic for CV issues
SE: Bleeding! Risk much lower than heparin
General: more expensive! Pre-filled syringes.
TX OVERDOSE W/ PROTAMINE SULFATE!

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40
Q

Fondaparinux (Arixtra)

A

Anticoag

Mech: binds to anti-thrombin, complex inactivates factor Xa, prevents Xa from converting prothrombin to thrombin
Effects: Admin SQ
SE: Bleeding! Use caution in renal failure pts! Pt w/ epidural cath may experience hematoma!
General: pre-filled syringes

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41
Q

Warfarin (Coumadin)

A

Mech: Blocks activation of vit K! Reduces synthesis of 4 vit K dependent clotting factors (specifically prothrombin)
Delayed onset of action cus it does not affect clotting factors already in circulation!!
99% protein bound on first dose!
Effects: Admin PO.
Long term prophylaxis of thrombosis in aFIB, art valves, hx of PE.
Peak effect not seen until 3-5 days.
Long half life! Remains effective up to 5 days after cessation
SE: bleeding! Risk much lower than heparin!
Monitor labs for INR! Weekly to start, once therapeutic levels, monthly.
Therapeutic INR = 2-3
Mech heart valve = 3-4.5
General: ANTIDOTE IS VIT K!! Admin PO or IV
MUST BE ADMIN SLOWLY OVER 1HR TO PREVENT ANAPHYLAXIS!
Pt goes for labs to check INR every month
Change in Vit K intake can influence how well it works. Edu pt to not change vit K habits

42
Q

Dabigatran etexilate (Pradaxa)

A

Direct Thrombin Inhibitor (DTI)

Mech: Binds to thrombin, prevents it from converting fibrinogen to fibrin
Faster onset than warfarin!
Effects: Admin PO. No need to monitor drug levels!! Fewer food-drug interactions! Same dose given regardless of weight or age
Used to prev recurrent DVT or PE
SE: Bleeding but lower risk! GI disturbances in 35% of pts!! Can produce GERD, gastric ulcer (reduce risk by taking w/ food)
General: PRAXBIND IS ANTIDOTE! (Mono ab) always a risk for anaphylaxis!

43
Q

Rivaroxaban (Xarelto)
Apixaban (Eliquis)
(-xaban)

A

Direct Factor Xa Inhibitors

Mech: binds to factor Xa, prevents conversion of prothrombin to thrombin
Effects: admin PO. Faster onset than warfarin. Used for DVT prev following knee/hip sx. Tx or prev of DVT/PE
SE: much lower bleeding risk than warfarin!
Spinal/epidural hema, (hold meds for sev hours before & after lumbar puncture)
General: No need to monitor labs!
ANDEXXA IS ANTIDOTE!!

44
Q

Clopidogrel (Plavix)
Plasugrel (Effient)
Ticagrelor (Brilinta)
(-grel)

A

ADP receptor antagonists , anti-plt med

Mech: Blocks P2Y12 ADP receptors on plts! Prevents ADP from binding & activating plt! Irreversible! Lasts for life of plt!
Pro-drug, activated by CYP450!
Effects: Admin PO, prev occlusion of Coronary Artery Stents!
SE: Bleeding! (Risk lower than ASA) GI & Intracranial bleeds most common!
Abdominal pain
Use caution w/ other ACs
MUST BE STOPPED 5DAYS PRIOR TO SX!
General: PPIs can inhibit CYP450 which would inactivate these drugs!

45
Q

Tirofiban (Aggrastat)
Eptifatide (Integrilin)
”Super Aspirin”

A

Glycoprotein IIb/ IIIa receptor antagonists

Mech: Blocks Gp IIb/IIIa receptors on plts & prev fibrinogen from attaching -> prev plt agg
Effects: Admin IV, used for short term Tx of ischemic events in pts w/ ACS s/p PCI
SE: Bleeding!
General:

46
Q

Alteplase (Activase)
Aka *tPA, synthetic version of naturally occurring tPA (tissue plasminogen activator)

A

Thrombolytic Med “clot buster”
Mech: Binds to plasminogen, promotes conversion to Plasmin, Plasmin digests fibrin clots!
Effects: admin w/ IV cath place RIGHT at the clot! Used for MI, PE, ischemic stroke!
SE: Bleeding! Especially in intracranial area!
Hemostasis restored w/ blood products (packed RBCs, FFP)
If that doesn’t work, antidote is Amicar!
General: Reduce IV and SQ injections to reduce risk of bleeding!
Minimize invasive procedures!
Use caution if used w/ warfarin or anti-plt meds!

