Test 1 Flashcards
1
Q
All drugs in the opiate category act by binding to specific opioid receptors in order to produce effects that mimic the actions of endogenous neurotransmitters, referred to as
A
the opiopeptins
2
Q
The opiopeptins include peptides such as
A
endorphins and enkephalins
3
Q
The analgesic properties of the opiates are primarily mediated by
A
mu receptors…mu 1 most commonly for pain
4
Q
enkephalins interact more selectively with what receptors
A
delta receptors in the periphery
5
Q
receptor possibly responsible for hallucinations and dysphoria often associated with opiate use
A
sigma receptor
6
Q
class of Morphine/ MS Contin
A
opioid analgesic
7
Q
ind. of Morphine/ MS Contin
A
pain relief
8
Q
MOA of Morphine/ MS Contin
A
Potent opioid agonist. High affinity for μreceptors. Morphine relieves pain both by raising the pain threshold at the brain stem, thalamic and spinal cord level as well as by altering the brain’s perception of pain. Patients treated with morphine may still be aware of the presence of pain but perception of the actual sensation of pain is blocked.
9
Q
Morphine/ MS Contin can also be used for what condition
A
acute myocardial infarction. It can potentially provide pain relief, decrease anxiety and also acts as a peripheral vasodilator.
10
Q
side effects of Morphine/ MS Contin
A
Morphine causes respiratory depression by reducing the sensitivity of respiratory center neurons to carbon dioxide. Respiratory depression is the most common cause of death related to morphine. Miosis (pin point pupils) is due to enhanced parasympathetic stimulation to the occulomotor nerve. Itching is a common side effect due to the fact that the opiate drugs can stimulate histamine release.
Morphine often causes nausea and vomiting due to stimulation of the chemoreceptor trigger (nausea center) in the brain. Constipation due to reduced G.I. smooth muscle motility. PARALYTIC ILEUS is possible. Morphine crosses the placenta, thus potentially creating physical dependence in infants exposed to the drug.
11
Q
class of Fentanyl/ Duragesic
A
opioid analgesic
12
Q
indication of Fentanyl/ Duragesic
A
pain relief, anesthesia
13
Q
MOA of Fentanyl/ Duragesic
A
similar to morphine with 80x the analgesic property of morphine. Used for anesthesia and for intractable pain
14
Q
Drug often used as a transdermal patch or lollypop form
A
Fentanyl/ Duragesic
15
Q
side effects of Fentanyl/ Duragesic
A
Respiratory depression with life threatening hypoventilation can occur. Patients using concomitant CYP 450 inhibitors may result in fatal blood levels of Fentanyl. Nausea/ vomiting. Constipation is a commonly occurring side effect and paralytic ileus can occur. Highly addictive.
16
Q
class of Codeine
A
opioid analgesic
17
Q
indication of Codeine
A
pain relief, antitussive
18
Q
MOA of Codeine
A
Opioid agonist, is converted to morphine in the body but mg per mg, codeine is much weaker analgesic then morphine.
19
Q
Can you cut a Fentanyl/Duragesic patch?
A
No, it will mess up the timed release of the patch.
20
Q
Should you place a heating pad on a Fentanyl/Duragesic patch?
A
No, it will increase the dose
21
Q
side effets of Codeine
A
Sedation, constipation, itching and increased potential for exaggerated response in certain individuals at risk due to genetic variability . The FDA has issued a Drug Safety Communication after reviewing reports of children who developed serious adverse effects, including death, after receiving codeine in the usual dosage range for pain relief following tonsillectomy and/or adenoidectomy for obstructive sleep apnea syndrome.
22
Q
Which is better at controlling cough: Codeine, Morphine, or Fentanyl?
A
Codeine
23
Q
Respiratory depression, a common side-effect of most opioids, is not clinically significant in normal doses of
A
Tramadol/ Ultram
24
Q
Drug used in the controlled withdrawal of heroin and morphine in addicted patients
A
Methadone…Dependence can develop but the withdrawal syndrome is much milder then with heroin or morphine.
25
class of Naloxone/ Narcan
opioid antagonist
26
indication of Naloxone/ Narcan
Opioid overdose. Naloxone/ Narcan is used to reverse the coma and respiratory depression of opioid overdose.
