Pharmacology Unit 3 Flashcards
1
Q
omeprazole
A
proton pump inhibitor
2
Q
esomeprazole
A
proton pump inhibitor
3
Q
lansoprazole
A
proton pump inhibitor
4
Q
cimetidine
A
H2 receptor antagonist; decrease gastric acid production; 4-5hr duration; high dose decrease testosterone binding and estrdiol hydroxylation causing galactorrhea in women and feminization in men
5
Q
ranitidine
A
H2 receptor antagonist; decrease gastric acid production; 6-8 hr duration
6
Q
famotidine
A
H2 receptor anatagonist; decrease gastric acid production; 10-12 hr duration
7
Q
misoprostol
A
synthetic PGE1 analog; reduce 80-90% of basal or food-indiced acid production; short acting; prevention of NSAID-induced gastric ulcers; adverse: diarrhea, exacerbate IBD, contractions in pregnancy
8
Q
sucralfate
A
barrier to protect epithelial cell layer; sucorse + AlOH3; stcks to duodenal ulcers; activated by acid, avoid antaacids or PPIs; Adverse: constipation, block drug absorption
9
Q
aluminum hydroxide
A
antacid; slow acting, delays emptying and motility; Adverse: constipation, nausea, phosphate loss, binds tetracycline, rebound acid secretion
10
Q
magnesium hydroxide
A
antacid; fast acting; stimulates gastric emptying and motility; avoid in renal disease, rebound acid secretion
11
Q
Mg-trisilicate
A
antacid; adverse: avoid in renal disease, silica is absorbed and may cause renal stones, rebound acid secretion
12
Q
calcium carbonate
A
antacid
13
Q
pirenzepine
A
muscarinic antagonist; decrease gastric acid production; decrease vagal transmission to enteric nerve by blocking ganglionic transmission (M1), decr stimulation of parietal and ECL cells; reduce basal acid production 40-50%; rarely used for significant anticholinergic effects
14
Q
bethanechol
A
cholinergic agonist; GI prokinetic agent; selective M2, M3 receptors to produce GI contraction;
Used to help urination post-surgical;
Adverse: cholinergic effects, disrupt natural reflex of oral contraction and anal relaxation
15
Q
neostigmine methylsulfate
A
AChE inhibitor; GI prokinetic agent; eccentuate normal ACh release to incr GI motility; used in ileus
16
Q
metoclopramide
A
Dopamine receptor antagonist; GI prokinetic agent, incr normal ACh release; incr lower esophageal sphincter tone, used in GERD; also antiemetic and laxative; adverse: antidopamine effects, parkinsonian symptoms, dystonias, tardive dyskenesia in chronic use
17
Q
tegaserod
A
5-HT4 partial agonist; GI prokinetic agent; stimulate intrinsic sensory neurons (chemical/mechanical stimulation) increase motility in IBS and chronic constipation/bloating, mildly effective; adverse: fatal cardiac arrhythmia, restricted distribution by FDA; last line therapy
18
Q
cisapride
A
5-HT4 partial agonist; GI prokinetic agent; also adenylate cyclase stimulant; used in GERD; adverse: fatal cardiac arrhythmia, restricted distribution by FDA; last line therapy
19
Q
Erythromycin (macrolide abx)
A
motilin agonist (stimulate upper small bowel motility produced by EC cells); GI prokinetic agent; cause gastric dumping and emtpying in ileus, scleroderma, and pseudo-obstructions; acute use only
20
Q
magnesium citrate
A
osmotic laxative; may stimulate motility through CCK receptors
21
Q
magnesium hydroxide
A
osmotic laxative; may stimulate motility through CCK receptors; milk of magnesia
22
Q
polyethyl glycol
A
osmotic laxative; alcohol
23
Q
lactulose
A
osmotic laxative; used for constipation from opioid and vincristine use; bacterial fermentation can drop pH and trap NH4 in colon of patients with hepatic disease
24
Q
mannitol
A
osmotic laxative; used for constipation from opioid and vincristine use
25
sorbitol
osmotic laxative; used for constipation from opioid and vincristine use
26
docusate
stool wetting/softener; surfactant that allows fatty substance and water in stool; do not increase frequency of defecation
27
bisacodyl
