HOSA: Pharamacology

Elderly

65 years of age and older

antiparkinsonian. used for palliative relief of major symptoms of Parkinson disease

(L-Dopamine, Requip, Symmetrel, Tasar)

mucolytic. breaks chemical bonds in mucus, lowering the viscosity

(Mucomyst)

antineoplastic. prevents the replication of neoplastic cells; used to treat tumors

(Myleran, Cytoxan)

muscle relaxant. produces relaxation of skeletal muscle

(Norflex, Paraflex, Robaxin, Skelaxin, Valium)

bronchodilator. dilates the bronchi

(Proventil, Isuprel)

pegvisomant

growth homrone receptor antagonist- can be used for acromegaly if surgical resection does not work.

Beta 1 selective antagonists

include acetobulol (partial agonist), atenolol, betaxolol, esmolol, and metoprolol Notice that its A to M (the 1st half of the alphabet)

Nitrosoureas

include carmustine, lomustine, semustine, streptozocin corss blood-brain abrrier and cross-link DNA Use: brain tumors SE: CNS (convulsions, diziness, ataxia)

Bile acid resins

include cholestyramine, colestipol, colesevelam Decrease LDL, slightly increase HDL, slightly INCREASE triglycerides MOA: prevent intestinal reabsorption of bile acids toxicity: GI upset, decreased abosrption of other drugs and fat soluble vitamins

Antitumor antibiotics

includes blemoycin, dactinomycin (actinomycin D), doxorubicin, aunorubicin

Rituximab

Monoclonal antibody against CD20, which is foundon most B cell neoplasms. Use: lymphoma, CML, IBD, rhematoid arthritis Use: increases risk for progressive multifocal leukoencephalopathy

Trastuzumab

Monoclonal antibody against Her-2, a tyrosine kinase receptor. Helps kill cancer cells that overexpress Her-2, through inhibition of HER2-initiated cellular signaling and antibody-depdedent cytotoxicity. Use: Her2 postiive breast cancer and gastric cancer Toxicity: Cardiotoxicity

Bevacizumab

Monoclonal antibody against VEGF. Inhibits angiogenesis SE: impaired wound healing

precautions

includes disease states or clinical situation when drug use involves risk or in which drug dosage modification is required

Ephedrine

indirect agoinst, releases stored catecholamines used for nasal decongensiton (vasoconstriction) and local urinary incontinence, and hypotension.

Barbituates

induce hepatic microsomal enzymes (CYP450 inducers) and thus increase warfarin metabolism and reduce its anticoagulant effect (could lead to stroke)

immunologic

induces immunity and prevents infectious diseases; stimulates body to produce antibodies (DTP, MMR, Engerix-B, Varivax)

immunologic

induces immunity and prevents infectious diseases; stimulates body to produce antibodies (DTP, MMR, Engerix-B, Varivax)\

Topical Medication on Infants

infants have a greater ratio of surface area to body weight so absorb medication much faster

-itis

inflammation

rhinitis

inflammation of the nasal lining

Insulin, intermediate acting

NPH

Mannitol

Osmotic diuretic. The nuerosurgeouns love beceuase decreased intracrnail pressure. Used for drug overdose and elevated intracranil pressure tox; could cause pulmonary edema Contraindicated in HF

Selegiline

Selectively inhibits MAO-B which prerentially metabolizes dopmaine over NE and 5-HT, increasing the availability of dopamine. Parkinson drug

Ivabradine

Selectively inhibits funny sodium channels, thereby prolonging the slow depolarization phase (phase 4) and slowing the SA node firing rate (HR). No effect on contractility (inotropy) and/or relaxation.

