Shared Flashcard Set

Details

Advanced Pharm test 1
n/a
271
Pharmacology
Graduate
09/19/2011

Additional Pharmacology Flashcards

 


 

Cards

Term
New drugs receive a __ yr patent on active ingredient
Definition
20
Term
___: compares the blood level of a drug necessary to acheive a therapeutic effect to the blood level at which toxicity occurs

A narrow one means?
Definition

therapeutic index

 

narrow = not much difference between beneficial and toxic blood levels

Term
4 main receptor types
Definition

ligand gated ion channels

g protein coupled receptors

enzyme linked receptors

intracellular receptors

Term
____: drug or hormone stimulates production of more receptors


___: excessive amounts of some drugs or hormones may reduce receptor production. More likely with continuous administration.
Definition

up regulation

down regulation

Term
Ways in which drugs can cause toxicity (5)
Definition

excessive activation or receptors

excessive suppression of receptors

drug interactions iwth other receptors

drug triggers immune (allergic) response

drug changes receptor concentration

Term
the study of the influence of GENETIC factors on the variation of DRUG METABOLISM in an individual or individuals
Definition
pharmacogenomics
Term
Two phases of drug elimination
Definition

Phase I: oxidation -- usually renders a drug inactive

 - involves CYP450 enzymes

 

Phase II: conjugation -- increases solubility for fecal and renal excretion by attaching drug to a water molecule

Term
CYP2D6 --> what is the 2, D, and the 6?
Definition

2: enzyme family

6: isoform

D: subfamily

Term
Impact of ___:

genetic diversity
Drug interactions & Adverse drug reactions
Definition

CYP450's

 

vary greatly between different races

Term
Pt who complains ____, means ???

1. "that stuff never works for me"
2. "I react strongly to all meds"
3. "Every med I've tried makes me miserable"
Definition

1. Fast/hyperactive drug metabolism

2. slow drug metabolism -- reduced or absent enzymes

3. multiple slow metabolic pathways

Term
Drug A is metabolized by enzyme X.

1. What happens if the activity of enzyme X is increased (induced)?

2. If x is decreased (inhibited)?
Definition

1. blood level of drug A plummets bc it's being decgraded too quickly

 

2. blood level of drug A increases because it's not being degraded

Term
CYP inducers/inhibitors:
- increase enzyme activity
- lower circulating levels of active drug
- reduce drug effectiveness

CYP inducers/inhibitors:
- diminish enzyme activity
- increase circulating levels of active drug
- increase risk of side effect or toxicity
Definition

inducers

inhibitors

Term
What is the autonomic two cell paradigm?
Definition


First neuron: 

1. parasympathetic: medulla & sacral spinal cord = "craniosacral system" = cranial nerves + sacral nerves (bladder, rectum, reproductive)

2. sympathetic: thoracolumbar spinal cord = "thoracolumbar system"

 

Second neuron:

1. parasympathetic: terminal ganglia (sa node, sweat glands)

2. Sympathetic: mostly larger vertebral ganglia


Term
"Cholinergic" refers to which branch of the ans?

"Adrenergic" refers to which system?
Definition

parasympathetic --> bc ACh is the main neurotransmitter of the parasympathetic system

 

sympathetic --> because epineprhine/NE are the main neurotransmitters

Term
two types of cholinergic receptors and which is pre and post ganglionic

two types of adrenergic receptors
Definition

nicotinic -- preganglionic

muscarinic -- postganglionic

 

alpha and beta

Term
use pupil size to explain the autonomic set point
Definition

tissues are receiving messages from both parasympathetic and sympathetic systems

 

pupils will shrink if parasympahetic (cholinergic) signals dominate but will dilate if sympathetic signals dominate

Term
parasympathetic effects on eyes, heart, vascular, pulmonary, GI, CNS, glands
Definition

ocular: miosis, + near vision

cardiac: slows rate, reduces contractility, decreases CO

vascular: indirect effects

Pulmonary: bronchiolar constriction

GI: increased secretion, relaxed sphincters, increased motility

Bladder: detrusor contraction

sexual response: arousal

CNS: reduced alertness

Glands: + secretion

Term
Sympathetic effects on eyes, heart, vascular, pulmonary, GI, CNS, glands, bladder, sexual response
Definition

eyes: mydriasis, + far vision

cardiac: increased rate and contractility

vascular: direct vasoconstriction

Pulmonary: bronchodilator

GI: reduced secretions, contracted sphincters, decreased motility

CNS: increased alertness

Glands: reduced secretions

bladder: relaxation

Uterus: relaxation

Sexual: orgasm

Term
Organophosphates (insecticides, nerve gas, ophthalmic) are an example of what kind of drug?

What are the side effects of this and how would you treat ssomeone who ingested it?
Definition

irreversible AChE antagonists

 

side effects: permenant parasympathetic activation

Tx: block action of ACh

Term
What are some indications for cholinergic agonists & anticholinesterases?

What are some adverse effects?
Definition

Indications: ophthalmic (miosis), GI/GU (ileus, bladder atony), myasthenia gravis, mushroom (atropine) poisoning, anesthesia reversal

 

Adverse effects: miosis, sweating, N/V/D, urinary urgency, bronchospasm, bradycardia, syncope

Term
Methacholine, carbechol, bethanechol, pilocarpine are all what kind of drug?
Definition
cholinergic agonists --> all have "chol"
Term
Edrophonium, physostigmine, puridostigmine, neostigmine are all what kind of drug?


What about the organophosphates (insecticides, nerve gas, ophthalmic)?
Definition

stigmines: reversible AChE inhibitors

 

organophosphates: irreversible AChE inhibitors

Term
What is PAM?
Definition
pralidoxime -- reverses the effects of anticholinesterases by AGING the bond
Term
What dx? What tx? how is it tested for?

Weakness of voluntary muscles - diplopia, limb weakness, repetitive movement
IMproves with rest

An autoimmune disorder -- antibodies against ACh receptors
Definition

myasthenia gravis

 

tx: ACh agonist, AChE inhibitors

immunosuppression

 

tested: edrophonium

thymectomy

Term
Adrenergic transmitter synthesis
Definition
tyrosine --> DOPA --> dopamine --> NE --> Epinephrine
Term
catecholamine neurotransmitter that is involved in psychotic diseases as well as renal and splanchnic vasculature
Definition
dopamine
Term
Treatment for anaphylaxis

side effects of this tx?
Definition

beta sympathetic agonist + glucocorticoids & antihistamines

 

side effects: tachycardia, arrhythmias, hyperglycemia

Term
reactive hyperemia caused by afrin
Definition

prolonged vasoconstriction due to chronic afrin use leads to hypoxia which leads to vasodilation

 

thus tolerance develops 

Term
What are the 3 general adrenergic agonists (A1, B1, B2)?

what are their indications?
Definition

Epinephrine: anaphylaxis, local anesthetic, acute asthma

 

