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First Aid > Pharm (First Aid) > Flashcards

Pharm (First Aid) Flashcards

1
Q

Bethanechol

A

Cholinomimetic agent

Posteroperative ileus, neurogenic ileus, urinary retention.

Activates bowel and bladder smooth muscle; resistant to AChE. “Bethany, call (bethanechol) me to activate your bowels and bladder.”

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2
Q

Carbachol

A

Cholinomimetic agent

Constricts pupil and relieves intraocular pressure in glaucoma

Carbon copy of actylcholine

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3
Q

Methacholine

A

Cholinomimetic agent

Challenge test for diagnosis of asthma

Stimulates muscarinic receptors in airway when inhaled.

Highly sensitive but nonspecific measure that can detect the degree of bronchial hyperreactivity in patients suspected of having asthma. A negative methacholine challenge test can help to exclude (rule out) the diagnosis).

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4
Q

Pilocarpine

A

Cholinomimetic agent

Potent stimulator of sweat, tears, and saliva

Open-angle and closed-angle glaucoma

Contracts ciliary muscle of eye (open-angle glaucoma), pupillary sphincter (closed-angle glaucoma); resistant to AChE. “You cry, drool, and sweat on your ‘pilow.’”

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5
Q

Donepezil

Galantamine

Rivastigmine

A

Indirect cholinergic agonists (anticholinesterase)

Alzherimer disease

Increase Ach

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6
Q

Edrophonium

A

Indirect cholinergic agonists (anticholinesterase)

Historically, diagnosis of myasthenia gravis (extremely short acting). Myasthenia now diagnosed by anti-AChR Ab (anti-acetylcholine receptor antibody) test.

Increase ACh

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7
Q

Neostigmine

A

Indirect cholinergic agonists (anticholinesterase)

Postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of neuromuscular junction blockade (postoperative).

Increase ACh

Neo CNS = No CNS penetration

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8
Q

Physostigmine

A

Indirect cholinergic agonists (anticholinesterase)

Anticholinergic toxicity; crosses blood-brain barrier -> CNS.

Increase ACh.

Physostigmine “phyxes” atropine overdose.

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9
Q

Pyridostigmine

A

Indirect cholinergic agonists (anticholinesterase)

Myasthenia gravis (long acting); does not penetrate CNS.

Increase ACh; Increase muscle strength.

Pyridostigmine gets rid of myasthenia gravis.

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10
Q

Adverse effects of cholinomimetic agents

A

Exacerbation of COPD, asthma, and peptic ulcers

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11
Q

Cholinesterase inhibitor poisoning

A

Often due to organophosphates, such as parathion, that irreversibly inhibit AChE.

Causes Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, and Salivation.

DUMBBELSS

Organophosphates are often components of insecticides; positing usually seen in farmers.

Antidote – atropine (competitive inhibitor) + pralidoxime (regenerates AChE if given early).

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12
Q

Atropine

Homatropine

Tropicamide

A

Muscarinic antagonist

Eye

Produce mydriasis and cycloplegia

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13
Q

Benztropine

A

Muscarinic antagonist

CNS

Parkinson disease (“park my Benz”).

Acute dystonia

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14
Q

Glycopyrrolate

A

Muscarinic antagonist

GI, respiratory

Parenteral: preoperative use to reduce airway secretions.

Oral: drooling, peptic ulcer.

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15
Q

Hyoscyamine

Dicyclomine

A

Muscarinic antagonist

GI

Antispasmodics for irritable bowel syndrome.

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16
Q

Ipratropium

Tiotropium

A

Muscarinic antagonist

Respiratory

COPD, asthma (“I pray I can breathe soon!”)

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17
Q

Oxybutynin

Solifenacin

Tolterodine

A

Muscarinic antagonist

Genitourinary

Reduce bladder spasms and urge urinary incontinence (overactive bladder)

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18
Q

Scopolamine

A

Muscarinic antagonist

CNS

Motion sickness

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19
Q

Atropine

A

Muscarinic antagonist.

Used to treat bradycardia and for ophthalmic applications.