47
Q

Budesonide/Formoterol (Pulmicort)
Fluticasone/Salmeterol (Flovent)

A

Inhaled corticosteroids

Mech: reduces synth of inflamm mediators (leukotrienes, histamine, etc)
Reduces recruitment of inflamm cells
Effects: Used for prophylaxis against inflammation in asthma! Common controller med!
SE: Oropharyngeal candidiasis (thrush) pts should rinse mouth & gargle warm water after to minimize risk Systemic: CHAOS
General: small pop develops neuropsychiatric effects

48
Q

Montelukast (Singulair)
Zafirlukast (Accolate)

A

Leukotriene Receptor Antagonists (LTRA)

Mech: suppress effects of leukotrienes = less inflamm
Effects: Admin PO, Controller med!
SE: Headache & GI most common, small pop develops neuropsychiatric effects
General:

49
Q

Cromolyn

A

Mast Cell Stabilizer

Mech: Prevents mast cell from releasing histamine!
Effects: SAFEST OF ALL ASTHMA MEDS!! Admin inhalation. Used for prophylaxis NOT immed tx
SE: tolerated very well
General: Very expensive!

50
Q

Albuterol (Ventolin, Proventil)
Levalbuterol (Xopenex)
Terbutaline (Brethine)
(-terol)

A

Bronchodilators Reliver/rescue meds
Short-acting beta agonists (SABA)

Mech: Stim Beta 2 receptors, causes bronchodilation
Effects: Usually only taken PRN
SE: Usually tolerated well, minimal systemic absorption unless taken PO = tachy & tremor (beta 2 activation on skeletal muscle)
General:

51
Q

Formoterol (Foradil)
Salmeterol (Serevent Discus)

A

Long-acting beta agonists (LABA)

Mech: Stim beta 2 receptors , causes bronchodilation
Effects: Taken on a fixed sched! Preferred over SABA for COPD tx! Must be combined w/ GC for tx of asthma. Tx asthma & COPD
SE: IF LABAs ARE NOT COMBINED W/ INHALED CORTICOSTERIOD, MORE LETHAL!
General:

52
Q

Theophylline (Theochron, Theolair)

A

Methylxanthines

Mech: Promotes relaxation of bronchial smooth muscle
Effects: occasionally used to tx asthma. Admin PO or IV, narrow Thera range 10-20mcg/mL
SE: Overall well tolerated, GI disturbances, CNS excitation
General: Educate pt that caffeine may intensify effects!

53
Q

Ipratropium bromide (Atrovent)
Tiotropium (Spiriva)
(-tropium)

A

Long acting muscarinic antagonists (LAMA)

Mech: Prevents ACh from binding, causes unopposed bronchodilation (& other anti-cholinergic effects if systemic)
Effects: Used for tx of asthma! Often admin w/ a beta 2 agonist!
SE: Anti-cholinergic SE’s (dry mouth, nasal congestion, headache, cough)
General:

54
Q

1st Gen (Sedating)
Diphenhydramine (Benadryl)

2nd Gen
Cetirizine (Zyrtec)
Levocetirizine (Xyzal)
Fexofenadine (Allegra)
Loratadine (Claritin)

A

Antihistamines

Mech: Bind to H1 receptors & prevent them from being activated by histamine, when H1 receptors in brain are blocked causes drowsiness! 2nd Gens do NOT cross BBB
Effects: 1st line tx for allergic rhinitis
SE: Mild sedation w/ Benadryl, urinary retention, dry mouth, constipation
General: best when taken prophylactically

55
Q

Budesonide (Rhinocort)
Triamcinolone (Nasacort)
Fluticasone (Flonase)