NE: hypotension/shock

 

Dopamine: hypotension/shock

Term
Alpha adrenergic agonists and their indications
Definition

phenyleprhine, methoxamine, clonidine, methylNE

 

vasoconstriction (Afrin and HTN)

Term
beta adrenergic agonists and indications and side effects
Definition

isoproterenol,

dobutamine - CHF, cardiogenic shock

terbutaline - asthma, arrest premature labor

 

side effects: tachycardia, anxiety, tremors, hyperglycemia

Term
two kinds of antiadrenergic drugs
Definition

alpha blockers - prazosin - HTN, BPH

 

beta blockers -

- non-selective: propanolol (NOT ASTHMA)

- Selective (B1 >>> B2): metoprolol, atenolol --> Asthma

- Combined (A1, B1, B2): Lebatolol --> HTN, hyperthyroid

 

beta contraindications: arrhythmias (withdrawal), uncontrolled CHF, bradycardia

Term
What are some non-pharmacologic HTN tx?
Definition


weight loss

dietary salt reduction
exercise
stress reduction

biofeedback





Term
Normal BP
Pre-HTN
Stage 1
Stage 2
Definition

Normal: <120/80

PreHTN: 120-140/80-90

Stage 1: >140/90

Stage 2: >160/90

Term
Factors that affect BP control
Definition

Cardiac Output:

- HR

- Contractility

- Filling pressure

 

Peripheral resistance:

- arterial diameter

- arterial length

- elasticity

 

BP = CO x PVR <-- Hydraulic Equation

Term
___ is the main focus of PVR reduction (and thus BP reduction)
Definition
vasodilation
Term
Essence of blood pressure control: __ + ___
Definition
sympathetic input (Alpha vascular receptors + beta cardiac receptors) + Renal blood flow (RAA system + total blood volume)
Term
What is the main side effect of ACE inhibitors and why?
Definition
Cough - due to increase in bradykinin
Term
steroid produced by adrenals that alters renal function by increasing Na loop absorption and changing hemodynamics

results in fluid retention, increased vascular volume, cardiac growthy factors, cardiac remodeling
Definition
aldosterone
Term
4 groups of antihypertensive drugs
Definition

diuretics

sympathoplegic/adrenergic blocking agents

vasodilators

reduce R-A-A system

Term
What drug group?

-lol
-pril
-sin
-sartan
-pine
Definition

-lol: beta blocker

-pril: ACE inhibitor

-sin: alpha blocker

-sartan: angiotensin receptor blocker

-pine: calcium chennel blocker (other than verapamil, diltiazem)

Term
What kind of drug?

reduces sodium and water retention
reduces blood volume
reduces cardiac output
reduces PVR
Definition
thiazide and loop diuretics
Term
inidcations, contraindications, and adverse effects of thiazides and thiazide-like diuretics
Definition

indications: HTN

contraindications: kindey failure

adverse effects: HYPOKALEMIA, Hyperglycemia, rash, ED, hyperuricemia, postural HTN

 

Term
Loop diuretic names, indications, adverse effects
Definition

Furosemide, torsemide, bumetanide, ethacrynic acid

 

indications: HTN, pulmonary edema (emergency), kidney hyperuricemia, hyperkalemia

 

Adverse effects: ototoxicity, HYPOKALEMIA, HYPOMAGNESMIA, hypotension

Term
potassium-sparing diuretics: two kinds, adverse effects, indications, contraindications
Definition

luminal membrane agents: triamterene, amiloride

Mineralcorticoid (aldosterone) antagonists: spironolactone, eplerone

 

Adverse effects:

HYPERKALEMIA

 

indications:

luminal: combined with thiazides or loops for HTN

mineralcorticoids: cirrhosis, PCOS, HTN adjunct

 

contraindications:

Luminal: ACE inhibitors, NSAIDs

Term
what condition?

muscle weakness
myalgia
heart arrhythmias
deaht
Definition
hypokalemia
Term
what condition?

malaise
palpitations
muscle weakness
fatal cardiac arrhtymia
Definition
hyperkalemia
Term
lithium and demeclocycline are what kind of diuretics?

They are not currently used clinically
Definition
ADH antagonists
Term
diuretic combinations
Definition

Thiazide + loop

Loop/thiazide + K sparing

 

 

pretty much every combo has HCTZ in it

 

Aldactazide

Dyazide

Maxzide

Moduretic

Term
what makes a diuretic clinically useful?
Definition
increases Na excretion (natriuresis) as well as H2O loss
Term
How is sodium homeostasis maintained? What is diuretic braking?
Definition

Hypothalamus/posterior pituitary axis: Antidiuretic hormone/vasopressin

 

Baroreceptors/atrial receptors: atrial natrietic peptide

 

Renin-Angiotensin-Aldosterone System

 

All this results in "diuretic braking" - with continued diuretic use, a new Na+ equilibrium set point is acheived and more diuretic may be needed

Term
is loop diuretic ototoxicity reversibl?
Definition

usually

 

Term
3 general sympathoplegic drugs - what do they do?
Definition

beta blockers

alpha blockers

central sympathoplegic

 

HTN meds

Term
How do beta blockers work as antihypertensives?
Definition

block beta-1 cardiac receptors which reduce CO

 

a few also modulate nitric oxide production which vasodilates

Term
What arrhythmias could be caused by B blockers?
Definition

dose-dependent bradycardia ---> syncope

 

AV node conduction slowing

 

Ventricular arrhythmias upon abrupt cessasion

Term
Nonselective b blockers

examples?
indications?
contraindications?
Definition

propanolol & nadolol

 

INdiacations: HTN, angina, SVT

Contraindications: COPD, asthma

Term
adverse effects of all beta blockers
Definition

FATIGUE
BRONCHOSPASM

ARRHYTHMIAS

ED

Metbolic changes

Term
Selective beta blockers

examples
indications
contraindications
Definition

metoprolol and atenolol

 

indications: HTN, angina (increase exercise tolerance)

 

contraindications: OK in copd/asthma but needs to be closely monitored

Term
Combined b1, b2, and a1 blockers
Definition

labetolol and carvedilol

 

indications: HTN + need for reduced pvr, heart failure

Term
beta blockers/partial agonists
Definition

acebutolol and pindolol

 

possess partial sympathetic activity (ISA)

 

indications: HTN pts with DM or slow HR --> lessens metabolic effects

Term
How do you take someone off a beta blocker?
Definition
taper off over 3-4 weeks
Term
metabolic effects of Beta blockers
Definition

reduced HDL

hypoglycemia

Linked to increased risk of Type II DM in elderly

Term
Beta blockers have recently lost favor in use for HTN. In what two conditions must they still be used?
Definition

CHF

recent MI

Term
Antihypertensive that lowers both arterial and venous resistance but has minimal effect on CO or renal fxn

relaxes bladder sphincter

Adverse effects: first dose phenomenon (reflex tachy, postural syncope. due to immediate vasodilation) more likely in volume/salt depleted --> DIURETICS

ex?
Definition

alpha blockers

 

