Multidiscipline pharm Flashcards
alpha-agonist that decreases aqueous humor synthesis via vasoconstriction
Use: glaucoma
epinephrine
Adv: mydriasis -> remember fight or flight -> open wide to see
alpha2-agonist decreases aqueous humor synthesis
Use: glaucoma
brimonidine
beta blockers used to decrease aqueous humor synthesis
Use: glaucoma
Timolol
Betaxolol
Carteolol
diuretic that decreases aqueous humor synthesis by inhibition of carbonic anhydrase
Use: glaucoma
acetazolamide
contracts the ciliary muscle and opens the trabecular meshwork to increase outflow of aqueous humor
direct cholinomimetics (2)
indirect cholinomimetics (2)
Use: glaucoma
Direct: pilocarpine, carbachol
Indirect: physostigmine, echothiophate
Adv: miosis & cyclospasm (contraction of ciliary muscle)
prostaglandin that increases outflow of aqueous humor
Use: glaucoma
Latanoprost
Adv: brown iris
- opioid receptor agonists that modulate (decrease) synaptic transmission by opening potassium channels & closing Ca2+ channels
- inhibit release of ACh, NE, 5-HT, glutamate & substance P
morphine fentanyl codeine loperamide methadone meperidine dextromethorphan diphenoxylate Adv: addiction, resp depression, constipation, miosis (no tolerance to miosis & constipation)
opioid receptor antagonists
naloxone
naltrexone
mu receptor partial agonist
kappa receptor agonist
Use: severe pain tx with less resp depression side effect
butorphanol
very weak opioid agonist
inhibits serotonin & NE reuptake
Use: chronic pain
Adverse: lowers seizure threshold; serotonin syndrome
tramadol
drug that induces hepatic enzymes and can result in decreased plasma levels of other medications
RIFAMPIN
others: Phenobarbitol, carbamazepine, phenytoin, nevirapine, griseofulvin, St. John’s wart, chronic alcohol use, modafinil
cause coronary vasospasm drug rxn
cocaine
sumatriptan
ergot alkaloids
cause cutaneous flushing drug rxn
Vancomycin
Adenosine
Niacin
Calcium channel blocker
cause dilated cardiomyopathy drug rxn
doxorubicin
daunorubicin
cause Torsades de pointes
Class III antiarrhythmics (sotalol) Class IA antiarrhythmics (quinidine) macrolides antipsychotics TCAs
cause adrenocortical insufficiency
glucocorticoid withdrawal
cause hot flash drug rxn
tamoxifen
clomiphene
cause hyperglycemia
tacrolimus protease inhibitors Niacin HCTZ beta blockers corticosteroids
cause hypothyroidism
Lithium
amiodarone
sulfonamides
cause acute cholestatic hepatitis, jaundice drug rxn
erythromycin
cause diarrhea drug rxn
metformin erythromycin colchicine orlistat acarbose "might excite colon on accident"
cause focal to massive hepatic necrosis drug rxn
halothane amanita phalloides (death cap mushroom) Valproic acid acetaminophen "liver Havac"
cause hepatitis drug rxn
INH
cause pancreatitis drug rxn
Didanosine corticosteroids alcohol valproic acid azathioprine diuretics (furosemide, HCTZ) "Drugs Causing A Violent Abdominal Distress"
cause pseudomembranous colitis (C diff) drug rxn
Clindamycin
ampicillin
cephalosporins
drugs that cause cinchonism
temporary deafness, ringing in ears, headache
quinidine
quinine
drugs that cause Parkinson-like syndrome
Antipsychotics
Reserpine
Metoclopramide
drugs that cause seizures
INH (Vit B6 deficiency) Buproprion Imipenem/cilastatin tramadol enflurane metaclopramide
Causes tardive dyskinesia drug rxn
Antipsychotics
Metoclopramide
Causes hemorrhagic cystitis
cyclophosphamide
ifosfamide
Causes interstitial nephritis drug rxn
methicillin
NSAIDs
furosemide
Causes pulmonary fibrosis drug rxn
Bleomycin Amiodarone Busulfan Methotrexate "breathing air badly from medications"
Causes SIADH drug rxn
carbamazepine
cyclophosphamide
SSRIs
“can’t concentrate serum sodium”
causes diabetes insipidus drug rxn
lithium
demeclocycline
causes Fanconi syndrome drug rxn
expired tetracycline
Causes SLE-like syndrome drug rxn
Sulfa drugs Hydralazine INH Procainamide Phenytoin Etanercept "having lupus is SHIPP-E"
Causes fat redistribution drug rxn
protease inhibitors
glucocorticoids