irritant laxative; used orally or rectally; overdose leads to catharsis; stimulate motility; dont chew to avoid gastric irritation (target is small intestine)
28
castor oil
irritant laxative; smooth muscle stimulant; ricinoleic acid speeds motility in small bowel; 4ml for laxative effect-16ml for catharsis
29
methylcellulose
bulk laxative
30
polycarbophil
bulk laxative
31
psyllium
bulk laxative
32
bismuth subsalicylate (pepto-bismol)
antidiarrheal; salicylate released in stomach and absorbed sytemically
33
diphenoxylate difenoxin
antidiarrheal; opioid piperidine derivatives; can have CNS effects; packaged with atropine to discourage abuse
34
loperamide
antidiarrheal; opioid poorly absorbed mu agonist; stops bowel motility; 50x morphine potency; doesnt enter CNS
35
octreotide
antidiarrheal; somatostatin derivative; parenteral block secretory diarrhea of hormone secreting tumors; inhibit gastrin and serotonin; Uses: post-surgical dumping, diarrhea assoc chemotherpay, pncreatitis; adverse: nausea, vomiting, bloating, injection site pain, gall stones with long term use
36
chlorpromazine
antiemetic; phenothiazine dopamine receptor antagonist; target D2 in CTZ and H1; uses: nausea, emesis, morning sickness (H1); adverse: parkinsonian symptoms, dysphoria
37
cyclizine
antiemetic; Antihistamine (h1); also has anticholinergic effects used in abdominal cancer; used in morning sickness, postop emesis; acts in STN and vestibular apparatus
38
diphenhydramine (Benadryl)
antiemetic; antiemetic; Antihistamine (h1); used in morning sickness, postop emesis; acts in STN and vestibular apparatus;
39
dimenhydrinate (Dramamine)
antiemetic; salt of dephenhydramine and chlorotheophylinate (stimulant to stop sedation)
40
dolasetron
antiemetic; 5-HT3 antagonist (CTZ, STN, and small intestine); oral and parenteral; 8 hr half-life
41
hydroxyzine
antiemetic; Antihistamine (h1); used in morning sickness, postop emesis; acts in STN and vestibular apparatus
42
granisetron
antiemetic; 5-HT3 antagonist (CTZ, STN, and small intestine); oral and parenteral; 10 hr half-life
43
metochlopramide
antiemetic; dopamine antagonist; prevents emesis and promotes defecation (prokinetic effect); preferred in chemotherpay induced nausea
44
ondansetron
antiemetic; 5-HT3 antagonist (CTZ, STN, and small intestine); oral and parenteral; 4 hr half-life
45
palonosetron
antiemetic; 5-HT3 antagonist (CTZ, STN, and small intestine) (highest affinity in class); parenteral only; 40 hr half-life
46
prochlorperazine
antiemetic; phenothiazine dopamine receptor antagonist; target D2 in CTZ and H1; uses: nausea, emesis, morning sickness (H1); adverse: parkinsonian symptoms, dysphoria
47
promethazine
antiemetic; Antihistamine (h1); used in morning sickness, postop emesis; acts in STN and vestibular apparatus
48
scopolamine
antiemetic; muscarinic (ACh) antagonist; parenteral or transdermal patch; acts on M receptor in vestibular apparatus; minimal CTZ effect (not effective with chemo-induced nausea; uses: short and long term motion sickness, post op emesis; adverse: xerostomia, blurred vision, may cause uncontrolled behavior when used with anxiety or pain
49
apomorphine
emetic agent; acts on CTZ; subQ; superseded by acrtivated charcoal
50
ipecac
emetic agent; acts on CTZ; superseded by activated charcoal; oral use shrotly after ingestion of drug or toxin
51
6-mercaptopurine
IBD thiopurine therpay; converted to 6-thiioguanine, inhibits DNA synthesis; immunosupressive; maintain remission of IBD and help fistulas in Crohns; adverse: pancreatitis, marrow supression, fever, rash, arthralgia, n/v
52
adalimumab
IBD immune modulator; human anti-TNF-a ab; may be less effective than infliximab; parenteral; for crohns and UC; adverse: incr infecctions (URIs), lack of repsonse to Tb
53
alosetron
IBS tx focues on motility; 5-HT3 antagoinst; decr bowel motility; used for diarrhea predominant in IBS; adverse: constipation -> ischemic colitis; dangerous
54
azathioprine