-azosin's: doxazosin, prazosin, terazosin

Term
how do you prevent the first dose phenomenon seen in alpha blockers?
Definition

1st dose under supervision

cocomitant beta blocker

1st dose at bedtime

Term
what drug?

central acting sympathoplegic drug with some alpha 2 activity

indications: htn, renal disease, and vasomotor flushes
Definition
clonidine
Term
2nd tier htn agents that have vasodilation effects and come in three classes: selective, somewhat selective, non-selective
Definition
Ca channel blockers
Term
what drug/class?

lower arteriole smooth muscle tone

intrinsic natriuretic effect --> rarely need diuretic

indications: HTN. pts on digoxin or warfarin, asthma, DM, angina
Definition
Selective Ca channel bockers (Nifedipine)
Term
___ is a vasodilator that is an adjunct to diuretics and beta blockers in severe htn that also causes hair growth (Rogaine)


___ is a vasodilator that is an adjunct to beta blockers and is used for chronic HTN in pregnancy but may cuase transient lupus like syndrome (pos ANA test)
Definition

minoxidil

 

hydralazine

Term
what drug?

action on RAA system to decrease blood volume and PVR

Indications: HTN

Contraindications: PREGNANCY

Adverse effects: FETOTOXIC, HYPERKALEMIA, COUGH
Definition
ACE inhibitors
Term
___ are antihypertensives that may have renoprotective effects when combied with arbs
Definition
renin inhibitors - aliskiren
Term
(-sartan's)

similar effects to ACE inhibitors but with less cough but higher price
Definition
ARBs
Term
If pt is stage 1 htn... what would you treat them with?
Definition

single drug: diuretic (HCTZ) or ACE inhibitor (-pril)

 

secondary choices are ARB (-sartan), beta blocker (-ol), Ca channel blocker (diltiazem), or alpha blocker

Term
If pt has stage II - III htn, what would you treat them with?
Definition

2-3 drugs wtih different sites of action = "stepped care"

 

1. ACE inhibitor (increases K+) + diuretic (decreases K+)

2. ACE inhibitor, diuretic, vasodilator

 

some have fixed dose combinations and can help the pt be compliant

 

Term
if a pt has htn and ___, treat with ___:

1. DM
2. CAD: MI or CHF
3. Renal disease
4. BPH
Definition

1. DM: ACE inhibitor or Ca channel blocker

2. CAD: ACE inhibitor + Beta blocker

3. Renal disease: ACE inhibitor, Ca channel blocker, renin inhibitor (aliskiren), or clonidine + ARB

4. BPH: alpha blocker

Term
What is a htn emergency? What should you treat wtih?
Definition

BP > 210/150

 

hopsitalized

 

Sodium Nitroprusside (vasodilator)

+

Beta blocker (labetalol)

+

Dopamine agonist (fenoldopam)

Term
What are two drugs that interfere with antihypertensives?
Definition

NSAIDS - block prostaglandin production = vasoconstriction

oral contraceptives - increase angiotensinogen production

Term
tx for iron deficiency

what are some side effects of this that cause pts not to be compliant?
Definition

1. ferrous sulfate 325 mg tabs 1-4/day for 3-6 mos

PLUS 500 mg vit C to reduce side effects and increase absorption

 

2. Last resort --> parentaral. Iron dextran, sodium ferric, or iron sucrose. Needs to be administered by hematologist

 

ORAL: GI upset - n/v/d, CONSTIPATION

Black stools

 

IM: anaphylaxis/hypersensitivity

Term
iron toxicity
Definition

chronic - hemachromatosis - organ failure

 

acute (peds) - necrotizing enteritis. >10 tablets can be fatal

 

caution pts with kids at home to keep iron locked up

Term
what causes B12 deficiency?
Definition
loss of intrinsic factor due to: pernicious anemia, gastric surgery, gastric atrophy (DM)
Term
what dz?

loss of intrinsic factor due to auto-antibodies, usually after age 50

consists of megaloblastic anemia + PROGRESSIVE NEURO DETERIORATION

Result of folate deficiency

tx?
Definition

pernicious anemia --

 

tx: folate. Can correct anemia but NOT neuro damage. B12 (cyanocobalamin) DOES correct neuro damage.

 

 

Term
Treatment
Definition
Term
an essential cofactor to amino acids and purines (hence, DNA)

that reduces homocysteine levels but does NOT lower risk of cardio disease

and assists in neural tube development (reduced risk for anencephaly and spina bifida

deficiency of this caused by: deit, decreased absorption (phenytoin, sulfas) or increased requirement (pregnancy, hemolytic anemia

what is something to beware of when this type of anemia is present?
Definition

folic acid (folate)

 

beware of coexisting B12 deficiency

Term
___ is produced in the kidneys in response to falling O2 levels to stimulate RBC production. Thus, pts with renal disease often have anemia.

it is commonly used to treat renal failure, cancer, AIDS, rheumatologic dz, autologous RBC donation, CHF, CAD, and for sports doping

toxicities of this drug?
Definition

erythropoeitin

 

any drug name with "epo" is this --> rHuEpo, epoetin alfa

 

toxicity: increased blood viscosity due to increased # of rbc (HTN, thrombus), allergy

 

in pts with anemia of chronic disease, the risk of death from CVA and MI increases significantly when hgb >12, as with increased EPO

Term
to form a clot, you need RBC, platelet, and fibrin

how is fibrin made?

how are platelets activated?

what breaks a thrombus apart?
Definition

fibrinogen + thrombin --> fibrin

thrombin comes from prothrombin

 

platelets must adhere --> activate --> aggregate

 

plasmin degrades fibrin into D-dimer and fibrin split products

- plasmin comes from plasminogen

Term
What are some natural anticoagulants?
Definition

1. antithrombin III - action accelerated by heparin

2. proteins S and C - genetic defects attack here

 

Term
what is the most common genetic cause of hypercoagulability?
Definition

abnormal factor V --> leiden mutation

- factor V cannot be inactivated by protein C

Term
formation of a thrombus where it doesn't belong

what are the triad of risk factors?
Definition

thrombosis

 

virchow's triad:

hypercoagulable state

circulatory stasis

endothelial injury

Term
what drug?

anticoagulant that acts by blocking prostaglandins

used to prevent CV disease in women >50 and men >40

toxicities?
Definition

aspirin (81-325 mg/day)

 

toxicity: GI irritation/ulcer/bleeding

 

Term
what drug?

an anti-ADP agent that interferes wtih platelet metabolism and thus works as an anticoagulant

used as an adjunct during coronary stent placement or as chronic supplemental use for MI and CVA prevention

toxicities?
Definition

clopidogrel (plavix) and ticlopidine (ticlid)

 

toxicity: N/v/d, hemorrhage, leukopenia --> all pretty much with ticlopidine. plavix is safer

Term
class of parenteral anticoagulants that are used for PCI or coronary syndromes

ex: abciximab (reopro), eptifibatide, tirofiban
Definition
IIb/IIIa receptor blockers
Term
anticoagulant that works by inhibiting vit K-dependent factors, thus levels of factor II, VII, IX and X fall and result in reduced thrombin levels

what test is done to see how pts on the drug are doing?

toxicities
Definition

warfarin

 

INR - need it between 2-3.5

this checks prothrombin time

 

toxicities: hemorrhage, fetotoxic, multiple drug interactions

 

ALWAYS check for potential drug interactions

Term
Anticoagulant that works by inhibiting thrombin by enhancing antithrombin III, which inhibits activation of factor X. Is a natural glycosaminoglycan.

