Highlights for the Final Flashcards
What sort of drug will more readily cross plasma membranes?
small, non-ionized, lipid soluble drugs
therapeutic index (TI) is
a ratio of the dose of a drug that produces toxicity relative to the dose of the same drug that produces a clinically desired response. Looked at as an equation, this would be T.I. = LD50 / EC50…thus a measure of the drug’s safety. A large value indicates that there is a wide margin between an effective dose and a toxic dose.
Which drug class has a high potential for abuse?
Class II
Stage 2 HTN
160-179/100-109
Stage 3 HTN
>180/110
What catalyzes angiotensinogen to angiotensin I
renin, a proteolytic enzyme formed in the granules of juxtaglomerular cells
Angiotensin I goes to Angiotensin II by being cleaved by
ACE (angiotensin converting enzyme) which is found mostly in the lungs but also the kidneys and brain and elsewhere
most potent vasoconstrictor produced by the body
angiotensin II
how do thiazide diuretics work
increase sodium and water excretion into urine by inhibiting sodium and chloride reabsorption in the cortical thick ascending limb and early distal tubule
side effect on minerals when taking thiazide diuretics
can cause calcium and uric acid to be reabsorbed by proximal tubule in increased amounts…so serum levels of calcium and uric acid rise
Primary thiazide diuretic
hydrochlorthiazide (HCTZ)/hydrodiuril
what supplement is generally recommended when taking hydrochlorthiazide/hydrodiuril
potassium
patients with a sulfa allergy should not take these drugs because they contain a sulfonamide moiety
hydrochlorthiazide (HCTZ)/hydrodiuril and furosemide/lasix
main loop diuretic
furosemide/lasix
what do loop diuretics do
inhibit chloride reabsorption in the ascending loop of Henle by blocking the Na+/K+/Cl- co-transporter system
***Rank diuretics from strongest to weakest
***loop > thiazide > potassium sparing?
loop diuretics can increase the loss of
sodium, potassium, calcium, and magnesium
bioavailability is
fraction of administered drug that reaches systemic circulation in an unchanged form…(if 100 mg of a drug is taken orally and 70 mg of the drug is absorbed unchanged, then the bioavailability of that drug is 70%)
half life is
the amount of time required for the plasma concentration of a drug to decrease by 50% after discontinuation of a drug
the EC50 or effective concentration 50 is
the concentration or dosage of an agent which induces a specified clinical effect in 50% of the subjects to which the drug has been administered.
LD50 or lethal dose 50 is
the concentration or dosage of an agent or drug which causes death in 50% of the subjects to which that agent or drug has been administered.
efficacy refers to
the degree to which a drug is able to induce maximal therapeutic effects. Efficacy is a term often used to compare drugs of different classes.
drug class with no approved medical use
Class I
drug class with moderate potential for abuse
Class III
drug class with low potential for abuse
Class IV
drug class contraindicated in pregnancy
Class X
preferred diuretic for patients with renal disease and HTN emergencies
loop diuretics
what do potassium sparing diuretics do
increase sodium excretion and inhibit potassium secretion in the distal convoluted tubule
examples of disease states the potassium sparing diuretics should not be used with
severe renal insufficiency, poorly controlled DM, and multiple myeloma
drugs that can cause hyperkalemia
ACE inhibitors and Angiotensin II receptor blockers
primary potassium sparing diuretic
spironolactone/aldactone
diuretic that has anti-androgenic properties and is thus used to treat hirsutism and PCOS
spironolactone/aldactone
prototype B-blocker
propranolol/inderal
beta blocker that acts at both Beta 1 (heart) and Beta 2 (lungs)
propranolol/inderal
beta blocker that is selective (acts at Beta 1)
atenolol/tenormin
disadvantage of B-blockers include
high incidence of adverse CNS affects, sexual dysfunction in men/women, and bradycardia
contraindications of beta blockers include
certain cardiac conduction abnormalities, severe asthma, and severe COPD
drug where abrupt withdrawal can lead to rebound HTN and/or rebound tachycardia, probably due to up-regulation of beta receptors during treatment…can result in MI or stroke
beta blockers
overuse of a beta blocker can result in
bradycardia and heart block
treatment of choice to reverse bradycardic effects of a beta blocker is
glucagon
first line treatment of HTN in conventional clinical practice
ACE inhibitors and calcium channel blockers
treatment for acute asthmatic attacks that are unresponsive to other medications
epinephrine (adrenalin)
indication of epinephrine
emergent treatment of asthma, status asthmaticus, anaphylaxis
OTC preparation containing a very low dose of epinephrine
what is primatene mist
class of albuterol/ventolin, proventil
beta 2 agonist
long acting beta 2 agonist
class of salmeterol/severent
when are anticholinergic drugs typically indicated
generally not indicated for acute asthma attacks but rather for maintenance therapy in asthma patients who cannot tolerate treatment with a beta agonist
primary anticholinergic drug
ipratropium/atrovent
class of zafirlukast/accolate
leukotriene receptor antagonist
drug for prophylaxis and treatment of chronic asthma
zafirlukast/accolate
how do corticosteroids work
inhibition of phospholipase A2 blocks release of arachadonic acid, the precursor of the prostaglandins and leukotrienes from membrane bound phospholipids. Histamine release and kinin activity is also suppressed by glucocorticoids.
primary inhaled steroid
beclomethasone/beclovent, vanceril
indication of beclomethasone/beclovent
asthma not controlled by sympathomimetics (bronchodilators) alone
indication for prednisone/deltasone
COPD, worsening asthma
Abrupt withdrawal of prednisone or other drugs with corticosteroid properties may result in severe and potentially life threatening
hypofunction of the adrenal glands, also known as Addisonian crisis.
