Multidiscipline pharm Flashcards by Melanie Bray

alpha-agonist that decreases aqueous humor synthesis via vasoconstriction
Use: glaucoma

epinephrine

Adv: mydriasis -> remember fight or flight -> open wide to see

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alpha2-agonist decreases aqueous humor synthesis

Use: glaucoma

brimonidine

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beta blockers used to decrease aqueous humor synthesis

Use: glaucoma

Timolol
Betaxolol
Carteolol

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diuretic that decreases aqueous humor synthesis by inhibition of carbonic anhydrase
Use: glaucoma

acetazolamide

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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)

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prostaglandin that increases outflow of aqueous humor

Use: glaucoma

Latanoprost

Adv: brown iris

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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)

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opioid receptor antagonists

naloxone

naltrexone

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mu receptor partial agonist
kappa receptor agonist
Use: severe pain tx with less resp depression side effect

butorphanol

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very weak opioid agonist
inhibits serotonin & NE reuptake
Use: chronic pain
Adverse: lowers seizure threshold; serotonin syndrome

tramadol

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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

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cause coronary vasospasm drug rxn

cocaine
sumatriptan
ergot alkaloids

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cause cutaneous flushing drug rxn

Vancomycin
Adenosine
Niacin
Calcium channel blocker

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cause dilated cardiomyopathy drug rxn

doxorubicin

daunorubicin

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cause Torsades de pointes

Class III antiarrhythmics (sotalol)
Class IA antiarrhythmics (quinidine)
macrolides
antipsychotics
TCAs

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cause adrenocortical insufficiency

glucocorticoid withdrawal

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cause hot flash drug rxn

tamoxifen

clomiphene

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cause hyperglycemia

tacrolimus
protease inhibitors
Niacin
HCTZ
beta blockers
corticosteroids

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cause hypothyroidism

Lithium
amiodarone
sulfonamides

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cause acute cholestatic hepatitis, jaundice drug rxn

erythromycin

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cause diarrhea drug rxn

metformin
erythromycin
colchicine
orlistat
acarbose
"might excite colon on accident"

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cause focal to massive hepatic necrosis drug rxn

halothane
amanita phalloides (death cap mushroom)
Valproic acid
acetaminophen
"liver Havac"

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cause hepatitis drug rxn

INH

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cause pancreatitis drug rxn

Didanosine
corticosteroids
alcohol
valproic acid
azathioprine
diuretics (furosemide, HCTZ)
"Drugs Causing A Violent Abdominal Distress"

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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