A

Intranasal Glucocorticoids

Mech: Bind to glucocorticoid receptors on cell surface. Promotes prod of proteins that suppress immune system.
Effects: Most effective Tx of seasonal rhinitis!!
SE: Drying of the nasal mucosa, Epistaxis (bloody nose), sore throat
Systemic = CHAOS s&s
General: pts may report unpleasant taste in mouth

56
Q

Codeine (Robutussin)

A

Opioid antitussive
Most effective cough suppressant available!*

Mech: bind to opioid receptors in CNS to elevate cough threshold
Effects: cough suppressant
SE: Resp depress
General: Not rec for children or people w/ reduced resp capacity

57
Q

Dextromethorphan (Robutussin, Delsym)

A

Non-opioid anti-tussives

Mech: Works in CNS to elevate cough threshold
Derivative of opioids
Effects: cough suppressant
SE: may cause mild inebriation
General: advise pt to avoid activities that require mental alterness

58
Q

Guaifenesin (Mucinex)

A

Expectorant

Mech: believed to improve water retention in resp tract , reduces viscosity of mucous
Effects:
SE: Nausea/vomiting, dizziness, drowsiness
General:

59
Q

Acetylcysteine (Mucomyst)

A

Mucolytic

Mech: binds directly to mucous to reduce viscosity
Effects: Admin by nebulizer
SE: Nausea/vomiting, chest tightness, bronchospasm, urticaria
General: Use w/ caution in people w/ asthma!!

60
Q

Gum, Nicotrol (nasal spray & inhalant by Rx)
Lozenge (Commit)
Transdermal patch (Habitrol)

A

Nicotine replacement therapy

Mech: deliver nicotine at a lower dose and slower rate than tobacco containing products, reduces nicotine withdrawal symptoms
Effects: Rec for people who smoke > 20 cigs/day, who smoke within 30min of awakening, who have failed to quit in the past.
SE: Skin irritation common for patch!
Contraindicated in pregnancy!
General: Gum improves cessation rates 40-60%

61
Q

Varenicline (Chantix)

A

Mech: Partial agonist at nicotinic receptors! Minimizes withdrawal symptoms, nicotinic receptor cannot Stim release of dopamine = less stimulus of reward center!!
Effects:
SE: Nausea, disturbed sleep
General: Very expensive!! Typically not covered by cessation programs

62
Q

Cyclosporine (Sandimmune, Neoral)

A

Calcineurin inhibitors
Most effective immunosuppressants available!

Mech: inhibit calcineurin, suppress prod of IL-2 (activates cytotoxic T cells & B cells)
Effects: drug of choice for prev of organ rejection from donor!
SE: Nephrotoxicity!! (Monitor BUN & creatinine)
Infection
Grapefruit juice inhibits metabolism, can increase levels by 200%!
General: Pt should report sore threat / fever immed!
Highly influenced by drugs that influence metabolism of CYP450

63
Q

Tacrolimus (Prograf)

A

Mech: Inhibits calcineurin, suppresses prod of IL-2 (activates cytotoxic T cells & B cells)
Effects: More effective than Cyclosporine BUT more TOXIC! Used for prophylaxis or organ rejection
SE: NEPHROTOXICITY, Infection, Neurotoxicity (headache, tremor, insomnia), GI effects , HTN, HyperK
General: Pt should report sore throat, fever immediately!
Highly influenced by drugs that influence CYP450

64
Q

Adalimumab (Humira)
Entanercept (Enbrel)
Infliximab (Remicade)

A

Disease-modifying anti-rheumatic drugs (DMARDs)
TNF antagonists

Mech: binds to TNF-a & neutralizes it, prevents from Stim inflamm
Effects: Used to tx rheumatoid arthritis
Admin IV or SQ (often auto inject pen)
SE: Injection site reactions, risk for serious infections (fungal, TB, legionella, pneumonia, react of latent HepB)
General: Pt needs to report any S&S of infection, avoid live vaccines, edu about latent disease going active

65
Q

Rituximab (Rituxan)

