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Pharmacology: Exam I > Exam I Medications Grouped > Flashcards

Exam I Medications Grouped Flashcards

1
Q

Treatments used for Otitis Externa (Non-Specific)

A

Anti-infectives with or without Steroids

Acid-Alcohol Solutions - for external auditory ear canal infections

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2
Q

Anti-Infectives without Steroids

A

Ciprofloxacin - fluoroquinolone (use for cellulitis, serious cases)
Ofloxacin - fluoroquinolone (use for cellulitis, serious cases)
Neomycin - watch for ototoxicity; not for tubed or perforated ears; itchy rash
Bacitracin
Mupirocin
Polymyxin B/Neomycin/Bacitracin (OTC)

Route: Topical

Purpose: treat Otitis Externa

Adverse Reactions: ear pain, discomfort, irritability, ototoxicity, contact dermatitis (itchy rash)

Contraindications: hypersensitivity to ingredients or vehicle; Neomycin should not be used if patient has tubed or perforated ears

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3
Q

Anti-Infectives with Steroids

A

Ciprofloxacin/Hydrocortisone - more common
Ciprofloxacin/Dexamethasone - more common
Hydrocortisone/Neomycin/Polymyxin B
Hydrocortisone/Neomycin/Colistin
Chloroxylenol/Pramoxine/Hydrocortisone

Route: Topical

Purpose: treat Otitis Externa; steroids are used for their anti-inflammatory, antipruritis, and anti-allergenic effects

Adverse Reactions: ear pain, discomfort, irritability, ototoxicity, contact dermatitis (itchy rash)

Contraindications: hypersensitivity to ingredients or vehicle; Neomycin should not be used if patient has tubed or perforated ears

More common to prescribe anti-infectives with steroids than without

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4
Q

Acid-Alcohol Solutions

A 
Acetic Acid/Aluminum Acetate
Acetic Acid/Propylene Glycol
Acetic Acid/Propylene Glycol/Hydrocortisone - steroid
Isopropyl Alcohol/Propylene Glycol
Isopropyl Alcohol/Glycerin

Route: Topical

Purpose: treat Otitis Externa and other superficial external auditory canal infections; increase acidity which promotes drying and kills bacteria

Adverse Reactions: stinging, burning, local irritation

Contraindications: perforated or tubed ears

anti-infectives and steroids are prescribed more often

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5
Q

Treatment for Water-Clogged Ears

A

solution of 95% isopropyl alcohol in 5% anhydrous glycerin

50:50 isopropyl alcohol (95%) and acetic acid (5%)

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6
Q

Treatment for Otitis Media

A

before prescribing, remember that only 50% of cases are bacterial

Pain - ibuprofen or acetaminophen

Amoxicillin - 6+ mo with unilateral or bilateral AOM with severe symptoms; 6-23 mo with bilateral AOM

Watch and Wait/Consider Amoxicillin - 6-23 mo with nonsevere AOM; 24+ mo with nonsevere AOM

Amoxicillin/Clavulanate (B-lactamase coverage) - if patient has had Amoxicillin recently or has had a previous Amoxicillin resistance

Ofloxacin for tubed ears

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7
Q

Cerumenolytics/Cerumen Softening Agents

A

Carbamide Peroxide 6.5% in anhydrous glycerin - bubbling sounds can occur; no more than 4 days (tympanic membrane damage)
Triethanolamine Polypeptide Oleate
Hydrogen Peroxide (3%) and Water - not good for drying
Glycerin
Olive Oil/Sweet Oil

Route: Topical

Purpose: soften earwax for removal

Adverse Reactions: mild itching, burning, ear pain, erythema of ear canal, allergic reactions (emergency)

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8
Q

Ophthalmic Anesthetics

A

Proparacaine 0.5% Solution - amino ester
Tetracaine 0.5% Solution - amino ester
Lidocaine - amino amide

Route: Topical

Purpose: numbing agents; bind to receptors within sodium channels in the sensory nerve endings, inhibiting their function; sodium cannot enter cells to cause depolarization; no depolarization along axon = no pain signal

work in 20-30 seconds and up to 15 minutes

A: rapid at conjunctival capillaries; local action

D: high protein binding - remains in blood stream

M: unknown in eye/skin; some metabolism may occur systemically

E: tetracaine and proparacaine through bile/feces

T 1/2: proparacaine < lidocaine < tetracaine

Adverse Reactions: burning and stinging when applied; severe keratitis, opacification, scarring of the cornea, and loss of vision if used for long periods

