Pharmacopoeia Flashcards
Heparin (unfractionated)
- Anticoagulant
- promotes antithrombin III (ATIII) activity, inactivating factor Xa and thrombin.
- Only given parenterally (IV, SC)
- Requires ongoing aPTT monitoring
- Used acutely (PE, DVT, DIC) and prophylactically in surgery or in patients at high risk for clotting disorders
- Antidote is Protamine if excessive bleeding is present
Cocaine
- Ester-type local anaesthetic
- Sodium channel blocker
- causes local vasoconstriction, prolonging duration of action
- relatively weak anaesthetic effect and high risk of abuse, so rarely used
Esbriet (Perfenidone)
- Anti-fibrotic, anti-inflammatory
- Used in management of IPF
- thought to interfere with production of inflammatory proteins like TGF-Beta and TNF
Claritin (Loratadine)
- Second-generation antihistamine, H1 receptor antagonist
- Blocks peripheral H1 receptors, does not closs blood-brain barrier
- Alleviates allergy symptoms without causing significant sedation/hypnosis
Decadron (Dexamethasone)
- Long-acting, high-potency corticosteroid
- Causes broad anti-inflammatory effects
- Decreases eicosanoid production
- Decreases inflammatory cytokine production
- Decreases inflammatory cell produciton and recruitment
- Reduces histamine production and release
- Used in dexamethasone suppression test and in long-term anti-inflammation, anti-immune treatment
- Prolonged use may disrupt HPA axis and lead to addisonian crisis when withdrawn
Apo-Hydro (Hydrochlorothiazide)
- thiazide diuretic
- Acts on NaCl symporter in DCT, causing natriuresis, kaliuresis, and Calcium retention
- First line diuretic for treatment of hypertension and edematous states.
- Also used in treatment of nephrolithiasis, diabetes insipidus, and renal disorders
- Common side effects: hypokalemia, hyperglycemia, hyperlipidemia, hyperuricemia
Levophed (Norepinephrine)
- Direct-acting adrenergic agonist, endogenous catecholamine
- Has high α1 specificity, so minimal cardiac effects with signigicant peripheral vasoconstriction
- incr. BP due to incr. SVR. high potential for reflex bradycardia (no beta effect)
- used in treatment of shock and hypotension
Diprivan (Propofol)
- Parenteral, non-opioid anaesthetic
- Cause GABA potentiation (similar to BZs) to produce sedation and anaesthesia
- generally used to induce anaesthesia which is maintained by an inhalational anaesthetic, except in short, minor procedures. (20s onset, 5-10 min duration)
- Reduces ICP and BP, so near ideal for head injury management
- prolonged use potentiates cardiovascular depression
Spiriva (Tiotropium bromide)
- Muscarinic-selective receptor antagonist (synthetic atropine analog)
- used for bronchodilation and reduced mucus secretion in asthma/COPD
Atrovent (Ipratropium bromide)
- Muscarinic-selective receptor antagonist (synthetic atropine analog)
- used for bronchodilation and reduced mucus secretion in asthma/COPD
QVAR (Beclomethasone dipropionate)
- Inhaled Corticosteroid (ICS)
- Used as an anti-inflammatory and to potentiate beta-agonists effects in asthma control
- MDI only given BID
Pulmicort (Budesonide)
- Inhaled Corticosteroid (ICS)
- Used as an anti-inflammatory and to potentiate beta-agonists effects in asthma control
- Turbuhaler DPI only, given BID
Viagra (sildenafil)
- Type 5 phosphodiesterase inhibitor (PDE5 inhibitor)
- PNS innervation of vascular smooth muscle causes vasodilation and cGMP release (causing further smooth muscle relaxation). PDE5 inhibitors slow the breakdown of cGMP leading to increased/prolonged vasodilation.
- As Viagra, sildenafil is used to treat erectile dysfunction
Ativan (Lorazepam)
- Benzodiazepine, sedative-hypnotic
- Lipid-soluble GABA agonist, causes CNS depression due to potentiation of GABA receptors and post-synaptic hyperpolarization
- Fast onset with medium duration of action and no active metabolites
- Dose dependent effects with ceiling effect: at low doses sedation only, at higher doses hypnosis and anterograde amnesia
Atropine (atropine)
- muscarinic receptor antagonist (belladonna alkaloid, tertiary amine)
- toxixicity is dose dependent, remember; dry as a bone, red as beet, mad as a hatter, blind as a bat
- causes dilatation, positive chronotropy, decreased secretions, decreased GI motility, bronchodilation, etc.