A

DMARDs
B-lymphocyte depleting agents

Mech: monoclonal abs that bind to a receptor exclusive to B-lymphocytes, promotes immune attack against b-lymph = b-lymph destroyed
Effects: IV ADMIN ONLY!
SE: SEVERE INFUSION REACTIONS (HypoT, bronchospasm, angioedema, shock) Pre-med w/ antihistamine & acetaminophen
Skin reactions including Stevens-Johnson syndrome (SJS, rare cutaneous reaction to meds. cells take portion of med & bind it to MHC 1, targeted & destroyed by body)
General:

66
Q

Acyclovir (Zovirax)

A

Mech: inhibits replication by suppressing synthesis of viral RNA
Effects: 1st choice for infections by HSV, VZV, CMV. Admin many routes
SE: IV: phlebitis & inflamm @ injection site, Nephrotoxicity! Pt needs to stay hydrated!!!
Neuro tox (tremors) esp in renal fail pts
PO: mild, GI & headache
General: resistance is possible in immunocompromised pts!

67
Q

Valacyclovir (Valtrex)

A

Prodrug of Acycolvir

Mech: Inhibits replication by suppressing synth of viral RNA
Effects: ONLY USE IN IMMUNOCOMPETENT INDIVIDUALS!
SE: Same as Acyclovir PLUS Thrombotic thrombocytopenic purpura (TTP) in immunocomp pt!
General:

68
Q

Ganciclovir (Cytovene)

A

Mech: suppresses rep of viral DNA
Effects: used for prev & tx of CMV in immunocompromised host
SE: Bone marrow suppression!!!
Can cause granulocytopenia & thrombocytopenia
Reproductive tox is big concern!
General: 85% of pop are carriers of CMV

69
Q

Interferon Alfa

A

Hepatitis Drug

Mech: prev viral entry into cell, prev synth of viral mRNA, prev synth of viral proteins, protein assemb, and protein release
Effects: synthetic version of nat occur compound. Almost always SQ!
PEGinterferon is the long-acting version of the drug!
SE: Flu like syndrome!! Depression & suicidal ideation
Thyroid dysfunction
Heart damage
General:

70
Q

Ribavirin (Rebetrol)
has a look-a-like med

A

Mech: unknown, nucleoside analog? Joins growing nucleotide chain, blocks the continuation of forming DNA
Effects: Commonly given w/ PEGinterferon, broad spectrum of antiviral activity
SE: Hemolytic anemia, fetal injury!!
General: Contraindicated in preg, use 2 forms of BC!!

71
Q

Boceprevir (Victrelis)

A

Mech: Inhibits protease (enzyme nec for maturation of a virus)
Effects: Given in conjunction with/ PEGinterferon & ribavirin, GREATLY enhances overall antiviral effects
SE: Generally well tolerated, mild fatigue, nausea, chills, altered taste
General:

72
Q

Ledipasvir/sofosbuvir (Harvoni)

A

Mech: Block 2 enzymes necessary for viral rep!
Effects: Tx hepatitis
SE: Headache & fatigue! Brady if taken with amiodarone!
General:

73
Q

Sofosbuvir/Velpatasvir (Epclusa)

A

Mech: Blocks 2 enzymes necessary for viral rep
Effects: Used to Tx hep
SE: Headache & fatigue PLUS react of latent hep B
General: Brady if taken w/ amiodarone

74
Q

Oseltamivir (Tamiflu)

A

Neuraminidase inhibitor

Mech: Inhibits neuraminidase (respon for seaparation of virus from host cell) Newly formed viruses cannot bud off!
Effects: MUST be taken WITHIN 48HRS after symptom onset!
Also shown to be effective in PREVENTING influenza
SE: HALLUCINATION AND SI HAVE BEEN REPORTED IN CHILDREN!!!
General:

75
Q

Flu vaccine - inactivated virus

A

Mech: given inactivated virus to develop immunity
Effects: protection begins 1-2 weeks after inoculation, lasts 6 months
Admin IM or intradermal
SE: soreness at site, fever, malaise if not vaxx in past
Small risk of Guillain-Barré syndrome (ascending paralysis, destruction of myelin sheath)
General: instruct pt to get vaxx in Oct/Nov to be covered for heigh of flu season.
Need to know if pt has egg allergy
CANNOT GET VAXX IF CURRENT FEVER!