27
MOA of Naloxone/ Narcan
Opioid antagonists bind with high affinity to opioid receptors but do not activate the receptor mediated response
28
isomer of codeine.
Dextromethorphan...effective antitussive and is commonly used in OTC cough meds. Generally has little to no analgesic, sedative or GI effects.
29
Pain relief agents you would not be expected to effect the GI
agents with DM aka dextromethorphan
30
The nonsteroidal anti-inflammatory drugs (NSAIDs) act by inhibiting the synthesis of
prostaglandins
31
Prostaglandins, thromboxanes and prostacyclins are all synthesized from the precursor fatty acid, arachadonic acid, via the
cyclooxygenase pathway
32
COX 1 and 2 inhibitors
aspirin and other salicylates, ibuprofen (motrin, advil), acetaminophen (tylenol)
33
isolated COX 2 inhibitor
Celecoxib (celebrex)
34
class of Aspirin/ Acetylsalicylic acid (ASA)
NSAID
35
indication of Aspirin/ Acetylsalicylic acid (ASA)
inflammation, pain, fever
36
MOA of Aspirin/ Acetylsalicylic acid (ASA)
Irreversible inhibition of COX-1 and COX-2 enzymes. Anti-inflammatory and analgesic effect largely due to blockade of prostaglandin synthesis at target tissues. Anti-pyretic effect due to blockade of prostaglandin synthesis at thermoregulatory centers in the hypothalamus.
Prostaglandin E2 (PGE2) is thought to sensitize nerve endings to the actions of bradykinins, histamines and other inflammatory mediators. Thus, aspirin serves to diminish pain by decreasing tissue sensitivity to the sensation of pain.
37
Drug that irreversibly inhibits COX-1 and COX-2 enzymes
Aspirin/ Acetylsalicylic acid (ASA)
38
side effects of Aspirin/ Acetylsalicylic acid (ASA)
Many potential side effects. Primarily G.I. irritation and peptic ulcer disease, nausea, and vomiting. Increased risk of bleeding. Renal insufficiency. Increased risk of Reye’s syndrome.
Salicylism involves dizziness, tinnitus, hyperventilation, mental status changes and potential for coma and death.
Treatment for salicylism involves I.V. hydration, alkalinization of urine and dialysis if renal insufficiency occurs.
39
class of Ibuprofen/ Motrin, Advil
NSAID
40
ind. of Ibuprofen/ Motrin, Advil
inflammation, pain, fever
41
MOA of Ibuprofen/ Motrin, Advil
Reversible inhibition of COX-1 and COX-2 enzymes. Anti-inflammatory and analgesic effect largely due to blockade of prostaglandin synthesis at target tissues.
42
class of Celecoxib/ Celebrex
NSAID
43
ind. of Celecoxib/ Celebrex
inflammation, pain, treatment of adenomatous polyps
44
MOA of Celecoxib/ Celebrex
reversible, selective COX-2 inhibition
45
side effects of Celecoxib/ Celebrex
presently unclear if a definite increased risk for cardiovascular disease exists with Celecoxib/ Celebrex
46
drug with reversible, selective COX-2 inhibition
Celecoxib/ Celebrex
47
2004, Merck & Co., Inc. announced a voluntary withdrawal of ___ from the U.S. and worldwide market due to safety concerns of an increased risk of cardiovascular events (including heart attack and stroke) in patients on
Rofecoxib/ Vioxx
48
class of Acetaminophen/ Tylenol
NSAID
49
indication of Acetaminophen/ Tylenol
pain, fever
50
MOA of Acetaminophen/ Tylenol
Not fully understood. Weak peripheral blockade of prostaglandin synthesis with stronger blockade of prostaglandin synthesis in hypothalamus
51
side effects of Acetaminophen/Tylenol
overdose (>7 gm/ 24 hrs) or when acetaminophen is taken with alcohol can lead to severe hepatic necrosis leading to liver failure, coma and death.
52
Never mix Acetaminophen/Tylenol with
alcohol
53
maximum safe dose of Acetaminophen/Tylenol in the absence of alcohol use or underlying liver disease
4 grams/24 hours
54
Acetaminophen is oxidatively metabolized in the liver via the mixed function P450 system to a toxic metabolite
N-acetyl-p-benzoquinone-imine (NAPQI).
