Potter Final Cumulative Flashcards
nicotine polacrilex gum- Nicorette class
nicotine replacement therapy
nicotine polacrilex gum- Nicorette MOA/Pcol
binds to CNS nicotinic receptors
nicotine stimulates epi and dopamine release
transient hyperglycemia
nicotine polacrilex gum- Nicorette Indication
smoking cessation
varenicline- Chantix class
nicotinic partial agonist
varenicline- Chantix MOA/Pcol
nicotinic partial agonist on alpha4, beta2 subunits of nicotinic receptor
CNS selective
varenicline- Chantix indication
smoking cessation
varenicline- Chantix ADR
nausea, depression, suicidal thoughts
varenicline- Chantix boxed warning
avoid in depressed patients and psychiatric illness
pyridostigmine- Mestinon class
AChE Inhibitor
pyridostigmine- Mestinon MOA/Pcol
peripherally acting reversible AChE inhibitor
increase ACh
pyridostigmine- Mestinon indication
myasthenia gravis
pyridostigmine- Mestinon misc.
does not cross BBB
neostigmine- Prostigmin class
AChE inhibitor
neostigmine- Prostigmin MOA/Pcol
peripherally acting AChE inhibitor
increase ACh
direct stimulation of Nm receptors
neostigmine- Prostigmin indication
myasthenia gravis
neostigmine- Prostigmin misc.
does not cross BBB
physostigmine- Eserine class
AChE inhibitor
physostigmine- Eserine MOA/Pcol
peripherally acting AChE inhibitor
increase ACh
physostigmine- Eserine indication
myasthenia gravis
overdose of anticholinergic agents
physostigmine- Eserine misc.
CNS and peripheral nervous system effects
donepezil- Aricept class
CNS acting AChE inhibitor
donepezil- Aricept MOA/Pcol
reversible AChE inhibitor
increase ACh
donepezil- Aricept indication
alzheimers
galantamine- Razadyne class
CNS acting AChE inhibitor
galantamine- Razadyne MOA/Pcol
reversible AChE inhibitor
increase ACh
bind directly to nicotinic receptors in CNS
galantamine- Razadyne indication
alzheimers
rivastigmine- Exelon class
CNS acting AChE inhibitor
rivastigmine- Exelon MOA/Pcol
pseudoirreversible AChE inhibitor by forming covalent bond
increase ACh
rivastigmine- Exelon indication
alzheimers
pilocarpine- Isoptocarpine class
muscarinic agonist
pilocarpine- Isoptocarpine MOA/Pcol
contracts sphincter- miosis
overall increase in outflow through trabecular meshwork
pilocarpine- Isoptocarpine indication
open angle glaucoma
sialogogue- oral formulation Salagen for Sjogrens syndrome
carbochol- Isopto carbachol class
muscarinic agonist
carbachol- Isopto carbachol MOA//Pcol
contracts sphincter- miosis
overall increase in outflow through trabecular meshwork
carbachol- Isopto carbachol indication
open angle glaucoma
bethanecol- Urecholine class
muscarinic agonist
bethanecol- Urecholine MOA/Pcol
increase GI motility, increase salivation and secretions
stimulates detrussor muscle contraction
bethanecol- Urecholine indication
post-operative ileus: decreased movement through GI
gastropariesis: paralysis of stomach
atonic bladder, urinary retention
atropine IV class
muscarinic antagonist
atropine IV MOA/Pcol
nonselective muscarinic antagonist
no effect on CNS at therapeutic concentrations
atropine IV indication
AV nodal heart block
sinus bradycardia
atropine IV ADR
urinary retention, constipation, tachycardia, dry mouth, mydriasis, decreased sweating
ipatropium- Atrovent class
muscarinic antagonist (SAMA)
ipatropium- Atrovent MOA/Pcol
M3 receptor stimulation causes smooth muscle bronchodilation
decrease mucus secretions
ipatropium- Atrovent indication
COPD (emphysema/chronic bronchitis)
asthma
rhinorrhea
ipatropium- Atrovent ADR
dry mouth
tiotropium- Spiriva class
muscarinic antagonist (LAMA)
tiotropium- Spriva MOA/Pcol
M3 receptor stimulation causes smooth muscle bronchodilation
decrease mucus secretions
tiotropium- Spriva indication
COPD- emphysema or chronic bronchitis
asthma
tiotropium- Spiriva ADR
dry mouth
aclindinium Br- Tudorza class
muscarinic antagonist
aclindinium Br- Tudorza MOA/Pcol
M3 receptor stimulation causes smooth muscle bronchodilation
decrease mucus secretions
aclindinium Br- Tudorza indication
COPD- emphysema or chronic bronchitis
scopolamine- Transderm Scop class
muscarinic antagonist
scopolamine- Transdern Scop MOA/Pcol
CNS acting
acts on chemoreceptor trigger zone (CTZ)
scopolamine- Transderm Scop indication
motion sickness prophylaxis
scopolamine- Transderm Scop use
1 patch placed behind ear every 2-3 days
scopolamine- Transderm Scop ADR
dry mouth, blurred vision
diphenoxylate+atropine- Lomotil class
muscarinic antagonist
diphenoxylate+atropine- Lomotil MOA/Pcol
decrease GI tone and movement inhibit secretions (dry mouth)
diphenoxylate+atropine- Lomotil indication
diarrhea
diphenoxylate+atropine- Lomitil misc.
