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NPLEX Pharm > PHARM > Flashcards

PHARM Flashcards

1
Q

Penicillin VK

A

B lactams

Staph, strep, gonorrhea, Hflu
Recurrent RF, dental abscesses, diphtheria

A/E: Black hairy tongue, anaphylaxis

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2
Q

Amoxicillin

A 
B lactams (Broad spectrum)
SAFE FOR PREGNANCY

1st line uncomplicated EENT
MAP USE: Meningitis, AOM, PUD, UTI, Salmonella, Extended spectrum

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3
Q

Cephalexin

A

Cephalosporin B lactase
SAFE FOR PREGNANCY

Cellulitis
Resp, skin, GU, bone, OM (Staph, strep, E.coli, Proteus, Klebsiella)

A/E: Penicillin allergy (10-15% cross allergy)

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4
Q

Doxycycline

A

Tetracycline - protein synthesis inhibitor
Broad Spectrum, take on EMPTY stomach

GC/CT if penicillin allergy, Mycoplasma, Lyme, Rickettsia, Acne, Cholera, ANTHRAX
*NOT first choice for any staph infection

A/E: Tooth discoloration (CI <8yo), photosensitivity

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5
Q

Azithromycin

A

Macrolide - protein synthesis inhibition
SAFE FOR PREGNANCY, take WITH food

STDS (Chlamydia, syphilis, chancoird
Respiratory (Diphtheria, TB)
2nd choice for AOM

CI: Liver disease

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6
Q

Clarithromycin

A

Macrolide - protein synthesis inhibition
SAFE FOR PREGNANCY, take WITH food

STDS (Chlamydia, syphilis, chancoird
Respiratory (Diphtheria, TB)
2nd choice for AOM

CI: Liver disease

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7
Q

Clindamycin

A

Lincosamide - protein synthesis inhibition

Topical for acne, peritonsillar abscess, neonatal GBS prophylaxis if penicillin allergy

A/E C. diff pseudomembranous colitis

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8
Q

Ciprofloxacin

A

Fluoroquinolone - DNA synthesis inhibitor
Broad spectrum

1st line UTIs (Pyelo = 400mg IV), GI
2nd line TB
ANTHRAX

A/E Tendon rupture, CI <18yo dt arrested growth plates

Increase Warfarin levels
Decreased absorption with antacids, Fe, Zn

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9
Q

Mupirocin

A

RNA synthesis inhibitor

Topical MRSA, Impetigo

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10
Q

Nitrofurantoin

A

NEVER use last trimester

Acute uncomplicated UTI (not E. Coli)

CI: G6PD, <3 months old, pregnancy, severe renal impairment, can cause hemolytic anemia in fetus

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11
Q

TMP/SMX

A

Broad Spectrum
*GIVE WITH FOLATE

Respiratory, UTI, Prostatitis, Salmonella, Shigella
2nd line AOM

A/E: Megaloblastic anemia, photosensitivity
CI: G6PD, pregnancy, <2 months
IA: Warfarin, OCP, Sulfonylureas

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12
Q

Triple Antibiotic Ointment

A

Allergic contact derm

Bacitracin ….[Replace with hydrocortisone for swimmer’s ear, superficial bacterial infx of external auditory canal]
Neomycin (permanent SNHL)
Polymyxin B

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13
Q

TB meds

A

Isoniazid (can be used for latent as well)
Rifampin (red tears/urine/saliva)

  • use both together for active infection
  • both hepatotoxic (increase LFT)
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14
Q

Anti-Fungals

A

Fluconazole: Trich, systemic, organ transplants
Nystatin: Not absorbed so good for GI
Terbinafine: Nails (hepatotoxic, SJS, neutropenia)

IA: Warfarin, phenytoin, oral hypoglycemics

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15
Q

Hydroxychloroquine

A

DMARD

Anti-malarial
Anti-rheumatic
Anti-inflammatory

A/E: nightmares, CVD, vision, photosensitivity
CI: long term use
IA: Digoxin, alcohol

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16
Q

Mebendazole

A

Anti-helminthic

A/E = ALL BENT = Angioedema, Liver enzymes elevated, BM decreased, Epigastric pain, Neuro, Teratogen

CI: <2yo

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17
Q

Permethrins

A

Scabies

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18
Q

Metronidazole

A

Anti-protozoal, anaerobic infx (C.dif, PUD, BV, Trich, Giardia, Peritonsillar abscess)

A/E = NIDA = Neurotoxic, Irritated GI/GU, Disulfiram Rxn with EtOH, Allergy/a metallic taste

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19
Q

Valacyclovir

A

HSV (active), Hep B post exposure, EBV, CMV, Varicella

A/E: Increased AST/ALT, GI, rash, delirium

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20
Q

HIV medication

A

Zidouvidine - reverse transcriptase inhibitor

CI: Lactation
A/E: BM suppression = anemia, neutropenia

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21
Q

Amantadine

A

Anti-cholinergic dopamine agonist

Parkinsons*
No longer recommended for Influenza A
Herpes zoster

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22
Q

Oseltamivir

A

Influenza A &B (spray, inhaler, IV)