55
antidote for acetaminophen/tylenol
N-acetylcystein (NAC)
56
Serotonin 1 (5 HT-1) receptors appear to elicit
vascoconstriction
57
Serotonin 2 (5 HT-2) receptors appear to elicit
vasodilation
58
class of Propranolol/ Inderal
non-selective beta blocker
59
indication of Propranolol/ Inderal
HTN, angina, AMI, panic attacks and migraine headaches
60
what class of meds is best for prodromal phase of headaches
Triptans
61
whats classes of meds are used for actual headache phase
analgesics, anti-emetics
62
MOA of Propranolol/ Inderal
blocks adrenergic stimulation which serves to decrease heart rate and myocardial oxygen demand and also decreases renin release
63
side effects of Propranolol/ Inderal
Bronchoconstriction, hypotension, bradycardia, fatigue, impotence. Abrupt discontinuation may cause rebound hypertension and tachycardia with subsequent increase in myocardial oxygen demand. Abrupt discontinuation increases the risk of arrythmias, stroke, angina and M.I.
64
class of Amitriptyline/ Elavil
tricyclic antidepressant (TCA)
65
ind. of Amitriptyline/ Elavil
migraine/tension headache, chronic pain, bipolar disorder and depression
66
MOA of Amitriptyline/ Elavil
CNS modulation of both serotonin and norepinephrine
67
side effects of Amitriptyline/ Elavil
Dizziness and marked drowsiness. Anticholinergic effects such as dry mouth, constipation, urinary hesitancy and blurred vision. Do not use with monoamine oxidase (MAO) inhibitors. The full benefits of Amitriptyline may take days to several weeks to be observed whereas side effects are usually noted within first several days.
68
Topiramate/ Topamax class
anticonvulsant
69
ind. of Topiramate/ Topamax
anticonvulsant approved for use in treating epilepsy and prophylaxis of migraine headaches. Off-label use for bipolar disorder.
70
MOA of Topiramate/ Topamax
Block voltage-dependent sodium channels in the CNS, augmenting the activity of the neurotransmitter gamma-amino butyrate (GABA) at some subtypes of the GABA-A receptor. MOA as a migraine medication is not fully known.
71
side effects of Topiramate/ Topamax
fatigue, dizziness, vision, changes, acute angle glaucoma, nausea, constipation
72
class of Methysergide/ Sansert
Ergot derivative - serotonin 2 receptor antagonist
73
ind. of Methysergide/ Sansert
prophylaxis of migraine and cluster headache
74
MOA of Methysergide/ Sansert
MOA not fully known, yet it appears to be a serotonin 2 receptor antagonist which results in vasoconstrictor effect
75
caution w/ use of Methysergide/ Sansert
Should never be used beyond ~6 months without a drug free interval. Dosage must be tapered to avoid rebound. Do not use within 24 hrs of a triptan because of increased risk of vasoconstrictive spasm.
76
Side effects of Methysergide/ Sansert
Multiple potential side effects make methysergide a less attractive choice then newer treatment options. These side effects include but are not limited to hypertension, thrombophlebitis, nausea and vomiting. Pulmonary fibrosis and retroperitoneal fibrosis are severe and potentially life threatening occurrences.
Heart valve thickening has also been reported. Contraindicated in pregnancy (Category X) and in patients with peripheral vascular disease. Because of potential severe side effects.
Methysergide is usually reserved for cases refractive to other medications and treatment modalities.
77
Life threatening Side effects of Methysergide/ Sansert
Pulmonary fibrosis and retroperitoneal fibrosis are severe and potentially life threatening occurrences.
78
class of Sumatriptan/ Imitrex
serotonin agonist
79
ind. of Sumatriptan/ Imitrex
migraine and cluster headache
80
MOA of Sumatriptan/ Imitrex
Serotonin agonist at 5-HT 1D and 1B receptors, found in small, peripheral nerves that innervate the intracranial vasculature.
81
side effects of Sumatriptan/ Imitrex
Dizziness, tingling, facial flushing, weakness, chest tightness or pain, arrythmias and hypertension. Use with caution in patients with high blood pressure and in patients with angina.
Serotonin syndrome is an uncommon potential side effect of all of the triptans. Symptoms of serotonin syndrome may include agitation, tremor, ataxia, fever, chills and diarrhea.
