Rx Final Flashcards
B2 Adrenergic Agonists (sympathomimetics)
ASTHMA: Bronchodilators
“short term relievers”
activates B2 receptor= inc cAMP= SM relaxes.
Dec mast cell mediator release, exudate. inc mucocillary clearance and surfactant.
epinephrine
isoproterenol
ASTHMA: Bronchodilators Nonselective B2 Adrenergic Agonists (sympathomimetics) use: rapid, emergency use inject/inhale side effects: cardiac/GI
albuterol
terbutaline
ASTHMA: Bronchodilators Short acting B2 Adrenergic Agonists (sympathomimetics) first line for acute exacerbation 1-4 hours use: acute asthma, COPD side effect: tachycardia, tremor toxicity and interactions with MAOi
salmeterol
formoterol
COPD/ASTHMA: Bronchodilators Long acting B2 Adrenergic Agonists (sympathomimetics) >12hrs, lipid soluble slow onset side effect: CYP3A4 interactions headache, cough
Symbicort
Advair
Dulera
ASTHMA: Bronchodilators
Combination drugs: B2 adrenergic+ anti-inflamm
Symbicort: budesonide+formoterol
Advair: fluticasone+salmeterol
Dulera: formoterol+mometasone
Atropine
ipratropium
tiotropium
ASTHMA: Bronchodilators
Muscarinic antagonists (anticholinergics)
blocks acetylcholine M3= bronchodilation and dries secretions
tx for COPD
side effects: mouth drying, tachycardia
theophylline
theobromine
ASTHMA: Bronchodilators
Methylxanthines
blocks adenosine A2 receptor (stops constriction) and PDE (inc cAMP)
use: maintenance therapy for moderate asthma
side effects: ess effective
caffeine-like sleep prodlems, tachycardia, diuretic, nervous,sz
corticosteroids
ASTHMA: Anti-inflammatory- “long term controllers”
most potent and effective
used in combo +B2 agonist
dec cytokines, arachidonic acid, prostaglandin, leukotriene, NF-kB
binds intracellular glucocorticoid receptors
prednisone
ASTHMA: Anti-inflammatory corticosteroids use: acute exacerbation and chronic severe asthma oral chronic use= adverse effects cushings, weight gain, mood alteration
beclomethasone
fluticasone
budesonide
ASTHMA: Anti-inflammatory corticosteroids inhaled long half life side effects: cataracts, dec bone desity/growth rate, oral candidiasis, dysphonia
leukotriene pathway modifiers
ASTHMA: Anti-inflammatory
inhibits receptor or synthesis of LTBr, LTC4 and LTD4
use: mild and persistent asthma (requires less steroid use)
zileuton
ASTHMA: Anti-inflammatory
leukotriene pathway modifiers:
inhibits leukotriene (5-lipoxygenase) synthesis
oral
prophylaxis
long lasting
use: intrinsic asthma (asa-induced and exercise)
less effective
side effects: hepatic injury and CYP1A2 inhibition, GI, headaches
zafirlukast
montelukast
ASTHMA: Anti-inflammatory leukotriene pathway modifiers: antagonize leukotriene (LTD4) receptor oral prophylaxis long lasting use: intrinsic asthma (asa-induced and exercise) less effective side effects: hepatic injury and CYP1A2 inhibition, GI, headaches
omalizumab (xolair)
ASTHMA: Anti-inflammatory Anti-IgE antibody: monoclonal antibody blocks IgE mast cell activation use: extrinsic asthma (allergic) subQ q3weeks expensive side effect: URI’s, headache, cancer
cromolyn
nedocromil
ASTHMA: Anti-inflammatory Anti-IgE antibody: reduces mast cell degranulation inhalation prophylaxis not used today less effective
bupropion
SMOKING CESSATION
dopaminergic-noradrenergic reuptake inhibitor
tricyclic antidepressant
also nicotinic acetylcholine receptor antagonist
varenicline
SMOKING CESSATION
nicotine receptor agonist
roflumilast
cilomilast
COPD: PDE4 inhibitor
inc cAMP= relax SM and dec inflamm
improved FEV1
azithromycin
COPD:
prophylactic antibiotic
side effect: hearing loss
Tx for COPD
COPD tx:
- short/long acting anticholinergic
- inhaled short/long-acting B2 agonist
- inhaled corticosteroid
- PDE4 inhibitor
- prophylactic antibiotic
Tx for ASTHMA
- Bronchodilators- “short term relievers”
- Anti-inflammatory- “long term controllers”
- Combination drugs: B2 adrenergic+ anti-inflamm
IV FLUIDS: isotonic fluid
concentration of solutes= plasma
isosmotic volume expansion
no change in osmolarity of ECF or ICF
IV FLUIDS: Hypotonic fluid
will swell the RBC’s
lower tonicity or solute concentration
lowers serum osmolarity in vascular space, fluid shift to intracellular/interstitial space
IV FLUIDS: Hypertonic fluid
will shrink the RBC’s
higher tonicity or solute concentration
increases serum osmolarity and draws water out of intercellular space
volume expanders: increases extracellular volume
IV FLUIDS: Crystalloids
solution of small molecules that flow easily across cell membranes: interstitial and intravascular
saline: isotonic (normal) 0.9%
IV FLUIDS: Crystalloids
NaCl
pH=5
osmolarity=300
distribution: extracellular fluid (250 in intravascular and 750 in interstitial)
will raise ECF volume and BP
use: fluid depletion (hypovolemia), low extracellular fluid:
shock, hemorrhage, n/v, wound drainage, mild hyponatremia, metabolic acidosis
risk: hyperchloremia, metabolic acidosis, dec renin/aldosterone, impaired coagulation, renal vasoconstriction and dec GFR, volume overload
saline:
Hypotonic .45%, .25%
IV FLUIDS: Crystalloids
shift fluid into cells
use: hypernatremia, DKA, hyperosmolar hyperglycemic state
risk of hyponatremia in extracellular volume depletion pts (post surgical, trauma, burns); increased cerebral edema, hypotension, hypovolemia
saline: Hypertonic
IV FLUIDS: Crystalloids
rarely used
use: severe hyponatremia, cerebral edema
risk: fluid volume overload and pulmonary edema
Dextrose
IV FLUIDS: Crystalloids
glucose, can be metabolized to intracellular/extracellular
pH=4
osmolarity=250, isotonic
distribution: free diffusion (60 in intravascular, 240 in interstitial, 700 in cells)
use: NPO pt’s
risk of osmotic diuresis and extracellular volume depletion in diabetics; volume overload and renal failure, cerebral edema
Lactated Ringer’s
IV FLUIDS: Crystalloids
(K, HCO3, Mg, Ca)
pH= 6.5
osmolarity= 275 (close to serum)
use: fluid replacement:
burn patients, n/v/d, fistula drainage, acute blood loss, third-space shifts
pro’s:lower incidence of imbalance, improved gastric perfusion
risk for hyperkalemia in renal failure pts
do not use in liver disease, lactic acidosis, or pH>7.5
IV FLUIDS: Colloids
solution with large molecules that don’t pass the cell membrane (stay intravascular).
