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Pharm Flashcards

1
Q

Bethanechol - MoA

A

Cholinomimetic - activates bladder and bowel smooth muscle; resistant to AChE

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2
Q

Carbachol - clinical use

A

constricts pupil and relieves intraocular pressure in glaucoma

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3
Q

Carbachol - MoA

A

Cholinomimetic - binds ACh receptor

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4
Q

Methacholine - Clinical use

A

challenge test for asthma diagnosis

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5
Q

Methacholine - MoA

A

cholinomimetic - stimulates muscarinic receptors in airway causing bronchoconstriction

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6
Q

Pilocarpine - clinical use

A

stimulator of sweat, tears, and saliva

treats open angle and closed angle glaucoma

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7
Q

Pilocarpine - MoA

A

Cholinomimetic - contracts ciliary muscle of eye (open-angle glaucoma), contracts pupillary sphincter (closed-angle glaucoma); resistant to AChE

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8
Q

Rivastigmine/Donepezil - clinical use

A

alzheimer disease

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9
Q

Rivistigmine/Donepezil - MoA

A

Anti-cholinesterase - increases ACh

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10
Q

Edrophonium - clinical use/MoA

A

diagnosis of myasthenia gravis (improves symptoms by increasing ACh in synapse)

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11
Q

Neostigmine - clinical use

A

Post-op and neurgenic ileus and urinary retention; myasthenia gravis, reversal of NMJ blockade

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12
Q

Neostigmine - MoA

A

Anti-AChE - increases ACh

No CNS penetration

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13
Q

Physostigmine - clinical use

A

anticholinergic toxicity (atropine overdose)

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14
Q

Physostigmine - MoA

A

anti-AChE - increases ACh

Crosses BBB - CNS activity

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15
Q

Pyridostigmine - clinical use

A

myasthenia gravis - long acting, increases muscle strength

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16
Q

Pyridostigmine - MoA

A

anti-AChE - increases ACh

Does NOT penetrate CNS

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17
Q

Cholinomimetic agents - contraindications

A

exacerbation of COPD, asthma, and peptic ulcers in susceptible patients

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18
Q

Cholinesterase inhibitor poisoning

A

Organophosphates - irreversibly inhibit AChE

DUMBBELSS - diarrhea, urination, miosis, bronchospasm, bradycardia, excitation of skeletal muscle and CNS, lacrimation, sweating, salivation

Antidote - Atropine + Pralidoxime (given early - regenerates AChE)

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19
Q

Atropine - clinical use

A

treat bradycardia and for ophthalmic applications (produces mydriasis and cycloplegia)

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20
Q

Atropine - MoA and effects

A 
Muscarinic antagonist:
Eye - pupil dilations and cycloplegia
Airway - decreases secretions
Stomach - decreases acid secretion
Gut - decreases motility
Bladder - decreases urgency (cystitis)
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21
Q

Atropine toxicity

A 
Atropine Man - HOT as a hare (inc body temp due to dec sweating)
DRY as a bone (dry mouth, dry skin)
RED as a beet (flushed skin)
BLIND as a bat (cycloplegia)
MAD as a hatter (disorientation)
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22
Q

Benzotropine - clinical use

A

Parkinson disease, acute dystonia

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23
Q

Benzotropine - MoA

A

muscarinic antagonist (CNS)

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24
Q

Glycopyrrolate - clinical use

A

parental: preop use to reduce airway secretions
Oral: decrease drooling, peptic ulcers

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25
Q

Glycopyrrolate - MoA

A

Muscarinic antagonist - GI/Respiratory

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26
Q

Hyocyamine/dicyclomine - clinical use

A

antispasmodics for IBS

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27
Q

Hyoscyamine/dicyclomine - MoA

A

muscarinic antagonist - GI

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28
Q

ipratropium/tiotroprium - clinical use

A

COPD and asthma relief

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29
Q

ipratropium/tiotropium - MoA

A

muscarinic antagonist - Respiratory

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30
Q

solifenacin/tolterodine - clinical use

A

reduce bladder spasms and urge urinary incontinence - overactive bladder

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31
Q

solifenacin/tolterodine - MoA

A

muscarinic antagonists - genitourinary

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32
Q

scopolamine - clinical use

A

motion sickness

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33
Q

scopolamine - MoA

A

muscarinic antagonist - CNS

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34
Q

Albuterol/Salmeterol - clinical use

A

Albuterol - acute asthma

Salmeterol - long-term asthma/COPD control

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35
Q

Albuterol/Salmeterol - MoA

A

sympathomimetic - B2>B1 adrenergic agonist

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36
Q

Dobutamine - clinical use

A

heart failure (inotropic>chronotropic), cardiac stress testing

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37
Q

dobutamine - MoA

A

sympathomimetic - B1>B2,alpha adrenergic agonist

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38
Q

Dopamine - clinical use

A

unstable bradycardia, HF, shock

inotropic and chronotropic alpha effects predominate at high dose

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39
Q

dopamine - MoA

A

sympathomimetic - D1=D2> beta > alpha adrenergic agonist

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40
Q

Epinephrine - clinical use

A

anaphylaxis, asthma, open-angle glaucoma

alpha effects predominate at high dose

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41
Q

epinephrine - MoA

A

sympathomimetic - beta > alpha adrenergic agonist

much stronger effect at B2-receptor than norepinephrine

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42
Q

isoproterenol - clinical use

A

electrophysiologic eval of tachycardia; can worsen ischemia

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43
Q

isoproterenol - MoA

A

sympathomimetic - B1 = B2 adrenergic agonist

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44
Q

norepinephrine - clinical use

A

hypotension (decreases renal perfusion)

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45
Q

norepinephrine - MoA

A

sympathomimetic - alpha1 > alpha 2 > B1 adrenergic agonist

Significantly weaker at B2 than epinepherine

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46
Q

Phenylephrine - clinical use

A

Hypotension (vasoconstrictor); ocular procedures (mydriatic); rhinitis (decongestant)

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47
Q

Phenylephrine - MoA

A

sympathomimetic - alpha 1 > alpha 2 adrenergic agonist

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48
Q

amphetamine - clinical use

A

narcolepsy, obesity, ADHD

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49
Q

amphetamine - MoA

A

indirect sympathomimetic general agonist
reuptake inhibitor
releases stored catecholamines

“turns on the faucet and blocks the drain”

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50
Q

cocaine - clinical use

A

vasoconstriction and local anesthesia

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51
Q

cocaine - MoA

A 
indirect sympathomimetic - general agonist
reuptake inhibitor (blocks the drain)
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52
Q

cocaine - contraindications

A

do not give beta-blockers when suspected cocaine intoxications - can lead to unopposed alpha 1 activations -> extreme hypertension

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53
Q

ephedrine - clinical use

A

nasal decongestion, urinary incontinence, hypotension

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54
Q

ephedrine - MoA

A

indirect sympathomimetic - general agonist

releases stored catecholamines

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55
Q

Clonidine - clinical use

A

hypertensive urgency, does not decrease renal blood flow

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56
Q

Clonidine - MoA

A

sympatholytic - alpha 2 agonist

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57
Q

Clonidine - toxicity

A

CNS depression, bradycardia, hypotension, respiratory depression, miosis

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58
Q

methyldopa - clinical use

A

HTN in pregnancy

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59
Q

methyldopa - MoA

A

sympatholytic - alpha 2 agonist

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60
Q

Methyldopa - toxicity

A

SLE-like syndrome, direct Coombs + hemolysis

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61
Q

Bethanechol - clinical use

A

postop ileus, neurogenic ileus, urinary retention

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62
Q

Phenoxybenzamine - clinical use

A

pheochromocytoma (preoperatively) to prevent catecholamine crisis (hypertension)