Frequent use of triptans (daily basis) can result in rebound headaches. Maximum dose generally 2 to 3 doses in a 24 hour period and no more then 12 to 18 doses per month.
82
max dose of Sumatriptan/ Imitrex
Maximum of 2 doses in 24 hours
83
uncommon potential side effect of all triptans
Serotonin syndrome is an uncommon potential side effect of all of the triptans. Symptoms of serotonin syndrome may include agitation, tremor, ataxia, fever, chills and diarrhea.
Frequent use of triptans (daily basis) can result in rebound headaches.
84
The nonsteroidal anti-inflammatory drugs (NSAIDs) act by inhibiting the synthesis of
prostaglandins. Prostaglandins are also referred to as eicosanoids since “eicosa” refers to the 20 carbon atom structure.
85
class of Butorphanol/ Stadol
opioid analgesic
86
ind. of Butorphanol/ Stadol
migraine headache that is refractory to triptans and to other agents as well as less potent analgesics. Butorphanol/ Stadol may also be used in other acute pain conditions.
87
MOA of Butorphanol/ Stadol
Mixed agonist-antagonist of opioid receptors
88
side effects of Butorphanol/ Stadol
Nasal irritation, drowsiness, dysphoria, nausea and vomiting. Because of the mixed agonist-antagonist properties of Butorphanol, withdrawal symptoms can be precipitated in patients with underlying addiction to opiates.
89
class of Prochlorperazine/ Compazine
typical neuroleptic
90
ind. of Prochlorperazine/ Compazine
anti-emetic particularly when associated with migraine headaches, vertigo, anti-psychotic
91
MOA of Prochlorperazine/ Compazine
primarily H1-histamine receptor antagonist. Also a D2 dopaminergic receptor antagonist and an alpha-adrenergic receptor antagonist.
92
side effects of Prochlorperazine/ Compazine
Drowsiness, dry mouth, constipation and urinary retention. Lowers seizure threshold. Extrapyramidal side effects generally seen only when Prochlorperazine is given at high doses over long periods of time.
93
class of Ondansetron/ Zofran
antiemetic
94
MOA of Ondansetron/ Zofran
blockade of serotonin (5HT3) receptor sites results insignificant anti-nausea effect.
95
Ind. of Ondansetron/ Zofran
severe nausea
96
Side effects of Ondansetron/ Zofran
dizziness, headache. Generally well tolerated.
97
non-pharm treatment options for migraines
Riboflavin (vitamin B2) 400 mg/ day
Magnesium 600 mg to 2000 mg/ day
Biofeedback
Acupuncture
Botulinum toxin (Botox) injection has shown promise as a therapeutic agent.
98
Treatment of acute gouty attack includes
NSAIDs, Steroids, Colchicine
99
Prophylactic treatment options for gout include
colchicine, allopurinol, probenecid
100
first line treatment for gout is
NSAIDs
101
class of Indomethacin/ Indocin
NSAID
102
ind. of Indomethacin/ Indocin
gout, arthritis, bursitis, migraine, hemicrania, pain and swelling
103
MOA of Indomethacin/ Indocin
COX-1 and COX-2 inhibition
104
side effects of Indomethacin/ Indocin
bleeding, gastritis, PUD, may exacerbate hypertension or CHF. Use with caution in patients with preexisting renal and/or liver disease.
105
Avoid use of Indomethacin/ Indocin in patients with
asthma and nasal or sinus polyps
106
class of Cortisone injection
steroid
107
ind. of Cortisone injection
cortisone injection are used to give short term pain relief and reduce the swelling from inflammation of a joint, tendon or bursa as well as for marked allergic reaction or post-epinephrine treatment of anaphylaxis
108
MOA of cortisone injection
decreases inflammation by inhibiting pro-inflammatory proteins
109
side effects of Cortisone injection
Use of cortisone has a number of potential systemic side effects: hyperglycemia, insulin resistance, diabetes mellitus, osteoporosis, anxiety, depression, amenorrhea, cataracts and glaucoma, among other problems.
110
class of Colchicine
mitotic inhibitor
111
ind. of Colchicine
Gout, both for acute flares and for prophylaxis
112
MOA of Colchicine
Colchicine inhibits microtubule polymerization by binding to tubulin, one of the main constituents of microtubules. The availability of tubulin is essential to mitosis therefore mitosis is inhibited the process in affected cells.
