T3: just drogas Flashcards
phenylephrine
a1-agonist
maintain BP during neurogenic shock, hemorrhoids, nasal congestion, supraventricular tachycardia, mydriatic
midodrine
a1-agonist
orthostatic hypotension, urinary incontinence
cocaine
indirect acting sympathomimetic
inhibits reuptake NE at symp. nerve terminals
local anesthetic, vasoconstriction, reduces epistaxis
pseudoephedrine/ephedrine
indirect acting sympathomimetic
stim. rel. of NE from symp. nerve endings and dir. stim. adr. rec.
pseudoephedrine: tx nasal/bronchial congestion
amphetamine/methamphetamine/
methylphenidate
indirect acting sympathomimetic
stim. catechol. rel. from symp. and central* nerve endings
acebutolol (sectral)
B1-blocker
(part. agonist and mem stab) compete reversibly with NE
antiHTN, prevent CV disease
protect against catecholamine and thyroid storm
atenolol (tenormin)
B1-blocker
antiHTN, prevent CV disease
protect against catecholamine and thyroid storm
esmolol (brevibloc)
B1-blocker
antiHTN, short duration, use in acute tx
protect against catecholamine and thyroid storm
metoprolol (lopressor, toprol-XL)
B1-blocker
(mem stab?)
antiHTN, prevent CV disease
protect against catecholamine and thyroid storm
nadolol (corgard)
B1 and B2 blocker
antiHTN, prevent CV disease, long-duration, chronic
protect against catecholamine and thyroid storm
pindolol
B1 and B2 blocker
(part. agonist and men stab?)
antiHTN, prevent CV disease
protect against catecholamine and thyroid storm
propranolol (inderal-LA)
B1 and B2 blocker
(mem stab)
antiHTN, prevent CV disease
protect against catecholamine and thyroid storm
timolol (timoptic)
B1 and B2 blocker
antiHTN, prevent CV disease
glaucoma: red. IOP by inhib. AH prod. (cil. epi) (little mem. stabilizing effect)
protect against catecholamine and thyroid storm
labetalol (trandate)
combo B-blocker PLUS a-blocker
antiHTN (primary) mod-severe, emergency tx of HTN crisis prevent CV disease
nebivolol
combo B1-blocker/endo-dep vasodilator
antiHTN, prevent CV disease (prod. NO from endothelium)
carvedilol
combo B1-blocker/a-blocker/antioxidant
heart failure
sotalol
combo B-blocker/K+channel blocker
arrythmias
phenoxybenzamine (dibenzyline)
non-selective a1 and a2 blocker
antiHTN, long-acting, pheochromocytoma pre-op/inop
only a-blocker that is non-competitive, irreversible
phentolamine (oraVerse)
non-selective a1 and a2 blocker
antiHTN, short-acting, “Phentolamine test”: dx pheos, use DURING pheo surg., NE OD, prev. local dermal tissue necrosis from NE
oraVerse reverses local anesthesia constriction
prazosin (minipress)
selective a1 blocker
antiHTN, long-term mild-mod, CV disease prevention, BPH relief, Raynaud’s, PTSD nightmares
terazosin (hytrin)
selective a1 blocker
antiHTN (BPH) prevent CV disease
doxazosin (cardura)
selective a1 blocker
antiHTN, (BPH), CV disease prevention
tamsulosin (flomax)
selective a1 blocker (a1A subtype)
BPH
alfuzosin (uroxatral)
selective a1 blocker (“uroselectivity”)
BPH
silodosin (rapaflo)
selective a1 blocker (a1A subtype)
BPH
reserpine
sympathetic neuronal blocker, peripherally-acting
antiHTN, CV disease prevention
dec. uptake of DA and NE into storage vesicles–>dec. available NE to rec.–>dec. CO and TPR
CNS effects, *irrev.
