random pharm Flashcards
what drug can be used to reverse serotonin syndrome?
Cyproheptadine
- antagonizes 5-HT2 receptor
what drug can be used to reverse neuroleptic malignant syndrome (NMS)?
Dantrolene
what drugs cause NMS?
- Haloperidol
- Fluphenazine
what drug can be used to reverse anticholinergic toxicity?
Physostigmine
- Olanzapine
- Clozapine
- Quetiapine
- Risperidone
- Aripiprazole
- Ziprasidone
SGA’s (atypical antipsychotics)
- Haloperidol
- Trifluoperazine
- Fluphenazine
- Chlorpromazine
- Thioridazine
FGA’s
Gq -> IP3, DAG • Arteriole constriction • Mydriasis • Reduced renin release • Glycogenolysis • Urinary retention (stimulates internal urethral sphincter)
alpha-1 agonists
- phenylephrine
Gs -> increased cAMP
• Increases SA/AV conduction (inotropy)
• Increases renin release
• Increases aqueous humor
beta-1 agonists
- dobutamine
Gs -> increased cAMP • Vasodilation • Bronchodilation • Uterine relaxation • Gluconeogenesis • Lipolysis
beta-2 agonists
- albuterol
- Prazosin (treats hypertension and BPH)
- Doxazosin
- Terazosin
- Tamsulosin (BPH)
alpha-1 blockers
abx that causes hypersensitivity reactions, including Stevens-Johnson syndrome
sulfamethoxazole/trimethoprim (SMX/TMP)
sulfamethoxazole MOA?
inhibits dihydropteroate synthase
trimethoprim MOA?
inhibits bacterial dihydrofolate reductase
atypical antipsychotic, is typically used to treat refractory schizophrenia
- notable side effect of this medication is decreased white blood cell count, known as agranulocytosis
clozapine
MAOI used to treat severe and refractory depression
- most notable side effect is malignant hypertension secondary to the use of eating tyramine-rich foods
phenelzine
short-acting benzodiazepine, is used to treat anxiety disorders
- often prescribed short-term for panic attacks
alprazolam
what are the most common side effects of SSRI’s?
sexual
- anorgasmia, prolonged time to orgasm, nighttime tumescence
topo II inhibitor used to treat ovarian, breast, and lung cancer
side effects:
- dilated cardiomyopathy
- skin reactions
- nausea/vomiting
- bone marrow suppression
doxorubicin
G2-specific antineoplastic that causes formation of iron free radicals
side effects:
• Pulmonary fibrosis
• Alopecia
• Skin rash
bleomycin
anticancer drug that binds to N7 of guanine to alkylate DNA
side effects:
• Nephrotoxicity (manage with amifostine)
• Nausea and vomiting (manage with ondansetron)
• Ototoxicity
• Peripheral neuropathy
cisplatin
M-phase antineoplastic that inhibits microtubule depolymerization (stops disassembly)
side effects: • Peripheral neuropathy • Bone marrow suppression • Hypersensitivity • Diarrhea
paclitaxel
diuretic class that block Na/Cl transporter in DCT, increasing Ca reabsorption in the distal tubule
thiazides
- less Na inside cells actives the Na/Ca antiporter on the basolat membrane
potassium-sparing diuretics that are competitive antagonists that either compete with aldosterone or intracellular cytoplasmic receptor sites at the collecting duct
spironolactone
- generally used in combination with loop diuretics to keep K+ levels WNL
diuretic that inhibits reabsorption of water and Na, acting at the portions of the nephron that are water-permeable (PCT, thin descending loop, collecting duct)
osmotic duiretics (mannitol, acetazolamide)
diuretic class that inhibit the Na-K-2Cl symporter in the thick ascending limb
loop diuretics
- cause an increase in K+, Mg and Ca excretion (bad for stones)
potentiates the effect of antithrombin III, thereby inhibiting thrombin and factor Xa
- also inhibits aldosterone in the collecting duct
heparin
which diuretics cause hyperkalemia?
