PHARM Flashcards by Alexis McKay

MOA: Blocks Na channels, State dependent- best in rapidly firing neurons
(combined with vasoconstrictors like Epi)
ADE: Arrhythmias, Cardiotoxicity

Local Anesthetics (indicated for minor procedures, and epidurals) **infected tissues need higher doses

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MOA: Local anesthetic with 1 “I” in name, blocks NA channels
ADE: prone to causing allergic rxns, arrhythmias

Esters “cocaine, procaine”

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MOA: Local anesthetic with 2 “I” in name, blocks NA channels
ADE: prone to LIVER FAILURE (metabolized in liver), arrhythmias, cardiotoxicity

Amides “Bupivacaine, lidocaine”

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Local anesthetic that blocks Na channels, Class 1B antiarrhythmic, and use for ventricular dyrhythmias
ADE: “tingling”, respiratory depression, fatigue/drowsy, seizures

Lidocaine (Amide)

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-Unknown Mechanism, act on GABA receptors
“HEISM” -HALOTHANE, ENFLURANE, ISOFLURANE, SEVOFLURANE, METHOXYFLURANE, Nitrous Oxide
ADE: resp depression, myocardial depression, bradycardia/hypotension, hepatotoxicity, nephrotoxicity, malignant hyperthermia, expansion of trapped gas

Inhaled Anesthetics
-Halothane: cause hepatotoxicity
-Enflurane: cause seizures
-Methoxyflurane: cause nephrotoxicity
-Nitric oxide: cause exp of trapped gas

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-MOA: potentates GABA-A, leads to rapid anesthesia induction

Propofol (IV anesthetic)

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-NMDA receptor antagonist (Arylcyclohexylamines), PCP analogs that block effects of glutamic acid at NMDA receptors
ADE: can lead to dissociative amnesia, hallucinations

Ketamine (IV anesthetic)

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-Benzo Receptor Antagonist

MOA: reverses benzos via competitive inhibit of the benzo binding site on GABA receptor

ADE: seizures, intensive monitoring is necessary

Flumazenil (Benzo Receptor Antag)

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-MOA: increase GABA

ADE: HYPOtension, respiratory depress, confusion, coma, drowsiness

TX: BY FLUMAZENIL

Benzo’s (Midazolam) -zepam/zolam
can be IV anesthetic

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MOA: INCREASE Chloride Channel Opening, DECREASING neuron firing

-ultra short acting, IV anesthesia induction, short surgical procedures, *DOES NOT PROVIDE ANALGESIA (just LOC)
-TX: anxiety, seizures
ADE: resp/cardio depression

Barbituates (Thiopental) IV anesthetic

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Gq protein coupled receptor, activates phospholipase C (PIP2–> DAG and IP3)
-DAG–> protein kinase C
-IP3–> phosphorylation

Leads to vasoconstriction, inc BP, pupillary dilator contraction, intestine/bladder sphincter contraction, in smooth muscle, URINARY RETENTION

Alpha 1 Receptor ***EPI PENS

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-Gi protein coupled receptor, inhibit CAMP from ATP
-VASOCONSTRICT
-DECREASE sympathetic outflow (NE), insulin release in pancreas, lipolysis in adipose, aqueous humor production (treats glaucoma)
-INCREASE platelet aggregation

Alpha 2 Receptor (Brimonidine) tx: glaucoma

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-Gs protein coupled receptor, stimulate adenylate cyclase to activate CAMP pathway–> protein Kinase A

-INCREASE HR/CO, contractility, renin release, lipolysis

Beta 1 Receptor

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-Gs protein coupled receptor, stimulate adenylate cyclase to activate CAMP pathway–> protein Kinase A

-VASOLDILATE
-INCREASE CO/contractility/HR, insulin, lipolysis, aqueous humor production in eye, uterus relaxation, RELAX ciliary muscle, bronchodilator (tx asthma)

Beta 2 Receptor tx: asthma/stop early labor

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-Cytochrome p450 inhibitors

-Quinidine, Ciprofloxacin, Isoniazid, Grapefruit juice, erythromycin, indinavir, cimetidine, sulfonamides, ketoconazole, amiodarone, Acute alc use

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-cytochrome p450 inducers
**be careful taking birth control, can stop ur BC from working or other medications the patient is on

-Griseofulvin, Phenytoin, Carbamazepine, Rifampin, Barbituates, Chronic Alc Use, St. John’s Wort

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-Class 1 Antiarrhythmic, fast inward NA currents

ADE: cinchonism, lupus like syndrome

Quinidine

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End in “Navir”

-HIV drugs

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-Flouroquinolone
-USED FOR GRAM NEG RODS of Urinaty/GI tracts

MOA: interferes with TOP II

-Ciprofloxacin (fluoroquinolone)

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-MOA: decreases synthesis of MYCOLIC ACIDS, key components of cell wall of Mycobacterium TB

(only mono therapy prophylaxis against TB)

Isoniazid

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-USED FOR B. PERTUSSIS, LEGIONELLA, MYCOPLASMA PNEUMO

-MOA: inhibits protein synthesis by binding to 23S RNA of 50S ribosomal subunit, blocking translocation

Erythromycin (macrolide)

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MOA: HIV protease inhibitor that is used as antiretroviral therapy

TX: HIV/AIDS

Indinavir

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MOA: Histamine H2 recetor ANTAG

TX: heartburn, decreases stomach acid production

Cimetidine

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MOA: INHIBIT fungal ergol sterol synthesis

Tx: systemic mycoses

Ketoconazole

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MOA: inhibit 50S ribosomal subunit, broad spectrum TX: BACT MENINGITIS (S. Pneumo, H. Influenza, N. Mening) AND ROCKY MOUNT SPOT FEVER ADE: bone marrow suppress, aplastic anemia, gray baby syndrome (dec UDP glue transfer)

Chloramphenicol (protein synthesis inhibit)

-Antiarrythmic med

Amiodarone

-Oral Antifungal Drug, skin/nails -MOA: interferes with microtubule function and mitosis of fungus

-Griseofulvin (Antifungal Drug)

-Antiepileptic Drug -Class 1B anti arrhythmic MOA: suppress abnormal brain activities by BLOCKING Na channels

Phenytoin (Antiepileptic Drug)

-Anticonvulsant, mood stabilizing drug TX: epilepsy, trigeminal neuralgia

Carbamazepine (Anticonvulsant, mood stabilizing drug)

MOA: inhibiting DNA dependent RNA polymerase TX: mycobacterium TB

Rifampin

Competitive muscarinic ANTAG MOA: BLOCKS ACH in Muscarinic Receptors -REVERSES "DUMBBeLSS" Diarrhea, urination, mitosis, bradycardia, bronchoconstriction, lacrimation, salivation, sweating -INC HR in bradycardia/dilates pupils/cycloplegia/mydriasis, ophthalmic procedures, and TX in organophosphate poisoning -Use in Malignant glaucoma -CONTRAINDICATED in narrow angle glaucoma ADE: hot as a hare, mad as a hatter, red as a beet, dry as a bone

Atropine (anticholinergic) **does NOT block CNS excitation (e in DUMBBeLLS) bc that is by Nicotinic receptors**

"B. O. AT. S"- blocks Ach, muscarinic antag -Benztropine -Oxybutynin -Atropine -Scopolamine -REVERSES "DUMBBeLSS" Diarrhea, urination, mitosis, bradycardia, bronchoconstriction, lacrimation, salivation, sweating