What’s significant about theophylline/theo-dur
bad TI, lethal dose is not far from effective dose
class of theophylline/theo-dur
xanthine or methylxanthine bronchodilators
class of codeine
narcotic analgesic and cough suppressant
MOA of codeine and dextromethorphan
suppresses the sensitivity of CNS cough centers in the medulla
Class of dextromethorphan
synthetic derivative of morphine
indication of dextromethorphan
cough suppression
MOA of diphenhydramine/benadryl
H1 receptor site blockage. The production and release of histamine is not blocked.
Does diphenhydramine/benadryl cross the BBB
yes
primary non-sedating antihistamine
loratadine/claritin
MOA of loratadine/claritin
H! receptor antagonist
Does loratadine/claritin
No
Mechanisms of varenicline/chantix
partial agonist of alpha 4/beta 2 nicotinic acetylcholine receptor sites`
side effects of varenicline/chantix
increasing reports of neuro-psychiatric symptoms that range from nightmares or insomnia to depression and suicidal ideations to increased agitation and rage
primary alpha blocker
prazosin/minipress (alpha 1)
indication of prazosin/minipress (alpha 1)
HTN, BPH
Drug class used as prophylaxis of migraine headache and for Raynaud’s syndrome
calcium channel blockers
calcium channel blockers should be used with more caution in patients with
Bradycardia or severe CHF
class of verapamil/isopten
calcium channel blocker
indication of verapamil/isopten
HTN, angina–especially vasospastic angina, CHF
long term use of calcium channel blockers is associated with increased risk for
breast cancer
ACE inhibitors reduce BP by
interfering with the generation of Angiotensin II from Angiotensin I…also inhibit the degradation of bradykinins, allowing for another mechanism by which peripheral vascular resistance can be reduced
what drug is considered least likely of the antihypertensive drugs to cause sexual dysfunction in males
ACE inhibitors
How do ACE inhibitors affect serum lipids, glucose or uric acid levels
They don’t affect them
ACE inhibitors can potentially increase serum
potassium
drug of choice for HTN patients with diabetes
ACE inhibitors
With ACE inhibitors, avoid concurrent use of
potassium sparing diuretic…but potassium wasting diuretics are quite commonly used in conjunction
drug class with the side effect of dry irritating cough
ACE inhibitors
Can you use ACE inhibitors during pregnancy
No
drug class with side effect of angioedema, life threatening when it involves the tongue and oropharyngeal area
ACE inhibitors
Primary ACE inhibitor
Lisinopril/Prinivil or Zestril
Do Angiotensin II receptor blockers cause cough and angioedema
Yes, although their potential to do so is less than ACE Inhibitors
Do Angiotensin II receptor blockers cause hyperkalemia?
Yes
primary Angiotensin II receptor blocker
Losartan/Cozaar
Can you take Losartan/Cozaar during pregnancy
Yes
example of a direct vasodilator
Minoxidil/Loniten
Minoxidil and Hydralazine is generally reserved for
severe hypertension, resistant to previous antihypertensive treatment attempts
What is the more potent direct vasodilator: Minoxidil or Hydralazine?
Minoxidil is more potent than Hydralazine but it is associated with more adverse effects, including potential for marked sodium and water retention and hirsutism
Drug that causes Hirsuitism
Minoxidil/Loniten
drug that causes drug induced lupus syndrome
Hydralazine
first drug FDA approved in new antihypertensive drug class known as direct renin inhibitors
Aliskiren (Tekturna)
drug that can cause angioedema
Aliskiren (Tekturna)
three main classes of drugs that have proven very effective in treating patients with stable angina pectoris
nitrates, beta blockers, calcium channel blockers
the treatment of choice to reverse the bradycardic effects of a beta blocker is
glucagon
Class of propranolol/inderal
non-selective beta blocker
drug used for panic attacks
propranolol/inderal
class of atenolol/tenormin
selective beta blocker
treatment of choice to reverse the symptomatic effects of bradycardia of a calcium channel blocker is
calcium gluconate…but glucagon can be given if calcium gluconate increases pulse rate
class of amlodopine/norvasc
calcium channel blocker
what do you do with someone with unstable angina
administer MONA = morphine, oxygen, nitrate, aspirin
how do you reverse morphine
naloxone
MOA for aspirin/ASA
Irreversibly inhibits cyclooxgenase enzyme. Inhibition of cyclooxgenase prevents the formation of thromboxane A2 and prostaglandins with resultant diminished platelet aggregation.
