Pharmacology Review Flashcards
Ionization
Decreases a molecule or drug’s ability to pass through membranes
Potency
The amount of drug needed to produce a pharmacological effect
Efficacy
The maximum effect of a drug
Schedule 1 Drug
Use is forbidden except for research
Drugs remain here if the potential for abuse is too high
Researchers must apply to the FDA for clearance to use for research
Schedule 2 Drug
High potential for abuse, may lead to physical and/or psychological dependence
Prescription may be written for a maximum 30 day supply with no refills (or 3 separate prescriptions each for a 30-day supply)
Prescription may be renewed by telephone in an emergency, but a written prescription must follow within 72 hours
“Rx Only”
Monitored by DEA, which sets quotas for amount manufactured and distributed
Schedule 3 Drug
Moderate to low physical dependence possible
High psychological dependence possible
Prescription must be renewed after 6 months or 5 refills
May be renewed by telephone or fax
Higher penalties than Schedule 4 for illegal possession
“Rx Only”
Monitored by DEA, which has quotas for amount manufactured and distributed
Schedule 4 Drug
Lower potential for abuse
Prescription must be renewed after 6 months or 5 refills
May be renewed by telephone or fax
Lower penalties than Schedule 3 for illegal possession
“Rx Only”
Monitored by DEA
Schedule 5 Drug
No prescription necessary, except in California
Not over-the-counter
Monitored by DEA, which has quotas for amount manufactured and distributed
Official Name
The name of the drug used in the official drug reference, the U.S.P.
Generic Name
The name handed down through antiquity, or the “code” name used during the test phased that is based on the chemical name
Trade Name
AKA Brand name or proprietary name, copyrighted and restricted to use by a single company
PDR
Manufacturers buy space and provide information similar to drug inserts
Cross-referenced to generic and chemical names
Manufacturers may not promote off-label use
The Pharmacopeia of the United States of America (U.S.P.)
Includes single drugs
Very authoritative, one of 2 official drug reference texts
Older drugs removed in favor of newer, more effective ones
National Formulary (N.F.)
Very authoritative, one of 2 official drug reference texts
Includes single drugs and formulas for drug mixtures
Often includes drugs removed from the U.S.P.
AMA Drug Evaluations
Drugs grouped according to use
General discussion provided of each group, with both favorable and unfavorable judgments expressed
Drug Facts and Comparisons
Drugs grouped according to use
Comparison of various drug forms, including over-the-counter drugs
Color photos
American Hospital Formulary Service (A.H.F.S.)
Similar to Drug Facts and Comparisons
Local drug administration
Drug action occurs only at the site of application (usually topical)
Systemic drug administration
Drug is distributed throughout the body, and action may be on whole body or on target organ(s)
Parasympathetic Nervous System
Rest and Digest
Wet and Juicy
Muscarinic cholinergic receptors at effector organs
2 effector neurons
Sympathetic Nervous System
Fight or Flight
Adrenergic receptors at effector organs
2 effector neurons
Voluntary Nervous System
1 effector neuron
Alpha adrenergic receptors
Targets of sympathetic nervous system, stimulated by norepinephrine
Contracts smooth muscle of vasculature, pupil lens (dilation), and sphincters of GI tract (slows motility)
Beta 1 adrenergic receptors
Targets of sympathetic nervous system, stimulated by norepinephrine
Positive inotropic and chronotropic effects on the heart
