Pharmacology Flashcards
What is the drug class of Metformin?
Biguanide (Antihyperglycemic agent)
What is the most common brand name for Metformin?
Glucophage
What is Metformin commonly used for?
Primarily used to manage Type 2 Diabetes Mellitus (T2DM) by improving blood sugar control.
What are off-label reasons for taking Metformin? (3)
-Polycystic Ovary Syndrome (PCOS) (Metformin increases the body’s sensitivity to insulin, there is excess insulin with PCOS)
-Gestational Diabetes
-Prevention of Type 2 Diabetes in high-risk individuals
What is the MoA for Metformin?
Metformin lowers blood glucose levels by:
-Reducing hepatic gluconeogenesis (decreasing liver glucose production)
-Increasing insulin sensitivity in peripheral tissues (helping muscles absorb glucose more efficiently)
-Decreasing intestinal glucose absorption
What are the most common side effects of Metformin? (4)
-Gastrointestinal (GI) issues (nausea, diarrhea, abdominal discomfort)
-Metallic taste
-Vitamin B12 deficiency with long-term use
-Lactic acidosis (rare but serious, especially in patients with kidney dysfunction)
What type of monitoring needs to be done when a patient is on Metformin? (4)
-Blood glucose levels & A1C (to assess effectiveness)
-Renal function (Creatinine, eGFR) (Metformin is excreted through the kidneys and is contraindicated in eGFR < 30 mL/min, as too much in the blood stream can cause lactic acidosis)
-Vitamin B12 levels (periodic checks for long-term use)
-Signs of lactic acidosis (unexplained weakness, muscle pain, difficulty breathing)
What drugs & substances are contraindicated when taking Metformin? (5)
-Contrast Dye (Iodinated contrast media): Risk of lactic acidosis—Metformin should be held before and after contrast imaging if renal function is impaired.
-Alcohol: Increases the risk of lactic acidosis.
-Certain Diuretics (Loop and Thiazide): May increase blood sugar levels.
-Beta-blockers: Can mask hypoglycemia symptoms.
-Other Antidiabetic Drugs (e.g., Insulin, Sulfonylureas): Can increase the risk of hypoglycemia.
What is the drug class of Risperidone?
Atypical (Second-Generation) Antipsychotic
What is the most common brand name for Risperidone?
Risperdal, Risperdal Consta (long-acting injection), Perseris (subcutaneous injection)
What is Risperidone commonly used for?
Risperidone is used to treat:
-Schizophrenia
-Bipolar Disorder (Manic or Mixed Episodes)
-Irritability Associated with Autism Spectrum Disorder
What are off-label reasons for taking Risperidone? (2)
-Dementia-related behavioral disturbances (though caution is needed due to increased risk of stroke in elderly patients)
-Severe aggression or agitation in certain psychiatric conditions
What is the MoA for Risperidone?
Risperidone works by modulating neurotransmitters in the brain:
-Blocks dopamine D2 receptors (reduces psychotic symptoms)
-Blocks serotonin (5-HT2A) receptors (may improve mood and reduce extrapyramidal side effects compared to first-generation antipsychotics)
What are the most common side effects of Risperidone? (6)
-Sedation & Drowsiness
-Weight Gain & Increased Appetite
-Increased Prolactin Levels (may cause breast enlargement, galactorrhea, or menstrual irregularities)
-Extrapyramidal Symptoms (EPS) (tremors, rigidity, restlessness)
-Orthostatic Hypotension (dizziness upon standing)
-Metabolic Effects (increased blood sugar, cholesterol)
What type of monitoring needs to be done when a patient is on Risperidone? (5)
-Weight, BMI, and Metabolic Panel (to monitor for weight gain, diabetes, and dyslipidemia)
-Blood Pressure (to watch for hypotension)
-Prolactin Levels (if symptoms suggest high prolactin)
-Neurological Monitoring (for EPS, such as tremors or involuntary movements)
-Mental Status & Suicide Risk (especially in younger patients)
What drugs & substances are contraindicated when taking Risperidone? (5)
-CNS Depressants (e.g., Benzodiazepines, Alcohol): Can increase drowsiness and sedation.
-Dopamine Agonists (e.g., Levodopa for Parkinson’s): Can reduce the effectiveness of either drug.
-Certain Antibiotics (e.g., Fluoroquinolones, Macrolides): May increase risperidone levels due to liver enzyme interactions.
-Carbamazepine (Anti-Seizure Drug): May decrease risperidone levels, reducing its effectiveness.
-SSRIs (e.g., Fluoxetine, Paroxetine): Can increase risperidone levels and side effects.
What is the drug class of Quetiapine?
Atypical (Second-Generation) Antipsychotic
What is the most common brand name for Quetiapine?