increase oncotic pressure and draw fluids in from extravascular space
pro’s: long duration, less volume
Albumin
IV FLUIDS: Colloids
increase oncotic pressure and draw fluids in from extravascular space
charged
use: shock
side effects: loss of capillary barrier and hyperalbuminema
risk in hypoalbuminemic pts (cirrhosis, neph syndrome)
Dextrans
Hetastarch
IV FLUIDS: Colloids
increase oncotic pressure and draw fluids in from extravascular space
risk: allergic reactions
Blood product
IV FLUIDS: Colloids
use: volume replacement, low hematocrit
Chlorothiazide HCTZ metolazone chlorthalidone indapamide
DIURETICS: Thiazides
inhibits distal tubule Na/Cl reabsorption; eliminates H2O
first choice
use: HTN, CHF, nephrotic syndrome, edema, diabetes insipidus
very strong
side effects: electrolyte imbalance (inc loss of K and Mg), inc uric acid, *hyponatremia and hypokalemia
Chlorothiazide
HCTZ
DIURETICS: Thiazides use: inc Ca resorb and vasodilation side effect: hypercalcemia, hyperuricemia, hyperglycemia, drug interactions (NSAID) dec GFR not in pregnancy (dec placental flow)
Furosemide (Lasix)
Ethacrynic Acid
Bumetanide
torsemide
DIURETICS: Loop
inhibit thick ascending loop Cl reabsorption
(Na/K+2Cl inhibitor)
side effect: electrolyte imbalance, dehydration
dec effective circulating volume
hypokalemia, hyperuricemia
Furosemide (Lasix)
DIURETICS: Loop
Use: low GFR pts, HTN emergency, CHF, edema, diabetes, nephrotic syndrome, hyperkalemia, hypercalcemia
also vasodilates
oral or IV
side effects: loss of Ca, Mg, and K in urine, electrolyte imbalance, ototoxicity, dec response over time
Amiloride
Spironolactone
Eplerenone
Triamterene
DIURETICS: Potassium Sparing
Na/H2O excretion at collecting tubule
retain K
side effects: hyperkalemia
Amiloride
DIURETICS: Potassium Sparing
increase distal convoluted tubule Na excretion and dec K secretion
**principal cells in collecting duct
use: metabolic alkalosis
rapid onset
side effect: hyperkalemia (EKG changes), Na/water depletion
diabetes= glucose intolerance
Spironolactone
DIURETICS: Potassium Sparing
aldosterone receptor antagonist (only diuretic that works from outside tubule) =dec Na resorb
use: edema, CHF, HTN, post MI, ascities
side effects: endocrine imbalances, hyperkalemia, gynecomastia
diabetics/renal insufficiency=anuria
Eplerenone
DIURETICS: Potassium Sparing aldosterone receptor antagonist K sparing diuretic use: edema, CHF, HTN **lower affinity for other steroid hormone receptors than spironolactone = less side effects
Triamterene
DIURETICS: Potassium Sparing inhibits collecting tubule Na reabsorption and K/H secretion rapid absorbed/excreted side effect: turns urine blue dec renal blood flow not in hyperaldosteronism highly toxic, renal fail
Acetazolamide
DIURETICS: Carbonic Anhydrase Inhibitors
blocks proximal tubule’s carbonic anhydrase
(blocks HCO3- resorb)
use: CHF, pulmonary edema, glaucoma, metabolic alkalosis, high altitude
PO/IV
side effect: acidosis, rash, hypersensitivity
metabolic acidosis, inc Cl and NH4+, hepatic cirrhosis, renal stones
Mannitol
DIURETICS: Osmotic
inhibits H2O reabsorption throughout nephron
use: acute renal fail, glaucoma, brain edema, drug overdose
generates high osmotic pressure to draw in H2O
IV
side effect: initial inc plasma volume and BP, can= HF
headache, n/v, chills, dizziness
hypernatremia