IBD thiopurine; converted to 6-mercaptopurine -> 6-thioguanine -> inhibit DNA synthesis
55
budesonide
IBD glucocorticoid; oral; 200X more portent than hydrocortisone but not well absorbed from bowel -topical tx for bowel; adverse: typical ssteroid effects, well tolerated (only 10% bioavailable and most removed by first pass)
56
infliximab
IBD immune modulator; anti-TNF-a "humanized" ab; interferes with inflammatory process; parenteral; for crohns and UC; adverse: incr infecctions (URIs), lack of repsonse to Tb
57
mesalamine
IBD 5-ASA therapy; pH senstive capsule released in ileum, delayed releasse capsule releases in jejunum; uses: IBD flar-ups, maintenance of remission of UC; adverse: interstitial nephritis, headache, dyspepsia, rash
58
olsalazine
IBD 5-ASA therapy; prodrug converted in in colon to mesalamine; uses: IBD flar-ups, maintenance of remission of UC; adverse: diarrhea, headache, dyspepsia, rash; better tolerated than sulfsalazine
59
prednisone
IBD glucocorticoid; oral use for acurte exacerbation and severe disease; target infalmmation and immune response; adverse: typical steroid effect (immunosupression, endocrine disruption, steroid psychoses)
60
sulfasalazine
IBD 5-ASA therapy; prodrug converted in in colon to mesalamine; uses: IBD flar-ups, maintenance of remission of UC; adverse: due to sulfa group - headache, nausea, fatigue, allergic rxn, contraindicated in pregnancy
61
heparin sulfate
anticoagulant; measured effect by PTT; binds anti-thrombin III and inactivation IXa, Xa, and IIa; administered as initial bolus followed by continuous infusion; Adverse: bleeding, heparin-induced thrombocytopenia (less with LMW); antagonized by protamine sulfate; FFP does not correct heparin effect
62
warfarin
anticoagulant; antagonizes vit K dependant gamma-carboxylation of procoagulants II, VII, IX, X and proteins C and S; blocks regeneration of reduced K; Monitored by INR (PT); antagonized by menadione (vit K); given oral; interacts with basically ALL drugs; adverse: bleeding (exaggerated by NSAID use), clotting with initial therpay withut heparin; teratogenic (not for pregnancy), cause skin necrosis (high dose); FFP can correct warfarin effect
63
dalteparin
LMW heparin
64
enoxaparin
LMW heparin
65
fondaparinux
ultra-LMW heparin
66
argatroban
direct thrombin inhibitor; IV; short acting; hepatically cleared; indication when heparin is needed and there is hx of heparin-induced thrombocytopenia
67
bivalirudin
direct thrombin inhibitor; IV; synthetic hirudin
68
dabigatran etexilate
direct thrombin inhibitor; oral; no antogonist!
69
t-PA
thrombolytic; activated plasminogen -> plasim -> fibrin degredation
70
streptokinase
thrombolytic; from B-hemolytic strep; forms complex with plasminogen -> activation; adverse: anaphylaxis and fever; must be given at arge dose to overcome neutralizing abs
71
urokinase
thrombolytic; isolated from human cells (no neutralizing abs); activates plasminogen; rapidly metabolized (10-15 min half-life)0
72
abciximab
anti-platelet; Anti-c7E3 ab; binds glycoprotine IIb/IIIa receptor and inhibits fibrinogen bindings platelets and platelet aggreagation
73
aspirin
anti-platelet; irreversilby inhibits COX for life of platelet -> thromboxane A2 production -> decr platelet aggregation, vasoconstriction; half-life 4hr but effect can last days
74
clopidogrel
anti-platelet; oral;adverse: thrombotic thrombocytopenia purpura
75
ticlopidine
anti-platelet; oral; prodrug converted to active metabolite by P450; blocks ADP receptor on platelet; blocks shape change and aggregation; useds: prevent thrombosis and cerebral vascular diseae; adverse: neutropenia in 1% pts
76
tirofiban
anti-platelet; small molecule inhibitor on IIb/IIIa on platelets; given continous IV with very short duration of action (reversible)
77
candesartan
AT1R antagonist; HTN and heart failure
78
irbesartan
AT1R antagonist; HTN and heart failure
79
losartan
AT1R antagonist; HTN and heart failure
