Final Exam Condensed - Could be helpful, could be fatal. Flashcards by Piper Dobner

this glucocorticoid has a SHORT DOA, it’s the preferred medication for cortisol replacement - it’s MOA affects gene transcription (as all in it’s class) - which is it?

Hydrocortisone / Cortef

SHORT DOA*

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this glucocorticoid has an INTERMEDIATE DOA, with a potency of 4, which glucocortoid is this?

Prednisone / Deltasone

If given for > 3 weeks - TAPER*

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this glucocortoid has a LONG DOA, it’s potency is 30, it’s FLUORINATED and a potent anti-inflammatory agent - name it

Dexamethasone / Decadron

LONG DOA*

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this Sch. II, Cat. C narcotic is known for causing the side effect of RESPIRATORY DEPRESSION - which opioid analgesic is this?

Morphine / MS Contin

works on mu receptor
indicated for ACUTE MI due to peripheral dilation

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this narcotic is 80X MORE POTENT than morphine. It comes in various delivery devices including a LOLLYPOP. As a category C pregnancy narcotic - which opioid analgesic is this?

Fentanyl / Duragesic

SE - Resp and CV depression
Grapefruit increases blood concentrations

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This black box warning exists for which opioid agonist?
“Respiratory depression and death have occurred in children who receive ____ following tonsillectomy and or adenoidectomy due to ultra-rapid metabolizers wiht a CYP2D6 polymorphism”

Codeine

Tylenol #3 - 30 mg codeine
Tylenol #4 - 60 mg codeine

Sch. II to V depending on codeine dose

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What schedule is heroin?

Schedule I

No prescriptions may be written for Schedule I substances, and they are not readily available for clinical use

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this centrally acting analgesic is used for moderate to severe pain - it’s MOA is important in that it acts centrally as a mild agonist in the mu opioid receptors and affects reuptake at noradrenergic and serotonergic systems - which drug is this?

Tramadol / Ultram

nervous tremor has been reported with weaning
no respiratory depression as seen in morphine and fentanyl

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What’s an important side effect we should be aware of with this irreversible COX 1 and 2 inhibitor?

Aspirin / ASA

REYE’S SYNDROME

do not give in children < 15-18 years of age
causes swelling in the liver and brain - fatal

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this NSAID is a COX 1 and 2 inhibitor (REVERSIBLE) - it’s initiated for migraine treatment in the pain phase - what is it?

Ibuprofen / Motrin, Advil

Indomethacin is the NSAID indicated for GOUT with SE of HA (random fact)

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This was the first injectable NSAID that was a great fake until the narcotics users caught on.

Ketorolac

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This NSAID is a selective COX-2 inhibitor, decreasing the GI irritation normally associated with NSAID use - however, it does have an increased risk of CVD

Celecoxib / Celebrex

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This NSAID is thought to have a strong CNS block (at the hypothalamus) of COX-3 inhibiting prostaglandin synthesis, it also weakly inhibits COX 1 and 2 in the periphery - which NSAID is this famous fever decreaser that we should, as NDs advise our patients to avoid.

Tylenol / Acetaminophen

Fever is our Friend
Other fun Tylenol facts:
DOA 4-6 hours, do not exceed 7g in 24 hrs. 
NEVER MIX WITH ETOH
NAPQI - toxic metabolite

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this is commonly injected for short-term pain relief and reduced swelling from inflammation of joints, tendors or bursa. It’s normally injected, but can be given PO, IM, IV and in a spray or topical formulation - what is this gout medication that works to decrease phospholipase A2 (effectively stopping arachidonic acid production)

Cortisone injection

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This is a mitotic inhibitor used to treat ACUTE GOUT flares while also being an effective preventative. It does have the unfortunate side effect of peripheral neuropathy and in OD can cause ARF and hypovolemic shock - what is this gout drug?

Colchicine

All ACUTE gout TX are:

NSAIDs
STEROIDs
Colchicine

Prophylaxis?

Allopurinol
Probenecid
Colchicine! (DOUBLE WHAMMY! It also prevents!)