guanethidine
sympathetic neuronal blocker, peripherally-acting
antiHTN (not used anymore)
dec. uptake of DA & NE into storage vesicles–>dec. available NE to rec.–>dec. CO and TPR
also directly blocks NE release from nerve endings
(interactions w/ tricyc. antideps: imipramine, desipramine)
methyldopa
sympathetic neuronal blocker, centrally-acting, prodrug
(actually a2-rec agonist! (neg FDBK))
antiHTN, esp. during pregnancy, CV disease prevention
*all centrally acting adr. blockers: stim. a2 adr. rec in brain (neg fdbk)–>indir. red SNA from CNS(vasomotor center)–>peripheral CV organs
clonidine (catapres)
sympathetic neuronal blocker, centrally-acting
(actually a2-rec agonist! (neg FDBK))
tx primary HTN, ADHD, hot flashes, PTSD, withdrawal (etOH, nicotine, morphine), analgesic into spinal cord
CV disease prevention can use patch for smooth BP control, more rebound HTN than methyldopa
guanabenz
sympathetic neuronal blocker, centrally-acting
(actually a2-rec agonist! (neg FDBK))
antiHTN, lowers cholesterol
guanfacine
sympathetic neuronal blocker, centrally-acting
(actually a2-rec agonist! (neg FDBK))
antiHTN, ADHD (intuniv)
aproclonidine
sympathetic neuronal blocker, centrally-acting
(actually a2-rec agonist! (neg FDBK))
lower post-surg. IOP (inc. a2 agonist in eye)
brimonidine
sympathetic neuronal blocker (a2 agonist)
lower IOP in glaucoma
nicotine
ganglionic stimulant (blocks at high doses) nicotine addiction tx
mecamylamine
ganglionic blocker (pre-post nicotinic neural) *discontinued* tx severe HTN, Tourette's, nicotine addiction tx (trimethaphan, hexametonium also discontinued)
epinephrine
adrenergic bronchodilator
*B agonists also stabilize mast cells, inhib. degranulation/rel. of autocoids
tx for acute/life-threatening asthma (B2 typically) (epi. inc. cardiac performance)
BLACK BOX FOR ALL ADR. BRONCHODILATORS: may cause death in asthmatic pts (CNS: seizures; heart: palpitations)
isoproterenol
adrenergic bronchodilator
metaproterenol (alupent)
adrenergic bronchodilator
albuterol (ventolin)
adrenergic bronchodilator
levalbuterol (xopenex)
adrenergic bronchodilator
salmeterol (serevent)
adrenergic bronchodilator
*long acting, not acute tx
terbutaline (brethine)
adrenergic bronchodilator
pirbuterol (maxair)
adrenergic bronchodilator
theophylline (theodur)
methylxanthine bronchodilators severe asthma also stabilize mast cells, inhib. phosphodiesterase-->inc. cAMP in smooth musc/mast cells interact w/ adenosine rec *narrow tx window*
aminophylline
methylxanthine bronchodilators severe asthma also stabilize mast cells, inhib. phosphodiesterase-->inc. cAMP in smooth musc/mast cells interact w/ adenosine rec *narrow tx window*
beclomethasone (QVAR, Vanceril)
corticosteroids
flunisolide (aerobid)
corticosteroids
triamcinolone (azmacort, nasocort)
corticosteroids
fluticasone (flovent, flonase)
corticosteroids
fluticasone + vilanterol = breo ellipta inhaler : COPD
budesonide (pulmicort, rhinocort)
corticosteroids
prednisone (oral)
corticosteroids allergic rxns, asthma (ppx, not nec. acute) (red. sev, shorten duration of attacks); v. severe allergies inhaled forms (vs. systemic) red. toxicity *corticosteroids primarily anti-inflammatory, inhib. autocoid syn., red. cell-mediated immunological damage; secondarily stabilize mast cells
mometasone (asmanex, nasonex)
corticosteroids
methylprednisonlone (oral)
corticosteroids
cromolyn sodium
mast cell stabilizer
inhib. rel. of histamine/other autocoids from sens. mast cells
ppx, not acute; use w/ other agents
asthma, allergic rhinitis/conjunctivitis, GI allergies
monteleukast (singulair)
leukotriene modulator
blocks leukotriene rec (CysLT 1 and 2)
aspirin-sensitive asthma, dec. freq and sev.
seasonal allergies
zafirleukast (accolate)
leukotriene modulator
blocks leukotriene rec (CysLT 1 and 2)
aspirin-sensitive asthma, dec. freq and sev.
