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Rachel Flash cards > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Mu1, Mu2, kappa, delta

A

inhibit calcium transport presynapitcally and potentiating potassium transport post synaptically , reduce synaptic action potential of central/c pain fibers

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2
Q

Mu1

A

pain reduction (#1 opioid pain receptor)

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3
Q

Mu2, Kappa side effect

A

have side effect of respiratory depression “kappa Kills and Mu2 is a character that kills”

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4
Q

codeine metabolism

A

morphine and hydrocodone –> hydromorphone

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5
Q

morphine and hydrocodone are metabolized into

A

hydromorphone

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6
Q

side effect of opiates

A

hypogonadism! Low Testosterone

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7
Q

NMDA antagonists

A

methadone and ketamine

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8
Q

Buprenorphine

A

Mixed agonist/antagonist at M1,2, K and delta receptors, often combined with naloxone for opioid detoxification/weaning…8-16 mg sublingual daily

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9
Q

Naloxone

A

Opioid antagonist, 0.2-2 mg IV

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10
Q

Tramadol

A

Mu agonist, as well as SNRI reuptake inhibitor, 25 - 100 mg q4-6 hr PRN

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11
Q

Acetaminophen

A

Phospholipids –PLA2–> AA –COX1,2–> PG, acetaminophen inhibits cox centrally which stop PG formation – helps with fever, pain…bc metabolized centrally no side effects of gastric/renal dz..ceiling effect of pain reduction is at 1,000 mg….4g total daily dose max (out of hospital we rec 3 g total daily dose)

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12
Q

NSAIDs

Cox 2 dont affect platelets

A

peripherally acting on COX 1&2
Reduces inflammatory pain (bc decr PG)

Ibuprofen 200-800 mg PO q4-6 hrs
Naproxen 220-500 mg PO q12 hrs
Indomethacin 25-50 mg PO BID (good for HO)
Diclofenac 1% gel 2-4 grams topically QID PRN; useful for superficial MSK pain like trochanteric bursitis , hand, wrist, shoulder
Celecoxib (COX2 select) 100-200 mg PO BID
Meloxicam (COX2 select) 7.5-30 mg PO Daily

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13
Q

Steroids

A

Inhibit PLA2, so inhibit phospholipid to AA transformation

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14
Q

Steroids

A

Inhibit PLA2, so inhibit phospholipid to AA transformation

Corticosteroids, such as prednisone, function by inhibiting the enzyme phospholipase A2 (PLA-2), which normally produces arachidonic acid. Without arachidonic acid, prostaglandins are also no longer produced. However, the direct effect of prednisone is to inhibit arachidonic acid production, which indirectly leads to decreased prostaglandins. NSAIDs directly inhibit the COX-1 and COX-2 enzymes, the effect of which directly inhibits the production of prostaglandins.

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15
Q

COX2

A

PG produced by COX1 that protect stomach are still working, inhibit cox 2 PG

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16
Q

COX 2> COX1 inhibitors

A

meloxicam (once daily dosing) and celecoxib (protect stomach)

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17
Q

COX 2> COX1 inhibitors

A

meloxicam (once daily dosing) and celecoxib (protect stomach)

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18
Q

Topical meds

A

fentanyl, diclofenac, lidocaine usually 2% (good for SCI IBD/TID PRN), lido patch 1 patch daily comes in 4-5%

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19
Q

Amitriptyline/NOR

A

anticholinergic, dry. mouth, constipation, urinary retention, QT prolongation….amitriptyline more potenet than nortriptyline (gentler, possibly less efficiatious)….ami gets metabolized into nortrip

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20
Q

Gabapentin MOA

A

blocks L type Ca2 in CNS, cleared by kidneys, 3600 mg max daily dose..binds to the alpha 2 delta subunit of calcium channel

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21
Q

Pregabalin

A

same mechanism, blocks L type Ca2 in CNS, approved for diabetic neuropathic pain, postherpetic neuralgia, and fibromyalgia

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22
Q

Duloxeitine/Venlafaxine

A

SNRI, antidepp and anti neuropathic pain, FDA approved for diabetic peripheral neuropathic pain and fibromyalgia. 30-60 mg daily , venlafaxine 25 mg PO TID or 37.5-75-150 PO extended release

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23
Q

Carbamazepine

A

Blocks Na channels on neurons , prevents signal transmission, useful for trigeminal neuralgia, mood stabilizer in TBI, 100-200 mg BID-QID