low dose atropine used to prevent opioid abuse
oxybutynin- Ditropan (immediate release) class
muscarinic antagonist
oxybutynin- Ditropan (immediate release) MOA/Pcol
antispasmodic on GU smooth muscle
decrease contraction of the detrussor muscle
increase bladder capacity
decrease urgency and frequency of urination
oxybutynin- Ditropan (immediate release) indication
urge urinary incontinence/over active bladder (OAB)
oxybutynin- Ditropan (immediate release) misc
highest rate of ADRs: dry mouth 71%, constipation 15%
oxybutynin- Ditropan XR (sustained release) class
muscarinic antagonist
oxybutynin- Ditropan XR (sustained release) MOA/Pcol
antispasmodic on GU smooth muscle
decrease contraction of the detrussor muscle
increase bladder capacity
decrease urgency and frequency of urination
oxybutynin- Ditropan XR (sustained release) indication
urge urinary incontinence/OAB
oxybutynin- Oxytrol (transdermal) class
muscarinic antagonist
oxybutynin- Oxytrol (transdermal) MOA/Pcol
antispasmodic on GU smooth muscle
decrease contraction of the detrussor muscle
increase bladder capacity
decrease urgency and frequency of urination
oxybutynin- Oxytrol (transdermal) indication
urge urinary incontinence/OAB
oxybutynin- Oxytrol (transdermal) use
apply 1 patch to arm or abdomen every 3-4 days
tolterodine- Detrol class
muscarinic antagonist
tolterodine- Detrol MOA/Pcol
antispasmodic on GU smooth muscle
decrease contraction of the detrussor muscle
increase bladder capacity
decrease urgency and frequency of urination
tolterodine- Detrol indication
urge urinary incontinence/OAB
fesoterodine- Toviaz class
muscarinic antagonist
fesoterodine- Toviaz MOA/Pcol
antispasmodic on GU smooth muscle
decrease contraction of the detrussor muscle
increase bladder capacity
decrease urgency and frequency of urination
fesoterodine- Toviaz indication
urge urinary incontinence/OAB
fesoterodine- Toviaz misc.
active metabolite- tolterodine derivative (hydrolysis, not CYP450)
trospium- Sanctura class
muscarinic antagonist
trospium- Sanctura MOA/Pcol
antispasmodic on GU smooth muscle
decrease contraction of the detrussor muscle
increase bladder capacity
decrease urgency and frequency of urination
trospium- Sanctura indication
urge urinary incontinence/OAB
trospium- Sanctura misc.
lowest % of ADR
darifenacin- Enablex class
muscarinic antagonist
darifenacin- Enablex MOA/Pcol
antispasmodic on GU smooth muscle
decrease contraction of the detrussor muscle
increase bladder capacity
decrease urgency and frequency of urination
darifenacin- Enablex indication
urge urinary incontinence/OAB
darifenacin- Enablex misc.