Beta 2 adrenergic receptors
Targets of sympathetic nervous system, stimulated by norepinehrine
Relaxation of bronchiole smooth muscle and urinary bladder
Muscarinic cholinergic receptors
Targets of parasymoathetic nervous system, stimukated by acetylcholine
Contraction of smooth muscle in bladder and pupil lens (constriction), stimulates exocrine glands, negative chronotropic effect on heart, and slight dilation of peripheral blood vessels
Nicotinic cholinergic receptors
Targets in ganglia, neuromuscular junctions, and the adrenal medulla
Postural hypotension
Body is unable to constrict blood vessels in response to to postural changes, blood remains pooled in the lower half of the body
Adrenergic antagonists may cause this, may be treated with adrenergic agonists
Pressor
Indicated for: Hypotension
MOA: Elevates blood pressure
Beta blockers
Indicated for: Hypertension, atrial fibrillation, atrial flutter, angina, wide angle glaucoma (timolol maleate), counteracting digitalis toxicity
MOA: Negative chronotropic, negative inotropic, negative dromotropic effects. Inhibits the release of renin, decreases fluid production in the eye
SE: GI, possible AV-block, bronchiole constriction
CI: Asthma, AV-block, heart failure
ACE Inhibitors
Indicated for: Heart failure (first-line therapy), hypertension, reduce diabetic nephropathy NOT A GOOD OPTION FOR BLACK PATIENTS
MOA: Decreases release of aldosterone (less fluid retention), less vasoconstriction
SE: Persistent cough, rash, proteinuria, GI
CI: Pregnancy, hyperkalemia, potassium-sparing diuretics (aldosterone antagonists/spironolactone, triamterene/amiloride)
Nitric Oxide (NO)
Indicated for: Angina
MOA: Relaxes smooth muscle of vasculature, decreases workload of heart, slightly dilates coronary vessels
SE: Tachycardia, headache, postural hypotension, GI
CI: Administration which send it to the liver, glaucoma, head trauma, storage in heat or light
Glycosides
Indicated for: Congestive heart failure, atrial flutter
MOA: Increase Ca release within heart muscle for positive inotropic effect and negative dromotropic effects, increase vagal tone
SE: GI, tinted vision, double vision, nervous irritability, ventricular tachycardia, ventricular fibrillations, A-V block
CI: Recent heart attack, ventricular tachycardia, partial heart block, cardioversion, Ca administration, hypokalemia, renal/hepatic disorder in older patients, non-potassium-sparing diuretics (thiazide, furosemide, ethacrynic acid, bumetanide, torsemide)
Adrenergic agonists/Antocholinergic agents
Indicated for: EMERGENCY cardiac arrest, hypotensive crisis, AV block, bradycardia
MOA: Positive inotropic effect, positive dromotropic effect, or blocks muscarinic negative chronotropic effect
SE: Tachycardia/arrhythmias, CNS stimulation, hypertenion
CI: Chronic use, congestive heart failure, angina (unless emergency), hypertension
Lidocaine
Indicated for: Ventricular tachycardia, cardiac surgery, heart attack, digitalis toxicity
MOA: Na channel blocker, negative dromotropic effect
Quinidine
Indicated for: Atrial fibrillation, atrial flutter, ventricular tachycardia, premature systoles
MOA: Na channel blocker, decrease excitability, negative dromotropic effect, negative inotropic effect, anticholinergic action at AV node to prevent cardiac slowing
SE: Cinchoism (GI, ototoxicity, blurred vision/blindness, headache)
CI: AV block, cardiac failure, allergy, glaucoma, urinary retention, hypokalemia or hyperkalemia
Heparin
Indicated for: Blood clot prevention, anaphylaxis
MOA: Prevents conversion of prothrombin to thrombin and fibrinogen to fibrin
CI: Bleeding tendencies
