Pharm Part 1 Flashcards
Verapamil
- Calcium channel blocker
- arrhythmia, for supraventricular tachyarrhythmias and paroxysmal tachycardia and atrial fibrillation
- Chronic stable angina stemming from AV node
Quinidine (Type 1A drugs)
arrhythmia, increases refractory period of cardiac muscle, for supraventricular tachyarrhythmias and atrial fibrillation
Phenytoin (Dilatin)
- arrhythmia, to reverse digitalis induced arrhythmias
- anti-epileptic
Lidocaine (Type 1B drugs)
- arrhythmia, decrease cardiac excitability, shortening action potention, for ventricular arrhythmias
Verapamil (angina)
angina, Ca2+ channel blocker, decrease oxygen demand by reducing afterload by reducing peripheral resistance via vasodilation
Propranolol (angina)
angina, reduces oxygen demand by preventing chronotropic responses to endogenous epinephrine
Nitroglycerin
angina, increases oxygen supply to heart by direct vasodilatory action on smooth muscle in coronary arteries
Captopril, lisinopril
HTN, ACE inhibitors
Spironolactone
HTN, diuretic, potassium sparing; antagonist for aldosterone in Collecting Tubes
Ethacrynic acid
HTN, loop or high ceiling diuretic, is associated with deafness/ototoxicity
Furosemide
HTN, diuretic, high-ceiling or loop acting; can cause deafness
Chlorothiazide
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
What are the three thiazides
dyazide
metolazone
indapamide
Hydralazine
HTN, directly acts to vasodilate vascular smooth muscle
Metoprolol
HTN, selective beta1 blocker, reduced CO and BP
Propranolol (HTN)
HTN, nonselective beta blocker reducing CO, inhibits renin secretion from juxtaglomerular cells
Clonidine
HTN, stimulates alpha2 receptors in CNS, reduces sympathetic outflow to peripheral vessels resulting in VD
- decrease HR, decrease CO and TPR
Methyldopa
HTN, acts centrally as a false NT to stimulate alpha 2 receptors to reduce SNS outflow, resulting in VD
- best for renal damage patients
Prazosin
HTN, alpha1 blocker, inhibits NE binding –> VD
Digitalis
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
Propranolol (arrhythmia)
arrhythmia, for paroxysmal tachycardia
Glycosides
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
Captopril
CHF and HTN, ACE inhibitor, blocks the enzyme that converts angiotensin I into angiotensin II
- angiotensin II causes casoconstriction and increase BP
guanethidine
- Enters the nerve and concentrated in transmitter vesicles, where it replaces norepinephrine
- reserved for severe hypertension
reserpine
depletes NE by inhibiting reuptake
atenolol
HTN, selective beta1 blocker
Doxazosin
HTN, alpha1 selective blocker
Timolol
HTN, non-selective beta blocker
Nadolol
HTN, non-selective beta blocker
Calcium Channel Blockers (antiangina)
decrease oxygen demand by reducing afterload by reducing peripheral resistance via vasodilation
Digitalis toxicity
- nausea and vomiting, yellow-green vision, extrasystole (heartbeat outside the normal rhythm), AV conduction block
- related to coadministration with chlorothiazide (potentiates toxicity)
Amide metabolized LA
in liver by p450 enzyme
- drug names with have 2 “i”
Ester metabolized LA
by esterases in plasma,
- drug names will have 1 “i”
- also a little in liver
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
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
How does LA enter membrane
only non-ionized (free base form) can penetrate tissues membranes and then becomes ionized once in neuron
How many mg of lidocaine are in one 2% capsule
36 mg
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
LA and Grave’s disease
could result in hypertensive crisis
Cocaine
only LA that doesn’t cause vasodilation
- VASOCONSTRICTION
- blocks reuptake of NE into adrenergic neurons
- produces powerful stimulation of cerebral cortex
Max dose of epi for cardiovascular disease patient
- 0.04 mg
- 1:100K epi capsule has 0.01 mg
Bisulfites
component of LA that causes an allergy (give mepivacaine)
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
Articaine
- Amide LA
- metabolized in bloodstream by esterases
Bupivacaine
longest duration of LA but highest risk of toxicity
what two LA are most likely to be cross-allergic
lidocaine and mepivacaine
Penicillin V
- naturally occurring
- more stable in acid for oral absorption
- excreted in urine
- poor against perio pathogens
- Cidal AB with narrow spectrum
What would you used to decrease excretion of penicillin
probenecid
- alters renal clearance
what AB would you use in allergic to penicillin
throw an ACE - mycin
- clindamycin
- azithromycin
- erthromycin
Which penicillin has the best gram-negative spectrum
Ampicillin