Eye: Pupil dilation, cycloplegia

Airway: Decrease secrtions

Stomach: Decrease acid secretion

Gut: Decrease motility

Bladder: Decrease urgency in cystitis

Toxicity

Increased body temperature (due to decreased sweating); rapid pulse; dry mouth; dry, flused skin; cycloplegia; constipation; disorientation

Can cause acute angle-closure glaucoma in elderly (due to mydriasis), urinary retention in men with prostatic hyperplasia, and hyperthemia in infants.

Side effects:

Hot as a hare

Dry as a bone

Red as a beet

Blind as a bat

Mad as a hatter

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20
Q

Tetrodotoxin

A

Highly potent toxin that binds fast voltage-gated Na+ channels in cardiac and nerve tissue, preventing depolarization (blocks action potential without changing resting potential). Causes nausea, diarrhea, paresthesias, weakness, dizziness, loss of reflexes.

Treatment is primarily supportive.

Poisoning can result from ingestion of poorly prepared pufferfish, a delicacy in Japan.

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21
Q

Ciguatoxin

A

Causes ciguatera fish posioning. Opens Na+ channels causing depolarization. Symptoms easily confused with cholinergic posioning. Temperature-related dysesthesia (e.g., “cold feels hot; hot feels cold”) is regarded as a specific finding of ciguetera.

Treatment is primarily supportive.

Caused by consumption of reef fish (e.g., barracuda, snapper, moray eel).

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22
Q

Scombroid poisoning

A

Acute-onset burning sensation of the mouth, flushing of face, eruthemia, urticaria, pruritus, headache. May cause anaphylaxis-like presentation (i.e., bronchospasm, angioedema, hypotension).

Treat supportively with antihistamines; if needed, antianaphylactics (e.g., bronchodilators, epinephrine).

Caused by consumption of dark-meat fish improperly stored at warm temperature. Bacterial histidine decarboxylase converts histidine -> histamine. Histamine is not degraded by cooking. Frequently misdiagnosed as allergy to fish.

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23
Q

Albuterol

Salmeterol

A

Direct sympathomimetics

Beta-2 > Beta-1

Albuterol for acute ashtma; salmeterol for long-term asthma or COPD control.

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24
Q

Dobutamine

A

Direct sympathomimetics

Beta-1 > Beta-2, alpha

Heart failure (HF) (ionotropic > chronotropic), cardiac stress testing.