Colchicine also inhibits neutrophil motility and neutrophil activity, resulting in an anti-inflammatory effect.
113
side effects of Colchicine
GI upset, anemia, neutropenia, hair loss, hair loss, PERIPHERAL NEUROPATHY. Colchicine overdose symptoms include: vomiting, diarrhea, acute renal failure and possible hypovolemic shock. No specific antidotes are known.
114
primary side effect of Colchicine
peripheral neuropathy
115
class of Allopurinol/ Zyloprim
Purine analog
116
indication of Allopurinol/ Zyloprim
hyperuricemia, gout, prophylaxis against tumor lysis syndrome
117
MOA of Allopurinol/ Zyloprim
xanthine oxidase inhibitor
118
side effects of Allopurinol/ Zyloprim
Nausea, vomiting, skin rash, SJS, Hypersensitivity syndrome consists of fever, skin rash, eosinophilia, hepatitis and decreased renal function.
119
what are Uricosurics?
Uricosuric medications are substances that increase the excretion of uric acid in the urine, thus reducing the concentration of uric acid in blood plasma. In general, this effect is achieved by action on the proximal tubule of the kidney. By decreasing plasma uric acid levels, uricosurics help to dissolve these crystals, while limiting the formation of new ones. However, the increased uric acid levels in urine can contribute to kidney stones.
120
class of Probenecid/Probalan
Uricosuric
121
ind. of Probenecid/Probalan
hyperuricemia, gout
122
MOA of Probenecid/Probalan
Probenecid works by interfering with the kidneys' organic anion transporter (OAT), which reclaims uric acid from the urine and returns it to the plasma. Thus, the tubular reabsorption of uric acid is decreased which serves to increase the urinary excretion of uric acid.
123
side effects of Probenecid/Probalan
GI upset, gastritis, nausea, vomiting. Anemia, leukopenia and possible hemolytic anemia, particularly in patients with glucose -6- phosphate dehydrogenase deficiency. Possible drug induced hepatitis, dizziness.
124
key side effects of Probenecid/Probalan
May cause the formation of uric acid renal stones, particularly in patients with renal insufficiency
Exacerbation of gout following therapy with Probenecid may occur.
125
common MOA of cytotoxic drugs
prevent clonal expansion of both B and T lymphocytes
126
class of Methotrexate/ MTX
anti-metabolite and anti-folate
127
ind. of Methotrexate/ MTX
Cancer, autoimmune diseases, including rheumatoid arthritis, psoriasis, psoriatic arthritis, lupus and Crohn's disease as well as an abortifacient. MTX has also been used for multiple sclerosis but is not yet FDA approved for this indication.
128
MOA of Methotrexate/ MTX
anti-metabolite and anti-folate drug
129
when taking Methotrexate/ MTX, assessment of what is necessary
creatinine levels at least every 2 months
130
side effects of Methotrexate/ MTX
The most common adverse effects include: nausea, abdominal pain, fatigue, fever, dizziness, ulcerative stomatitis, low white blood cell count and thus predisposition to infection. Other adverse effects include acute pneumonitis and rarely, pulmonary fibrosis.
Methotrexate is a highly teratogenic drug and is considered category X by the FDA. Women must not take the drug during pregnancy, if there is a risk of becoming pregnant, or if they are breastfeeding. To engage in any of these activities (after discontinuing the drug), women must wait until the end of a full ovulation cycle.
131
While using Methotrexate/ MTX for cancer, the use of what is contraindicated
folic acid, because Methotrexate/ MTX is a folate inhibitor
132
class of Azathioprine/ Imuran
purine anti-metabolite immuno-suppressant
133
ind. of Azathioprine/ Imuran
Prevention of transplant rejection, inflammatory bowel disease, SLE and rheumatoid arthritis.
134
MOA of Azathioprine/ Imuran
Metabolic breakdown products of Azathioprine act to inhibit purine synthesis which will block protein synthesis, particularly in cells that experience rapid turnover.
135
side effects of Azathioprine/ Imuran
Rapidly growing cells are most readily affected, leading to hair loss, bone marrow suppression, GI toxicity, leukopenia, and thrombocytopenia. Decreased ability to fight infection. Can cause pancreatitis. Known to cause birth defects.