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63
Q

phenoxybenzamine - MoA

A

alpha blocker (irreversible)

side effects - orthostatic hypotension and reflex tachycardia

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64
Q

Phentolamine - MoA

A

alpha blocker (reversible)

side effects - orthostatic hypotension and reflex tachycardia

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65
Q

Phentolamine - clinical use

A

give to patients on MAI inhibitors who eat tyrosine rich foods

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66
Q

Mirtazapine - clinical use

A

anti-depressant

side effects - sedation, increased serum cholesterol, increased appetite

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67
Q

Mirtazapine - MoA

A

alpha 2 selective blocker

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68
Q

Prazosin, terazosin, doxazosin, tamsulosin (-osin) - MoA

A

Selective alpha 1 blocker

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69
Q

Prazosin, terazosin, doxazosin, tamsulosin (-osin) - clinical use

A

urinary symptoms of BPH, PTSD (prazosin)
hypertension (NOT tamsulosin)

side effects - first dose orthostatic hypotension, dizziness, headache

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70
Q

Beta blocker effects - Angina

A

decrease heart rate and contractility, resulting in decreased O2 consumption

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71
Q

Beta blocker effects - MI

A

decrease mortality (metoprolol, carvedilol, bisoprolol)

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72
Q

beta blocker effects - SVT

A

decrease AV conduction velocity - class II antiarrhythmics (esmolol and metoprolol)

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73
Q

Beta blocker effects - hypertension

A

decrease CO, decrease renin secretion

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74
Q

Beta blocker effects - HF

A

decrease mortality in chronic HF

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75
Q

Beta blocker effects - glaucoma

A

Timolol - decreases secretion of aqueous humor

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76
Q

Beta blocker - toxicity

A

impotence, cardiovascular adverse effects (bradycardia, AV block, HF), CNS effects (seizures, sedation, sleep alterations), dyslipidemia (metoprolol), asthma/COPD exacerbations

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77
Q

B1 selective antagonists (B1>B2)

A

acebutolol, atenolol, esmolol, metoprolol

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78
Q

Non-selective Beta antagonists

A

pindolol (partial agonist), propranolol, timolol

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79
Q

Non-selective alpha and beta antagonists

A

carvediol and labetalol

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80
Q

Antihypertensive therapy - primary HTN

A

thiazide diuretics, ACE-I, ARBs, dihydropyridine calcium channel blockers

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81
Q

antihypertensive therapy - HTN w/ HF

A

diuretics, ACE-I/ARBs, beta-blockers, aldosterone agonists

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82
Q

antihypertensive therapy - diabetics

A

ACE-I, ARBs - protective against diabetic nephropathy

Calcium channel blockers, thiazide diuretics, beta-blockers

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83
Q

antihypertensive therapy - pregnancy

A

methyldopa (alpha-agonist), hydralazine, labetalol, nifedipine

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84
Q

Dihydropyridine calcium channel blockers - clinical use

A

(Amlodipine)

HTN, Angina (including Prinzmetal), Raynaud phenomenon

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85
Q

Dihydropyridine calcium channel blockers - MoA

A

(Amlodipine)
block voltage dependent calcium channels - decreased intracellular calcium - decreased muscle contractility (vascular smooth muscle)

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86
Q

Dihydropyridine calcium channel blockers - toxicity

A

(amlodipine)

reflex tachycardia, gingival hyperplasia

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87
Q

non-dihydropyridine calcium channel blockers - MoA

A

Diltiazem and verapamil

block voltage dependent calcium channels - decreased intracellular calcium - decreased muscle contractility (heart) - decreases CO

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88
Q

non-dihydropyridine calcium channel blockers - clinical use

A

diltiazem and verapamil

HTN, angina, atrial fibrillation/flutter

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89
Q

non-dihydropyridine calcium channel blockers - toxicity

A

verapamil - hyperprolactinemia, constipation, AV block

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90
Q

hydralazine - clinical use

A

severe HTN, HF

safe during pregnancy; administer w/ beta blocker to prevent reflex tachycardia

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91
Q

hydralazine - MoA

A

increases cGMP - smooth muscle relaxation

vasodilates arterioles > veins

decreases afterload

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92
Q

hydralazine - toxicity

A

compensatory tachycardia (contraindicated in angina, CAD), fluid retention, headache, angina

Lupus-like syndrome in slow-acetylators

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93
Q

Nitroprusside - clinical use

A

hypertensive emergency

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94
Q

Nitroprusside - MoA

A

increases cGMP via direct release of NO - dilation of arterioles and veins

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95
Q

Nitroprusside - toxicity

A

cyanide toxicity - releases cyanide

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96
Q

Fenoldopam - clinical use

A

hypertensive emergency

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97
Q

Fenoldopam - MoA

A

dopamine D1 receptor agonist - coronary, peripheral, renal, and splanchnic vasodilation

decreases BP, increases natriuresis

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98
Q

Nitrates - nitroglycerin, isosorbide dinitrate and mononitrate

MoA

A

vasodilate by increasing NO in vascular smooth muscle - increased cGMP and smooth muscle relaxation

dilate veins&raquo_space; arterioles - decreases preload

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99
Q

Nitrates - nitroglycerin, isosorbide dinitrate and mononitrate
Clinical use

A

angina, acute coronary syndrome, pulmonary edema

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100
Q

Nitrates - nitroglycerin, isosorbide dinitrate and mononitrate
toxicity

A

reflex tachycardia (treat with beta blockers), hypotension, flushing, headache

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101
Q

HMG-CoA reductase inhibitors (statins) - MoA

A

inhibit conversion of HMG-CoA to mevalonate (cholesterol precursor)

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102
Q

HMG-CoA reductase inhibitors (statins) - lipid profile effects

A

decrease LDL&raquo_space;> TG = VLDL

increase HDL

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103
Q

HMG-CoA reductase inhibitors (statins) - toxicity

A

hepatotoxic - increased LFT

myopathy when used with fibrates or niacin

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104
Q

Bile acid resins (cholestyramine) - MoA

A

prevent intestinal reabsorption of bile acids - liver uses cholesterol to produce new bile acids

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105
Q

Bile acid resins (cholestyramine) - lipid profile effects

A

decreases LDL

slightly increases HDL and TG

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106
Q

Bile acid resins (cholestyramine) - toxicity

A

GI upset, decreased absorption of other drugs and fat-soluble vitamins

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107
Q

Ezetimibe - MoA

A

prevents cholesterol absorption at the small intestine brush border

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108
Q

Ezetimibe - lipid profile effects

A

decreases LDL

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109
Q

Ezetimibe - toxicity

A

rarely increases LFT, diarrhea

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110
Q

Fibrates (gemfibrozil) - MoA

A

upregulate LPL - increase TG clearance

Active PPAR-alpha to induce HDL synthesis

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111
Q

Fibrates (gemfibrozil) - lipid profile effect

A

decrease TG»>LDL, increase HDL

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112
Q

Fibrates (gemfibrozil) - toxicity

A

myopathy (inc risk w/ statins)

cholesterol gallstones

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113
Q

Niacin (B3) - lipid profile effect

A

decreases LDL>TG

increases HDL

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114
Q

Niacin (B3) - MoA (lipids)

A

inhibits lipolysis in adipose tissue; reduces hepatice VLDL synthesis

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115
Q

Niacin (B3) - toxicity (lipid-lowering agent)

A

red, flushed face (due to inc PG) - decreased by taking NSAIDS
hyperglycemia, hyperuricemia

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116
Q

Cardiac glycosides (digoxin) - MoA

A

inotrope
directly inhibits sodium-potassium ATPase - indirectly inhibits sodium-calcium exchange - increases intracellular calcium - + inotropy

Indirect - stimulates vagus nerve - decreases HR

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117
Q

Cardiac glycosides (digoxin) - clinical use

A

HF, atrial fibrillation

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118
Q

Cardiac glycosides (digoxin) - toxicity

A

cholinergic - nausea, vomiting, diarrhea, blurry vision, arrhythmias, AV block

hyperkalemia - poor prognosis

Factors increasing toxicity - renal failure, hypokalemia, verapamil, amiodarone, quinidine

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119
Q

Cardiac glycosides (digoxin) - antidote

A

slowly normalize potassium, cardiac pacer, anti-digoxin Fab fragments, magnesium

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120
Q

Quinidine - MoA

A

Class IA antiarrhythmic - blocks open/active sodium channels (phase 0)
increases APD and ERP in ventricular AP (decreases slope of phase 0)
increases QT interval (prolongs repolarization - phase 3)

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121
Q

Procainamide - MoA

A

Class IA antiarrhythmic - blocks open/active sodium channels (phase 0)
increases APD and ERP in ventricular AP (decreases slope of phase 0)
increases QT interval (prolongs repolarization - phase 3)

