PHARM Flashcards
Penicillin VK
B lactams
Staph, strep, gonorrhea, Hflu
Recurrent RF, dental abscesses, diphtheria
A/E: Black hairy tongue, anaphylaxis
Amoxicillin
B lactams (Broad spectrum) SAFE FOR PREGNANCY
1st line uncomplicated EENT
MAP USE: Meningitis, AOM, PUD, UTI, Salmonella, Extended spectrum
Cephalexin
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)
Doxycycline
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
Azithromycin
Macrolide - protein synthesis inhibition
SAFE FOR PREGNANCY, take WITH food
STDS (Chlamydia, syphilis, chancoird
Respiratory (Diphtheria, TB)
2nd choice for AOM
CI: Liver disease
Clarithromycin
Macrolide - protein synthesis inhibition
SAFE FOR PREGNANCY, take WITH food
STDS (Chlamydia, syphilis, chancoird
Respiratory (Diphtheria, TB)
2nd choice for AOM
CI: Liver disease
Clindamycin
Lincosamide - protein synthesis inhibition
Topical for acne, peritonsillar abscess, neonatal GBS prophylaxis if penicillin allergy
A/E C. diff pseudomembranous colitis
Ciprofloxacin
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
Mupirocin
RNA synthesis inhibitor
Topical MRSA, Impetigo
Nitrofurantoin
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
TMP/SMX
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
Triple Antibiotic Ointment
Allergic contact derm
Bacitracin ….[Replace with hydrocortisone for swimmer’s ear, superficial bacterial infx of external auditory canal]
Neomycin (permanent SNHL)
Polymyxin B
TB meds
Isoniazid (can be used for latent as well)
Rifampin (red tears/urine/saliva)
- use both together for active infection
- both hepatotoxic (increase LFT)
Anti-Fungals
Fluconazole: Trich, systemic, organ transplants
Nystatin: Not absorbed so good for GI
Terbinafine: Nails (hepatotoxic, SJS, neutropenia)
IA: Warfarin, phenytoin, oral hypoglycemics
Hydroxychloroquine
DMARD
Anti-malarial
Anti-rheumatic
Anti-inflammatory
A/E: nightmares, CVD, vision, photosensitivity
CI: long term use
IA: Digoxin, alcohol
Mebendazole
Anti-helminthic
A/E = ALL BENT = Angioedema, Liver enzymes elevated, BM decreased, Epigastric pain, Neuro, Teratogen
CI: <2yo
Permethrins
Scabies
Metronidazole
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
Valacyclovir
HSV (active), Hep B post exposure, EBV, CMV, Varicella
A/E: Increased AST/ALT, GI, rash, delirium
HIV medication
Zidouvidine - reverse transcriptase inhibitor
CI: Lactation
A/E: BM suppression = anemia, neutropenia
Amantadine
Anti-cholinergic dopamine agonist
Parkinsons*
No longer recommended for Influenza A
Herpes zoster
Oseltamivir
Influenza A &B (spray, inhaler, IV)
A/E SUICIDE
Interferon-a-2
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
Doxorubicin
Breast cancer, Kapos’s sarcoma, multiple myeloma, ovarian CA
A/E Heart damage
Trastuzumab
“trust her, but not too much because shell kill your baby” - HER 2+ breast CA
A/E: Heat, lung problems, fetal harm
Methotrexate
Anti-metabolite/folate (DMARD)
*must sup with folate
PREGNANCY X
Cancer, RA, Abortion, psoriasis, crohns, AS
CI: Lethal with NSAIDS dt GI toxicity
Vinblastine
IV only (from periwinkle)
Testicular CA, Hodgkin’s, Kaposi’s sarcoma
A/E: Fatal intrathecally
IA: CYP3A4, Hypericum
Anastrazole
Aromaste inhibitor - reduces serum estradiol
Breast CA (post surgery and mets)
A/E: clots
Paclitaxel
“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
5-FU
Pyrimidine analogue
Sup with folate
Many cancers, topical for BCC
SERMs (2)
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
TNF-alpha inhibitor
Immunsuppressant
Adalimumab - inflammatory disease (RA, PsA, IBD, AS)
A/E: Serious infection, TB reactivation, CA
DMARDS (5)
Hydroxychloroquine Methotrexate Penicillamine Sulfasalazine Tofacitinib
Penicillamine
RA, Increases Copper excretion (Wilson’s disease)
Sulfsalazine
