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NERB > Pharm Part 1 > Flashcards

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
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2
Q

Quinidine (Type 1A drugs)

A

arrhythmia, increases refractory period of cardiac muscle, for supraventricular tachyarrhythmias and atrial fibrillation

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3
Q

Phenytoin (Dilatin)

A
  • arrhythmia, to reverse digitalis induced arrhythmias

- anti-epileptic

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4
Q

Lidocaine (Type 1B drugs)

A
  • arrhythmia, decrease cardiac excitability, shortening action potention, for ventricular arrhythmias
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5
Q

Verapamil (angina)

A

angina, Ca2+ channel blocker, decrease oxygen demand by reducing afterload by reducing peripheral resistance via vasodilation

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6
Q

Propranolol (angina)

A

angina, reduces oxygen demand by preventing chronotropic responses to endogenous epinephrine

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7
Q

Nitroglycerin

A

angina, increases oxygen supply to heart by direct vasodilatory action on smooth muscle in coronary arteries

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8
Q

Captopril, lisinopril

A

HTN, ACE inhibitors

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9
Q

Spironolactone

A

HTN, diuretic, potassium sparing; antagonist for aldosterone in Collecting Tubes

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10
Q

Ethacrynic acid

A

HTN, loop or high ceiling diuretic, is associated with deafness/ototoxicity

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11
Q

Furosemide

A

HTN, diuretic, high-ceiling or loop acting; can cause deafness

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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
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13
Q

What are the three thiazides

A

dyazide
metolazone
indapamide

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14
Q

Hydralazine

A

HTN, directly acts to vasodilate vascular smooth muscle

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15
Q

Metoprolol

A

HTN, selective beta1 blocker, reduced CO and BP

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16
Q

Propranolol (HTN)

A

HTN, nonselective beta blocker reducing CO, inhibits renin secretion from juxtaglomerular cells

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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

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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

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19
Q

Prazosin

A

HTN, alpha1 blocker, inhibits NE binding –> VD

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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
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21
Q

Propranolol (arrhythmia)

A

arrhythmia, for paroxysmal tachycardia

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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

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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

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24
Q

guanethidine

A
  • Enters the nerve and concentrated in transmitter vesicles, where it replaces norepinephrine
  • reserved for severe hypertension
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25
Q

reserpine

A

depletes NE by inhibiting reuptake

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26
Q

atenolol

A

HTN, selective beta1 blocker

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27
Q

Doxazosin

A

HTN, alpha1 selective blocker

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28
Q

Timolol

A

HTN, non-selective beta blocker

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29
Q

Nadolol

A

HTN, non-selective beta blocker

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30
Q

Calcium Channel Blockers (antiangina)

A

decrease oxygen demand by reducing afterload by reducing peripheral resistance via vasodilation

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31
Q

Digitalis toxicity

A
  • nausea and vomiting, yellow-green vision, extrasystole (heartbeat outside the normal rhythm), AV conduction block
  • related to coadministration with chlorothiazide (potentiates toxicity)
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32
Q

Amide metabolized LA

A

in liver by p450 enzyme

- drug names with have 2 “i”

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33
Q

Ester metabolized LA

A

by esterases in plasma,

  • drug names will have 1 “i”
  • also a little in liver
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34
Q

prilocaine

A

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
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35
Q

how does LA work

A

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

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36
Q

How does LA enter membrane

A

only non-ionized (free base form) can penetrate tissues membranes and then becomes ionized once in neuron

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37
Q

How many mg of lidocaine are in one 2% capsule

A

36 mg

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38
Q

What happens when LA given at high dose

A

can lead to generalized state of CNS depression which can result in respiratory depression, myocardial depression and death

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39
Q

LA and Grave’s disease

A

could result in hypertensive crisis

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40
Q

Cocaine

A

only LA that doesn’t cause vasodilation

  • VASOCONSTRICTION
  • blocks reuptake of NE into adrenergic neurons
  • produces powerful stimulation of cerebral cortex
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41
Q

Max dose of epi for cardiovascular disease patient

A
  • 0.04 mg

- 1:100K epi capsule has 0.01 mg

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42
Q

Bisulfites

A

component of LA that causes an allergy (give mepivacaine)

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43
Q

Procaine

A
  • 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
Q

Articaine

A
  • Amide LA

- metabolized in bloodstream by esterases

45
Q

Bupivacaine

A

longest duration of LA but highest risk of toxicity

46
Q

what two LA are most likely to be cross-allergic

A

lidocaine and mepivacaine

47
Q

Penicillin V

A
  • naturally occurring
  • more stable in acid for oral absorption
  • excreted in urine
  • poor against perio pathogens
  • Cidal AB with narrow spectrum
48
Q

What would you used to decrease excretion of penicillin

A

probenecid

- alters renal clearance

49
Q

what AB would you use in allergic to penicillin

A

throw an ACE - mycin

  • clindamycin
  • azithromycin
  • erthromycin
50
Q

Which penicillin has the best gram-negative spectrum

A

Ampicillin

51
Q

What AB are cross allergic with penicillin

A

cephalosporins and ampicillin

cephalexin, cephradine, cefadroxil, cefazolin

52
Q

What AB would you use again penicillinase producing bugs like Staphlococcal aureus