136
class of Cyclosporine/ Sandimmune (Restasis)
an immunosuppressant drug derived from a soil fungus
137
ind. of Cyclosporine/ Sandimmune (Restasis)
Prevent rejection of kidney, liver and heart transplants as well as for treatment of RA and other autoimmune diseases such as severe psoriasis.
138
MOA of Cyclosporine/ Sandimmune (Restasis)
T-cell inhibition. Blocks the signal to lymphocytes to produce IL-1, IL-2, IL-3, IL-4, and interferon gamma
139
side effects of Cyclosporine/ Sandimmune (Restasis)
Nausea, vomiting, diarrhea, loss of appetite, high blood pressure, kidney damage, tremors, headaches, seizures, excessive hair growth, excessive gum growth, confusion, coma, and gout.
As is the case with all immunosuppressive drugs, there is increased risk for infection leading to sepsis for any patient taking Cyclosporine.
140
blood levels of Cyclosporine/ Sandimmune (Restasis) are increased when patients consume
grapefruit juice
141
class of Tacrolimus/ Prograf
An immunosuppressant drug related to the macrolide class of antibiotics extracted from soil microorganism.
142
ind. of Tacrolimus/ Prograf
Protection against rejection of organ transplantation. Topical treatment for severe eczema.
143
MOA of Tacrolimus/ Prograf
T-cell inhibition similar to that of Cyclosporine. Tacrolimus is approximately 100x more potent in its immunosuppressive effects then an equal volume of Cyclosporine.
144
side effects of Tacrolimus/ Prograf
Also very similar to Cyclosporine in side effect profile with nausea, vomiting, diarrhea, loss of appetite, high blood pressure, kidney damage and increased risk for infection.
145
DMARDs stands for
Disease-modifying anti-rheumatic drugs
146
class of Etanercept/ Enbrel
DMARD, recombinant-DNA drug
147
ind. of Etanercept/ Enbrel
Moderate to severe rheumatoid arthritis, moderate to severe polyarticular juvenile arthritis, psoriatic arthritis, ankylosing spondylitis and moderate to severe plaque psoriasis.
148
MOA of Etanercept/ Enbrel
Reduction of inflammatory response via anti-TNF alpha therapy.
149
side effects of Etanercept/ Enbrel
Very broad side effect profile with notable decreased resistance to infection. Increasing number of reports of potential for increased risk for leukemia, lymphoma and solid tumors, as well as increasing number of reports of serious liver injury, congestive heart failure and demyelinating central nervous system disorders.
150
Eye drop to increase tear production
Cyclosporine/ Sandimmune (Restasis)
151
class of Infliximab/ Remicade
DMARD, recombinant-DNA drug
152
ind. of Infliximab/ Remicade
RA, Crohn's disease, U.C.
153
MOA of Infliximab/ Remicade
According to product labeling, Infliximab neutralizes the biological activity of TNFα by binding with high affinity to the soluble (free floating in the blood) TNFα and the trans-membrane (located on the outer membranes of T cells and similar immune cells) forms of TNFα, thus preventing the effective binding of TNFα with its receptors.
154
difference between Etanercept/ Enbrel and Infliximab/ Remicade
Infliximab/ Remicade causes programmed cell death of TNFalpha expressing activated T cells but Etanercept/ Enbrel does not
155
when you see a drug ending in "-imab" you can generally assume
its a recombinant drug
156
Etanercept/ Enbrel is not used for
Crohn's or UC, Infliximab/ Remicade is used for them.
157
which drug used for RA or Lupus is also used to treat Malaria
Hydroxychloroquine/ Plaquenil
158
class of Hydroxychloroquine/ Plaquenil
Immunosuppressant and anti-malarial
159
ind. of Hydroxychloroquine/ Plaquenil
RA, SLE, Sjogren's as well as malaria in area of the world in which there is low rick for Hydroxychloroquine/ Plaquenil resistant malaria
160
MOA of Hydroxychloroquine/ Plaquenil
blocks activation of TLRs on plasmacytoid dendritic cells. May involve an anti-spirochete activity as well as an anti-inflammatory activity
161
higher does of this drug requires frequent eye-dilated exams because it can cause the cornea to become opaque
Hydroxychloroquine/ Plaquenil
162
2 big side effects of Hydroxychloroquine/ Plaquenil
Effects on the cornea and patients with G6PD enzyme deficiency who take Hydroxychloroquine can develop a severe anemia and should be closely monitored if the drug is not stopped.