80
valsartan
AT1R antagonist; HTN and heart failure
81
captopril
ACE inhibitor; mild-moderate HTN and heart failure
82
enalapril
ACE inhibitor; mild-moderate HTN and heart failure
83
lisinopril
ACE inhibitor; mild-moderate HTN and heart failure
84
aliskerin
non-peptide direct renin inhibitor for essential hypertension; adverse; same associated with ARBs and ACE inhibitors + GI/allergic symptoms; uses: HTN in combo with RAS inhibitors (ACEi or ARBs); adverse: diabetic/renal impairment, hyperkalemia, dry cough, angioedema (rare)
85
conivaptan
vasopressin (V1/V2) receptor antagonist; approved for treatment of hyponatremia from SIADH; IV administration in hospitalized pts
86
tolvaptan
vasopressin (V2) receptor antagonist; used for tx of hypervolemic and euvolemic hyponatremia resistant to fluid restriction in heart failure, cirrhosis, and SIADH
87
atenolol
B1 selective antagonist; nonvasodilating: unopposed alpha effect in periphery; uses: HTN, CHD, angina
88
metoprolol
B1 selective antagonist; nonvasodilating: unopposed alpha effect in periphery; uses: HTN, CHD, angina; sustained-release reduces risk of death in heart failure
89
propranolol
non-selective B1,2 antagonist; uses: HTN, CHD, angina
90
doxazosin
alpha1-receptor antagonist; htn, pheochromocytoma
91
prazosin
alpha1-receptor antagonist; htn, pheochromocytoma
92
terazosin
alpha1-receptor antagonist; htn, pheochromocytoma
93
carvedilol
mixed a/b antagonist; vasodilating beta blocker; used in htn and heart failure; antioxidant and anitproliferative; dont promote DM
94
labetolol
mixed a/b antagonist; vasodilating beta blocker; chronic htn and htn emergency; NOT heart failure; dont promote DM
95
reserpine
sympatholytic; deplete NE in nerve endings, inhibit reuptake; decrease peripheral resistance and CO; uses: rare: mild-mod HTN; adverse: postural hypotension, sedation, dry mouth, nightmares, mental depression
96
a-methyldopa
a2 receptor agonist; central-mediated anti-htn; target a2 in brainstem -> decr sympathetic outflow, incr vagal tone to heart;; uses: mild-mod (drug resistant) HTN; adverse: withdrawal, sedation, xerostamia, nightmares, depression, ortho hypo
97
clonidine
a2 receptor agonist; central-mediated anti-htn; target a2 in brainstem -> decr sympathetic outflow, incr vagal tone to heart
98
guanebenz
a2 receptor agonist; central-mediated anti-htn; target a2 in brainstem -> decr sympathetic outflow, incr vagal tone to heart
99
fosinopril
ACE inhibitor; mild-moderate HTN and heart failure
100
diatezam
Ca blocker; cardioselective; class IV anti-arrhythmic; oral/IV use: re-entry SVT involving AV node, slow AV conduction; adverse: bradycardia, hypotension (vascular tone), negative inotrope->avoid in HF, shock
101
verapamil
Ca blocker; cardioselective; class IV anti-arrhythmic; oral/IV use: re-entry SVT involving AV node, slow AV conduction; adverse: bradycardia, hypotension (vascular tone), negative inotrope->avoid in HF, shock
102
amlodipine
Ca blocker; vasoselective
103
nicardipine
Ca blocker; vasoselective
104
nifedipine
Ca blocker; vasoselective
105
nimodipine
Ca blocker; vasoselective; more lipophilic -> used in cerebral hemorrhage and vasospasm
106
ambrisentan
ETA endothelin receptor blocker; uses: pulmonary htn; adverse: edema, headache, inhibit spermatogenesis, resp tract infections, decr hematocrit, hepatic effects
107
bosentan
nonselective endothelin receptor blocker; uses: pulmonary htn; adverse: edema, headache, inhibit spermatogenesis, resp tract infections, decr hematocrit, hepatic effects
108
diazoxide
vasodilator; IV; activate K channel->hyperpolarize-> relax VSM; uses: htn emergency and maligant htn; adverse: relfex incr tachy, CO, renin, fluid retention, hyperglycemia, hyperuricemia
109
epoprostenol
prostacyclin analog; direct vasodilator via cAMP, counter thromboxane A2; uses: pulmonary htn, potent antihypertensive with continuous infusion (IV),