2 preparations

indications: MI or clot, surgery, immobility, AV shunt

in what form should this never be given?

how is it monitored?

toxcity
Definition

heparin

 

unfractionated heparin or low molecular weight heparin (lovenox)

 

never gien IM due to hematoma due to local anticoag

 

monitor: PTT and Anti-Xa levels

 

toxicity: hemorrhage, thrombocytopenia, bone loss (osteopenia)

Term
PRegnant woman wtih DVT - what do you treat her with?
Definition

heparin

 

NOT WARFARIN

Term
what dz?

two types: benign and dangerous

Benign (type I): mild platelet count drop in first 5-6 days of ___ therapy. Platelet count starts at 175k and drops to 150K

dangerous (type II): immune related serious drop in platelet count (50% or more). Start off at 175K and drops to 50K. Associated wtih THROMBOSIS
Definition
HIT - heparin induced thrombocytopenia
Term
why does HIT cause thrombosis when heparin and thrombocytopenia usually cause bleeding?
Definition
because platelets are consumed in clot formation
Term
why give lovenox over heparin?
Definition

less risk of thrombocytopenia/HIT

less risk of osteopenia

 

less monitoring

Term
3 kinds of low molecular weight heparins
Definition

lovenox (enoxaparin)

dalteparin (fragmin)

tinzaparin (innohep)

 

all end in -aparin

Term
anticoagulant that works by inhibiting thrombin by activating antithrombin III, which inhibits factor X. avg molecular weight 4,500.

less monitoring of factor X activity (PTT)

approved for home use
Definition
Enoxaprin (lovenox)
Term
anticoagulant

synthetic pentasaccharide w/ similar antithrombin III action to heparin

better at DVT prevention than LMW heparin in hip replacements and equivalent in treatment of thrombosis

Indications: prophylaxis for post op thrombosis
Definition
fondaparinux (arixta)
Term
THIAZIDES AND LOOP DIURETICS CAUSE ... ?
Definition
hypokalemia -- WILL BE ON TEST
Term
Direct thrombin inhibitors (anticoagulants)

recombinant form of hirudin - from medicinal leeches
- parenteral for PCI or as heparin alternative (hx of HIT)
- not good for long term use due to antibodiese
Definition

 

lepirudin

Term
1st new oral anticoagulant in 50 years

direct thrombin inhibitor
no monitoring but very expensive

may be better at preventing stroke than warfarin for afib


problems: non-reversible, more GI problems
Definition
dabigatran
Term
3 treatment options of acute thrombus

1. ___: activates plasminogen to become plasmin. needs to be done within 2-6 hours of MI or stroke. also done for DVT, PE, clotted shunts & catheters. recommended when PCI is not available. available options? contraindications?


2. anticoagulation

3. thrombectomy
Definition

1. thrombolysis - all -ase's: streptokinase, urokinase, alteplase, reteplase, tenecteplase. All parenteral.

- contraindications: surgery w/in 10 days, serious GI bleed within 3 mos, hx of HTN, bleeding disorder, previous hemorrhagic CVA, pregnancy

 

 

Term
what do you use to reverse anticoagulants?


1. reversing fibrinolytics

2. reversing hepparin

3. reversing warfarin
Definition

1. aminocaproic acid - increased risk of MI, renal failure

2. protamine sulfate

3. vit K, fresh frozen plasma

Term
Atherosclerosis:

- ___: when LDL cholesterol accumulates under endothelium
- Monocytes collect under this and oxidize LDL
- ___: when monocytes becomes macrophages and ingest oxidized LDL
- damaged endothelium permits more LDL to accumulate

HDL someohow mitigates the process
Definition

fatty streak

foam cells

Term
facts about ____:

- it is at it's core an inflammatory process
- endogenously-produced lipids are most responsible for it
- it is now reversible due to medical therapy
Definition
atherosclerosis
Term
main goals and secondary goals of lipid therapy
Definition

Main: lower LDL, raise HDL

 

seocndary: lower trigs and total cholesterol

Term
5 general groups of lipid-lowering agents
Definition

niacin

bile acid binding agents

HMG-CoA reductase inhibitors = "statins"

Fibric acid derivatives = "Fibrates"

inhibitors of sterol absorption

Term
what lipid-lowering drug?

lowers VLDL and LDL, raises HDL-C
- most potent at raising HDL
- Not most potent at lowering LDL

gaining popularity, but doesn't seem to be too effective

adverse effects: HEPATOTOXICTY (>2 mg/day), GOUT flares, cutaneous flush, GI problems, impaired glucose tolerance
Definition
Niacin
Term
What lipid-lowering drug?

helps break up enterohepatic circulation to block reabsorption of bile acids so lipids are passed through stool.

lowers LDL, may help raise HDL

ex: cholestyramine, colestipol, colesevalam

Adverse effects: Gi issues, impaired absoprtion of fat soluble vitamins & drugs (dig, warfarin, aspirin, statins, thiazides)
Definition
blie acid binding drugs
Term
what group of lipid-lowering drugs?

HMG CoA reductase inhibitors

block sterol synthesis

Lowers LDL, modest rise in HDL

lowers risk of CHD proportionally to fall in LDL

adverse effects: ELEVATED HEPATIC ENZYMES, MYOPATHY & RHABDOMYALYSIS (weakness, sore muscles, renal failure)
drug interactions: amiodarone & verapamil

Contraindications: PREGNANCY, TEENS & CHILDREN, LACTATION


Indications: lipid lowering, anti-inflammatory, reduced colon cancer risk, may help lower risk of Alzheimer's
Definition
statins
Term
what lipid-lowering agents?

derivatives of fibric acid

enhance lipoprotein lipase activity --> lowers LDL, moderate raise in HDL

lower fibrinogen levels

ex: gemfibrozil, fenofibrate

adverse effects: gall stones, increases warfarin effect

Contraindications: pregnancy, severe liver or kidney dysfxn
Definition
fibrates
Term
what lipid-lowering agent?

ezetimibe (zetia)

drops LDL 15%, synergistic with statins

possible hepatotoxicity
Definition
sterol absorption inhibitor
Term
Lipid lowering therapy