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this purine analog works as a xanthine oxidase inhibitor to treat prophylactically against gout - what is this medication that can cause Steven Johnson Syndrome as a rare, but not so awesome side effect

Allopurinol / Zyloprim

not used acutely, need 2+ weeks for it to be effective
SE - Steven Johnson Syndrome

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This gout medication is a prophylactic agent. It works by increasing urinary excretion of uric acid (a uricosuric) by inhibiting the ORGANIC ANION TRANSPORTER - it is NOT used ACUTELY - what is it?

Probenecid / Probalan

C/I with salicylates
Can increase blood levels of penicillin*

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This PROPHYLACTIC migraine medication is a non-selective beta blocker - with this MOA, it has the unfortunate side effect of bronchoconstriction - what is it?

Propranolol / Inderal

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This medication is used to treat migraine at the prodrome state. It’s a SEROTONIN AGONIST given PO/SQ or as a NASAL SPRAY* - with a rare side effect of serotonin syndrome - which commonly used medication is this?

Sumatriptan / Imitrex
works on 5-HT1B and D receptors

constricts BV
SE - Acute MI

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This is used for the PAIN phase of MIGRAINE. It’s an opioid analgesic that comes in the convenience of a NASAL SPRAY - which medication is this?

Butorphanol / Stadol

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This is an anti-emetic commonly used for migraine headaches - it’s a H1 histamine receptor antagonist that drops the seizure threshold while also causing EXTRAPYRAMIDAL effects of lip smacking, sticking out tongue, face and arm movements if given at high doses for too long - name this typical neuroleptic!

Prochlorperazine / Compazine

SE Extrapyramidal effects/Tardive Dyskinesia

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this immune modulating medication works as an anti-metabolite and anti-folate - with an MOA of folate antagonism, it can cause side effects of pneumonitis and PULMONARY FIBROSIS. It’s used for autoimmune diseases - name it

Methotrexate / MTX

if used for CA treatment, do not give folic acid
Cat X for PREG
abortifacient

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this immunosuppressant derived from soil fungus works by inhibiting T cells - making it an effective drug for prevention of organ transplant rejection - what drug is this?

Cyclosporine / Sandimmune

blood levels increase with grapefruit

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this immunosuppressant from the macrolide class of antibiotics, extracted from soil microorganisms utilizes T cell inhibition to treat SEVERE ECZEMA - while being 100x more potent than cyclosporine - what is this medication targeting calcineurin

Tacrolimus / Prograf

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This DMARD, recombinant DNA drug is used to treat severe RA and other AI disease by reducing the inflammatory response by anti-TNF alpha therapy - it does NOT help with IBD. Given SQ - what is this?

Enteracept / Enbrel other anti-TNF DMARD that DOES work for UC/Crohns Infliximab/Remicade** d/t APOPTOSIS (IV only)

this immunosuppressant is an anti-malarial as well, it blocks the activation of TLR on plasmacytoid dendritic cells. IT's also an anti-spirochete - what is this drug that can cause possible corneal and macular damage therefore requiring dilated eye exams annually when used?

Hydroxychloroquine / Plaquenil

this anti-mitochondrial medication reduces inflammation by suppressing phagocytosis and lysosomal enzyme activity when taken up by macrophages - what is this medication commonly given to kiddos refractory to other treatment?

gold salts / auranofin

This antidepressant works by preventing breakdown of catecholamines in the CNS. When patients are using this (generally, it's only RX'd in refractory patients) they must be careful to avoid these foods due to the increased risk of fatal HTN

MAO Inhibitors - AVOID TYRAMINE CONTAINING FOODS (all the good ones, wine, cheese, chocolate.. take all of those away and be sure another SE is increased depression)

this tricyclic antidepressant causes the side effects of dizziness, drowsiness, and the anticholinergic side effects that are opposite of sludge.. What is this medication used to treat major depression and bipolar disorder - with a potential for flu-like symptoms called "discontinuation syndrome"

Amitriptyline / Elavil - cardiotoxic, prolongs QT interval - 10X daily dose is toxic

this tetracyclic antidepressant works by inhibiting serotonin reuptake while being a partial antagonist effectively increasing serotonin levels in the synapse - what is it?