A/E SUICIDE

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23
Q

Interferon-a-2

A

Chronic HBV, HCV*, cancer, polycythemia vera, condylomata accuminata

A/E = IFN ALPHA = Inhibit BM, Flu, Neurotoxic, AI, Liver enzymes increase, Proteinuria, HYPOTHYROID/Hypotension/tachycardia, Alopecia

CI: AI, infants, pregnancy C, transplants
Extreme myelosuppression if combined with Zidovudine

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24
Q

Doxorubicin

A

Breast cancer, Kapos’s sarcoma, multiple myeloma, ovarian CA

A/E Heart damage

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25
Q

Trastuzumab

A

“trust her, but not too much because shell kill your baby” - HER 2+ breast CA

A/E: Heat, lung problems, fetal harm

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26
Q

Methotrexate

A

Anti-metabolite/folate (DMARD)
*must sup with folate
PREGNANCY X

Cancer, RA, Abortion, psoriasis, crohns, AS

CI: Lethal with NSAIDS dt GI toxicity

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27
Q

Vinblastine

A

IV only (from periwinkle)

Testicular CA, Hodgkin’s, Kaposi’s sarcoma

A/E: Fatal intrathecally
IA: CYP3A4, Hypericum

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28
Q

Anastrazole

A

Aromaste inhibitor - reduces serum estradiol

Breast CA (post surgery and mets)

A/E: clots

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29
Q

Paclitaxel

A

“we need to gather in a pack to fight the bad CA”
Binds tubulin- effects rapidly dividing cells

Advanced ovarian CA, ovarian/breast CA mets unresponsive to 1st line drugs, non-small cell lung CA

*Give with steroids and histamine for anaphylaxis prevention

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30
Q

5-FU

A

Pyrimidine analogue
Sup with folate

Many cancers, topical for BCC

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31
Q

SERMs (2)

A

Raloxifine - prophylaxis post-menopausal osteoporosis, antagonist in uterine/ breast
CI: clot, pregnancy
IA: Warfarin, NSAID, Tamoxifen

Tamoxifen - compete with E2 for E-R proteins. E+ CA, partial agonist in bone and endometrium.
BBW= uterine CA, stroke, PE

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32
Q

TNF-alpha inhibitor

A

Immunsuppressant

Adalimumab - inflammatory disease (RA, PsA, IBD, AS)

A/E: Serious infection, TB reactivation, CA

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33
Q

DMARDS (5)

A 
Hydroxychloroquine
Methotrexate
Penicillamine
Sulfasalazine
Tofacitinib
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34
Q

Penicillamine

A

RA, Increases Copper excretion (Wilson’s disease)

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35
Q

Sulfsalazine

A

Give with 800mg Folic Acid

IBD (Crohns*), RA

CI: Preg, sulfonamide/salicylate allergy

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36
Q

Tofacitinib

A

JAK inhibitor

RA when refractive to methotrexate

BBW: Fatal infection

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37
Q

Cyclosporine

A

Immunosuppressive

Organs transplants, sjogrens, psoriasis, RA

A/E: Nephrotoxic, tremor, HA, HTN, Hyperlipidemia

IA: CCB, anti-fungals, antibiotics, glucocorticoids, hypericum

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38
Q

Pro-Coagulant

A

Vitamin K (factors = 2, 7, 9, 10)

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39
Q

Anti-platelet agents (2)

A

Clopidogrel: MI/stroke prophylaxis (esp with aspirin allergy)
*IA: mb Phenytoin, Tamoxifen, PPI

Aspirin: NSAID COX inhibitor
*IA: Phenytoin
*CI: <12 dt Reyes, G6PD, pregnancy, lactation
A/E: Salicylism (vertigo, vomit, tinnitus, hearing loss), ulcers, asthma, metabolic acidosis

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40
Q

Vitamin K recycling antagonist

A

Warfarin - does not effect already established thrombus.
Monitor PT/INR dt narrow therapeutic window

Effect increased by acetaminophen, androgens, B blockers, corticosteroid, omeprazole, phenytoin

CI: Dietary changes in K*, Pregnancy C, ulcers, HTN, organ impairment, bacterial endocarditis

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41
Q

Factor X inactivator (heme)

A

Heparin: binds anti-thrombin III to prevent conversion o fibrinogen to fibrin via intrinsic pathway

Caution with menstruating, liver d/o, bleeding d/o

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42
Q

Chelators (5)

A 
Deferoxamine: Fe
DMPS: Mercury, gold, arsenic
DMSA: lead, mercury, arsenic, antimony
EDTA: lead, mercury, Fe
Penicillamine: Cu, heavy metals
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43
Q

Latanoprost

A

Glaucoma - reduces IOP by increasing outflow of aqueous humor

A/E: Eye sx including darkening iris

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44
Q

Atropine

A

Anticholinergic

Dilates the eye for eye exams, bradycardia, organophosphorus poisoning, Parkinsonism

CI: Narrow angle glaucoma, myasthenia graves, severe GI disease, hemorrhage

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45
Q

Decongestants (2)

A

Sympathomimetics = vasoconstriction, secrolytic

Oxymetazoline
Phenylephrine

A/E: rebound congestion/rhinitis
CI: > 3 days, glaucoma, MAOI
Caution with HTN, BPH, DM, thyroid