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24
Q

Lidocaine infusion

Steroid injection

A

Inhibit sodium channels on C fibers

steroid injection blocks PLA2 so no AA or PGs, also have. DIRECT neuronal inhibition

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25
Q

Capsaicin MOA

A

depletes substance P, decr pain signal transmission

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26
Q

Baclofen MOA

A

Gaba B receptor agonist, withdrawal itchy bitchy twitchy, renally cleared

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27
Q

Diazepam MOA

A

Gaba A receptor agonist

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28
Q

CLACK

A

gaba A works on Cl
Gaba B1 works on calcium
GabaB2 works on K

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29
Q

tizanidine MOA

A

alpha 2 agonist (as is clonidine), inhibits spinal reflex arch, hepatically cleared!

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30
Q

dantrolene MOA

A

peripherally acting, binds to Ryanodine receptor in SR in muscle cells and inhibits calcium release which inhibits muscle contraction.

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31
Q

Botox injections MOA

A

inhibit presynaptic syntaxin , synaptobrevin and SNP 25 proteins which are full of NTs about to be released into the synapse. By cleaving these proteins, the toxin prevents ACh from being released….3 days onset, 3 week peak, 3 months duration.

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32
Q

Polyethylene glycol

A

osmotic laxative that pulls fluid into the bowel lumen

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33
Q

Lactulose

A

Traps NH3 in bowel to tx hepatic encephalopathy…osmotic laxative … docusate is a stool softner, senna is a stimulant

34
Q

Bisacodyl

A

Rectal wall irritant that is used to stimulate rectal propulsion and evacuation of stool bolus, use gloved finger with lidocaine gel to sweep and dilate it more

35
Q

UMN bladder tx

A

small, spastic, calm bladder down…Bladder empties via cholinergic, parasympathetic, pelvic nerve (S2-4) and stores via noradrenergic sympathetic hypogastric nerve (T11-L2)

36
Q

Oxybutynin

A

anticholinergic, inhibits Muscarinic cholinergic activity, blocks detrusor squeezing, 5-10 mg daily

37
Q

Tolterodine

A

same mech of oxybutynin, M antagonist a little gentler, 2-4 mg daily

38
Q

Mirabegron “B3”

A

B3 agonist , agonizing those receptors you are storing urine…bladder wall selective bc B3 only on bladder wall so less systemic effects

39
Q

Bethanechol

A

procholinergic to incr detrusor activity and promote empyting, useful in LMN/cauda equina, cholinergic side effects runny nose, hypersalivation, diarrhea

40
Q

Good urinary medication for LMN/cauda equina syndrome

A

bethanechol (agonist cholinergic receptors on detrusor which promotes emptying)

41
Q

Tamsulosin

A

Alpha 1 blocker, alpha blockers close bladder neck , useful in DSD

42
Q

Heparin

A

rapid acting agent that activates antithrombin 3, which then inhibits factor Xa, rapid reversal with protamine sulfate, risk of HIT so monitor platelets

43
Q

Enoxaparin

A

is a lower molecular weight heparin, also reversed with protamine sulfate, tx is 1 mg/kg body mass BID

44
Q

Amantadine

A

Non-competitive antagonist of the NMDA receptor, which increases dopamine release and prevents dopamine reuptake., can decr seizure threshold

45
Q

Methylphenidate

A

NE/D reuptake inhibitor, DOES NOT LOWER SEIZURE THRESHOLD (like amantadine)

46
Q

Donepezil (Aricept)

A

Cholinesterase inhibitor, promotes ACh accumulation in brain, useful neurostimulant esp in anoxic brain injury

47
Q

Levetiracetam

A

Na channel inhibiton ? but MOA unknown ,
prevents early posttraumatic seizures (7 days…. as it hasnt been shown to prevent late seizures) , sedation, used for mood stabilization

48
Q

Phenytoin

A

possible Na channel block, good for early PTS prevention, but docs often use keppra for favorable side effect profile

49
Q

Valproate

A

V gated Na channel blockade, good for seizures and mood stabilizer

50
Q

Carbamazepine

A

useful for mood stabilizer and trigeminal neuralgia

51
Q

Trazodone

A

SSRI , helps with sleep and mood

52
Q

Mirtazapine

A

TCA ….. antagonist on central alpha 2 receptors which causes increased release of serotonin and norepinephrine