Anticholinergics

"PARK my BENZ" MOA: muscarinic antag, blocks Ach -can be used with Levodopa therapy to TX Parkinsons to reduce imbalance ADE: blurry vision, dry mouth, urinary retention, tachy, constipation, psychosis

Benztropine (anticholinergic)

-antispasmodic med MOA: muscarinic antag, blocks Ach -TX: bladder spasms, stops frequent urination or urge incontinence

Oxybutynin (anticholinergic)

"SCOPe SICKNESS" MOA: muscarinic antag, blocks Ach TX: motion sickness, has sedative properties

Scopolamine (anticholinergic)

MOA: muscarinic antag, blocks Ach TX: reduces airway secretions/stomach acid (helps in peptic ulcer) **used with Neostigmine (Nm blocker) to prevent bradycardia

Glycopyrrolate (anticholinergic)

MOA: muscarinic cholinoreceptors AGONIST, increase PSNS activity/Ach -Bethanechol -Pilocarpine -Methacholine -Carbachol

Direct Cholinomimetics

MOA: muscarinic cholinoreceptors AGONIST, increase PSNS activity/Ach TX: stimulate bladder contraction/GI motility, prevent urine retention

Bethanechol (direct cholinomimetic)

MOA: muscarinic cholinoreceptors AGONIST, increase PSNS activity/Ach -Causes Bronchoconstriction, Used as a test in diagnosis of asthma

Methacholine (direct cholinomimetic)

MOA: muscarinic cholinoreceptors AGONIST, increase PSNS activity/Ach **CONTRACTS Ciliary muscle for open angle glaucoma, and Pupillary/Iris Sphincter for closed angle glaucoma -Stimulates saliva, sweat, tears, MIOSIS -RESISTANT to acetylcholinesterase TX: open angle/closed angle Glaucoma/ xerostomia ADE: detached retina, decreased visual acuity, eye irritation, RARELY: bradycardia/bronchospasms

Pilocarpine (direct cholinomimetic) **CONTRAINDICATION: AVOID IN ASTHMA OR BRADYCARDIA

MOA: muscarinic cholinoreceptors AGONIST, increase PSNS activity/Ach **RELIEVES intraocular pressure, pupillary constriction--> open angle -TX: open angle glaucoma

Carbachol (direct cholinomimetic)

MOA: DECREASE acetylcholinesterase enzyme to INCREASE Ach (Acetylcholinesterase inhibitors) ADE: CAUSE "DUMBBeLLS" DOESN'T CROSS BBB: -Edrophonium -Pyridostigmine/Neostigmine CROSSES BBB: -Physostigmine -Donepezil

Indirect Cholinomimetics (Acetylcholinesterase Inhibitors) CAUSE "DUMBBeLLS" (anticholinergic reverses it- the B.O.AT.S)

MOA: DECREASE acetylcholinesterase enzyme to INCREASE Ach (REVERSIBLE Acetylcholinesterase inhibitor) USE: to DIAGNOSE Myasthenia Gravis, "tensilon test", patients immediately show weakness, also to reverse non depolarizing drug blockade **DOESNT CROSS BBB

Edrophonium (reversible indirect cholinomimetic acetylcholinesterase inhibitor)

MOA: DECREASE acetylcholinesterase enzyme to INCREASE Ach (REVERSIBLE Acetylcholinesterase inhibitor) TX: MYASTHENIA GRAVIS **DOESN'T CROSS BBB

Pyridostigmine Neostigmine (also used to reverse Nm blockers in anesthesia/ Post surgery ileus) *indirect cholinomimetic acetylcholinesterase inhibitors

MOA: DECREASE acetylcholinesterase enzyme to INCREASE Ach (Acetylcholinesterase inhibitors) -MORE HYDROPHOBIC that others TX: atropine/anticholinergic drug overdoses, and induces miosis to help decrease intraocular press in Glaucoma **CROSSES BBB

Physostigmine (indirect cholinomimetic acetylcholinesterase inhibitor)

MOA: DECREASE acetylcholinesterase enzyme to INCREASE Ach (Acetylcholinesterase inhibitors) TX: ALZHEIMERS DZ (to help increase Ach) ADE: N/V, Dizziness **CROSSES BBB

Donepezil (indirect cholinomimetic-acetylcholinesterase inhibitor)

-CAUSES "DUMBBeLSS" Diarrhea, urination, miosis, bradycardia, bronchoconstriction, lacrimation, salivation, sweating TX: Atropine (cross BBB) + Pralidoxime (cant cross)

Acetylcholinesterase Inhibitor Poisoning

Include "CUR" MOA: Reversible competitive inhibitors of Ach, leads to less receptors available for Ach to bind to USE: muscle paralysis during mech ventilation or surgery, -Atracurium -Mivacurium -Pancuronium -Rocuronium -Tubocurarine -Vecuronium

Nondepolarizing Nm BLOCKING drugs TX: with acetylcholinesterase inhibitors (to increase Ach again) Neostigmine, Edrophonium

Tx: to reverse Nondepolarizing Nm Blocking drugs (Ach competitive inhibitors) "cur"

Neostigmine (tx myasthenia gravis) and Edrophonium (diagnoses myasthenia gravis) **both are acetylcholinesterase inhibitors

-short term paralytic used in hospital MOA: Nm blocking drug binding to motor nicotinic receptor, Ach AGONIST -OPENS Na Channels **keeps the nerve stuck in depolarizing/paralysis Phase 1: Paralysis, NON reversible Phase 2: Paralysis, Reversible/Ach receptors are desensitized to Ach (tx with Neostigmine to help reverse and overcome desensitization)

Succinylcholine (Ach receptor Agonist) **induces paralysis

"AD BAC has HTN" 1- ACE inhibitors, lowers Ang 2 in body, preventing EA constriction in kidney, decreasing GFR, less aldosterone secretion (-"pril") 2-Diuretics, lower BP by reducing fluid volume (osmotic, carbonic anhydrase inhibitors, loop, thiazide, potassium sparing) 3-Beta Blockers, reduce HR/CO/renin (-"olol") 4-Ang 2 receptor blockers, prevents Ang 2 from binding to AT1 receptor, reducing vasoconstriction (-"sartan") 5-Calcium Chann Blockers (dihydropyridine), decrease resistance (-"dipine")

Hypertension Medications for high blood pressure

MOA: inhibits ACE/RAAS (-"pril") lowers Ang 2 in body, preventing EA constriction in kidney, decreasing GFR, less aldosterone secretion TX: HTN, CHF, Diabetic Neuropathy ADE: increases bradykinin (vasodilator), cough *CAPTOPRIL MNEUMONIC*

ACE inhibitors (-pril)

-ADE: "CAPTOPRIL MNEUMONIC" -COUGH -ANGIOEDEMA -POTASSIUM INCREASE (hyperkalemia) -TASTE CHANGES -HYPOTENSION -PREGNANCY PROBS (can cause stillbirth, baby kidney damage, congenital malformations) -RASH -INC RENIN -LOWER ANG 2

ACE inhibitors (-pril) TOXICITY **affect EFFERENT ARTERIOLE OF GLOMERULUS

MOA: prevents Ang 2 from binding to AT1 receptor, reducing vasoconstriction, (-"sartan") *DO NOT AFFECT BRADYKININ (unlike ace inhibitors)... NO cough USE: patients who are intolerant to ACE inhibitors, HTN, CHF, diabetic neuropathy *CONTRAINDICATION: pregnancy