Must be given parenterally
Coumarin derivatives
Indicated for: Blood clot prevention
MOA: Interference with vitamin K and with formation of prothrombin
CI: Bleeding tendencies
Aspirin/Salicylates
Indicated for: Pain, fever, inflammation, and venous/coronary thrombosis prevention
MOA: Long-lasting COX-2 Inhibition
SE: GI irritation, CNS stimulation, possible respiratory aklalosis from respiratory stimulation, transient ototoxicity, possible decrease in GFR
CI: Children/teenagers with flu or chicken pox, bleeding disorders
Plasma-protein bound, CP450
NSAIDS
Indicated for: Pain, fever, inflammation and blood clot prevention
MOA: Short-acting COX-2 inhibition
SE: Kidney damage, liver damage, bone marrow effects
Minimal GI effects
Recombinant Tissue Plasminogen Activator (rTPA)
Indicated for: Acute pulmonary embolism, coronary thrombosis, strokes, deep venous thrombosis, arterial clots
MOA: Convert plasminogen to plasmin, dissolving the clot and preventing clot formation
CI: Bleeding disorders, cerebrovascular accident over 2 hours old, tumor, surgery/childbirth within the last few months
Iron
Indicated for: Anemia
MOA: Replaces necessary component of hemoglobin
SE: Headache, GI, staining/injury of teeth
Vitamin B12
Indicated for: Anemia
MOA: Replaces necessary component for DNA synthesis
Folic acid:
Indicated for: Anemia
MOA: Replaces necessary component for DNA synthesis
SE: May allow nerve damage to progress if B12 deficiency
Red blood cells/whole blood
Indicated for: Anemia
MOA: Replaces blood cells
CI: Hepatitis, transfusion reactions
Erythropoietin
Indicated for: Anemia
MOA: Stimulates production of red blood cells
CNS Stimulants
Amphetamines/Ritalin: ADHD
Xanthines: Pain from headaches, asthma, bronchitis, emphysema, drowsiness
Cocaine: Derivatives used as local anesthetic
Epilepsy
Caused by too much stimulation, counter by increasing GABA
Parkinson’s Disease
Caused by too little dopamine and too much acetylcholine, counter by increasing dopamine or decreasing acetylcholine
Depression
Caused by too little norepinephrine and serotonin, counter by increasing norepinephrine and/or serotonin
Schizophrenia
Caused by too much dopamine, countered by decreasing dopamine
Manic-depressive episodes (bipolar disorder)
Caused by unbalanced norepinephrine, counter by decreasing norepinephrine release and increasing reuptake
Inhalation anesthetics
Indicated for: Anesthesia
Responses: Loss of consciousness, amnesia
SE: Respiratory depression, decreased blood pressure, decreased heart rate, arrhythmia, postoperative nausea/vomiting, possible malignant hypothermia
Thiopental
Indicated for: Intravenous anesthesia
Responses: Rapid loss of consciousness
SE: Respiratory depression, decreased blood pressure, decreased heart rate, increased sensitivity to pain
Ketamine
Indicated for: Intravenous anesthesia
Responses: Analgesia without loss of consciousness at l;ow dose, loss of consciousness at high dose
SE: Nightmares, hallucinations
Barbiturates
Indicated for: Anxiety, insomnia, anesthesia, convulsions
MOA: GABA-independent CNS depression by enhancing Cl entrance and hyperpolarizing cells
SE: Drowsiness, impaired performance, hangover effect, hyperalgesia, respiratory depression if overdose
CI: Addictive, additive with other sedative-hypnotics, withdrawals, activates CP450
Benzodiazepenes
Indicated for: Anxiety, insomnia, anesthesia, convulsions
MOA: GABA-dependent CNS depression
SE: Drowsiness, impaired performance, hangover effect, respiratory depression if overdose
CI: Addictive, additive with other sedative-hypnotics, withdrawals, activates CP450