- used to reverse cholinesterase overdose and as a positive chronotrope
Tagamet (Cimetidine)
- H2-receptor antagonist
- reduces gastric acid secretion to reduce dyspepsia/gastroenteritis in GERD
Allegra (Fexofenadine)
- Second-generation antihistamine, H1 receptor antagonist
- Blocks peripheral H1 receptors, does not closs blood-brain barrier
- Alleviates allergy symptoms without causing significant sedation/hypnosis
TNKase (Tenecteplase)
- fibrinolytic, thrombolytic, recombinant tPA
- causes plasmin activation from plasminogen, with high specificity for fibrin-bound plasminogen
- longer duration of action than alteplase
- used in resolution of STEMI
Alvesco (Ciclesonide)
- Inhaled Corticosteroid (ICS)
- Used as an anti-inflammatory and to potentiate beta-agonists effects in asthma control
- MDI only, given QD
Haldol (Haloperidol)
- first generation, typical antipsychotic
- blocks D2 receptors in the mesocortical, mesolimbic and other pathways
- high potency, very high risks of extrapyramidal side effects
- generally only useful in treatment of positive symptoms of schizophrenia.
- prolonged use may lead to tardive dyskinesia or neuroleptic malignant syndrome
Accolate (Zafirlukast)
- Leukotriene Receptor Antagonist (LTRA)
- second-line asthma controller
- given as adjunct with ICS or as second-line monotherapy where ICS not tolerated
- not useful in severe exacerbations of asthma
Sublimaze (Fentanyl)
- Strong, synthetic opioid, full opioid agonist
- 100x potency relative to morphine with fewer CV effects, faster onset, and less hangover than morphine
- powerful analgesic for acute and chronic pain
- adverse effects include sedation, respiratory depression, constipation, miosis, N/V
Lovenox (Enoxaparin)
- Anticoagulant, fractionated heparin / LMWH
- promotes antithrombin III (ATIII) activity, inactivating factor Xa
- Only given parenterally (IV, SC)
- Does not require ongoing aPTT monitoring
- Used acutely (PE, DVT, DIC) and mainly prophylactically in surgery or in patients at high risk for clotting disorders
- Antidote is Protamine if excessive bleeding is present
Bricanyl (Terbutaline)
- Non-catecholamine direct-acting adrenergic
- selective, short-acting β2 agonis (SABA). May activate β1 reeptors at higher doses.
- used to promote bronchodilation in COPD and asthma as a rescue medication
- adverse effects include tachycardia, tremor, and nervousness
Deltasone (Prednisone)
- Intermediate acting corticosteroid
- Causes broad anti-inflammatory effects
- Decreases eicosanoid production
- Decreases inflammatory cytokine production
- Decreases inflammatory cell produciton and recruitment
- Reduces histamine production and release
- Used to treat cancer, inflammation, allergy, and autoimmune disorders
- Prolonged use may disrupt HPA axis and lead to addisonian crisis when withdrawn
Sotacor (Zaleplon)
- non-BZ sedative-hypnotic
- used in management of sleep disorders
- increases GABA activity in CNS
- less tolerance and dependence forming than the BZ drugs
- preserves sleep architecture
Pravachol (Pravastatin)
- Statin, antihyperlipidemic
- HMG-CoA inhibitor, reduces LDL by 20-50%
- Shown to reduce mortality due to atherosclerosis
- adverse effects include muscle damage, GI issues, memory impairment, and NIDDM
- Pravachol has the lowest rate of adverse effects and drug interactions of any statin
Lopressor (Metoprolol)
- Selective β1-antagonist (beta-blocker)
- oral or parenteral
- good antihypertensive, antianginal, antiarrhythmic
- relatively short half-life (3-4hr)
Aldactone (Spironolactone)
- Potassium-sparing diuretic, aldosterone receptor antagonist
- inhibits binding of aldosterone in the late DCT and collecting duct, which prevents expression of sodium channels.
- Used in combination with other diuretics to prevent hyperkalemia, in treatment of primary hyperaldosteronism, and in PCOS as an anti-androgenic
- Adverse effects; gynecomastia and infertility in men, hyperkalemia.