Ang 2 receptor blockers (-"sartan")

Class 4 antiarrthymic -slow AV conduction (-"dipine") USE: angina pectoris, arrhythmias, essental HTN *CONTRAINDICATED IN HEART BLOCKS ADE: bradycardia, hypotension, constipation, peripheral edema, gingival hyperplasia

Calcium channel Blockers Verapamil and Diltiazem (non-dihydropyridine), (-"dipine")

MOA: inhibit Na-K-2Cl symporter in the THICK ASCENDING limb of loop of henle. -Lower BP by reducing fluid volume, increases urine production, inhibiting Na/Cl reabsorption USE: HTN, HYPERCALCEMIA, CHF ADE: *allergic run, increase GOUT (hyperuricemia), ototoxicity, HYPOCALCEMIA, HYPOKALEMIA, HYPOMAGNESIUM, METABOLIC ALKALOSIS **FUROSEMIDE is a SULFA drug, CONTRAINDICATED IN PT WITH SULFA ALLERGY

Loop Diuretics (furosemide-sulfa drug) *Ethacrynic Acid (phenoxyacetic acid derivative) is NOT a sulfa drug, so if pt needs a loop diuretic thats allergic to sulfa, can take E. Acid* (everything else is same as Furosemide

MOA: osmotic diuretic, decreases water and Na reabsorption in PCT, inc water/Na EXCRETION, decreasing ECF volume, INCREASES URINE FLOW **INC PLASMA/TUB FLUID OSMOLALITY USE: high ICP, glaucoma, oliguric renal failure, drug overdoses ADE: dehydration

Mannitol (osmotic diuretic) *CONTRAINDICATED IN CHF/ANURIC PATIENTS (if they have no production of urine to begin with)

**FIRST LINE TX FOR HTN MOA: inhibit NaCl and water reabsorption form DCT by blocking Na/Cl cotransporter (water also blocked) USE: HTN, HYPOcalcemia, HYPERnatremia, edema ADE: HYPERglycemia, HYPERlipidemia, HYPERcalcemia, HYPERuricemia, HYPOnatremia, HYPOmagnesium, HYPOkalemia Metabolic Alkalosis, DEHYDRATED **Hydrochlorothiazide is a SULFA drug, CONTRAINDICATED IN PT WITH SULFA ALLERGY/ DO NOT GIVE TO PT BREASTFEEDING/PREGNANT

Thiazide Diuretics (Hydrochlorothiazide- sulfa drug) **"thiazides cause hyperGLUC: hyperGLYCEMIA, hyperLIPIDEMIA, hyperURICEMIA, hyperCALCEMIA"

-MOA: inhibits carbonic anhydrase in PCT, leads to sodium bicarb diuresis/reduced bicarb in kidneys/ body, **SULFA drug USE: glaucoma (dec IOP/dec aqueous humor in eye), altitude sickness, pseudo tumor cerebri, CHF, metab alkalosis ADE: hyperchloremic metab acidosis, paresthesias, TYPE 2 renal tubular acidosis,

Acetazolamide (Carb Anhydrase Inhibitor)

-Blocking Na Channels/Competitive Aldosterone receptor Antagonist in Cortical Collecting Tubule/collecting duct USE: CHF, HTN, HYPOKALEMIA (to increase K), HYPERALDOSTERONISM, EDEMA ADE: HYPERkalemia (muscle weakness, fatal arrhythmias), HYPOaldosterone, HYPOnatremia, Gynecomastia/ED/low libido with spironolactone/Endocrine effects **TELL PT TO AVOID POTASSIUM SUPPLEMENTS

K+ sparing diuretics (Spironolactone-androgen blocker ADE)/Eplerenone (like spironolactone but no androgen ADE) **Amiloride and Triamterene are K+ sparing diuretics that act on Epithelial Sodium Channels (ENaC)

MOA: block/slow fast conduction in Na channels, especially depolarized cells -REDUCES Phase 0 Depolarization SLOPE/rate -INCREASE ERP/QT/AP/QRS -INCREASE threshold for firing in abnormal pacemaker cells -STATE DEPENDENT TX: Atrial/Ventricular Tachy, Reentranct, Ectopic SVT arrhythmias (Wolfe parkinson), local anesthetics **CONTRAINDICATED IN HYPERKALEMIA PT (too much K)

Class IA Antiarrhythmics (Na channel blockers) -Procainamide, Quinidine, Disopyramide "Double Quarter Pounders" ALL^ ADE: TORSADES

-Class 1A Antiarrhythmic (Na channel blocker) -longest half life -USE: Ventricular Arrhythmias ADE: Big anticholinergic side effects, worsen heart block/severe HF, TORSADES

DISOPYRAMIDE

-Class 1A Antiarrhythmic (Na channel blocker) -Similar to others except less GI ADE, and is safer to use intravenously ADE: DRUG INDUCED LUPUS (anti histone antibodies), TORSADES

PROCAINAMIDE **only Class 1A that has ADE with drug induced lupus

-Class 1A Antiarrhythmic (Na channel blocker) USE: SVT and Ventricular Arrhythmias, also used for prevention ADE: CINCHONISM (dizzy, ringing in ears, diarrhea), thrombocytopenia, TORSADES

QUINIDINE **only Class 1A that has ADE with cinchonism and thrombocytopenia

-MOA: highly selective for ischemic or depolarized Purkinje/Ventricular tissue, -shorten duration of ERP -DECREASE AP, QT -affect ischemic tissue USE: POST MI TX, ventricular arrhythmias, digitalis overdose, TREATS TORSADES!!! **SEIZURES ADE: CNS depress (lidocaine), GI probs (mexiletine), Drug induced lupus/ gingival hyperplasia, teratogenic effects, hirsutism/HYPERTRICHOSIS (excessive hair growth) (ALL IN PHENYTOIN), TINGLING

CLASS 1B NA CHANNEL BLOCKERS -MEXILETINE -LIDOCAINE -TOCAINIDE -PHENYTOIN "MAYO, LETTUCE, TOMATO, PICKLE"

CLASS 1B NA CHANNEL BLOCKER ADE: GI probs, abd discomfort

MEXILITINE

"LAST RESORT" Na channel blocker, use dependent in AV NODE/ACCESSORY TRACTS -INCREASE QRS -NO EFFECT ON AP, minimal QT TX: SEVERE V TACH Flecainide also tx: paroxysmal AFib and Atrial flutter ADE: CHF, bradycardia, new arrhythmias **CONTRAINDICATED IN POST - MI, ischemic heart disease

CLASS 1C ANTIARRYTHMICS NA CHANNEL BLOCKER -PROPAFENONE -FLECAINIDE "FRIES PLEASE"

-K CHANNEL BLOCKER -used when others fail MOA: INCREASE AP/ERP/QT, they PROLONG depolarization in AV MYOCYTES (do not slow conduction like in Class 1A) USE: ARRYTHMIAS VTACH: amiodarone/Sotalol afib/flutter: ilbutilide, dofetilide ADE: ilbutilide/sotalol can cause TORSADES