53
Q

Pyridostigmine “gets RID of MG”

A

Anticholinesterase , so more ACh, Myasthenia gravis

54
Q

Riluzole

A

Blocks glutamate in CNS prolongs survival by a few months

55
Q

Nusinersen

A

alters splicing activity of SMN2 gene so it produces more SMN protein, used in SMA, shown to improve motor function and ambulation

56
Q

Anesthetic duration (block Na channels which are at the nodes of Ranvier)

A

lidocaine 1-3 hrs
ropivacaine 4-6 hrs (least toxic to tenocytes)
bupivacaine 4-8 hrs

57
Q

Prolotherapy

A

dextrose 25% solution, chaper than PRP, regenerative brings more blood

58
Q

Which two bowel meds are osmotic laxatives

A

polyethylene glycol and lactulose

59
Q

FDA approved for diabetic peripheral neuropathy

A

Duloxetine and pregabalin are FDA-approved to treat pain due to peripheral neuropathy in diabetes.

60
Q

Avoid use with NSAIDs bc it may potentiate bone marrow suppression, GI side effect, hepatotoxicity

A

methotrexxate

61
Q

GI irritation, rash, hypersensitivity, renal toxcitity, headache

A

sulfasalazine

62
Q

GI, liver , leukopenia

A

azathioprine

63
Q

alopecia, n/v, bladder side effect, pulm fibrosis, leukopenia, thrombocytopenia

A

cyclophosphamide

64
Q

immunosuppression, HTN, renal insufficiency

A

Cyclosporine

65
Q

Mucosal ulcer, rash, proteinuria, nephropathy, leukopenia, thrombocytopenia, anemia

A

gold salts (tx for JRA)

66
Q

IL2 blocker

A

cyclosporine

67
Q

meds that induce parkinson type symptoms

A

Metoclopramide (Reglan)
Lithium
Haloperidol

68
Q

MS meds

A

Immunomodulator agents include interferon beta-1a (Avonex and Rebif), interferon beta-1b (Betaseron), and glatiramer acetate (Copaxone). These have been shown to reduce relapse rates in MS patients. Immunosuppressive agents include cyclosporine, azathioprine, methotrexate, and mitoxantrone, and can reduce relapse rate but have a greater side-effect profile and are therefore used as a second-line agent. Intravenous immunoglobulin is also an immunosuppressive agent and is still being studied for use in this patient population. Steroids can hasten recovery, but do not prevent further attacks, or alter progression.

69
Q

early monitoring of what in myasthenia

A

spirometry

It is vital to do pulmonary function tests (PFTs) in patients diagnosed with MG. The forced vital capacity is probably the most important PFT, as it correlates to the function of the pulmonary muscles, including the diaphragm. Severe myasthenia may cause respiratory failure due to exhaustion of the respiratory muscles.

70
Q

Xa inhibitor/ direct thrombin inhibitor

A

RIvaroxaban, apixaban, dabigatran

71
Q

restless leg drugs

A

levodopa-carbidopa, ropinirole, pramipexole

72
Q

treat huntington by waht receptors

A

decreasing dopamine and increasing Ach (antipsychotics, SSRI)

73
Q

Parkinson

A

want to decrease acetylcholine and increase dopamine……benztropine anticholinergic, mao b or comt decr dopamine breakdown.

74
Q

increases endogenous release of dopamine

A

AMANTADINE

75
Q

benztropine

A

anticholinergic- parkinson dz

76
Q

ziprasadone (geodon) increases

A

QT interval

77
Q

selective alpha1 adrenergic inhibitor that can be used to induce urination.

A

(doxazosin)

78
Q

TCA tox on EKG

A

A widened QRS complex can be seen with

79
Q

particulate steroids

A

Triamcinolone, betamethasone acetate, and methylprednisolone

80
Q

ratio of intrathecal baclofen to oral baclofen

A

100:1

81
Q 
hydrocodone 1
oxycodone 1.5
codeine 0.15
methadone 1-20 mg/day 4, 21-40 mg/day 8, 41-60 mg/day 10
tapentadol 0.4 (mu and NE reuptake inhibitor)
vicodin 1
tramadol 0.1
hydromorphone 4
fentanyl patch 7.2
oxymorphone 3oxy
A

.

82
Q

6 monoacetylmorphine

A

metabolite of heroin… can detect in urine.

Rachel Flash cards (24 decks)

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