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46
Q

Dementia (2)

A

“Chol-ing to demented Don by the Riva”
Cholinesterase inhibitors

Donepezil
Rivastigmine
…can also be used for Myasthenia Gravis

A/E: N/V, salivation, bradycardia, sweating, resp distress, HTN
CI: Liver, ulcers, asthma, CHF

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47
Q

GABA Analogue (2)

A

Gabapentin
Pregablin

Epilepsy, neuralgia, bipolar mania, menopause

A/E: STATUS EPILEPTICS, SUICIDE, Preg C

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48
Q

Na Channel Blockers (2)

A

“The CAR drove in a MAZE trying to BLOCK SODIUM, ran over a PHENY fella (folate), who started SEIZING, was in a lot of PAIN and went MANIC – then the car drove off when he shouldn’t have (NO ABSENCE SEIZURE)”

Carbamazepine - mania, pain, epilepsy

  • Ci: MAOI, ABSENCE seizure, CHF, BM, liver
  • IA: OCP, Acetaminophen, lithium…many…

Phenytoin (*give with FOLATE)

  • 1st line tonic clonic, partial, alternative to Diazepam for status epileptics, neuralgia, eclampsia
  • A/E = PHENyTOIN = Peripheral neuropathy, HYPERPLASIA OF GUMS/hirsutism, enlarged LN, nystagmus, teratogenicity, osteomalacia, insulin inhibition, nausea
  • SUICIDE
  • CI: Absence, DM, pregnancy D
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49
Q

Diazepam

A

Benzo = Epilepsy, Anxiolytic

A/E: Sudden unexplained death, suicde

Diazepam = seDation in allergy (vs Alprazolam which is Addicting)

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50
Q

Dopamine precrusor

A

Levadopa/carbidopa

Parkinsons

  • Takein morning away from protein
  • Pyridoxine (B5) increases peripheral DA catabolism

CI: Glaucoma, MAOI, Melanoma, Liver or kidney disease, COPD, PUD, Preg C, Psychosis

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51
Q

Dopamine Agonists (2)

A

“Yo BRO your HUGE (acromegaly), LACTATING (hyperprolactinemia), and SHAKING - is that PARKINSONS, or DIABETES Type II? Granny PRAMI will help you”

Bromocriptine - also for acromegaly (dec GH), hyperprolactinemia, DMII
*A/E: Pulmonary fibrosis

Pramipexole

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52
Q

Amantadine

A

Parkinsons, influenza (not 1st line tx for either disease)

A/E: SJS; long 1/2 life = delayed SE (lots)
CI: CHF, edema, Liver or kidney disease, epilepsy

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53
Q

Interferon-beta-1

A

MS (anti-inflammatory, strengthens BBB)

A/E: Flu (decreased risk with NSAIDS), fatigue, thyroid
Synergistic with Zidovudine
Many CI

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54
Q

Sumatriptan

A

Migraines / Cluster HA - 5HT1 agonist, vasoconstriction

CI: Ischemic heart disease, hx of MI or stroke, ophthalmic HA, MAOI, other 5HT agonist

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55
Q

Ketamine

A

NMDA receptor antagonist (nerve block)

CI: psychosis

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56
Q

Amide anesthetics (2)

A

Lidocaine: 1-10 min onset, 30-60m duration, topical
Bupivacaine: 8-12 min onset, 3-4h duration

metabolized in the liver

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57
Q

Ester anesthetic (1)

A

Procaine: slower onset, same duration as Lidocaine, no topical effect

Metabolized in periphery = more reactions

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58
Q

1st generation anti-histamines (can be used for sleep) (3)

A

Diphenhydramine
Hydroxyzine

“I want to HYDroxyzine in my room, SLEEP, and DI(E)phenyramine.

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59
Q

Zolpidem

A

Non-benzo GABA potentiator; sedative, anxiolytic

Rapid onset but short duration

Rebound insomnia - must taper, don’t use more than 7-10 days

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60
Q

Atypical Antipsychotics (2)

A

Block 5HT and DA [Bipolar]
“BIPOLAR is ATYPICAL and RIS(KY)peridone because it aRIP(s)razole you between two different moods”

Risperidone - irritability in autism
*A/E: weight gain, tardive dyskinesia, neuroleptic malignant syndrome

Aripirazole
*A/E: dysglycemia, cation with DM

BBW: increase mortality in elderly with dementia related psychosis

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61
Q

Lithium

A

Bipolar mania; decrease cAMP = decreased serotonin/NE

Monitor levels, thyroid, and Na (hypothyroidism and hyponatremia common-NO low sodium diets)

CI: Diuretics, NSAIDS, FLuoextine
COGNITIVE IMPAIRMENT = RENAL TOXICITY

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62
Q

SSRI (2)

A

First line anxiety, MDD, OCD, eating d/o

Escitalopram
Fluoxetine (1st line depression and panic d/o)

CI: MAOI and TCA dt serotonin syndrome (need 5-14 day wash out) , liver disease, mania, seizures, pregnancy D, lactation
A/E: SUICIDE <24yo, sexual dysfunction

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63
Q

Benzos (2)