CLASS 3 ANTIARRHTHMICS K CHANNEL BLOCKER -AMIODARONE (long half life, always check function tests- causes pulmonary fibrosis, hepatotoxicity, hypo/hyper thyroid)- VTACH -ILBUTILIDE (afib/a flutter) (ade: TORSADES) -dofetilide (afib/a flutter) -sotalol (non selective b blocker) ADE: dizzy, TORSADES (VTACH)

-decrease conduction velocity (SA/AV nodes) -INCREASE PR/ERP TX: SVT DUE TO AV NODAL REENTRY/HTN/angina/Raynauds (Verapamil/Diltiazem), subarachnoid hemorrhage (Nimodipine) ADE: CHF, AV block, sinus node depression, peripheral edema, constipation/gingival hyperplasia (especially verapamil)

CLASS 4 ANTIARRHTHYMICS CALC CHANNEL BLOCKERS -VERAPAMIL -DILTIAZEM -NIMODIPINE

MOA: inhibit bacterial cell well synthesis, block transpeptidase/bind to PBP **BACTERICIDAL: cause bacterial cell death ADE: HS type 3 rxns, vit k deficiency, disulfiram like rx when taken with alcohol, nephrotoxicity when taken with ahminoglycosides, pseudomembranous colitis, AI hemolytic anemia

Cephalosporins (Beta lactams)

*least extensive coverage *inhibit bacterial cell wall *P, E, K, S,S * USE: gram positive cocci bacterial infections (staph/strep), also as pre operative prophylaxis, also gram neg (p. mirabilis, E. coli, Klebs) *Methicillin sens Staph Aureus (MSSA), with cephalexin

FIRST GEN CEPHALOSPORINS (beta lactams) (FAZ/LEX) -Cefazolin (IV/IM) -Cephalexin (oral) -endocarditis prophylaxis *P, E, K, S,S *

*inhibit bacterial cell wall -gram neg, gram pos cocci, anaerobes *P, E, K, H, E, N, S" P. MIRABILIS E. COLI KLEBS H. INFLUENZ ENTEROBACTER N. GON SERRATIA marcessans CEFUROXIME: only second gen that can CROSS BBB, (active against H. influenza, N. Gonorrhea, Lyme)

SECOND GEN CEPH (B LACTAMS) "FOX WEARS FUR CLOTHES" -cefoxitin -cefuroxime -cefaclor- ADE: SERUM SICKNESS

*inhibit bacterial cell wall/block peptidoglycan synthesis -gram neg, gram pos cocci except enterococcus that are resistant to other gens "serious gram neg" -TX all bacterial meningitis besides listeria THEY ALL CROSS BBB CEFTAZIDIME: ONLY 3RD GEN that can tx pseudomonas

THIRD GEN CEPH (B LACTAMS) "tax, taz, triax, at dinner" -cefotaxime -ceftriaxone -cefdinir -ceftaz **only one against pseudomonas

*inhibit bacterial cell wall -cover pseudomonas/enterococcus -mod-severe hospital acquired infections by multi resistant bacteria including resistant strep pneumonia/enterococcus

FOURTH GEN CEPH (B LACTAMS) "fepi the fourth" -cefepime

*inhibit bacterial cell wall **MOST COVERAGE, BUT DO NOT HAVE COVERAGE AGAINST PSEUDOMONAS -specifically created for resistant bacteria like meth res staph aureus (MRSA) -BROAD spectrum gram pos/neg INCLUDING ENTEROCOCCUS FAECALIS/LISTERIA

FIFTH GEN CEPH (B LACTAMS) "5 TAR TOBI" -ceftobiprole -ceftaroline

MOA: bind to 23S ribosomal RNA in the 50S subunit which catalyzes formation of peptide bond, inhibits protein synthesis by blocking translocation *bacteriostatic ***gram pos cocci, atypical pneumonia, chlamydia ADE: can lead to QT prolong, TORSADES, diarrhea, p450 inhibit, skin rash, eosinophilia, cholestatic hepatitis

Macrolides "-thromycin" (erythromycin, azithromycin" **MACRO: -motility probs -arrhythmias (torsades) -cholestatic hep -rash -eOsinophilia -p450 inhibit

MOA: inhibits TOP 2 (DNA gyrase) and 4, prevents bacteria from replicating their DNA **bactericidal USE: gram neg rods, pneumonia, GI infxns, UTI, genital infections ADE: tendon rupture, cartilage damage in young pt, QT prolong/teratogen/diarrhea/headache

Fluoroquinolones (-floxacin) -Levo/Cipro: have psedommonas coverage **avoid antiacids/polyvalent cations/TERATOGEN

Cell Wall Inhibitors "CC is MVP" *they have a beta lactam ring in their molecular structure

-penicillins -cephalosporins -monobactams -carapenems -vancomycin

MOA: cell wall inhibitor -gram neg coverage, useful for penicillin allergies

Aztreonam (monobactam- only important one)

MOA: cell wall inhib -gram pos, gram neg, anaerobic coverage **Cilastin is often used with this to prevent breakdown by the kidneys

Carbapenems (imipenem and meropenem) *they have a beta lactam ring in their molecular structure

-Clavulanic acid, sulbactam, tazobactam

Beta-Lactamase Inhibitors

Penicillins that have activity against pseudomonas:

-Ticarcillin, piperacillin *they have a beta lactam ring in their molecular structure

-resistant to penicillinase Penicillins that have activity against S. Aureus:

-Oxacillin, Nafcillin *they have a beta lactam ring in their molecular structure

MOA: inhibit 30s subunit of ribosome leading to cell death, inhibit formation of initiation complex, resistance by Transferase enzymes **bactericidal activity -against gram neg rods (including pseudomonas, enterobacter) -RESISTANT to anaerobes bc they require O2 for uptake, acetylation, adenylation, phosphorylation ADE: nephrotoxic (esp w cephalosporins), ototoxic (esp w loop diuretics), teratogen

-Aminoglycosides (-"mycin" (gentamicin, neomycin, amikacin) *Neomycin is popular bowel surgery prep

-protein synthesis inhibit -inhibits 50S subunit/blocks translocation *bacteriostatic -gram pos, anaerobes, strep/MRSA, aspiration pneumo/lung abscess/STI (LUNG INFXN ABOVE DIAPHRAGM) -B. Fragilis/C perf ADE: pseudomemb. colitis

Clindamycin

-protein synthesis inhibitors -inhibit 30S bacterial subunit, to prevent aminoacyl attachment -broad spectrum, limited CNS penetration/divalent cations inhibit absorption (cant take with milk, antacids, iron) -lyme, myco pneumo, chlamydia, rickett, H. pylori ADE: photosensitivity, teeth discoloration in children/GI distress, pill esophagitis/ TERATOGENS/inhibit bone growth in kids

Tetracyclines (doxycycline, minocycline)

-protein synthesis inhibitor -inhibit 50S ribosomal subunit /bind 23S r RNA -ONLY against gram pos bacteria *bacteriostatic (meth resist MRSA, Vano resist enterococci) ADE: bone marrow suppress, peripheral neuropathy, SEROTONIN SYND (excess serotonin, so do not use SSRI's/MALI's), decreased platelets, lactic acidosis **AVOID TYRAMINE FOODS (cheese, meat, pickle, wine)

Linezolid

Protein Synthesis Inhibitors (50S)/block translocation- 23S rRNA *bacteriostatic *MCLC*