Somatostatin (octreotide)

Use: acromegaly, carcinoid syndrome (improves diarrhea and flushing), gastrinoma, glucagonoma, esophageal varices (reduces portal hyptertesnion), also VIPOMA

Dantrolene

Use: malignat hyperthermia and neuroepiletpic malignant syndorme. Prevents Ca2+ release from SR

Neuromuscular blocking drugs

Use: muscle paralysis in surgery. Selective for motor nicotinic receptor. Depolarizing: Succinylcholine: strong ACh receptor agonist; rproudces sustained depolarziation and prevents muscle contraction. Reversal: Phase I- no antidote. Phase 2: repolarized but blocked: treat with anticholinesteraste inhibiotrs: neostigmine. Possible hypercalcemia, hyperkalemia, and malignant hyperthermia Nondepolarizing: Tubocurarine and anything with urium or onium in the name. These are competitive antagonists with ACh receptors over ACh. Neostigmine can reverse.

Depot antipsychotics

Used for long term maintenance Promote highest level of function Compliance is improved Not given orally

Phenoxybenzamine

Used for pheo (peropteratively). It is an irreversible antagonist of alpha receptors (lowers efficacy)

Prednisone, prednisolone

Used in combinatin with chemotherapy for blood cancers. Also used in autoimmune disease.

Rifampin

Used prophylactically for close contacts in those with menigocococcal meningitis (Neisseria meningitidis). Neisseria menigitidis is a gram-negative cocci seen in pairs that often afflicts college-aged students.

Intestinal transit is ______ in neonates

Prolonged -->because of reduced motility and peristalsis

Protease inhibitors (like Ataznavir)

are used for HIV and prevent formation of mature viral proteins. Side effects include hyperglycemia, lipodystrophy and drug-drug interactions due to inhibition of CYP 450.

Atropine, homatropine, and tropicamide

are used in the eye during eye exam. Atropine has longer half-life whereas homatropine and tropicamide are shorter. They all produce mydriasis and cycloplegia (paralysis of cilliary/accomodation muscle)

Alpha 1 blockers such as Doxazosin, prazosin, and Terazosin

are useful for treatment of both benign prostatic hyperplasia and hypertension.

ad lib

as desired

ad lib (ad libitum)

as desired

UD

as directed

PRN

as needed

p.r.n.

as needed

Busulfan

cross-links DNA Use: CML, also before bone marrow transplants SE: severe myelosupression, pulmonary fibrosis, hyperpigmentation (similar to bleomycin with pulm fibrosis and hyperpigmentation)

cc

cubic centimeter

mEq

milliequivalent

mg

milligram

mL

milliliter

Ciguatoxin

mimics cholinergic poisoning (DUMBBELLS) Opening of Na+ channels causing depol temperature-related dysesthesia is specific get from reef fish (barracuda, snapper, morray eel)

neuroleptic

modifies psychotic behavior (Risperdal, Zyprexa, Stelazine)

neuroleptic

modifies psychotic behavior (Risperdal, Zyprexa, Stelazine)\

Aliskiren

direct renin inhibitor Use; hypertension Tox: hyperkalemia, hypotension. Don't use when already taking ARBs or ACE

DC, disc, dc

discontinue

Succinylcholine

fast-acting, depolarizing neuromuscular blocking agent used for rapid-sequence intubation that causes equal reduction of all 4 twitches during train of four stimulation (phase I blockade). Prolonged administrant of succinylcholine or use in patients that have abnormal cholinesterase activity causes transition to a phase II (nondepolarzing) block, seen as a progressive reduction in each of the 4 twitches. sucks = depolarizes

lipo-

fat

Doxorubicin

form free radicals and can cause a dilated cardiomyopathy

PCI

Cannulation into the femoral artery above the inguinal ligament signficantlly increases the risk of retroperitoneal hemorrhage

Blood-brain barrier

Capillaries in CNS different - no pores Only lipophilic drugs can cross membrane Excludes ionised drugs

Vancomycin

MOA: inhibits cell wall peptidoglycan formation by binding D-ala D-ala portion of cell wall precursors. Bactericidal. Not suspcetible to beta-lactamases. Use: gram-positive bugs only- serious multidrug resistant organisms like MRSA, S. epi, and sensitive enterococcus species, and clostridium difficile (oral here) Toxicity: well-tolerated in general but NOT trouble free (nephrotoxicity, ototoxcity, thrombophlebitis), diffuse flushing-red man syndrome (can largely be prevented with anti-histmaines and slow infusion rate) MOR: modificaiton of D-ala D-ala to D-ala D-lac.

