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Pharm Cards Midterm 2
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99
Pharmacology
Graduate
01/13/2010

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Term
A1 Receptor Effects
Definition
Vasoconstriction, decrease glandular secretion, constriction of radial muscle, decreased motility
Term
A1 Receptor Location
Definition
Arterioles, veins, glands eye, intestine, myocardium
Term
A2 Receptor Location
Definition
CNS post and postsynaptic terminals, B islet cells in the pancreas, larger vessels, skin, mucosa, kidney
Term
A2 Receptor Effects
Definition
Decreased sympathetic outflow from brain, decreased NE release, decreased islet cell secretion.
Term
B1 Receptor Location
Definition
Heart: Myocardial tissue and conduction system
Term
B1 Receptor Effects
Definition
> Heart rate, > contractility > conduction velocity > automaticity
Term
B2 Location
Definition
Trachea, bronchioles, bronchi, uterus, arterioles (not brain and skin), veins vascular smooth muscle, liver
Term
B2 Effects
Definition
Tracheal/bronchial relaxation, uterine relaxation, circulatory dilation.
Term
M1 Receptor Location (Muscarinic)
Definition
Stomach, ganglion, CNS
Term
M2 Location
Definition
Heart lung stomach bladder
Term
M1 Cholinergic action
Definition
Incrase acid/pepsin secretion, stimulate ganglia, facilitate neurotransmission.
Term
M2 Cholinergic actions
Definition
Slows heart rate, decreases contractility and conduction velocity. Causes bronchoconstriction, increases secretions, increases GI motility. Relaxes sphincter
Term
M3 Location
Definition
Glands eye
Term
M3 Cholinergic action
Definition
Increases glandular secretions. In the eye, causes miosis (constriction) and accommodation.
Term
Phenoxybenzamine, prazosin, terazosin
Definition
Peripheral receptor blockade
Adrenergic
a1 blocker (sympatholitic)
Term
Propranolol, timolol, metoprolol, esmolol, atenolol, betaxolol
Definition
Peripheral receptor blockade
Adrenergic
Beta adrenergic blockers. (At high doses, B1 selectivity can be lost and some B2 effects can be seen.
Term
Atropine
Definition
Muscarinic blocker (cholinergic). Produces Mydriasis (dilation), and cycloplegia, good for examining retina. Amblyopia, treat anterior uveitis, decrease secretions pre operatively, treat GI spasms, symptomatic bradycardia, pulseless electrical activity in heart, organophosphate poisoning.
ADE: excessive mydriasis/cycloplegia, facial flushing, xerostomia, confusion, urinary retention, tachycardia, contraindicated narrow-angle glaucoma.
Term
Atracurium, vecuronium, mecamylamine
Definition
Nicotinic blocker. (cholinergic)
Term
Parasympathomimetic
Definition
Cholinergic stimulant
Nicotine
Term
Parasympatholytic
Definition
Cholinergic blocking agent
Term
pilocarpine
Definition
Parasympathomimetic
Tx: Open angle glaucoma. Causes miosis (constriction) and changes aqueous outflow. ADE: irritation/conjunctivitis, burning, ciliary spasm, lacrimation.