Phenothiazones
Indicated for: Schizophrenia, manic phase of mani-depressive disorder
MOA: Block the effects of dopamine
SE: More sedation, dry mouth, blurred vision, constipation, urinary retention, orthostatic hypotension, reflex tachycardia, fewer extrapyramidal effects, endocrine imbalance
Thioxanthenes
Indicated for: Schizophrenia, manic phase of manic-depressive disorder
MOA: Block effects of dopamine
SE: Some sedation, blurred vision, dry mouth, constipation, urinary retention, orthostatic hypotension, reflex tachycardia, more extrapyramidal
Butyrophenones
Indicated for: Schizophrenia, manic phase of manic-depressive disorder
MOA: Block effects of dopamine
SE: Little sedation, fewer autonomic side effects, more extrapyramidal
Lithium
Indicated for: Manic-depressive disroder
MOA: Decreases norepinephrine release, increases norepinephrine reuptake
SE: Slurred speech, hand tremor, GI irritation, polyuria, polydipsia, renal damage, hypothyroidism,
CI: Low therapeutic index, Na abnormality, pregnancy
Narcotic antitussives
Indicated for: Cough that is nonproductive and threatens injury
MOA: Depress cough center in medulla
SE: Addictive, constipation, respiratory depression
Non-narcotic antitussives
Indicated for: Cough that is nonproductive and threatens injury
MOA: Reduce activity of stretch receptors in lungs, depress cough center
H1 Antagonists
Indicated for: Allergic reactions, motion sickness
MOA: Prevent action of histamine, CNS depression which decreases sensitivity of inner ear
SE: Sedation, dry mouth, blurred vision
CI: Additive with other sedatives, asthma, blood abnormalities
H2 Antagonists
Indicated for: Gastric ulcers, heartburn
SE: GI, Inhibits CP450, gynecomastia, mental confusion in older patients
Sympathomimetics
Indicated for: Rescue drug for asthma
MOA: Beta 2 agonist, bronchiole dilation
SE: Tachycardia, palpitations, hypertension, GI, headache, dizziness
Xanthines
Indicated for: Chronic asthma, pulmonary edema
MOA: Bronchiole dilation
SE: GI, stimulation of emetic center, CNS stimulation, hypotension, headache
Anticholinergic
Indicated for: Chronic asthma (as adjunct)
MOA: Inhibit bronchoconstriciton
SE: Drying of airways
Mast Cell Stabilizers
Indicated for: Asthma attack prevention, especially exercise-induced asthma in older patients
MOA: Prevents allergic histamine response
SE: Bronchospasms, throat irritation, bitter taste
Leukotriene Receptor Antagonists
Indicated for: Chronic asthma
MOA: Prevents leukotrienes from causing inflammation
SE: Headache, GI upset, CP450 inhibition
Corticosteroids
Indicated for: Asthma rescue drug, COPD
MOA: Suppression of antibody formation, promotes bronchodilation
SE: Hoarseness, dry mouth, local infections in mouth and pharynx, osteoporosis, cataracts, growth stunting, infection, poor wound healing, salt/water retention, CNS stimulation
Demulcents
Agents with soothing effects
Expectorants
Increase secretion of mucus in bronchi or reduce mucus viscosity
Cathartics
Laxatives or purgatives
Carminatives
Antiflatulents
Penicillin
Spectrum: Narrow
MOA: Bactericidal cell wall synthesis inhibitors
Cephalosporins
Spectrum: Narrow, klebsiella
MOA: Bactericidal cell wall synthesis inhibitors
Resistant to penicillinase
Carbapenems
Spectrum: Broad, most gram-postitive and gram-negative bacteria
MOA: Bactericidal cell wall synthesis inhibitors
Resistant to beta lactamase
Monobactams
Spectrum: Troublesome gram-negative bacteria
MOA: Bactericidal cell wall synthesis inhibitors
Little-to-know cross-allergenicity to penicillins
Glycopeptides
MOA: Cell wall synthesis inhibitor.
Drug of last resort, very toxic.