most selective of the OAB meds (M3 selective)
solifenacin- Vesicare class
muscarinic antagonist
solifenacin- Vesicare MOA/Pcol
antispasmodic on GU smooth muscle
decrease contraction of the detrussor muscle
increase bladder capacity
decrease urgency and frequency of urination
solifenacin- Vesicare indication
urge urinary incontinence/OAB
rocuronium- Zemuron class
NMJ blocker- paralytic
rocuronium- Zemuron MOA/Pcol
non-depolarizing, competitive antagonist
compete with ACh for nicotinic receptors in skeletal muscle
can block ganglionic and pre-synaptic nicotinic receptors at high doses (toxicity)
rocuronium- Zemuron indication
surgery- skeletal muscle paralysis (allows for decreased anesthetia)
facilitate intubation, endotrachial tube insertion, on a ventilator, medically induced coma
rocuronium- Zemuron misc.
IV agent with quick onset, short duration of action
vercuronium- Norcuron class
NMJ blocker- paralytic
vercuronium- Norcuron MOA/Pcol
non-depolarizing, competitive antagonist
compete with ACh for nicotinic receptors in skeletal muscle
can block ganglionic and pre-synaptic nicotinic receptors at high doses (toxicity)
vercuronium- Norcuron indication
surgery- skeletal muscle paralysis (allows for decreased anesthetia)
facilitate intubation, endotrachial tube insertion, on a ventilator, medically induced coma
vercuronium- Norcuron misc.
IV agent with quick onset, short duration of action
succinylcholine- Anectine class
NMJ blocker- paralytic
succinylcholine- Anectine MOA/Pcol
depolarizing agent
initial increase in muscle activity
Phase I- therapeutic; channel constantly open to decrease muscle contraction
Phase II- toxic; succinylcholine physically binds in channel
succinylcholine- Anectine indication
surgery- skeletal muscle paralysis (allows for decreased anesthetia)
facilitate intubation, endotrachial tube insertion, on a ventilator, medically induced coma
onabotulinumtoxinA- Botox class
botulinum toxin derivative
onabotulinumtoxinA- Botox MOA/Pcol
prevents release of ACh from pre-junctional motor neurons into the NMJ
produces a state of degeneration (have to get new fibrils to regain activity)
temporary paralysis of locally injected muscles
onabotulinumtoxinA- Botox indication
hyperhidrosis- abnormal increase in sweating inadequately managed with topical agents
stabismus (one eye pulled to side) and blepharospasm (uncontrolled blinking)
migraine prophylaxis
glabellar lines: creases in face
onabotulinumtoxinA- Botox misc.
lots of unlabeled uses
100 U/vial
boxed warning- can spread from injection site
can last for 12 months
rimabotulinumtoxinB- Myobloc class
botulinum toxin derivative
rimabotulinumtoxinB- Myobloc MOA/Pcol
prevents release of ACh from pre-junctional motor neurons into the NMJ
produces a state of degeneration (have to get new fibrils to regain activity)
temporary paralysis of locally injected muscles
rimabotulinumtoxinB- Myobloc misc.
5000 U/vial
theophylline class
methylxanthine phosphodiesterase inhibitor
theophylline MOA/Pcol
non-selective PDE
bronchodilator- inhibits cAMP dependent PDEs in bronchial smooth muscle
prostaglandin antagonist
decrease release of mediators from mast cells and leukocytes
increase diaphragm contractility and mucocilary clearance
theophylline indication
adjunct treatment of asthma- decrease dependence on beta-agonists and inhaled corticosteroids
adjunct in COPD for pts who are not controlled with anti-cholinergics and beta2 agonists
roflumilast- Daliresp class
phosphodiesterase inhibitor
roflumilast- Daliresp MOA/Pcol
inhibits PDE-IV
anti-inflammatory effect thru suppression of proinflammatory cytokines ie IL-6, TNF-alpha
roflumilast- Daliresp indication
COPD with excess mucous production
cilostazol- Pletal class
phosphodiesterase inhibitor
cilostazol- Pletal MOA/Pcol
inhibits cAMP- PDE-III
increase vasodilation
decrease platelet aggregation
cilostazol- Pletal indication
peripheral vascular disease, intermittent claudication
decrease pain experience with movement
inamrinone- Inocor IV class
phosphodiesterase inhibitor
inamrinone- Inocor IV MOA/Pcol
PDE-III inhibitor inhibits the breakdown of cAMP keeping Ca channels open
increase contractile force of failing hearts (+ iontropy)
vasodilation
inamrinone- Inocor IV indication
acute decompensated heart failure
inamrinone- Inocor IV misc.