Bad for: parkinsons patients, asthma, PUD, hyperthyroidism, abnormal blood pressure, epilepsy, tachycardia. 1-2 drops 6x a day
Term
carbachol
Definition
Parasympathomimetic
surgical miotic agent (constriction). For open angled glaucoma. Lowers pressure. 1-2 drops 3x a day. ADE: irritation/conjunctivitis/ burning, viliary spam, lacrimation, etc.
Term
Pyridostigmine
Definition
Parasympathomimetic
Cholinesterase inhibitor. Used for myasthenia gravis and reversal of non depolarizing muscle relaxants. PO IM IV dosage forms
Term
Scopolamine
Definition
Muscarinic blocker. Produces cycloplegia and mydriasis (dilation). Used to prevent N/V associated with potential ADEs: xerostomia, confusion, increased body temp, facial flusing, urinary retention, tachycardia, contraindicated in narrow-angle glaucoma.
Term
Homatropine
Definition
Muscarinic blocker. Used as a cycloplegic mydriatic agent (refraction). Tx of acute inflammatory conditions of uveal tract.
ADE: Blurred vision, photophobia, local irritation, increased IOP.
Term
Phenylephrine
Definition
(Sympathomimetic) A1 stimulant. Mydriasis but not cycloplegia. Relieves redness of eye. !!Don't use within 21 days of an MOA inhibitor.
ADE: Increased bloodp ressure, headache, dizziness.
Term
Propylthiouracil
Definition
Use: Hyperthyroidism
ADE: Fever, blood dyscrasias, skin rash/itch, arthralgia, peripheral neuropathy, dizziness, loss of taste, N/V, stomach pain, renal and hepatic complications.
Term
Methimazole
Definition
Tx: Hyperthyroidism.
ADE: Fever, blood dyscrasias, skin rash/itch, peripheral neuropathy, dizziness, loss of taste, N/V,. stomach pain, renal * hepatic complications
Term
Levothyroxine
Definition
***DRUG OF CHOICE***
Tx: Hypothyroidism
ADE: (dose related) Chest pain, diarrhea, leg cramps, appetite change, fast heart rate, remor, headache, irritability, insomnia, sensitivity to heat.
Admin: SLow increase in dosage helps prevent adverse effects.
**Can take a while to work.. (months)
Term
MAO
Definition
Hormone that controls storage & metabolism of carbs/protein/fat. Substitute for insulin in type1 patients.
USES: Type-1 diabetes mellitus / possibly type 2.
ADE: Hypoglycemia
Drug interactions: beta adrenergic blocking agents **Ophthalmic formulations(can modify carb metabolism and lead to hyperglycemia. Corticosteroids (antagonize insulin effects).
Term
Insulin Aspart
Definition
Rapid-Acting insulin.
Onset: 5-10 minutes
Peak: 1-3 hours.
Duration: 3-5 hours.
Term
Insulin Lispro
Definition
Rapid-Acting insulin
Onset:15 mins.
Peak: 05.-1.5 hours.
Duration. 4-5 hours
Term
Insulin Glulisine
Definition
Rapid-acting insulin.
Onset:10-15 mins.
Peak: 55 mins.
Duration: Shorter than regular insulin. (3-5 hours).
Term
NPH
Definition
Intermediate Acting insulin
Onset: 1-2 Hours
Peak: 6-14 hours
Duration:18-24 Hours.
Term
Insulin Glargine
Definition
Long acting insulin.
Onset: Slow release over 24 hours.
Peak: None
Duration: 24 hours.
Term
insulin Detemir
Definition
Long-acting Insulin. (like pancreas)
Onset: Slow release over 24 hours.
Peak 6-8 hours.
Duration: 12 -24 hours depending on the dose per pt weight.
Term
Glyburide
Definition
Medication for diabetes (Type 2)
Action: Sulfonylurea agent. Stimulates acute release of insulin from function beta cells. May increase insulin sensitivity in target cells.
ADE: Hypoglycemia
Comments: Ocular side effects!! Blurred vision and changes in accommodation.
Term
Glipizide
Definition
Medication for diabetes (Type-2)
Action: Sulfonylurea agent. Stimulates acute release of insulin from functional beta cells. May increase insulin sensitivity in target cells.