- aldosterone inhibitors (spironolactone)
- ENaC channel blockers in the late distal tubule/collecting duct (amiloride, triamterene)
first line tx for pyelonephritis?
SMX-TMP
- fluoroquinolones if sulfa allergy
MOA of fluoroquinolones?
inhibit bacterial DNA topoisomerase II and IV
old tetracycline abx
- pt presents w/ polyuria and polydipsia with bouts of dehydration
- proteinuria, hypokalemia, hypophosphatemia, and hyperchloremic metabolic acidosis
Fanconi syndrome
- when stored for long periods of time in a moist environment, tetracycline degrades and forms the toxic degradation product, anhydro-4-epitetracycline
preferred diuretic for pt w/ fluid overload?
loop diuretics
- in comparison with thiazide diuretics, loop diuretics allow for a greater loss of urine and relatively less loss of sodium making them very effective in persons who have volume overload
loop diuretics for fluid overload, thiazides for HTN
- loop diuretics keep more fluid in the tubular lumen (lose Ca, bad for stones)
- thiazides excrete more sodium (reabsorb Ca, good for stones)
where does spironolactone exert its effects?
collecting tubule, NOT duct
anticonvulsant that inhibits sodium channels in neuronal axons
- side effects: hirsutism, megaloblastic anemia, confusion, ataxia, nystagmus, osteomalacia, and gingival hyperplasia
phenytoin
anticonvulsant that blocks both sodium and calcium channels
- may cause Stevens-Johnson syndrome, disseminated intravascular coagulation, angioedema, and aplastic anemia
lamotrigine
decrease carbohydrate polymerization of the mycobacterium cell wall by blocking arabinosyltransferase
ethambutol
TB med that inhibits DNA-dependent RNA polymerase
rifampin
TB drug that binds to intracellular proteins in the hepatocytes, leading to actin disruption and mitochondrial disruption
isoniazid
- give pyridoxine!! (B6)
what GABA activator is used to treat MS muscle spasms?
baclophen
- results in hyperpolarization by 3 distinct actions:
1. Closure of presynaptic calcium channels
2. Increased postsynaptic K+ conductance
3. Inhibition of dendritic calcium influx channels
tx for absence seizures that inhibits the T-type calcium channels in thalamocortical neurons
ethosuximide
acetylcholinesterase inhibitor used particularly for Alzheimer’s disease, which is associated with loss of cholinergic neurons
donepezil
short-acting acetylcholinesterase inhibitor used to diagnose myasthenia gravis
edrophonium
med used for acute gout attacks?
colchicine
- inhibits polymerization of β-tubulin into microtubules, to prevent the activation, degranulation, and migration of neutrophils (affects cytoskeleton)
anti-rheumatoid drug that causes retinal deposits
hydroxychloroquine
bisphosphonate that inhibits bone resorption (osteoclast activity) and has been found to increase bone density in women with post-menopausal osteoporosis
alendronate
- must be taken with water to prevent esophageal perforation. Osteonecrosis of the jaw is another complication that is caused by suppression of bone turnover
example of drug that follows zero order kinetics?
phenytoin
- rate of drug elimination is constant regardless of the plasma concentration of the drug (linear)
when would you see a narrow pulse pressure vs wide?
- narrow pulse pressure: constrictive pericarditis
- wide pulse pressure: aortic regurgitation
what is preferred tx for stabile angina?
- nitrates (dilate peripheral veins -> decrease preload, cardiac load)
- b-blocker (reduce HR and contractility, decrease O2 demand)
overdosing on what med causes: • Bradycardia • Hypotension • *Hypoglycemia* • Fatigue
b-blocker
- give glucagon
overdosing on what med causes: • Bradycardia • Hypotension • Tachycardia • *Hyperglycemia* • Dizziness
CCB’s
- give calcium and insulin
what drug class lowers LDL, mildly decreases TG and will mildly increase HDL? - only cholesterol med with mortality benefit
statins
what drug class significantly lowers TG, mildly lowers LDL and mildly increases HDL?
fibrates
what drug class significantly lowers LDL, and mildly lowers TG with no effect on HDL?
