Final Exam Flashcards
zolpidem (ambien)
MOA: non benzo, short acting hypnotic
Uses: short term use for insomnia
Side effects: dizziness, drowsiness, headaches, anxiety, cognitive dysfunction, hepatic encephalopathy; potential for misuse; dependence
zopiclone
MOA: short acting Benzo like drug
uses: short term use for insomnia
side effects: dizziness, drowsiness, headaches, anxiety, cognitive dysfunction, amnesia, anxiety, agitation, restlessness, worsening depression, respiratory depression; potential for misuse; dependence; withdrawal effects
dayvigo (lemborexant)
MOA: newer sleep aid, blocks orexin and suppresses wakefulness
Uses: insomnia
side effects: abnormal dreams, drowsiness, headache, worsening depression; potential for misuse
-no dependence**
dantrolene (direct acting muscle relaxant)
MOA: Acts directly on skeletal muscle by interfering with release of calcium ion
Uses: short term muscle spasms and pain, MS, CP, rheumatic disorders, huntington’s, parkinsons, trigeminal neuralgia, malignant hyperthermia
- side effects: euphoria, CNS depression, lightheadedness, dizziness, drowsiness, fatigues, confusion
contraindications: alcohol, CNS depressants, active liver disease
baclofen (central muscle relaxants)
-MOA: works centrally on the CNS; reduces tonic somatic motor activity influencing both alpha and gamma motor neurons –> depresses the CNS
contraindications: heart failure, arrhythmias, hyperthyroidism, use of MAOIs
amphetamine salts
MOA: stimulates cerebral cortex and thalamus. causes mood elevation, euphoria, increased mental alertness and capacity for work, decreased fatigue and drowsiness, and prolonged wakefulness. relaxation of bronchial smooth muscle, increased respiration, and dilation of pulmonary arteries
Uses: ADHD, narcolepsy
side effects: hypertension, tachycardia, agitation, anxiety, insomnia, loss of appetite, dry mouth, abdominal pain
contraindications: hypertension, heart failure, PVD, CAD, hyperthyroidism, glaucoma, agitation
Methylphenidate (concerta, ritalin)
uses: ADHD, narcolepsy
Side effects: same as amphetamines + temporary slowing of growth in prepubescent children
Contraindications: same as amphetamines
Atomoxetine (strattera)
-Uses: ADHD, narcolepsy
Side effects: hypertension, urinary retention; increased suicide risk; excessive sweating, dry mouth, constipation, reduced appetite, nausea, vomiting, erectile dysfunction, drowsiness, headache, insomnia, agitation, worsening psychiatric symptoms, prolonged QT
contraindications: narrow-angle glaucoma; history of adrenal gland cancers; severe cardiovascular disease; severe hypertension; uncontrolled hyperthyroidism
orlistat
MOA: binds to lipase and blocks them → reduces fat absorption. reduces fat absorption by 30%
-uses: obesity
-side effects: oily spotting, flatulence, and fecal incontinence. decreased absorption of vitamin A,D,E
-limiting dietary intake of fat can help with side effects
Triptans
MOA: serotonin receptor agonists, work by stimulating serotonin receptors in the brain. stimulate 5-HT receptors in cerebral arteries → causes vasoconstriction → reduces headache. take at first sign of headache
Indications: migraines
side effects: vasoconstriction effects, serotonin syndrome
contraindications: heart disease or symptoms of heart disease, peripheral vascular diseases; CAD, uncontrolled hypertension;
cardiac arrthymias, sepsis, impaired renal or hepatic function
barbiturates
-MOA: CNS depressant
-Uses: pre-op sedation, anesthesia adjunct, anticonvulsant (prevention of generalized tonic–clonic seizures and fever-induced convulsions)
- side effects: dizziness, drowsiness, lethargy, paradoxical restlessness, thrombocytopenia, hypotension, bradycardia, CNS depression
memory impairment, respiratory depression
contraindications: pregnancy, severe respiratory difficulties, severe liver disease
Hydantoins (Dilantin)
- MOA: Therapeutic range = 10-20
- Uses: tonic-clonic and focal seizures
- side effects: lethargy, abnormal movements, ataxia, mental confusion, cognitive changes (suicidal thoughts) gingival hyperplasia, thrombocytopenia, hepatitis