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122
Q

Disopyramide - MoA

A

Class IA antiarrhythmic - blocks open/active sodium channels (phase 0)
increases APD and ERP in ventricular AP (decreases slope of phase 0)
increases QT interval (prolongs repolarization - phase 3)

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123
Q

Quinidine - clinical use

A

Class IA antiarrhythmic - blocks open/active sodium channels (phase 0)

atrial and ventricular arrythmias, re-entrant and ectopic SVT and VT

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124
Q

Procainamide - clinical use

A

Class IA antiarrhythmic - blocks open/active sodium channels (phase 0)

atrial and ventricular arrythmias, re-entrant and ectopic SVT and VT

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125
Q

Disopyramide - clinical use

A

Class IA antiarrhythmic - blocks open/active sodium channels (phase 0)

atrial and ventricular arrythmias, re-entrant and ectopic SVT and VT

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126
Q

Quinidine - toxicity

A

Cinchonism (headache and tinnitus)
thrombocytopenia
torsades de pointes due to long QT

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127
Q

Procainamide - toxicity

A

Reversible SLE - like symptoms (slow acetylators)
thrombocytopenia
torsades de pointes due to long QT

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128
Q

Disopryamide - toxicity

A

Heart failure
thrombocytopenia
torsades de pointes due to long QT

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129
Q

Lidocaine - MoA

A

Class IB antiarrhythmic - blocks inactive sodium channels (phase 0)

decrease slope of phase 0 and shorten AP duration
preferentially affect ischemic or depolarized purkinje and ventricular tissue

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130
Q

Mexiletine - MoA

A

Class IB antiarrhythmic - blocks inactive sodium channels (phase 0)

decrease slope of phase 0 and shorten AP duration
preferentially affect ischemic or depolarized purkinje and ventricular tissue

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131
Q

Lidocaine - clinical use

A

acute ventricular arrhythmias (post-MI)

digitalis induced arrythmias

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132
Q

Mexiletine - clinical use

A

acute ventricular arrhythmias (post-MI)

digitalis induced arrythmias

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133
Q

Lidocaine - toxicity

A

least cardiotoxic antiarrhythmics

CNS stimulation - seizures; CNS depression; CV depression

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134
Q

Mexiletine - toxicity

A

least cardiotoxic antiarrhythmics

CNS stimulation - seizures; CNS depression; CV depression

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135
Q

flecainide - MoA

A

Class IC antiarrhythmic - blocks fast sodium channels (phase 0)

decreases slope of phase 0, significantly prolongs ERP in AV node and accessory bypass tracks
No effect of ERP in purkinje and ventricles; minimal effect on AP duration

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136
Q

Propafenone - MoA

A

Class IC antiarrhythmic - blocks fast sodium channels (phase 0)

decreases slope of phase 0, significantly prolongs ERP in AV node and accessory bypass tracks
No effect of ERP in purkinje and ventricles; minimal effect on AP duration

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137
Q

Flecainide - clinical use

A

SVTs, including atrial fibrillation

last resort in refractory VT

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138
Q

Propafenone - clinical use

A

SVTs, including atrial fibrillation

last resort in refractory VT

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139
Q

Flecainide - toxicity

A

pro-arrhythmic (post-MI) - sudden death

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140
Q

Propafenone - toxicity

A

pro-arrhythmic (post-MI) - sudden death

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141
Q

Class II antiarrhythmics

A

Beta blockers!
Esmolol (cardioselective)
metoprolol, propranolol, atenolol, timolol, carvedilol

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142
Q

Class II antiarrhythmics - MoA

A

Beta blockers
decrease SA and AV nodal activity by decreasing cAMP and calcium currents

suppress abnormal pacemaker activity by decreasing slope of phase 4 (prolonged depolarization)

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143
Q

Class II antiarrhythmics - clinical use

A

SVT, ventricular rate control in atrial flutter and atrial fibrillation

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144
Q

Class II antiarrhythmics - toxicity

A

impotence, exacerbation of COPD/asthma, CV effects (bradycardia, AV block, HF), CNS effects (sedation, sleep alteration)

may mask symptoms of hypoglycemia

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145
Q

Amiodarone - MoA

A

Antiarrhythmics - Class III (mimics I,II,III,IV) - potassium channel blocker - slows phase 3 - prolongs repolarization
increases AP duration, increases ERP, increases QT

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146
Q

Ibutilide - MoA

A

Antiarrhythmics - Class III - potassium channel blocker - slows phase 3 - prolongs repolarization
increases AP duration, increases ERP, increases QT

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147
Q

Sotalol - MoA

A

Antiarrhythmics - Class III - potassium channel blocker - slows phase 3 - prolongs repolarization
increases AP duration, increases ERP, increases QT

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148
Q

Dofetilide - MoA

A

Antiarrhythmics - Class III - potassium channel blocker - slows phase 3 - prolongs repolarization
increases AP duration, increases ERP, increases QT

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149
Q

Amiodarone - clinical use

A

atrial fibrilation, atrial flutter, VT

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150
Q

Sotalol - clinical use

A

atrial fibrilation, atrial flutter, VT

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151
Q

Ibutilide - clinical use

A

atrial fibrilation, atrial flutter

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152
Q

Dofetilide - clinical use

A

atrial fibrilation, atrial flutter

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153
Q

Amiodarone - toxicity

A

pulmonary fibrosis (check PFTs)
hepatotoxicity (check LFTs)
hyperthyroidism (Check TFTs)
acts as hapten - blue/grey skin deposits - photodermatitis
neurologic effects
constipation
CV effects - bradycardia, heart block, HF

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154
Q

Class IV antiarrhythmics

A

verapamil, diltiazem
calcium channel blockers - block slow calcium channels - slow rise of AP (phase 0) and prolong repolarization (phase 3)

decrease conduction velocity, increase ERP, increase PR
prevent nodal arrhythmias, rate control in atrial fibrillation

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155
Q

Adenosine

A

antiarrhythmic - increases potassium efflux - hyperpolarizes the cell and decreases intracellular calcium (Gi coupled - decreases cAMP)

diagnose/abolish SVT

Very short acting

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156
Q

Aspart, glulisine, lispro - MoA

A

rapid acting insulin - bind insulin receptor (tyrosine kinase)
Liver: increases glucose stored as glycogen
Muscle: increases glycogen, protein synthesis; increases potassium uptake
Fat: increases TG storage

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157
Q

Detemir, glargine - MoA

A

long acting insulin - bind insulin receptor (tyrosine kinase)
Liver: increases glucose stored as glycogen
Muscle: increases glycogen, protein synthesis; increases potassium uptake
Fat: increases TG storage

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158
Q

Metformin - MoA

A

biguanide - mechanism unknown
increases glycolysis, peripheral glucose uptake (insulin sensitivity)
decreases gluconeogenesis

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159
Q

Metformin - clinical use

A

oral - first line therapy for T2DM
cause modest weight loss

can be used in pts w/o islet cell function

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160
Q

Metformin - toxicity

A

GI upset, lactic acidosis (contraindicated in renal insufficiency)

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161
Q

Chlorpropamide, tolbutamide - MoA

A

first gen sulfonylureas

close potassium channel in beta-cell membrane - cell depolarizes - insulin release via calcium influx

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162
Q

Chlorpropamide, tolbutamide - clinical use

A

first gen sulfonylureas

stimulate release of endogenous insulin in T2DM.
Requires some islet cell function to work (not for T1DM).

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163
Q

Chlorpropamide, tolbutamide - toxicities

A

first gen sulfonylureas

risk of hypoglycemia (renal failure)
disulfiram-like effects

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164
Q

Glimepiride, glipizide, glyburide - MoA

A

2nd gen sulfonylureas

close potassium channel in beta-cell membrane - cell depolarizes - insulin release via calcium influx

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165
Q

Glimepiride, glipizide, glyburide - clinical use

A

2nd gen sulfonylureas

stimulate release of endogenous insulin in T2DM.
Requires some islet cell function to work (not for T1DM).