110
hydralazine
vasodilator; reduce intracellular Ca; preferential effect on arterioles vs arteies and veins; decr peripheral resistance, MAP; Uses: mild-mod HTN; adverse: reflex tachy, incr CO -> angina, ischemia, headache, anorexia, dizzy, sweating, incr renin, immune response -> lupus
111
minoxidil
vasodilator; preferentail effect on arterioles vs veins; activate K channel -> hyperpolarize -> relax VSM; uses: mild-mod htn; adverse:reflex tachy, CO, renin, fluid retention (contraindicated in HF), pericardial effusion/tamponade; abnormal hair growth (used for alopecia as rogaine)
112
nitroglycerin
direct nitrovasodilator; preferential effect on veins; NO->GC->cGMP->dilation; uses: produce hypotension in surgery and hypertensive emergency, tx for angina; short duration, tolerance; adverse: headache
113
nitroprusside
direct nitrovasodilator; generates NO->GC->cGMP->dilate veins and arteries, decr preload and afterload; uses: produce hypotension in surgery and hypertensive emergency; adverse: rapid decr in MAP, cyanide accumulation-> impair renal function
114
chlorothiazide
thiazide diuretic; DCT Na/K symporter; uses: htn; adverse: hypokalemia, gout (low uric acid excretion), sulfa allergies
115
chlorthalidone
thiazide diuretic; DCT Na/K symporter; uses: htn; adverse: hypokalemia, gout (low uric acid excretion), sulfa allergies
116
hydrochlorothiazide
thiazide diuretic; DCT Na/K symporter; uses: htn; adverse: hypokalemia, gout (low uric acid excretion), sulfa allergies
117
bumetanide
loop diuretic; TAL Na/K/2Cl symporter; adverse: hypokalemia, gout
118
ethacrynic acid
loop diuretic; TAL Na/K/2Cl symporter; ototoxic; adverse: hypokalemia, gout
119
furosemide
loop diuretic; TAL Na/K/2Cl symporter; preferred tx for "congestive" heart failure; adverse: hypokalemia, gout
120
amiloride
K sparing diuretic; ENaC inhibitor; used in combo with thiazide diuretic; adverse: hyperkalemia
121
eplerenone
K sparing diuretic; aldosterone R inhibitor
122
spironolactone
K sparing diuretic; aldosterone R inhibitor
123
triamterene
K sparing diuretic; ENaC inhibitor
124
acebutolol
cardioselective B1-antagonist; CHD, angina
125
atenolol
cardioselective B1-antagonist; CHD, ; class II antiarrhythmic; oral/IV use: atrial arrhythmia, slow AV conduction, prevent sudden death post MI
126
esmolol
cardioselective B1-antagonist; CHD, angina; class II antiarrhythmic; IV short half-life use: atrial arrhythmia, alsow AV conduction
127
metoprolol
cardioselective B1-antagonist; CHD, angina; class II antiarrhythmic oral/IV use: atrial arrhythmia, slow AV conduction, prevent sudden death post MI
128
nadolol
nonselective B antagonist; CHD, angina
129
pindolol
nonselective partial B agonist; CHD, angina
130
propranolol
nonselective B antagonist; CHD, angina; Class II antiarrhythmic; oral/IV use: atrial arrhythmia, slow AV conduction; negative inotrope->avoid in HF, bronchospam-> avoid in asthma
131
timolol
nonselective B antagonist
132
avanafil
PDE5 inhibitor; erectile dysfunction; onset: 15 min, 5-10 hr half-life
133
tadalafil
PDE5 inhibitor; erectile dysfunction; onset: 15-30min, 17 hr half-life; low dose daily use "weekend drug"
134
sildenafil (Viagra)
PDE5 inhibitor; erectile dysfunction, primary pulmonary htn; onset: 1 hr, 4 hr half-life
135
vardenafil
PDE5 inhibitor; onset: 45 min, 4 hr half-life
136
verapamil
Ca channel blocker; cardioselective; uses: CHD, htn, supraventricular arrhythmia; adverse: negative chronotropic/inotropic effects -> can cause heart failure, arrhythmias, heart block, braycardia; avoid use in heart failure
137
diltiazem
Ca channel blocker; cardioselective; uses: CHD, htn, supraventricular arrhythmia; adverse: negative chronotropic/inotropic effects -> can cause heart failure, arrhythmias, heart block, braycardia
138
amlodipine
Ca channel blocker; vasoselective (dihydropyridine)
139
felodipine
Ca channel blocker; vasoselective (dihydropyridine)
140