-Macrolides -Clindamycin -Linezolid -Chloramphenicol

Protein Synthesis Inhibitors (30s), bactericidal *AT*

-Aminoglycosides -Tetracyclines

MOA: inhibition of bacterial DNA replication, broad spectrum **inhibit dihydropteroate synthase and dihydrofolate reductase** USES: gram pos/neg/MRSA

Sulfonamides (sulfamethoxazole/Trimethoprim) Sulf: inhibits first enzyme DHP synthase Trim: inhibits second enzyme DHF reductase

MOA: cell wall inhibitor, has beta lactam ring, blocks transpeptidase (PBP) cross linking of cell wall, activates auto lytic enzymes **bactericidal/beta lactamase sensitive USES: gram pos, spirochetes (syphilis) ADE: HS rxns (type 1), hemolytic anemia

Penicillins

MOA: binds to D ala D ala (CHANGES TO D ala D lac), Inhibiting cell wall mucopeptide (N-acetylglucosamine/N-actetylmuramic acid) **bacteriostatic against C DIFF (given to pt ORALLY w pseudomem colitis from taking c diff), bactericidal against S. AUREUS (IV) **ONLY FOR GRAM POS/MRSA ADE: RED MAN syndrome (nephrology, oto, thrombophlebitis-swelling/blood clot) **nonspecific mast cell degranulation leads to histamine release, diffuse flushing of face/neck/torso, prevented with antihistamine/slow IV infusion rate **DRESS syndrome, delayed onset (drug rxn w eosinophils and systemic symptoms) fever, face edema, organ dysfunction

Vancomycin

What Tetracycline treats SIADH/hyponatremia with ADE of nephrogenic DI in people without SIADH? (ADH antagonist)

Demeclocycline

What Tetracycline has the longest acting, longest half life, most lipid soluble, highest penetration in the brain with ADE large amount of CNS effects like vertigo?

Minocycline

What Tetracycline is used in prophylaxis against malaria, is fecally eliminated, and CAN be used in patients with renal failure?

doxycycline

MOA: INHIBIT fungal ergol sterol synthesis, damages DNA -bactericidal, forms free radical toxic metabolites, damages DNA USE: garnella, trich, e. histolytica, ADE: METALLIC TASTE IN MOUTH, disulfiram rxn w alcohol , ANAEROBIC LUNG INFXNS BELOW DIAPHRAGM (clinda is above)

Metronidazole

-Immunosuppressent that impedes the innate immune response via dec activation of B cells. (Neut/Eiosin are inhibit with this med) TX: malaria, RA, SLE, porphyria cutanea tardia ADE: cardiotoxic, retinopathy (bullseye appear of macula/corneal damage), prolong QT, hemolysis in pt with G6PD def, Gi upset

Hydroxychloroquine (antiparasitic, immunosuppressive drug) **should get eye exams within one year of starting

-oral anticoagulant/prevents thrombosis/embolism MOA: inhibits epoxide reductase/interferes w vit k clotting factors /p450 **targets extrinsic path -inactivates prothrombin, factors 2, 7, 9, 10, C, S ADE: lead to excessive bleeding/hemorrhage/necrosis if taken in EXCESS, TREAT THIS WITH VIT K!!! (treats fact 2, 7, 9, 10, protein C/S and helps reverse anticoagulation of warfarin)/ or fresh frozen plasma *MUCH quicker than Vit K

Warfarin TERATOGEN, MONITOR INR/PT

treats fact 2, 7, 9, 10, protein C/S and helps reverse anticoagulation of warfarin (slow)

Vitamin K

treats fact 2, 5, 7, 9, 10, 11, protein C/S and helps reverse anticoagulation of warfarin (FASTER than vit k)

Fresh Frozen Plasma

What is the medication for Acetaminophen overdose?

N-acetylcysteine - replenishes glutathione

- inhibit thrombin (factor 2) to suppress clotting factors, and prevent platelet aggregation (no decrease in platelets) *continuous IV, frequent aPTT monitoring ADE: can cause bleeding, but not associated with causing HIT, you will add this to stop HIT

Dabigatron (oral) and Argatroban - both Direct thrombin inhibitors

MOA: targets 10a and 2a (thrombin) -cofactor of antithrombin, inactivates X/IIa/short half life (helps break clots) -binds to inhibitor antithrombin 3, causing activation of antithrombin 3, inactivates 9, 10, thrombin -LMWH has longer half life/bioavailability (acts more on Xa) only inactivates factor 10, so aPTT is NOT prolonged USE: Acute coronary syndrome, a fib, embolism ADE: bleeding, heparin induced thrombocytopenia (HIT) (5-10 days after exposure, caused by heparin platelet factor 4 antibody complex--> PLATELET RELEASE/AGGREGATION, PLATELETS FALL BY 50%, you will stop heparin, start DIT- fondaparinux/danaparoid/rivaroxaban. Can be diagnosed with serotonin release assay)) TX OTHER HEPARIN OVERDOSE WITH PROTAMINE SULFATE

HEPARIN SAFE IN PREG -MONITOR aPTT (but not if using LMWH)

-histamine H1 receptor antagonists -diphenhydramine (benadryl) -Promethazine -Phenergan -Chlorpheniramine USE: allergies, N/V, Motion sickness, anaphylaxis ADE: sedation, anticholinergic effects

FIRST GEN ANTIHISTAMINES

-histamine H1 receptor antagonists (faster/longer acting...liphophobic) -azelastine + fluticasone (nasal spray) -cetirizine -loratadine -fexofenadine ***FEWER CNS effects/less anticholinergic/ less sedative than first gen

SECOND GEN ANTIHISTAMINES

-Inhibits ergosterol synthesis/P450 -INHIBITS 14 a DEMETHYLASE (that converts lanosterol to ergosterol) USES: fungal/candida (pseudohyphae and budding yeast), LOCAL AND LESS SERIOUS SYSTEMIC MYCOSES EXCEPT FLUCONAZOLE ADE: inhibits testosterone synthesis, gynecomastia/liver dysfunction, teratogen

-Azoles (ketoconazole)/antifungal Itraconazole: Blastomyces, Cocci, Histoplas -voriconazole: Invase aspergillosis -Fluconazole: can be used for CHRONIC cryptococcus/candida in AIDS, candida

-anytipyretic/analgesic drug MOA: reversible inhibition of COX enzymes in CNS, direct action on hypothalamus/OCCURS PRIMARILY IN CNS USES: fever, pain, given to children instead of aspirin (prevent Reye's) -lacks anti inflammatory/anti platelet efects (seen w aspirin/NSAIDS) ADE: CENTRILOBULAR hepatic necrosis (overdose= INc NAPQI and inc reactive oxygen species) TX OVERDOSE WITH N-ACETYLCYSTEINE (GLUTATHIONE)

ACETAMINOPHEN (tylenol)-

-anti inflammatory, anti analgesic, anti pyretic MOA: REVERS INHIB OF COX 2/1, BLOCKS PROTAGLANDIN/ THROMBOXANE SYNTHESIS COX 2 INHIBITOR = anti inflammatory COX 2/COX 1 INHIB COMBO= anti analg BLOCK PGE2 (via COX inhibit)= for fever BLOCK PGE2 (indometh)= CLOSE PDA ADE: interstitial nephritis, gastric ulcer, renal ischemia/RASH IN CHILDREN/thrombosis/do NOT TAKE W ALC

NSAIDS (ibuprofen, advil, motrin, naproxen, indomethacin, keorolac, aspirin) **AVOID W ALCOHOL

-ani inflammatory/antipyretic/anti analgesic/ antiplatelet (INC bleeding time w/out affecting PT or PTT) MOA: IRREVERSIBLY inhibit COX 2/1, suppresses PROTAGLANDIN/ THROMBOXANE SYNTHESIS USE: fever, pain, HA, CV disease (prevent MI/ischemic stroke) ADE: REYE'S SYN= micro vesicular statuses of hepatocytes/hepatoenceph. /death , TINNITUS, PEPIC ULCER, mixed resp alkalosis/met acidosis, nephropathy / hyperthermia / hyperventilating TX: FOR ASPIRIN TOXICITY= SODIUM BICARBONATE

ASPIRIN (acetylsalicylic acid)/NSAID but it is irreversible not reversible (if overdose= sodium bicarb)

Tetracyclines Fluoroquinolones Sulfamethoxazole Thiazide diuretics/loop diuretics ALL have a ADE of what??