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9
Q

Ophthalmic Anti-infectives

A

Sulfacetamide - bacteriostatic (inhibites bacterial dihydrofolate synthesis); watch sulfa-allergy or hypersensitivity
Bacitracin - bacteriostatic (inhibits incorporation of amino acids and nucleotides)
Erthromycin - bacteriostatic (prevents protein synthesis in bacteria); infants and children
Tobramycin, Gentamicin - bacteriocidal (aminoglycosides)
Fluoroquinolones (ciprofloxacin, moxifloxacin, etc.) - inhibit DNA synthesis of bacteria; contact wearers
Polymixin B - high affinity for phospholipids (increase permeability of cell walls, killing bacteria)

Route: Topical

Purpose: treat Conjunctivitis

Adverse Reactions: local irritation (Sulfacetamide and Gentamicin), blurry vision, super infections (resistance), hypersensitivity to Sulfacetamide

Contraindications: Sulfa-allergy

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10
Q

Allergic Conjunctivitis Treatments (Non-specific)

A 
Ophthalmic Mast Cell Stabilizers
Ophthalmic Antihistamines (more common)
Ophthalmic Vascoconstrictors/Decongestants (side effects)
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11
Q

Ophthalmic Mast Cell Stabilizers

A

Nedocromil 2% Solution
Cromolyn Sodium 4% Solution
Iodoxamide 0.1% Solution

Route: Topical

Purpose: treat Allergic Conjunctivitis; reduces histamine release (prevent mast cell degranulation)

Adverse Reactions: transient stinging, blurry vision, photophobia, mydriasis, rhinitis, sinusitis, headache

prescribed less often than antihistamines

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12
Q

Ophthalmic Antihistamines

A 
Azelastine
Epinastine
Emedastine
Ketotifen (more common)
Levocabastine
Olopatadine (more common)

Route: Topical

Purpose: treat Allergic Conjunctivitis; H1 receptor antagonists (block histamine); temporary relief of symptoms

Adverse Reactions: transient stinging and burning, blurry vision, mydriasis, rhinitis, headache

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13
Q

Ophthalmic Vasoconstrictors/Decongestants

A

Phenylephrine - bad for narrow-angle glaucoma
Naphazoline - decongestant of choice
Tetrahydrozoline - less likely to alter pupil size
Oxymetazoline - relatively free of side effects

Purpose: treat Allergic Conjunctivitis; weak sympathomimetic (raise blood pressure and constrict conjunctival blood vessels); temporary relief of eye redness

Avoid if: heart disease, high blood pressure, enlarged prostate, narrow-angle glaucoma (contraindication)

Systemic Adverse Reactions: tachycardia, aggravation of arrhythmias

Local Adverse Reactions: mydriasis, burning/stinging, blurry vision

Interactions: increase pressure effects if used with MAOIs and tricyclics

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14
Q

Allergic Conjunctivitis OTC Combination Products

A

Naphazoline + Pheniramine
Naphazoline + Antazoline

Avoid if: heart disease, high blood pressure, enlarged prostate, narrow-angle glaucoma

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15
Q

Dry Eye Treatments/Ophthalmic Lubricants (2 Non-specific +1)

A

Artificial Tears
Ocular Emollients
Cyclosporine

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16
Q

Artificial Tears

A 
Cellulose Derivatives (Carboxymethylcellulose) - longer duration; causes eye crust
Polyvinyl Alcohol (glycerin, propylene glycol, polyethylene glyc0ls, polysorbate 80) - shorter duration; no crust formation
Povidone adn Dextran 70 - can cause transient stinging and burning

Route: Topical

Purpose: treat Dry Eye; act as demulcents (protective film) to mimic mucin (glycoprotein mucus) in tears

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17
Q

Ocular Emollients

A 
Lanolin
Mineral Oil
Petrolatum
White Ointment
White Wax
Yellow Wax

Route: Topical

Purpose: treat dry eyes; protect and prevent drying

Adverse Reactions: blurry vision (but last longer than drops)

more expensive versions tend to last longer

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18
Q

Cyclosporine

A

Restasis

Purpose: treat Keratoconjunctivitis Sica (dry eyes); immunosuppressant: polycyclic peptide that inhibits interleukin-2 (needed for T-cell activity)

