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Pharmacology I > EXAM ONE DRUGS > Flashcards

EXAM ONE DRUGS Flashcards

PNS CNS

1
Q

PHENYTOIN

THERAPEUTIC USES

A

All forms of epilepsy EXCEPT absence seizures

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2
Q

PHENYTOIN

MECHANISM OF ACTION

A

TRADITIONAL ANTISEIZURE

Slows recovery of sodium channels from inactive to active state

Results in a blockade of sodium entry ONLY into hyperactive neurons

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3
Q

PHENYTOIN

SIDE EFFECTS

A

Toxicity: Nystagmus, sedation, ataxia, diplopia, cognitive impairment

Gingival Hyperplasia

Measles-ish rash that can progress to SJS or TEN

DRESS

Teratogen in pregnancy

IV: can cause cardiac dysrhythmias and hypoTN if given too quickly

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4
Q

PHENYTOIN

PATIENT EDUCATION

A
  1. Optimal Dose will take time to find
  2. Emphasize importance of strict adherence
  3. Danger of quick withdrawal
  4. Maintain a frequency chart
  5. Purpose and importance of lab draws
  6. No driving etc. until seizures controlled
  7. CNS depression may occur, don’t use with alcohol or other depressants
  8. Folic acid during pregnancy
  9. Watch for suicidal behavior
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5
Q

CARBAMAZEPINE

MECHANISM OF ACTION

A

TRADITIONAL ANTIPSYCHOTIC

Same as phenytoin: delays sodium channel recovery

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6
Q

CARBAMAZEPINE

THERAPEUTIC EFFECTS

A
  1. Tonic-clonic, simple partial, and complex partial
  2. Symptomatic control in bipolar refractory to lithium
  3. neuralgia associated with trigeminal and glossopharyngeal nn
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7
Q

CARBAMAZEPINE

ADVERSE EFFECTS

A

FEWER THAN PHENYTOIN

Minimal effects on cognitive function

Can have neurologic effects during the firs weeks of treatment, but usually reduced as use goes on

Bone marrow suppression

Aplastic Anemia (very rare), but all patients should have serial CBCs

Teratogenic

Promotes ADH secretion

Morbilliform rash, SJS, TEN, DRESS

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8
Q

CARBAMAZEPINE

PATIENT EDUCATION

A

Same as phenytoin. ALSO:

May inactivate oral contraceptives

Accelerates hepatic drug metabolism (may effect other drugs)

No grapefruit juice

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9
Q

LAMOTRIGINE

MECHANISM OF ACTION

A

Blocks sodium channels and partly blocks calcium channels as well

Both actions target decreases the release of glutamate

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10
Q

LAMOTRIGINE

THERAPEUTIC USES

A
  1. adjunctive therapy of partial seizures age > 2
  2. adjunctive therapy of generalized seizures with lennox-gastaut age > 2
  3. adjunctive therapy of primary generalized tonic-clonic seizures age > 2
  4. monotherapy for partial seizures age . 16
  5. long term maintenance of bipolar
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11
Q

LAMOTRIGINE

ADVERSE EFFECTS

A

Dizziness, diplopia, blurred vision, headache

N/V

SJS, TEN, DRESS

Blood dyscrasias

aspetic meningitis

Risk for suicide

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12
Q

BACLOFEN

MECHANISM OF ACTION

A

CENTRALLY ACTING

acts within the spinal cord to suppress hyperactive reflexes involved in muscle movement regulation

Structural analog of GABA, so maybe its mimicking the actions of GABA? No one is sure

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13
Q

BACLOFEN

THERAPEUTIC USES

A

Reduces spasticity from MS and spinal cord injury

decreases flexor and extensor spasms, suppresses resistance to passive movement

NO DIRECT MUSCLE RELAXATION

Not approved for management of spasticity r/t stroke, PD or Huntington

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14
Q

BACLOFEN

ADVERSE EFFECTS

A

CNS depression (usually only during early phase of therapy))

Withdrawal can cause hallucinations and seizures

N/V/ constipation, urinary retention

Hypotension

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15
Q

BACLOFEN

PATIENT EDUCATION

A

Possible depressant effects, avoid alcohol

Hypotension, nausea, vomiting, constipation

No abrupt discontinuation, taper over 1-2 weeks

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16
Q

CYCLOBENZAPRINE

MECHANISM OF ACTION

A

CENTRALLY ACTING

Used to treated localized muscle spasms

Reduces tonic motor activity in the brainstem

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17
Q

CYCLOBENZAPRINE

THERAPEUTIC USES

A

Acute muscle spasm and associated pain

The most efficacious drug for this purpose

NOT effective against spasticity

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18
Q

CYCLOBENZAPRINE

ADVERSE EFFECTS

A

CNS: drowsiness, dizziness, most intense early on and then lessen

Anticholinergic effects: structurally similar to Tricyclic antidepressants, so has some anticholinergic effects (xerostomia, photophobia, constipation etc)