1st, 2nd, 3rd lines

in pregnancy?
Definition

1st: statin

2nd: bile acid binding

3. niacin, fibrates

 

pregnancy: bile acid binding

Term
___ is the most potent drug at raising HDL
Definition
niacin
Term
what is the key feature of ischemic disease?
Definition
diminished oxygen transport
Term
treatment of acute ischemia (MI, unstable angina)
Definition

transport to hospital

aspirin

oxygen

PCI or fibrinolytics

Term
prevention of angina and chf
Definition

lifestyle changes

ACE inhibitors

Beta blockers

statins

Aspirin and/or plavix

Term
Angina:

1. occurrences are predictable based on level of effort or emotions and are RELIEVED WITH REST -- most common form

2. extreme fatigue with minimal exertion. pt feels wiped out. due to vasospasm. associated with smoking and younger pts

3. pain at rest, change in frequency of pain. increased risk for acute coronary syndrome

all must last less than 20 min to be considered angina
Definition

stable

variant (prinzmetals)

unstable

 

Term
tx for prinzmetal's angina
Definition
ca channel blockers
Term
% occlusion and anginal symptoms

50-70%
70-90%
>90%
Definition

50-70: sx wtih heavy exertion or vasospasm

 

70-90%: sx with moderate or light exercise - stable angina

 

>90: sx at rest: unstable angina

Term
what conditions could produce or aggrevate angina?
Definition

hyperthyroidism

severe anemia

arrythmias

Term
stable angina tx
Definition

nitrates

beta blockers

ca channel blockers

ace and arb

hyperlipidemia tx - statins

Term
sublingual vs. transdermal nitroglycerin for angina
Definition

sublingual: faster onset, shorter duration

peripheral vasodilation

HA

--> more acute

 

transdermal: slower onset, longer duration

improved exercise tolerance, helps prevent nocturnal angina from emotional dreams

--> more preventative

Term
isosorbide dinitrate + hydralazine = ?
Definition
bildil - for african americans with CHF
Term
what drugs are contraindicated wtih nitrates?
Definition
ED drugs -- sildenafil, vardenafil, tadalafil
Term
__ are good drugs in preventing anginal attacks


contraindications?
Definition

beta blockers

 

contraindications: prinzmetals, severe LV failure

 

be careful because it can cause severe bradycardia & AV blockade

Term
prognosis for stable angina
Definition

some will improve

 

most progress to MI or CHF in 3-5 years

Term
how is the R-A-A system related to CHF?
Definition

aldosterone increases salt and water retention and thus causes cardiac remodeling

 

cardiac remodeling is the reason CHF gets worse and the heart loses contractility

Term
first drug to prove reduced mortality in CHF pts
Definition
enalapril (ACE inhibitor)
Term
acute CHF treatment
Definition

hospitalize - O2, loop diuretics

 

stabilize: inotropic agents, LVADs

 

evaluate

Term
chronic CHF treatment (8 things)
Definition

reduce cardiac workload - limit activity, reduce weight, control htn

 

restrict sodium - 2 g/day

 

give diuretic: loop (spironolactone is dangerous)

 

ACE inhibitor or ARB

 

dig (esp if comorbid afib)

 

beta blockers -- stable Class II-IV CHF

 

vasodilators (bildil for AAs)

 

treat hyperlipidemia - statins

Term
what two drugs can be used for emergency vasodilation in CHF?
Definition

sodium nitroprusside

 

nesiritide

Term
What inotropic agents can be used for CHF?
Definition

cardiac glycosides: dig

--> for outpatient CHF

 

beta adrenergic agonists:

Dobutamide, dopamine

 

phosphodiesterase inhibitors: amrinone, milrinone

Term
what drug?

only oral inotropic agent
increases intracellular Ca
increases cardiac parasympathetic tone

low therapeutic index -- easily toxic

toxicity: arrhythmia, anorexia, nausea, HA, visual changes, fatigue, some estrogenic effects

toxicity risk factors: hypokalemia, hypothyroidism, renal insufficiency, drug interactions (verapamil, quinidine)
Definition
digoxin
Term
how do you treat dig toxicity?
Definition

stop dig

 

correct aggravating circumstances (hypokalemia, drug interactions)

 

neutralize circulating dig -- digoxin immune fab (digibind)

 

Term
when should you use dig in CHF?
Definition
comorbid afib
Term
CHF/angina surgery
Definition

revascularization (CABG, PCI)

 

cardioplasty - reduce left vent volume

Term
which way do na and k flow during depolarization of an AP?
Definition
NA in - K out
Term
___ is the fastest depolarizer in the heart
it is the pacemaker -- "leads the orchestra"
and is least sensitive to anti-arrhythmic effects
Definition
Term
wolfe parkinson white (wpw)
Definition
form of cardiac arrhythmia
Term
Causes of impulse abnormalities leading to arrhythmias
Definition

ISCHEMIA, HYPOXIA

alkalosis/acidosis

excessive catecholamines

drug toxicity

overstretching of cardiac fibers

scars

Term
antiarrhythmic classes
Definition

Class I: Na channel blockers (quinidine, procainamide, lidocaine)

- "use dependent" - target the most frequently depolarizing cells

 

class II: Beta blockers

- useful in treating tachyarrhythmias, and preventing ventricular arrhythmias

 

Class III: K channel blockers (amiodarone, sotalol, bretylium)

- useful in tachyarrhytmias

 

Class IV: ca channel blockers

- most effeective against atrial arrhythmias

Term
Special niches for antiarrhythmics:

V tach?

V fib?

SVT?

A fib?
Definition

v tach: lidocaine, amioderone

 

vfib: liodcaine, amioderone, epinephrine

 

svt: adenosine

 

atrial fib: propanolol, amioderone

Term
the most common chronic arrhythmia

loss of normal atrial contraction causes 20-30% drop in LV output

vent rate becomes too rapid and irregular - pulse is IRREGULARLY IRREGULAR

risks: MURAL THROMBI in enlarged left atria --> stroke, tachy to point of hypotension

tx?
Definition

afib

 

tx:

1. rate control: beta blockers, amiodarone, dig

 

2. restore sinus rhythm - cardioversion

 

3. anticoagulant to prevent stroke - warfarin, aspirin

Term
what drug?

useful in tx of afib, vfib, vtach

numerous side effects: pulmonary fibrosis, liver toxicity, blocker t4-t3 conversion, photodermatitis (blue-gray skin)

drug interactions: CYP3A4: cimetadine, macrolides (-mycins), fluconazole, grapefruit juice
Definition
amioderone
Term
young pt with palpitations, Sob, tachycardia

what tx?
Definition

adenosine

 

they're in PSVT

Term
double edged sword of antiarrhythmics
Definition

they can stop arrhythmias but they can also cause them

 

risky to use them chronically except amiodarone and beta blockers

Term
basic endocrine system:

second messengers are ___ hormones

DNA transcription is done by ___ hormones
Definition

peptide

steroid

Term
what is an example of a hormone that can interact wtih another hormones receptors and thus influence another system?
Definition