Intramuscular disadvantages

Limited to small vol

DPP-4 inhibitors

Linagliptin, saxagliptin, sitagliptin INcrease insulin, decrease glucagon. Side effects: mild urinary and respiratory infections

Oxazolidinones

Linezolid MOA: inhbiit protein synthesis by binding 50S and preventing formation of inititation complex. Ue: Gram-psotivie specieis including MRSA and VRE toxicity: Bone marrow supression (especially thrombocytopenia), peripheral neuropathy, serotonin syndrome (hey!) MOR: point mutation of rRNA

Cidofovir

MOA: inhibit viral DNA polymerase. Doese not require phosphorylation by viral kinase Use: CMV retinitis (HIV patients); acyclovir-resistnat HSV Toxicity: Nephrotoxicity- coadminister with probenecid and saline to decrease)

Daptomycin

MOA: lipopeptide that disrutps cell membrane in gram-positive cocci. Use: skin infections (especially MRSA), bacterima, endocarditis, VRE Toxicity: myopathy, rhabdomylysis not used in pneumonia (inactivated by surfactant)

Lithium

MOA: not known (possibly phospoinositol inhibition) Use: Mood stabilizer for bipolar disorder - blocks relapse and acute manic events as well. Also used to treat SIADH. Tox: tremor, hypothyroidism, polyuria (nephrogenic diabetes insipidus), teratogenesis (Ebstein anomaly)

For basic drug, pKa of 10 what is ionization state in small intestine

weak base there4 with increasing env pH, inisation decreases S. intestine higher pH there4 lower ionisation/mainly uncharged Drug easily absorbed

For basic drug, pKa of 10 what is ionization state in stomach

weak base therefore with increasing env pH, ionisation decreases pH in stomach low there4 ionisation high low drug absorbtion

FDA Recall Class II

would be used in a case where use of a violative product may cause temporary health problems and the probability of serious adverse health consequence is remote

sig

write on label

gram-

x-ray

Anesthetic

xylocaine (lidocaine), Marcaine (bupivicaine)

Carbachol

primarily used for glaucoma and works by constricting pupils to relieve intraocular pressure (carbon copy of ach)

sedative

produces calming effect without causing sleep; depresses CNS (Amytal, Buticaps, phenobarbital)

sedative

produces calming effect without/ with causing sleep; (Amytal, Buticaps, phenobarbital)

vasopressor

produces contraction of muscles of capillaries and arteries; elevates BP; used to treat allergic reactions (Aramine, Levophed)

anesthetic

produces lack of feeling either local or general depending upon type and how administered (lidocaine, Xylocaine, Novocain)

anesthetic

produces lack of feeling either local or general depending upon type and how administered (lidocaine, Xylocaine, Novocain)\

vasodilator

produces relaxation of blood vesels; lowers BP (Isordil, nitroglycerin)

muscle relaxant

produces relaxation of skeletal muscle (Norflex, Paraflex, Robaxin, Skelaxin, Valium)

hypnotic

produces sleep or hypnosis; depresses CNS (chloral hydrate, Placidyl, Seconal)

hypnotic

produces sleep or hypnosis; depresses CNS (chloral hydrate, Placidyl, Seconal)\

antidote

counteracts poisons and their effects (Narcan)

Anticholinergic

Drug that blocks the action of the parasympathetic nervous system

Beta-blocker

Drug that blocks the action of the sympathetic nervous sysetm

Antiarrythmic

Drug that controls or prevents cardiac irregularities

Antilipemic

Drug that lowers the serum cholesterol and low-density lipoproteins (LDL's) and increases the high-density lipoproteins (HDLs)

Agonist

Drug that mimics the action of a neurotransmitter when it binds to a particular receptor site - i.e. & triggers the cell's response in a manner similar to the action of the body's own chemical messenger.