A

Increase GABA = tx anxiety

Alprazolam - addicting
Diazepam - long acting, epilepsy, EtOH withdrawal, mania, causes sedation in elderly

A/E: Anterograde amnesia - taper

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64
Q

Buspirone

A

Non-Bento for GAD (work on Ne, Dopamine receptors)

*No withdraw, sedation, or dependance
CI: MAOI dt increased BP

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65
Q

Haloperidol

A

Blocks D2, H1, cholinergic, alpha-adrenergic
Anti-psychotic

CI: CNS depression, dementia

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66
Q

Prochlorperazine

A

Blocks D, cholinergic, alpha-adrenergic
Psychosis and vomiting tx

A/E: Tardive dyskinesia
CI: CNS, BM depression, <2 yo

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67
Q

Dextroamphetamine

A

Sympathomimetic
Give with Zinc??

Narcolepsy, inhibit appetite, ADD/ADHD

CI: MAOI

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68
Q

Methylphenidate

A

Sympathomimetic, increases NEpi
Give with 55mg Zinc to increase effect

Narcolepsy, ADD/ADHD

CI: MANY; CVD, DM, anxiety, GI, TCA, MAOI, Preg C

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69
Q

Modafinil

A

Non-amphetamine stimulant (decrease GABA)

“Mooooo I can’t sleep”
Narcolepsy

A/E: SJS

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70
Q

Phentermine

A

Sympathomimetic

“Phentermine- never mind I don’t want food or a baby”

Decreases appetite
PREGNANCY X

CI: Glaucoma, DM, HTN

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71
Q

Clonidine

A

Alpha-2 agonist (decrease vasoconstriction, decrease cardiac output)

HTN, ADD/ADHD, menopause, opioid withdrawal, DM diarrhea

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72
Q

Caffeine

A

Methylxanthine, phosphodieserase inhibitor

Stimulant

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73
Q

Cocaine

A

local anesthetic by reducing Na+ permeability

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74
Q

Varenicline

A

Nicotinic Ach-R partial agonist

“i VARy much want to quit smoking because it’s IClInE (icky). - fml “
BBW: SUICIDE

75
Q

Nicotine

A

patch/gum

IA: B lockers
CI: CVD, children

*monitor HTN if used with Bupropion
Nightmares = toxicity

76
Q

Bupropion

A

Atypical Antidepression
Smoking cessation, depression

CI: seizures, eating disorder*, MAOI, Benzo
A/E: Fewer sexual side effects, takes several weeks to feel effect

77
Q

Hallucinogens (2)

A

Cannabis - affects 5HT, increases catecholamines, inhibits parasympathetic, inhibits prostaglandins

Ketamine

78
Q

Phenylzine

A

MAOI
Increase NE, D, 5HT [Depression]

IA: Fermented/tyramine foods
Mb cause B6 deficiency
CI: Antidepressants/any med with an effect on catecholamines

79
Q

Amitriptyline

A

TCA - increases NE, 5HT (&laquo_space;need to supplement these if tapering)

CI: MAOI, SSRI

80
Q

Trazadone

A

SARI - 5HT antagonist & reuptake inhibitor

Antidepressant, off label insomnia

A/E: Drowsy, weight gain, sex dysfunction, angina, SUICIDE <25yo, false positive MDMA test
CI: MAOI, CYP3A4

81
Q

Benzoyl peroxide

A

ACNE; antibacterial - topical

A/E: photosensitive

82
Q

Isotretinoin

A

ACNE; retinoid that reduces sebaceous gland size and sebum production

A/E cheilitis, increased LFT, Pregnancy C, added toxicity with vitamin A

83
Q

Topical steroids for eczema (3)

A

Mometasone
Fluticasone
Hydrocortisone

“I need steroids for my eczema so I can play the HYdrocortisone pitched FLUTicasone for my MOMetasone”

84
Q

Capsaicin

A

Topical for pain, rubifacient, counter-irritant

85
Q

Calcipotriol

A

Psoriasis - aids in proliferation and differentiation

CI: hypercalcemia

86
Q

Selenium sulfide

A

Seborrhea, tinea versicolor, dandruff

87
Q

5-alpha reductase inhibitor for BPH

A

Finasteride

Decrease serum DHT
BPH and male pattern baldness

A/E: ED, false decrease in tPSA
CI: Preg X

88
Q

Alpha -1 antagonist for BPH

A

Tamsulosin - blocks R near bladder neck = improved urine flow

CI: Decreased hepatic function, lactation

89
Q

Two medications for ED

A

Testosterone (preg X) - toxic forms = cypionate, propionate

Sildenafil (PDE V inhibitor, smooth muscle relaxant, inflow of blood) - take 1 dose 1 hour before sex
*A/E: HA, sudden cardiac death
*CI: Nitrate use dt hypotension
IA: Heparin

90
Q

Tolteridine

A

Urinary Incontinence via antimuscarinic

“I TOLd you and got TERI eyed that I had to pee again”

91
Q

Phenazopyridine

A

Urinary analgesic (does not treat infection)

1st line interstitial cystitis

*Turns body fluids deep orange - red urine and orange pee, will interfere with UA results