TSH can bind to FSH receptors

 

thus ovarian cysts can result from untreated hypothyroidism

Term
target cells stop producing hormone receptors after prolonged exposure to large hormone concetrations

this is an example of?
Definition
down regulation
Term
What hormones does the hypothalamus produce?

the anterior pituitary?
Definition

hypothalamus: releasing and inhibiting factors + vasopressin/oxytocin

 

anterior pituitary: acth, tsh, fsh/lh, prolactin, somatotropin (growth hormone)

Term
what dz can be treated wtih growth hormone?
Definition

Gh deficiency - dwarfism

 

short kids (normal GH but delayed growth) & turners -- works OK

 

adverse effects: usually none, hypo thyroidism, myalgia, arthralgia (growing pains), cytochrome P450 activation (may impact other meds), acromegaly (with high doses)

Term
somatostatin & analogs

indciations
Definition

analogs: octreotide, lanreotide

 

indications: acromegaly & carcinoid sndrome

Term
what are some conditions in which prolactin levels get too high?

how can this be treated?
Definition

hypothyroidism

idiopathic hyperprolactinemia

pituitary tumor

 

tx: ergot dopamine agonists - bromocriptine, pergolide, cabergoline

Term
a type of fungus that causes smooth muscle contraction and is thus useful HTn, peripheral vasospasm, and contracting postpartum uterus
Definition
ergot
Term
what hyperprolactinemia-inducing drug is contraindicated in psychotic pts?
Definition
dopamine agonists
Term
3 gonadotropins

for what condition are these used as treatment?

what are some dangers of this?
Definition

FSH

LH

HCG

 

infertility

 

multiple births

ovarian hyperstimulation syndrome - ascites, pleural effusion, renal failure, CV collapse, PE

Term
produced by hypothalamus - stimulates FSH and LH release from pituitary
Definition
GnRH
Term
utilization of GnRH treatments:

1. infusion pump (factrel, lutrepulse) for ___

2. GnRH agonists (lupron) to acheive downregulation to produce medical menopause for what diseases?

3. GnRH antagonist (cetrotide, antagon) to prevent ____
Definition

1. amenorrhea

 

2. endometriosis, fibroids

 

3. premature ovulation

Term
for
Definition
Term
What is a less aggressive approach to inducing ovulations than using gonadotropins?
Definition
trigger endogenous release of FSH and LH via: clomiphene citrate (clomid) and aromatase inhibitors (letrozole & anastrozole)
Term
2 hormones produced by the posterior pituitary and their functions
Definition

1. oxytocin

- induce labor

- augment labor

- milk ejection reflex "letdown"

 

2. vasopressin (ADH)

- treatment of diabetes insipitus

 

Term
Thyroid hormones:

What controls what controls what?
Definition
Thyrotropin releasing hormone (TRH) --> thyrotropin (TSH) -- > T3  (triiodothyronine) & T4 (tetraiodothyronine/thyroxine)
Term
T3/T4 are stored by __ in the thyroid follicles

they are transported via ___. What happens if you increase or decrease this molecule?
Definition

thyroglobulin (Tg)

 

thyroxine binding globulin (TBG).

- increase - amount of free t3/t4 drops - estrogen

- decrease - amount of free t3/t4 rises - androgens

Term
What drug is used for hypothyroidism or post-thyroid removal?

how do you know what dose to give?

advance dose cautiously in elderly --> why?
Definition

levothyroxine (T4)

 

adjust dose based on sx:

- lethargic, haven't lost weight --> give more

- jittery, nervous --> give less

 

elderly --> increases metabolism and cardiac O2 requirements in those who'vehad hypothyroid for a long time

Term
causes of hypothyroidism & hyperthyroidism
Definition

HYPO: primary (gland failure) 99%

hashimoto's thyroiditis

absence/destruction

low iodine intake -- goiter

 

HYPER: grave's disease, Toxic Nodular Goiter

Term
sx of ____:

poor memory
inability to concentrate
hair loss
weight gain
cold intolerance
weakness
fatigue
dry skin
menstrual irregularities
Definition
hypothyroidism
Term
sx of ____:

restlessness
insomnia
tremor
weight loss
heat intolerance
weakness
fatigue
muscle cramps
menstrual irregularites
exophthalmos
Definition

hyperthyroidism

 (thyrotoxicosis)

Term
exophthalmos is only seen in what kind of hyperthyroidism?
Definition
grave's disease -- not toxic goiter or giving too much T4
Term
Hyperthyroidism tx
Definition

quickly control sx - beta blockers

 

utilize antithyroid agents to prevent thyroid storm

- thioamides, iodides, anion inhibitors

 

DEFINITIVE TX:

- thyroid excision/ablation

Term
what drug?

block synthesis of T3/T4 -- used to treat hyperthyroidism

PTU (propylthiouracil) -- used for pregnant pts

Methimazole -- single daily dose

improve sx within a week

adverse rxn: rash, peripheral edema, agranulocytosis
Definition
thioamides
Term
what drug?

prevent reuptake of iodide by thte thyroid
limited usefulness (drug induced hyperthyroidism)

main choice: potassium perchlorate

can cause aplastic anemia due to bone marrow suppression
Definition
anion inhibitors
Term
what drug?

suppress t3/t4 release to treat hyperthyroidism

quick onset but can only be used 2-8 weeks

interferes with thioamide action and radioactive iodine
- start thioamides first
- don't use if radioactive iodine is likely
Definition
iodides
Term
What drug?

block T4--> T3 conversion to treat hyperthyroidism

onset of action - few days

choices: iopanpoic acid, diatrizoat sodium, ipodate sodium

for pts who don't respond to other tx
Definition
iodinated contrast media
Term
when is radioactive iodine contraindicated?
Definition
pregnancy
Term
why would you want to do radioactive iodide thyroid ablation over surgical removal?
Definition

surgery causes more t3/t4 to be released --> thyroid storm

 

recurrent laryngeal in danger of being cut

Term
uncommon but life threatening form of hyperthyroidism
causes: stress, coexisting illness, idiopathic

sx: high fever, tachycardia, arrhythmia, n/v/d, coma

tx?
Definition

thyroid storm

 

tx: hospitalization + beta blocker + ca channel blocker + potassium iodide + PTU + hydrocortisone

Term
5 steroid hormones
Definition

estrogen

progestin

glucocorticoid

androgen

mineralcorticoid

Term
4 types of glucocorticoids
Definition

cortisol - natural

hydrocortisone - cream

prednisone - oral

methylprednisolone - IM

dexamethasone - iV/IM

triamcinolone - topical or aerosol

Term
3 types of corticosteroids
Definition

glucocorticoids

mineralcorticoids

androgens

Term
glucocorticoid actions & adverse effects
Definition

glucose production

resistance to stress

hematopoeisis

anti-inflammatory

other

 

adverse:

1. sx of cushing's syndrome: Bone loss/osteoporosis, adrenal suppression, weight gain,

2. adrenal suppression: poor tolerance of trauma, sepsis, anesthesia

Term
glucocorticoid indications
Definition

antiinflammatory

major surgical procedures - anti nausea

cancer chemo - anti nausea

accelerate fetal lung development

Term
indications for glucocorticoid inhibitors & mineralcorticoid receptor blockers
Definition

glucocorticoid inhibitors: cushing's

 

mineralcorticoid RBs (spironolactone): HTn, hyperaldosterone

Term
how do you avoid adrenal suppression when using glucocorticoids?
Definition

low dose, short course

 

every other day dose

 

taper off

Term
ACTH secreting pitutiary adenoma causes ____

anything else that causes increased secretion of cortisol is ___
Definition

cushing's disease

 

cushing's syndrome

Term
glucocorticoid receptor blocker - used as early pregnancy abortion drug
Definition
mifepristone
Term
what glucocorticoid synthesis blocker can be used as an antfungal?
Definition
ketoconazole
Term
mineralcorticoid blocker risks
Definition

hyperkalemia (spironolactone)

 

excessive sodium loss

Term
which of the following represents a contraindication to the use of salicylates?

Hypercoagulable state
CHD
Gout
Cholelithiasis
Definition
gout
Term
which NSAID is considered by some experts to be the safest?
Definition
Naproxen
Term
absorption of which of the following drugs is diminished by antacids containing aluminum and/or magnesium?
Definition
mycophenolate mofetil
Term
Which of the following enhances the activity of NK cells?

IL2, IL1, inferferon-gamma
Definition
all
Term
Which of the following is used to treat or prevent allograft rejection?

antithymocyte globulins
muromonab-CD3
tacrolimus
Definition
all
Term
hepatic necrosis is possible with large doses of which of the following drugs?

acetaminophen
nabumetone
aspirin
ketorolac
Definition
acetaminophen
Term
the use of salicylates can increase the plasma concentration of which of the following drugs?

thyroxine
propanolol
losartan
prednisone
Definition
thyroxine
Term
which of the following is contraindicated in pts allergic to sulfa drugs?

nabumetone
celecoxib
ketorolac
sulindac
Definition
celecoxib
Term
A 55 year old woman is complaining of intermittent bladder incontinence due to irritability and over activity of her bladder musculature (particularly her detrusor). She is currently on no medications and has no known medical allergies.
1. What autonomic related drug(s) would you recommend for treatment?
2. What side effects would you advise this patient to observe for?
3. Just as you go to write her prescription, she recalls that she was recently diagnosed with narrow (or closed) angle glaucoma. Will this information cause any changes in what you wish to prescribe?
Definition

1. anticholinergic, antimuscarinic -- atropine

2. dependent on dosing - increased HR, oral dryness, inhibition of sweating, increased thirst, mydriasis

3. yes - anticholinergics' mydriasis effect can increase IOP

 

 

Term
A 4 year old boy is brought to the emergency department after drinking about a cup full of malathion insecticide.

Which of the following drugs would be most useful in treating this youngster’s toxic symptoms?

Bethanechol
Atropine
Nesotigmine
Propanolol
Definition
Atropine
Term
What drugs might be useful in treating insecticide (organophosphate) poisoning?
Definition

atropine

PAM

Term
: A 22 year old woman develops wheezing and swelling of her lips within a minute of being stung by a bee.

What drug would you give her?

What dose?

What side effects?
Definition

Epinephrine

 

0.3-0.5 mg IM/SQ

 

Tachy, arrhythmias, hyperglycemia

Term
This drug must be used cautiously in pts with asthma
Definition
beta blockers
Term
these antihypertensive drugs (2) are contraindicated in pregnancy
Definition

ARBs

ACE inhibitors

Term
This antihypertensive drugs can cause hypokalemia
Definition
diuretics - thiazides & loops
Term
complex of cytologic and chemical reactions in blood vessels and adjacent tissues in reponse to an injury or abnormal stimulation caused by a physical, chemical, or biological agent
Definition
inflammation
Term
Histologic features of inflammation
Definition

vasodilation

increased vascular permeability - fluid gets out to cause swelling

 

formation of fluid exudate - edema + fibrin

 

formation of cellular exudate - WBC, macrophages

Term
Innate and Adaptive immune system: cellular and humoral components
Definition

Innate:

cellular - macrophages, granulocytes, NKs

humoral - complement

 

Adaptive:

cellular - T & B lymphocytes

humoral - immunoglobulins

Term
4 types of immunosuppressant drugs
Definition

glucocorticoids (steroids)

cytokine inhibitors

antimetabolites

monoclonal antibodies/antithymocyte antibodies

Term
3 indications for immunosuppression
Definition

allergy

autoimmune disease

prevention of allograft rejection

Term
3 approaches to allergy treatment
Definition

1. suppress immune response via antihistamines and glucocorticoids

 

2. desensitization immunotherapy (allergy shots)-- induce immune system to make sufficient IgG against an allergen so that IgE won't bind

 

3. Anti IgE

Term
2 antimetabolites
Definition

azothioprine

toxicity: bone marrow suppression

 

mycophenolate mofetil:

more commonly used

- organ transplants, RA

 

Term
Small protein signaling hormones that modulate immune response by activating macrophages, cytotoxic lymphocytes, and NK cells

ex?
Definition

cytokines

 

TNF-a

Interleukins

Interferon

Term
3 selective cytokine inhibitors & their indications
Definition

cyclosporine - organ transplant and RA

- nephrotoxicity

 

tacrolimus - more effective than cyclosporine

- nephro and neurotoxicity

 

sirolimus - effective in graft vs. host reactions

- hyperlipidemia

Term
3 types of immunosuppressive antibodies
Definition

antithymocyte globulins - horse or rabbit

- inhibit T cell function

- may stimulate immune response because they're from another animal

 

IVIG

 

mabs

- target specific cytokines or lymphocytes

Term
Pooled immunoglobulins (mostly IgG) from thousands of donors against all kinds of different infections.

3 main indications of use:
- immunodeficiencies
- inflammatory/autoimmune disorders
- serious acute infection

lasts 2-3 mos
Definition
IVIG
Term
custom made antibodies that bind to a target of interest

usual source: mice

are either humanized or chimeric
Definition
monoclonal antibody
Term
monoclonal antibody nomenclature:

Target:
tu =
ci or cir =
neu =
li or lim =


Type:
xi =
zu =
Definition

tu - tumor

ci/cir - circulation

neu - neural

immune - li or lim

 

xi - chimeric

zu - humanized

Term
excessive initial release of cytokines when giving an immunosuppression med

prevent with premeds, such as?
Definition

cytokine release syndrome

severe form is cytokine storm

 

premeds: acetominophen

glucocorticoids

antihistamines

Term
3 rheumatoid arthritis drugs
Definition

azathioprine

mycophenolate mofetil (MMF)

TNF-a blockers

Term
___ are signaling molecules that are secreted and function locally and are part of the body's response to injury and inflammation

ex?
Definition

autacoids

 

eicosanoids - prostaglandins

Term
___ are dietary essential fatty acids that are esterified acids in cell lipids. Arachadonic acid is their precursor.