Antagonist

Drug that neutralizes or counteracts the effects of a neurotransmitter or another drug when it binds to a particular receptor site.

Antiemetic

Drug that prevents or treats nausea, vomiting, or motion sickness

Antiulcer

Drug that reduces gastric acid secretion, or that acts to prevent or treat gastric or duodenal ulcers

C-V Dependency Potential

Limited physical or psychological

antidote

counteracts poisons and their effects (Narcan)\

AD

right ear

OD

right eye

Ipratropium

"I pray I can breathe soon" Used for asthma and COPD anything else with tropium also here as a muscarinic antagonist

antibiotic; destroys or inhibits growth of microorganisms

(Kelfin, Rocephin, Pentids, penicillins, Augmentin) the above do what?

Aortic Regurgitation

"Water-hammer" pulses (full and then collapses) and head-bobbing with each heart beat (de Musset sign) are characteristic findings of this murmur. Bounding femoral pulses.

anti-inflammatory. prevents inflammation

(Advil, Motrin, Naprosyn)

antihistamine. acts to prevent the action of histamine (allergies)

(Allegra, Benadryl, Dimetane)

antiemetic. prevents or relieves nausea and vomiting

(Dramamine, Marinol, Phenergan, Reglan, Tigan)

expectorant. facilitates removal of secretion from broncho-pulmonary mucous membrane

(Robitussin, Mucinex)

antidepressant. prevents or relieves symptoms of depression

(Tofranil, Marplan, Nardil)

analgesic. agent that relieves pain without causing loss of consciousness

(Tylenol, Advil, Motrin)

-penia

(blood cell) decrease

anticoagulant. prevents or delays blood clotting

(heparin, warfarin, Coumadin)

antimanic. used for treatment of manic episode of manic-depressive and bipolar disorder

(lithium)\

TCAs do what in UMs? PMs?

*UMs*: decrease therapeutic effects *PMs*: increase adverse effects

What could you use for anticoagulation? Beware of what for them

*Warfarin* --many drug interactions --drug food interactions --bleeding risk *LMWH* --renal function --eyesight --arthritis

C-V Abuse Potential / Medical Use

++++High abuse potential / Accepted

C-IV Abuse Potential / Medical Use

+++High abuse potential/ Accepted

C-III Abuse Potential / Medical Use

++High abuse potential / Accepted

orthostatic hypotension

, occurs when a person's blood pressure falls when suddenly standing up from a lying or sitting position

C-III Dispensing Restrictions

- Written or oral prescription that expires in 6 months - No more than 5 refills in 6-mo period - Container must have warning label

C-IV Dispensing Restrictions

- Written or oral prescription that expires in 6 months - No more than 5 refills in 6-mo period - Container must have warning label

C-V Dispensing Restrictions

- Written prescription or over the counter (varies with state law)

C-II Dispensing Restrictions

- Written prescriptions only* - No prescription refills - Container must have warninglabel

Slid 14 (need to review case)

------------

A.C.E. Inhibitors

-Angiotensin Converting Enzyme Inhibitors block the conversion of angiotensin I to angiotensin II -avoiding Angiotensin II may avoid increased blood pressure and vasoconstriction -usually have the prefix "PRIL"

A.2.R.B.

-Angiotensin 2 Receptor Blockers block Angiotensin 2 enzymes from specific receptor sites -avoiding Angiotensin 2 activity helps prohibit vasoconstriction -usually have the suffix "ARTAN"

NSAID

-Non Steroidal Anti-Inflammatory Drugs are commonly used as pain killers and Fever Reduces -non-narcotic and can be sold OTC

S.S.R.I.