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166
Q

Glimepiride, glipizide, glyburide - toxicity

A

2nd gen sulfonylureas

risk of hypoglycemia (renal failure)

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167
Q

Pioglitazone, rosiglitazone - MoA

A

Glitazones/thiazolidinediones

increase insulin sensitivity in peripheral tissue
binds to PPAR-gamma nuclear transcription regulator

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168
Q

Pioglitazone, rosiglitazone - clinical use

A

Glitazones/thiazolidinediones

mono- or combined therapy for T2DM

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169
Q

Pioglitazone, rosiglitazone - toxicity

A

Glitazones/thiazolidinediones

weight gain, edema
hepatotoxicity, HF, increased risk of fractures

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170
Q

exenatide, liraglutide - clinical use/MoA

A

GLP-1 analogs - T2DM

increase insulin
decrease glucagon

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171
Q

exenatide, liraglutide - toxicity

A

GLP-1 analogs - T2DM

nausea, vomiting, pancreatitis

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172
Q

linagliptin, saxagliptin, sitagliptin - clinical use/MoA

A

DPP-4 inhibitors - T2DM

increase insulin
decrease glucagon

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173
Q

linagliptin, saxagliptin, sitagliptin - toxicity

A

DPP-4 inhibitors

mild urinary or respiratory infections

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174
Q

pramlintide - clinical use/MoA

A

amylin analogs - T2DM, T1DM

decrease gastric emptying
decrease glucagon

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175
Q

pramlintide - toxicity

A

hypoglycemia, nausea, diarrhea

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176
Q

canagliflozin - clinical use/MoA

A

SGLT-2 inhibitors - Type 2 DM

block reabsorption of glucose in PCT

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177
Q

canagliflozin - toxicity

A

SGLT-2 inhibitors

glucosuria, UTIs, vaginal yeast infections

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178
Q

acarbose, miglitol - clinical use, MoA

A

alpha-glucosidase inhibitors - T2DM

delayed carbohydrate hydrolysis and glucose absorption - decreased postprandial hyperglycemia

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179
Q

propylthiouracil - MoA/clinical use

A

block thyroid peroxidase, inhibiting the oxidation of iodide and then organification (coupling) or iodine - inhibition of thyroid hormone synthesis
Blocks 5-deiodinase - decreases peripheral conversion of T4 to T3

hyperthyroidism; can be used in pregnancy

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180
Q

methimazole - MoA/clinical use

A

block thyroid peroxidase, inhibiting the oxidation of iodide and then organification (coupling) or iodine - inhibition of thyroid hormone synthesis

Hyperthyroidism

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181
Q

propylthiouracil - toxicity

A

skin rash, agranulocytosis, aplastic anemia, hepatotoxicity

182
Q

methimazole - toxicity

A

skin rash, agranulocytosis, aplastic anemia

can cause aplastic crisis - teratogenic

183
Q

Levothyroxine, triiodothyronine - MoA

A

thyroid hormone replacement

184
Q

Levothyroxine, triiodothyronine - toxicity

A

tachycardia, heat intolerance, tremors, arrhythmias

185
Q

ADH antagonists - clinical use

A

SIADH, block action of ADH and V2-receptor

186
Q

desmopressin

A

central DI

187
Q

oxytocin - clinical use

A

stimulates labor, uterine contractions, milk let-down

controls uterine hemorrhage

188
Q

somatostatin (otreotide) - clinical use

A

acromegaly, carcinoid syndrome, gastinoma, glocagonoma, esophageal varices

189
Q

Demeclocycline - MoA

A

ADH antagonist

190
Q

Demeclocycline - clinical use

A

SIADH

191
Q

Demeclocycline - toxicity

A

nephrogenic DI, photosensitivity, abnormalities in bones and teeth

192
Q

glucocorticoids - MoA

A

metabolic, catabolic, anti-inflammatory, immunosuppressive effects mediated by glucocorticoid response elements, inhibition of phospholipase A2, inhibition of transcription factors (NF-KB)

193
Q

glucocorticoids - clinical use

A

Addison disease
inflammation
immunosuppression
asthma

194
Q

glucocorticoids - toxicity

A 
iatrogenic cushing syndrome
adrenal insufficiency (with abrupt stop)
195
Q

Cinacalcet - MoA

A

sensitizes calcium sensing receptor in PTH glands to circulating calcium - decreases PTH

196
Q

Cinacalcet - clinical use

A

hypercalcemia due to primary or secondary hyperparathyroidism

197
Q

Cinacalcet - toxicity

A

hypocalcemia

198
Q

valproic acid - clinical use

A

all types of seizures except status epilepticus
bipolar disorder
myoclonic seizures

199
Q

valproic acid - toxicity

A

GI, rare but fatal liver toxicity (measure LFTs), neural tube defects, tremor, weight gain

200
Q

gabapentin - MoA

A

inhibits high voltage gated calcium channels

GABA analog

201
Q

gabapentin - clinical uses

A

simple and complex seizures
postherpetic neuralgia
peripheral neuropathy

202
Q

phenobarbital (seizure) - MoA

A

increases GABAa action

203
Q

phenobarbital (seizure) - clinical use

A

simple, complex, tonic-clonic seizures

first line in neonates

204
Q

phenobarbital (seizure) - toxicity

A

sedation, tolerance, dependance, cardirespiratory depression

induces CYP450

205
Q

topiramate - MoA

A

blocks sodium channels, increases GABA action

206
Q

topiramate - clinical use

A

simple, complex, tonic-clonic seizures

migraine prevention

207
Q

topiramate - toxicity

A

sedation, metal dulling, kidney stones, weight loss

208
Q

Lamotrigine - MoA

A

blocks voltage gated sodium channels

209
Q

Lamotrigine - clinical use

A

all seizure types except status epilepticus

210
Q

Lamotrigine - toxicity

A

Stevens-Johnson syndrome (titrated slowly)

211
Q

levetiracetam - MoA

A

unknown - may modulate GABA and glutamate release

212
Q

levetiracetam - clinical use

A

simple, complex, tonic-clonic seizures

213
Q

Tiagabine - MoA

A

increases GABA by inhibiting reuptake

214
Q

Tiagabine - clinical use

A

simple and complex seizures

215
Q

Vigabatrin - MoA

A

increases GABA by irreversibly inhibiting GABA transaminase

216
Q

Vigabatrin - clinical use

A

simple and complex seizures

217
Q

Barbiturates (general) - MoA

A

Phenobarbitol, pentobarbitol, thiopental, secobarbital

facilitate GABAa action by increasing DURATION of chloride channel opening - decreases neuronal firing

218
Q

Barbiturates (general) - clinical use

A

sedative for anxiety, seizures, insomnia, induction of anesthesia (thiopental)

219
Q

Barbiturates (general) - toxicity

A

respiratory and CV depression
CNS depression
induces CYP450
contraindicated in porphyria

220
Q

benzodiazepines (general) - MoA

A

facilitate GABAa action by increasing FREQUENCY of chloride channel opening.
decrease REM sleep
most have long half-life and active metabolites

221
Q

short-acting benzodiazepines

A

alprazolam, triazolam, oxazepam, midazolam

higher addictive potential

222
Q

benzodiazepines - clinical use

A

anxiety, spasticity, status epilepticus (lorazepam/diazepam), alcohol detox (DTs), night terrors, sleepwalking, general anesthetic, hypnotic

223
Q

benzodiazepines - toxicity

A

daytime drowsiness assoc w/ ataxia and falls

dependence, additive CNS depression w/ EtOH

Treat OD with flumazenil

224
Q

Zolpidem, Zaleplon, Eszoplicone - MoA

A

non-benzo hypnotics

act via BZ1 subtype of GABA receptor

225
Q

Zolpidem, Zaleplon, Eszoplicone - clinical use

A

insomnia

226
Q

Zolpidem, Zaleplon, Eszoplicone - toxicity

A

ataxia, headache, confusion
decreased dependence
short duration (rapid liver metabolism)

227
Q

Malignant hyperthermia

A

due to inhaled anesthetics + succinylcholine = fever and sever muscle contractions

antidote = dantrolene

228
Q

Thiopental - IV anesthetic

A

high potency, high lipid solubility, rapid entry into brain and rapid redistribution to muscle/fat

decreases cerebral blood flow

229
Q

Midazolam - IV anesthetic

A

benzo - short-acting

may cause severe post-op respiratory depression and decreased BP (treat w/ flumazenil); anterograde amnesia

230
Q

Ketamine (anesthetic)