ADE: Hypoglycemia, wt. gain, hepatic and renal comlications, blood dyscrasias, GI disturbances, headache, increased cardiac risk in those with CV disease.
Comments: !! Ocular side effects: Blurred vision and changes in accommodation.
Term
Glimepiride
Definition
Medications for Diabetes (Type-2)
Action: Sulfonylurea agent. Stimulates acute release of insulin from functional beta cells. May increase insulin sensitivity in target cells.
ADE: Hypoglycemia
Comments: !! Blurred vision & changes in accommodation.
Term
Acarbose
Definition
Medication for diabetes (Type-2)
Term
Miglitol
Definition
Medication for diabetes (Type 2)
Term
Metformin
Definition
**IMPORTANT DRUG TO KNOW**
Medication for diabetes (Type 2)
Action: Potentiates the effect of endogenous insulin. May work by decreasing hepatic glucose production and improving insulin sensitivity.
ADE: N/V/D, flatulence, rash, weakness,headache, hypoglycemia, lactic acidosis, myalgia, blood dyscrasias, chest discomfort.
Admin:Caution with other drugs that lower blood glucose. Risk of hypoglycemia
Comments: Renal function should be monitored. The drug may be discontinued in renal dysfunction. Medication is held before surgeries and use of contrast media.
Term
Pioglitazone
Definition
Medications for diabetes (Type 2)
ADE: Caution with patients with edema, or heart failure b/c of fluid retention. Avoid in hepatic impairment. Can cause edema, wt gain, induce CHF tooth disorders, headache, myalgia, sinusitis, anemia.
Comments: !! rare reports of decreased visual acuity, macular edema.
Term
Rosiglitazone
Definition
Medications for diabetes (Type 2)
ADE: Caution in patients with edema or heart failure. Liver function should be monitored.
Can cause Edema, wt. gain, induce CHF, tooth disorders, headache, myalgia, sinusitis, anemia.
Comments: !! Decreased Visual acuity and macular edema have been reported.
Term
Sitagliptin
Definition
Type 1 and Type 2 diabetes Tx.
ADE: Upper respiratory tract infections, sore throat, diarrhea, N/V, pancreatitis, hypoglycemia, weight gain, headache, rash etc.
Term
Albuterol
Definition
***DRUG OF CHOICE***
REspiratory Med: Asthma COPD, emphysema
Action: B2 adrenergic receptor agonist causes bronchodilation.
ADE: Vasodilation, tachycardia, palpitations, tremor, CNS stimulation.
Term
Levalbuterol
Definition
Respiratory Med: Asthma, COPD, emphysema
Action: B2 adrenergic receptor agonist causes bronchodilation.
ADE:Basodilation, tachycardia, palpitations, tremor, CNS stim. Can cause atrial fibrillation if used too often in elderly.
Term
Pirbuterol
Definition
Respiratory Meds: ASthma, COPD, emphysema.
Action: B2 adrenergic receptor agonist causes bronchodilation.
ADE: Basodilation, tachycardia, palpitations, tremor, CNS stimulation.
Admin: INH form only (lasts 4-6 hours)
Term
Tiotropium
Definition
Respiratory MEd: Bronchospam associated with COPD in adults, maintenance use.
ADE: Cough, dry mouth and ***Blurred vision**
**Caution in narrow angle glaucoma.**
Term
Systemic cortico steroids
Definition
Respiratory Med: for Acute asthma and COPD exacerbation.
Action: Decrease inflammation and edema in respiratory tract, enhance sympathomimetic bronchodilator activity.
ADE: Na+/water retention, elevated blood glucose, can alter e-lytes, GI irritation CNS effects. ***BLURRED VISION AND CHANGE IN IOP!***
Admin: PO/IV/IM
Comment: Taper off as soon as possible to avoid adrenal reliace.
Term
Flunisolide
Definition
Respiratory Med: For chronic asthma (maintenance)
Action: Decrease inflammation and edema in respiratory tract, enhance sympathomimetic bronchodilator activity.
ADE:Increase risk of oral candidiasis. Some potential drug interactions.
Admin: Inhalant form.
***Blurred vision, change in IOP***
Term
Fluticasone