-Selective Seratonin Re-Uptake Inhibitors increase the body's seratonin level by inhibiting its re-uptake into the presynaptic cell -commonly indicated as an anti-depressant

Transdermal Patch

-a medicated adhesive patch applied directly on the skin to deliver a specific dosage of a drug -systemic effects and should be rotated to different sites on the body

Drug Abuse Prevention/ Control Act of 1970

-known as the CSA -completely replaced the Harrison Act -required the use of DEA numbers -required comprehensive record keeping and transaction tracking -enforced the DEA under the US Dept of Justice

Emulsions

-a suspension involving one liquid in a second liquid with which the first will not mix

DEA Schedule IV

-abuse potential exists -ex. ambien, darvocet, lorazepam

DEA number verification

-add the 1st, 3rd, and 5th digits -add the 2nd, 4th, and 6th digits. double it -add the two totals together. the second digit is the check digit -preceded by two letters: first letter represents the type of practice or institution the DEA number is issued to, the second letter represents the first letter of the practitioner's last name

HMG-CoA Reductase Inhibitors

-also known as Statins -inhibit the body's cholesterol production and usually have the suffix "STATIN"

Beta Blockers (B1)

-also known as beta-adrenergic blocking agents -block adrenaline receptors, which are part of the CNS and mediate a "fight or flight" response, which would cause actions in the heart -usually have the suffix "OLOL"

Poison Prevention Packaging Act of 1970

-also known as the PPPA -designed to reduce the risk of children ingesting dangerous substances -required locking caps on most prescription

Caplet

-an oval shaped tablet

Topical

-applied to the skin surface or a mucous membrane

FDA

-approve new drugs to be sold in the US -process New Drug Applications (NDA) -regulate package inserts -regulate drug advertising -issue recalls -federal agency

FDA (food and drug administration)

-approve new drugs to be sold in the US -process New Drug Applications (NDA) -regulate package inserts -regulate drug advertising -issue recalls -federal agency

NDA Process Time

-can usually take 12-15 years -patent only last 20 years from the time the application for patent was filled

NDC: xxxx-xxxx-##

-identifies the packaging -unique to the size and quantity of the product

Syrups

-contain a high concentration of sucrose or sugar to sweeten, for ease of use

syrups

-contain a high concentration of sucrose or sugar to sweeten, for ease of use

The Durham-Humphrey Amendment of 1951

-created a distinction between "OTC" and "Legend Drugs" -required legend drugs to carry the statement: "Caution: Federal law prohibits dispensing without a prescription." -emphasis on this act was to insure safety through qualified medical supervision

DEA Controlled Drug Prescriptions must contain at least:

-date of prescription issue -patient's name and address -practitioner's name, address, and phone number -drug name -drug strength -dosage form and instructions -exact quantity prescribed -complete directions for use -number of refills authorized -a valid DEA number

NDC: xxxx-####-xx

-identifies the product -number unique to the formulation and strength of the product

DEA Schedule II

-does have medical use -high potential for abuse -relative potential for psychological and physical dependency -ex. oxycodone, codeine, retalin -no refillls allowed -cannot be "called in" or transmitted electronically unless it is an absolute emergency

DEA Schedule III

-does have medical use -moderate abuse potential exits -ex. vicodin and tylenol w/ codeine

Oral Suspension

-drug is mixed with, but not completely dissolved into a liquid -needs to be shaken before administration in order to suspend the drug particles evenly

oral suspension

-drug is mixed with, but not completely dissolved into a liquid -needs to be shaken before administration in order to suspend the drug particles evenly

Enemas

-drug is suspended in a solution and infused into the rectum

Oral powders

-drugs in powder form are usually dissolved in juice or water before administration

Combat Methamphetamine Epidemic Act (2005)

-enacted to regulate the OTC sales of pseudoephedrine -identity and address of each purchaser to be kept for two years -daily sales of regulated products not exceed 3.6 grams -30 day purchase limit not to exceed 9 grams -30 day purchase via mail order not to exceed 7.5 grams

DEA (Drug Enforcement Agency)

