Pharm Flashcards
propanolol
non-selective b-blocker SI: hyperlipidemia, 1st degree heart block
cabergoline
dopamine agonist used to treat prolactinoma. ALT: bromocriptine, quinagolide
amifostine
cytoprotective free-radical scavenger. given to CA pts receiving platinum based chemo
cisplatin
platinum containing chemo, creates reactive oxygen which forms DNA crosslinks. SI: NEPHRO TOXIC. use amifostine to prevent damage.
allopurinol and drug interactions
Xanthanine oxidase inhibitor. prevents the production of uric acid. interacts with 6-mp which needs to be reduced
octreotide
synthetic somatostatin. inhibits secretion of many hormones. used to treat carcinoid sx.
hydroxyzine
nonselective antihistmine. etoh withdrawal, anxiety, n/v, puritis
Prazosin, terozosin, doxazosin
(-zosin)
Alpha 1 Selective Antagonist
Used to treate HTN and urinary retention in BPH
Toxicity= 1st dose orthostatic hypotension, dizziness, headaches
Alpha 2 Selective Antagonist
Mirtazapine
Treats depression
Toxicity= sedation, increased serum choletrol and increased appetite
B1 Selective Anatagonist
Acebutolol (partial agonist) Betaxolol Esmolol (short acting) Atenolol Metoprolol
*these are good for patients with co-morbid pulmonary disease
Partial Beta Agonist
Pindolol
Acebutolol
Non-Selective B Antagonist
Propanolol
Timolol
Nadolol
Pindolol (partial agonist)
Non-selective alpha and beta antagonists
vasodilatory
Carvedilol
Labetolol
Atropine
Muscarinic Antagonist
used for glaucoma and bradycardia
others: Homatropine, Tropicamide
Benztropine
Muscarinic Antagonist
Parkinson’s
MOA, Use, ADRs, and Mechanism of Resistance
MOA: blocks viral penetration/uncoating (M2 protein) and causes release of dopamine from intact nerve terminals
Use: prophylaxis of Influenza A and Parkinson’s
ADRs: Ataxia, dizziness, slurred speech
Resistance: mutated M2 protein (90% of Flu A is resistant)
Scopolamine
Muscarinic Antagonist
Motion sickness
Ipratropium
Muscarinic Antagonist
Asthma, COPD
Oxybutinin
Muscarinic Antagonist
bladder spasms/urgency
Other: Glycopyrrolate
Methscopolamine
Muscarinic Antagonist
Peptic ulcers
Others: pirenzepine, propatheline
Pheoxybenzamine
Non-selective alpha blocker
(irreversible) used for Pheos before surgical removal.
Toxicity= orthostatic hypotension, reflex tachy
Phentolamine
Non-selective alpha blocker
(reversible) used for people taking MAO-I that ate tyrosine rich foods
Toxicity= orthostatic hypotension, reflex tachy
P450 Inducers
Quinidine, Barbituates, St. John’s Wort, Phenytoin, Rifampin, Griseofulvin, Carbamazepine, Chronic alcohol use
“Queen Barb Steals Phen-phen, and Refuses Greasy Carbs CHRONICally”
P450 Inhibitors
Macrolides, Amioderone, Grapefruit juice, Isoniazid, Cimentidine, Ritoniavir, Acute alcohol abuse, Cirpflozacin, Ketoconazole, Sulfonamides.