Anexate (Flumazenil)
- Benzodiazepine antagonist, reversal agent
- Competitive BZ receptor antagonist
- used to reverse BZ overdose and BZ sedation
- short half-life (7-15 minutes) with unpredictable effects that may potentiate seizures. Rarely indicated due to low mortality with benzo overdose
Singulair (Montelukast)
- Leukotriene Receptor Antagonist (LTRA)
- second-line asthma controller
- given as adjunct with ICS or as second-line monotherapy where ICS not tolerated
- not useful in severe exacerbations of asthma
Persantine (Dipyridamole)
- antiplatelet
- relatively weak antiplatelet effect, but also acts as a coronary vasodilator by causing adenosine release
- Often combined with aspirin for post-CVA therapy
Protamine (Protamine sulphate)
- heparin antidote
- used to treat uncontrollable bleeding in the context of heparin administration
BLES (Bovine Lipid Extracted Surfactant)
- Natural surfactant extracted from bovine lungs
- First choice treatment for managment of RDS
- Reduces pulmonary gas-liquid interface surface tension and work of breathing
- Instilled through endotracheal tube
Celebrex (Celecoxib)
- NSAID, selectie COX-2 inhibitor
- Reduces PG production associated with inflammation without causing gastric irritation
- used in management of pain and inflammation
- increased risk of cardiovascular events (MI, CVA)
Oxeze (Formoterol)
- Long-acting Beta Agonist (LABA), Fast-acting Beta Agonist (FABA)
- 12hr duration of action with relatively fast onset
- Used always as combination therapy with an ICS for asthma control
- causes bronchodilation and potentiates anti-inflammatory effects of ICS
- may be used for asthma control or relief
Flovent (Fluticasone propionate)
- Inhaled Corticosteroid (ICS)
- Used as an anti-inflammatory and to potentiate beta-agonists effects in asthma control
- MDI or Diskus DPI given BID
Xylocaine (Lidocaine)
- Class 1B antiarrhythmic
- Preferentially binds to sodium channels in the inactivated state
- Has fast, rate-dependant kinetics. Slows conduction in rapidly depolarizing tissue and limits reentry
- Used in the management of refractory Ventricular arrhythmias, esp. VTach and VFib
- Second-line choice if amiodarone is unsuccessful
Xylocaine (Lidocaine)
- Amide-type local anaesthetic
- sodium channel blocker that produces use-dpendent and size-dependent blockade
- may be given with epi to induce vasoconstriction and prolong duration of action
- relatively strong local anaesthetic effect
Prozac (fluoxetine)
- SSRI antidepressent
- selectively blocks reuptake of serotonin, increasing serotonin concentration in the synaptic cleft
- highly effective with a low rate of adverse effects (e.g. sedation, anticholinergic effects, ortho hypo, dysrhythmia)
- most common and first line drug in treatment of depression
Imovane (Zopiclone)
- non-BZ sedative-hypnotic
- used in management of sleep disorders
- increases GABA activity in CNS
- less tolerance and dependence forming than the BZ drugs
- preserves sleep architecture
Xolair (Omalizumab)
- Anti-IgE antibody
- inhibits inflammatory mediator release from mast cells
- used to treat asthma that is not controlled by med/high ICS/LABA combination therapy
- given SQ every 2-4 weeks for 3-4 months
Spiriva (Tiotropium)
- Long-Acting Anti-Muscarinic
- Used as combination therapy with ICS for “ultra” long-acting control of asthma symptoms
- also used in COPD management
- most useful where there is parasympathetic/vagal mediated bronchoconstriction and mucus production
Neosynephrine (Phenylephrine)
- Non-catecholamine direct-acting adrenergic
- relatively pure α1-agonist
- Used to promote mydriasis
- Used as a nasal decongestant
- Used in the emergency or surgical setting as a vasopressor (prominent push-dose vasopressor)
Prolastin
- Alpha1 Proteinase Inhibitor
- Used in patients with alpha1 antitrypsin deficiency to reduce alveolar damage due to elastin degradation
- alpha1 antitrypsin usually inhibits elastase and protease, preventing damage from these endogenous enzymes.