Adverse Reactions: burning sensation, eye discomfort

expensive, not first line - only prescribe under specialist recommendation

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19
Q

Corneal Edema Treatment

A

Sodium Chloride (2-5%)

Route: Topical

Purpose: solution pulls water from the eye

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20
Q

Pupillary Dilation Agents

A

Tropicamide - 20-30 minute peak effect, lasts 2-7 hours
Cyclopentolate 0.5, 1, or 2% Solution - 25-75 minutes to peak effect, lasts 6-24 hours
Homatropine 1 or 5% Solution - lasts 24-72 hours

Route: Topical

Purpose: mydriasis, block parasympathetic receptors (normally cause pupil constriction)

Adverse Reactions: tachycardia, flushing of cheeks, blurry vision, photophobia, dry mouth, slurred speech, drowsiness, hallucinations, congestion, irritated eyes

Contraindications: Closed-Angle Glaucoma - dilation can occlude outlfow of aqueous humor

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21
Q

Fluorescin

A

used to detect corneal defects

yellow, water-soluble dibasic-acid xanthine dye

does not stain cornea, but will appear bright

green/yellow on a corneal abrasion or defect

fluoresces under ultraviolet light (Wood’s Lamp)

not absorbed

can stain contacts

22
Q

Glaucoma Treatments (Non-specific)

A 
Prostaglandin Analogues
Beta Blockers
Alpha-adrenergic Agonists
Carbonic Anhydrase Inhibitors
Cholinergics
Mannitol
23
Q

Prostaglandin Agonists

A 
Latanprost
Bimatoprost
Tafluprost
Travoprost
Unoprostone

Route: Topical

Purpose: treat Glaucoma; synthetic protaglandin and act on prostaglandin receptor (RF); increase outflow through uveoscleral pathway

Adverse Reactions: iris pigmentation,eyelid darkening, lengthening of eyelashes, intraoccular inflammation, keratitis, macular edema, hyperemia (most common)

Typically First-Line

24
Q

Beta Blockers

A 
Timolol
Carteolol
Levobunolol
Metipranolol
Betaxolol - cardioselective (less respiratory side effects)

Purpose: treat Glaucoma; block sympathetic nerve endings in ciliary epithelium (form aqueous humor); decrease aqueous humor formation

Adverse Reactions: bradycardia, bronchospasm, depression, fatigue, ocular dryness

25
Q

Alpha (2) Adrenergic Agonists

A

Brimonidine
Apraclonidine

Purpose: treat Gluacoma; cause vasoconstriction in the eyes, which leads to a decrease in aqueous humor production; possible increases outflow

Adverse Reactions: ocular allergy, somnolence, bitter taste, systemic hypotension, irregular heart rate

26
Q

Carbonic Anhydrase Inhibitors

A 
Acetazolamide - oral tablet
Methazolamide - oral tablet
Dorzolamide
Brinzolamide
Dichlophenamide

Purpose: treat Gluacoma; decrease production of aqueous humor by slowing action of carbonic anhydrase (forms aqueous humor)

27
Q

Cholinergics

A

Pilocarpine - direct
Carbachol - direct
Echothiophate - indirect; long half life; irreversible

Purpose: treat Glaucoma; stimulate parasympathetic response (similar to acetylcholine), causing pupil constriction (miosis); ciliary muscles contract, which open canal of Schlemm

Direct - stimulate ocular cholinergic receptors (mimic acetylcholine)

indirect - bind to and inactivate cholinesterases (break down acetylcholine); prevents acetylcholine degradation

Adverse Reactions: blurred vision, poor night vision, eye pain, headache

Acetazolamide interacts with Aspirin, Cyclosporine, Lithium, and Phenytoin

28
Q

Combination Glaucoma Treatment

A

Timolol 0.5% + Dorzolamide 2%

29
Q

Acute Glaucoma Treatment

A

Pilocarpine 2% ever 15 minutes
Acetazolamide 500 mg IV or po
Oral Glycerine or Isosorbide 1cc/kg
Immediately Refer to Ophthalmology