-Seroquel
-Seroquel XR (extended release)
What is Quetiapine commonly used for? (3)
Quetiapine is used to treat:
-Schizophrenia
-Bipolar Disorder (Manic, Depressive, and Maintenance Phases)
-Major Depressive Disorder (MDD) - Adjunct Therapy (when combined with an antidepressant)
What are off-label reasons for taking Quetiapine? (3)
It is sometimes used off-label for:
-Insomnia (due to its sedative effects, but this is controversial)
-Anxiety Disorders
-PTSD (Post-Traumatic Stress Disorder)
What is the MoA for Quetiapine?
Quetiapine works by modulating neurotransmitters in the brain:
-Blocks dopamine D2 receptors (reduces psychotic symptoms)
-Blocks serotonin (5-HT2A) receptors (improves mood and reduces extrapyramidal symptoms compared to first-generation antipsychotics)
-Strong antihistamine (H1) effects (causes sedation)
-Mild alpha-adrenergic blockade (can cause dizziness and low blood pressure)
What are the most common side effects of Quetiapine? (6)
-Sedation & Drowsiness (very common)
-Weight Gain & Increased Appetite
-Dizziness & Orthostatic Hypotension (low blood pressure when standing)
-Dry Mouth
-Constipation
-Metabolic Effects (increased risk of diabetes and high cholesterol)
What type of monitoring needs to be done when a patient is on Quetiapine? (5)
-Weight, BMI, and Metabolic Panel (to track weight gain, diabetes risk, and cholesterol levels)
-Blood Pressure (to check for hypotension)
-Mental Status & Suicide Risk (especially in younger patients)
-Extrapyramidal Symptoms (EPS) (though less common, can still occur)
-Eye Exams (long-term use may be linked to cataracts)
What drugs & substances are contraindicated when taking Quetiapine? (5)
-CNS Depressants (e.g., Alcohol, Benzodiazepines, Opioids): Increased sedation and risk of respiratory depression.
-Antihypertensives (Blood Pressure Medications): May enhance the blood pressure-lowering effect, causing dizziness.
-CYP3A4 Inhibitors (e.g., Ketoconazole, Fluconazole, Erythromycin): Can increase quetiapine levels, leading to more side effects.
-CYP3A4 Inducers (e.g., Carbamazepine, Phenytoin, Rifampin): Can decrease quetiapine levels, making it less effective.
-Other Dopamine-Affecting Drugs (e.g., Levodopa for Parkinson’s): May counteract each other’s effects.
What is the drug class of Ozempic?
Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist
What is the generic name for Ozempic and the two other brand names?
Generic Name: Semaglutide
Brand Names: Ozempic (injectable), Rybelsus (oral version), Wegovy (higher-dose version for weight management)
What is Ozempic commonly used for? (2)
Ozempic is primarily used for:
-Type 2 Diabetes Mellitus (T2DM) (to improve blood sugar control)
-Cardiovascular Risk Reduction (reduces risk of heart attack and stroke in diabetic patients)
What are off-label reasons for taking Ozempic? (1)
Weight Management (Wegovy is FDA-approved for weight loss, but Ozempic is sometimes used for the same purpose)
What is the MoA for Ozempic?
Ozempic mimics the natural GLP-1 hormone to:
-Increase insulin secretion (only when blood sugar is high, reducing hypoglycemia risk)
-Decrease glucagon release (prevents excessive glucose production by the liver)
-Slow gastric emptying (promotes fullness and reduces appetite)
What are the most common side effects of Ozempic? (7)
-Gastrointestinal (GI) issues (nausea, vomiting, diarrhea, constipation)
-Decreased appetite & weight loss
-Injection site reactions
-Fatigue
-Hypoglycemia (especially if used with insulin or sulfonylureas)
Serious but rare side effects:
-Pancreatitis (severe abdominal pain, nausea)
-Gallbladder disease (gallstones, cholecystitis)
-Thyroid C-cell tumors (in animal studies, risk in humans unclear)
What type of monitoring needs to be done when a patient is on Ozempic? (5)
-Blood Glucose & A1C Levels (to assess diabetes control)
-Weight & BMI (to monitor for excessive weight loss)
-Renal Function (Creatinine, eGFR) (especially in patients with kidney disease)
-Pancreatic Enzymes (Lipase, Amylase) (if symptoms suggest pancreatitis)
-Thyroid Function & Nodules (if there is a family history of thyroid cancer)
What drugs & substances are contraindicated when taking Ozempic? (4)
-Insulin & Sulfonylureas (e.g., Glyburide, Glipizide): Increases risk of hypoglycemia.
-Oral Medications (e.g., Birth Control Pills, Levothyroxine): May have delayed absorption due to slowed gastric emptying.
-Warfarin (Blood Thinner): Requires close monitoring of INR levels.