SE: Red Man Syndrome
Aminoglycosides
Spectrum: Broad, klebsiella, enterobacter, e coli, pseudomonas
MOA: Bactericidal protein synthesis inhibitor
SE: Ototoxicity, renal damage, neuromuscular blockade at neuromuscular junction
Quinolones/Fluroquinolones
Spectrum: Broad,
MOA: Bactericidal DNA inhibitors
SE: nausea, anaphylaxis rashes, visual disturbance, phototoxicity, depressed bone marrow, acute interstitial nephritis, arthritis, tendonitis, cartilage erosion in young animals
Macrolides
Spectrum: Narrow
MOA: Bacteriostatic protein synthesis inhibitors
SE: GI, ototoxicity, allergy, jaundice
Resistant strains develop easily
Tetracycline
Spectrum: Broad, animal-borne infections and STIs
MOA: Bacteriostatic protein synthesis inhibitors
SE: Discoloration of children’s teeth, phototsensitivity, superinfection possible if taken chronically for acne, decreases efficacy of oral contraceptives
Lincosamides
MOA: Bacteriostatic protein synthesis inhibitor
Used in patients allergic to penicillin
Chloramphenicol
Spectrum: Broad, typhoid, meningeal infections, salmonella, anaerobic infections
MOA: Bacteriostatic protein synthesis inhibitor
SE: Grey baby syndrome
Sulfonamides
Spectrum: Broad, otitis media, UTI, vaginal infections
MOA: Bacteriostatic folic acid synthesis inhibitor
SE: Renal damage, resistance common
Trimethoprim
Spectrum: Broad
MOA: Bacteriostatic folic acid synthesis inhibitor
CI: Folate deficiency
Acne Treatments
Tretinion/Retinoic Acid: May cause temporary worsening, photosensitivity, UV sensitivity
Benzoyl Peroxide
Topical Antibiotics (clindamycin, erythromycin, tetracycline)
Tetracycline Oral: GI upset, vaginitis, skin infections, fungal infections, superinfection, decreases efficacy of oral contraceptives, contraindicated in pregnancy
Erythromycin Oral: GI upset, vaginitis, skin infections, fungal infections, used with caution in pregnancy
Oral Contraceptives
Oral 13/Cisretinoic Acid/Acutane: Highly teratogenic, dry skin, alopecia, hypertriglyceridemia, hepatitis, acute pancreatitis, pseudotumor cerebri, joint/muscoluskeletal pain, skeletal hyperostoses
Wide Angle Glaucoma
Caused by poor drainage of aqueous humor due to abnormal blood vessel permeability or overproduction of fluid
Treated with prostaglandin analogs, adrenergic drugs, beta blockers/timolol maleate, osmotic diuretics, and carbonic anhydrase inhibitors
Narrow Angle Glaucoma
Caused by poor drainage of aqueous humor due to position of the iris
Treated with cholinergic drugs to reduce fluid formation
Ocular Steroids
Indicated for: allergic reactions of the eye, severe injury, non-pus producing inflammation
Caution with pus-producing inflammation, will suppress immune system
Emollient
Fatty/oily substance used to soften/soothe irritated skin/mucus membrane
Keratolytic
Keratin dissolver, softens and loosens outer layer of the skin
Secretion
Movement of waste products/foreign materials from the blood into the renal tubule
Filtration
Passive transport of nutrients and wastes from the glomerulus to Bowman’s capsule
Reabsorption
Active transport of nutrients from the renal tubule to the blood
Correction of Acidosis
Kidney reabsorbs more HCO3 rather than Cl, actively secretes more H rather than K
May cause hyperkalemia
Correction of Alkalosis
Kidney resorbs more Cl rather than HCO3, actively secretes more K rather than H
May cause hypokalemia
Thiazides
Indicated for: Hypertension (first-line drug), fluid retention, acute pulmonary edema
MOA: Inhibits HCO3 reabsorption from the proximal tubule and Cl reabsorption from the ascending loop of Henle, vasodilator
SE: Weakness, GI, hypokalemia, hyperglycemia (in diabetics), aggravation of gout from increased uric acid in blood, and skin reactions
The ONLY diuretic safe for pregnancy
Furosemide
Indicated for: Emergency diuretic. Congestive heart failure, acute pulmonary edema, acute hypertension, chronic renal failure
MOA: Inhibits Cl reabsorption from the ascending loop of Henle, vasodilator
SE: Electrolyte imbalance (especially hypokalemia, deydration, hypotension, and transient to permanent ototoxicity
Ethacrynic acis, Bumetanide, Torsemide
Indicated for: Edema of various causes
MOA: Inhibit Na reabsorption fro the proximal renal tubule, inhibit Cl reabsorption from the ascending loop of Henle