A
  • dicloxacillin
  • augmentin
  • unasyn
53
Q

What AB has extended spectrum against pseudomonas and proteus species

A

carbenicillins

54
Q

what Ab would you prescribe for heart valve prophylactics for endocarditis

A
  • amoxicillin

- clindamycin

55
Q

Clindamycin

A
  • high concentrations in gingival fluid
  • penetrates into bone but not CSF
  • will produce GI upset
  • mostly affects gram positive organism
56
Q

what AB will cause pseudomonas colitis

A

clindamycin

57
Q

Tetracycline

A
  • 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
Q

Bactericidal agents

A

kill rapidly growing cells by inhibiting cell wall synthesis

59
Q

Bacteriostatic agents

A

limit population growth, but do not kill bugs but interfer with protein synthesis

60
Q

what are some bacterial cidal agents

A

Very Finely Proficient At Cell Murder

  • Vancomycin
  • Fluoroquinolones - -floxacin
  • penicillin - amoxicillin
  • aminoglycosides - gentamycin, streptomycin
  • cephalosporins - cef-
  • metronidazole
61
Q

what are some bacterial static agents

A

ECSTATiC

  • Erythromycin
  • clindamycin - lincomycin
  • Sulfonamides - sulf-
  • Tetracycline - minocycline
  • Azithomycin (Z-pac)
  • Trimethoprim
  • Chloramphenicol
62
Q

Nystatin and Clotrimazole

A

binds to ergosterol in fungal cell walls to weaken walls

63
Q

what AB affects folic acid synthesis

A

sulfonamides which compete with PABA

64
Q

symptoms seen during allergic reaction to penicillin

A
  • dermatitis
  • stomatitis
  • bronchoconstriction
  • cardiovascular collapse
65
Q

which AB causes bone marrow distrubances

A

chloramphenicol

  • aka aplastic anemia
  • bone marrow suppression
66
Q

Which AB is associated with allergic cholestatic hepatitis

A

erythromycin

- metabolized by liver and excreated via bile

67
Q

Erythromycin inhibits metabolism of what drugs

A

Terfenadine and digoxin because of p450 inactivation

68
Q

systemic anti-fungal

A

amphoterican B
ketoconazole
Fluconazole (crosses BBB)

69
Q

penciolovir

A
  • cream

- herpes simple virus type 1

70
Q

acyclovir

A

HSV-1, HSV-2, varicella zoster, encephalitis

71
Q

valacyclovir

A

prodrug that is converted to acyclovir by 1st pass metabolism

72
Q

ganciclovir

A

cytomegalic retinitis

73
Q

topical antifungal agents

A
  • clotrimazole

- miconazole

74
Q

Anti-fungal used primarily for hair and nail fungal infections

A

griseofulrine

75
Q

Aspirin mechanisms of action

A
  • 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
Q

Aspirin therapeutic effects

A

pain relief, antipyretic effects, antirheumatic, anti-inflammatory effects

77
Q

Aspirin adverse/toxic effects

A

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
Q

Acetaminophen

A

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
Q

Corticosteroids (like Prednisone, Hydrocortisone, Triamcinolone)

A

anti-inflammatories; inhibit phospholipase A2, enzymatic step that precedes prostaglandin synthetase

80
Q

Ibuprofen

A

NSAID, much less GI irritation, is anti-inflammatory, will have gastric irritation and bleeding after prolonged use

81
Q

Diflunisal (Dolobid)

A

NSAID, longer half-life than acetaminophen and ibuprofen

82
Q

Pentazocine

A
  • 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
Q

what analgesic do you give to a pt with history of drug addiction

A

ibuprofen

84
Q

COX-1 enzyme produce

A

prostaglandins in GI tract

85
Q

COX-2 enzyme produce

A

prostaglandin at sites of surgery, infection or inflammation

86
Q

COX-2 selective inhibitors

A
  • Robecoxib (Vioxx)
  • Celebrex
  • Bextra
  • safer for bleeding disorders
  • no effect on platelets
87
Q

Heparin

A

prevents blood clotting and found in Mast cells and Basophils

  • prevent fibrin formation
  • affects factor Xa with small effect on PTT time
88
Q

where does codeine and hydrocodone work

A

CNS

89
Q

Hydrocodone combination drug start with what letter

A

V

90
Q

what combination drug can you use while pregnant

A

Tylenol 3 (codeine and acetaminophen)

91
Q

Synthetic narcotic of morphine

A

Meperidine

92
Q

what drug can help suppress cough reflex

A

codeine

93
Q

Propoxyphene

A

oral synthetic opioid analgesic structurally similar to methadone

94
Q

Indomethan

A

NSAID

- strong

95
Q

Phenylbutazone

A

NSAID

96
Q

Nalbuphine

A

mixed agonist-antagonists, has both agonistic and antagonistic activites

97
Q

Naloxone

A

antagonist to treat overdose of morphine

98
Q

Methadone

A

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
Q

Morphine effects

A

respiratory depression, euphoria, sedation, dysphoria, analgesia, constipation (trick you with diarrhea) , urinary (trick you with diuresis) retention

100
Q

Morphine/Opiod overdose

A

coma, respiratory depression, miosis

101
Q

Morphine mechanism of action

A

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
Q

Opioids

A

Meperidine, morphine, codeine

103
Q

sulfonamides

A

compete with PABA in folic acid synthesis so there is folic acid deficiency

104
Q

Streptomycin adverse effects

A

8th nerve damage, will affect balance and hearing

105
Q

Amphotericin B adverse effects

A

nephrotoxicity and hypokalemia

NERB (3 decks)

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