Drug w markedly increased risk for the development of Reye’s syndrome in children with fevers due to viral conditions such as mumps or chickenpox
aspirin/ASA
what can be used in patients who are intolerant or allergic to aspirin
ADP receptor antagonists
class of Clopidogrel/ Plavix
platelet aggregation inhibitor
what do Glycoprotein IIB/IIIA inhibitors do
prevent the binding of fibrinogen, thereby blocking platelet aggregation.
class of Abciximab/ ReoPro
glycoprotein IIB/IIIA inhibitor
how does regular weight heparin act as an anti-coagulant
Regular weight heparin acts as an anti-coagulant by binding to antithrombin III. The heparin-antithrombin III complex then binds to and inactivates activated factor X (Xa) and factor II (thrombin). Heparin ultimately acts to prevent conversion of fibrinogen to fibrin. Heparin does not actively lyse clots but is able to inhibit further thrombogenesis.
What reverses the effects of heparin
Protamine sulfate
how does low molecular weight heparin act
directly inactivates factor X (Xa) in the clotting cascade…proven to be as effect as regular weight Heparin but with fewer reported side effects
class of Enoxaparin/ Lovenox
low molecular weight heparin
MOA of Warfarin/Coumadin
Antagonizes vitamin K. This interferes with the synthesis of vitamin K dependent clotting factors (factors II, VII, IX, and X).
Anti-coagulant effects of Coumadin may be reversed with
Vit. K
Coumadin should not be used by
Pregnant women
class of Rivaroxaban/ Xarelto
anticoagulant
MOA of Rivaroxaban/Xarelto
direct inhibiton of factor Xa
class of streptokinase
Thrombolytic (clot buster)
Antidote to bleeding in the class of drugs known as “clot busters” (streptokinase)
Aminocaproic acid (Amicar) is a plasmin in-activator and antifibrinolytic. It is utilized for bleeding that occurs as a result of streptokinase and other agents in this class of drugs referred to as the “clot busters”.
anti-arrhythmic drug class Ia, Ib, Ic
sodium channel blockers
anti-arrhythmic drug class II
beta adrenergic receptor blockade
anti-arrhythmic drug class III
potassium channel blockade
anti-arrhythmic drug class IV
calcium channel blockade
class of Quinidine/Quinidex
anti-arrhythmic–Class Ia
MOA of Quinidine/Quinidex
sodium channel blocker
drug that causes Cinchonism
Quinidine/Quinidex
symptoms of cinchonism include
blurred vision, tinnitus, nausea, vomiting, headache, disoreintation and possible psychotic states
drug that may induce Torsade de Pointes
Quinidine/Quinidex
Class of Mexiletine/Mexitil
anti-arrhythmic Class Ib
MOA of Mexiletine/Mexitil
blocks open sodium channels
Class of Flecainide/ Tambocor
anti-arrhythmic Class Ic
drug to treat Wolff-Parkinson-White syndrome
Flecainide/ Tambocor
MOA of Flecainide/ Tambocor
sodium channel blocker
therapeutic index of Flecainide/ Tambocor
narrow
primary Class II/Beta Blocker
Atenolol/Tenormin
Primary Class III/K+ channel blocker
Amiodarone/ Cordarone
MOA of Amiodarone/ Cordarone
potassium channel blockade
drug that contains high levels of iodine
Amiodarone/ Cordarone
drug that causes Blue-gray coloring of skin can occur as a result of iodine deposition
Amiodarone/ Cordarone
primary Class IV/Ca++ channel blocker
Verapamil/ Calan, Isoptin
MOA of Verapamil/ Calan, Isoptin
calcium channel blockade
initial drug of choice for PSVT
Adenosine/ Adenocard
class of atropine
anti-arrhythmic
indication of atropine
cardiac use is in treatment of bradycardia
MOA of Atropine
anticholinergic agent - atropine is a competitive inhibitor of the muscarinic acetylcholine receptors thus it can be thought of as a parasympatholytic.
cardiac drugs which can be administered via an endotracheal tube (for absorption through the lungs)
Atropine, Lidocaine, and Epinephrine (ALE)
side effects of atropine
Blurred vision, dilated pupils, dry mouth and increased heart rate are usually among the first toxic effects of atropine
antidote for organophsophate poisoning
atropine
uses of atropine
cycloplegic to temporarily paralyze accommodation and as a mydriatic to dilate the pupils, diarrhea to decrease secretions and slow peristalsis, preoperatively to decrease bronchial and salivary secretions
classic symptoms of acute organophosphate poisoning
muscarinic in nature…SLUDGE: salivation, lacrimation, urination, diarrhea, gastric distress, emesis
Toxicity due to atropine results in
decreased secretions; flushed, dry, warm skin, visual changes and delirium with hallucinations…Dry as a bone, red as a beet, hot as a hare, blind as a bat, mad as a hatter.
specific antidote for atropine toxicity or tropane alkaloid toxicity is
physostigmine, a reversible acetylcholinesterase inhibitor.
Which has a longer half life and is now seldom used because of increased risks of toxicity: Digoxin or digitoxin?