30
Q

Mannitol

A

Purpose: Short-term, Emergent Treatment of Glaucoma

MOA: causes blood to by hypertonic compared to intraocular and spinal fluids - pull water into bloodstream to be secreted

used to interupt an acute narrow-angle glaucoma attack

Severe Adverse Reactions: headache, back pain, diuresis, circulatory overload, pulmonary edema, cerebral hemorrhage

31
Q

Allergic Rhinitis Treatment (Non-Specific)

A 
Avoid Allergens
Intranasal Corticosteroids
Oral/Intranasal Antihistamines (Mild)
Oral/Topical Decongestants
Intranasal Cromolyn
Intranasal Antichilinergics
Leukotriene Receptor Antagonists
Immunotherapy (severe)
32
Q

Intranasal Corticosteroids

A

Beclomethasone
Mometasone - more common
Budesonide
Ciclesonide
Triamcinolone Acetonide - more common; no alcohol (less side effects)
Flunisolid
Fluticasone Furoate - more common; no alcohol (less side effects)
Fluticasone Propionate - more common; no alcohol (less side effects)

Purpose: treat Allergic Rhinitis (more persistent and severe); reduce ocular symptoms, nasopharyngeal itching, sneezing, rhinorrhea; decreases influx of inflammatory cells, reducing cytokines (chemical released by mast cells) and resulting inflammation of nasal mucosa

Adverse Reactions: bitter aftertaste, burning, epistaxis, headache, nasal dryness, possible systemic absorption, stinging, throat irritation

more effective than antihistamines in more persistent and severe cases

33
Q

Oral Antihistamines

A 
1st Generation:
Chloropheniramine
Brompheniramine
Diphenhydramine
Clemastine
2nd Generation:
Loratidine
Cetirizine - most effective 2nd gen; can cross BBB and cause sedation in 1/10
Fexofenadine
Desloratadine - prodrug

Purpose: treat Allergic Rhinitis; reduce nasopharyngeal itching, sneezing, rhinorrhea; H1 receptor antagonists

1st Generation: older, nonselective, sedating, cross BBB, more effective, dosed several times daily

2nd Generation: newer, nonsedating, less effective, 24 hr effect

A: rapid

D: 60-70% protein bound

M: minimal; desloratadine is a prodrug

E: fexofenadine, desloratadine, loratadine through feces and urine; others through urine

T 1/2: variable

do not drive, avoid alcohol, prostatic hyperplasia can occur, narrow-angle glaucoma possible

34
Q

Intranasal Antihistamines

A

Azelastine
Olopatadine

Purpose: treat Allergic Rhinitis; treat symptoms of conjunctivitis, rhinitis, congestion by blocking H1 receptors

Adverse Reactions: bitter aftertaste, headache, nasal irritation, sedation, epistaxis

35
Q

Oral Decongestants

A

Phenylephrine (OTC Sudafed PE) - not effective orally
Pseudoephedrine - effective Sudafed; must get from pharmacist

Purpose: treat Allergic Rhinitis; reduce rhinorrhea; alpha-adrenergic agonists that cause vasoconstriction, so less mucous is produced

Adverse Reactions: headache, elevated blood pressure and heart rate, tremor, urinary retention, dizziness, tachycardia, insomnia

Contraindications: hypertension, heart disease, diabetes, hyperthyroidism, enlarged prostate, narrow-angle glaucoma, blood pressure

no effect on histamine

36
Q

Topical Decongestants

A

Phenylephrine - good topical use; bad oral use
Oxymetazoline
Saline Nasal Drops (safer, less side effects)

Purpose: treat Allergic Rhinitis; reduce rhinorrhea; alpha agonists that cause local vasoconstriction, which decrease mucosal edema

Adverse Reactions: local burning, nasal irritation and dryness, sneezing

do not use for more than 3-5 days; watch for rebound congestion

no effect on histamine

37
Q

Intranasal Cromolyn

A

Purpose: treat Allergic Rhinitis; mast cell stabilizer that prevents histamine release; relieves nasopharyngeal itching, sneezing, and rhinorrhea

Adverse Reactions: nasal irritation, nasal burning, stinging, sneezing, cough, unpleasant taste, epistaxis

Dosed 4-6 times daily &
2-3 weeks for max effect; must be taken regularly (downside, not first line)