163
which drug is most likely the last drug of choice to treat RA
Gold Salt: Auranofin/Ridaura
164
Side effects of Gold Salts
decreased appetite, nausea, hair thinning and diarrhea, rash, and thrombocytopenia. Renal toxicity is generally the most severe complication.
165
disease that requires glucocorticoid for survival
addison's disease
166
patients using inhaled steroids are at increased risk of
thrush
167
for steroids, the greater the anti-inflammatory effect, the ___ the mineral corticoid effect
the less the mineral corticoid effect
168
what is tachyphylaxis
a rapid decrease in the response to a drug over a relatively short time period
169
what can be used to prevent tachyphylaxis
topical corticosteroids
170
the active ingredient in some Preparation H products is
Phenylephrine in a 0.25% concentration, a drug which constricts blood vessels
171
Short acting (8-12 hours) steroids
Hydrocortisone
172
Intermediate acting (18-36 hours) steroids
Prednisone
173
Long acting (24-72+ hours) steroids
Dexamethasone, Betamethasone
174
Rate these steroids in terms of anti-inflammatory effect: Dexamethasone, Hydrocortisone, Betamethasone, Prenisone
Lowest to Highest: hydrocortisone, prednisone, dexamethasone, betamethasone
175
abrupt withdrawal of glucocorticoids can lead to exacerbation of the underlying disease as well as
acute adrenal infusfficiency syndrome aka Addisonian crisis, which can be a lethal event
176
class of Hydrocortisone/ Cortef
glucocorticoid/corticosteroid
177
ind. of Hydrocortisone/ Cortef
Preferred drug for cortisol replacement therapy.
178
MOA of Hydrocortisone/ Cortef
affects gene transcription to either stimulate or repress protein production
179
class of Prednisone/ Deltasone
glucocorticoid/corticosteroid
180
ind. of Prednisone/ Deltasone
Preferred drug for reactive airways disease or moderate to severe allergic reaction. Important drug for leukemia reaction.
181
MOA of Prednisone/ Deltasone
Affects gene transcription to either stimulate or repress protein production
182
class of Dexamethasone/ Decadron
fluorinated corticosteriod
183
Ind. of Dexamethasone/ Decadron
Extremely potent anti-inflammatory. Useful in IV form for reducing intracranial pressure.
184
MOA of Dexamethasone/ Decadron
Affects gene transcription to either stimulate or repress protein production
185
class of Triamcinolone inhaler/Azmacort
corticosteroid
186
ind. of Triamcinolone inhaler/Azmacort
asthma, COPD. Not indicated for treating an acute asthma attack once it has already began.
187
MOA of Triamcinolone inhaler/Azmacort
Diminished inflammation of bronchial wall. Affects gene transcription and alters protein production.
188
Side effects of Triamcinolone inhaler/Azmacort
Thrush, sore throat, nosebleeds, increased coughing, headache, runny nose and other side effects as noted in prior slides.
189
class of Fludrocortisone/ Florinef
Halogenated glucocorticoid/Mineralcorticoid agonist
190
ind. of Fludrocortisone/ Florinef
mineralcorticoid replacement for patients with Addison's disease and in other cases of hyponatremia
191
MOA of Fludrocortisone/ Florinef
sodium retention. Main effect is via reduction of sodium loss to the urine at the renal tubular cells.
192
drug not indicated as an anti-inflammatory agent
Fludrocortisone/ Florinef
193
Side effects of Fludrocortisone/ Florinef
Salt retention, edema, hypertension, rash, nausea and vomiting, as well as the potential side effects that are attributable to glucocorticoids.
194
Key Addisonian crisis symptom and additional symptoms
Key: Hyponatremia and hypoglycemia
Additional: severe lethargy, severe vomiting/diarrhea, hypotension, confusion, LOC, convulsions, fatal if untreated
195
Schedule I
no currently accepted medical use and high potential for abuse
196
schedule II
potential for abuse less than schedule I but still high
197
schedule III
moderate to low potential for dependence
198
schedule IV
low potential for abuse/dependence
199
schedule V
lowest potential for abuse