Photosensitivity- must tell pt to wear sunscreen

Metronidazole Procarbazine 1st gen sulf (chlorpropamide) 3rd gen cefperazone 2nd gen cefamandole ALL have a ADE of what??

Disulfiram like Rxn- must tell pt to avoid alcohol

How do you treat torsades? (PVT)

Magnesium Sulfate

How do you treat Afib/Aflutter?

-Adenosine Amiodarone -Beta Block -Calc chan block (V/D) -Digoxin

How do you treat digoxin toxicity?

Magnesium Sulfate

How do you treat Monomorphic Vent Tachy?

Amiodarone Lidocaine

How do you treat Paroxysmal Supraventricular Tachy?

Adenosine

How do you treat Sinus Bradycardia?

Atropine

How do you treat tricyclic antidepressant toxicity? (aspirin)

Sodium Bicarbonate

How do you treat serotonin syndrome? (hyperreflexia, disoriented, vomit, Hypertonic Emergency/fever, tremors, agitation, rigid, flushed skin, dilated pupils) -probably mixed w depression meds/"took med for migraine" (probs sumatriptan)

Cyproheptadine-serotonin antag (5-HT2 Block)

How do you treat Neuroleptic Malignant Syndrome? (taking typical antipsychotics (D2 blockade) like haloperidol and fluphenazine, causing parkinsonism, HTN, hyperthermia, normal/reduced bowels?

-Dantrolene (ryanodine receptor binding/inhibiting calcium release from SR), cooling, sedation

How do you treat Strep Pneumonia (gram pos lancet shaped diplococci, MCC of bacterial meningitis)?

Ceftriaxone plus vancomycin (steroids before antibiotics)

How do you treat N. Meningitis (gram neg diplococcus, common in young pt in dorm rooms/army recruits)

Ceftriaxone

How do you treat Listeria Mono? (facultative anaerobic gram pos rod, older pt >50)

Trimeth-Sulfa or Ampicillin (if penicillin allergy)

How do you treat HSV/HSV encephalitis? (temporal lobe necrosis, blood tinged CSF, periodic materializing epileptiform discharges on EEG)

Acyclovir

Treatment of Cryptococcal Meningitis? (AIDS < 100, super high opening pressure, india ink stain quick diagnosis)

Amph B + Flucytosine

Treatment of Tox. Gondii? (AIDS <100, not on prophylactic TMP-SMX, multiple ring enhancing lesions on MRI)

Pyrimethamine and Sulfadiazine

-MOA: main antagonism of both postsynaptic serotonin 2A and dopamine receptors TX: SCHIZOPHRENIA (hallucinations, hearing things, disorganized speech, delusions) ADE: LOW NEUTROPHIL COUNT (AGRANULOCYTOSIS), weight gain, neuroleptic malignant syndrome

-CLOZAPINE *atypical antipsychotic (must monitor WBC count for first 6 months of pt taking and CBC if pt has any fever or infection signs)

MOA: monoamine oxidase inhibitor (halI), irreversibly blocking monoamine oxidase (enzyme responsible for NT degradation such as serotonin, NE, dopa) TX: depression -TYRAMINE CONTAINING FOOD INTERACTION!!! ADE: SEVERE HTN/HTN CRISIS, encephalopathy, papilledema, cardiac ischemia, acute kidney failure YOU TREAT THIS ^^^^ WITH PHENTOLAMINE (reversible nonselective alpha blocker)

Phenelzine (MAO-I)

What treats Strep Pneumonia (all bacterial meningitis bacteria)?

third gen cephalosporins + vancomycin

Bacterial Meningitis in children strands (pos kerning, brudzinski, etc)

-Strep pneumo -H. influenza -N. Meningitis

MOA: block potassium channel in pancreatic B cell membrane to reduce outflow of potassium, opens calcium channel, increasing calcium, releasing insulin to manage elevated glucose levels use: type 2 diabetic drug ADE: elderly is at high risk of ADE, hypoglycemia, rapid HR, dizzy, sweating, increased appetite, weight gain

Second Generation Sulfonylureas -glipizide -glyburide -glimepiride

First Generation Sulfonylureas -chlorpropamide -tolbutamide

MOA: decreased hepatic gluconeogenesis via inhibition of mitochondrial glycerophosphate dehydrogenase/ activates AMP kinase to allow for reduced hepatic gluconeogenesis **inc glycolysis, insulin sens, peripheral glucose uptake use: type 2 diabetes ADE: lactic acidosis, dec vitamin B12 levels, GI upset

Metformin (biguanide class)

Moa: peroxisome PPAR-y AGONISTS, allows for glucose uptake into fat and muscle, reduces insulin resistance/inc insulin sensitivity ADE: fluid retention, weight gain, edema, HF, fractures, osteoporosis, monitor liver function

Thiazolidinediones (pioglitazone, rosiglitazone)

MOA: competitive inhibitors of intestinal brush border ALPHA GLUCOSIDASE (delays starch digestion), DEC GLUCOSE ABSORPTION, DEC POSTPRANDIAL HYPERGLYCEMIA use: type 2 diabetes ADE: flatulence, GI pain, diarrhea

Alpha glucosidase inhibitors -acarbose, miglitol

MOA: suppresses glucagon release, delays gastric emptying, controls appetite use: type 2 diabetes ADE: pancreatitis, medullary thyroid cancer

GLP-1 agonists -liraglutide, dulaglutide

MOA: inhibit DPP4, enhances GLP-1, DEC glucagon/gastric emptying, promotes satiety.. INC GLUCOSE DEP INSULIN RELEASE use: type 2 diabetes ADE: URI, HA, may increase risk of cancer, RESP infixes

DPP4 Inhibitor -sitagliptan, saxagliptin

type 2 diabete drugs: "1, 2 Always Take Diabetes Meds Gamma"

1st gen sulfonylureas (tolbutamide/chlorpropamide) 2nd gen sulfonylureas (glip, glyb, glime) Metformin Thiazolidinediones (pioglitazone, rosiglitazone) Alpha glucosidase inhibitors (acarbose, miglitol) GLP 1 agonists (-liraglutide, dulaglutide) DPP4 Inhibitor (sitagliptan, saxagliptin)