nicardipine
Ca channel blocker; vasoselective (dihydropyridine)
141
nifedipine
Ca channel blocker; vasoselective (dihydropyridine); Adverse: can worsen acute MI, gingival hyperplasia
142
nimodipine
Ca channel blocker; vasoselective (dihydropyridine; more lipophilic -> used in cerebral hemorrhage and vasospasm
143
isosorbide dinitriate
direct nitrovasodilator; venodilator; incr venous capacitance; short acting uses: angina, heart failure (combined with hydralazine - not as effective as ACEI in incr survival);
144
prasugrel
thienopyridineanti-platelet therapy for CAD; requires hepatic biotransformation; irreversible ADP antagonist at P2Y receptor; blocks GPIIa/IIIb and platelet aggregation; uses: combo with aspirin in acute coronary syndrome stents, MI, stroke; more bioavailability, 10x higher level of active metabolite, longer duration of action
145
clopidogrel
thienopyridineanti-platelet therapy for CAD; requires hepatic biotransformation; irreversible ADP antagonist at P2Y receptor; blocks GPIIa/IIIb and platelet aggregation; uses: combo with aspirin in acute coronary syndrome stents, MI, stroke; adverse: neutropenia, genetic variability in metabolism; 85% inactivated
146
ranolazine
partial fatty acid oxidation inhibitor; new class of antianginal; inhibits late Na current to reduce Na ans Ca overlaod in ischemic myocytes; shift ATP production from FA to glycolysis; minimal effects on heart; reserved for refractory chronic angina
147
cholestyramine
bile acid sequestrant; bind bile acid and prevent absorption, upregulates LDL receptor in liver; adverse: dyspepsia, constipation, decr absorption of other drugs
148
colestipol
bile acid sequestrant; bind bile acid and prevent absorption, upregulates LDL receptor in liver; adverse: dyspepsia, constipation, decr absorption of other drugs
149
atorvastatin
HMG CoA R inhibitor
150
fluvastatin
HMG CoA R inhibitor; active drug
151
lovastatin
HMG CoA R inhibitor; prodrug; adverse: myositis
152
simvastatin
HMG CoA R inhibitor; prodrug; upregulation of LDL receptor; decr cholesterol synthesis; Adverse: marked first pass metabolism, hepatotoxic, rhabdomyolysis
153
pravastatin
HMG CoA R inhibitor; active drug
154
clofibrate
fibric acid; incr activity of lipoprotein lipase ->clears chylomicrons and VLDLs quickly; decr trig > cholesterol; raises HDL; adverse: GI, myositis
155
gemfibrozil
fibric acid; incr activity of lipoprotein lipase ->clears chylomicrons and VLDLs quickly; decr trig > cholesterol; raises HDL; adverse: GI, myositis
156
ezetimibe
absorbed and glucuronidated -> excreted in bile -> imparis intestinal absorption of cholesterol
157
nicotinic acid
water soluble vitamin; inhibits VLDL secretion->decr production of LDL; decr trigs>cholesterol;adverse: decr fibrinogen->bleeding, PG mediated vasodilation (immediate release), glucose intolerance, hyperuricemia, PUD, hepatic dysfunction (sustained release); timed release with aspirin limits effect
158
probucol
incr LDL catabolism, block LDL oxidation; modest cholesterol reduction; adverse: prolong QT interval ->arrhythmias, lowers HDL; not on US market
159
rizatriptan
5HT1 agonist; acute migraines/cluster headaches
160
sumatriptan
5HT1 agonist; acute migraines, cluster headaches; highly effective; decr release of inflammatory vasodilatory peptides; vasocaonstriction through receptors in cranial blood vessels; adverse: few recurrent migraines, coronary spasm, CI in hepatic failure (metabolism route); same for all triptans
161
zolmitriptan
5HT1 agonist; more lipophilic than sumatriptan, longer half-life
162
cyproheptadine
nonselective serotonin 5-HT1,2 antagonist; for carcinoid tumor; also H1 antagonist; adverse: drowsiness, GI disturbance
163
ketanserin
5-HT2 receptor antagonist;lowers MAP in HTN pts; not approved in US; blocks 5-HT2 on VSM, blocks a1 on VSM;
164
ergonovine