92
Q

Bismuth Subsalicylate

A

Pepto-Bismol
Coats stomach, tx diarrhea, protective against H.Pylori, GERD

AE: Black tongue and stool
CI: Aspirin allergy

93
Q

Loperamide

A

Opioid analog activates R in GI smooth muscle, inhibiting peristalsis = tx for diarrhea

CI: bood diarrea, high fever, infectious diarrhea, pseudomembranous colitis, <2 yo

94
Q

Docusate

A

Stool softener (detergent pulls water into fecal matter)

CI: Mineral oil, obstruction

95
Q

Biscadoyl

A 
Stimulant laxative (takes 8 hours to work, take before bed)
*DO NOT give with milk/antacids (enteric coated)

CI: >10 days, eating disorder, pregnancy

“BISCquick doesn’t work quick (8 hours) to get the poop out. Probably because you mixed it with milk - shouldn’t have done that”

96
Q

Sodium Phosphate enema

A

Osmotic effect = laxative

97
Q

Misoprosotol

A

Binds parietal cells = increases HCO3- and decreases pepsin

Tx for NSAID induced ulcers

CI: Preg X

98
Q

Sucralfate

A

Not absorbed, powerful demulcent - protective for ulcers (not NSAID induced)

99
Q

Ranitidine

A

H2 blockers; short term ulcer tx

SAFE FOR PREGNANCY

“I RAN to DINE and got an ULCER, it didn’t last long though (short term) because I got Pregnant (safe)”

100
Q

Esomeprazole

A

PPI - SAFE FOR PREG

A/E: Decreases B12/folate absorption, rebound hypersection

101
Q

DIcyclomine

A

IBD (think cyclic - diarrhea and constipation)

CI: Glaucoma (anticholinergic)

102
Q

Nausea/Vomiting Drugs (3)

A

Diphenhydramine (antihistamine)
Ondanestron (blocks 5HT3-R, good for chemo/surgery)
Prochlorperazine (Antipsychotic/antiemetic)

“The PROfessional ChlOREOGRAPHER and onDANCEstRon nearly DIed from deHYDRAtion (Diphenhydramine) due to vomiting at the METoclorpromaide after CA tx”

103
Q

Metoclopramide

A

DA-R antagonist
N/V associated with chemo and radiation
2nd line for GERD
Diabetic gastroparesis

A/E: Extrapyramidal effects
CI: >12 weeks dt permanent tardive dyskinesia

104
Q

Loratadine

A

2nd generation antihistamine (blocks H1 but not muscarinic or sedating)

Tx for seasonal allergies, urticaria

A/E: QT prolongation, HA
CI: Liver disease, lower respiratory disease including pneumonia

105
Q

Diphenhydramine

A

1st generation antihistamine (blocks H1 and muscarinic receptors, sedating)

Tx: allergies, motion sickness, parkinsonism, cough, insomnia

Dose: 50mg IM for anaphylaxis

A/E: Anti-muscarinic effects
CI: Sedatives, BPH, glaucoma, neonates, location, <6 years old

106
Q

Hydroxyzine

A

1st generation antihistamine (blocks H1 and muscarinic, sedating)

Tx: allergies, anxiety, urticaria

CI: Pregnancy X in 1st trimester, Pregnancy C in 2nd and 3rd trimester

Similar SE and CI as Diphenhydramine

107
Q

Antitussives (3)

A

Dextromethorphan (works on cough center in medulla)
*CI: SSRI, nonSSRI, MAOI, acute attack

Codeine - opioid
Hydrocodone -opioid

“DEXTRomepthorphan can’t STOP COUGHING in his lab while he is HYdrocodone and CODEIN(g)e. nerd.”

108
Q

Fluticasone

A

Inhaled steroid

Tx: Asthma prophylaxis (maintenance-not rescue), allergic rhinitis, nasal polyps

CI: milk allergy
A/E: Candida, URTI, HA

109
Q

Albuterol

A

Sympathomimetic B2 adrenergic agent
SHORT ACTING

Tx: Rescue asthma, COPD
Onset: 15 minutes, Duration: 3-4 hours

CI: MAOI, TCA, Sympathomimetics
A/E: tremor, HTN, vomiting, vertigo, dry mucous

110
Q

Salmeterol

A

Sympathomimetic B2 adrenergic agonist

  • LONG ACTING*
  • Never use as standalone Rx, should be Rx with glucocorticoids

Tx: Asthma (nocturnal and exercise) (*NOT for acute asthma)
Dose: 1 inha. 30 minutes before exercise, or once every 12 hours

BBW: Increase asthma related deaths, QT prolongation

111
Q

Tiotroprium bromide / Ipratroprium bromide

A

Antimuscarinic (atropine derivative) bronchodilator

Tx: COPD maintenance tx
Ipratroprium is shorter acting*

CI: acute asthma, milk allergy

112
Q

Oxymetazoline

A

Sympathomimetic decongestant

Tx: Nasal drops/spray, eye drops

CI: Glaucoma, CVD, hyperthyroid, <6 yo

113
Q

Decongestants (4)

A

ALL: SYMPATHOMIMETICS

Phenylephrine (CI: MAOI, B blockers, V tacky, HTN, closed angle glaucoma)