Causes myopathy drug rxn
Fibrates Niacin Colchicine hydroxychloroquine IFN-alpha penicillamine statins glucocorticoids
Causes hemolysis in G6PD deficiency
INH Sulfonamides Dapsone Primaquine Aspirin Ibuprofen Nitrofurantoin
nonlinear pharmacokinetics
extensive binding to plasma proteins
Used for tonic-clonic & partial seizures
MOA: blocks voltage-gated sodium channels
phenytoin
Adverse: diplopia, ataxia, gingival hyperplasia, hirsutism, neuropathy
drugs for absence seizures
clonazepam
ethosuximide
valproic acid
drugs for myoclonic seizures
clonazepam
lamotrigine
valproic acid
for absence seizures
MOA: decreases Ca2+ currents (T-type)
ethosuximide
voltage-gated sodium channel blockers used for seizures
prolong the refractory period for a neuron
Phenytoin Carbamazepine Lamotrigine Zonisamide Note: lamotrigine blocks both sodium & calcium channels & decreases glutamate
increase the frequency of GABA-mediated chloride channel opening
benodiazepines
increase the duration of the GABA-mediated chloride channel opening
also block glutamic acid
At high concentration: block sodium channels
These depress neuronal activity in the midbrain reticular formation, prolonging the inhibitory effects of GABA & glycine.
Use: anxiety, seizures, insomnia, anesthesia
barbiturates: Phenobarbital Pentobarbital Thiopental Secobarbital
hypnotic drug that activates melatonin receptors in the suprachiasmatic nuclei
decreases latency of sleep onset with minimal rebound insomnia or withdrawal
ramelteon
Given before niacin to prevent flush
Aspirin
Flush is thought to be mediated by prostaglandin
increases blood flow to muscle during exercise
epinephrine
can decrease diastolic bp
NTs thought to be deficient in ADHD
DA and NE in the prefrontal cortex
growth factor that influences neuron growth and survival
brain-derived neurotrophic factor (BDNF)
Note: the two week delay in efficacy of anti-depressants is thought to be due to production of of BDNF
amino acid precursor of serotonin
tryptophan
if have symptoms of depression, check for?
levels of thyroid hormone, estrogen & testosterone
Mechanism of action of antidepressants
Increase availability of NTs
bind to SERT and NET to prevent reuptake
SNRIs:
Venlafaxine
Desvenlafasine
Duloxetine
MOA: inhibition of SERT
SSRIs Fluoxetine certroline Citalopram drugs are highly lipophilic
TCA antidepressant with anticholinergic properties
imipramine
MOA: prevention of NT reuptake by NET and SERT
found primarily in the brain, gut, placenta and liver
breaks down epi, NE, DA and 5-HT
MAO-A
associated with the EPS of antipsychotic medications
blockade of D2 receptors in nigrostriatal pathway
schizophrenia is thought to involve increased density of D2 receptors
5-HT2A and 5-HT2C receptors modulate the release of dopamine, NE, glutamate, GABA and acetylcholine, as well as other NTs of the cortex, limbic region and striatum
unpleasant senstations of inner restlessness
akathisia
Note: the most unwanted effect of antipsychotics is tardive dyskinesia
It’s caused by the relative deficiency of ACh because of supersensivity of DA receptors of caudate & putaman
enhance effects of GABA allosterically and increase the frequency of chloride channel opening
benzodiazepines
Effects on sleep:
○ Decreases latency of sleep onset
○ Increases duration of stage 2 nonREM sleep
○ Duration of REM sleep is decreased
○ Duration of stage 4 nonREM slow-wave sleep is decreased
Tolerance: downregulation of BZ receptors
reflects the concentration of anesthetic soluble in the blood
blood:gas partition coefficient
concentration required to prevent a response to a surgical incision in 50% of population (evidenced by immobility which is mediated by neural inhibition within the spinal cord)
Minimal Alveolar Concentration (MAC)
MAC is dependent upon cerebral blood flow and can be reduced by inhaled anesthetics
what circumstance would NO be a poor choice for anesthetic
fetal manipulation
NO has little effect on uterine smooth muscle.