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25
Dobutamine
Direct sympathomimetics D1 = D2 \> beta \> alpha Ustable bradycardia, HF, shock; ionotropic and chronotropic alpha effects predominate at high doses
26
Epinephrine
Direct sympathomimetics Beta \> alpha Anaphylaxis, asthma, open-angle glaucoma; alpha effects predominate at high doses. Significantly stronger effect at beta-2-receptor than norepinephrine.
27
Isoproterenol
Direct sympathomimetic Beta-1 = Beta-2 Electrophysiologic evaluation of tachyarrhythias. Can worsen ischemia.
28
Norepinephrine
Direct sympathomimetics Alpha-1 \> Alpha-2 \> Beta-1 Hypotension (but decreases renal perfusion). Significantly weaker effect at beta-2-receptor than epinephrine.
29
Phenylephrine
Direct sympathomimetics Alpha-1 \> alpha-2 Hypotension (vasoconstrictor), ocular procedures (mydriatic), **rhinitis (decongestant)**
30
Amphetamine
Indirect sympathomimetics Indirect general agonist, reuptake inhibitor, also releases stored catecholamines Narcolepsy, obesity, ADHD
31
Cocaine
Indirect sympathomimetics Indirect general agonist, reuptake inhibitor Causes vasoconstriction and local anesthesia. *Never give beta-blockers if cocaine intoxication is suspected* (can lead to unopposed alpha-1 activation and extreme hypertension).
32
Ephedrine
Indirect sympathomimetics Indirect general agonist, releases stored catecholamines Nasal decongenstion, urinary incontinence, hypotension.
33
Clonidine
Sympatholytic (alpha-2 agonist) Hypertensive emergency (limited situations); dose not decrease renal blood flow ADHD, Tourette syndrome Toxicity: CNS depression, bradycardia, hypotension, respiratory depression, miosis
34
Alpha-methyldopa
Sympatholytic (alpha-2 agonist) Hypertensionin pregnancy Toxicity: Direct Coombs + hemolysis, SLE-like syndrome
35
Phenoxybenzamine
Irreversible alpha-blocker (nonselective) Pheochromocytoma (used preoperatively) to prevent catecholamine (hypertensive) crisis. Side effects: Orthostatic hypotension, reflex tachycardia
36
Phentolamine
Reversible alpha blocker (non-selective) Give to patients on MAO inhibitors who eat tyramine-containing foods. Side effects: Orthostatic hypotension, reflex tachycardia
37
Prazosin Terazosin Doxazosin Tamsulosin
Alpha-1 selective blockers (**-osin ending**) Urinary symptoms of BPH; PTSD (prazosin); hyperstension (except tamsulosin) Side effects: 1st-dose orthostatic hypotension, dizziness, headache
38
Mirtazapine
Alpha-2 selective blocker Depression Side effects: Sedation, increased serum cholesterol, increased appetite
39
Acebutolol Atenolol Betaxolol Esmolol Metoprolol
Beta-1-selective antagonist (Beta-1 \> beta-1\_ (acebutolol -- partial agonist) Selective antagonists mostly go from **A** to **M** (Beta-**1** with 1st half of alphabet)
40
Nadolol Pindolol Propranolol Timolol
Nonselective beta antagonists (beta-1 = beta-2) pindolol = partial agonist Nonselective antagonists mostly go from N to Z
41
Carvedilol Labetalol
Nonselective alpha and beta antagonists Nonselective alpha and beta antagonists have modified suffixes (instead of "olol")
42
Nebivolol
Combines **cardiac selective beta-1-adrenergic blockade** with **stimulation of beta-3** receptors, which activate nitric oxide synthase in the vasculature.
43
Acetaminophin: antidote
N-acetylcysteine (replenishes glutathione)
44
AChE inhibitors, organophosphates: antidotes
Atropine \> pralidoxime
45
Amphetamines (basic): antidote
NH4Cl (acidify urine)
46
Antimuscarinic, anticholinergic agents: antidotes
Physostigmine salicylate, control hyperthermia
47
Benzodiazepines: antidote
Flumazenil
48
Beta-blockers: antidote
Glucagon
49
Carbon monoxide: antidote
100% O2, hyperbaric O2
50
Copper, arsenic, gold: antidote
Penicillamine
51
Cyanide: antidote