zileuton (zyflo)
leukotriene modulator
inhibits lipooxygenase enzyme, dec. leukotriene formation
aspirin-sensitive asthma, dec. freq and sev. (QID)
ipratropium (atrovent)
antimuscarinic
prevent acetylcholine-induced bronchospasm
quaternary, few syst. effects
tiotropium (spiriva)
antimuscarinic
prevent acetylcholine-induced bronchospasm
COPD
aclidinium (tudorza)
antimuscarinic
prevent acetylcholine-induced bronchospasm
COPD
advair diskus
(salmeterol/fluticasone)
combo product for asthma
combivent
(ipratroium/albuterol)
combo product for asthma
symbicort
(formoterol/budesonide)
combo product for asthma
dulera
(formoterol/mometasone)
combo product for asthma
omalizumab (xolair)
immunomodulator (anti-IgE), MoAb
asthma
give IV, inj.
diphenhydramine (benadryl)
H1 histamine antagonist
tx allergic rhinitis, dermatitis, conjunctivitis NOT asthma/anaphylaxis; dec. severity of symptoms
fexofenadine (allegra)
H1 histamine antagonist
tx allergic rhinitis, dermatitis, conjunctivitis NOT asthma/anaphylaxis; dec. severity of symptoms
cetirizine (zyrtec)
H1 histamine antagonist
tx allergic rhinitis, dermatitis, conjunctivitis NOT asthma/anaphylaxis; dec. severity of symptoms
loratidine (claritin, alavert)
H1 histamine antagonist
tx allergic rhinitis, dermatitis, conjunctivitis NOT asthma/anaphylaxis; dec. severity of symptoms
hydrochlorothiazide (microzide)
diuretic (thiazide)
works at distal convoluted tubule, prev. reabsorp. NaCl
antiHTN, prevent CV disease
furosemide (lasix)
diuretic (loop)- most powerful!
works at thick asc. limb of loop of Henle, prev. reabsorb. Na and Cl
antiHTN, prevent CV disease
spironolactone (aldactone)
diuretic
K+ sparing, works at collecting duct
antiHTN, prevent CV disease
verapamil (calan)
Ca2+ channel blocker
antiHTN, prevent CV disease (works in heart)
nifedipine (procardia-XL)
Ca2+ channel blocker
antiHTN, prevent CV disease (works @ arts)
captopril (capoten)
ACE inhibitor
prev. conversion of AngI–>AngII
antiHTN, prevent CV disease
losartan (cozaar)
Angiotensin II rec blocker (ARBs)
works AFTER AngII produced; blocks binding
antiHTN, prevent CV disease
lovastatin (mevacor)
HMG-CoA reductase inhibitor
tx for hyperlipoproteinemia (reduce cholesterol), prevent CV disease
levothryoxine (synthroid)
synthetic T4
tx for hypothyroidism
(2nd most prescribed drug in US)
131-Iodine
tx hyperthyroidism
kills thyroid cells, need other hyperthyroid drugs to make pt EUTHYROID before 131-I, also for thyroid Ca
not for nursing moms
propylthiouracil (PTU)
thionamide
tx hyperthyroidism, thyroid storm
inhibit steps 3 (iodination) and 4 (coupling of iodotyrosines)
do not inhibit release of T4/T3
also inhibits deiodinase (T4–>T3), better for more severe cases
better for pregnant pts
KI (Potassium Iodide, Lugol’s solution)
iodine
tx hyperthyroidism, thyroid storm
inhibits synthesis AND release of pre-formed/stored hormone, temporary, used w/ thionamides (1st) (thy. storm)
then propranolol, glucocorticoids, antipyretics (NOT ASA)
alendronate (fosomax)
amino substituted bisphosphonate
more potent, longer acting
osteoporosis, Paget’s disease
incorp. into bone-inhib pyrophosphates in osteoclasts-slow bone turnover
risedronate (actonel)
pyridinal bisphosphonate
osteoporosis, Paget’s disease
incorp. into bone-inhib pyrophosphates in osteoclasts-slow bone turnover (binds hydroxyapatite in bone)
ibandronate (boniva)
bisphosphonate (1x/month)
osteoporosis, hypercalcemia (malignancy)
incorp. into bone-inhib pyrophosphates in osteoclasts-slow bone turnover
zoledronic acid (relclast, zometa)
bisphosphonate (take 1x/year!)