contraindications: liver failure, bradycardia
Iminostilbenes (Tegretol)
uses: focal onset seizures, general onset seizures, bipolar disorder and neuropathic pain
side effects: Nausea, headache, dizziness, unusual eye movements, visual change,
minor anticholinergic effects
Contraindications: bone marrow depression;
severe hepatic disease; concurrent use of certain anti-fungals; may worsen myoclonic or absent seizures
succinimide (zarontin)
uses: uncomplicated absence seizures (children)
side effects: Nausea, abdominal pain, dizziness, drowsiness
GABA analogs (gabapentin)
- Uses: neuropathic pain, adjunctive treatment for seizures; chronic pain; pruritus; restless leg syndrome
side effects: weight gain, drowsiness, dizziness, nausea, visual and speech changes, edema
lamotrigine
uses: simple or complex focal seizures, generalized seizures, tonic-clonic seizures, bipolar
side effects: relatively minor CNS and GI symptoms, drowsiness, ataxia, headache, skin rashes, nausea, blurred vision
levetiracetam (Keppra)
-uses: adjunct for focal seizures
- side effects: generally well tolerated, Dizziness; drowsiness; suicidal ideation
Topiramate (Topomax)
Uses: adjunct for seizures, migraine prophylaxis, eating disorders, tremors
-side effects: weight loss (4-17%), GI upset, dizziness, drowsiness, ataxia, decreased bone density
Valproic Acid
Uses: seizures, migraine prophylaxis, bipolar
Side effects: Dizziness, drowsiness, gastrointestinal upset, tremor, weight gain, hair loss, hepatotoxicity, pancreatitis
Contra: liver impairment, urea cycle disorders, use in women of child bearing potential
anti metabolite side effects
fever, malaise
-hair loss
-nausea, vomiting, diarrhea, myelosuppression
-neurological, cardiovascular, pulmonary, hepatobiliary, GI, genitourinary (GU), dermatological, ocular, otic, and metabolic toxicity
-tumour lysis syndrome
folic acid antagonist (methotrexate0)
MOA: interferes with folic acid, works on S phase
Uses: solid tumours (breast, head, neck, lung), acute lymphocytic leukemia, non-hodgkins lymphoma, RA, psoriasis
side effects: stomatitis, black tarry stools, hair loss
contra: NSAIDs
purine antagonists
- interrupts metabolic pathways of purine nucleotides → interrupts DNA/RNA synthesis → tumour cells die
-Uses: leukemia
pyrimidine antagonism
MOA: interrupts metabolic pathways of pyrimidine bases → interrupts DNA/RNA synthesis
mitotic inhibitors (vincristine)
MOA: Can work in various phases of the cell cycle. All work shortly before or during mitosis and thus retard cell division.
Uses: combination therapy, solid tumours (testicular, breast, ovarian, small cell lung), leukaemia
side effects: neurotoxic, hair loss, nausea and vomiting, and myelosuppression
topoisomerase 1 inhibitors (topotectan)
MOA: inhibits proper DNA function
uses: ovarian and colorectal cancer
side effects: bone marrow suppression
cholinergic diarrhea, N,V,D
Antineoplastic enzymes (Erwinase)
- MOA: Synthesized using cultures of bacteria and recombinant DNA technology
- uses: Acute lymphocytic leukaemia
- side effects: impaired pancreatic function,
alkylating drugs
-MOA: Used to treat various types of cancer by preventing cancer cells from reproducing (alter DNA)
- uses: ovarian, testicular, lymphoma, leukemia, breast, retinoblastoma
- side effects: nephrotoxicity (hydration important ++), neuropathy, ototoxicity, hemorrhagic cystitis
cytotoxic antibiotics
- MOA: -Natural substances produced by the mold Streptomyces. cell cycle non-specific and blocks DNA synthesis
- uses: combination therapy
- side effects: Bone marrow suppression & heart failure (cardiomyopathy), pulmonary fibrosis, pneumonitis
aromatase inhibitors
- MOA: inhibits aromatase → conversion of certain hormones is prevented → decreases or delays tumour mass growth, responsive to hormones
Uses: post therapy for breast cancer
Side effects: hot flashes, osteoporosis, hypertension, mood disorders, weakness, arthralgia
SERMs (tamoxifen)
