Final review Flashcards
What the drug does to the body
pharmacodynamics
What the body does to the drug
pharmacokinetics “ADME”
compound that binds to the receptor and stimulates biological response
agonist
block or reverse effect of agonists
antagonist
opposite effect of agonist
inverse agonist
maximal response a drug can produce
efficacy
measure of dose required to produce a response
potency
theraputic dose
lethal dose/effective dose
LD = kills 50%
ED = 50% respond
Is a higher index or lower index a safer drug?
larger
most common form of drug deactivation
active drug to inactive metabolite
inactive drug to active metabolite
prodrug
acetaminophen drug metabolism
active drug to toxic metabolite
What’s St. John’s wort effect on reuptake?
inhibits 5-HT, NE, DA
What are ADRs of St. John’s Wort?
photosensitization and mild GI effects, induces formation of CYP450 isoforms (3A4, 2C9, 1A2) and p-glycoprotein drug transporter
lowers effectiveness of birth control pills, cyclosporine, digoxin, HIV PIs, warfarin
What can coenzyme q be used for?
cardiovascular CHF, HTN, statin induced myopathy, Parkinson’s
What’s the chemistry behind coenzyme q?
antioxidant
What are the ADRs of coenzyme q?
GI disturbances (MC), rash, thrombocytopenia, dizziness, irritability, headache
similar to vitamin K and can decrease effects of warfarin
What’s the evidence of coq?
significantly lower SBP by 11 and DBP by 7, improve ejection fraction by 3.7%, supplementation ameliorated statin associated muscle symptoms
What are first gen oral antihistmaines?
chlorpheniramine
diphenhydramine
doxylamine
hydroxyzine
meclizine
promethazine
What are second gen oral antihistamines?
cetirizine
desloratadine
fexofenadine
loratadine
levocetirizine
What’s the MOA of oral antihistamines?
block H1 receptor-mediated response to histamine, competitive binding
What’s the difference between 1st and 2nd gen oral antihistamines?
1st = penetrate CNS, cause sedation, interact w/ other receptors
2nd = specific for H1
When to consider abx for bacterial sinusitis?
> 10 days, facial/dental pain, fever, maxillary edema
What to treat bacterial sinusitis with if PCN allergy?
clindamycin, cefdinir, doxy
Can you put eye drops in teh ear?
yes
can you put ear drops in the eye?
no
pharmacodynamic DI: drug alters pharmacologic action of another drug – can it be remediated by dosing?
no
pharmacokinetic DI: drug alters concentration, ex: P-glycoprotein, anion transporting polypeptides, cytochrome P450 – can it be remediated by dosing?
yes
What are medications that cause hyperkalemia?
angiotensin converting enzyme inhibs (ACE)
angiotensin receptor blockers (ARB)
potassium-sparing diuretics (amiloride, triamterene)
trimethoprim
aldosterone antagonists (spironolactone, eplereonone)
NSAIDS
Digoxin
Cyclosporine or tacrolimus
What are signs of a sedative-hypnotic overdose?
slurring, drunken behavior, dilated pupils, weak/rapid pulse, clammy skin, shallow respiration, coma, death
What are signs of a sedative-hypnotic withdrawal?
weight loss, paresthesias, headache
What indicates opioid overdose?
euphoria -> sedation -> resp depression -> coma -> death
pinpoint pupils! (exp meperidine), drowsiness/sedation, bradycardia
What indicates opioid withdrawal?
lacrimation, rhinorrhea, yawning, sweating, tremor, muscle jerks
What indicates stimulant (amphetamine) overdose?
agitation, restlessness, tachy, hyperthermia, hyperreflexia, seizures
What indicates stimulant withdrawal?
increased appetite, sleepiness, exhaustion, mental depression
What indicates cocaine overdose?
euphoria, self confidence, mental alertness
What’s the DOC for cyanide?
cyanokit - hydroxycobalamin (v B12) so nontoxic cyanocobalamin is formed
What is the antidote for warfarin?
phytonadione (vitamin K) 5-10mg
What are G+ pathogens?
staph, strep, enterococci, listeria
What do tetracyclines have DI with?
polyvalent cations decreasing absorption, take 2 hrs before or after
When are macrolides reliable?
H. flu (not ery) H. pylori, MAC
mod=s. pneumoniae, s. pyogenes
When are macrolides clinically utilized?
community acquired respiratory infections, atypical mycobacterial infections, traveler’s diarrhea
When are macrolides your DOC?
chlamydia, H. pylori
What are ADRs of fluoroquinolones?
prolongation of QT interval, Achilles tendon rupture
NO in pregnant women and children
inhibits warfarin metabolism too
What are ADRs of metronidazole?
metallic taste, dark urine, disulfuram-like reaction with ETOH
How do you treat paronychia for MSSA versus MRSA?
cephalexin vs doxycycline
Dental infection?
clindamycin
dog bites?
augmentin
UTIS?
cipro, macrobid, bactrim
C diff?
metronidazole, vanc
CAP outpatient?
doxycycline or doxy + beta-lactam or lavaquin alone
What are the 3 opioid receptors?
mu delta kappa
What opioids are metabolized to active metabolites by CYP2D6?
codeine, oxycodone, hydrocodone
fentanyl and methadone have no active metabolites!
How to treat pain with hepatic impairment?
hydrocodone, morphine, oxycodone
How to treat pain with renal impairment?
fetanyl
How to treat acute pain?
mild - tramadol, codeine, hydrocodone
moderate - oxycodone
severe - hydromorphone, meperidine, morphine, fetanyl
How to treat chronic pain?
mild - tramadol
norco, percocet, morphine, fetanyl