-Other GLP-1 Receptor Agonists (e.g., Trulicity, Victoza): Should not be used together.
What do ACE inhibitors end in?
“pril” (ex: ramipril)
What does ACE stand for with ACE inhibitors?
Angiotensin-Converting Enzyme (ACE) Inhibitors
What are ACE inhibitors used for? (5)
ACE inhibitors are used to treat:
-Hypertension (High Blood Pressure)
-Heart Failure (to improve survival and reduce hospitalizations)
-Post-Myocardial Infarction (Heart Attack) (to protect heart function)
-Chronic Kidney Disease (CKD) & Diabetic Nephropathy (to slow progression of kidney disease)
-Stroke Prevention (especially in patients with high cardiovascular risk)
What is the MoA of ACE inhibitors?
ACE inhibitors lower blood pressure and protect the heart and kidneys by:
-Blocking the Angiotensin-Converting Enzyme (ACE) → reduces the production of angiotensin II (a hormone that constricts blood vessels).
-Relaxing blood vessels → decreases blood pressure and reduces the heart’s workload.
-Reducing aldosterone levels → decreases sodium and water retention, lowering blood volume and pressure.
What are the most common side effects of ACE inhibitors? (7)
-Dry, persistent cough (due to increased bradykinin levels)
-Hypotension (Low Blood Pressure)
-Dizziness & Lightheadedness
-Fatigue
-Hyperkalemia (High Potassium Levels)
Serious but rare side effects:
-Kidney dysfunction (especially in patients with existing kidney disease)
-Anaphylaxis or angioedema (swelling of the face, lips, or throat)
What type of monitoring needs to be done when a patient is on an ACE inhibitor? (4)
-Blood Pressure (to ensure effective control and avoid hypotension)
-Renal Function (Creatinine, eGFR) (to monitor kidney health)
-Potassium Levels (K⁺) (to prevent hyperkalemia)
-Symptoms of Angioedema (especially in Black patients, who have a higher risk)
What drugs & substances are contraindicated when taking an ACE inhibitor? (5)
-Potassium-Sparing Diuretics (e.g., Spironolactone, Amiloride): Can increase potassium levels dangerously.
-NSAIDs (e.g., Ibuprofen, Naproxen): Can reduce the effectiveness of ACE inhibitors and worsen kidney function.
-Lithium (Mood Stabilizer): Increases lithium levels, leading to toxicity.
-Other Antihypertensives (e.g., ARBs, Beta-Blockers): May cause excessive blood pressure reduction.
-Diuretics (e.g., Furosemide, Hydrochlorothiazide): Can enhance blood pressure-lowering effects but may increase the risk of dehydration.
What do ARBs end in?
“sartan” (ex: candesartan)
What does ARBs stand for?
Angiotensin II Receptor Blockers (ARBs)
What are ARBs used for? (5)
ARBs are used to treat:
-Hypertension (High Blood Pressure)
-Heart Failure (to reduce hospitalizations and improve survival)
-Chronic Kidney Disease (CKD) & Diabetic Nephropathy (to protect kidney function)
-Post-Myocardial Infarction (Heart Attack) (to support heart recovery)
-Stroke Prevention (especially in high-risk patients)
If a patient develops a persistent cough with an ACE inhibitor, what is often used as an alternative?
An ARB, like candesartan.
What is the MoA for an ARB?
ARBs block the effects of angiotensin II, a hormone that narrows blood vessels and increases blood pressure. They work by:
-Blocking angiotensin II receptors (AT1 receptors) → prevents vasoconstriction, lowering blood pressure.
-Reducing aldosterone secretion → decreases sodium and water retention, lowering blood volume.
-Protecting the heart and kidneys → reduces strain on the cardiovascular system.
Do ARBs cause a dry cough? Why or why not?
Unlike ACE inhibitors, ARBs do NOT cause a dry cough because they do not increase bradykinin levels.
What are the most common side effects of ARBs? (6)
-Dizziness & Lightheadedness
-Fatigue
-Hyperkalemia (High Potassium Levels)
-Hypotension (Low Blood Pressure)
Serious but rare side effects:
-Angioedema (much less common than with ACE inhibitors)
-Kidney dysfunction (especially in patients with pre-existing kidney disease)
What type of monitoring needs to be done when a patient is on an ARB? (4)
-Blood Pressure (to ensure effective control and avoid hypotension)
-Renal Function (Creatinine, eGFR) (to monitor kidney health)
-Potassium Levels (K⁺) (to prevent hyperkalemia)
-Symptoms of Angioedema (though less common than with ACE inhibitors)
What drugs & substances are contraindicated when taking an ARB? (5)
-Potassium-Sparing Diuretics (e.g., Spironolactone, Amiloride): Can increase potassium levels dangerously.