A

IV arylcyclohexylamine - PCP analog that acts as dissociative anesthetic

blocks NMDA receptors

increases cerebral blood flow

231
Q

Propofol (anesthetic)

A

IV - used in ICU for sedation
Potentiates GABAa

rapid induction, good for short procedures
less post-op nausea than thiopental

232
Q

local anesthetics (esters and amides) - MoA

A

block sodium channels by binding receptors on inner portion of channel - prefer activated channels, so most effective in rapidly firing neurons

pain>temp>touch>pressure

small myelinated > small unmyelinated > large myelinated > large unmyelinated

233
Q

succinylcholine - MoA

A

depolarizing neuromuscular block

strong ACh receptor agonist - produces sustained depolarization and prevents muscle contraction

selective for motor (nicotinic) receptors

234
Q

succinylcholine - phase I blockade

A

prolonged depolarization - no antidote

potentiated by cholinesterase inhibitors

235
Q

succinylcholine - phase II blockade

A

repolarized but blocked - ACh receptors are available but desensitized
antidote is cholinesterase inhibitors

236
Q

succinylcholine - toxicity

A

hypercalcemia, hyperkalemia, malignant hyperthermia

237
Q

Tubocurarine, atracurium, pancuronium, etc

A

non-depolarizing neuromuscular blocking drugs
competitive ACh antagonists

reverse blockage with neostigmine (give w/ atropine to prevent muscarinic effects), edrophonium, and cholinesterase inhibitors

238
Q

Dantrolene - MoA

A

prevents release of calcium from SR of skeletal muscle

239
Q

Dantrolene - clinical use

A

malignant hyperthermia and neuroleptic malignant syndrome (antipsychotics)

240
Q

Baclofen - MoA

A

activates GABA B receptors at spinal cord - induces skeletal muscle relaxation

241
Q

Baclofen -CLINICAL USE

A

back pain/muscle spasms

242
Q

cyclobenzaprine - MoA

A

centrally affecting skeletal muscle relaxant

structurally similar to TCAs - similar anticholinergic side effects

243
Q

cyclobenzaprine - clinical use

A

muscle spasms

244
Q

L-Dopa - MoA

A

increases level of dopamine in brain (dopamine precursor)

crosses BBB and is converted by dopa decarboxylase to dopamine

245
Q

Carbidopa - MoA

A

peripheral Dopa Decarboxylase inhibitor - allows more L-Dopa to enter CNS and limits peripheral side effects

246
Q

L-Dopa - toxicity

A

arrhythmias from increased peripheral formation of catecholamines
long term - dyskinesias following administration, akinesia between doses (“on/off” phenomenon)

247
Q

Selegine - MoA

A

selectively inhibits MAO-B increasing the availability of dopamine

248
Q

selegiline - clinical use

A

adjunctive to L-Dopa in parkinson; may enhance adverse effects of L-Dopa

249
Q

Tolcapone/Entacapone - MoA

A

COMT inhibitors - block peripheral conversion of L-Dopa to 3-O-methyldopa

Tolcapone - also central COMT inhibitor and blocks conversion of dopamine to 3-MT in CNS

250
Q

Bromocriptine - MoA

A

dopamine agonist (ergot) (parkinson disease)

251
Q

pramipexole, ropinirole - MoA

A

dopamine agonist (non-ergot) (parkinson disease)

252
Q

Amantadine - MoA

A

increases dopamine release and inhibits reuptake
(Parkinson disease)

also used as antiviral - influenze and rubella

253
Q

Benzotropine - MoA

A

antimuscarinic that improves tremor and rigidity in parkinson disease
curbs excess cholinergic activity

254
Q

Memantine

A

NMDA receptor antagonist - helps prevent excitotoxicity (mediated by calcium)

Alzheimer Disease

dizziness, confusion, hallucinations

255
Q

Tetrabenazine and reserpine - MoA/clinical use

A

inhibit vesicular monoamine transporter (VMAT) - limits dopamine packaging and release - decrease dopamine availability

Huntington disease

256
Q

Haloperidol - MoA/clinical use

A

D2 receptor antagonist - Huntington

257
Q

Sumatriptan - MoA

A

5-HT-1B/1D agonists
inhibit trigeminal nerve activation
prevent vasopeptide release
induce vasonstiction

258
Q

Sumatriptan - toxicity

A

coronary vasospasm - contraindicated in Prinzmetal angina or CAD
mild paresthesia

259
Q

leuprolide - MoA

A

GnRH analog

pulsatile = agonist; continuous = antagonist

260
Q

leuprolide - clinical use

A

pulsatile - infertility

continuous - prostate cancer, uterine fibroids, precocious puberty

261
Q

estrogens (ethinyl estradiol, DES, mestranol) - clinical use

A

hypogonadism or ovarian failure, menstrual abnormalities, HRT

men - androgen-dependent prostate cancer

262
Q

clomiphene - MoA

A

selective estrogen receptor modulator
antagonist at estrogen receptors in hypothalamus - prevents normal feedback inhibition and increases the release of LH and FSH from pituitary, stimulating ovulation

263
Q

clomiphene - clinical use

A

stimulates ovulation - infertility due to anovulation

264
Q

tamoxifen - MoA

A

selective estrogen receptor modulator - antagonist at breast; agonist at bone/uterus

265
Q

tamoxifen - clinical use

A

treat/prevent recurrence of ER/PR + breast cancer

266
Q

raloxifene - MoA

A

selective estrogen receptor modulator - antagonist at breast/uterus; agonist at bone

267
Q

raloxifene - clinical use

A

osteoporosis

268
Q

anastrozole/exemestane - MoA

A

aromatase inhibitors

269
Q

anastrozole/exemestane - clinical use

A

ER + breast cancer in post-menopausal women

270
Q

progestin - MoA

A

bind progesterone receptors - decrease growth and increase vascularization of endometrium

271
Q

progestin - clinical use

A

oral contraceptives, endometrial cancer, abnormal uterine bleeding

272
Q

mifepristone - MoA

A

competitive inhibitor of progestins at progesterone receptors

273
Q

mifepristone - clinical use

A

termination of pregnancy (co-admin w/ misoprotol - PGE1)

274
Q

oral contraceptives

A

estrogen and progestins inhibit LH/FSH - prevents estrogen surge - prevents LH surge - no ovulation

progestins - thicken cervical mucus and inhibit endometrial proliferation

275
Q

terbutaline, ritodrine - MoA

A

B2 agonists that relax the uterus

276
Q

terbutaline, ritodrine - clinical use

A

decrease contraction frequency in women during labor

277
Q

danazol - MoA

A

synthetic androgen that acts as partial agonist at androgen receptors

278
Q

danazol - clinical use

A

endometriosis, hereditary angioedema

279
Q

testosterone, methyltestosterone - MoA

A

agonists at all androgen receptors

280
Q

testosterone, methyltestosterone - clinical use

A

hypogonadism, promotes development of secondary sex characteristics, stimulates anabolism to promote recovery (post-burn/injury)

281
Q

Finasteride - MoA

A

5a-reductase inhibitor

282
Q

Finasteride - clinical use

A

male pattern baldness, BPH

283
Q

flutamide - MoA

A

nonsteroidal competitive inhibitor at androgen receptors

284
Q

flutamide - clinical use

A

prostate carcinoma

285
Q

ketoconazole - MoA

A

inhibits 17,20-desmolase - inhibits steroid synthesis

286
Q

ketoconazole - clinical use

A

PCOS - reduction of androgen symptoms

can cause gynecomastia and amenorrhea

287
Q

spironolactone - clinical use

A

PCOS - reduction of androgen symptoms

can cause gynecomastia and amenorrhea

288
Q

spironolactone - MoA

A

inhibits steroid binding, 17a-hydroxylase, and 17,20-desmolase

289
Q

tamsulosin - MoA

A

alpha-1 agonist - selective for alpha 1A,D receptors in prostate

inhibits smooth muscle contraction

290
Q

tamsulosin - clinical use

A

BPH

291
Q

sildenafil, vardenafil, tadalafil - MoA

A

inhibit PDE-5 - increases cGMP, smooth muscle relaxation in corpus cavernosum

increases blood flow and penile erection

292
Q

sildenafil, vardenafil, tadalafil - toxicity

A

headache, flushing, dyspepsia, cyanopsia

life-threatening hypotension in pts taking nitrates

293
Q

minoxidil - MoA

A

direct arteriolar vasodilator

294
Q

minoxidil - clinical use

A

androgenetic alopecia; severe refractory hypertension

295
Q

Burkitt Lymphoma

A

increased C-myc activity

t(8,14)

