FINAL Flashcards
indications for glucocorticoids?
Indications: inflammation, allergic conditions, reactive airway dz, allergies, arthritis, auto-immune conditions, replacement therapy for Addison’s dz (needed for pt survival)
MOA of glucocorticoids?
• MOA: inhibit access of leukocytes to inflammatory sites, interfere w/fxn of leukocytes, endothelial cells, fibroblasts and suppress production and effects of multiple factors involved in body’s inflammatory response; inhibits phospholipase A2 which blocks the release of Arachadonic acid (precursor of prostaglandins and leukotrienes from membrane bound phospholipids); also suppresses histamine release and kinin activity
SEs of glucocorticoids?
• SE: reduced resistance to infxns, hyperglycemia, possible DM, severe bone loss, avascular necrosis, cataracts, myopathy, thinning of the skin, diminished wound healing, easy bruising, insomnia, mental status changes, wt gain dt increased appetite
indications and MOA of hydrocortisone?
- Indications: preferred drug for cortisol replacement therapy
- MOA: affects gene transcription to either stimulate or repress protein production
indications and MOA of prednisone?
- Indications: preferred drug for reactive airway dz or moderate to severe allergic rxn, important drug for leukemia rxn
- MOA: affects gene transcription to either stimulate or repress protein production
indications and MOA for dexamethasone?
- Indications: extremely potent anti-inflammatory, also useful in IV form for reducing intracranial P
- MOA: affects gene transcription to either stimulate or repress protein production
indications and MOA for triamcinolone inhaler?
- Indications: asthma, COPD, NOT for acute asthma attack once it has begun
- MOA: diminishes inflammation of bronchial wall, affects gene transcription and alters protein production
indications, MOA and SE for flurdrocortisone?
- Indications: mineralcorticoid replacement for pts w/Addison’s dz and in other cases of hyponatremia
- MOA: sodium retention, main effect is via reduction of sodium loss to the urine at renal tubular cells; NOT INDICATED AS AN ANTI-INFLAMMATORY AGENT
- SE: salt retention, edema, HTN, rash, N/V as well as normal glucocorticoid side effects
MOA for most analgesics?
opiate analgesics work by binding to specific opioid receptors in order to produce effects that mimic actions of endogenous neurotransmitters; all opioid receptors are G protein coupled receptors and inhibit adenylate cyclase, involved in postsynaptic hyperpolarization, reduce presynaptic Ca2+ influx which inhibits neuronal activity
indications, MOA and SE of morphine?
- Indications: pain relief
- MOA: potent opioid agonist, high affinity for mu receptors; relieves pain both by raising the pain threshold at the brain stem, thalamic and spinal cord levels as well as by altering the brain’s perception of pain
- SE: respiratory depression by reducing sensitivity of respiratory center neurons to CO2, miosis, itching, N/V, constipation, paralytic ileus
indications, MOA and SE of fentanyl?
- Indications: pain relief, anesthesia
- MOA: similar to morphine w/80x the analgesic property of morphine, used for anesthesia and intractable pain
- SE: respiratory depression w/life threatening hypoventilation can occur, pts using concomitant CYP450 inhibitors may result in fatal blood levels of fentanyl, N/V, constipation, highly addictive
indications, MOA of buprenorphine?
- Indications: control moderate acute pain in non-opioid-tolerant individuals in lower dosages, control moderate chronic pain
- MOA: semi-synthetic opioid
indications, MOA and SE of codeine? DEA and PG category?
- Indications: pain relief, antitussive
- MOA: opioid agonist, converted to morphine in the body but mg per mg codeine is a much weaker analgesic than morphine
- SE: sedation, constipation
- DEA category CII to CV depending on dose of codeine
- PG category C
indications of and when to never use T#3, T#4?
- Indications: pain relief
* Do not use following tonsillectomy and/or adenoidectomy for obstructive sleep apnea syndrome
indications, MOA and SE of tramadol?
- Indications: mild to moderate pain
- MOA: centrally acting analgesic; mild agonist actions at the mu opioid receptor and affects reuptake at noradrenergic and serotonergic systems
- SE: respiratory depression
indications, MOA of methadone?
- Indications: controlled withdrawal of heroin and morphine in addicted patients
- MOA: synthetic, orally effective opioid, approximately equal in potency to morphine but induces less euphoria and longer DOA
indications of naltrexone
• Indications: management of EtOH dependence and opioid dependence
indications, MOA of naloxone?
- Indications: emergent tx of narcotic overdose, reverse coma and respiratory depression of opioid overdose
- MOA: opioid antagonist, binds w/high affinity to opioid receptors but do not activate receptor mediated response
indications, MOA and SE of dextromethorphan?
- Indications: cough medication
- MOA: dextro-isomer of codeine
- SE: little to no analgesic, sedative or GI effects
indications, MOA and SE of aspirin?
- Indications: inflammation, pain, fever
- MOA: irreversible inhibition of COX-1 and COX-2 enzymes; PGE2 thought to sensitize nerve endings to the actions of bradykinins, histamines and other inflammatory mediators
- SE: GI irritation, PUD, N/V, increased risk of bleeding, Reye’s syndrome in children, salicylism
indications, MOA and SE of ibuprofen?
- Indications: inflammation, pain, fever
- MOA: Reversible inhibition of COX-1 and COX-2 enzymes, blockage of PG synthesis at target tissues; NSAID
- SE: no increased risk for Reye’s syndrome
indications, MOA and SE of celecoxib?
- Indications: inflammation, pain, tx of adenomatous polyps
- MOA: reversible, selective COX-2 inhibition
- SE: may increase risk for CVD
indications, MOA and SE of acetaminophen? how to tx overdose?
• Indications: pain, fever
• MOA: not fully understood, weak peripheral blockade of PG synthesis w/stronger blockade of PG synthesis in the hypothalamus
• SE: no increased risk for Reye’s syndrome; NEVER mix w/alcohol; if take greater than 7 g in 24 hrs or taken with EtOH can lead to severe hepatic necrosis leading to liver failure, coma and death (all due to NAPQI byproduct)
o Tx overdose with gastric lavage or ipecac syrup or N-acetylcysteine as late as 8 hours
indications, MOA and SE of propranolol?
- Indications: hypertension, angina, AMI, panic attacks, migraine headaches
- MOA: blocks adrenergic stimulation which serves to decrease HR and myocardial O2 demand and also decreases renin release; non-selective beta blocker
- SE: bronchoconstriction, hypotension, bradycardia, fatigue, impotence, abrupt discontinuation may cause rebound HTN and tachycardia w/subsequent increase in myocardia O2 demand (increased risk of arrhythmias, stroke, angina, MI)