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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
Alpha (2) Adrenergic Agonists
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
Carbonic Anhydrase Inhibitors
``` 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
Cholinergics
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
Combination Glaucoma Treatment
Timolol 0.5% + Dorzolamide 2%
29
Acute Glaucoma Treatment
Pilocarpine 2% ever 15 minutes Acetazolamide 500 mg IV or po Oral Glycerine or Isosorbide 1cc/kg Immediately Refer to Ophthalmology
30
Mannitol
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
Allergic Rhinitis Treatment (Non-Specific)
``` Avoid Allergens Intranasal Corticosteroids Oral/Intranasal Antihistamines (Mild) Oral/Topical Decongestants Intranasal Cromolyn Intranasal Antichilinergics Leukotriene Receptor Antagonists Immunotherapy (severe) ```
32
Intranasal Corticosteroids
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
Oral Antihistamines
``` 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
Intranasal Antihistamines
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
Oral Decongestants
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
Topical Decongestants
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
Intranasal Cromolyn
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
Intranasal Anticholinergics
Ipratropium Purpose: treat Allergic Rhinitis; reduce rhinorrhea by blocking acetylcholine receptors (block parasympathetic response, leading to vasoconstriction) Adverse Reactions: epistaxis, headache, nasal dryness
39
Leukotriene Receptor Antagonist
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
Immunotherapy
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
Cold Treatments (Non-specific)
``` humidifiers increase fluid intake rest Decongestants Analgesics (pain relievers) Local Anesthetic (Lozenges, sprays) Cough Medications ```
42
Fever Treatments
Acetaminophen | Non-steroidal Anti-Inflammatory Drugs - ibuprofen or naproxen
43
Possibly Effective Cough Treatment
``` High-Dose Inhaled Corticosteroids (wheezing children) Buckwheat Honey Nasal Irrigation with Saline Vapor Rub Zinc Sulfate ```
44
Cough Treatment Options
Antitussives Expectorant Sore Throat Remedies
45
Narcotic Antitssives
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
OTC Antitussive
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
Non-narcotic, Non-OTC Antitussive
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
Expectorant
Guaifenesin Purpose: treats productive cough; thins mucus to enhance clearance Adverse Reaction: GI effects counsel patient to increase fluid intake
49
Sore Throat Remedies
saline gargle sprays, lozenges (numb locally: benzocaine, dyclonine, phenol, menthol buckwheat honey high fluid intake
50
Treatment for Urticaria and Angioedema
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
Anaphylaxis Treatment
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
Epinephrine
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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