Functions in cardio, blood, renal, closing the ductus, smooth muscle (bronchial and uterine)

something about chemical stimuli, mechanical stimuli, and phospholipase A2 ???
Definition
eicosanoids
Term
Arachidonic acid (eicosanoid precursor) becomes prostaglandind and thromboxanes if exposed to ____, and becomes leukotrienes if exposed to ____
Definition

cyclooxygenase (cox)

lipoxygenase

Term
Difference between cox 1 and cox 2?
Definition

cox 1- ubiquitous, physiologic - found in all tissues

 

cox 2 - induced only by inflammation

- when treating inflammation, you want to block cox 2, not cox 1

Term
local signaling autacoid that fine tunes cell functions and secretions, is a mediatory of inflammatory response, and has a very short half life
Definition

prostaglandin

 

E & F are main ones

Term
Why would you want to be careful giving an anti-prostaglandin (cox inhibitor) to a pregnant woman or a pt with impaired renal fxn?
Definition

cox inhibitors close the ductus arteriosus -- giving it to a pregnant woman could cause the ductus to close too early

 

prostaglandins assist in renal function so giving someone a cox inhibitor for a long period of time can cause renal problems

Term
3 types of cox inhibitors and an example of each
Definition

1. Non specific and irreversible - Aspirin

 

2. nonspecific and reversible - all other NSAIDS, including salicylates

 

3. selective Cox-2 inhibitors

Term
What drug?

Antipyretic effect (CNS thermoregulatory center) + analgesic (at hypothalmaus/thalamus & tissues) + anti-inflammatory
Definition
Aspirin
Term
Salicylate toxicity
Definition

GI: acid production increases, mucus production decreases, chronic blood loss (3-8 ml/day) due to small erosions

 

Resp: resp alkalosis due to hyperventilation, acidosis at high doses

 

renal: sodium & potassium retention

 

drug reactions

 

overdose potential: 10 g can be fatal to kids

 

Reye's syndrome

Term
Hepatitis and encephalitis in kids who take aspirin for a viral infection
Definition
reye's syndrome
Term
Ibuprofen (motrin & advil) and naproxen (aleve, anaprox, naprosyn) are all what kind of NSAID?
Definition
propionic acid derivatives
Term
___ is an indolacetic acid derivative (an NSAID) that has greater anti-inflammatory effect than aspirin but is also more toxic.

it is used to close patent ductus arteriosus'
Definition

indomethacin

 

 

other indolacetic acids: slindac & etodiac

Term
what are piroxican and meloxicam?
Definition
oxicam derivatives - a type of salicylate
Term
What are mefenamic acid and meclofenamate?
Definition
fenemates -- types of salicylates
Term
what drug?

an NSAID with very strong anti-inflammatory reaction (the strongest of the NSAIDs) but weak antipyretic and analgesic action

it is not available in the US due to irreversible agranulocytosis
Definition
phenylbutazone
Term
___ is an NSAID used in acute pain settings - emergencies, post-op. It is only available IM or IV.
Definition
ketrolac (toradol)
Term
What drugs?

Cox-2 specific inhibitors - although they still act somewhat on Cox-1 (still some ulcers), they produce far less ulcers than non-specific NSAIDs

used in pts who require long term NSAIDs and have GI disorders (GERD, peptic ulcer hx)
Definition

Celecoxib (celebrex)

Valdecoxib (bextra)

rofecoxib (vioxx) --> now off the market due to increased MI/CVA risk

Term
These antiHTN can cause hyperkalemia
Definition
ARBs, ACE inhibitors
Term
These antiHTN are helpful in pts with prior MI
Definition
ACE inhibitor, Beta Blocker
Term
What is the most common reason for failure of antiHTN therapy?
Definition
lack of pt compliance
Term
For a pt who has developed the dangerous form of HIT, what alternative anticoagulant would you recommend?
Definition
lepirudin, argatroban, fondaparinux
Term
What drug has proven efficacy in reducing pain cuased by sickle cell?
Definition
hydroxyurea
Term
maximum anti-factor Xa activity of lovenox is achieved about __ hours after subQ dose
Definition
4
Term
which diuretic can cause drowsiness and paresthesias?

furosemide
triamterene
spironolactone
acetazolamide
Definition
acetazolamide
Term
which of the following electrolyte imbalances can predispose a pt to dig toxicity?

hypokalemia
hypercalcemia
hypomagnesmia
Definition
hypokalemia
Term
the intense cutaneous flush often seen after ingestion of niacin can be reduced or prevented by taking __ beforehand
Definition
aspirin
Term
which class of diuretics has the greatest ability to increase Ca excretion in the urine?
Definition
loop
Term
Drugs such as sildenafil (viagra) are contraindicated in pts taking ....?
Definition
nitrates
Term
which of the following drugs would be best for prinzmetal's angina?

nifedipine
propanolol
losartan
adenosine
Definition
nifedipine (calcium channel blocker)
Term
which class of lipid modifying drugs would you recommend for a 35 y/o woman with hereditary hyperlipidemia who is 7 weeks pregnant?
Definition
bile acid sequestrants
Term
which drug has been shown to increase survival in pts diagnosed with CHF?

lisinopril
propanolol
spironolactone
valsartan
Definition

lisinopril

propanolol

valsartan

Term
what drug would you recommend to help control the sx of a thyroid storm in a pt with asthma?
Definition
calcium channel blocker - diltiazem
Term
which of the following glucocorticoids has the greatest anti-inflammatory effect?
Definition
betamethasone
Term
Which of the following would be an indication for the use of aminoglutethimide?

thyroid storm
autoimmune disease
breast cancer
adrenal insufficiency
Definition
breast cancer
Term
which class of drugs is normally the first choice for a fib?
Definition
beta blocker
Term
which of the following is useful in the tx of refractory acromegaly?

follitropin beta
cabergoline
desmopressin
pegvisomant
Definition
pegvisomant
Term
which antiarrhythmic drug commonly used to treat ventricular arrhythmias is structurally related to thyroxine?
Definition
amiodarone
Term
in addition to hydrocortisone, what other drug may be necessary in tratment of addison's disease
Definition
fludrocortisone
Term
name a drug which can induce the CYP450 enzymes responsible for degrading thyroxine and thereby result in lower circulating levels of t4?
Definition
phytoin, rifampin, phenobarbitol
Supporting users have an ad free experience!