- Used in management of alpha1 antitrypsin-associated emphysema
Noctec (Chloral hydrate)
- Non-BZ sedative hypnotic
- given as a prodrug
- generally only given as preanesthetic sedation in pediatric patients
Normodyne (Labetalol)
- α and β blocker
- used in the treatment of hypertension and for its potent anti-oxidant effects
- non-selctive beta effect, so should not be used in persons with asthma
Aspirin (Acetylsalicylic acid)
- NSAID, antiplatelet
- non-competitive cyclooxygenase inhibitor. At low doses selectively inhibits thromboxane A2 production without affecting prostacyclins
- prevents platelet aggregation
- given prophylactically or acutely for MI and stroke
Diamox (Acetazolamide)
- Carbonic anhydrase inhibitor, diuretic
- Inhibits Carbonic anhydrase at the PCT, which causes increased bicarbonate excretion and a weak diuretic effect
- may cause a secondary metabolic acidosis
- used in treatment of glaucoma, acute mountain sickness, and epilepsy
Amidate (Etomidate)
- Parenteral anaesthetic
- Acts on GABA receptors to produce anaesthesia/sedation
- Rapid onset and very few cardiovascular side effects, so ideal for hyperacute situations
- used in RSI and conscious sedation
- Prolonged use inhibits steroid synthesis
Lipitor (Atorvastatin)
- Statin, antihyperlipidemic
- HMG-CoA inhibitor, reduces LDL by 20-50%
- Shown to reduce mortality due to atherosclerosis
- adverse effects include muscle damage, GI issues, memory impairment, and NIDDM
- Lipitor has a long half life and can be taken at any time of day
Dobutrex (Dobutamine)
- Direct-acting adrenergic agonist, exogenous catecholamine
- Has only β affinity, so produces positive cardiac effects and vasodilation
- Positive inotrope and dromotrope without significant chronotropic effects! Increases SBP and stroke volume without increasing HR while dropping SVR
- preferred drug for treating cradiogenic shock or heart failure
Symbicort (Budesonide+ Formoterol)
- Combination ICS and LABA
- used to control asthma that is not adequately controlled with low-dose ICS alone
- ICS and LABA potentiate each others’ effects, improving both anti-inflammatory and bronchodilatory actions
- May be used as a reliever for brief exacerbations of asthma
describe the function of Zyban (bupropion) in smoking cessation therapy
- antidepressant (atypical, norep and dopamine reuptake inhibitor)
- increases dopamine concentration when ceasing smoking
- more effective when combined with NRT
Elavil (amitryptiline)
- tricycylic antidepressent (TCA)
- inhibits reuptake of serotonin and norepinephrine, increasing synaptic concentration
- highly effective in treatment of depression, but with many adverse effects
- onset of 2-4 weeks
- adverse effects include; sedation, anticholinergic effects, orthostatic hypotension, and cardiac dysrhythmia. OD may cause wide-QRS tachy. Prolonged use may lead to serotonin syndrome
Cinquair (Rexlizumab)
- Anti-IL-5 agent
- Inactivates interleukin-5 (IL-5) which is involved in recruitment, activation, differentiation, and growth of eosinophils. Cinquair reduces number of activated eosinophils in blood and sputum
- used in management of refractory asthma, reduces inflammation and airway remodelling
Dilaudid (Hydromorphone)
- Strong, semi-synthetic opioid, full opioid agonist
- 10x potency relative to morphine with fewer CNS, GI, and CV effects than morphine
- powerful analgesic for acute and chronic pain
- adverse effects include sedation, respiratory depression, constipation, miosis, N/V
Ventolin (Salbutamol)
- Non-catecholamine direct-acting adrenergic
- selective, short-acting β2 agonis (SABA). May activate β1 reeptors at higher doses.