Definition
Respiratory Med: Chronic asthma
Action: Decrease inflammation and edema in respiratory tract, enhance sympathomimetic bronchodilator activity.
ADE: Increased risk of oral candidiasis, Some drug interactions.
Admin: Inhaled.
Comment: BLURRED VISION & CHANGE IN IOP!
Term
Montelukast, Zafirlukast &Zileuton
Definition
Respiratory med: Chronic asthma prevention /maintenance
Term
Blepharitis
Definition
Staphylococcus aureus, staphylococcus epidermidis, seborrhea, dry eye, rosacea
Term
Hordeolum
Definition
Staphylococcus aureus
Term
Bacterial conjunctivitis
Definition
Staph aureus, N. gonorrheae, C. trachomatis, strep pneumoniae, Hemophilus influenze
Term
Viral conjunctivitis
Definition
Herpes simplex types 1 and 2, adenovirus
Term
Bacterial Keratitis
Definition
Pseudomonas aeruginosa, staph aureus, staph epidermidis, strep pneumoniae, group A strep, Enterobacteriaceae, Listeria
Term
Viral keratitis
Definition
Herpes simplex types 1 & 2, Varicella-zoster virus.
Term
Dicloxacillin
Definition
Penicillin (stops cell wall synth)
Effective against strep and staph cocci. Oral form only. (Lost of resistance)
ADE: Allergy: Immediate or delayed. Rash or shock. GI effects with oral use: Nausea vomiting, diarrhea. Confusion, seizures and encephalopathy. Blood dyscrasias can occur: eosinophilia, thrombocytopenia, leukopenia, neutropenia.
**Most Likely: No need to renal adjust**
Term
Amoxicillin
Definition
Penicillin. against strep staph and listeria, & some gram-negative rods and cocci.
Oral only.
ADE: Allergy: Immediate or delayed. Rash or shock. GI effects with oral use: Nausea vomiting, diarrhea. Confusion, seizures and encephalopathy. Blood dyscrasias can occur: eosinophilia, thrombocytopenia, leukopenia, neutropenia.
**DOES NOT WORK AGAINST PSEUDOMONAS **
**Needs to be dose adjusted in patients with renal impairment**
Term
Amoxicillin/clavulanate
Definition
Penicillin:
Clavulanate added to restore effectiveness of amoxicillin against some bacteria that acquired resistance.
ORALLY (strep& Staph)
Some gram-negative rods and cocci.
ADE: Allergy: Immediate or delayed. Rash or shock. GI effects with oral use: Nausea vomiting, diarrhea. Confusion, seizures and encephalopathy. Blood dyscrasias can occur: eosinophilia, thrombocytopenia, leukopenia, neutropenia.
**Does not work against pseudomonas.
** Needs to be dose-adjusted in patients with renal impairment.
Term
Cephalosporins:
Cephalexin and Cefadroxil
Definition
*First Generation*
MOA: Bacteriocidal: Inhibits bacerial cell wall synthesis, inhibits bacterial enzymes which assemble peptidoglycan.
USE: Effective against gram + not good for pseudomonas or enterococci. (oral only
ADE: Renal dose adjustment in patients who have renal impairment. 2-10% of patients alergic to penecillians are alergic to cephalosporins too.
Term
Cephalosporins:
Cefaclor
Definition
MOA: Bacteriocidal: Inhibits bacerial cell wall synthesis, inhibits bacterial enzymes which assemble peptidoglycan.
Cephalosporin (Inhibits cell wall production).
Same gram + coverage as cephalexin, but has a bit more gram - rod coverage.
** Does not cover enterococci or Pseudomonas.
ADE: Renal dose adjustment in patients who have renal impairment. 2-10% of patients alergic to penecillians are alergic to cephalosporins too.
Term
Fluoroquinolones ( ciprofloxacin, gatifloxacin, levofloxacin, moxifloxacin, norfloxacin, besifloxacin.
Definition
Inhibition of bacterial DNA gyrase, interferes with bacterial reproduction.
Some gram + many gram - bacteria. NOT GOOD AGAINST MRSA
Uses: Most ophthalmic solutions used in bacterial conjunctivitis will be used for 7 days. Corneal ulcers/keratitis will be used for 5-14 days.