Digitoxin…both have very low TI’s though
MOA of Digoxin
Inhibitors the Na+/K+ ATPase pump which serves to increase inward current of sodium followed by a greater influx of calcium. Cardiac contraction is enhanced by the increased concentration of intracellular calcium. Also increases renal perfusion.
drug that may cause characteristic flattening or even inversion of the T wave on EKG.
Digoxin/ Lanoxin
drug where you get blurred vision, double vision, flickering dots or flashes of light, halos may appear around objects
Digitalis
treatment of Digitalis intoxication
Digoxin-Fab fragments/ Digibind …they attach to Digoxin molecules and rapidly remove them from receptor sites
Omega-3 fish oil available as a prescription drug
Lovaza
class of Niacin/ Niaspan
Anti-hyperlipidemic/B vitamin
drug where Intense flushing and pruritis is common.
Niacin/ Niaspan
how can flushing and itching when taking Niacin/ Niaspan be minimized
ASA or NSAIDs taken 30 minutes to an hour before the niacin dose.
Niacin/Niaspan is Contraindicated in patients with
poorly controlled DM, active liver disease or active peptic ulcer disease.
safest form of niacin that is currently available
non-prescription Inositol hexaniacinate
category of meds that decrease triglyceride production in the liver
fibric acid derivatives
most commonly used fibric acid derivative
Gemfibrozil/Lopid
noted contraindication for Gemfibrozil/Lopid
contraindicated in patients with pre-existing gallbladder disease and liver disease
what do statins do
HMG-CoA reductase inhibitors
drug class that can lead to rhabdomyolysis, the severe and rapid muscle breakdown which can lead to acute renal failure
statins
statin drug that was recalled after multiple deaths from rhabdomyolysis
Cerivastatin/Baycol
primary statin drug
Atorvastin/Lipitor
Can Atorvastin/ Lipitor be used by pregnant women?
no, category X. Also contraindicated in breast feeding mothers as all statin drugs are.
type of drug that binds cholesterol and forms insoluble complexes which are excreted in the feces
bile acid sequestrants
bile acid sequestrants are often used in conjunction with
niacin
primary bile acid sequestrant
cholestyramine/questran
class of Ezetimibe/ Zetia
anti-hyperlipidemic - cholesterol absorption inhibitor
MOA of Ezetimibe/ Zetia
inhibits intestinal absorption of cholesterol at the brush border
examples of synthetic antimicrobial drugs
sulfonamides and Quinolones
class of Sulfamethoxazole with Trimethoprim/ Bactrim
sulfonamide antibiotic in combination with an additional folic acid inhibitor
MOA of Sulfamethoxazole with Trimethoprim/ Bactrim
interference with folic acid formation at a successive step to sulfonamides…synergistically inhibits two steps in folic acid synthesis
two types of drugs that each affect folic acid production
trimethoprim and sulfonamides
what part of folic acid production do sulfonamides affect
dihydropteroate synthetase
what part of folic acid production does trimethoprim affect
dihydrofolate reductase
Drug that causes Stevens Johnson syndrome (topical epidermal necrolysis)
Sulfamethoxazole with Trimethoprim/Bactrim
penicillin typically treats infections caused by
susceptible Gram-positive organisms
what type of antibiotic are penicillins
beta-lactam
MOA of penicillin G
Beta lactam component binds to PBPs on bacteria and thereafter inhibits cross linking of components of bacterial cell wall.
MOA of Amoxicillin/ Amoxil
Binds to penicillin binding protein and inhibits protein synthesis in the bacterial cell wall.
antibiotic that can cause pseudomembranous colitis
Amoxicillin and clavulanate/Augmentin
interesting thing about dose of Amoxicillin and clavulanate/Augmentin
two 250 mg Augmentin capsules will give you twice the clavulanate dose of one 500 mg Augmentin capsule.
general action of cephalosporins
disrupt the synthesis of the peptidoglycan layer of bacterial cell walls, resulting in cytolysis and cell death
First generation of Cephalosporins start with
Ceph-…later generations start with Cef-
advantage of first generation cephalosporin
great gram + coverage but poor gram -
advantage of third generation cephalosporin
great gram- coverage but poor gram+ coverage
MOA of Cephalexin/Keflex
Similar to penicillin with inhibition of protein synthesis of the bacterial cell wall via beta lactam activity.
Approximately 5%* of penicillin allergic patients will also be allergic to the
cephalosporin class of drugs.
Macrolides tend to accumulate within
leukocytes and are therefore actually transported into the site of infection
class of Erythromycin
macrolide antibiotic
MOA of Erythromycin
inhibit protein synthesis by binding to 50 S bacterial ribosome
Broad spectrum antibiotic that is generally bacteriostatic in low concentrations and bactericidal in high concentrations. May be used in penicillin allergic patients.