5HT2 partial agonist/weak antagonist; diagnostic tool in vasospastic angina; control postpartum/postabortal hemorrhage (vasoconstriction); adverse: vasospasm, GI disturbance
165
ergotamine
partial 5HT1/2 agonist; VSM constrictor; effect for migraines through 5HT1 effects
166
methysergide
5TH2 antagonist/5HT1 partial agonist; tx for carcinoid tumor; adverse: CNS disturbance, hallucinations
167
quinopril
ACE inhibitor; approved for heart failure
168
digoxin
cardiac glycoside; inhibits Na/K ATPase -> increased intracellular Ca-> positive inotropic effect-> reflex decr SNS activity-> incr renal perfusion; sensitize cariac baroreceptors, incr vagal tone -> decr SNS; inhibit NA/K in kindey->incr Na excretion-> decr renin production; heart failure, arrhythmias- slows ventricular response in a fib/flutter; adverse: arrhythmias, heartblock; used at dose below cardiac effect, does not incr survival in HF patients
169
digitoxin
cardiac glycoside
170
dobutamine
beta agonist of choice for systolic dysfunction and congestion; does not activate dopamine receptors; inotropic effect predominates, little chronotropic effect
171
dopamine
beta agonist (alpha at high dose); positive inotropic/chronotropic effect; short term use in decompensated HF; adverse: tachycardia can cause ischemia in CAD, dopamine receptor activation
172
inamrinone
cAMP PDE inhibitor; short term support of circulation in advanced HF; incr intracellular Ca; balanced venous/arterial dilation; incr CO, decr afterload
173
milrinone
cAMP PDE inhibitor; short term support of circulation in advanced HF; more favorable side effect profile; selective for PDE3; best PDE for short term pareneral inotropic support
174
disopyramide
Class 1A Na channel blocker; oral; uses: ventr arrhyth, recurrent atrial arrhyth; adverse: anti-muscarinic, negative inotrope-> avoid in heart failure
175
procainamide
Class 1A Na channel blocker; oral/IV; uses: ventricular arrhyth, recurrent atrial arrhyth; adverse: lupus effects, nausea
176
lidocaine
Class 1B Na channel blocker; IV; acute vent arrhyth; adverse: CNS toxicity, active metabolite cleared by kidney-> avoid in renal failure
177
mexiletine
Class 1B Na channel blocker; oral; use: when lidocaine works acutely, use for chronic vent arrhyth; adverse: CNS toxicity
178
flecainide
Class 1C Na channel blocker; oral; use: recurrent atrial arrhth; adverse: arrhythmogenic, avoid with structual heart disease or post MI (A fib in otherwise nl heart)
179
propafenone
Class 1C Na channel blocker; oral; use: recurrent atrial arrhth; adverse: arrhythmogenic, avoid with structual heart disease or post MI (A fib in otherwise nl heart)
180
amiodarone
Class III K channel blocker; oral/IV use: atrial/vent arrhyth; less arrhythmogenic in pts with HF or post MI; adverse: accumulate in tissue, causing dose related pulmonary, liver, thyroid, eye, skin toxicity; regular monitoring; bradycardia B-blocking effects
181
dofetilide
Class III K channel blocker; oral use: atrial arrhythmia; adverse: prolonged QT-> torsade de pointe; should be started in hospital
182
ibutilide
Class III K channel blocker; IV use: acute conversion of atrial fib/flutter; adverse: prolonged QT-> torsade de pointe; should be started in hospital
183
sotalol
Class III K channel blocker; oral use: atrial/vent arrhythmia; adverse: prolonged QT-> torsade de pointe - should be started in hospital; bradycardia B-blocking effect
184
adenosine
acitvates K channels and inhibits Ca channels (Gi-> decr intracelluluar Ca; IV short half-life use: SVT, a fib/flutter; aids in diagnosis (blocks AV node for ~10 sec); adverse: brief asystole, heart block
185
glycerin
irritant laxative; suppository acts as hydroscopic agent and lubricant; increases water retention and stimulates peristalsis and evacuation reflex
186
bisoprolol
selective B1 antagonist; reduces risk of death in heart failure
187
quinidine
Class 1A Na channel blocker; oral/IV; uses: vent arrhth, recurrent atrial arrhth; adverse: diarrhea, anit-muscarinic