296
Q

CML

A

BCR-ABL translocation (9,22)

increased tyrosine kinase activity

297
Q

Heparin - MoA

A

activator of antithrombin - decreases thrombin and factor Xa

short halflife

298
Q

Heparin - clinical use

A

immediate anti-coag for PE, acute coronary syndrome, MI, DVT

use during pregnancy (does NOT cross placenta)

Monitor with PTT

299
Q

Heparin - toxicity

A

bleeding, HIT, osteoporosis, drug-drug interactions

Rapid reversal - protamine sulfate (negatively charged - binds positively charged heparin molecules)

300
Q

Heparin - LMWH

A

enoxaprarin, dalteparin - act more on factor Xa
better bioavailability, longer half-life
can be administered subcutaneously w/o lab monitoring
Not easily reversible

301
Q

Fondaparinux

A

direct Xa inhibitor

302
Q

Heparin-induced thrombocytopenia

A

development of IgG antibodies against heparin-bound platelet factor 4 (PF4)

antibody-heparin-PF4 complex activates platelets - thrombosis and thrombocytopenia

STOP heparin, do NOT give coumadin

303
Q

argatroban, bivalirudin, dabigatran

A

direct thrombin inhibitors - use in pts with HIT

304
Q

Warfarin - MoA

A

interferes with gamma carboxylation of Vit-K dependent clotting factors (2,7,9,10,S,C)

increases PT

305
Q

warfarin - clinical use

A

chronic anti-coagulation
cannot use in pregnant women
follow PT/INR

306
Q

Warfarin - toxicity

A

bleeding, teratogen, skin/tissue necrosis, drug-drug interactions

early transient hypercoag - small vessel microthrombi (necrosis)
VitK - reversal
rapid reversal - fresh frozen plasma

307
Q

Apixaban, rivaroxaban - MoA

A

direct factor Xa inhibitors

308
Q

Apixaban, rivaroxaban - clinical use

A

treat/prophylax - DVT, PE, stroke (in pts with a.fib)

309
Q

Apixaban, rivaroxaban - toxicity

A

bleeding - no reversal agents

310
Q

Thrombolytics - MoA

A

alteplase, reteplase, streptokinase, tenecteplase

directly or indirectly aid conversion of plasminogen to plasmin
plasmin cleaves thrombin and fibrin clots
increase PT and PTT, no change in platelet counts

311
Q

thrombolytics - clinical use

A

alteplase, reteplase, streptokinase, tenecteplase

early MA, early ischemic stroke, severe PE

312
Q

thrombolytics - toxicity

A

alteplase, reteplase, streptokinase, tenecteplase

bleeding - contraindicated in pts w/ bleeding, history of intracranial bleed, recent surgery, severe HTN
treat toxicity w/ aminocaproic acid (inhibits fibrinolysis)

313
Q

Aspirin - MoA

A

irreversibly inhibits COX-1 and COX-2 by covalent acetylation
increase bleeding time, decrease TXA2 and prostaglandins
no effect on PT and PTT

314
Q

Aspirin - clinical use

A

antipyretic, analgesic, anti-inflammatory, anti-platelet

315
Q

aspirin - toxicity

A

gastic ulceration, tinnitus (CN VIII), acute renal failure (chronic use), interstitial nephritis, upper GI bleeding

OD - initially causes hyperventilation and respiratory alkalosis, transitions to metabolic mixed acidosis-respiratory alkalosis

316
Q

ADP receptor inhibitors - MoA

A

clopidogrel, prasugrel, ticagrelor (reversible), ticlopidine

inhibit platelet aggregation by irreversibly blocking ADP receptors
prevents expression of GP IIb/IIIa on platelet surface

317
Q

ADP receptor inhibitors - clinical use

A

acute coronary syndrome, coronary stenting
decrease incidence or recurrence of thrombotic stroke

clopidogrel, prasugrel, ticagrelor (reversible), ticlopidine

318
Q

ADP receptor inhibitor - toxicity

A

clopidogrel, prasugrel, ticagrelor (reversible), ticlopidine

neutropenia - ticlopidine!
TTP

319
Q

Cilostazol, dipyridamole - MoA

A

phosphodiesterase III inhibitor - increases cAMP in platelets resulting in inhibition of aggregation

vasodilators

320
Q

Cilostazol, dipyridamole - clinical use

A

intermittent claudication, coronary vasodilation, prevention of stroke/TIA, angina prophylaxis

321
Q

Cilostazol, dipyridamole - toxicity

A

nausea, headache, flushing, hypotension, abdominal pain

322
Q

GP IIb/IIIa inhibitors - MoA

A

abciximab, eptifibatide, tirofiban

bind GP IIb/IIIa on activated platelets and prevent aggregation

323
Q

GP IIb/IIIa inhibitors - clinical use

A

unstable angina, percutaneous transluminal coronary angioplasty

abciximab, eptifibatide, tirofiban

324
Q

GP IIb/IIIa inhibitors - toxicity

A

abciximab, eptifibatide, tirofiban

bleeding, thrombocytopenia

325
Q

meningitis in newborns

A

group B strep (gram + cocci, beta-hemolytic, catalase -, bacitracin resistant)
E. coli (gram - rods, lactose fermenter, metallic green on EBM)
listeria (gram + rods, tumbling motility)

326
Q

meningitis in children (6mo-6yrs)

A

S. pneumo (lancet shaped diplococci, gram+, alpha hemolytic, bile soluble)
N. meningitidis (gram - diplococci, ferments maltose)
H.influenzae B (gram - coccoid rods, grow on chocolate agar or w/s.aureus)
Enteroviruses

327
Q

meningitis - adults (6 yrs-60yrs)

A

S.pneumo (lancet shaped diplococci, gram+, alpha hemolytic, bile soluble)
N. meningitidis - #1 in teens (gram - diplococci, ferments maltose)
Enterovirus
HSV

328
Q

meningitis - 60+ yrs

A

S.pneumo (lancet shaped diplococci, gram+, alpha hemolytic, bile soluble)
gram negative rods
listeria (gram + rods, tumbling motility)

329
Q

methylphenidate, dextrophetamine, methamphetaine - MoA

A

CNS stimulants - increases catecholamines in the synaptic cleft, especially NE and dopamine

330
Q

methylphenidate, dextrophetamine, methamphetaine - clinical use

A

ADHD, narcolepsy, appetite control

331
Q

Antipsychotics - neuroleptics - MoA

A

haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine (haloperidol + -azines)

block D2 receptors - increases cAMP

332
Q

antipsychotics - neuroleptics - clinical use

A

schizophrenia, psychosis, acute mania, Tourette syndrome, huntington

333
Q

anti-psychotics - neuroleptics - toxicity

A

High potency (Trifluoperazine, fluphenazine, haloperidol) - neurologic side effects (extrapyramidal symptoms)

Low potency (chlorpromazine, thioridazine) - non-neuro side effects (anticholinergic, antihistamine, alpha 1 blockade effects)

chlorpromazine - corneal deposits
thioridazine - retinal deposits
Haloperidol - NMS, tardive dyskinesia

334
Q

neuroleptic malignant syndrome

A

rigidity, myoglobinuria, autonomic instability, hyperpyrexia

“FEVER - Fever, Encephalopathy, Vitals unstable, Enzymes elevated, Rigidity”

treat w/ dantrolene, D2 agonists

335
Q

tardive dyskinesia

A

oral-facial movements - long term antipsychotic use ( 4 mo)

336
Q

extrapyramidal system effects

A

treat with benztropine or diphenhydramine

4 hr - acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4 day - akathisia (restlessness)
4 weeks - bradykinesia (parkinsonism)
4 months - tardive dyskinesia

337
Q

atypical antipsychotics

A

olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone - atypical for Old CLOZets to Quietly RISPER from A to Z

338
Q

atypical antipsychotics - MoA

A

olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone

not completely understood - varied effects on 5-HT2, dopamine, and alpha and H1 receptors