Trazodone / Desyrel - treats anxiety, sleep and ED

This SSRI* decreases serotonin uptake at presynaptic cleft - it's used for major depression and OCD - What is it?

Fluoxetine / Prozac - NSAIDs may increase risk of GI bleed - Serotonin Syndrome (agitation, ataxia, tremor, etc) - ok'd for use in children Paxil is SSRI not ok for kids

This SNRI* is indicated when the depression is accompanied by peripheral neuropathy and fibromyalgia - with a black box warning of increased risk of suicidal thinking in 18-24 year olds with MDD and other psychiatric d/o's

Duloxetine / Cymbalta C/I with heavy alcohol use

This NDRI* with some nicotinic receptor antagonism is used to treat depression as well as aid in smoking cessation - what is it?

Bupropion / Wellbutrin

This antipsychotic (typical neuroleptic) can cause PARKINSONIAN symptoms, extrapyramidal SE such as tardive dyskinesia and can increase prolactin - what is the D2 R blocker?

Chlorpromazine / Thorazine

this typical neuroleptic is a H1 receptor ANTAGonist - indicated mostly as an anti-emetic to decrease nausea and vomiting - what it is?

Prochlorperazine / Compazine - 10-20X more potent than Chlorpromazine w/o Parkinsonian SE

this typical neuroleptic is indicated for ACUTE AGITATION BEHAVIOR - by working chiefly as D2 dopaminergic R blockers - Vitamin H

Haloperidol / Haldol - Parkinsonian SE* - Neuroleptic Malignant Syndrome

this atypical neuroleptic can cause acute psychosis if withdrawn too quickly from therapy. It has the unfortunate side effect of WEIGHT GAIN and hyperglycemia, DM and stroke (in the elderly). What is this dopamine, serotonin blocker?

Respiradone / Risperdal Olanzapine/Zyprexa is the other atypical that causes stroke in elderly

This short-acting non-benzo hypnotic is used for initiating sleep for those with insomnia - what is it?

Zolpidem / Ambien

this melatonin AGonist, sedative hypnotic works by binding MT1 and MT2 receptors, with no GABA binding effect (therefore not an anxiolytic) - what drug is this

Ramelteon / Rozerem

this benzodiazepine ANTAGONIST (ie ANTIDOTE) reverses CNS depression caused by benzo overdose - what is this drug that need to be administered every 1-2 hours with increased risk of withdrawal syndrome?

Flumazenil / Romazicon - remember, charcoal does not work in benzo OD unless alcohol is involved or other charcoal sensitive agents

This barbituate is an anticonvulsant that is cat D for pregnancy, and only given if life-threatening condition - what is this?

Primidone / Mysoline Phenobarbital is a known metabolite of primidone

This benzodiazepine is indicated for STATUS EPILEPTICUS - however, Lorazapam is commonly used in place of it due to a longer half life - which second choice drug is this?

Diazepam / Valium | - works on voltaged gated Cl channels

This is a LONG ACTING benzo with marked abuse potential and the ability to decrease IQ in children

Clonazepam / Klonopin

this anticonvulsant has the unfortunate side effect of GINGIVAL HYPERPLASIA and NYSTAGMUS - with a SLOW ONSET and LONG half-life - name this seizure prophylaxis drug

Phenytoin / Dilantin GINGIVAL HYPERPLASIA - Ethosuximide/Zarontin (absence seizure drug)

this anticonvulsant also causes the unfortunate side effect of GINGIVAL HYPERPLASIA as well as LUPUS LIKE SYNDROME - it's indicated for ABSENCE seizures and can increase phenytoin levels dt liver metabolism - what is it?