Epinephrine (acute asthma, anaphylaxis, open angle glaucoma/occular HTN as eye drops)

Pseudoephrine (alpha and beta agonist; CI MAOI dt HTN crisis, pheochromocytoma)

Oxymetazoline

114
Q

Guaifenesin

A

Mucolytic expectorant for cough

115
Q

Leukotriene blocker

A

Montelukast

Tx:Prophylaxis and maintenance of asthma (>1 yo), aspirin induced asthma, exercise induced asthma, allergic rhinitis

A/E: Churg-strauss syndrome (blood vessel inflammation dt eosinophilic granulomatosis)

116
Q

Inhaled steroids (2)

A

Mometasone (also used topically for eczema)

Fluticasone (also used topically for eczema)

117
Q

Lisinopril

A

ACE-I (decreases angiotensin II = vasoconstriction)
*SUPP with Zinc

Tx: HTN, HF, post MI, Diabetic neuropathy

A/E: DRY COUGH, angioedema, kidney failure, teratogens, hyperkalemia because POTASSIUM SPARING

118
Q

Valsartan

A

ARB (decreases peripheral resistance)

Tx: HTN with LVH (non-black population), HF, DM neuropathy

A/E: Hyperkalemia*

119
Q

Atenolol

A

Selective B1 blocker (decrease contractility/heart rate, vasodilation, smooth muscle relaxant)

Tx: HTN, Angina, MI

120
Q

Propanolol

A

Non-selective B1 and B2 blocker (decrease contractility/heart rate, vasodilation, smooth muscle relaxant)

Crosses BBB=more side effects; rebound HTN and tachycardia

121
Q

General contraindications for B blockers

A 
Asthma
Block
COPD
DM
hypErkalemia
122
Q

Amlodopine

A

CCB - decrease muscle contractility causing peripheral vasodilation

Tx: HTN, angina (stable and prinz), pre-eclampsia
*NOT first line for CHF

A/E: DEPLETES K, edema

123
Q

Diuretics (3)

A

Furosemide (loop)
Hydrochlorothiazide (thiazide)
Spironolactone (K sparing / aldosterone antagonist)

124
Q

Furosemide

A

Loop diuretic

Tx: HTN

Increases excretion of H2O, Ca, Mg, Na, Cl, K (EVERYTHING)
Decreases excretion of uric acid

A/E: Hypokalemia, hyperuricemia, ototoxic, nutrient depletion
CI: allergy to SULFONAMIDES, pregnancy

125
Q

Hydrochlorothiazide

A

Thiazide diuretic

Increases excretion Na, K, Cl, Mg
*Decreases Ca excretion

Tx: HTN, HF, Edema, Nephrolithiasis (calcium), Osteoporosis, Nephrogenic DI

A/E: Hypokalemia, hyperglycemia, other nutrient depletions
CI: allergy to SULFONAMIDES, pregnancy

126
Q

Spironolactone

A

K sparing diuretic (aldosterone agonist works in distal convoluted tubule)

Increases Na, H2O excretion

Tx: HELP =HTN, HF, edema, low potassium, primary hyperaldosteronism

127
Q

What diuretics are contraindicated with a sulfonamide allergy

A

Furosemide (loop) and Hydrochlorothiazide

128
Q

Drugs for angina

A

Nitroglycerine
Beta blockers
CCB

(also can sup with L-arginine, Mg glycerinate, zinc)

129
Q

Nitroglycerine

A

Vasodilator via NO (fast acting so use when symptomatic)

Tx: Angina, CHF, HTN emergencies
Sublingual is MC, transdermal is a sustained release option but will build tolerance

CI: Sildenafil within 24 hours (both do similar actions- penis WILL BLOW UP), headache

130
Q

Sympathomimetic for the heart and pretty much everything else

A

Epinephrine - vasoconstriction via alpha 1, bronchodilation via B2 (increases HR and contractility)

131
Q

Classes of anti-arrhythmic drugs (5)

A 
I: Na channel blocker
II: Beta blocker
III: K channel blocker
IV: CCB
V: Digoxin
132
Q

Na channel blocker for arrhythmia

A

Lidocaine (used as last resort in hospital setting due to BBW of death, casual.)

133
Q

Amiodarone

A

K channel blocker (slows HR)

Tx: Arrhythmias (A fib, ventricular)
Used short term in emergency med

A/E: MANY: Pulmonary fibrosis, heart block, hypotension, thyroid issues, hepatotoxic, cornary/skin deposits

134
Q

Dignoxin

A

Class V anti-arrhythmic (inhibits Na/K/ATPase… Ca accumulates)

Tx: LVHF, A flutter (2nd line)

A/E: NARROW THERAPEUTIC WINDOW and long half life, yellow halos/vision, hypokalemia with diuretics, Gi sx, arrhythmia (CI in vtachy and V fib), flu like symptoms

135
Q

Gemfibrozil

A

Fibrate (chol reducer)

Use when low HDL, high LDL, high TG (type IV and V)
*but must treat thyroid and DM first if that is the cause of lipidemia

IA: Warfarin, statins
A/E: GEEM = gallstones, elevated LFT, enhanced anticoagulants, myositis/rhabdomyolysis