Give with 800mg Folic Acid
IBD (Crohns*), RA
CI: Preg, sulfonamide/salicylate allergy
Tofacitinib
JAK inhibitor
RA when refractive to methotrexate
BBW: Fatal infection
Cyclosporine
Immunosuppressive
Organs transplants, sjogrens, psoriasis, RA
A/E: Nephrotoxic, tremor, HA, HTN, Hyperlipidemia
IA: CCB, anti-fungals, antibiotics, glucocorticoids, hypericum
Pro-Coagulant
Vitamin K (factors = 2, 7, 9, 10)
Anti-platelet agents (2)
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
Vitamin K recycling antagonist
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
Factor X inactivator (heme)
Heparin: binds anti-thrombin III to prevent conversion o fibrinogen to fibrin via intrinsic pathway
Caution with menstruating, liver d/o, bleeding d/o
Chelators (5)
Deferoxamine: Fe DMPS: Mercury, gold, arsenic DMSA: lead, mercury, arsenic, antimony EDTA: lead, mercury, Fe Penicillamine: Cu, heavy metals
Latanoprost
Glaucoma - reduces IOP by increasing outflow of aqueous humor
A/E: Eye sx including darkening iris
Atropine
Anticholinergic
Dilates the eye for eye exams, bradycardia, organophosphorus poisoning, Parkinsonism
CI: Narrow angle glaucoma, myasthenia graves, severe GI disease, hemorrhage
Decongestants (2)
Sympathomimetics = vasoconstriction, secrolytic
Oxymetazoline
Phenylephrine
A/E: rebound congestion/rhinitis
CI: > 3 days, glaucoma, MAOI
Caution with HTN, BPH, DM, thyroid
Dementia (2)
“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
GABA Analogue (2)
Gabapentin
Pregablin
Epilepsy, neuralgia, bipolar mania, menopause
A/E: STATUS EPILEPTICS, SUICIDE, Preg C
Na Channel Blockers (2)
“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
Diazepam
Benzo = Epilepsy, Anxiolytic
A/E: Sudden unexplained death, suicde
Diazepam = seDation in allergy (vs Alprazolam which is Addicting)
Dopamine precrusor
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
Dopamine Agonists (2)
“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
Amantadine
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
Interferon-beta-1
MS (anti-inflammatory, strengthens BBB)
A/E: Flu (decreased risk with NSAIDS), fatigue, thyroid
Synergistic with Zidovudine
Many CI
Sumatriptan
Migraines / Cluster HA - 5HT1 agonist, vasoconstriction
CI: Ischemic heart disease, hx of MI or stroke, ophthalmic HA, MAOI, other 5HT agonist
Ketamine
NMDA receptor antagonist (nerve block)
CI: psychosis
Amide anesthetics (2)
Lidocaine: 1-10 min onset, 30-60m duration, topical
Bupivacaine: 8-12 min onset, 3-4h duration
metabolized in the liver
Ester anesthetic (1)
Procaine: slower onset, same duration as Lidocaine, no topical effect
Metabolized in periphery = more reactions
1st generation anti-histamines (can be used for sleep) (3)
Diphenhydramine
Hydroxyzine
“I want to HYDroxyzine in my room, SLEEP, and DI(E)phenyramine.
Zolpidem
Non-benzo GABA potentiator; sedative, anxiolytic
Rapid onset but short duration
Rebound insomnia - must taper, don’t use more than 7-10 days
Atypical Antipsychotics (2)
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
Lithium
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
SSRI (2)
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
Benzos (2)
Increase GABA = tx anxiety
Alprazolam - addicting
Diazepam - long acting, epilepsy, EtOH withdrawal, mania, causes sedation in elderly
A/E: Anterograde amnesia - taper
Buspirone
Non-Bento for GAD (work on Ne, Dopamine receptors)
*No withdraw, sedation, or dependance
CI: MAOI dt increased BP
Haloperidol
Blocks D2, H1, cholinergic, alpha-adrenergic
Anti-psychotic
CI: CNS depression, dementia
Prochlorperazine
Blocks D, cholinergic, alpha-adrenergic
Psychosis and vomiting tx
A/E: Tardive dyskinesia
CI: CNS, BM depression, <2 yo
Dextroamphetamine
Sympathomimetic
Give with Zinc??