ADE: If allergic to one fluoroquinolone, can easily cross react with others. Avoid over use for conjunctivitis. (can cause white precipitate)

Watch out for: Seizure history, or patients on blood thinners.
Can cause :Photosensitivity and photophobia, burning/stinging sensation, blurred vision, redness/irritation in eye, eye pain, foreign body sensation, tearing, dry eye.
**Severe damage possible too: Allergy / exfoliative dermatitis,facial edema, dizziness.
Term
Polymyxin
Definition
Poly myxinbactericidal agent, binds to cytoplasmic membranes, disrupting the structure and altering membrane permeability. (Against sensitive gram negative bacteria)

NOT LONG TERM TREATMENT
Term
Bacitracin
Definition
Bactericidal agent.
Binds to bacterial cell membranes and interferes with cell wall synth. Against sensitive Gram-positive bacteria.


NOT LONG TERM TREATMENT
Term
Tetracyclines
Definition
MOA: Inhibit bacterial protein synth by binding to 30-S ribosomal subunit. Bacteriostatic effects: variable -> gram-positive bacterial, reliable -> systemic listeria infections.
Some gram - (Neisseria meningitidis and legionella.
Effective for Mycoplasma, chlamydia, and rickettsia.
**WATCH OUT FOR SUN BURN! (photosensitivity)***
(NEBO- oral use VERY rare, only specific conditions: chlamydial inclusion conjunctivitis, trachoma. Oral group = doxy and tetra)

Avoid use in pregnancy and in children.

Cross sensitivity btw agents in SAME class

GI effects: colitis
Term
Macrolides
Definition
Inhibit protein sytn by binding to 50-S ribosomal subunit.
Against: Gram-positive bacteria (Group A, B,C and G strep, strep pneumoniae, MSSA, listeria)
Some Gram - ( N. meningitidis, M. catarrhalis, H influenzae, legionella).
Good for mycoplasma, chlamydia, rickettsia and some clostridia.
ADE: Hepatic complications (hepatitis & Jaundice) renal complications, GI effects
Ototoxicity
Allergic reactions.

Azithromycin: trmt of eyelid infections & chlamydial DZ, NO RENAL ADJ.
Erythromycin: superficial ocular infections, YES RENAL ADJ.
Term
Aminoglycosides
Definition
Inhibition of bacterial protein synthesis by binding to 30-2 (and 50-s) BOTH.
USED MOSTLY FOR GRAM - bacteria, and some MSSA
Uses: Ophthalmic products include: gentamicin 0.3% ointment and solution, tobramycin 0.3% ointment and solution, and neomycin). Sometimes used prophylactically, still some conjunctivitis or keratitis.
Term
Trifluridine
Definition
Antiviral: 1% Opthalmic solution for herpes and keratoconjunctivitis.. Thymidine is incorporated into viral DNA.
Term
Vidarabine
Definition
Antiviral agent. 3% opthalmic ointment for herpes, keratoconjunctivitis. Inhibits viral DNA polymerase and prevents lenthening or building of DNA viral chains.
NOT FOR ADENOVIRUS.
ADE: Increased sensitivity to light.
Term
Clonidine,Guanabenz, Guanfacine, methyldopa
Definition
Antihypertensive medications
Action: A2 agonists
***Blurred vision, conjunctivitis and dry eyes are possible.
Term
Doxazosin, Terazosin, Tamsulosin
Definition
Class: Selective alpha-adrenergic antagonists
Uses: Hypertension, BPH (Benign Prostatic Hypertrophy).
** Vision abnormalities (blurry vision, etc.) and conjunctivitis can occur.
Term
Beta adrenergic blocking agents Labetalol, carvedilol [DRUG OF CHOICE], sotalol, metoprolol, atenolol
Definition
Uses: Hypertension & cardiac arrhythmias, glaucoma, angina, migraine
** Many drug to drug interactions
**Dryness or soreness of the eyes**
Term
Calcium channel agonists: Nifedipine, diltiazen,amlodipine
Definition
Action: Blocks calcium influx during slow channel exchange, dilates peripheral arterioles, some are used for antiarrhythmnic properties, also used for angina.
** Drug to drug
**Transient blindness has been reported rarely with nifedipine.
Term
Aldosterone receptor antagonist: Spironolactone
Definition
Uses: Hypertension CHF, CHF after MI, edema
Term
Ace inhibitors: Captopril, Lisinopril, Enalapril, Ramipril
Definition
Uses: hypertension, CHF, MI
ADE: Dizziness, tachycardia,headache, cough, bradykinin accumulation.
**DRUG TO DRUG***
**Rare vision defects **
Term
Angiotensin receptor blockers: Losartan, Valsartan, Irbesartan
Definition
Uses: Hypertension
ADE: Hypotension, dizziness, other ADE's
**Conjunctivitis and blurred vision have been reported.
Term
Thiazide Diuretics: Hydrocholorthiazide, Metolazone
Definition
Uses: Edema, hypertension.
Term
Loop Diuretics: Fuosemide, Forsemide, Ethacrynic acid
Definition
Uses: Edema, hypertension, Lasix also used for hypercalcemia.
ADR:Electrolyte imbalance