- used to promote bronchodilation in COPD and asthma as a rescue medication
- adverse effects include tachycardia, tremor, and nervousness
Coumadin (Warfarin)
- anticoagulant
- Inhibits production of clotting factors II, VII, IX, and X, thereby inhibiting both intrinsic and extrinsic pathways, but especially extrinsic
- Delayed onset of action (3-5 days), initially given with LMWH
- effectiveness is assessed by INR (should be 2-3 for warfarin. 1.1 or less is normal)
- Used in long term PO prophylactic treatment for DVT, with artificial heart valves, and AFib
Cymbalta (duloxetine)
- SNRI antidepressant
- Inhibits reuptake of Serotonin and Norep with few other NT interactions
- Used in treatment of affective and anxiety disorders
- Fewer adverse effects than TCAs
Provocholine (Methacoline)
- Direct-acting cholinergic with greater M3 muscarinic specificity
- Broad systemic effects, but mainly respiratory (SLUDGE), decreased heart rate, increased PR-interval, increased gastric secretions and GI motility
- Used in the methacholine challenge test (MCT) for asthma. Small doses of methacholine may induce bronchospasm and excessive mucus production in those with reactive airways
Versed (Midazolam)
- Benzodiazepine, sedative-hypnotic
- Lipid-soluble GABA agonist, causes CNS depression due to potentiation of GABA receptors and post-synaptic hyperpolarization
- Fast onset with short duration of action, generally only given IV (or IM)
- Dose dependent effects with ceiling effect: at low doses sedation only, at higher doses hypnosis and anterograde amnesia
- used in acute settings for induction of anaesthesia, termination of seizures, and delirium
Aspirin (ASA)
- NSAID, non-specific COX inhibitor
- causes irreversible inhibition of platelet COX enzymes. Reduces PG and TXA2 production in a dose-dependent fashion
- used for anti-inflammation, anti-inflammatory, analgesic, and anti-platelet effects
- Has an anti-platlet effect which is longer-acting than analgesia
- Increased risk of GI bleeding, ulcers, can cause tinnitus, respiratory alkalosis, and asthma
- may potentiate Reye’s syndrome in children with viral infection
Serevent (Salmeterol)
- Long-acting Beta Agonist (LABA)
- 12hr duration of action with relatively slow onset
- Used always as combination therapy with an ICS for asthma control
- causes bronchodilation and potentiates anti-inflammatory effects of ICS
- never to be used as monotherapy or as a rescue inhaler
Coreg (Carvedilol)
- α and β blocker
- used in the treatment of hypertension and for its potent anti-oxidant effects
- non-selctive beta effect, so should not be used in persons with asthma
Nucala (Mepolizumab)
- Anti-IL-5 agent
- Inactivates interleukin-5 (IL-5) which is involved in recruitment, activation, differentiation, and growth of eosinophils. Nucala reduces number of activated eosinophils in blood and sputum
- used in management of refractory asthma, reduces inflammation and airway remodelling
Cordarone (Amiodarone)
- Class 3 antiarrhythmic, potassium channel blocker, thyroxine analog
- also blocks sodium and potassium channels and beta-adrenoceptors
- Decreases SA automaticity, prolongs AV nodal and ventricular refractory periods. Increases PR and QT intervals and may widen QRS.
- Orally given to suppress both supraventricular and ventricular dysrhytmias
- Given IV to terminate VT and VF
- Many adverse effects; bradycardia, torsades de pointes, thyrotoxicity, photosensitivity, pulmonary fibrosis
Mannitol
- osmotic diuretic
- increases filtrate osmolarity, drawing additional fluid into urine and causing diuresis
- Used in treatment of cerebral edema, increased intraocular pressure (glaucoma), and to icrease urine volume
Sufenta (Sufentanil)
- Strong, synthetic opioid, full opioid agonist
- 1000x potency relative to morphine with fewer CV effects, faster onset, and less hangover than morphine
- powerful analgesic for acute and chronic pain
- adverse effects include sedation, respiratory depression, constipation, miosis, N/V
Robinul (Glycopyrrolate)
- Quaternary amine muscarinic receptor antagonist
- not absorbed by CNS
- used in the setting of surgery to dry secretions and inhibit muscarinic effects of neuromuscular blocking agents (rocuronium, succinylcholine)
Adenocard (Adenosine)
- Antiarrhythmic, endogenous nucleoside, non-Vaughan-Williams class
- Binds to A1 receptors to cause AV Nodal Blockade (may cause complete heart block and brief asystole). Causes increased potassium efflux and membrane hyperpolarization.