short term use only, increased mortality when used long term
sildenafil- Viagra class
phosphodiesterase inhibitor
sildenafil- Viagra MOA/Pcol
inhibits cGMP PDE-V
causes relaxation of the smooth muscle of the corpus cavernosum
sildenafil- Viagra indication
erectile dysfunction
pulmonary artertial hypertension (PAH)
SSRI associated sexual dysfunction
sildenafil- Viagra misc.
4 hr duration
ADR: NAION
CI: nitrates
vardenafil- Levitra class
phosphodiesterase inhibitor
vardenafil- Levitra MOA/Pcol
inhibits cGMP PDE-V
causes relaxation of the smooth muscle of the corpus cavernosum
vardenafil- Levitra indication
erectile dysfunction
pulmonary artertial hypertension (PAH)
SSRI associated sexual dysfunction
vardenafil- Levitra misc.
4 hr duration
ADR: NAION
CI: nitrates
tadalafil- Cialis class
phosphodiesterase inhibitor
tadalafil- Cialis MOA/Pcol
inhibits cGMP PDE-V
causes relaxation of the smooth muscle of the corpus cavernosum
tadalafil- Cialis indication
erectile dysfunction
pulmonary artertial hypertension (PAH)
SSRI associated sexual dysfunction
tadalafil- Cialis misc.
36 hours duration, daily dosing available
ADR: NAION
CI: nitrates
avanafil- Stendra class
phosphodiesterase inhibitor
avanafil- Stendra MOA/Pcol
inhibits cGMP PDE-V
causes relaxation of the smooth muscle of the corpus cavernosum
avanafil- Stendra indication
erectile dysfunction
avanafil- Stendra misc.
4 hr duration
CI: nitrates
pseudoephedrine- Sudafed class
alpha1 adrenergic agonist
psuedoephedrine- Sudafed MOA/Pcol
vasoconstriction in systemic and ocular blood vessels
decrease secretions in eyes and nose
psuedoephedrine- Sudafed indication
rhinitis, conjuctivity
stress urinary incontience
psuedoephedrine- Sudafed ADR
increase BP, arrhythmias, increase HR, increase blood glucose
phenylephrine class
alpha1 adrenergic agoinst
phenyeprhine MOA/Pcol
vasoconstriction in systemic and ocular blood vessels
decrease secretions in eyes and nose
phenyleprine indication
rhinitis, conjunctivitis
hypotension, shock
phenylephrine ADR
increase BP, arrhythmias, increase HR, increase blood glucose
tetrahydralazine- Visine class
alpha1 adrenergic agonist
tetrahydralazine- Visine MOA/Pcol
vasoconstriction in ocular blood vessels
decrease secretions in eyes and nose (ocular or nasal administration)
tetrahydralazine- Visina indication
rhinitis, conjunctivitis
apraclonidine- Iopidine class
alpha2 agonist
aproclonidine- Iopidine MOA/Pcol
peripheral: presynaptic alpha2 stimulation decreases aqueous humor production and decreases IOP
apraclonidine- Iopoidine indication
glaucoma
clonidine- Catapres class
alpha2 adrenergic agonist
clonidine- Catapres MOA/Pcol
major: CNS inhibition of sympathetic tone (alpha2 stimulation presynaptic and postsynaptically decreases NE)
sympatholytic
peripheral: presynaptic alpha2 stimulation decreases NE release
primary effect on heart is to decrease HR and CO
clonidine- Catapres indication
HTN
clonidine- Catapress misc.
rebound HTN when high doses abruptly discontinued
CNS ADR: excessive sedation, drowsiness
guanfacine- Intuniv class
alpha2A adrenergic agoinst
guanfacine- Intuniv MOA/Pcol
major: CNS inhibition of sympathetic tone (alpha2 stimulation presynaptic and postsynaptically decreases NE)
sympatholytic
guanfacine- Intuniv indication
ADHD
guanfacine- Intuniv misc.