MAGIC RACKS
5 Antimetobolites (chemo agents)
Methotrexate, 5FU, 6-Mercatopurine, 6-Thioguanine, and Cytarabine
Methotrexate
MOA: Folic Acid analog that inhibits dihyrdrofolate reductase
Use: Leukemia, lymphoma, choriocarcinoma, sarcoma, abortions, ectopic pregancy, RA, psoriasis
ADR: myelosupression (reversible with leucovorin), macrovesicular fatty liver change, mucositis, teratogenic
5-Fluoruricil
MOA: Pyrimidine analog bioactivated to 5F-dUMP, which covalently complexes folic acid, inhibiting Thymidylate synthase ultimately decreasing protein synthesis
Use: colon cancer, solid tumors, basal cell (topical)
ADR: myelosupression (not reversible with leucovorin), photosensitivity
6-Mercaptopurine
MOA: Purine (thiol) analog, decreasing denovo purine synthesis. Activated by HGPRTase and inactivated by Xanthanine Oxidase
Use: Leukemias, Lymphomas (not CLL or Hodgkins)
ADR: bone marrow, GI, Liver
Which chemo agent has increased toxicity if given with allopurinol
6-Mercaptopurine
6-Thioguanine
MOA: same as 6-MP
Use: ALL
ADRs: bone marrow depression, liver
*can be given with allopurinol
Cytarabine
MOA: Pyrimidine analog causing inhbtion of DNA polymerase
Use: AML, ALL, high-grade Hodgkins
ADRs: leukopenia, thrombocytopenia, megaloblastic anemia
Antimetabolites are specific for which stage of the cell cycle
S phase
Anti-tumor Antibiotics
Dactinomycin, Doxorubicin, Bleomycin, Etopside
Alkylating Agents
Cyclophosphamide, ifosfamide, nitrosoureas, busulfan
Cyclophosphamide
covelently X-link DNA at guanine N-7. requires activation by liver
Use: non-hodgkins, breast, ovarian cancers, and immunosupresasnt
ADRs: myelosuppression, hemorrhagic cystitis
Drug used to prevent homeorrhagic cystitis caused by Cyclophosphamide
Mesna
Nitrosoureas
Carmustine, Lomustine, Semustine, Streptozocin
MOA: requires bioactivation, able to cross blood brain barrier and enter CNS
Use: brain tumors (including glioblastoma multiforme)
ADRs: CNS toxicity (dizzy, ataxia)
Busulfan
Alkylates DNA
Use: CML and to ablate bone marrow before bone marrow transplant
ADR: pulmonary fibrosis, and hyperpigmentation
Microtubule Inhibitors
Vincristine, vinblastine, Paclitaxel, and other Taxols
Taget tubulin
Vincristine/ Vinblastine
MOA: alkaloids bind to tubulin in Mphase and block polymerization of microtubles so the mitotic spindle cannot form
Use: hodgkin’s, Wilm’s tumor, choriocarcinoma, ALL
ADR: neurtoxicity (areflexia, peripheral, neuritis) and paralytic ileus- Vincristine
Vinblastine- blasts bone marrow
Paclitaxel
Hyperstabilizes polyermized mictorbules in M phase so the mitotic spindle can’t break down
use: Ovarian and breast cancer
ADR: myelosuppression and hypersensitivity
Cisplatin
Cross-links DNA
Use: Testicular, bladder, ovary, and lung carcinomas
ADR: Nephrotoxicty and acoustic nerve damage
Chemo agent that causes acoustic nerve damage
Cisplatin
How to prevent Cisplatin nephrotoxicity
give with Amifostine (free radical scavenger) and clhoride diuresis
Hydroxyurea
inhibits ribonucleotide reducatase, thus DNA synthesis
Use: melanoma, CML. sickle cell (increases HbF)
ADRs: bone marrow suppression, GI upset
Prednisone as a chemo agent
may trigger apoptosis and may even work on non-dividing cells
Most common glucocorticoid in cancer chemotherapy
Prednisone
Tamoxifen/ Raloxifene
SERMs- receptor antagonists in breast and bone.
used for breast cancer and can prevent osteoporosis
ADR of Tamoxifen
may increase risk of endometrial cancer bc it has partial estrogen agonist effects there.
Drug used for Metastatic Breast Cancer
Trastuzumab (monoclonal antibody against HER-2 (erb-B2))
Can cause cardiotoxcity
Tyrosine kinase inhibitor for philadelphia chromosome bcr-abl
Imatinib (gleevac)
Rituximab
monoclonal antibody against CD20, found on most Bcell lymphomas
Used for non-hodgkins, and RA
eplernone
TX of Conn’s syndrome (hyperaldosteronism). similar to spirinolactone but with less side effects
pentazocine
opiod Mu partial agonist and weak antagoist. used to decrease addition to opiods. can cause withdrawl in addicts.
given hyperthyroidism
propothiouracil ( inhibits peroxidase in thyroid and peripheral) or methimazole only works in thyroid not peripherally (meth not safe in pregnancy)
phenoxybenamine
used to treat pheochromocytoma, do you remember rule of 10’s?