Erythromycin
MOA of Azithromycin/ Zithromax
inhibit protein synthesis by binding to 50 S bacterial ribosome
drug that should not be given with calcium supplements or with dairy products as they are chelated by the drug and will markedly diminish drug absorption and bioavailability
Tetracyclines
drug that should not be used in infants and children younger than age 8 or 15 or in pregnant women because they can permanently stain teeth
Tetracyclines
class of Tetracycline/ Sumycin
Tetracycline antibiotic
MOA of Tetracycline/ Sumycin
inhibits bacterial protein synthesis by interfering with 30 S ribosome. Bacteriostatic rather than bactericidal.
drug commonly used to treat acne and acne rosacea. Chlamydia. Lyme disease. Rocky Mountain Spotted Fever.
Tetracycline/ Sumycin
Drug that chelates calcium ions. Accumulates in bone and teeth. Avoid taking this class of drugs with dairy products or calcium supplements.
Tetracycline/ Sumycin
Gentamicin/ Garamycin class
aminoglycoside antibiotic
MOA of Gentamicin/ Garamycin
Binds to 30 S and 50 S ribosomal subunits interfering with protein synthesis. Bactericidal.
Potentially nephrotoxic and ototoxic antibiotic
Gentamicin/ Garamycin
mechanism of Quinolones
inhibit bacterial DNA gyrase, thereby inhibiting DNA replication and transcription
drug class with side effect of tendon damage or spontaneous tendon rupture
Quinolones
class of Ciprofloxacin/Ciproxin
Quinolone antibiotic
MOA of Ciprofloxacin/Ciproxin
Inhibits DNA gyrase, an enzyme responsible for properly uncoiling DNA during transcription.
1st generation Quinolones have good coverage with
Gram - bacteria
2nd generation Quinolones have good coverage with
Gram + bacteria
Who should Ciprofloxacin/Ciproxin be avoided in
The Quinolones chelate calcium and can be deposited in cartilage, thus the use of oral or parenteral forms should be avoided in all children and infants and all pregnant and lactating females.
Specific drug that is associated with increased risk for tendon injury (esp. Achilles tendon injury) in adults taking the drug and also reduces the metabolic breakdown of caffeine, thus prolonging the effects.
Ciprofloxacin/Ciproxin
class of Metronidazole/ Flagyl
Imidazole class of antibiotics
MOA of Metronidazole/ Flagyl
activated intermediates of the drug bind to DNA and inhibit further nucleic acid synthesis
Drug that drinking alcohol can result in Disulfiram-like (aka Antabuse-like) reaction with nausea, vomiting, flushing, and tachycardia.
Metronidazole/Flagyl
drug that interrupts the breakdown of alcohol
Metronidazole/Flagy
MOA of Nitrofurantoin/ Macrobid
disrupts both DNA and RNA of bacteria which are sensitive to the drug.
Drug with rare adverse effects include pulmonary fibrosis and drug-induced autoimmune hepatitis.
Nitrofurantoin/ Macrobid
class of Clindamycin/Cleocin
lincosamide antibiotic
MOA of Clindamycin/Cleocin
binds to 50 S ribosomal subunits of bacteria which acts to inhibit protein synthesis
class of Vancomycin/ Vancocin
glycopeptide antibiotic
MOA of Vancomycin/ Vancocin
Inhibits synthesis of bacterial cell wall phospholipids as well as inhibition of peptidoglycan polymerization at a site separate from the penicillin binding proteins sites utilized by beta lactam antibiotics.
Are Clindamycin and Erythromycin related drugs?
No
Drug associated with a complication reffered to as Red Man Syndrome or Red Neck Syndrome…characterized by intense facial flushing, diffuse erythema, and possible bullae formation and desquamation
Vancomycin/ Vancocin
MOA of Rifampicin/Rifampin
Rifampicin inhibits DNA-dependent RNA polymerase in bacterial cells thus preventing transcription to RNA and subsequent translation to proteins.
Antibiotic for treatment of traveler’s diarrhea
Rifaximin/Xifaxan
Drug that turns urine and saliva orange
Rifampicin/Rifampin
MOA of Mupirocin/Bactroban
selective binding to bacterial isoleucyl-tRNA synthetase, which halts the incorporation of isoleucine into bacterial proteins.
topical drug to treat bacterial skin infections, such as IMPETIGO, boils, and folliculitis
Mupirocin/Bactroban
MOA of Bacitracin
interferes with the transfer of cell wall precursors from the bacterial cell membrane to the cell wall.
Class of Neomycin
aminoglycoside antibiotics
How do aminoglycosides work
binding to the bacterial 30S ribosomal subunit, leaving the bacterium unable to synthesize proteins vital to its growth.
Neomycin and other members of the aminoglycoside class are extremely effective in killing
Gram - bacteria
MOA of Polymycin B
bind to the bacterial cell membrane and alters its structure, making it more permeable. Increased cell wall permeability results in marked water uptake by the bacterial cell and subsequent cell death.