76
Q

Flu vaccine - live, attenuated virus

A

Mech: introduced to live, weakened virus
Effects: Protection begins 1-2 weeks post inoculation, lasts 6mo
SE: CANNOT BE GIVEN TO IMMUNOCOMPROMISED!
Runny nose, nasal congestion, cough
General: CANNOT GET VAXX IF CURRENT FEVER

77
Q

Zidovudine (Retrovir)
Lamivudine (Epivir)

A

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

Mech: Chem relatives of nucleosides & nucleotides.
Suppresses synth of viral DNA by incorporating into chain, blocking further growth
Effects: mainstay of HIV therapy
SE: BONE MARROW SUPPRESSION!! May need blood transfusions
Lactic acidosis (enzyme that breaks down LA can’t form) and hepatomegaly
General: use of additional drugs that suppress bone marrow can increase risk of anemia & neutropenia

78
Q

Efavirenz (Sustiva)

A

Non-NRTIs (NNRTIs)

Mech: Binds DIRECTLY to HIV reverse transcriptase, inactivating enzyme!
Effects: no structural relationship to nucelosides
SE: If rash STOP IMMEDIATELY!
CNS symp like dizziness, drowsiness
Teratogenic!!
General:

79
Q

Ritonavir (Norvir)
Lopinavir/Ritonavir (Kaletra)

A

Protease Inhibitors (PIs)

Mech: prev HIV protease from cleaving the long protein chain into the individual enzymes & structural proteins = virus remain immature & non-infectious!
Effects: Often combined with NRTIs to reduce viral load to undetectable levels!
SE: INHIBITS CYP450!
We’ll tolerated, diarrhea, nausea, headache, prolongs segments of EKG
General:

80
Q

Raltegravir (Isentress)

A

Integrase strand transfer inhibitor (INSTI) aka Integrase inhibitor

Mech: Inhibits integrase, HIV DNA cannot be incorporated into DNA of host!
Effects: only drug in this cat!
SE: Insomnia, headache, severe hypersensitivity (SJS) rare
General:

81
Q

Enfuvirtide (Fuzeon)

A

HIV Fusion Inhibitor

Mech: Prev HIV envelope from fusing w/ cell membrane of host cell.
Blocks entry of HIV into host cell
Effects: 2x/day SQ Injections! Expensive!
SE: Injection site reaction in 98% of pts!!
Teratogenic
Increased pneumonia risk
Hypersensitivity
General:

82
Q

Truvada or Descovy (emtricitabine-tenofovir)

A

PrEP

Mech: Both drugs are nucleotide/nuceloside reverse transcriptase inhibitors
Prevents conversion of viral RNA to viral DNA
Effects: Descovy only approved for people AMAB
SE: Nephrotoxicity, Hepatotoxicity!
Lactic acidosis
Osteoporosis
General:

83
Q

Penicillin G
Nafcillin
Ampicillin
Amoxicillin
Piperacillin - effective against Pseudomonas

A

Mech: PCNs are bactericidal! Bind to PCN binding protein (PBPs) in cell membrane
Inhibit enzymes that synth cell walls! Activates autolysins !
Effects: PCN G tends to be very safe, cannot be given PO!
All PCNs can be administered IM but vary in absorption
Benzathine PCN G abosrbed SLOWLY over weeks
Amox & Amp have additional SEs of diarrhea
SE: ALLERGIC REACTION IS #1 CONCERN! Reaction ranges from rash-anaphylaxis.
Tx for reaction is Epi 1:1000 concentration IM!
IF ANAPHYL TO PCNs, WILL NOT GIVE CEPHALOSPORINS!
General: Bacteria can be resistant to PCNs, thick outer membrane of Gram Neg cannot be pen by PCN
Beta lactamase, enzyme prod by bacteria that destroys betal-lactamase ring of PCN
MRSA creates PBPs w/ poor affinity to PCN