339
Q

atypical antipsychotics - clinical use

A

olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone

schizophrenia - positive and negative symptoms
bipolar, OCD, anxiety, depression, mania, tourette

340
Q

atypical antipsychotics - toxicity

A

olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone

fevers EPS and anticholinergic effects that neuroleptics; all prolong QT interval

Olanzapine/clozapine - significant weight gain
Clozapine - agranulocytosis (weekly WCB monitoring)
Risperidone - increase prolactin - decreases GnRH, LH, FSH - irregular menstruation

341
Q

Lithium - clinical use

A

mood stabilizer for bipolar
blocks relapse and acute manic events

treats SIADH

342
Q

Lithium - toxicity

A

LMNOP - Movement (tremor), Nephrogenic DI, hypOthyroidism, Pregnancy problems

causes Epstein’s anomaly in newborns if taken during pregnancy

excreted by kidneys - reabsorbed in PCT with Na+; Thiazide use can cause lithium toxicity

343
Q

Buspirone - MoA

A

stimulates 5-HT1A receptors

344
Q

Buspirone - clinical use

A

GAD
does not cause sedation, tolerance, addiction

takes 1-2 weeks for effect
does NOT interact with alcohol

345
Q

SSRIs

A

Fluoxetine, paroxetine, sertraline, citalopram

346
Q

SSRI - MoA

A

Fluoxetine, paroxetine, sertraline, citalopram

5-HT specific reuptake inhibitors

takes 4-8 wks for effect

347
Q

SSRI - clinical use

A

Fluoxetine, paroxetine, sertraline, citalopram

depression, GAD, panic disorder, OCD, bulimia, social phobias, PTSD

348
Q

SSRI - toxicity

A

Fluoxetine, paroxetine, sertraline, citalopram

fever than TCAs
GI distress, SIADH, sexual dysfunction
serotonin syndrome - w/ any drug that increases 5-HT

349
Q

serotonin syndrome

A

hyperthermia, confusion, myoclonus, CV instability, flushing, diarrhea, seizures

treat w/ cyproheptadine (5-HT2 receptor antagonist)

350
Q

SNRIs

A

venalfaxine, duloxetine

351
Q

SNRIs - MoA

A

venalfaxine, duloxetine

inhibit 5-HT and NE reuptake

352
Q

SNRIs - clinical use

A

depression

venalfaxine - GAD, panic disorder, PTSD
duloxetine - peripheral diabetic neuropathy

353
Q

SNRIs - toxicity

A

venalfaxine, duloxetine

increased BP, stimulant effects, sedation, nausea

354
Q

TCAs

A

amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine

355
Q

TCAs - MoA

A

amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine

block reuptake of NE and 5-HTq

356
Q

TCAs - clinical use

A

amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine

depression, OCD (clomipramine), peripheral neuropathy, chronic pain, migraine prophylaxis

357
Q

TCAs - toxicity

A

amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine

Tri-C: Convulsions, Coma, Cardiotoxicity (arrhythmia due to inhibiting Na+ channel conduction) - use NaHCO3 to prevent arrhythmias

respiratory depression, hyperpyrexia, confusion and hallucinations in elderly due to anticholinergic effects

sedation, alpha 1 block (postural hypotension), atropine-like effects (amitriptyline > nortriptyline), prolong QT

358
Q

MAO-I

A

Tranylcypromine, phenelzine, isocarboxazid, selegiline (selective MAO-B)

359
Q

MAO-I - MoA

A

Tranylcypromine, phenelzine, isocarboxazid, selegiline (selective MAO-B)

increase amine neurotransmitters (NE, 5-HT, dopamine)

360
Q

MAO-I - clinical use

A

Tranylcypromine, phenelzine, isocarboxazid, selegiline (selective MAO-B)

atypical depression, anxiety

361
Q

MAO-I toxicity

A

Tranylcypromine, phenelzine, isocarboxazid, selegiline (selective MAO-B)

hypertensive crisis (w/ ingestion of tyramine) CNS stimulation

contraindicated w/ SSRIs, TCAs, St. John’s wort, meperidine, dextromethorphan - prevent serotonin syndrome

362
Q

bupropion - MoA

A

atypical antidepressant
smoking cessation
increase NE and dopamine (unknown mechanism)

363
Q

bupropion - toxicity

A

stimulant effect (structurally similar), headache, seizures in anorexic/bulimic pts, no sexual side effects

364
Q

Mirtazapine- MoA

A

alpha 2 antagonist - increases release of 5-HT and NE
potent 5-HT2 and 5-HT3 receptor antagonist

atypical antidepressants

365
Q

mirtazapine - toxicity

A

sedation, increased appetite, weight gain, dry mouth

366
Q

trazodone - MoA

A

blocks 5-HT2 and alpha 1 receptors

367
Q

trazodone - clinical use

A

atypical antidepressant - primarily for insomnia (high dose for anti-depressive effect)

368
Q

trazadone - toxicity

A

sedation, nausea, priapism (trazaBONE), postural hypotension

369
Q

Cluster A personality disorders

A

“Weird” - odd or eccentric, inability to develop meaningful social relationships, no psychosis, genetic association with schizophrenia

Paranoid “Accusatory”
Schizoid “Aloof”
Schizotypal “awkward”

370
Q

pervasive distrust and suspiciousness; projection is major defense mechanism

A

paranoid personality disorder (cluster A)

371
Q

voluntary social withdrawal, limited emotional expression, content with social isolation

A

schizoid personality disorder - cluster A

372
Q

eccentric appearance, odd beliefs/magical thinking, interpersonal awkwardness

A

schizotypal personality disorder - cluster A

373
Q

cluster B personality disorders

A

dramatic, emotional, erratic
generic association with mood disorders and substance abuse

“Wild” (Bad to the Bone)
Antisocial, borderline, histrionic, narcissitic

374
Q

disregard for and violation of the rights of others, criminality, impulsivity

A

antisocial PD - cluster B

M»F; must be >18 w/ history of conduct disorder

375
Q

unstable mood and interpersonal relationships, impulsivity, self-mutilation, boredom, sense of emptiness

A

borderline PD - cluster B

F»M

splitting = major defense mechanism

376
Q

excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with apperance

A

histrionic PD - cluster B

377
Q

grandiosity, sense of entitlement, lacks empathy and requires excessive admiration, often demands the best and reacts to criticism with rage

A

narcissistic PD - cluster B

378
Q

cluster C personality disorders

A

“worried” anxious or fearful; genetic association with anxiety disorders
Cowardly - avoidant
compulsive - Obsessive-compulsive
clingy - dependent

379
Q

hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others

A

avoidant PD - cluster C

380
Q

preoccupation with order, perfectionism and control; ego-syntonic

A

obsessive-compulsive PD - cluster C

381
Q

submissive and clingy, excessive need to be taken care of, low self-confidence

A

dependent PD - cluster C

often stuck in abusive relationships

382
Q

alcohol intoxication

A

emotional lability, slurred speech, ataxia, coma, blackouts
serum GGT - sensitive indicator of alcohol use
AST&raquo_space; ALT

383
Q

Alcohol withdrawal

A

tremor, tachycardia, HTN, malaise, nausea, DTs

384
Q

Delirium tremens

A

life threatening alcohol withdrawal that peaks 2-4 days after last drink
autonomic hyperactivity (tachycardia, tremors, anxiety, seizures)
5-15% mortality rate

treat w/ benzos

alcoholic hallucinations - 12-18 hrs after last drinks

385
Q

opioid intoxication

A

euphoria, respiratory and CNS depression, decreased gag reflex, pinpoint pupils, seizures (OD)

treat w/ naloxone or naltrexone

386
Q

opioid withdrawal

A

sweating, dilated pupils, piloerection, fever, rhinorrhea, diarrhea, yawing, nausea, cramps

treat w/ long-term support, buprenorphine, methadone

387
Q

barbiturate - intoxication

A

low safety margin - marked respiratory depression

treat by managing symptoms (increase BP, assist respiration)

388
Q

barbiturate withdrawal

A

delirium, life-threatening CV collapse

389
Q

benzos - intoxication

A

greater safety margin than barbiturates

ataxia, minor respiratory depression

treat with flumazenil

390
Q

benzos withdrawal

A

sleep disturbance, depression, rebound anxiety, seizure

391
Q

amphetamine intoxication

A

euphoria, grandiosity, pupillary dilation, agitation, insomnia, arrhythmias, tachycardia, anxiety