what drug class have a risk profile that is too great to be used for an infection like Strep throat
aminoglycosides
class of Clotrimazole/ Lotrimin
antifungal
MOA of Clotrimazole/ Lotrimin
binds to ergosterol molecules on the fungal cell membrane and causes membrane leakage during cell division
class of Nystatin/ Mycostatin
antifungal, may be used both topically and systemically
MOA of Nystatin/ Mycostatin
binds to ergosterol molecules on the fungal cell membrane and causes membrane leakage during cell division
current drug of choice for onychomycosis
Terbinafine/ Lamisil
Terbinafine/ Lamisil is mainly effective on group of fungi known as
dermatophytes
class of Fluconazole/ Diflucan
antifungal, both topical and systemic
MOA of Fluconazole/ Diflucan
inhibits fungal membrane synthesis
anti-fungal that can be used as vaginal suppository for yeast vaginitis
Fluconazole/ Diflucan
Can inhibit Fluconazole/ Diflucan can inhibit cytochrome enzyme systems responsible for metabolism of many drugs
Fluconazole/ Diflucan
class of Amphotericin B/Amphocil
antimycotic
MOA of Amphotericin B/Amphocil
binds to ergosterol molecules on the fungal cell membrane and disrupts membrane integrity, resulting in death of the fungal cell
Drug with fevers and shaking chills are common. Pre-treatment with Benadryl, NSAIDs or Prednisone often used to mitigate the fever and chills.
Amphotericin B/Amphocil
Isoniazid (INH) / Nitrazid class
antibiotic
MOA of Isoniazid (INH) / Nitrazid
Isoniazid is a pro-drug and must be activated by bacterial catalase. The activated form of INH inhibits the synthesis of mycolic acid in the mycobacterial cell wall
Drug that competes with an enzyme that is needed to produce pyridoxine
Isoniazid (INH) / Nitrazid
peripheral neuropathy is a common side effect when using ____ and is caused by
when using Isoniazid and is caused by INH induced pyridoxine deficiency…so you should take B6 in conjunction
class of Rifampin/ Rifadin
antibiotic
MOA of Rifampin/ Rifadin
inhibits DNA-dependent RNA polymerase in bacterial cells thus preventing transcription of messenger RNA and subsequent translation to protein production
Standard treatment of TB
Rifampin/Rifadin, Isoniazid (INH)/Nitrazid, Pyrazinamide/Pyrazinamide, Ethambutol/Myambutol
drug that is a nicotinamide analog with an unknown mechanism of action
Pyrazinamide
MOA of Ethambutol
inhibits mycolic acid synthesis in the mycobacterial cell wall
Multi-drug resistant tuberculosis (MDR-TB) is defined as TB that is resistant to at least
Isoniazid and Rifampin
acronym for CDC recommended empiric treatment of patient suspected of having MDR-TB
SHREZ MC
7 drugs that make up SHREZ MC are
Streptomycin + Hydrazine + Rifampin + Ethambutol + pyraZinamide + Moxifloxacin (a fluoroquinolone) and Cycloserine (a broad spectrum antibiotic)
how soon do you need to administer Oseltamivir/ Tamiflu for it to be effective
w/in 48 hours of symptoms
MOA of Oseltamivir/ Tamiflu
neuramidase inihbitiion, preventiing virus from budding off from cell. Oseltamivir/ Tamiflu was first orally active neuraminidase inhibitor to be commercially developed.
Zanamivir/ Relenza is not recommended in people with
history of asthma or COPD due to risk of serious bronchospasm
MOA of Zanamivir/ Relenza
neuramidase inhibitor
drug that is used as a treatment for the early stages of Parkinson’s disease
Amandatine/ Symmetrel…best used as short term therapy (6-12 months)…its an anti-viral that was recommended as prophylaxis for influenza
primary drug for herpesvirus infection
Acyclovir/Zovirax
class of Acyclovir/ Zovirax
antiviral
MOA of Acyclovir/ Zovirax
guanosine analog that is incorporated into the virus DNA and inhibits further viral synthesis
Does Acyclovir/ Zovirax actively cross the blood barrier?
Yes. It can be used to treat herpes meningitis and encephalitis.
4 main categories of drugs used as treatment or prophylaxis against HIV
reverse transcriptase inhibitors (RTIs), protease inhibitors (PIs), fusion inhibitors, integrase inhibitors
primary Nucleoside reverse transcriptase inhibitor
Zidovudine (AZT)/ Retrovir
MOA of Zidovudine (AZT)/ Retrovir
pyrimidine analog that is incorporated into the viral DNA by reverse transcriptase. Incorporation into viral DNA terminates further replication
____ inhibitors are currently used to treat HIV and Hep C
protease inhibitors
primary protease inhibitor
Saquinavir/ Invirase
MOA of Saquinavir/ Invirase
Protease enzyme inhibition prevents viral protein molecules from being cleaved into smaller fragments, which prevents both the replication of the virus within the cell and the release of mature viral particles from an infected cell.
interferon alpha is for
Hep C
Interferon Beta is for
relapsing multiple sclerosis
interferon gamma is for
chronic granulomatous diseases
indication of Interferon alpha
chronic hep B and C, genital warts due to HPV, Kaposi’s sarcoma and hairy cell leukemia
MOA of Interferon alpha
Interferon is a naturally occurring glycoprotein that interferes with the ability of a virus to infect cells. Interferon appears to induce host cell enzymes that inhibit viral RNA translation and subsequent viral synthesis within the infected host cell.