*discontinue if muscle pain (rhabdo)

136
Q

Atorvastatin

A

HMG-CoA Reducatse Inhibitor (cholesterol reducer)
SUPP with 75-100mg CoQ10***

Increases HDL, lowers LDL, total chol, and TG

IA: Fibrates, niacin
A/E: Elevated LFT, myositis, rhabdomyolysis (discontinue if muscle pain)

137
Q

Drugs for HF (4)

A

Digoxin
Valsartan
Spironolactone
Lisinopril

(maybe others? this is what the book listed)

138
Q

Drug categories for HTN (6- that we had to know for the exam)

A 
ACE-I (Lisinopril)
Alpha 2 agonist (Clonidine)
Angiotensin II blocker (Valsartan)
Beta blocker (Atenolol, Propanolol)
CCB (Amlodopine)
Diuretics (Furosemide, Hydrochlorothiazide, Spironolcatone)
139
Q

Steroids for inflammation (musculoskeletal)

A

Prednisone - 4x stronger than cortisol, longer acting vs hydrocortisone
Methylprednisone = 5
Hydrocortisone = 1
Dexamethasone = 30 (this was not listed under MS section, but is listed under steroids for endocrine so here it is)

*must taper or withdrawal will induce rebound anaphylaxis and inflammation

140
Q

NSAIDS (3)

A

Aspirin: platelet aggregation, fever, pain, inflammation

  • MAX DOSE = 4g or liver damage
  • A/E: Reye’s syndrome, Salicyism, Pregnancy D

Ibuprofen

  • CI: with aspirin, decreases cartilage synthesis, Preg 3rd trimester
  • Increases ulcers so give with Corydalis

Naproxen
*A/E: Ulcers

141
Q

Celecoxib

A

COX 2 inhibitor for inflammation (& Ankylosing spondylitis)
Less GI distress than aspirin

A/E: thrombosis, preoperative pain from CABG

142
Q

Muscle relaxants (4)

A

Carisoprodol - often mixed with date rape drug
Cyclobenzaprine - anticholinergic A/E
Diazepam - benzo
Ketamine - NMDA antagonist

Use for acute MS conditions (1-2 weeks)
CI: CNS depressants

143
Q

Alendronate

A

Bisphophonate (inhibits osteoclasts)
Take on empty stomach with 6-8oz water and remain upright for 30 minutes

Tx: osteoporosis

A/E: Esophageal erosion, osteonecrosis of the jaw, hypocalcemia

144
Q

Acetaminophen

A

Centrally acting analgesic (inhibits prostaglandin synthesis for pain and fever) *NOT anti-inflammatory

IA: EtOH - 3 drinks and 3g can shut down liver.
Also CI to have >4g in 24 hours? (so upper limit 3-4g??)

145
Q

Allopurinol

A

Xanthine oxidase inhibitor, decreases uric acid production

Tx: PREVENTION for gout

146
Q

Colchicine

A

Inhibits microtubule formation, preventing neutrophils from mediating gout sx

Tx: TREATMENT of gout

CI: Renal/hepatic failure, elderly, pregnancy

147
Q

Capsaicin

A

Rubifacient, topical counter-irritant for pain, vasodilation, blocks substance P

148
Q

Opioids (4)

A

kapp and mu receptor activities (most Class II)
Codeine - pain, cough (OK in pregnancy)
Hydrocodone - CLASS III; pain, cough (Naloxone is antidote)
Morphine - strongest non-synthetic opiate. Pain, severe cough, labor
Oxycodone - pain, cough. (Naloxone is antidote) CI <18yo

149
Q

Heroin

A

Opioid agonist.

Pain, MI, Pulmonary edema

150
Q

Methadone

A

Synthetic opioid agonist for addiction and detox

Use short term dt anticholinergic effects

151
Q

Naltrexone

A

Competitive opioid antagonist for ADDICTION

LDN for crohns and CA

152
Q

Naloxone

A

Competitive opioid antagonist for ACUTE OD

*Use in emergency medicine (Demi Lovato)

153
Q

Pregnenelone

A

Precursor to progesterone, mineralocorticoids, glucocorticoids, androgens, estrogens

154
Q

Biggest safety precaution with steroids?

A

TAPER - or withdrawal can be fatal

*also concerned about avascular hip necrosis and adrenal suppression with Hydrocortisone dose >30mg and Prednisone dose >7.5mg

(Hydrocortisone 1, Prednisone 4, Methylprednisone 5, Dexamethasone 30)

155
Q

Estrone

A

Estrogen highest in post-menopausal (least bioactive)

Tx: Osteoporosis prophylaxis, HRT

A/E: Procarcinogenic
CI: Pregnancy C
IA: Effect decreased by anticonvulsants and folic acid

156
Q

Estradiol

A

E2 - bioidentical

Tx: Atrophic vaginitis, BrCA, osteoporosis, DUB/AUB (used to evaluate amenorrhea)

A/E: Clot formation
CI: E+ tumor, pregnancy X

157
Q

Estriol

A

E3 - Natural; highest in pregnancy

Tx: Atrophic vaginitis, protective, HRT

CI: Pregnancy
A/E: Clot formation

158
Q

Estrogens conjugated

A

Made from pregnant mare’s urine

Tx: Atrophic vaginitis, hypogonadism in females, osteoporosis, AUB, vWF?