non-stimulant
methyldopa- Aldomet class
alpha2 adrenergic agonist
methyldopa- Aldomet MOA/Pcol
CNS inhibition of sympathethic tone (alpha2 stimulation presynaptic and postsynaptically decreases NE)
methyldopa- Aldomet indication
HTN in pregnancy
dobutamine- Dobutrex classs
beta1 adrenergic agonist
dobutamine- Dobutrex MOA/Pcol
positive inotropic agent
dobutamine- Dobutrex indication
short term use to support cardiac function during CHF or MI
isoproterenol- Isuprel class
adrenergic agonist
isoproterenol- Isuprel MOA/Pcol
beta1, beta2 agonist
isoproterenol- Isuprel indication
acute asthma attacks (IV only)
heart block
Epi class
adrenergic agonist
Epi MOA/Pcol
alpha1, alpha2, beta1, beta2, beta3 agonist
eye: mydriasis; increase aqueous outflow; decrease IOP; ocular decongestant (alpha1)
Arteries: net effect vasoconstriction (alpha1 > beta2)
Lungs: bronchodilation (beta2)
Heart: increase rate and force (beta1 and beta2)
Epi indication
anaphylaxis (Epi-Pen)
open angle glaucoma
albuterol- Ventolin class
SABA beta2 adrenergic agonist
albuterol- Ventolin MOA/Pcol
relaxes bronchial smooth muscle to cause bronchodilation
albuterol- Ventolin indication
asthma
COPD
albuterol- Ventolin ADR
skeletal muscle tremor, increase HR
levalbuterol- Xopenex class
SABA beta2 adrenergic agonist
levalbuterol- Xopenex MOA/Pcol
relaxes bronchial smooth muscle to cause bronchodilation
levalbuterol- Xopenex indication
asthma
COPD
levalbuterol- Xopenex ADR
skeletal muscle tremor, increase HR
salmeterol- Serevent class
LABA beta2 adrenergic agonist
salmeterol- Serevent MOA/Pcol
relaxes bronchial smooth muscle to cause bronchodilation
salmeterol- Serevent indication
asthma
COPD
salmeterol- Serevent misc.
ADR: skeletal muscle tremor, increase HR
FDA: decrease in overall attacks, increase life-threatening attack in asthma
formoterol- Foradil class
LABA beta2 adrenergic agonist
formoterol- Foradil MOA/Pcol
relaxes bronchial smooth muscle to cause bronchodilation
formoterol- Foradil indication
asthma
COPD
formoterol- Foradil misc.
ADR: skeletal muscle tremor, increase HR
FDA: decrease in overall attacks, increase life-threatening attack in asthma
indacaterol- Atcapta class
ultra LABA beta2 adrenergic agonist
indacaterol- Atcapta MOA/Pcol
relaxes bronchial smooth muscle to cause bronchodilation
indacaterol- Atcapta indication
COPD
indacaterol- Atcapta ADR
skeletal muscle tremor, increase HR
salmeterol+fluticasone- Advair class
LABA + ICS
salmeterol+fluticasone- Advair MOA/Pcol
relaxes bronchial smooth muscle to cause bronchodilation
anti-inflammatory effect
salmeterol+fluticasone- Advair indication
asthma
COPD
formoterol+budesonide- Symbicort class
LABA + ICS
formoterol+budesonide- Symbicort MOA/Pcol
relaxes bronchial smooth muscle to cause bronchodilation
anti-inflammatory effect
formoterol+budesonide- Symbicort indication
asthma
COPD
formoterol+mometasone- Dulera class
LABA + ICS
formoterol+mometasone- Dulera MOA/Pcol
relaxes bronchial smooth muscle to cause bronchodilation
anti-inflammatory effect
formoterol+mometason- Dulera indication
asthma
COPD
mirabegron- Myrbetriq class
beta3 adrenergic agonist
mirabegron- Myrbetriq MOA/Pcol
binds to beta3 receptors in detrussor smooth muscle causing relaxation and urinary storage
mirabegron- Myrbetriq indication
urge urinary incontinence (UUI)/OAB
mirabegron- Myrbetriq misc.
takes weeks for full effect