When treating hepatitis C, pegylated interferon is often administered with the drug
Ribavirin
name the two recombinant protein vaccinations
Hep B and HPV
Gardasil and Cervarix protect against what two types of HPV
HPV 16 and 18, 6 and 11
substances added to boost the immune response to a vaccine
adjuvant
examples of aluminum containing vaccines
Hep A, Hep B, and DTaP
as of 2005 the only childhood vaccine in the US that still contained more than trace amounts of Thiomersal is
influenza vaccine
what type of vaccine is Hib
conjugate
what type of vaccine is Meningococcal
conjugate
for people that are asplenic, revaccination at period intervals is recommended for what vaccine
pneumococcal vaccine…also recommended for nephrotic syndrome
Psyllium/ Metamucil class
fiber laxative
MOA of Psyllium/ Metamucil
contains soluble and insoluble fiber. adds bulk to stool as well as absorbing fluid into the feces to soften the stool
“Drug” that can contain gluten if in wafer form
Psyllium/ Metamucil
class of Docusate/ Colace
stool softener
MOA of Docusate/ Colace
anionic surfactant
class of Magnesium Hydroxide/ Milk of Magnesia
osmotic laxative, antacid
Bisacodyl/ Dulcolax class
stimulative laxative
MOA of Bisacodyl/ Dulcolax
increases intestinal motility
class of Loperamide/ Imodium
antidiarrheal - analog of Meperidine
MOA of Loperamide/ Imodium
diminished peristalsis due to activation of opiate receptors in GI tract. Loperamide is an opioid receptor agonist and acts on the u-opioid receptors in the myenteric plexus within the large intestines. It does not affect the central nervous system like other opioids. Dimished activity of the myenteric plexus decreases the motility of the circular and longitudinal smooth muscles of the intestinal wall. This increases the amount of time substances stay in the intestine, allowing for more water to be absorbed out of the fecal matter.
class of Diphenoxylate with Atropine/ Lomotil
antidiarrheal
MOA of Diphenoxylate with Atropine/ Lomotil
combination of morphine analog and acetylcholine inhibitor results in diminished peristalsis
what antidiarrheal is generally no indicated beyond 48 hours
Diphenoxylate with Atropine/ Lomotil
What is the active ingredient in Kaopectate
Bismuth subsalicylate (same as Pepto-Bismol). It was formerly kaolin clay (kaolinite) and pectin.
moderate to severe N/V may require more potent agents that block
the 5-HT3 receptor sites
Meclizine/ Antivert class
antiemetic, H1 blocker
class of Metoclopramide/ Reglan
antiemetic/pro-kinetic
MOA of Metoclopramide/ Reglan
dopamine 2 blocker and mixed serotonin 3 antagonist/serotonin 4 agonist
class of Ondansetron/ Zofran
antiemetic
MOA of Ondansetron/ Zofran
blockade of serotonin (5HT3) receptor sites results in significant anti-nausea effect
what is an effective agent for severe nausea due to various chemotherapeutic agents (given approx. 30 min prior)
Ondansetron/ Zofran
MOA of Emetic/ Syrup of Ipecac
stimulation of medullary chemoreceptor trigger zone and local irritant of GI tract
Emetic/ Syrup of Ipecac is not given with
charcoal
class of Calcium carbonate/ Tums
antacid
MOA of Calcium carbonate/ Tums
neutralization of stomach acid, reducing mucosal irritation
side effect of Calcium carbonate/ Tums
constipation
class of Ranitidine/ Zantac
H2 Histamine receptor antagonist
MOA of Ranitidine/ Zantac
blocks the action of histamine on parietal cells in the stomach, decreasing acid production by these cells
class of Omeprazole/ Prilosec
Proton Pump Inhibitor
Esomeprazole/ Nexium–what is it
single enantiomer form of Omeprazole that AstraZeneca made because they lost their patent
rank least to most potent drug classes for stomach acid
antacid, H2 blocker, PPI
therapy of choice for PUD
triple therapy for 7-14 days for PUD due to H Pylori
antibiotics used in Triple Therapy for PUD
Amoxicillin, Erythromycin, Clarithromycin (Biaxin), Tetracycline or Metronidazole (Flagyl)…NOT Zithromax
5-aminosalicylic acid (5-ASA), also called Mesalamine can be used to treat
inflammatory bowel disease
class of 5-ASA/ Mesalamine
aminosalicylates
MOA of 5-ASA/ Mesalamine
inhibition of leukotriene production, anti-prostaglandin and anti-oxidant effects
5-ASA/ Mesalamine, is it more useful for Crohn’s or UC
far more useful for UC
Who benefits more from antibiotics: Crohn’s or UC?