392
Q

amphetamine withdrawal

A

anhedonia, increased appetite, hypersomnolence, existential crisis

post-use crash: depression, lethargy, weight gain, headache

393
Q

cocaine intoxication

A

impaired judgement, pupillary dilation, hallicinations, paranoid ideations, angina, sudden cardiac death

treatment: alpha blockers, benzos (NOT beta blockers)

394
Q

cocaine withdrawal

A

hypersomnolence, malaise, severe craving, depression/suicidality

post-use crash: depression, lethargy, weight gain, headache

395
Q

caffeine intoxicatoin

A

restlessness, increased diuresis, muscle twitching

396
Q

caffeine withdrawal

A

lack of concentration, headache

397
Q

nicotine intoxication

A

restlessness

398
Q

nicotine withdrawal

A

irritability, anxiety, craving

treatment: nicotine patches/gum/etc, bupropion, varenicline

399
Q

varenicline

A

partial nicotinic receptor agonist - decreases nicotine w/d symptoms and decreases reward from nicotine

400
Q

PCP intoxication

A

belligerence, impulsivity, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium, seizures

treatment: benzos, rapid-acting anti-psychotic

401
Q

PCP withdrawal

A

depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep

402
Q

LSD intoxication

A

perceptual distortion, depersonalization, anxiety, paranoia, psychosis, flashbacks

403
Q

Marijuana intoxication

A

euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, social withdrawal, increased appetite, dry mouth, conjunctival injections, hallucinations

404
Q

marijuana withdrawal

A

irritability, depression, insomnia, nausea, anorexia

peak w/in 48 hrs (may last 5-7 days)

405
Q

methadone

A

long-acting oral opiate for heroin detox and maintenance

406
Q

naloxone

A

antagonist - must be injected (not orally bioavailable)

407
Q

buprenorphine

A

opiate partial agonist

408
Q

naltrexone

A

long-acting opiate antagonist used for relapse prevention once detoxed from heroin

409
Q

HIV therapy

A

HAART
2 nucleoside reverse transcriptase inhibitors + 1 protease inhibitor OR integrase inhibitor OR non-nucleoside reverse transcriptase inhibitor

410
Q

protease inhibitors

A

-navir (Navir tease a protease)

atazanavir
darunavir
fosamprenavir
indinavir
lopinavir
ritonavir
saquinavir
411
Q

protease inhibitors - MoA

A

-navir

assembly of virons depends on viral protease (pol gene) - PI prevents maturation of new viruses

412
Q

protease inhibitors - toxicity

A

hyperglycemia, GI intoleraqnce, lipodystrophy

indinavir - nephrotoxicity, hematuria

contraindicated w/ rifampin (CYP inducer)

413
Q

nucleoside reverse transcriptase inhibitors

A 
abacavir
didanosine
emtricitabine
lamivudine
stavudine
tenofir
zidovudine
414
Q

nucleoside reverse transcriptase inhibitors - MoA

A

competitively inhibit nucleotide binding to reverse transcriptase and terminate DNA chain

all need to be phosphorylated to be active EXCEPT tenofovir
zidovudine - general prophylaxis and during pregnancy

415
Q

Nucleoside reverse transcriptase inhibitors - toxicity

A 
bone marrow suppression (reversed with G-CSF and EPO)
peripheral neuropathy
lactic acidosis (except tenofovir)
anemia (zidovudine)
pancreatitis (didanosine)
416
Q

non-nucleoside reverse transcriptase inhibitors

A

delvirdine
efavirenz
nevirapine

417
Q

non-nucleoside reverse transcriptase inhibitors - MoA

A

bind to reverse transcriptase in a different site from NRTIs

do not require phosphorylation

418
Q

non-nucleoside reverse transcriptase inhibitors - toxicity

A

rash, hepatotoxicity
vivid dreams - efavirenz
only use nevirapine in pregnancy

419
Q

raltegravir - MoA

A

integrase inhibitors - inhibits HIV genome integration into host chromosome by reversibly inhibiting HIV integrase

420
Q

raltegravir - toxicity

A

integrase inhibitor

increases creatine kinase

421
Q

enfuvirtide - MoA

A

fusion inhibitor - binds gp41, inhibiting viral cell entry

causes skin reaction at injection site

422
Q

maraviroc - MoA

A

fusion inhibitor - binds CCR5 in surface of T cells/monocytes
inhibits interaction with gp120

423
Q

H2 blockers (GI) - MoA

A

cimetidine, ranitidine, famotidine, nizatidine

reversible block of H2 receptors - decrease H+ secretion by parietal cells

424
Q

H2 blockers (GI) - clinical use

A

cimetidine, ranitidine, famotidine, nizatidine

peptic ulcer, gastritis, mild esophageal reflux, zollinger-ellison

425
Q

H2 blocker (GI) - toxicity

A

cimetidine, ranitidine, famotidine, nizatidine

cimetidine - inhibits CYP450; antiandrogenic effects, crossed BBB and placenta

cimetidine and ranitidine - decrease renal excretion of creatinine

426
Q

proton pump inhibitors - MoA

A

omeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole

irreversible inhibit H+/K+ ATPase in parietal cells

427
Q

PPI - clinical use

A

omeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole

peptic ulcer, gastritis, esophageal reflux, zollinger-ellison

428
Q

PPI - toxicity

A

omeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole

C.diff infection, pneumonia
decreased serum Mg with longterm use

429
Q

bismuth, sucralfate - MoA

A

binds to ulcer base - physical protection; allows HCO3 to reestablish pH gradient in mucosa

430
Q

bismuth, sucralfate - clinical use

A

ulcer healing, travelers diarrhea

431
Q

misoprostol - MoA

A

PGE1 analog - increases production and secretion of gastric mucous barrier (mucus and bicarb)
decreases acid production

432
Q

misoprostol - clinical use

A

prevention of NSAID inducted peptic ulcers
maintain PDA

induction of labor (off label); abortifacient

433
Q

misoprostol - toxicity

A

diarrhea

434
Q

octreotide - MoA

A

long acting somatostatin analog, prohibits actions of splanchnic vasodilatory hormones

435
Q

octreotide - clinical use

A

acute variceal bleeds, acromegaly, VIPoma, carcinoid tumors

436
Q

octreotide - toxicity

A

nausea, cramps, steatorrhea

437
Q

antacids - MoA

A

neutralize protons in gut

alter gastric and urinary pH; delay gastric emptying

438
Q

antacids - toxicity

A

all can cause hypokalemia

Aluminum hydroxide - constipation, hypophosphatemia, prox. muscle weakness, osteodystrophy, seizures

Calcium carbonate - hypercalcemia, rebound acid, chelates other drugs (tetracycline)

Magnesium hydroxide - diarrhea, hyporeflexia, hypotension, cardiac arrest

439
Q

sulfasalazine - MoA

A

combo of sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory)

activated by colonic bacteria

440
Q

sulfasalazine - clinical use

A

Ulcerative colitis, Crohn disease (colitis component)

441
Q

sulfasalazine - toxicity

A

malaise, nausea, sulfonamide toxicity, reversible oligospermia

442
Q

odansetron - MoA

A

5-HT3 antagonist, decreases vagal stimulation

powerful anti-emetic (central acting)

443
Q

odansetron - clinical use

A

post-op and cancer anti-emetic

444
Q

odansetron - toxicity

A

headache, constipation, prolonged QT interval

445
Q

metoclopramide - MoA

A

D2 receptor antagonist
increases resting tone, contractility, LES tone, motility

does NOT influence colon transport time

446
Q

metoclopramine - clinical use

A

diabetic and post-op gastroparesis, anti-emetic

447
Q

metoclopramine - toxicity

A

parkinsonian effects, tardive dyskinesia

restlessness, fatigue, drowsiness, depression, diarrhea

448
Q

orlistat - MoA

A

inhibits gastric and pancreatic lipase - decrease breakdown/absorption of dietary fats

449
Q

orlistat - clinical use

A

weight loss

450
Q

orlistat - toxicity

A

steatorrhea, decreased absorption of fat soluble vitamins

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