MOA: alkylating agent, cross links DNA (PLATINUM CONTAINING ANTINEOPLASTIC TUMOR TX) USE: testicular, bladder, ovary, lung carcinomas ADE: Nephrotoxicity (administer amifostine), neurotoxic, ototoxic, SEVERE N/V, BM suppress, Renal magnesium wasting, HYPOCALCEMIA, HYPOMAGNESIUM, HYPOKALEMIA, HYPONATREMIA (Usually requires serotonin 5HT3 antagonist (ondansetron), and Neurokinin 1 blocker (aprepitant) to prevent N/V)

CISPLATIN

MOA: Binds to DNA and iron, DNA-bleomycin-iron (Fe3+) complexes cause DNA breaks (antineoplastic drug) Use: Hodgkin lymphoma, testicular cancer ADE: pulmonary fibrosis, hyperpigmentation, rash

Bleomycin

MOA: alkylating agents at N7 of guanine *antineoplastic drug ADE: hemorrhagic cystitis *administer mesna, BM suppression, Vessication (mechlorethamine), N/V

Cylophosphamide, Ifosfamide

MOA: inhibit Top 2 of S and G2 phases (antineoplastic tumor drug), to increase DNA degradation USE: Small cell lung cancer, testicular carcinomas, lymphoma/leukemia, Ewing sarcoma ADE: N/V, BM suppression, hypersensitivity, HAIR LOSS (alopecia), GI irritation

Etoposide, Teniposide

MOA: inhibit Top 1 of S phase (antineoplastic tumor drug), preventing DNA unwinding, replication USE: colon cancer, ovarian cancer, small cell lung cancer ADE: N/V, BM suppression, weakness, diarrhea

Topotecan, Irinotecan

MOA: alkylating agent (antineoplastic tumor drug) and cross links strands of DNA, cell cycle nonspecific USE: Chronic Myelogenous Leukemia, and for BM ablation before BM transplant ADE: pulmonary fibrosis, hyperpigmentation

Busulfan

MOA: intercalating agent, produces free radicals, inhibits TOP 2 of cell cycle nonspecific (antineoplastic tumor drug) ADE: N/V, BM suppression, cardiotoxic from free radicals (administer dexrazoxane)

Doxorubicin

MOA: inhibit Microtubule polymerization of M phase/ inhibit mitotic spindle formation (antineoplastic tumor drug) ADE: peripheral neuropathy, BM Suppression

Vinca Alkaloids: 1. Vincristine (peripheral neuropathy) USE: diffuse b cell lymphoma, ALL, lymphoma, neuroblastoma, rhabdomyosarcoma, wilms tumor 2. Vinblastine (BM suppression) USE: Kaposi sarcoma, Langerhans, lymphoma, testicular cancer

MOA: inhibit microtubule DEpolymerization at M phase / PREVENT mitotic spindle BREAKDOWN (antineoplastic tumor drug) USE: MC for advanced ovarian carcinoma, breast cancer, non small cell lung cancer ADE: Hypersensitivity, N/V, peripheral neuropathy , BM suppression

Taxane Class: Paclitaxel, Docetaxel

MOA: non ergot, synthetic dopamine agonists, can be administered to patients with Parkinson's who are taking levodopa and are experiencing restless legs/on off phenomenon **nonergot derivatives do not exacerbate vasospasm in pt with concomitant peripheral vascular disease/pulmonary/retroperitoneal fibrosis USE: Parkinsons, restless leg ADE: N/V, uncontrolled impulses (gambling), hallucinations, delusions, postural hypotension

Pramipexole (scavenge free radicals), ropinrole (effective as mono therapy), Rotigotine (transdermal formulation)

MOA: ERGOT dopamine agonists, can be administered to patients with Parkinson's who are taking levodopa and are experiencing restless legs/on off phenomenon USE: Parkinsons, restless leg, HYPERPROLACTINEMIA/ADENOMAS ADE: VASOSPASMS, N/V, uncontrolled impulses (gambling), hallucinations, delusions, postural hypotension

Bromocriptine (ergotamine)- **can also treat hyperprolactinemia and adenomas

MOA: inhibits enzymatic action of aromatase, that normally converts androgens into estrogens in females. USE: hormone receptor positive breast cancer

Anastrozole

MOA: androgen that suppresses the mid cycle surge of FSH and LH, resulting in reduction of ovarian estrogen production ADE: excessive hair growth!! USE: endometriosis, fibrocystic breast cancer

Danazol

MOA: competitive inhibitor of 5 alpha reductase, which normally metabolizes testosterone --> dihydrotestosterone (DHT). this blocks peripheral conversion of testosterone to DHT leading to a decrease of DHT USE: chronic treatment of benign prostatic hyperplasia, and male pattern baldness, TERATOGEN IN PREGNANCY(STAY AWAY FROM PREG FEMALES, can cause baby boy to have feminism characteristics) **HAS NO ROLE IN MANAGING METASTATIC PROSTATE CANCER, PSA> 5 = BPH, PSA>50= PROSTATE CANCER

Finasteride

MOA: osteoclast inhibitor that can be used as adjunct therapy in the management of bony metastases from prostate cancer. (helps with pain control/prevention of fractures) **useful for PREVENTING SKELETAL COMPLICATIONS (PSA> 50, prostate cancer)

Denosumab

MOA: block the serotonin transporter and the reuptake of serotonin from neuronal synapses***FIRST LINE THERAPY FOR DEPRESSION BUT MAY CAUSE ED IN MALE PATIENTS USE: major depression, anxiety, bulimia, OCD, PTSD, phobias ADE: N/V, ERECTILE DYSFUNCTION, SEROTONIN SYNDROME, insomnia, bleeding, weight gain, inhibitors of P450 Management*** for serotonin syndrome, use cyproheptadine and manage seizures with benzos. For ED: give with a PD5 inhibitor or consider changing to BUPROPION

SSRI'S -Fluoxetine -Citalopram -Paroxetine -Sertraline -Escitalopram -Fluvoxamine ***FIRST LINE THERAPY FOR DEPRESSION BUT MAY CAUSE ED IN MALE PATIENTS

What do NSAIDS block the conversion of? **IN AFFERENT ARTERIOLE OF GLOMERULUS

BLOCK arachidonic acid--> prostaglandins using COX phospholipids --> arachidonic acid in plasma membrane by phospholipase A2, then arachidonic acid--> prostaglandins is blocked by COX (NSAIDS only have affect on COX not phospholipase A2)

Typical Antipsychotics MOA? TREAT POS SYMPTOMS **HALEY TRIES FLUT, THOUGH CANT PLAY** high potency= ^ EPS, low sedation Haloperidol Trifluorperazine Fluphenazine low potency= ^ Sedation, low EPS Thioridazine (causes pigment retinal deposits) Chlorpromazine (causes cornea deposits) Pimozide (used for tourettes)

Block postsynaptic D2 receptors in mesolimbic, TX: schizophrenia (antipsychotic meds) ADE: HYPERPROLACTINEMIA.. "males have white discharge coming from breast" due to blocking dopamine receptors, Neuro Malignant Syndrome (tx with dantrolene), parkinson sxs, tardive, akathisia, etc.