- Used to terminate PSVT, including in WPW
- Extremely short T1/2 (~10s)
- May cause bronchoconstriction and reduces epinephrine sensitivity
Valium (Diazepam)
- Benzodiazepine, sedative-hypnotic
- Lipid-soluble GABA agonist, causes CNS depression due to potentiation of GABA receptors and post-synaptic hyperpolarization
- Fast onset with long duration of action
- Dose dependent effects with ceiling effect: at low doses sedation only, at higher doses hypnosis and anterograde amnesia
Tylenol (Acetaminophen)
- Not strictly an NSAID; non-opioid analgesic/antipyretic
- MOA not udnerstood, but may involve COX-3. Does not affect COX-1 or COX-2
- reduces pain and fever associated with inflammation
- No associated GI effects or Reye’s syndrome
- causes hepatic toxicity in overdose that rapidly escalates with higher doses as toxic metabolites accumulate
TXA (Tranexamic Acid)
- procoagulant, antiplasmin
- inhibits activation of plasmin from plasminogen
- used in management of heavy menstrual bleeding, hemophilia, and traumatic hemorrhage
Cortef / Solu-Cortef (Hydrocortisone)
- Short-acting corticosteroid
- Causes broad anti-inflammatory effects
- Decreases eicosanoid production
- Decreases inflammatory cytokine production
- Decreases inflammatory cell produciton and recruitment
- Reduces histamine production and release
- Short-acting CS mainly used in CS-replacement therapy (addison’s) or as topical anti-inflammatory
- Prolonged use may disrupt HPA axis and lead to addisonian crisis when withdrawn
Benadryl (Diphenhydramine)
- First-generation antihistamine, H1 receptor antagonist
- Blocks H1 receptors systemically, including the CNS
- Used to manage symptoms of allergy, but may cause unwanted sedation/hypnosis
Activase (Alteplase-Recombinant)
- fibrinolytic, thrombolytic, recombinant tPA
- causes plasmin activation from plasminogen, with moderate-to-high specificity for fibrin-bound plasminogen
- only thrombolytic recommended for acute PE
- also used in stroke and MI management (tenecteplase preferred for STEMI)
Isuprel (Isoproterenol)
- Direct-acting adrenergic agonist, exogenous catecholamine
- Has only β affinity, so produces positive cardiac effects and vasodilation (as well as bronchodilation)
- Strong positive chronotrope! Causes increased HR and SBP, with decreased SVR and diastolic BP
- Risk of tachyarrhythmias, useful in treatment of heart blocks and bradycardia
Clozaril (Clozapine)
- second generation, atypical antipsychotic
- blocks 5-HT and D2 receptors in the mesocortical, mesolimbic and other pathways
- high potency, low risk of EPSs, but many other systemic side effects stemming from alpha blockade and anticholinergic effects
- useful in treating both positive and negative symptoms of schizophrenia
- prolonged use may lead to tardive dyskinesia or neuroleptic malignant syndrome
Zemuron (Rocuronium)
- non-depolarizing neuromuscular blocking agent (ND NMBA)
- competitive inhibitor of muscle-type nicotinic ACh receptors
- induction of paralysis during medical procedures (ex: intubation)
- intermediate acting consider pancuronium for longer duration of action
Tracium (Atracurium)
- non-depolarizing neuromuscular blocking agent (ND NMBA)
- competitive inhibitor of muscle-type nicotinic ACh receptors
- induction of paralysis during medical procedures (ex: intubation)
- intermediate acting, may have increased histamine release but lower hepatotoxicity vs. rocuronium
Zantac (Ranitidine)
- H2-receptor antagonist
- reduces gastric acid secretion to reduce dyspepsia/gastroenteritis in GERD
Advair (Fluticasone + Salmeterol)
- Combination ICS and LABA
- used to control asthma that is not adequately controlled with low-dose ICS alone
- ICS and LABA potentiate each others’ effects, improving both anti-inflammatory and bronchodilatory actions
- Should NOT be used as a reliever
Inderal (Propranolol)
- Non-selective β-antagonist (beta-blocker)
- Primarily given orally but may be given parenterally
- One of the first developed and thus has the ridest range of approved clinical uses
- hypertenion, angina, cardiac dysrhythmias, migraine, AMI, pheochromocytoma
- Has more CNS side effects than other non-selective beta-blockers
Adrenalin (Epinehrine)
- Direct-acting adrenergic agonist, endogenous catecholamine
- Has equal α and β affinity, so both cardiac and vascular effects
- effects are highly dose dependent! at lower doses there is greater β activation, so there is MSK vasodilation and positive cardiac effects leading to increased systolic, decreased diastolic. At higher doses there is increased α1 effect and diastolic may increase as well.