Nitrite + thiosulfate, hydroxocobalamin
52
Digitalis (digoxin): antidote
Anti-dig Fab fragments
53
Heparin: antidote
Protamine sulfate
54
Iron: Antidote
De**fe**roxamine, de**fe**rasirox
55
Lead: Antidote
EDTA dimercaprol succimer penicillamine
56
Mercury, arsenic, gold: Antidote
Di**mer**caprol (BAL) succimer
57
58
Methanol, ethylene glycol (antifreeze): antidote
Fomepizole \> ethanol, dialysis
59
Methemoglobin: antidote
**Meth**ylene blue, vitamin C
60
Opioids: antidote
Naloxone Naltrexone
61
Salicylates: antidotes
NaHCO3 (alkalinzie urine) Dialysis
62
TCAs: antidote
NaHCO3 (plasma alkalinization)
63
tPA, streptokinase, urokinase: antidotes
Aminocaproic acid
64
Warfarin: antidote
Vitamine K (delayed effect) Fresh frozen plasma
65
Drug reaction: coronary vasospasm
Cocaine Sumatriptan Ergot alkaloids
66
Drug reaction: Cutaneous flushing
**V**ancomycin **A**denosine **N**iacin **C**a2+ channel blockers (**VANC**)
67
Drug reactions: Dilated cardiomyopathy
Anthracyclines (e.g., doxorubicin, daunorubicin); prevent with dexrazoxane
68
Drug reaction: Torsades de pointes
Class III (eg., sotalol) arrhythmics class IA (e.g., quinidine) antiarrhythmics macrolide antibiotics, antipsychotics TCAs
69
Drug reaction: Hot flashes
Tamoxifen Clomiphene
70
Drug reaction: Hyperglycemia
**T**acrolimus **P**rotease inhibitors **N**iacin **H**ydrochlorothiazide **C**orticosteroids (**T**aking **P**ills **N**ecessitates **H**aving blood **C**hecked)
71
Drug reaction: Hypothyroidism
Lithium Amiodarone Sulfonamides
72
Drug reaction: Acute cholestatic hepatitis, jaundice
Erthromycin
73
Drug reaction: Diarrhea
**M**etformin **E**rythromycin **C**olchicine **O**rlistat **A**carbose **M**ight **E**xite **C**olon **O**n **A**ccident
74
Drug reaction: Focal to massive hepatic necrosis
**H**alothane, ***A**manita phalloides* (death cap mushroom), **V**alproic acid, **Ac**etaminophen Liver "**HAVAc**"
75
Drug reaction: Hepatitis
Rifampin Isoniazid Pyrazinamide Statins Fibrates
76
Drug reaction: Pancreatitis
**D**idanosine **C**orticosteroids **A**lcohol **V**alproic acid **A**zathioprine **D**iuretics (furosemide, hydrochlorathiazide) **D**rugs **C**ausing **A** **V**iolent **A**bdominal **D**istress
77
Drug reaction: Agranulocytosis
**G**anciclovir **C**lozapine **C**arbamezepine **C**olchicine **M**ethimazole **P**ropylthiouracil **G**angs **CCC**rush **M**yeloblasts and **P**romyelocytes
78
Drug reaction: Aplastic anemia
**C**arbamazepine **M**ethimazole **N**SAIDs **B**enzene **C**hloramphenicol **P**ropylthiouracil **C**an't **M**ake **N**ew **B**lood **C**ells **P**roperly
79
Drug reaction: Direct Coombs-positive hemolytic anemia
Methyldopa Penicillin
80
Drug reaction: Hemolysis in G6PD deficiency
**I**soniazid **S**ulfonamides **D**apsone **P**rimaquine **A**spirin **I**buprofen **N**itrofurantoin Hemolysis **IS D PAIN**
81
Drug reaction: Megaloblastic anemia
**P**henytoin **M**ethotrexate **S**ulfa drugs Having a **blast** with **PMS**
82
Drug reaction: Thrombocytopenia
Heparin
83
Drug reactions: Thrombotic complications
OCPs Hormone replacement therapy
84
Drug reaction: Fat redistrubition
Protease inhibitors Glucocorticoids
85
Drug reaction: Gingival hyperplasia
Phenytoin Ca2+ channel blockers cyclosporine
86
Drug reaction: Hyperuricemia (gout)
**P**yrazinamide **T**hiazides **F**urosemide **N**iacin **C**yclosporine **P**ainful **T**ophi and **F**eet **N**eed **C**are
87
Drug Reaction: Myopathy
Fibrates Niacin Colchicine Hydroxychloroquine Interferon-alpha Penicillamine Statins Glucocorticoids
88
Drug reaction: Photosensitivity
**S**ulfonamides **A**miodarone **T**etracyclines 5-**F**U **SAT F**or **Photo**
89
Drug reaction: Rash (Stevens-Jonshon syndrome)
Anti-epileptic drugs (espeically lamotrogine), allopurinol, sulfa drugs, penicillin
