Pharm Part 1 Flashcards
1
Q
Verapamil
A
- Calcium channel blocker
- arrhythmia, for supraventricular tachyarrhythmias and paroxysmal tachycardia and atrial fibrillation
- Chronic stable angina stemming from AV node
2
Q
Quinidine (Type 1A drugs)
A
arrhythmia, increases refractory period of cardiac muscle, for supraventricular tachyarrhythmias and atrial fibrillation
3
Q
Phenytoin (Dilatin)
A
- arrhythmia, to reverse digitalis induced arrhythmias
- anti-epileptic
4
Q
Lidocaine (Type 1B drugs)
A
- arrhythmia, decrease cardiac excitability, shortening action potention, for ventricular arrhythmias
5
Q
Verapamil (angina)
A
angina, Ca2+ channel blocker, decrease oxygen demand by reducing afterload by reducing peripheral resistance via vasodilation
6
Q
Propranolol (angina)
A
angina, reduces oxygen demand by preventing chronotropic responses to endogenous epinephrine
7
Q
Nitroglycerin
A
angina, increases oxygen supply to heart by direct vasodilatory action on smooth muscle in coronary arteries
8
Q
Captopril, lisinopril
A
HTN, ACE inhibitors
9
Q
Spironolactone
A
HTN, diuretic, potassium sparing; antagonist for aldosterone in Collecting Tubes
10
Q
Ethacrynic acid
A
HTN, loop or high ceiling diuretic, is associated with deafness/ototoxicity
11
Q
Furosemide
A
HTN, diuretic, high-ceiling or loop acting; can cause deafness
12
Q
Chlorothiazide
A
HTN, diuretic, thiazide, when administered with digitalis, will increase penetration of digitalis into myocardium
- most widely used
- Inhibits Na+ resorption causing excretion of Na+, K+ and water
13
Q
What are the three thiazides
A
dyazide
metolazone
indapamide
14
Q
Hydralazine
A
HTN, directly acts to vasodilate vascular smooth muscle
15
Q
Metoprolol
A
HTN, selective beta1 blocker, reduced CO and BP
16
Q
Propranolol (HTN)
A
HTN, nonselective beta blocker reducing CO, inhibits renin secretion from juxtaglomerular cells
17
Q
Clonidine
A
HTN, stimulates alpha2 receptors in CNS, reduces sympathetic outflow to peripheral vessels resulting in VD
- decrease HR, decrease CO and TPR
18
Q
Methyldopa
A
HTN, acts centrally as a false NT to stimulate alpha 2 receptors to reduce SNS outflow, resulting in VD
- best for renal damage patients
19
Q
Prazosin
A
HTN, alpha1 blocker, inhibits NE binding –> VD
20
Q
Digitalis
A
glycoside for arrhythmia, decreases rate of AV conduction, for atrial fibrillation and paroxysmal tachycardia
- alters Ca+ movement, increase in force of contraction of myocardial tissue (inotropic effect)
- inhibits Na+, K+ ATPase leading to calium influx, decrease HR
- Thiazides increase toxicity
21
Q
Propranolol (arrhythmia)
A
arrhythmia, for paroxysmal tachycardia
22
Q
Glycosides
A
CHF, ex: digitalis and digoxin, have positive inotropic effect, increasing force of contraction of myocardium by inhibiting Na+/K+ ATPase and thus increasing Ca2+ influx, reduces compensatory changes associated with CHF like heart size, rate, edema
23
Q
Captopril
A
CHF and HTN, ACE inhibitor, blocks the enzyme that converts angiotensin I into angiotensin II
- angiotensin II causes casoconstriction and increase BP
24
Q
guanethidine
A
- Enters the nerve and concentrated in transmitter vesicles, where it replaces norepinephrine
- reserved for severe hypertension
25
reserpine
depletes NE by inhibiting reuptake
26
atenolol
HTN, selective beta1 blocker
27
Doxazosin
HTN, alpha1 selective blocker
28
Timolol
HTN, non-selective beta blocker
29
Nadolol
HTN, non-selective beta blocker
30
Calcium Channel Blockers (antiangina)
decrease oxygen demand by reducing afterload by reducing peripheral resistance via vasodilation
31
Digitalis toxicity
- nausea and vomiting, yellow-green vision, extrasystole (heartbeat outside the normal rhythm), AV conduction block
- related to coadministration with chlorothiazide (potentiates toxicity)
32
Amide metabolized LA
in liver by p450 enzyme
| - drug names with have 2 "i"
33
Ester metabolized LA
by esterases in plasma,
- drug names will have 1 "i"
- also a little in liver
34
prilocaine
causes methemoglobinemia
- Methemoglobin is a form of hemoglobin that contains the ferric [Fe3+] form of iron. The affinity for oxygen of ferric iron is impaired.