Cardia rhythm disturbances (similar to tricyclics - ST, conduction delays)

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19
Q

CYCLOBENZAPRINE

PATIENT EDUCATION

A

Same as for others: CNS effects, avoid alcohol, etc

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20
Q

DANTROLENE

MECHANISM OF ACTION

A

DIRECT ACTING!

Acts within the skeletal muscles

Suppresses release of calcium from the SR

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21
Q

DANTROLENE

THERAPEUTIC USES

A

Relieves spasticity associated with MS, Cerebral Palsy, SCI

MALIGNANT HYPERTHERMIA

Causes a significant reduction in strength

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22
Q

DANTROLENE

ADVERSE EFFECTS

A

Hepatic Toxicity (need serial LFTs) - BAD black box warning

Muscle weakness

drowsiness

diarrhea

If given IV, ⅓ will have facial flushing

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23
Q

DANTROLENE

PATIENT EDUCATION

A

Possible depressant effects

liver dysfunction s/s

Avoid CNS depressants

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24
Q

LEVADOPA-CARBIDOPA

MECHANISM OF ACTION

A

Levadopa: undergoes conversion to dopamine in the brain and activates dopamine receptors

Carbidopa: inhibits decarboxylases - blocks destruction of levodopa in the periphery, allowing more to reach the brain