90
SLE-like syndrome
**S**ulfa drugs **H**ydralazine **I**soniazid **P**rocainamide **P**henytoin **E**tanercept Having lupus is "**SHIPP-E**"
91
Drug reaction: Tendonitis, tendon rupture, and cartilage damage
Fluoroquinolones
92
Drug reaction: Cinchonism
Quinidine Quinine
93
Drug reaction: Parkinson-like syndrome
**A**ntipsychotics **R**eserpine **M**etoclopramide Cogwheel rigidity of **ARM**
94
Drug reaction: Seizures
**I**soniazid (vitamin B6 deficiency), **B**uproprion, **I**mipenem/cilastatin, **E**nflurane With seizures, **I** **BI**t**E** my tongue
95
Drug reaction: Tardive dyskinesia
Antipsychotics Metoclopramide
96
Drug reaction: Diabetes insipidus
Lithium Demeclocycline
97
Drug reaction: Fanconi syndrome
Expired tetracycline
98
Drug reaction: Hemorrhagic cystitis
Cyclophosphamide Ifosfamide Prevent by coadministering with mesna
99
Drug reaction: Interstital nephritis
Methicillin NSAIDs Furosemide
100
Drug reaction: SIADH
**C**arbamazepine, **C**yclophosphamide, **SS**RIs **C**an't **C**oncentrate **S**erum **S**odium
101
Drug reaction: Pulmonary fibrosis
**B**leomycine **A**miodarone **B**usulfan **M**ethotrexate **B**reathing **A**ir **B**adly from **M**edications
102
Drug reaction: Antimuscarinic
Atropine TCAs H1-blockers Antipsychotics
103
Drug reaction: Disulfiram-like reaction
Metronidazole Certain cephalosporins Griseofulvin Procarbazine 1st generation sulfonylureas
104
Drug reaction: Nephrotoxicity/ototoxicity
Aminoglycosides Vancomysin Loop diuretics Cisplatin Cisplatin toxicity may respond to amifostine
105
Sulfa drugs Examples Adverse Effects
Probenecid Furosemide Acetazolamide Celecoxib Thiazides Sulfonamide antibiotics Sulfasalazine Sulfonylureas **P**opular **FACTSSS** Patients with sulfa allergies may develop fever, UTI, Stevens-Johnson, hemolytic anemia, thrombocytopenia, agranulocytosis, and urticaria (hives).
106
-azole
Ergosterole synthesis inhibitor E.g., ketoconazole
107
-bendazole
Antiparasitic/antihelminthic E.g., Mebendazole
108
-cillin
Peptidoglycan synthesis inhibitor E.g., ampicillin
109
-cycline
Protein synthesis inhibitor E.g., Tetracycline
110
-ivir
Neuraminidase inhibitor E.g., Oseltamivir
111
-navir
Protease inhibitor Ritonavir
112
-ovir
DNA polymerase inhibitor E.g., Acyclovir
113
-thromycin
Macrolide antibiotic E.g., azithromycin
114
-ane
Inhalational general anesthetic e.g., Halothane
115
-azine
Typicla antipsychotic Thioridazine
116
-barbital
Barbituate E.g., Phenobarbital
117
-caine
Local anesthetic E.g., Lidocaine
118
-etine
SSRI E.g., fluoxetine
119
-ipramine, -tryptyline
TCA E.g., Imipramine, amitriptyline
120
-triptan
5-HT1B/1D agonists Sumatriptan
121
-zepam, -zolam
Benzodiazepine Diazepam, alprazolam
122
-chol
Cholinergic agonist E.g., Bethanecol, carbachol
123
-curium, -curonium
Nondepolarizing paralytic E.g., atracurium, vecuronium
124
-olol
Beta blocker E.g., propranolol
125
-stigmine
AChE inhibitor E.g., Neostigmine
126
-terol
Beta-2-agonist E.g., Albuterol
127
-zosin
Alpha-1-antagonist E.g., Prazosin
128
-afil
PDE-5 inhibitor E.g., Sildenafil
129
-dipine
Dihydropyridine calcium channel blocker E.g., Amlodopine
130
-pril
ACE inhibitor E.g., Captopril
131
-sartan
Angiotensin-II receptor blocker E.g., Losartan
132
-statin
HMG-CoA reductase inhibitor E.g., Atorvastatin
133
-dronate
Bisphosphonate E.g., Alendronate
134
-glitazone
PPAR-gamma activator E.g., Rosiglitazone
135
-prazole
Proton pump inhibitor E.g., omeprazole
136
-prost
Prostaglandin analog E.g., Latanoprost
137
-tidine
H2-antagonist E.g., Cimetidine
138
-tropin
Pituitary hormone E.g., somatotropin
139
-ximab
Chimeric monoclonal Ab E.g., Basiliximab
140
-zumab
Humanized monoclonal Ab Daclizumab

First Aid (4 decks)

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