Drug used before a bone marrow transplant
Busulfan
Drugs that can induce Lupus
HIP
Hydralizine
Iszoniazid
Procanimide
Treatment for Absence Seizures
Ethosuximide
Tx for closed/narrow angle glaucoma
pilocarpine
Tx for CMV retinitis
Foscarnet
1st line Treatment for Supraventricular Tachycardia
Adensoine
Treatment for digoxin toxicity or torsades
Mg2+
ADRs of Adenosine
Flushing, Hypotension, and Chest pain
Ca2+ channel blockers Types, MOA, and ADRs
Dihydropyridine: Nifedipine, Amlodipine (peripheral)
MOA: lower bp
Nondihydropyiridine: Verapimil, Diltiazem (cardiac)
MOA: lower contractility of heart
ADRs: constipation, flsuhing, edema, CHF, AV block, sinus node depression
ADR of Ibutilide
Torsades
Do these 3 lab tests before starting Amioderone
Pulmonary, Liver, and Thyroid Function Tests
MOA of Beta-Blockers and class of anti arrhythmic
decrease cAMP, decrease Ca2+ currents, supressing abnoraml pacemaker by decreasing the slope of phase 4 of the cardiac action potential
Class II
Digoxin, class, MOA, use, toxicity, antidote
Cardiac Glycoside
MOA: direct inhibition of Na/K ATPase, leading to indirect inhibition of Na/Ca exchanger, increasing intracellular Ca thus increase in inotropy. Stimulates vagus nerve
Use: CHF (increase contractility) and A-Fib (decrease AV and SA node conduction)
Tox: cholinergic, increase PR, decrease QT, T wave inversion, hyperkalemia, arrhthmia, worsended by renal failure, hypokalemia, and quinidine, and hypercalcemia
Antidote: slowly normalize K, lidocaine, anti-dig Fab fragments, Mg2+
How do meds reduce angina
decrease myocardial O2 consumption by decreasing bp, HR, ejection time, EDV, or Ionotropy
Lipid Lowering Agent causing Vit A,D,E,& K deficiency
Bile Acid Resins (colestipol, colesevelan, cholestryramine)
Target of tPA
Plasminogen
Target of clopidogrel
ADP receptor of platelet cells- irreversible blockage
prevents gp IIb/IIIa expression thus inhibiting fibrinogen binding and platelet aggregation
Target of Abciximab
glycoprotein IIb/IIIa receptors
MOA of Warfin
interferes with normal synthesis of gamma carboxy of vitamin k dependent clotting factors
MOA of Heparin
cofactor of antithrombin, decreasing thrombin and Xa
Coagulation labs with Warfin
normal bleed time
nomral platelets
Increased PT (monitor)
Increased PTT
Coagulation labs of Heparin
normal bleed time
nomral platelets
Increased PT
Increased PTT/INR (monitor)
Seizure prophylaxis for pregnant women
Phenobarbital
Use of Dantrolene
Malignant hyperthermia and neuroleptic malignant syndrome
Treatment for Acute Status Epilepticus
Diazepam
MOA of Bromocriptine
Dopomine Receptor agonsit
Treatment for Chronic Pain
Tramadol
Use of Benztropine in Parkinson’s
curbs excess cholinergic activity
Used for induction of anesthesia
Thiopental
Selegeline MOA and use
Used in parkinson’s, MAO-B inhibitor inhibits breakdown of dopamine and preferentially metabolizes NE and 5HT
Chemo agent that causes Pulmonary Fibrosis
Bleomycin
Chemo agent that can cause dilated cardiomyopathy
Doxorubicin
Chemo agent that can cause hemorrhagic cystitis and what is used to prevent this side-effect
cyclophosphamide
use mesna to prevent