84
Q

Ampicillin/Sulbactam (Unasyn)
Amoxicillin/Clavulanate (Augmentin)
Piperacillin/Tazobactam (Zosyn)

A

PCN combine w/ B-Lactamse inhibitor

Mech: Prev destruction of b-lactam ring by binding to b-lactamase
Effects: if pt doesn’t improve after starting w/ abx, you switch to one of these!
SE:
General:

85
Q

1st Gen:
Cephalexin (Keflex)
2nd Gen:
Cefaclor (Ceclor)
3rd Gen:
Ceftriaxone (Rocephin)
4th Gen:
Cefipime (Maxipime)
5th Gen:
Ceftaroline (Teflaro) Only one w/ activity to MRSA

A

Cephalosporins (Cef- or ceph-)

Mech: As gen’s increase: better at resisting b-lactamase, better activity against gram neg bacteria & anaerobes, increased ability to cross BBB
Effects: Need to consider pts renal fx!
SE: BAT = Bleeding (increases Vit K metab)
Allergic reaction (usually rash, Ana is rare)
Thrombophelbitis (rotate IV infusion sites)
General: Interaction with Acl!!! Disulfiram reaction (strong adverse reaction to alc, makes pt sick)

86
Q

Imipenem (Primaxin)

A

Carbapenems (-penem)

Mech: Bactericidal , binds to PBPs = weakens cell wall & causes lysis
Effects: Must be given IV!
SE: GI effects most common!
General:

87
Q

Aztreonam (Azactam)

A

Monobactams

Mech: Binds to PBPs = bactericidal, highly resistant to b-lactamase
Effects: can only be given IV or IM
SE: pain at injection site
Thrombophelbitis at IV site
General:

88
Q

Vancomycin

A

Mech: Binds to molecules that are precursors to cell wall synth
Effects: Most widely used antibiotic in US hospitals!
Typically used to Tx C.diff infections (admin PO) and MRSA
Admin by slow IV infusion except for Tx of c.diff (PO)
SE: Renal failure, “Vanco flushing syndrome” stim release of histamine, vasodilation and flushing
Thrombophelbitis
General:

89
Q

Getamicin
Tobramycin
Amikacin (Amikin)

A

Aminoglycosides
Bactericidal inhibitors of protein synthesis

Mech: Bind to ribosome w/ 3 effects:
Inhibit onset of protein synthesis
Premature term of protein synthesis
Prod of abnormal code leading to cell membrane lysis/failure
Effects: monitoring of drug levels is important!! elevated TROUGH is assoc w/ toxicity!!
Peak measure 1hr after admin
Trough 30min before admin
SE: Serious tox!!! Especially in kidney & ear!
Ototoxicity = high pitched tinnitus
Nephrotox = acute tubular necrosis, usually reversible
General: HIGHLY polar so not absorbed in gut, can’t cross BBB!
AMNO =
Aerobic organisms only
Mostly bactericidal
Inhibits protein synthesis/IV only
Nephrotox/Neuro musc block
Ototoxicity

90
Q

Tetracycline
Doxycycline (Vibramycin)

A

Tetracyclines (-cycline)

Mech: Bind to ribosome, prevents binding of tRNA, chain of amino acids cannot be built , growth of bacteria is stopped
Effects: 1st LINE TX FOR: CHALMYDIA TRACHOMATIS, LYME DISEASE, BACILLUS ANTRACIS, ROCKY MOUNTAIN SPOTTED FEVER, H. PYLORI
SE: Binds to Ca in developing teeth causing GREY STAINING! DO NOT GIVE TO CHILDREN UNDER 8yo!
Hepato * Nephrotox
Suprainfection
General: Binds to Ca products (dairy) and inactivates abx!
Edu pt to not take w/ milk or dairy, don’t take with Ca supplements, or iron supplements

91
Q

Erythromycin
Azithromycin (Zithromax)
Clarithromycin (Biaxin)

A

Macrolides (-thromycin)

Mech: broad spectrum similar to PCNs
Binds to ribosome and prevents chain of amino acids being built
Effects: **1st LINE DRUG FOR: LEGIONELLA PNEUMONIA, BORDETELLA PERTUSSIS, CORYNEBACTERIUM DIPHTHERIAE
SE: GI irritation, prolong QT
General: INHIBITS CYP450!!
Can lead to Dig tox, increased bleeding w/ warfarin!