Ethosuximide / Zarontin

this anticonvulsant, atypical analgesic affects N-type Ca channels and is specifically indicated for POST-HERPETIC NEURALGIAs as well as migraines

Gabapentin / Neurontin - can be added to monotherapy in anticonvulsants where monotherapy is goal

This anticonvulsant decreases excitatory effects of glutamate and aspartate - it's used for partial seizures as well as treatment of BIPOLAR TYPE I disorder - name this sucker

Lamotrigine / Lamictal works by decreasing effects of glutamate and aspartate (excitatory)

This is the first line therapy for Parkinsons

Levodopa - definitive tx - generally combined with Sinemet to increase bioavailability of this dopamine precursor to CNS by blocking conversion peripherally

this is the second line therapy for Parkinsons, with additional indications for PROLACTIN SECRETING ADENOMAS

Bromocriptine / Parlodel D2 AGonist SE - pulmonary fibrosis (also TX this)

This antiviral is indicated as third line therapy for Parkinsons, but also for INFLUENZA A tx, it antagonizes NMDA receptors diminishing dopamine reuptake - what is this?

Amantadine / Symmetral | - sadly, only good for approx. 6 mo of treatment

This fourth line medication for Parkinson's is especially indicated for TREMOR and DROOLING - it's side effects are the most desired - as an anticholinergic - it can dry the mouth. However, it also causes constipation, hallucinations, psychosis.. What is this palliative tx?

Benztropine / Congentin SE - Toxic Psychosis (antidote with Physostigmine)

This drug is a synthetic replacement of T4, used commonly for hypothyroidism - long term use can increase risk of CVD and osteoporosis (therefore take caution when dosing in 65 yrs +) which drug is it?

Levothyroxine effective in 6-8 weeks (steady state levels) SE - CVD, Osteoporosis

This drug, if given before cortisol replacement in Addisons - can be fatal - what is it?

Levothyroxine Thyroid replacement before Cortisol can be fatal!

What are the equivalencies of Levo to Armour to Cytomel?

Thyroid USP/Armour - 60mg Levothyroxine - 100mcg Cytomel 25mcg

this synthetic T3 replacement is used for hypothyroid, however have increased risk of what?

Cytomel increased risk of CVD and OSTEOPOROSIS

this thioamide is 10x more active than PTU - blocking T4 to T3 conversion in the CNS, used to treat HYPERthyroid and given IV admin for thyroid storm - what is it and what side effect is a huge problem with this medication (also making is C/I in pregnancy)

Methimazole / Tapazole AGRANULOCYTOSIS ** DO NOT DOSE LONGER THAN 6-12 months **

This thioamide works mostly by blocking PERIPHERAL conversion of T4 to T3 - it is generally NOT used for thyroid storm

Propylthiouracil / PTU Cat D for pregnancy - only use if benefits outweigh risks

With this hyperthyroid treatment - which works by large doses blocking release of thyroxine from the thyroid gland - has benefits that last 2-3 weeks without the SE of HYPERKALEMIA - which element is this?

Iodine / Super Saturated Potassium Iodine (SSKI)

This biguanide works by decreasing hepatic glucose production and has the potential to cause B12 deficiency as well as lactic acidosis - but for a pharmaceutical? It's a badass diabetes drug and generally first line for type II - what is it?

Metformin / Glucophage RX WRITING: metformin hydrochloride (500mg) T PO bid ac Disp 60(sixty) Refills: (six)

this second line therapy for diabetes works by stimulating intact beta cells to release insulin - it can cause weight gain, cat C for pregnancy and becomes ineffective in 5-10 years - which drug is this and when is it strictly contra-indicated?

Chlorpropamide/Diabinese (first generation sulfonylurea) CI in SULFA ALLERGY*

this meglitinide - ie a non-sulfonylurea secreagogue binds ATP sensitive K channels stimulating beta cells to release insulin - what is this medication?

Nateglinide / Starlix SE hypoglycemia and WEIGHT GAIN

this thiazolidinediones helps to improve insulin sensitivity in muscle and fat while decreasing hepatic glucose production - it takes 6-14 weeks to be effective - what is this?

Rosiglitazone / Avandia NOT ok to use with INSULIN however, it's sister glitazone ACTOS is approved with insulin

This TZD is expensive and can cause CHF as a side effect - what is this?