ADHD STIMULANT med for kid that "blocks reuptake of dopamine and NE in presynaptic neurons through inhibition of monoamine transporters"

Methylphenidate

ADHD NON-STIMULANT med that is a "selective NE reuptake inhibitor"

Atomoxetine

ADHD NON-STIMULANT meds that are a "alpha 2 agonist"

-Clonidine -Guanfacine

ADHD NON-STIMULANT/DEPRESSION med that are a "NE and dopamine reuptake inhibitor" **CONTRAINDICATION: do NOT give to patient with bulimia/eating disorders, lowers seizure threshold

Bupropion (good for smokers, mostly used if pt doesn't want to take SSRI/had problem with sexual dysfunction w/ SSRI)

What is a muscle relaxant used for muscle spasms that is associated with Multiple Sclerosis? MOA: binds GABA B RECEPTORS and reduces release of excitatory NT (glutamate and aspartate release) by Gi mechanism

Baclofen (anti-spasm drug)

Atypical Antipsychotics MOA? TREATS NEG SYMPTOMS "A CORQ" Aripiprazole Clozapine (ade- agranulocytosis/low neutrophils) Olanzapine Risperidone Quetiapine **all have ADE of weight gain, PROLONG QT

5HT2A BLOCKERS> D2 antagonist, have less dopamine blockade so they are preferred over typical antipsychotics **main antagonism of both postsynaptic serotonin 2A and dopamine receptors **GET A CBC IF FEVER PRESENT

Tricyclic Antidepressant MOA? Amitriptyline Nortriptyline Imipramine (treats bedwetting)

Inhibit reuptake of serotonin/NE by binding to NT transporters **also have additional receptor blockade of Muscarinic, alpha 1, histamine receptors

Drug for smoker/bulimia that is a partial agonist at nicotinic Ach receptors? ADE: may cause sleep probs/decreased mood, so do not give to pt with depression (should give them bupropion if they dont have bulimia)

Varenicline

What stimulant drug has ~20 hour length of time, can cause violence, diaphoresis, HTN, severe agitation, Tachycardia, psychosis, **TOOTH DECAY**, injection marks up and down arm

Methamphetamine

What drug causes vertical/horizontal nystagmus, AMS, agitation, choreoathetosis, seizures, acute psychosis? **decreased pain perception/SUPER HERO STRENGTH delusions

PCP

What drug causes BRADYCARDIA/HYPOTENSIONS, miosis, hypothermia, hypo reflex, CNS/resp depression, dec bowel sounds, constipation?

Heroin (OPIODS)

What drug causes HTN, tachy, euphoria, violence, anger, pupil dilation, weight loss, INC IN SELF CONFID?

Cocaine

What drug is a precursor for dopamine, crosses the BBB, increases central dopamine levels, and is used for tx of Parkinson's? (first line)

Levodopa

What drug is a irreversible peripheral dopa decarboxylase inhibitor, reduces peripheral conversion of levodopa to dopamine, as dopamine cant cross BBB, THUS allowing INC PERIPHERAL DOPA TO CROSS BBB (Parkinson's tx)? (first line)

Carbidopa

what drugs are COMT inhibitors, decreases breakdown of levodopa to 3-O methyldopa (3-OMD), ALLOWING MORE CENTRAL LEVODOPA / INC HALF LIFE OF LEVODOPA? (not first line)

Tolcapone, Entacapone

What are the RIPE meds for M. TB/HIV aids pt?

R-rifampin I-isoniazid P-pyrazinamide (CAN INC URIC ACID REABSORPTION--> INCREASE GOUT) E-Ethambutol

What drugs block sodium in cortical collecting tube? (potassium sparing diuretics)

Amilioride Triamterene

what drugs are competitive aldosterone receptor antagonists? (potassium sparing diuretics)

Spironolactone Eplerenone

MAO-INHIBITORS? (ade: HTN crisis after eating meal w tyramine) *PRITS*

-Phenelzine -Rasagiline -Tranylcypromine -Isocarboxazid -Selegiline TX THIS WITH PHENTOLAMINE

What is the MOA of SNRI?

inhibition of serotonin and/or NE reuptake from neuronal synapses

What drugs are these: -venlafaxine -duloxetine

SNRI's

What drugs are loop diuretics? (tx: Hypercalcemia, Na/K/2Cl in TAL ADE: hypocalc/hypomag/hypokal/ hyponat, OTOTOXIC, interstitial nephritis, gout

-furosemide -bumetanide -torsemide NON SULFA: E. Acid (more ototoxic)

what is the drug with MOA of inhibiting Na/K ATPase and increased vagal tone? TX: CHF/Afib ADE: brady, ST downslope, N/V, visual disturbances (yellow green eye tint, blurry, scotoma, halo, diplopia), gynecomastia

Digoxin

What drugs are these? -prazosin -terazosin -doxazosin -tamsulosin (inc urinary stream, inhibits contraction, tx BPH)

Alpha 1 blocker (lead to vasodilation)

What drug inhibits alcohol dehydrogenase and is used in tx of methanol/ethylene glycol overdose?

Fomepizole

How do you treat genital herpes?

Acyclovir/famciclovir/valacyclovir - MOA: inhibit DNA polymerase, leads to DNA chain termination

how do you treat syphilis?

Penicillin G -MOA: inhibit transpeptidase

what are the 2 drugs to treat Chlamydia? (one is for preg)

-Doxy (tetra- binds 30s to prevent elongation) -Azithromycin (macro- binds 50s to stop translocation) *safer in preg

how do you treat trichonomas/ gard intestinalis?

-Metronidazole MOA: form nitrogen free radicals that damage cellular components (DNA/proteins)

How do you treat gonorrhea? (mucoprurlent discharge)

-Ceftriaxone (3rd gen ceph, lipophilic) inhibit transpeptidase

what drug to relieve chest pain the fastest? (angina pectoris)

Nitroglycerin (MOA: activate myosin light chain phosphatase)

How do you treat Lupus/SLE?

-Glucocorticoids MOA: diffuse thru PM to regulate gene expression

k opioid receptor agonist AND a u opioid receptor partial agonist used as analgesia for severe pain

Butorphanol

estrogen therapy is contraindicated in patients with what

ER 2+ breast cancer

what diuretic is used to treat metabolic alkalosis

acetazolamide (carb anhydr inhibitor)

what inhibits COX2 only in the arachidonic acid path

celecoxib

what alkylating agent can cross the BBB

nitrosureas

what antineoplastic drug increases free radical formation causing DNA strand breaks

Bleomycin

what is preferred drug for tx schizophrenia

atypical antipsychotics (5HT 2 block) *A CORQ*

use of selegiline or rasagiline may enhance the ade of what

L-DOPA

opioid toxicity is tx with what

naloxone

what is used for relapse prevention in opioids

naltrexone

Class 4 antiarrhythmics are used clinically for

prevention of arrhythmias and A fib rate control

what 2 beta2 agonists are used to relax uterus and decrease contractions in women during labor

Terbutaline Ritodrine

which local anesthetic is associated with arrhythmias

cocaine

use of both pd5 inhib and nitrates can lead to what

life threatening hypotension

what is a small molecule inhibitor of V600E mutated BRAF used in metastatic melanoma

Vemurafenib

what is a substance P antagonist that blocks NK1 receptors in brain

aprepitant

what synthetic androgen is used to treat hereditary angioedema

danazol

rubonucleotide reductase inhibitor used to treat polycythemia vera and CML

hydroxyurea

which anti epileptics are also used as migraine prophylaxis

valproic acid and topiramate

moa of allopurinol and fevuxostate is

inhibition of xanthine oxidase

which anti epileptic is associated with kidney stones

topiramate

overdoses of amphetamines are treated with what

ammonium chloride

what interferes with reduction-oxidation reaction w molecular oxygen

nifutimox