Narcolepsy, inhibit appetite, ADD/ADHD
CI: MAOI
Methylphenidate
Sympathomimetic, increases NEpi
Give with 55mg Zinc to increase effect
Narcolepsy, ADD/ADHD
CI: MANY; CVD, DM, anxiety, GI, TCA, MAOI, Preg C
Modafinil
Non-amphetamine stimulant (decrease GABA)
“Mooooo I can’t sleep”
Narcolepsy
A/E: SJS
Phentermine
Sympathomimetic
“Phentermine- never mind I don’t want food or a baby”
Decreases appetite
PREGNANCY X
CI: Glaucoma, DM, HTN
Clonidine
Alpha-2 agonist (decrease vasoconstriction, decrease cardiac output)
HTN, ADD/ADHD, menopause, opioid withdrawal, DM diarrhea
Caffeine
Methylxanthine, phosphodieserase inhibitor
Stimulant
Cocaine
local anesthetic by reducing Na+ permeability
Varenicline
Nicotinic Ach-R partial agonist
“i VARy much want to quit smoking because it’s IClInE (icky). - fml “
BBW: SUICIDE
Nicotine
patch/gum
IA: B lockers
CI: CVD, children
*monitor HTN if used with Bupropion
Nightmares = toxicity
Bupropion
Atypical Antidepression
Smoking cessation, depression
CI: seizures, eating disorder*, MAOI, Benzo
A/E: Fewer sexual side effects, takes several weeks to feel effect
Hallucinogens (2)
Cannabis - affects 5HT, increases catecholamines, inhibits parasympathetic, inhibits prostaglandins
Ketamine
Phenylzine
MAOI
Increase NE, D, 5HT [Depression]
IA: Fermented/tyramine foods
Mb cause B6 deficiency
CI: Antidepressants/any med with an effect on catecholamines
Amitriptyline
TCA - increases NE, 5HT («_space;need to supplement these if tapering)
CI: MAOI, SSRI
Trazadone
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
Benzoyl peroxide
ACNE; antibacterial - topical
A/E: photosensitive
Isotretinoin
ACNE; retinoid that reduces sebaceous gland size and sebum production
A/E cheilitis, increased LFT, Pregnancy C, added toxicity with vitamin A
Topical steroids for eczema (3)
Mometasone
Fluticasone
Hydrocortisone
“I need steroids for my eczema so I can play the HYdrocortisone pitched FLUTicasone for my MOMetasone”
Capsaicin
Topical for pain, rubifacient, counter-irritant
Calcipotriol
Psoriasis - aids in proliferation and differentiation
CI: hypercalcemia
Selenium sulfide
Seborrhea, tinea versicolor, dandruff
5-alpha reductase inhibitor for BPH
Finasteride
Decrease serum DHT
BPH and male pattern baldness
A/E: ED, false decrease in tPSA
CI: Preg X
Alpha -1 antagonist for BPH
Tamsulosin - blocks R near bladder neck = improved urine flow
CI: Decreased hepatic function, lactation
Two medications for ED
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
Tolteridine
Urinary Incontinence via antimuscarinic
“I TOLd you and got TERI eyed that I had to pee again”
Phenazopyridine
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
Bismuth Subsalicylate
Pepto-Bismol
Coats stomach, tx diarrhea, protective against H.Pylori, GERD
AE: Black tongue and stool
CI: Aspirin allergy
Loperamide
Opioid analog activates R in GI smooth muscle, inhibiting peristalsis = tx for diarrhea
CI: bood diarrea, high fever, infectious diarrhea, pseudomembranous colitis, <2 yo
Docusate
Stool softener (detergent pulls water into fecal matter)
CI: Mineral oil, obstruction
Biscadoyl
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”
Sodium Phosphate enema
Osmotic effect = laxative
Misoprosotol
Binds parietal cells = increases HCO3- and decreases pepsin
Tx for NSAID induced ulcers
CI: Preg X
Sucralfate
Not absorbed, powerful demulcent - protective for ulcers (not NSAID induced)
Ranitidine
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)”
Esomeprazole
PPI - SAFE FOR PREG
A/E: Decreases B12/folate absorption, rebound hypersection
DIcyclomine
IBD (think cyclic - diarrhea and constipation)
CI: Glaucoma (anticholinergic)
Nausea/Vomiting Drugs (3)
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”
Metoclopramide
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
Loratadine
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
Diphenhydramine
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
Hydroxyzine
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
Antitussives (3)
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.”