PCSK-9 inhibitors
- Evolocumab
what 2 drug classes only lowers LDL and nothing else?
- Cholesterol absorption blockers: ezetimibe
2. Bile acid resins: cholestyramine, colestipol
what drug lowers LDL, increases HDL, and mildly decreases TG?
- causes flushing
niacin
- affects glycemic control (bad for diabetics)
- can precipitate gout by increasing uric acid levels
tx for chagas disease?
nifurtimox
tx for trigeminal neuralgia?
carbemazepine
what is the antidote for ethylene glycol toxicity?
Fomepizole
- works as an inhibitor of alcohol dehydrogenase, the enzyme that is responsible for the metabolism of ethylene glycol and methanol
organophosphate pesticides?
cholinesterase inhibitors
- pralidoxime directly affects the inactivated cholinesterase enzyme
what antihypertensives cause peripheral edema?
CCB’s
- amlodipine, nifedipene
what is the first line tx of glaucoma?
prostaglandins: latanoprost
- increase outflow of aqueous humor
nonselective beta blocker that also blocks a-1 receptors
- decreases venous return, SVR, and HR
labetalol
selective CCB that improves outcomes in pts with SAH, by preventing/reducing the extent of ischemic neurologic defectis caused by cerebral vasospasm
nimodipine
anti-inflammatory that binds tubulin and inhibits polymerization
- reduces neutrophil chemotaxis (acute gout flare)
colchicine
glycopyrrolate, hyoscyamine, propanthelene
selective muscarinic antagonists
- used to lessen GI sx of pyridostigmine (inhibits ACh degradation) for MG
meds that increase risk of osteoporosis?
PPI’s, glucocorticoids, aromatase inhibitors, anticonvulsants that induce CYP450 (carbamazepine, phenobarbital, phenytoin)
why give desmopressin to kid with vWD?
increases vWF release from endothelial cells
MOA of methimazole and PTU?
thioamides inhibit thyroid peroxidase, the enzyme responsible for iodine organification and coupling of iodotyrosines
- PTU also decreases peripheral conversion of T4 -> T3
do macrolides inhibit or induce CYP3A4?
inhibit
- watch out for concurrent abx use with statins (statins can cause myoglobinuria, and can be exacerbated by erythromycin/clarithromycin)
donepezil, rivastigmine
AChE-inhibitors used to treat Alzheimers
- can precipitate bradycardia and AV block d/t unopposed PNS stimulation
what meds up-regulate LPL, resulting in increased oxidation of fatty acids
- also inhibit cholesterol 7a-hydroxylase which halts the synthesis of bile acids
fibrates (fenofibrate, genfibrozil)
- reduced bile acid production decreases cholesterol solubility -> increases likelihood of gallstones
difference between paclitaxel and vinka alkaloids?
- paclitaxel inhibits microtubule disassembly (makes it super stable)
- vinkas inhibit microtubule formation
both cause neuropathy!
preferred anticoag for venous thromboembolism in pregnancy?
enoxaparin (low molecular weight heparin)
anti-HER2 monoclonal Ab?
tratuzumab (trat-TWO-zumab for HER-two)
what is the antidote for b-blocker overdose?
glucagon
- increases HR and contractility independent of adrenergic receptors (upregulates cAMP -> increasing Ca release)
peripheral dopamine-1 receptor agonist that raises intracellular cAMP -> vasodilation
- tx for hypertensive emergency
fenoldapam
what is the first line tx for essential tremor
- tremor that gets worse when holding an object, improves with alcohol
propranolol
what synthetic hormone acts like FSH and triggers the formation of a dominant ovarian follicle?
menotropin (human menopausal gonadotropin)
- HCG mimics LH surge (can be given to induce ovulation)
tx for organophosphate poisoning (AChE-I)?
- atropine: relieves muscarinic hyperstimulation
2. THEN pralidoxime: cholinesterase reactoivator works at both muscarinic and nicotinic