Patients with Crohn’s disease
two of the most commonly used antibiotics for treating Crohn’s disease
Metronidazole/Flagyl and Ciprofloxacin/Ciprofloxin
Budesonide/ Entocort is used to treat
mild to moderate Crohn’s disease
Azthioprine/ Immuran class
immunomodulator
MOA of Azthioprine/ Immuran
inhibits purine synthesis, resulting in an anti-proliferative effect and induction of apoptosis of T-cells
Infliximib/ Remicade class
immunomodulator - TNF inhibitor
MOA of Infliximib/ Remicade
inhibits the pro-inflammatory cytokine, TNF-alpha
major side effect of Infliximib/ Remicade
drug induced lupus
several medications are available to treat urge incontinence by
blocking acetylcholine action on the bladder and diminish detrusor muscle contraction
class of Oxybutynin/ Ditropan
anticholinergic med
MOA of Oxybutynin/ Ditropan
competitive antagonism of M3 subtype of the muscarinic acetylcholine receptor
class of Tolterodine/ Detrol
anticholinergic med
indication of Tolterodine/ Detrol
used to relieve frequent urination and inability to control urination due to urge incontinence
MOA of Tolterodine/ Detrol
competitive antagonism of M2 and M3 subtypes of the muscarinic acetylcholine receptor
Tolterodine/ Detrol and Oxybutynin/ Ditropan have potential interactions with
drugs metabolized by cytochrome P450
class of Imipramine/ Tofranil
tricyclic antidepressant, mainly used in the treatment of clinical depression but is also used in cases of urge incontinence and enuresis
MOA of Imipramine/ Tofranil
blocks reuptake of serotonin and norepinephrine and appears to diminish acetylcholine uptake in smooth muscle
2 very important things about Imipramine/ Tofranil
black box warning about increased risk for suicidal ideation and suicide. Overdose can be fatal due to a heart block.
drug used frequently for enuresis
Imipramine/ Tofranil
two main medication for management of BPH are
alpha blockers and 5alpha-reductase inhibitors
class of Tamsulosin/ Flomax
alpha 1 receptor antagonist
MOA of Tamsulosin/ Flomax
smooth muscle relaxation via alpha adrenergic antagonism
side effects of Tamsulosin/ Flomax
retrograde ejaculation
class of Finasteride / Proscar
5 alpha-reductase inhibitor
indication of Finasteride / Proscar
BPH
MOA of Finasteride / Proscar
blocks conversion of testosterone to dihydrotestosterone
Drug that is used for male pattern baldness and BPH
a lower dosage of Finasteride / Proscar
Drug that women who are or who may become pregnant must not handle crushed or broken
Finasteride / Proscar
the drug of choice for cystitis has been
TMP-Sulfa/Bactrim
drug that changes urine to distinct dark orange or reddish color
Phenazopyridine/ Pyridium
drug that has been known to permanently discolor contact lenses
Phenazopyridine/ Pyridium
Drug that should be used with caution in people with Parkinson’s disease because, as a dopamine antagonist, it may worsen the condition
Metoclopramide/ Reglan
dilution of epinephrine for anaphylaxis or status asthmaticus
1:1000 SQ or IM
dilution of epinephrine for cardiac issues (i.e. life threatening bradycardia)
1:10,000 I.V.
dilution of epinephrine for local injection when epinephrine is used along with an anesthetic agent (i.e. Lidocaine with epi)
1:50,000
treatments for bacterial vaginosis
metronidazole or clindamycin
treatments for cervicitis
azithromycin or doxycycline
treatments for chlamydia in adults and adolescents
azithromycin and doxycycline
treatment for chlamydia in pregnent people
azithromycin
treatments for chlamydia in infants, children, and neonates
erythromycin and ethylsuccinate
treatment for acute epididymitis likely caused by sexually transmitted CT and GC
ceftriaxone and doxycycline
treatment for acute epididymitis likely caused by sexually transmitted CT and GC and enteric organisms (anal sex)
ceftriaxone, levofloxacin, ofloxacin
acute epididymitis caused by enteric organisms
levofloxacin or ofloxacin
treatments for genital herpes simplex
acylcovir or valacyclovir or famciclovir
treatment for genital warts (HPV)
imiquimod or podofilox or sinecatechins or trichloroacetic acid or bichloroacetic acid
treatments for gonoccocal infections in adults and adolescents
ceftriaxone or azithromycin
treatment for pharyngeal gonorrhea
ceftriaxone or azithroycin
gonococcal conjunctivitis
ceftriaxone plus azithromycin
gonorrhea in children
ceftriaxone
treatment for Lymphogranuloma venereum
doxycycline
treatments for Nongonococcal Urethritis (NGU)
azithromycin or doxycycline
treatments for Pediculosis Pubis
permethrin or pyrethrins with piperonyl butoxide
treatments for Pelvic Inflammatory Disease
cefotetan plus doxycycline parenterally or IM: ceftriaxone with doxycycline
treatment for Scabies
permethrin or ivermectin
treatment for syphilis
benzathine penicillin G
treatment for Trichomoniasis
metronidazole or tinidazole
treatment for strep throat
penicillin or erythromycin if allergic
treatment of acute otitis media
amoxicllin, cephalosporin, or azithromycin if allergic
treatment for acute sinusitis
amoxil or a cephalosporin, erythromycin if allergic
treatments for bronchitis
amoxil, tmp-sulfa, or azithromycin
treatments for pneumonia
erythromycin or azithromycin, possibly quinolones
treatment for cystitis
TMP-sulfa
treatment for pyelonephritis
quinolones
treatment of celluliis
TMP-sulfa or mupiocin (bactroban)