○ Muscle rigidity, hyperthermia, rapid onset of tachycardia and hypercapnia, hyperkalemia and metabolic acidosis
-may occur with use of succinylcholine
Malignant hyperthermia
Tx: dantrolene
MOA: decreases Ca2+ release from the SR
- produce analgesia by binding with G protein-coupled receptors located in the brain and spinal cord
1. Close voltage-gated Ca2+ channels on presynaptic nerve terminals, reducing NT release
2. Hyperpolarize postsynaptic neurons by opening K+ channels → inhibition
opioid agonists
GI effects of opioids
§ Decreased motility
§ Decreased HCl release
§ Tone increased with periodic spasms of intestine while peristaltic waves are diminished: delays passage of fecal mass
what medication class enhances the analgesic effects of opioids
amphetamines
○ Selective 5-HT1 agonists that decrease nausea and vomiting of migraine
triptans
Sumatriptan
activation requires release of glutamate onto a receiving neuron that is depolarized
NMDA receptor
blocked by magnesium at negative potentials
○ Shape and color distortion, depersonalization, hallucinations, distorted time perception, dizziness, nausea, paresthesias, blurred vision
○ Do not induce dependence or addiction
○ Increase glutamate release at the cortex
○ Main target 5-HT2a receptor
LSD, mescaline & psilocybin
block the magnesium binding site in the NMDA channel, preventing excessive excitability, reducing the rate of clinical deterioration
memantine
NMDA, AMPA, or kainic acid
glutamate receptors
decrease sympathetic outflow by activation of alpha2 receptors to reduce blood pressure by reducing cardiac output &/or vascular resistance.
Methyldopa -> hemolysis
Clonidine -> rebound HTN if dced
Adverse of both: sedation
alpha1 blockers used for HTN
prazosin, doxazosin, terzosin
Adverse: orthostatic hypotension
Bonus: relax prostate smooth muscle (BPH tx)
how do beta blockers help with HTN?
initially, they decrease cardiac output
After a few days they reduce vascular resistance by decreasing ANG II
Note: nebivolol has direct vasodilator action
dihydropyridine CCB used to tx HTN
MOA: blocks L-type Ca channels
nifedipine**
-dipine drugs
Adverse: excessive cardiac depression; constipation
vasodilator effects are > than cardiac depressor effects
drug to treat HTN by opening K+ channels and vasodilation of arterioles
Causes hirsutism so can be used to tx male-pattern baldness
minoxidil
Used to tx HTN
MOA: causes release of NO from endothelial cells
hydralazine
Adverse: lupus-like syndrome
Can be used in combo with isosorbide dinitrate to treat heart failure
D1 receptor agonist used for hypertensive emergencies
MOA: marked arteriolar vasodilation
fenoldopam
Used for prophylaxis in those definitely exposed to N meningitidis, as well as the carrier state
Rifampin
Antibiotic of choice for lung abscess in alcoholic (most likely due to aspiration)
Clindamycin
Used in tx of hypoglycemia to inhibit insulin release
Relaxes vascular smooth muscle ( hypertensive crisis)
Diazoxide
GnRH analog with agonist activity when used in pulsatile fashion; antagonist when used continuously
Used for prostate cancer, uterine fibroids, precocious puberty, infertility (pulsatile for infert)
Leuprolide
Increases LH and FSH release from ant pituitary
Used to stimulate ovulation
Clomiphene
Antagonist at breast tissue
Agonist at uterus and bone
Tx: breast cancer
Tamoxifen
Raloxifene does not affect uterus and can be used to tx osteoporosis
Aromatase inhibitors
Anastrozole
Exemestane
5 alpha reductase inhibitor
Finesteride
Nonsteroidal competitive inhibitor of androgens at testosterone receptor
Flutamide
Alpha 1 antagonist used to treat BPH by inhibiting smooth muscle contraction
Tamsulosin