38
Q

Intranasal Anticholinergics

A

Ipratropium

Purpose: treat Allergic Rhinitis; reduce rhinorrhea by blocking acetylcholine receptors (block parasympathetic response, leading to vasoconstriction)

Adverse Reactions: epistaxis, headache, nasal dryness

39
Q

Leukotriene Receptor Antagonist

A

Montelukast

Purpose: treat Allergic Rhinitis; reduce ocular symptoms, sneezing, and rhinorrhea; by blocking leukotriene, a chemical released by mast cells

Adverse Reactions: elevated levels of alanine transaminase, aspartate transaminase, bilirubin (mess with lab values)

good option for patients with asthma - also treats asthma

40
Q

Immunotherapy

A

subcutaneous injections given for 5-7 years that can last up to 12 years

very effective

reserved for patients who are unresponsive or cannot tolerate other treatment, patients who want to avoid long-term med use, patients with allergic asthma

41
Q

Cold Treatments (Non-specific)

A 
humidifiers
increase fluid intake
rest
Decongestants
Analgesics (pain relievers)
Local Anesthetic (Lozenges, sprays)
Cough Medications
42
Q

Fever Treatments

A

Acetaminophen

Non-steroidal Anti-Inflammatory Drugs - ibuprofen or naproxen

43
Q

Possibly Effective Cough Treatment

A 
High-Dose Inhaled Corticosteroids (wheezing children)
Buckwheat Honey
Nasal Irrigation with Saline
Vapor Rub
Zinc Sulfate
44
Q

Cough Treatment Options

A

Antitussives
Expectorant
Sore Throat Remedies

45
Q

Narcotic Antitssives

A

Codeine - prodrug,
morphine is its active metabolite (some may not metabolize fast enough, some may metabolize too fast and risk overdose)
Hydrocodone

Purpose: reduce night cough: suppress cough centrally in the medulla of the brain - bind to opioid receptors and produce analgesia, sedation, and cough suppression; best use to help patients sleep

Adverse Reactions: sedation, respiratory, nausea (codeine), depression (hydrocodone), constipation

avoid alcohol, not for children under 12

no more effective than placebo

46
Q

OTC Antitussive

A

Dextromethorphan

Purpose: for nonproductive cough; suppresses cough at the medulla by elevating the threshold for cough reflex

Adverse Reactions: drowsiness, GI effects

Drug Interactions: MAO inhibiters

A: absorbed in GI

D: crosses BBB

M: prodrug, liver, CYP2D6

E: urine

T 1/2: 2-24 hours; variable

47
Q

Non-narcotic, Non-OTC Antitussive

A

Benzonatate

Purpose: treats cough; anesthetizes respiratory passage and lung stretch receptors; numbs cough reflex

Adverse Reactions: hypersensitivity, GI upset, sedation

M: liver

E: urine

pill rolls easily - difficult for elderly

48
Q

Expectorant

A

Guaifenesin

Purpose: treats productive cough; thins mucus to enhance clearance

Adverse Reaction: GI effects

counsel patient to increase fluid intake

49
Q

Sore Throat Remedies

A

saline gargle
sprays, lozenges (numb locally: benzocaine, dyclonine, phenol, menthol
buckwheat honey
high fluid intake

50
Q

Treatment for Urticaria and Angioedema

A

Hives and Swelling

Second Generation Antihistamines
Fexofenadine
Desloratadine
Loratadine
Cetirizine
First Generation (if necessary)
Diphenhydramine

Follow-up with short course Oral Corticosteroids

Prescribe Epipen in case the next exposure leads to Anaphylaxis

51
Q

Anaphylaxis Treatment

A

Epinephrine First!

Antihistamines - symptom relief; diphenhydramine
Corticosteroids - prevent biphasic or rebound reaction; prednisone (po), prednisolone (po, liquid for kids, injection, etc.), dexamethasone (IV, po, other); only for short-term

52
Q

Epinephrine

A

Purpose: treat Anaphylaxis; alpha and beta adrenergic agonist (sympathetic response) causing bronchodilation

Adverse Reactions: agitation, anxiety, tremulousness, headache, dizziness, pallor, palpitations, arrhythmias

A: injection - rapid

D: systemic

M: hepatic, rapidly degraded

E: renal/urine

Pharmacology: Exam I (4 decks)

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