MT 1 Flashcards
Imipramine (Tofranil)
Anti Depressant, Tricyclic Amine (TCA)
FDA approved: Depression Enuresis (bed wetting)
Off Label: Neuropathic Pain (ex: diabetic neuropathy)
Opto Rxn: Accommodative disturbance, angle-closure glaucoma, blurred vision, mydriasis
Amitriptyline (Elavil)
Anti Depressant, Tricyclic Amine (TCA)
FDA approved: Depression
Off Label: Neuropathic Pain (ex: diabetic neuropathy)
Opto Rxn: Accommodative disturbance, blurred vision, mydriasis, increased IOP
Topiramate (Topamax)
Anti Convulsant
FDA approved: Epilepsy, migraine prophylaxis
Gabapentin (Neurontin)
Anti Convulsant
FDA Approved: Seizures, post herpetic neuralgia (PHN)
Off Label: Diabetic Neuropathy
Opto Rxn: Nystagmus
Bevacizumab (Avastin)
Anti Neoplastic, VEGF Inhibitor monoclonal antibody (mAb)
Off Label: age-related macular degeneration
Etanercept (Enbrel)
Tumor Necrosis Factor (TNF) Inhibitor
a recombinant DNA - derived protein – linked to human IgG1
treatment of rheumatoid arthritis
a disease modifying antirheumatic agent (DMARD)
Infliximab (Remicade)
Tumor Necrosis Factor (TNF) Inhibitor
mnoclonal antibody (mAb) binds to human tumor necrosis
Treatment of rheumatoid arthritis, Crohn disease,& ulcerative colitis
A Disease modifying antirheumatic agent & gastrointestinal agent (DMARD and GI)
Moxifloxacin (Vigamox, Moxeza)
fluoroquinolone antibiotic for the treatment of bacterial conjunctivitis
Vigamox 3x a day
Moxeza 2x a day
Opto Antibiotics that can have Chelation (altered drug mech)
Binding of metal ion, Al, Mg, Ca, Fe
Tetracyclines (Doxycycline - Vibramycin)
Fluoroquinolones (Ciprofloxacin - Cirpo)
Levoflaoxacin (Levaquin)
Combined drug effects of :
Diphenhydramine (Benadryl)
Opioid Agonists
Sleep Medications
Can have CNS additive CNS depressant effects
Vancomycin and Gentamicin
Drug Interaction : Synergism “1+1=3”
Vancomycin and Gentamicin used in combination to treat bacterial endocarditis
Vancomycin inhibits bacterial wall synthesis
gentamicin interferes with bacterial protein synthesis
Naloxone (Narcan)
Drug interaction: Antagonism “1+ (-1) = 0”
administered in opioid overdose – reverses effects of morphine/ CNS depressant effects of substance drug
Amoxicillin with Clavulanate (Augmentin)
Drug Interaction: Potentiation “0+1=2”
amoxicillin = penicillin antibiotic
clavulanate (clavulanic acid) has now killng action
combined clavulanic acid protects the amoxicillin molecule by binding to beta-lactamases produced by bacteria
NSAIDs
Nonsteroidal inflammatory Drugs
ex: Ibuprofen (Motrin, Advil)
Affects Hearts, GI, and Kidneys
Drugs that have Extensive Volume of Distribution
2 drugs
Zithromax (Azithromycin)
Vibramycin (Doxycycline)
Drug Examples with Drug Deposition
2 Drugs
Amiodarone (Pacerone, Codarone)
Corneal microdeposits, >90%, 10% have visual disturbances
Optic Neuritis (1%)
Vibramycin (Doxycycline)
may induce hyperpigmentation, oral cavities
Pediatrics: tooth enamel hypoplasia (permanent tooth discoloration)
Nepafenac (Nevanac and Ilevro)
nonsteroidal antiflammatory (NSAID) ophthalmic drug
for pain and inflammation post-cataract surgery
Hydrolyzed in ocular tissue to amfenac (active drug)
Clopidogrel (Plavix)
Pro drug - antiplatelet agent – to reduce platelet aggregation and maintain vessel patency
Black Box Warning
Clinical Importance for Poor Metabolizers
CYP450 2C19 target enzyme
Lower conversion to active metabolite may result in reduced platelet inhibition
Higher risk of Cardiovascular event
Do not take Omeprazole or Esomeprazole
Codeine
Opioid analgesic – Prodrug –> active metabolite is Morphine
BBW
Clinical importance
CYP450 2D6
Ultra-rapid metabolizer
May experience morphine toxicity – respiratory depression
–> high morphine levels
Warfarin
Anticoagulant
Poor Metabolizers
Will NOT metabolize warfarin as effectively to an inactive metabolite
– requires lower doses of warfarin
Example of Maintenance Doses
Provastatin (Pravachol) : 20mg tab
Moxifloxacin (Vigamox) - one drop to affected Eye
Omeprazole (Prilosec)
& Esomeprazole (Nexium)
Proton Pump Inhibitor
Gastroesopheal reflux disease, peptic ultcer and heart burn
suppress gastric acid secretion by inhibit proton pumps
can be replaced with:
Lansoprazole (prevacid)
Pantoprazole (protonix)
Rabeprazole (aciphex)
Dexlansoprazole (Dexilant)
Trastuzumab (Herceptin)
Antineoplastic agent (Anti-Her2) monoclonal antibody
Tx: breast and gastric cancer
mech: binds to HER2 protein
^requires + HER2 genomic testing to ensure efficacy
IV infusion
Oral Tryosine Kinases Inhibitors (TKIs)
chemotheapy that inihibits enzyme tyrosine kinase
inhibits cancer cell proliferation