- used in treatment of shock and hypotension
Prostigmin (Neostigmine)
- Reversible cholinesterase inhibitor (indirect-acting cholinergics)
- Relatively long-acting (compared to edrophonium)
- Used in long-term treatment of myasthenia gravis
Tenormin (Atenolol)
- Selective β1-antagonist (beta-blocker)
- oral or parenteral
- good antihypertensive, antianginal, antiarrhythmic
- Low rate of CNS side effects due to poor lipid solubility
Lasix (Furosemide)
- Loop diuretic
- Inhibits the Na/K/2Cl cotransporter in thick ascending limb of loop of henle
- high-ceiling dose-dependent diuretic
- Preffered first line diuretic for edematous states
- Adverse effects: hypokalemia, hypomagnesemia, hypocalcemia, hyperglycemia, hyperuricemia, ototoxicity
Tensilon (Edrophonium)
- Short-acting reversible cholinesterase inhibitor (indirect-acting cholinnergic)
- rapidly increases ACh concentrations
- may be used to reverse neuromuscular blockade
- used to diagnose between myasthenic crisis (not enough ACh) and a cholinergic crisis (too much ACh) in myasthenia gravis
Motrin/Advil (Ibuprofen)
- NSAID, non-selective COX inhibitor
- competitively inhibits COX enzymes, reducing PG and TXA2 synthesis in inflammation
- used to reduce pain, inflammation
- May cause GI, hepatic, and renal side effects due to COX-1 inhibition
- does not produce the anti-platelet effects of ASA
Zenhale (Mometasone + Formoterol)
- Combination ICS and LABA
- used to control asthma that is not adequately controlled with low-dose ICS alone
- ICS and LABA potentiate each others’ effects, improving both anti-inflammatory and bronchodilatory actions
- May be used as both controller and reliever
Pradaxa (dabigatran)
- Anticoagulant, direct thrombin inhibitor
- Competitively inhibits thrombin protease site, which inhibits fibrin formation
- no INR monitoring is required
- is increasingly replacing warfarin for chronic management of DVT, AFib due to lower risk of adverse events, no need for monitoring, and fewer food interactions
- not for patients with valve replacement!
Inotropin (Dopamine)
- Direct-acting adrenergic agonist, endogenous catecholamine
- Effect is highly dose-dependent. At low doses it is D1 selective and promotes renal perfusion (uncommon). At medium doses it stimulates β1 receptors (incr. inotropy and decr. SVR). At high doses it stimulates α1 receptors, causing vasoconstriction
- used in treatment of shock and hypotension
Describe the function of Champix (verenicline) in smoking cessation therapy
- partial nictone receptor agonist
- acts as a competitive antagonist in presence of nicotine while maintaining baseline dopamine release
Ketamar (Ketamine)
- Non-opioid parenteral anaesthetic, sedative, dissociative
- Blocks excitatory NTs at NMDA receptors. Produces dissociative anaesthesia
- Anaesthesia characterized by analgesia, reduced sensory perception, incomplete loss of consciousness, immobility, and amnesia
- Causes increased BP and no respiratory depression (great for trauma)
- produces unpleasent emergence including hallucinations and delirium; less common in pediatric patients!
Morphine
- Strong, natural opioid, full opioid agonist
- considered the prototype opioid
- powerful analgesic for acute and chronic pain
- adverse effects include sedation, respiratory depression, constipation, miosis, N/V
- hydromorphone preferred for chronic pain management due to fewer adverse effects
Anectine (Succinylcholine)
- depolarizing neuromuscular blocking agent (D NMBA)
- non-competitive agonist of muscle-type nicotinic ACh receptors causes protracted depolariztion
- induction of paralysis during medical procedures (ex: intubation)
- short onset and short-acting
Demerol (Meperidine)
- Strong synthetic full opioid analgesic
- 0.1X potency relative to Morphine
- Less smooth muscle effects less pronounced than with other opioids. Fewer GI, biliary, and uterine side effects
- Safer for pregnant patients, or those with cholecystitis
Buscopan (Scopolamine)
- muscarinic receptor antagonist (belladonna alkaloid, tertiary amine)
- toxixicity is dose dependent, remember; dry as a bone, red as beet, mad as a hatter, blind as a bat
- causes dilatation, positive chronotropy, decreased secretions, decreased GI motility, bronchodilation, etc.
- greater CNS effect than atropine therefore used to treat motion sickness
Precidex (Dexmetetomidine)
- alpha-2 agonist
- used in treatment of hypertension and for sedation in anaesthetized/intubated patients in an ICU setting
- used due to lack of respiratory depression
Brevibloc (Esmolol)
- Selective β1-antagonist (beta-blocker)
- IV-only!
- good antihypertensive, antianginal, antiarrhythmic
- very short half-life compared to other beta-blockers, used in emergent settings (check out that trade name!)
Dolophine (Methadone)
- Long-acting synthetic full opioid agonist
- Does not tend to produce euphoria or other reinforcing effects
- Used in management of chronic pain and in opioid addiction treatment