*** Can cause blurred vision ***
Term
Carbonic anhydrase inhibitors Acetazolamide, Brinzolamide, Dorzolamide
Definition
Uses: glaucoma
MOA: *****Inhibits carbonic anhydrase lowers IOP

**TRANSIENT MYOPIA HAS BEEN REPORTED
Term
Warfarin
Definition
Uses: Deep vein thrombosis,atrial fibrillation, pulmonary embolism, and heart valve replacement surgeries.
ADE: Bleeding necrosis, GI upset.

Drug interactions:****NSAIDs, aspirin, clopidogrel, antibiotics, heparin, thrombolytic agents can increase bleeding risk.

**Effects reversed by use of vitamin K.
Term
Aspirin, NSAIDs
Definition
Uses:Reduces risk of AMI, stroke, and TIA (ministroke). Anti-inflammatory and analgesic indications.
ADE: GI bleeding
**Reports of visual disturbances, blurred vision, with some NSAIDS**
Term
Clopidogrel
Definition
Anticoagulant
**ADE: Cataracts and conjunctivitis**
Term
Post Synaptic Neurons
Definition
Transmit imipulses to end organs by releaseing NE (Sympathetic), or ACh (Parasympathetic)
Term
ACh
Definition
Parasympathetic: Transmits all parasympathetic signals to end organs (heart , lungs) binds to MUSCARINIC RECEPTORS.

Sympathetic and parasympathetic: from preganglionic neurons in brain/spinal cord to NICOTINIC ganglionic receptors on postganglionic nuerons.

ALL ganglionic transmition is cholinergic.

When released from NEURONS: causes muscle contraction by binding to NICOTINIC receptors on muscle cells.

In BRAIN: neurotransmitter with MUSCARINIC receptors.
Term
Not identifiable through a gram stain
Definition
Legionella, chlamydia, rickettsiae, mycoplasma
Term
Bacilli
Definition
Rod-shaped. Example: E. Coli
Term
Spirillum
Definition
Short rigid spirals Ex. Vibrio
Term
Spirochetes
Definition
Protozoa-like bacteria that are thin, flexible, motile and spiral-shaped. Ex. Borrelia
Term
Fungus like
Definition
Bacteria that possess branchingfilamentous elements resembling fungal hyphae. Ex. Mycobacteria.
Term
Rickettsiae
Definition
Extremely small parasitic bacteria once thought to be virusesbecause their growth takes place within host cell. They do have a cell wall. Ex. Coxiella.
Term
Mycoplasma
Definition
Very small bacteria that lack a rigid cell wall. Bound by unit membranes. (Not seen with gram's stain) Antibody titers can help dx. Ex. Mycop0lasma pneumoniae.
Term
Chlamydia
Definition
Smaller than Rickettsiae, these bacteria were also once thought to be viruses. Chlamydia are obligate intracellular parasites which do possess cell walls and ribosomes, but must rely on the intracellular processes of the host cell to produce metabolic energy.
Term
Specimen collection: Colonies surrounded by greenish zones
Definition
(Partially hemolytic bacteria)
Alpha hemolytic streptococci ( S. viridans, or S. pneumoniae)
Term
Specimen Collection: colonies surrounded by clear zones
Definition
fully hemolytic bacteria
Beta hemolytic streptococci such as group A streptococci.
Term
Minimum inhibitory concentration (MIC)
Definition
The lowest in-vitro concentration of antibiotic in solution with a bacterial suspension that prevents/inhibits growth of the bacteria after an incubation peroid.

If the concentration of antibiotic represented by the MIC can be achieved in the patient's serum by normal routes of delivery, the bacteria is said to be sensitive to the antibiotic.

If the MIc is above the achievable level or is within range that would be toxic to a patient, then the bacteria is said to be resistant oteh antibiotic.
Term
Bacteriocidal
Definition
Antibiotics whose mechanisms of action usually result in bacterial cell death.
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