reclast: osteoporosis, Paget’s disease
zometa: hypercalcemia (malignancy)
incorp. into bone-inhib pyrophosphates in osteoclasts-slow bone turnover
raloxifene (evista)
selective ESTROGEN receptor modulator (SERM)
osteoporosis (postmenopausal)
dec. osteoclast activity AND inc. osteoblast activity
(less breast ca, HD risk then general estrogen) (agonist in bone, antag in breast/uterus)
calcitriol (rocaltrol)
1,25 hydroxyvitamin D
inc. dietary Ca2+ absorp. in GI, promotes osteoblast act.
osteoporosis, (hypoparathyroidism)
calcitonin (calcimar)
from parafollicular C cells, lowers serum Ca2+ (inhib. osteolysis), decreases osteoclast activity
hypercalcemia, Paget’s disease (bone), 2nd line for postmen. osteoporosis
methimazole (tapazole)
thionamide
tx hyperthyroidism, thyroid storm
inhibit steps 3 (iodination) and 4 (coupling of iodotyrosines)
do not inhibit release of T4/T3
T3 or 3,5,3’-triidothyronine (cytomel)
tx for hypothyroidism
very potent
rarely used except in sev. situations (in conjunction w/ levothyroxine)
desiccated animal thyroid (armour thyroid)
tx for hypothyroidism
combo T3, T4; not 1st choice, use if don’t respond to levothyroxine
weight loss products OTC
liotrix (euthroid)
tx for hypothyroidism
4:1 mixture T4:T3, expensive, rarely used
aspirin, ibuprofin, NSAIDs, etc
inhib. PG syn (COX-1 and COX-2)
act at nerve endings in CNS
anti-inflammatory effects
acetaminophen
inhibs. PG syn in nerve endings and CNS, not periphery
no antiinflammatory action
ketorolac (toradol)
injectable NSAID
alt. to opioid for short-term pain
celocoxib
selective COX-2 inhib (rofecoxib, valdecoxib no longer on the market)
local anesthetics (lidocaine)
block sodium channels in nerve endings and axons and stop gen/cond of APs
opioids
agonists at rec. for endorphins and enkephalins
act in limbic system
can act in SC to inhibit pain transmission
morphine
u agonist opioid analgesic
severe pain
codeine
u agonist opioid analgesic
moderate pain
fentanyl (sublimaze)
u agonist opioid analgesic
severe pain
heroin
u agonist opioid analgesic
schedule 1: do not prescribe (no shit)
hydrocodone (vicodin, lortab)
u agonist opioid analgesic
moderate pain
hydromorphone (dilaudid)
u agonist opioid analgesic
severe pain
meperidine (demerol)
u agonist opioid analgesic
controversial!
methadone (dolophine)
u agonist opioid analgesic
controversial!
severe pain
tx heroin addiction
oxycodone (percodan, percocet, oxycontin)
u agonist opioid analgesic
controversial!
severe pain
pentazocine (talwin)
partial/mixed agonist/antagonist opioid analgesic
buprenorphine (buprenex, subutrex, suboxone)
partial/mixed agonist/antagonist opioid analgesic
tramadol (ultram)
partial/mixed agonist/antagonist opioid analgesic
controversial!
moderate pain
vicodin
5 mg hydrocodone + 500 mg acetaminophen
be careful w/ combos, may OD
amitriptyline
antidepressant, tx for chronic pain w. opioids, neurogenic pain
carbamazepine
anticonvulsant, tx for neurogenic pain
gabapentin (neurontin)
anticonvulsant, tx for neurogenic pain
pregabalin (lyrica)
anticonvulsant, tx for neurogenic pain
ciclesonide (alvesco, omnaris)
corticosteroid
norepinephrine
antidote for too much ganglionic block: CV support for neurogenic shock
pamidronate (aredia)
amino substituted bisphosphonate
hypercalcemia of malignancy, Paget’s disease (occas.)
zoledronate (zometa)
new bisphosphonate
hypercalcemia