Fluticasone
Inhaled steroid
Tx: Asthma prophylaxis (maintenance-not rescue), allergic rhinitis, nasal polyps
CI: milk allergy
A/E: Candida, URTI, HA
Albuterol
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
Salmeterol
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
Tiotroprium bromide / Ipratroprium bromide
Antimuscarinic (atropine derivative) bronchodilator
Tx: COPD maintenance tx
Ipratroprium is shorter acting*
CI: acute asthma, milk allergy
Oxymetazoline
Sympathomimetic decongestant
Tx: Nasal drops/spray, eye drops
CI: Glaucoma, CVD, hyperthyroid, <6 yo
Decongestants (4)
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
Guaifenesin
Mucolytic expectorant for cough
Leukotriene blocker
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)
Inhaled steroids (2)
Mometasone (also used topically for eczema)
Fluticasone (also used topically for eczema)
Lisinopril
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
Valsartan
ARB (decreases peripheral resistance)
Tx: HTN with LVH (non-black population), HF, DM neuropathy
A/E: Hyperkalemia*
Atenolol
Selective B1 blocker (decrease contractility/heart rate, vasodilation, smooth muscle relaxant)
Tx: HTN, Angina, MI
Propanolol
Non-selective B1 and B2 blocker (decrease contractility/heart rate, vasodilation, smooth muscle relaxant)
Crosses BBB=more side effects; rebound HTN and tachycardia
General contraindications for B blockers
Asthma Block COPD DM hypErkalemia
Amlodopine
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
Diuretics (3)
Furosemide (loop)
Hydrochlorothiazide (thiazide)
Spironolactone (K sparing / aldosterone antagonist)
Furosemide
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
Hydrochlorothiazide
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
Spironolactone
K sparing diuretic (aldosterone agonist works in distal convoluted tubule)
Increases Na, H2O excretion
Tx: HELP =HTN, HF, edema, low potassium, primary hyperaldosteronism
What diuretics are contraindicated with a sulfonamide allergy
Furosemide (loop) and Hydrochlorothiazide
Drugs for angina
Nitroglycerine
Beta blockers
CCB
(also can sup with L-arginine, Mg glycerinate, zinc)
Nitroglycerine
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
Sympathomimetic for the heart and pretty much everything else
Epinephrine - vasoconstriction via alpha 1, bronchodilation via B2 (increases HR and contractility)
Classes of anti-arrhythmic drugs (5)
I: Na channel blocker II: Beta blocker III: K channel blocker IV: CCB V: Digoxin
Na channel blocker for arrhythmia
Lidocaine (used as last resort in hospital setting due to BBW of death, casual.)
Amiodarone
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
Dignoxin
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
Gemfibrozil
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)
Atorvastatin
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)
Drugs for HF (4)
Digoxin
Valsartan
Spironolactone
Lisinopril
(maybe others? this is what the book listed)
Drug categories for HTN (6- that we had to know for the exam)
ACE-I (Lisinopril) Alpha 2 agonist (Clonidine) Angiotensin II blocker (Valsartan) Beta blocker (Atenolol, Propanolol) CCB (Amlodopine) Diuretics (Furosemide, Hydrochlorothiazide, Spironolcatone)
Steroids for inflammation (musculoskeletal)
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
NSAIDS (3)
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
Celecoxib
COX 2 inhibitor for inflammation (& Ankylosing spondylitis)
Less GI distress than aspirin
A/E: thrombosis, preoperative pain from CABG
Muscle relaxants (4)
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
Alendronate
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
Acetaminophen
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??)