-NSAIDs (e.g., Ibuprofen, Naproxen): Can reduce the effectiveness of ARBs and worsen kidney function.
-Lithium (Mood Stabilizer): Increases lithium levels, leading to toxicity.
-Other Antihypertensives (e.g., ACE Inhibitors, Beta-Blockers): May cause excessive blood pressure reduction.
-Diuretics (e.g., Furosemide, Hydrochlorothiazide): Can enhance blood pressure-lowering effects but may increase the risk of dehydration.
What are the contraindications for ACE inhibitors & ARBs? (3)
-Both should be avoided in pregnancy (can cause fetal harm).
-Caution in patients with bilateral renal artery stenosis (risk of acute kidney failure).
-Should not be used together due to the increased risk of hyperkalemia and kidney injury.
Why are ACE inhibitors the preferred first line treatment over ARBs? (3)
-Stronger Evidence for ACE Inhibitors: ACE inhibitors have been studied longer and more extensively than ARBs.
-Cost and Availability: ACE inhibitors have been available longer and are often cheaper.
-Bradykinin-Related Benefits of ACE Inhibitors: ACE inhibitors increase bradykinin levels, which leads to vasodilation and anti-inflammatory effects. This may provide additional cardiovascular and kidney benefits beyond just blocking angiotensin II.
-ARBs are used if patients cannot tolerate ACE inhibitors, especially due to cough or angioedema.
What are the effects of increased bradykinin on the body (4)
Effects of Increased Bradykinin
✔ Beneficial:
-Stronger vasodilation → Enhanced blood pressure reduction.
-Improved endothelial function → Protective effects in cardiovascular disease.
❌ Side Effects:
-Persistent dry cough (caused by bradykinin-induced irritation in the lungs).
-Angioedema (bradykinin can cause excessive swelling in some people, especially in the face, lips, or throat).
Why do ACE inhibitors increase bradykinin levels?
ACE inhibitors increase bradykinin levels because they block the enzyme angiotensin-converting enzyme (ACE), which normally breaks down bradykinin.
What is the drug class of Midazolam?
-Benzodiazepine
-Sedative/Hypnotic
What is the brand name for Midazolam?
Versed
What is Midazolam used for? (4)
Midazolam is used for:
-Procedural Sedation & Anesthesia Induction (e.g., before surgery, endoscopy, or intubation)
-Seizure Management (acute seizures or status epilepticus)
It is sometimes used off-label for:
-Insomnia (short-term use only)
-Alcohol Withdrawal Management
What is the MoA for Midazolam?
Midazolam works by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that calms brain activity:
Binds to GABA-A receptors → increases GABA activity → produces sedation, amnesia, and muscle relaxation.
Short-acting benzodiazepine → rapid onset and short duration, making it ideal for procedural sedation.
What are the common side effects of Midazolam? (8)
-Drowsiness & Sedation
-Dizziness & Confusion
-Amnesia (Memory Loss) (often intentional in procedural use)
-Hypotension (Low Blood Pressure)
-Respiratory Depression (especially at high doses or in combination with opioids)
-Paradoxical Reactions (agitation, restlessness—rare but possible)
Serious but rare side effects:
-Respiratory Arrest (especially in elderly or critically ill patients)
-Dependence & Withdrawal Symptoms (with prolonged use)
What monitoring needs to occur when taking Midazolam? (4)
-Respiratory Rate & Oxygen Saturation (to prevent respiratory depression)
-Blood Pressure & Heart Rate (to monitor for hypotension)
-Level of Consciousness (LOC) (to assess sedation depth)
-Risk of Dependence & Withdrawal Symptoms (if used long-term)
What drugs & substances are contraindicated when taking Midazolam? (5)
-Opioids (e.g., Morphine, Fentanyl): Increases risk of respiratory depression.
-Other CNS Depressants (e.g., Alcohol, Barbiturates, Antihistamines): Enhances sedation effects, increasing the risk of overdose.
-Macrolide Antibiotics (e.g., Erythromycin, Clarithromycin): Can increase midazolam levels by inhibiting liver metabolism.
-Azole Antifungals (e.g., Ketoconazole, Fluconazole): Can prolong the effects of midazolam.
-Grapefruit Juice: May increase midazolam levels by slowing its breakdown in the liver.
What is a benzodiazepine and what are three common types?
A benzodiazepine is a type of psychoactive drug that affects the central nervous system by enhancing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity. This results in sedation, muscle relaxation, reduced anxiety, and anticonvulsant effects.
Common types: Diazepam (Valium), Lorazepam (Ativan), Alprazolam (Xanax), Clonazepam (Klonopin), Temazepam (Restoril), Midazolam (Versed)
What needs to be consider before prescribing a benzodiazepine?
Due to the risk of addiction and dependence, benzodiazepines are usually prescribed for short-term use or under close medical supervision.