MOA: binds to estrogen receptors to inhibit estrogen effects & decrease DNA synthesis
-Tamoxifen is cytostatic rather than cytocidal
-inhibits cancer growth (vs kills the cells)
Uses: treatment and risk reduction of breast cancer for 5-10 years (post initial treatment)
Side effects: Hypertension, peripheral edema, mood disorders, depression, hot flashes, nausea, weakness, and osteoporosis
estrogen receptor antagonists
MOA: binds to estrogen receptors to inhibit tumour growth
Uses: breast cancer
Side effects: Vasodilation, pharyngitis, headache, hot flashes, pain, N&V
anti androgens (bicalutamide)
MOA: blocks androgens
Uses: prostate cancer
Side effects: anemia, peripheral edema, muscle aches , gynecomastia, hot flashes, nausea, diarrhea
gonadotropin releasing hormone agonists
MOA: decreased LH and FSH and subsequent testosterone and estrogen decrease
Uses: gender transitioning, prostate, breast, endometrial cancer, endometriosis, fibroids
Side Effects: hair loss, increased body odour, headaches, flushing, hot flashes, nausea, vomiting, weight changes
antineoplastic hormones
MOA: causes marked decrease in plasma testosterone and increases estrogen
Uses: male tumours
Side effects: edema, SOB, leg cramps, chest wall tenderness, anorexia, nausea, diarrhea
NSAIDs
MOA: Works by blocking the chemical activity of the cyclooxygenase (COX) enzymes; can also inhibit the leukotriene pathway, prostaglandin pathway or both
Uses: various inflammatory conditions, mild to moderate pain
Side Effects: dyspepsia, heartburn, GI bleed, hepatotoxicity, AKI, tinnitus, altered hemostasis
Contra: risk for bleeding, vitamin K deficiency, peptic ulcer disease, current hemorrhagic stroke, and severe kidney or liver disease
Aspirin
Uses: secondary prevention of blood clots associated with MI or stroke. pain, inflammatory conditions, fever, and for certain autoimmune conditions
Side effects: increased risk of bleeding
Contra: children with flu like symptoms → can cause Reye’s syndrome
Indomethacin
MOA: NSAID derivative (analgesic, antipyretic and anti-inflammatory, anti-rheumatic properties)
Uses: acute gouty arthritis, RA, OA, bursitis, tendonitis, and ankylosing spondylitis
Ketorolac (Toradol)
MOA: anti-inflammatory, with strong analgesic properties (comparable to opioids)
Uses: moderate-to-severe acute pain resulting from orthopedic injuries, surgeries or severe migraines
-should be used for limited intervals
Side effects: kidney impairment, edema, GI pain, dyspepsia, and nausea
ibuprofen
Uses: pain, fever, RA, OA, dental pain, MSK disorders, dysmenorrhea
Side effects: increase risk or stroke and bleeding, can increase blood pressure and at high doses/long periods of time
Cox-2 inhibitors
MOA: COX-2 inhibitors allow for anti-inflammatory effects while reducing the prevalence of adverse effects such as GI upset, ulceration/bleeding
Uses: OA, RA, acute pain, ankylosing spondylitis, dysmenorrhea
Side Effects: headache, sinus irritation, diarrhea, fatigue, dizziness, lower extremity edema, and hypertension
Contra: hypersensitivity to celecoxib, sulfonamides, aspirin, other NSAIDs, 3rd trimester, breastfeeding, heart failure
Enolic Acid Derivatives (meloxicam)
MOA: potent NSAIDs, better GI tolerance
Uses: mild to moderate OA, RA, and gouty arthritis
Allopurinol
MOA: helps prevent excessive uric acid production in individuals with gout
Uses: gout, tumour lysis syndrome
Side effects: acute gout attacks, agranulocytosis, aplastic anemia, serious and potentially fatal skin conditions
Colchicine
MOA: reduces the inflammatory response to deposits of urate crystals in joint tissue
-second line
Uses: gout
side effects: N,V,D
-take on empty stomach
Probenecid
MOA: inhibits the reabsorption of uric acid in the kidney and thus increases the excretion of uric acid
-ineffective in clients with kidney impairment
Uses: gout
immunosuppressants (general)
MOA: selectively suppress certain T lymphocyte cell lines to suppress the immune system
Uses: helps to reduce organ rejection, MS, RA
side effects: increased risk for opportunistic infections