- oxygen–hemoglobin dissociation curve therefore shifted to the left
35
how does LA work
prevents generation of nerve impulses by interfering with sodium transport into the neurons resulting in depolarization (decrease Na+ uptake)
- no effect on K+ at nerve axon
36
How does LA enter membrane
only non-ionized (free base form) can penetrate tissues membranes and then becomes ionized once in neuron
37
How many mg of lidocaine are in one 2% capsule
36 mg
38
What happens when LA given at high dose
can lead to generalized state of CNS depression which can result in respiratory depression, myocardial depression and death
39
LA and Grave's disease
could result in hypertensive crisis
40
Cocaine
only LA that doesn't cause vasodilation
- VASOCONSTRICTION
- blocks reuptake of NE into adrenergic neurons
- produces powerful stimulation of cerebral cortex
41
Max dose of epi for cardiovascular disease patient
- 0.04 mg
| - 1:100K epi capsule has 0.01 mg
42
Bisulfites
component of LA that causes an allergy (give mepivacaine)
43
Procaine
- ester LA
- also known as Novacaine
- highly allergic compound "paraminobenzoic acid" PABA which is what procaine is metabolized into and excreted in through kidneys
44
Articaine
- Amide LA
| - metabolized in bloodstream by esterases
45
Bupivacaine
longest duration of LA but highest risk of toxicity
46
what two LA are most likely to be cross-allergic
lidocaine and mepivacaine
47
Penicillin V
- naturally occurring
- more stable in acid for oral absorption
- excreted in urine
- poor against perio pathogens
- Cidal AB with narrow spectrum
48
What would you used to decrease excretion of penicillin
probenecid
| - alters renal clearance
49
what AB would you use in allergic to penicillin
throw an ACE - mycin
- clindamycin
- azithromycin
- erthromycin
50
Which penicillin has the best gram-negative spectrum
Ampicillin
51
What AB are cross allergic with penicillin
cephalosporins and ampicillin
| cephalexin, cephradine, cefadroxil, cefazolin
52
What AB would you use again penicillinase producing bugs like Staphlococcal aureus
- dicloxacillin
- augmentin
- unasyn
53
What AB has extended spectrum against pseudomonas and proteus species
carbenicillins
54
what Ab would you prescribe for heart valve prophylactics for endocarditis
- amoxicillin
| - clindamycin
55
Clindamycin
- high concentrations in gingival fluid
- penetrates into bone but not CSF
- will produce GI upset
- mostly affects gram positive organism
56
what AB will cause pseudomonas colitis
clindamycin
57
Tetracycline
- static
- broadest spectrum against gram positive and negative cocci and bacilli
- arrest rapid bone loss associated with acute periodontitis (AA) or ANUG
- higher concentration in gingival fluid than serum
- effectiveness reduced with ingestion of antacid or dairy products
- chelates with calcium
- liver damage or hepatotoxicity can happen
- teeth discolorization, super infection, GI symptoms (diarrhea)photosensitivity (burn skin easy)
58
Bactericidal agents
kill rapidly growing cells by inhibiting cell wall synthesis
59
Bacteriostatic agents
limit population growth, but do not kill bugs but interfer with protein synthesis
60
what are some bacterial cidal agents
Very Finely Proficient At Cell Murder
- Vancomycin
- Fluoroquinolones - -floxacin
- penicillin - amoxicillin
- aminoglycosides - gentamycin, streptomycin
- cephalosporins - cef-
- metronidazole
61
what are some bacterial static agents
ECSTATiC
- Erythromycin
- clindamycin - lincomycin
- Sulfonamides - sulf-
- Tetracycline - minocycline
- Azithomycin (Z-pac)
- Trimethoprim
- Chloramphenicol
62
Nystatin and Clotrimazole
binds to ergosterol in fungal cell walls to weaken walls
63
what AB affects folic acid synthesis
sulfonamides which compete with PABA
64
symptoms seen during allergic reaction to penicillin
- dermatitis
- stomatitis
- bronchoconstriction
- cardiovascular collapse
65
which AB causes bone marrow distrubances
chloramphenicol
- aka aplastic anemia
- bone marrow suppression
66
Which AB is associated with allergic cholestatic hepatitis
erythromycin
| - metabolized by liver and excreated via bile
67