CI: Pregnancy X

159
Q

General A/E and CI for estrogens?

When do estrogens peak in the cycle (best for testing)?

A

A/E: ACHES = abdominal pain, chest pain, HA, eye problems, leg swelling

CI: CVD, Hypercalcemia, complicated DM, Liver disease, older than 35 years old

Peak days 8-12

160
Q

Progesterone

  • What days does it peak?
  • Effect on hormones?
  • Uses, etc.
A

Peak days 16-25 (marker of ovulation)
Maintains pregnancy, if woman continues to miscarry around week 20 - supplement with Progesterone

Tx: Prevents endometrial hyperplasia with postmenopausal estrogen therapy**, amenorrhea, DUB, contraception, PMS, fibroids, insomnia

CI: clots, liver disease, BrCA, undiagnosed AUB
IA: Increased excretion with Phenytoin, Carbamazepine,. IA with Rifampin

Take same time of day, thickens cervical mucus, decreases LH/FSH/ovulation. SAFE for lactating

161
Q

Levonorgestrel

A

5yr progestin IUD

162
Q

Medroxyprogesterone acetate

A

IM progestin q3 months

Contraception, endometriosis

163
Q

Norelegestromin/EE

A

PATCH

Progestin, monophasic

164
Q

Norgestimate/EE

A

PILL

Progestin and Estrogen

165
Q

DHEA

A

Androgen hormone - increases E and T, decreases cortisol

Tx: Reverse aging, ED, osteoporosis, MS, depression, wt loss

CI: breast/uterine CA, endometriosis, fibroids, G6PD, prostate CA
Monitor with Amiodorone, statin, buspirone, cortisone, diazepam, warfarin

166
Q

Testosterone

A

Only give for hypogonadism if consistent with sx and AM plasma T <3ng/ml

C/I in males: gynecomastia, liver CA, BPH, prostate CA, transfer to partner?
C/I in females: clit hypertrophy, hirsutism, acne, amenorrhea, PREG X

167
Q

Lispro

A

Rapid (1h) short acting (3-4) hr insulin. Bolus dosing with meals

IA: B blockers, can mask sx of hypoglycemia

168
Q

Regular insulin

A

Rapid (2-3h), short acting (5-7hr)

IA: b blockers

169
Q

Glargine

A

Slow onset (12hr), long acting (24hr) insulin

IA: b blockers

170
Q

Glucagon

A

Hypoglycemia
IV, IM, SQ

I: pheochromocytoma

171
Q

Oxytocin

A

Hormone produced by pituitary

Tx: Labor induction, post partum hemorrhage, incomplete abortion, helps stimulate contractions for milk production

CI; Pregnancy C
A/E mom: tachycardia, N/V, EENT sx
A/E fetus: Arrhythmia, CNS, jaundice

172
Q

Lugol’s solution

A

Inhibits thyroid hormone release, replenishes iodine, protects from radiation

short term HYPERthyroid, and HYPOthyroid tx (iodine is confusing)

173
Q

Propylthiouracil

A

inhibits TPO, inhibits T4 to T3 conversion in periphery with 5’ deiodinase

HYPERthyroid, thyroid storm

A/E: Agranulocytosis, life threatening HEPATOTOXICITY

174
Q

Levothyroxine

A

T4

CI: uncorrected adrenal deficiency

175
Q

Liothyronine

A

T3

176
Q

Thyroid USP

A

T4/3 blend from pig thyroid

177
Q

Melatonin

A

Pineal gland hormone
Antioxidant, sleep

Sleep <5mg, CA <30mg

IA: SSRI

178
Q

Metformin

A

DM 2
Biguanide - increases insulin R # and affinity AND decreases hepatic glucose output

BBW: Weight loss, decreased lipids, lactic acidosis

A/E: Lactic acidosis, diarrhea, B12 elf
CI: Diabetes type 1!!, Metabolic acidosis, rental failure

179
Q

Glyburide

A

DM 2
Sulfonyluria - stimulates insulin release
*better for lack of insulin not resistance - can make DM worse if there is a peripheral resistance problem

CI: SULFA allergy, diabetic ketoacidosis

180
Q

Ligraglutide

A

DM 2

GLP1 agonist - incretin mimetic to increase insulin secreted in elected blood glucose, slows gastric emptying

181
Q

Canaglifozin

A

DM 2
SGLT2 antagonist - lowers renal glucose threshold = increase urinary glucose excretion

A/E: increased urination, vag/penis stuff (according to kat)

182
Q

Sitagliptin

A

DM 2

DPP4-inhibitor - increases/prolongs incretin increasing insulin release and decreasing serum glucose

183
Q

5 drugs that particularly require drug monitoring

A 
Digoxin
Phenytoin
Lithium (A/E; thyroid, renal, heme)
Carbamazepine
Warfarin

[also Theophylline but not on our list - just listed in the emergency med section]

184
Q

Folate depleting drugs (6)

A

5FU, Phenytoin, TMP/SMX, Methotrexate, OCP, Sulfasalazine

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