92
Q

Clindamycin (Cleocin)

A

Mech: Binds to ribosome & prev chain of amino acids
Effects:
SE: POTENTIALLY FATAL C.DIFF ASSOC DIARRHEA!!!! SUPRAINFECTION!
General:

93
Q

Linezolid (Zyvox)

A

Mech: Binds to ribosome prev chain of amino acids
Effects: RESERVED FOR MULTI-DRUG RESISTANT ORGANISMS !!! Like MRSA, VRE!
SE: GI irritation
General:

94
Q

Sulfamethoxazole

A

Sulfonamides (Sulfa drugs)

Mech: Structurally similar to PABA, Sulfonamide is incorporated into molecule instead of PABA, stops prod of folic acid!!
Effects: usually used to Tx UTIs
SE: Hypersensitivity = mild rash & fever most common
Photosensitivity
Hemolytic anemia!
Kernicterus (bilirubin in brain)
SJS can occur
General: Inhibits hepatic metab of some drugs like warfarin, cross hypersensitivity with other sulfur-based drugs

95
Q

Trimethoprim/Sulfamethoxazole (Bactrim)

A

Mech: Interfers w/ consecutive steps in synth of folic acid
Effects: Used for UTIs + pneumocystis pneumonia
SE: Fetal malformation!!
Hemolytic anemia!
HyperK!
GI disturb , itching & rash
General:

96
Q

Ciprofloxacin (Cipro)
Levofloxacin (Levaquin)
Moxifloxacin (Avelox)

A

Fluoroquinolones (-floxacin)

Mech: inhibits 2 bacterial enzymes responsible for DNA rep & cell division
Effects: CYP450 inhibitor!!!
SE: TENDON RUPTURE!! ACHILLES TENDON!!
Phototoxicity!
Mild GI
General: tell pt to not take with milk, dairy, Ca supplements, iron, antacids

97
Q

Metronidazole (Flagyl)

A

Mech: Prodrug is taken in by anaerobic organisms, converted into active form, breaks DNA strands
Effects: ONLY EFFECTIVE AGAINST ANAEROBES!!!
SE: Metallic taste in mouth, Hypersensitivty reaction (SJS)
General: Disulfiram like reaction w/ alc!

98
Q

Isoniazid (Nydrazid)
aka INH

A

TB Drug

Mech: Not clear, believed to reduce prod of important component of cell wall
Effects:
SE: Hepatox , peripheral neuropathy, CNS effects (Seizures)
General:

99
Q

Rifampin (Rifadin)

A

TB Drug

Mech: Inhibits DNA dependent RNA polymerases , blocks RNA synthesis , Blocks protein synthesis
Effects: INDUCES CYP450!!!
Lower warfarin level
Lower dig level
Lower BC level
SE: DISCOLORATION OF BODY FLUIDS : red/orange color to urine, sweat, saliva, tears, harmless.
hepatox
General:

100
Q

Amphotericin-B (Amphotec)

A

Polyene anti-fungal

Mech: binds to ergosterol on the surface of fungal cell membrane, increased permeability
Effects: must be admin IV (poor GI absorption)
SE: Binds to sterols on mammalian cells like cholesterol!!
Infusion reactions
Nephrotox
HypoK
General: reduce SEs by pre-Tx w/ Benadryl & acetaminophen!
Nystatin (Mycostatin) is in the same fam but MUCH less toxic (topical)

101
Q

Fluconazole (Diflucan)
Ketoconazole (Nizoral)
Miconazole (Monistat)

A

Azole antifungals (-conazole)

Mech: inhibits prod of ergosterol, necessary for fungal cell membranes
Results in leakage & rupture
Effects: better alt to Ampotericin B for SYSTEMIC fungal infections! Slightly less toxic and admin PO!
SE: INHIBITS CYP450!!!
GI Disturbances
General:

Pharm (6 decks)

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