What AB are cross allergic with penicillin
cephalosporins and ampicillin
cephalexin, cephradine, cefadroxil, cefazolin
What AB would you use again penicillinase producing bugs like Staphlococcal aureus
- dicloxacillin
- augmentin
- unasyn
What AB has extended spectrum against pseudomonas and proteus species
carbenicillins
what Ab would you prescribe for heart valve prophylactics for endocarditis
- amoxicillin
- clindamycin
Clindamycin
- high concentrations in gingival fluid
- penetrates into bone but not CSF
- will produce GI upset
- mostly affects gram positive organism
what AB will cause pseudomonas colitis
clindamycin
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)
Bactericidal agents
kill rapidly growing cells by inhibiting cell wall synthesis
Bacteriostatic agents
limit population growth, but do not kill bugs but interfer with protein synthesis
what are some bacterial cidal agents
Very Finely Proficient At Cell Murder
- Vancomycin
- Fluoroquinolones - -floxacin
- penicillin - amoxicillin
- aminoglycosides - gentamycin, streptomycin
- cephalosporins - cef-
- metronidazole
what are some bacterial static agents
ECSTATiC
- Erythromycin
- clindamycin - lincomycin
- Sulfonamides - sulf-
- Tetracycline - minocycline
- Azithomycin (Z-pac)
- Trimethoprim
- Chloramphenicol
Nystatin and Clotrimazole
binds to ergosterol in fungal cell walls to weaken walls
what AB affects folic acid synthesis
sulfonamides which compete with PABA
symptoms seen during allergic reaction to penicillin
- dermatitis
- stomatitis
- bronchoconstriction
- cardiovascular collapse
which AB causes bone marrow distrubances
chloramphenicol
- aka aplastic anemia
- bone marrow suppression
Which AB is associated with allergic cholestatic hepatitis
erythromycin
- metabolized by liver and excreated via bile
Erythromycin inhibits metabolism of what drugs
Terfenadine and digoxin because of p450 inactivation
systemic anti-fungal
amphoterican B
ketoconazole
Fluconazole (crosses BBB)
penciolovir
- cream
- herpes simple virus type 1
acyclovir
HSV-1, HSV-2, varicella zoster, encephalitis
valacyclovir
prodrug that is converted to acyclovir by 1st pass metabolism
ganciclovir
cytomegalic retinitis
topical antifungal agents
- clotrimazole
- miconazole
Anti-fungal used primarily for hair and nail fungal infections
griseofulrine
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
Aspirin therapeutic effects
pain relief, antipyretic effects, antirheumatic, anti-inflammatory effects
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)
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
Corticosteroids (like Prednisone, Hydrocortisone, Triamcinolone)
anti-inflammatories; inhibit phospholipase A2, enzymatic step that precedes prostaglandin synthetase
Ibuprofen
NSAID, much less GI irritation, is anti-inflammatory, will have gastric irritation and bleeding after prolonged use
Diflunisal (Dolobid)
NSAID, longer half-life than acetaminophen and ibuprofen
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)
what analgesic do you give to a pt with history of drug addiction
ibuprofen
COX-1 enzyme produce
prostaglandins in GI tract
COX-2 enzyme produce
prostaglandin at sites of surgery, infection or inflammation
COX-2 selective inhibitors
- Robecoxib (Vioxx)
- Celebrex
- Bextra
- safer for bleeding disorders
- no effect on platelets
Heparin
prevents blood clotting and found in Mast cells and Basophils
- prevent fibrin formation
- affects factor Xa with small effect on PTT time
where does codeine and hydrocodone work
CNS
Hydrocodone combination drug start with what letter
V
what combination drug can you use while pregnant
Tylenol 3 (codeine and acetaminophen)
Synthetic narcotic of morphine
Meperidine
what drug can help suppress cough reflex
codeine
Propoxyphene
oral synthetic opioid analgesic structurally similar to methadone
Indomethan
NSAID
- strong
Phenylbutazone
NSAID
Nalbuphine
mixed agonist-antagonists, has both agonistic and antagonistic activites
Naloxone
antagonist to treat overdose of morphine
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
Morphine effects
respiratory depression, euphoria, sedation, dysphoria, analgesia, constipation (trick you with diarrhea) , urinary (trick you with diuresis) retention
Morphine/Opiod overdose
coma, respiratory depression, miosis
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
Opioids
Meperidine, morphine, codeine
sulfonamides
compete with PABA in folic acid synthesis so there is folic acid deficiency
Streptomycin adverse effects
8th nerve damage, will affect balance and hearing
Amphotericin B adverse effects
nephrotoxicity and hypokalemia