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25
**LEVADOPA-CARBIDOPA** THERAPEUTIC USES
First line drug for Parkinson Disease dyskinesias
26
**LEVADOPA-CARBIDOPA** ADVERSE EFFECTS
N/V Dyskinesias Postural hypotension early in tx Dyskinesias Psychosis CNS effects Dark sweat and urine
27
**LEVADOPA-CARBIDOPA** PATIENT EDUCATION
benefits may be delayed from weeks to months possibility of “off” times and avoiding high protein meals Take meds with low-fat, low-protein food to reduce nausea levadopa-induced movement disorders avoid child-proof containers for meds cardiac sensitivity increase salt intake or alpha agonist for hypoTN
28
**AMANTADINE** MECHANISM OF ACTION
Antiviral agent that was found to be effective in PD Lots of theories about how it does this
29
**AMANTADINE** THERAPEUTIC USE
Relieving dyskinesias from levodopa
30
**AMANTADINE** ADVERSE EFFECTS
confusion, light headedness, anxiety effects from muscarinic blockade: blurred vision, urinary retention, dry mouth, constipation May develop mottled discoloration of the skin (livedo reticularis)
31
**AMANTADINE** PATIENT EDUCATION
Watch out for side effects awareness that efficacy will decrease over time
32
**ENTACAPONE** MECHANISM OF ACTION
COMT inhibitor inhibits metabolism of levodopa in the periphery
33
**ENTACAPONE** THERAPEUTIC USES
increases the efficacy of levadopa Often combined with Levodopa and Carbamazepine in one formulation Only downside is that taking all three as one dose limits the ability to titrate one or the other, so often given as a separate pill/dose
34
**ENTACAPONE** ADVERSE EFFECTS
Can worsen the side effects of levodopa, because it's increasing the amount that gets to the brain Increases the levels of drugs metabolized by COMT like methyldopa, dobutamine, and isoproterenol If they're on these meds, will need REDUCED doses of those drugs, because they won't metabolize them as quickly
35
**ENTACAPONE** PATIENT EDUCATION
Vigilance for side effects may need decreased dose of levodopa once entacapone is started
36
**PRAMIPEXOLE** MECHANISM OF ACTION
Non-ergot dopamine receptor agonist (unlike levodopa, it doesn't become dopamine, it just activates the receptor like dopamine would) direct activation of dopamine receptors in the striatum
37
**PRAMIPEXOLE** THERAPEUTIC USES
Used in early onset as monotherapy for PD Used in late stage PD as an agonist with levodopa It's less effective at relieving motor dyskinesias, but it's also less likely that levodopa to cause them
38
**PRAMIPEXOLE** ADVERSE EFFECTS
Monotherapy: nausea, dizziness, somnolence, insomnia, constipation, weakness, hallucinations Associated with IMPULSE CONTROL DISORDERS
39
**PRAMIPEXOLE** PATIENT EDUCATION
Can cause sleep attacks Screen for impulse disorders Orthostatic hypotension
40
**TIZANIDINE** MECHANISM OF ACTION
Centrally acting muscle relaxant exact MOA is unclear maybe enhances presynaptic inhibition of motor neurons in the CNS Acts as an agonist at presynaptic alpha 2 receptors
41
**TIZANIDINE** THERAPEUTIC USES
spasticity off label: acute back pain
42
**TIZANIDINE** ADVERSE EFFECTS
CNS depression hepatic toxicity Physical dependence hypotension (very similar to clonidine) dry mouth, hypotension, hallucinations, psych s/s
43
**TIZANIDINE** PATIENT EDUCATION
Possibility for CNS depression risk of falls avoid alcohol and first-generation antihistamines to avoid double CNS depression Don't discontinue abruptly withdrawal will ensure
44
**PYRIDOSTIGMINE** MECHANISM OF ACTION
Reversible cholinesterase inhibitor acts as a substrate for cholinesterase, tying it all up so that Ach can remain in circulation
45
**PYRIDOSTIGMINE** THERAPEUTIC USES
Myasthenia Gravis
46
**PYRIDOSTIGMINE** ADVERSE EFFECTS
**Excessive muscarinic stimulation:** salivation, gastric secretion, increased tone/motility in GI tract, bradycardia, sweating, miosis **neuromuscular blockade:** causes accumulation of Ach at the NMJ, preventing repolarization of mm cells
47
**PYRIDOSTIGMINE** PATIENT EDUCATION
* Take before engaging in rigorous activity * If you miss a dose, don't take another one until the scheduled time * report SOB, drooling, N/V/D, excessive sweating * Keep a list of medications on your person in case you have an attack
48
**DONEPEZIL** MECHANISM OF ACTION
Cholinesterase Inhibitor Prevents the breakdown of Ach, enhancing transmission by central cholinergic neurons More selective for the form of AChE in the brain that that found in the periphery
49
**DONEPEZIL** THERAPEUTIC USES
Mild to Severe Alzheimer's Disease
50
**DONEPEZIL** ADVERSE EFFECTS
N/V/D Bradycardia, Fainting Spells, Falls, Fall-related injuries
51
**DONEPEZIL** PATIENT EDUCATION
* Explain that the drug likely will not dramatically improve symptoms (Only 1 in 12 see improvement) * Lightheadedness and risk for falls * Frequent snacks and meals to maintain weight * keep a list of new symptoms and problems for follow up appointments