Allopurinol
Xanthine oxidase inhibitor, decreases uric acid production
Tx: PREVENTION for gout
Colchicine
Inhibits microtubule formation, preventing neutrophils from mediating gout sx
Tx: TREATMENT of gout
CI: Renal/hepatic failure, elderly, pregnancy
Capsaicin
Rubifacient, topical counter-irritant for pain, vasodilation, blocks substance P
Opioids (4)
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
Heroin
Opioid agonist.
Pain, MI, Pulmonary edema
Methadone
Synthetic opioid agonist for addiction and detox
Use short term dt anticholinergic effects
Naltrexone
Competitive opioid antagonist for ADDICTION
LDN for crohns and CA
Naloxone
Competitive opioid antagonist for ACUTE OD
*Use in emergency medicine (Demi Lovato)
Pregnenelone
Precursor to progesterone, mineralocorticoids, glucocorticoids, androgens, estrogens
Biggest safety precaution with steroids?
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)
Estrone
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
Estradiol
E2 - bioidentical
Tx: Atrophic vaginitis, BrCA, osteoporosis, DUB/AUB (used to evaluate amenorrhea)
A/E: Clot formation
CI: E+ tumor, pregnancy X
Estriol
E3 - Natural; highest in pregnancy
Tx: Atrophic vaginitis, protective, HRT
CI: Pregnancy
A/E: Clot formation
Estrogens conjugated
Made from pregnant mare’s urine
Tx: Atrophic vaginitis, hypogonadism in females, osteoporosis, AUB, vWF?
CI: Pregnancy X
General A/E and CI for estrogens?
When do estrogens peak in the cycle (best for testing)?
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
Progesterone
- What days does it peak?
- Effect on hormones?
- Uses, etc.
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
Levonorgestrel
5yr progestin IUD
Medroxyprogesterone acetate
IM progestin q3 months
Contraception, endometriosis
Norelegestromin/EE
PATCH
Progestin, monophasic
Norgestimate/EE
PILL
Progestin and Estrogen
DHEA
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
Testosterone
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
Lispro
Rapid (1h) short acting (3-4) hr insulin. Bolus dosing with meals
IA: B blockers, can mask sx of hypoglycemia
Regular insulin
Rapid (2-3h), short acting (5-7hr)
IA: b blockers
Glargine
Slow onset (12hr), long acting (24hr) insulin
IA: b blockers
Glucagon
Hypoglycemia
IV, IM, SQ
I: pheochromocytoma
Oxytocin
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
Lugol’s solution
Inhibits thyroid hormone release, replenishes iodine, protects from radiation
short term HYPERthyroid, and HYPOthyroid tx (iodine is confusing)
Propylthiouracil
inhibits TPO, inhibits T4 to T3 conversion in periphery with 5’ deiodinase
HYPERthyroid, thyroid storm
A/E: Agranulocytosis, life threatening HEPATOTOXICITY
Levothyroxine
T4
CI: uncorrected adrenal deficiency
Liothyronine
T3
Thyroid USP
T4/3 blend from pig thyroid
Melatonin
Pineal gland hormone
Antioxidant, sleep
Sleep <5mg, CA <30mg
IA: SSRI
Metformin
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
Glyburide
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
Ligraglutide
DM 2
GLP1 agonist - incretin mimetic to increase insulin secreted in elected blood glucose, slows gastric emptying
Canaglifozin
DM 2
SGLT2 antagonist - lowers renal glucose threshold = increase urinary glucose excretion
A/E: increased urination, vag/penis stuff (according to kat)
Sitagliptin
DM 2
DPP4-inhibitor - increases/prolongs incretin increasing insulin release and decreasing serum glucose
5 drugs that particularly require drug monitoring
Digoxin Phenytoin Lithium (A/E; thyroid, renal, heme) Carbamazepine Warfarin
[also Theophylline but not on our list - just listed in the emergency med section]
Folate depleting drugs (6)
5FU, Phenytoin, TMP/SMX, Methotrexate, OCP, Sulfasalazine
