Pharmacology: cardio, heme, MSK, immune Flashcards
NSAID types
Ibuprofen ect: reversible COX inhibition for the life of the enzyme (3 days)
Aspirin: irreversible COX inhibition (suicide inhibition). Block TX2 in platelets diminishing aggregations for the life of the platelets (8-9 days)
Acetominophen: reduces, not blocks, COX. COX must be oxidized to function. But works only in the brain, reducing pain but not inflammation. Also has endocannabinoid activity.
Naproxen: Aleve. Avoid in third trimester. Many interactions- SSRIs, lithium, methotrexate, etc
Indomethacin: serious drug, don’t use for aches & pains. Used for arthritites, HAs, to close PDA, to stop labor, to decrease amniotic fluid.
Ketorolac: injectable. Used for moderate-severe pain <5 days (can cause kidney damage with long-term use). Avoid with probenecid, pentoxyphilline, or use with chemo/radiation.
Diclofenac: for gout, PMS, arthritides, kidney stones. Topically for actinic keratosis.
Clopidogrel
Anticoagulant. Blocks an ADP receptor on platelets, decreasing platelet aggregation.
Heparin
Inactivates thrombin, factor Xa, and other proteases.
Half-life of an hour. Low-molecular weight heparin has a half-life of 4 hours.
IV/subQ only. IM will cause hematomas.
Warfarin
Vitamin K antagonist.
Prevents synthesis of VK-dependent clotting factors (2, 7 9, 10) and protein C and protein S
Enoxaparin
Blocks clotting factors Xa
Dabigatron
Used post-surgery to prevents clots. Prevents DVT, strokes.
Blocks thrombin
Rivaroxaban
Blocks factor Xa
Alprostadil
Vasodilator for ED, injected into the penis
Desmopressin
Synthetic ADH; works as an antidiuretic. Works on aquaporin channels in the kidney.
Used to treat von Willebrand, disease, hemophilia A, diabetes insipidus and bed wetting
Epoetin alfa
Synthetic EPO, stimulate RBC production. Used to treat anemia from chemo.
Pentoxyphilline
PDE-I, nonselective.
Used for intermittent claudication from PAD and hemorrhoids
Clozapine vs clonazepam
Clozapine: atypical antipsychotic
Clonazepam: benzo for panic disorder
Celecoxib
Selective COX-2 inhibiting NSAID.
Also has use in familial polyposis and possible mental illness (bipolar, schizophrenia).
Increased risk of MI and stroke; don’t use in anyone at risk.
Tramadol
Opioid AND SNRI medication. Oral or injection.
Don’t use in pregnancy, small risk of miscarriage.
Goes through 3A4 and 2D6; don’t use with antidepressants, other opioids, trazodone, cyclopenzaprine, triptans or ergot, or amphetamines.
Meloxicam
NSAID used to treat OA. COX-2 selectivity. Don’t use in heart disease.
Diazepam
Valium. Benzo used to treat seizures, EtOH withdrawal, panic, eclampsia, and pre-surgery for sedation and to promote memory loss, IE, used before endoscopy.
Colchicine
Used to treat gout and Behcet’s.
MOA: inhibits microtubules, mitosis, neutrophil migration, mast cell degranulation and ROS formation
SEs: rhabdomyolosis
Allopurinol
Xanthine oxidase inhibitor. Gout.
Prednisone uses?
Immune suppressant obviously
Also for migraines, hormone-sensitive tumors, and blood cancers (ALL, Hodgkin’s and non-Hodgkin’s, multiple myeloma)
4x as strong as hydrocortisone
Hydrocortisone
Synthetic cortisol! Treatment of choice when someone’s adrenals stop making actual cortisol (adrenocorticoid insufficiency).
It is seen as strength of 1.
Dexamethasone = 40x
Prednisone = 4x
Methocarbamol
Carbamate drug, MOA not totally understood. Has GABA receptor activity and side effects similar too, but not quite as serious as, benzos and barbiturates.
Used to treat MSK pain and injury.
Tizanidine
MOA unclear, used to treat MSK spasms. Probably an alpha-2-agonist (like clonidine).
QT prolongation.
CYP 1A2 inhibitor, many interactions with antibiotics, anti-arrhythmics, HTN meds and levadopa
Triamcinolone
Topical steroid
Osteoporosis medications
Raloxifine: SERM, prevents OP, increases T in men
Alendronate: bisphosphanate, inhibits osteoclast-mediated bone resorption, tx for OP
Calcitonin: inhibits osteoclasts. Used for hypercalcemia and OP. Work against PTH and vitamin D. Increased levels in medullary thyroid cancer (in the parafollicular cells).
Denosumab: human monoclonal antibody. Prevents OP, tx bone mets. RANKL inhibitor- blocks osteoclasts.
Red man syndrome can be caused by which antibiotic ?
Vancomycin. Its thrombophlebitis and flushing. Tx: Benadryl
Glycopeptide antibiotic, its in a class all to itself. Its created by a soil bacteria called A. orientalist. Usually given by IV, Staph, MRSA.
Which antibiotics are bactericidal vs bacteriostatic?
Bactericidal:
Bactrim (inhibits folate synthesis)
Flouroquinolones (inhibit DNA unwinding)
Penicillins, cephalosporins (cell wall lysis)
Metronidazole (inhibits nucleic acid synthesis)
Nitrofurantoin (builds up in the bladder, breaks DNA)
Rifaximin (binds beta-subunit of RNA polymerase)
Vancomycin
Bacteriostatic:
Tetracyclines, macrolides, lincosamides (bind 30s, inhibit protein synthesis)
Which antibiotic increases the risk of C diff colitis by 4x?
Clindamycine
Also: cephalosporins, fluoroquinolones.
Tx: Metronidazole, Vancomycin, or Rifaximin
Avoid using bactrim in patients on which drugs?
Anything that spares K+ (ACEI, spironolactone)
Anti-arrhthmics and anything that prolongs QT
Methotrexate
Sulfonylureas (avoid w other sulfa drugs!)
And lots others
Nitrofurantoin
Builds up in the bladder and breaks DNA. Bactericidal.
Used for UTIs. Brand name: Macrobid.
Tetracycline antibiotics
Doxyxyxline, Minocycline.
Bacteriostatic; binds 30s subunit
Also kills protozoans
Macrolides
Azithromycin, Clarithromycin, Erythromycin
Bacteriostatic; binds 30s subunit
Use in patients with penicillin allergy
Lincosamide antibiotics
Clindamycin
Bacteriostatic; binds 30s subunit
Increased risk of C diff colitis
MOA of the following Parkinson’s drugs:
Levodopa
Carbidopa
Pramipexole
Levodopa: synthetic L-dopa, dopamine precursor (take 30m before meals otherwise they inhibit absorption of the drug). Avoid B6 before that encourages dopamine metabolism.
Carbidopa: inhibits peripheral breakdown of levodopa
Pramipexole: dopamine agonist