Erythromycin inhibits metabolism of what drugs
Terfenadine and digoxin because of p450 inactivation
68
systemic anti-fungal
amphoterican B
ketoconazole
Fluconazole (crosses BBB)
69
penciolovir
- cream
| - herpes simple virus type 1
70
acyclovir
HSV-1, HSV-2, varicella zoster, encephalitis
71
valacyclovir
prodrug that is converted to acyclovir by 1st pass metabolism
72
ganciclovir
cytomegalic retinitis
73
topical antifungal agents
- clotrimazole
| - miconazole
74
Anti-fungal used primarily for hair and nail fungal infections
griseofulrine
75
Aspirin mechanisms of action
- analgesic effects: inhibits synthesis of prostaglandins
- antipyretic effects: inhibits synthesis of prostaglandins in hypothalamus, cutaneous vasodilation
- bleeding time: inhibits thromboxane A2 synthesis and thus platelet aggregation slows
76
Aspirin therapeutic effects
pain relief, antipyretic effects, antirheumatic, anti-inflammatory effects
77
Aspirin adverse/toxic effects
occult bleeding from GI tract, tinnitus, nausea and vomiting, acid-base disturbance, metabolic acidosis, decreased tubular resorption of uric acid, salicylism, delirium, hyperventilation
Aspirin should be avoided in feverish child = Reye's Syndrome (give acetaminophen instead)
78
Acetaminophen
no anti-inflammatory activity, is hepatotoxic, does not cause GI upset, liver toxicity esp when combined with alcohol or taking 4g/day, is choice for feverish kid, may induce methemoglobinemia at high doses
- does not affect platelet aggregation
79
Corticosteroids (like Prednisone, Hydrocortisone, Triamcinolone)
anti-inflammatories; inhibit phospholipase A2, enzymatic step that precedes prostaglandin synthetase
80
Ibuprofen
NSAID, much less GI irritation, is anti-inflammatory, will have gastric irritation and bleeding after prolonged use
81
Diflunisal (Dolobid)
NSAID, longer half-life than acetaminophen and ibuprofen
82
Pentazocine
- mixed agonist-antagonists, has both agonistic and antagonistic activities
- work by activating (agonizing) κ-opioid receptors (KOR) and blocking (antagonizing) μ-opioid receptors (MOR)
83
what analgesic do you give to a pt with history of drug addiction
ibuprofen
84
COX-1 enzyme produce
prostaglandins in GI tract
85
COX-2 enzyme produce
prostaglandin at sites of surgery, infection or inflammation
86
COX-2 selective inhibitors
- Robecoxib (Vioxx)
- Celebrex
- Bextra
- safer for bleeding disorders
- no effect on platelets
87
Heparin
prevents blood clotting and found in Mast cells and Basophils
- prevent fibrin formation
- affects factor Xa with small effect on PTT time
88
where does codeine and hydrocodone work
CNS
89
Hydrocodone combination drug start with what letter
V
90
what combination drug can you use while pregnant
Tylenol 3 (codeine and acetaminophen)
91
Synthetic narcotic of morphine
Meperidine
92
what drug can help suppress cough reflex
codeine
93
Propoxyphene
oral synthetic opioid analgesic structurally similar to methadone
94
Indomethan
NSAID
| - strong
95
Phenylbutazone
NSAID
96
Nalbuphine
mixed agonist-antagonists, has both agonistic and antagonistic activites
97
Naloxone
antagonist to treat overdose of morphine
98
Methadone
used in detox of morphine addicts, is full agonist with analgesic properties, when taken orally is not euphoric in addicts, just acts to produce tolerance and physical dependence, withdrawal is less severe because of long half-life
99
Morphine effects
respiratory depression, euphoria, sedation, dysphoria, analgesia, constipation (trick you with diarrhea) , urinary (trick you with diuresis) retention
100
Morphine/Opiod overdose
coma, respiratory depression, miosis
101
Morphine mechanism of action
binds mu receptors in CNS
causes vomiting by stimulating medullary chemoreceptor trigger zone
decrease in ventilation due to loss of sensitivity of medullary resp center to CO2
102
Opioids
Meperidine, morphine, codeine
103
sulfonamides
compete with PABA in folic acid synthesis so there is folic acid deficiency
104
Streptomycin adverse effects
8th nerve damage, will affect balance and hearing
105
Amphotericin B adverse effects
nephrotoxicity and hypokalemia