Pioglitazone / ACTOS

this alpha-glucosidase inhibitor interferes iwth hydrolysis of CHO at the brush border - delaying glucose absorption - what is this drug that must be given STRAIGHT GLUCOSE if OD'd

Acarbose / Precose

This DPP-4 inhibitor cannot be combine with insulin because it's MOA involves increasing insulin secretion - what is this medication?

Sitagliptin / Januvia

this bisphosphonate both prevents and treats osteoporosis by inhibiting osteoCLAST activity, however it has a shitty side effect of ESOPHAGITIS - what is this

Alendronate / Fosamax - must take without food, while remaining upright x30-60 mins to reduce risk of esophagitis 2 others TREAT osteoporosis - Calcitonin / Miacalcin - Calcimar

this synthetic hormone used to treat osteoporosis by inhibiting osteoCLAST activity - is given as a NASAL SPRAY

Calcitonin / Miacalcin 2 others TREAT osteoporosis - Aldendronate/Fosamax - Calcimar

this human monoclonal antibody treats osteoporosis by targeting RANKL (protein promoting bone removal via osteoclasts)

Denosumab / Prolia other RANKL drug - Teriparatide/Fortea - synthetic PTH, increases RANKL expression while increasing calcium availability (like PTH)

What's the recommended dosage of vitamin D for infants?

400 IU

this synthetic progestin can be used to chemically castrate sex offenders within days at high doses - what is this hormone replacement therapy that can also increase LDL and risk of DVT?

Medroxyprogesterone / Provera cannot use for >2years if contraceptive - increases risk of osteoporosis.

This synthetic spironolactone can be used to treat premenstrual dysphoric disorder (PMDD)

Drospirenone / YAZ

This device is a combination of estrogen and progestin that is worn for 3 weeks, with 1 week off to allow for menstruation - what is this?

Nuva Ring

This is a copper IUD

ParaGard

how long is the Mirena (levonorgesterel - long acting progestin) active? what dose is in this IUD?

5 year effective 52mg LNG initially, secretes 20mcg/day Liletta is the SAME Skyla - effective 3 yrs, 13.5mg LNg, 14mcg/day

how effective is this emergency contraceptive that is progestin only and suggested to be used within 72 hours of unprotected sex

Plan B / Ella 60% effective selective progesterone receptor modulator

this progestin antagonist can be used in the first 2 mo of pregnancy as an abortant (initiating labor) - what drug is this?

Mifepristone / mifeprex given with misoprostol (prostaglandin antagonist) can use 200mg instead of 600mg

this SERM is used for infertility - it binds E receptor sites in the brain increasing GnRH which increases LH and FSH secretion - stimulating ovulation

Clomiphene / Clomid

this sex hormone suppressant works as a SYNTHETIC ANALOG to GnRH effectively interrupting production of T and E - given SQ/IM - this drug is used to treat prostate cancer or precocious puberty

Leuprolide / Lupron

this type II ALPHA REDUCTASE INHIBITOR limits the conversion of T to it's active form DHT - making it an anti-androgen - it's effective for BPH but also alopecia.. what is this>

Finasteride / Proscar / Propecia - TERATOGENIC - women, beware! Do not touch, do not sniff, do not hang out with!

Viagra - increases NO which leads to increased cGMP activation allowing for SM relaxation and vasodilation - ta-da! Erection! What enzyme does it inhibit?

PDE5 inhibitor

this anticholinesterase is used to TX alzheimers, but can be used in autistic children to increase their vocabulary and expressive language

Donepezil / Aricept | Centrally acting, 100% bioavailable PO

this anticholinesterase is most beneficial for patients with aggressive disease progression of dementia and hallucinations - what is it and what additional enzyme is blocked that makes it so effective for hallucinations - also - it's so damn convenient with it's PATCH administration.. You don't even know you're being treated!

Rivastigmine / Exelon - inhibits BUTYRYLCHOLINESTERASE

this dementia medication works on the NMDA receptor by modulating the Ca influx and decreasing excitability of the neuron - what is this?

Memantine/Namenda