SE: Toxicity (worsens with chronic use), dehydration, hypotension, hypokalemia, alkalosis, transient to permanent ototoxicity, myalgia
RAPID, NOT ADMINISTERED MORE THAN ONCE PER DAY
NO VASODILATOR EFFECT
Carbonic Anhydrase Inhibitors
Indicated for: Seizure adjunct, prevention of motion sickness, wide angle glaucoma
NO LONGER USED FOR DIURESIS
Aldosterone antagonists/Spironolactone
Indicated for: Diuresis while preventing hypokalemia
MOA: Inhibits aldosterone from drawing water back into the body from the renal tubules
USE IN COMBINATION WITH THIAZIDES, OR WHEN OTHER DIURETICS INEFFECTIVE OR TOO TOXIC
SE: Hyperkalemia if given without thiazide or other loop diuretic, gynecomastia in men
NO EFFECT ON ADRENALECTOMIZED PATIENT
Triamterene/Amiloride
Indicated for: Diuresis while preventing hypokalemia
MOA: Antagonistic of aldosterone, works independently of aldosterone presence
SE: HYperkalemia if given without thiazide, blood urea elevation with chronic use, possible blood glucose elevation
EFFECTIVE FOR ADRENALECTOMIZED PATIENT
Osmotic Diuretics
Indicated for: Dehydration of overhydrated cells (especially in brain or eye), maintenance of high urine volume
MOA: Osmotically attracts water by adding sugar to the blood stream
Caution: Congestive heart failure, pulmonary edema, possible circulatory overload, possible hypertension
Natural Immunity
Inborn immunity preventing microbes from flourishing on tissue
Active Acquired Immunity
Formation of antibodies by the individual in response to an antigen
May be stimulated by vaccination (against viruses) or toxoids (against bacterial toxins)
Passive Acquired Immunity
Administration of preformed antibodies into the individual, so no memory is established
May be antivenins, Gamma globulins, or Rho Gam
Adrenocorticosteroids
Produced by the adrenal cortex
Production stimulated by ACTH
Include mineralcorticoids (aldosterone), glucocorticoids (cortisol), and reproductive hormones (androgens, estrogens, progesterone)
Glucocorticoid (Cortisol) Treatment
Indicated for: Addison’s disease, inflammatoery response suppression, bronchodilation, cancer, diagnostic ACTH suppression
SE: Mimic Cushing’s Syndrome. Adrenal gland atrophy due to negative feedback, delayed wound healing, immunosuppression, peptic ulcers, amenorrhea, osteoporosis, catarcacts, growth stunting in children, and CNS stimulation
Caution: Drug interactions, including antidiabetics, oral anticoagulants, vaccines, hypokalemia-causing drugs, and aspirin. Stress. Withdrawal must be done slowly.
Mineralcorticosteroid (Aldosterone) Treatment
Indicated for: Maintenance of Na, K and blood volume due to adrenal insufficiency
Drug used instead of true aldosterone
Insulin Deficiency
Hyperglycemia, polyuria, polydipsia, dehydration, ketoacidosis, fruity breath, hunger, vascular damage (eyes extremeties, heart, kidneys, brain), neuropathy, infection (gangrene), edema, albuminuria
Oral Hypoglycemic Agents
Sulfonylureas, Alpha-Glucosidase Inhibitors, Biguanides, Thiazolidinediones
Indicated for: Supplementation of dietary control in Type 2 diabetes
Estrogen Therapy
May cause: Postmenopausal bleeding, thromboembolism, GI, endomtetrial cancer, vaginal cancer in women whose mothers were treated with diethylsilbesterol (DES)
Progesterone Therapy
May cause: Thromboembolism and cancer (less so than estrogen if low doses used), increased risk of cardiovascular disease and stroke (if high doses used), fatigue, depression
Androgen/Testosterone Therapy
May cause: Retention of Na, K, Cl, and water (contributing to heart failure), jaundice, nausea
Female: Acne, facial hair, voice deepening, excess muscle development
Male: Impotence, decreased spermatogenesis, gynecomastia, liver abnormalities, psychotic episodes
Children: Premature close of epiphyseal plates, abnormal sexual maturation
Biphosphonates
Indicated for: Postmenopausal osteoporosis, hypercalcemia of malignancy, Paget’s disease
DRUG OF CHOICE
MOA: Inhibit both normal and abnormal bone reabsorption, especially in patients with most severe bone loss
Ca Channel Blockers
Indicated for: Hypertension, atrial tachycardia, angina
GOOD FOR BLACK PATIENTS
May cause peripheral edema, dizziness, fatigue, flushing, constipation, GI