52
**OXYBUTYNIN** MECHANISM OF ACTION
Muscarinic Antagonist Competitively blocks the actions of Ach at muscarinic receptors, primarily at M3
53
**OXYBUTYNIN** THERAEUTIC USES
Overactive Bladder (OAB) (urge incontinence, not stress incontinence)
54
**OXYBUTYNIN** ADVERSE EFFECTS
* Dry mouth, constipation, tachycardia, urinary retention * mydriasis, blurred vision * confusion, hallucinations, insomnia, agitation * metabolized by CYP3A4
55
**OXYBUTYNIN** PATIENT EDUCATION
* sipping fluids/gum/saliva substitute for xerostomia * sunglasses and dim lighting * void right before taking to avoid retention * increase dietary fiber, use mild laxatives * avoid heat, at risk for hyperthermia
56
**ATROPINE** MECHANISM OF ACTION
Muscarinic Antagonist Competitive blockade of muscarinic receptors, preventing ACh action
57
**ATROPINE** THERAPEUTIC USES
* Preanesthetic to prevent reflex bradycardia and copious secretions * dilating eyes for examinations and surgery * Bradycardia * Intestinal hypertonicity and hypermotility * PUD * Asthma * Biliary Colic * Muscarinic agonist poisoning
58
**ATROPINE** ADVERSE EFFECTS
* Xerostomia * Blurred Vision/Photophobia * Elevated IOP * urinary retention * constipation * anhidrosis (can't sweat) * Tachycardia * Asthma (thickens secretions)
59
**ATROPINE** PATIENT EDUCATION
Same as for other muscarinic antagonists: * risk for hyperthermia * don't drive with blurry vision * sugar free gum for xerostomia * pee before taking
60
**SCOPOLAMINE** MECHANISM OF ACTION
Anticholinergic drug similar to atropine BUT produces sedation instead of excitation suppresses emesis and motion sickness
61
**SCOPOLAMINE** THERAPEUTIC EFFECTS
* motion sickness * preanesthetic sedation * obstetric amnesia
62
**SCOPOLAMINE** ADVERSE EFFECTS
Same as atropine
63
**SCOPOLAMINE** PATIENT EDUCATION
Same as atropine, but explain risk for oversedation no major life decisions etc. no other CNS depressants
64
**IPRATROPRIUM** MECHANISM OF ACTION
Muscarinic Antagonist Causes bronchodilation
65
**IPRATROPRIUM** THERAPEUTIC USES
Asthma, Rhinitis, COPD
66
**IPRATROPRIUM** ADVERSE EFFECTS
* bronchitis * nausea * xerostomia, reduced secretions * paradoxical bronchospasms
67
**IPRATROPRIUM** PATIENT EDUCATION
* best for chronic control, not acute * urinary retention possible * dry mouth etc.
68
**NOREPINEPHRINE** RECEPTOR SPECIFICITY CHEMICAL CLASSIFICATION
* Alpha 1 * Alpha 2 * Beta 1 Catecholamine
69
**NOREPINEPHRINE** PHYSICAL EFFECTS
* Elicits all the responses as epinephrine, except that it does not activate Beta 2 * Used to tried hypotension and cardiac arrest
70
**DOPAMINE** RECEPTOR SPECIFICITY CHEMICAL CLASSIFICATION
CATECHOLAMINE * Dopamine * Beta 1 * Alpha 1
71
**DOPAMINE** PHYSICAL EFFECTS
* Dose Dependent * Low: Dopamine (renal vasodilation) * Medium: Beta 1 (cardiac output) * High: Alpha 1 (vasoconstriction)
72
**ALFUZOSIN / PRAZOSIN / TAMSULOSIN** CLASSIFICATION
SELECTIVE ALPHA 1 BLOCKERS
73
**ALFUZOSIN / PRAZOSIN / TAMSULOSIN** THERAPEUTIC USES
Alfuzosin: BPH only Prazosin: HTN, off label BPH Tamsulosin: BPH only
74
**ALFUZOSIN / PRAZOSIN / TAMSULOSIN** ADVERSE EFFECTS
* **Alfuzosin**: Dizziness * **Prazosin**: Orthostatic HypoTN, reflex tachycardia, nasal congestion, “*first dose effect”* * **Tamsulosin:** Abnormal ejaculation, rhinitis
75
**ALFUZOSIN / PRAZOSIN / TAMSULOSIN** PATIENT EDUCATION
* First-dose hypotension (prazosin mostly) * Avoid driving for 24 hours after first dose * Take initial dose at bedtime * home monitoring of BP and HR required, and patient should not take/call doctor if they develop bradycardia or hypoTN
76
**PROPANOLOL** MECHANISM OF ACTION
First generation non-selective Beta Blocker Blocks cardiac beta 1 receptors
77
**PROPANOLOL** THERAPEUTIC USES
* Beta 2 * Bronchoconstriction * Vasoconstriction * Reduced glycogenolysis * Beta 1 * Reduced Heart Rate * Negative inotrope * Suppresses impulse conduction through the AV node * Suppresses secretion of renin
78
**CLONIDINE** MECHANISM OF ACTION
Centrally acting Alpha 2 Agonist Reduces presynaptic synthesis of NE
79
**CLONIDINE** THERAPEUTIC USES
* Hypertension * Severe pain * ADHD
80
**CLONIDINE** ADVERSE EFFECTS
* Drowsiness * Xerostomia * Rebound hypertension * Abuse
81
**CLONIDINE** PHARMACOLOGIC EFFECTS
* Bradycardia * Decreased CO * Vasodilation * Decreased BP
82
**CLONIDINE** PATIENT EDUCATION
* Take major portion at bedtime to minimize sedation * Patches aren't MRI safe * Record BP daily * Don't discontinue abruptly * CNS depression * Dry mouth measures
83
**DICYCLOMINE** MECHANISM OF ACTION
Muscarinic Antagonist
84
**DICYCLOMINE** THERAPEUTIC USES
a.k.a. Bentyl IBS Diarrhea and Hypermotility
85
**DICYCLOMINE** ADVERSE EFFECTS
* Dry mouth * Blurred vision * Urinary retention * Constipation * Risk for hyperthermia

Pharmacology I (29 decks)

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