-federal agency -enforce the CSA ( controlled substances act) -track controlled substances manufactured and sold -investigates all violations involving controlled substances -set the DEA Sch. Definitions -issue DEA numbers

Narcotic Tax Act of 1914

-known as the Harrison Narcotic Act -provided authority for the IRS to collect taxes on Opiates thru tax stamps -required that any entity which produced, distributed, dispensed or sold opiates be registered with the IRS -emphasis was on attempting to control the massive flow of opiates in order to protect the public from rising addiction

Dosage Form: Enteral Medication

-given orally and pass through the GI tract to be absorbed into the bloodstream and metabolized by the liver -includes oral, naso-gastric, and rectal routes

NDC: ####-xxxx-xx

-identifies the drug's manufacturer -number is unique to the maker or re-packager of the product

Inhalation

-inhaled through the mouth or nose and usually on the respiratory system before entering into the bloodstream -often used to treat respiratory diseases, but gases are inhaled for general anesthesia as well

Proton Pump Inhibitors

-inhibit the action of the gastric proton pump thereby reducing gastric acid production -usually have the suffix "PRAZOLE"

Antibiotics

-inhibit the reproduction of new bacteria cells

Dosage Form: Parenteral medication

-injected or placed into the body tissues and do not pass through the liver before entering the bloodstream -can include injections, topical and inhalation reoutes -generally refers to injection

Dosage Form: Parenteral Medication

-injected or placed into the body tissues and do not pass through the liver before entering the bloodstream -can include injections, topical, and inhalation routes -generally refers to injection

NDA Process: New Drug Clinical Trials: Phase II

-involves 100-300 volunteers -emphasis on the drug effect against what it's designed to treat -effets compared with similar patients receiving different treatments

NDA Process: New Drug Clinical Trials: Phase I

-involves 25-100 volunteers -safety tolerated dosage determined -identification of major side effects -emphasis on safety and maximum tolerated dosages

NDA Process: New Drug Clinical Trials: Phase III

-involves 300-3000 volunteers -emphasis on the drugs overall effect -effects compared with patients taking placebos -study of different population and different dosages -testing the drug in combination with other drugs -final phase before presenting to FDA for approval

Benzodiazephines

-known as "Benzos" -used as anti-anxiety agents, muscle relaxants, sedatives and hypnotics -usually have the suffix "PAM"

Federal Food, Drug and Cosmetic Act of 1938

-known as FDCA 1938 -replaced the Food and Drug act of 1906 -provided better clarification about misbranding definitions -provided better clarification about adulteration definitions -gave the FDA authority to require adequate testing of new drugs for safety

The Kefauver-Harris Amendment of 1962

-known as the "Drug Efficacy Amendment" -required drug manufacturers to provide proof of the effectiveness and safety of their drugs before approval -required drug advertising to be more closely regulated and disclose accurate information about side effects

Federal Food and Drug Act of 1906

-known as the Pure Food and Drug Act -provided authority for federal inspection of meat products and prohibited the sale of adulterated foods -required that "secret elixirs" containing ingredients like: cocaine, heroin, morphine and alcohol which were available at most stores as miracle cure-alls be labeled with correct information about their ingredients as well as suggested dosages -replaced by the Federal Food, Drug and Cosmetic Act of 1938

Anti-Diabetics/ Sulfonylureas

-lower glucose levels in blood -only used to treat type II Diabetes

DEA Schedule V

-lowest abuse potential -ex. cough medicine w/ codeine or anti-diarrheas

Lozenge and Troche

-lozenges and troches are meant to be dissolved slowly in the mouth and generally have a local effect

Tinctures

-may contain as little as 17% alcohol or as much as 80% alcohol

tinctures

-may contain as little as 17% alcohol or as much as 80% alcohol

Schedule II drug prescription:

-must be manually signed by the practitioner. no exceptions -may not be faxed or called in, except for a valid emergency -may not have any refills

DEA Form 222

-must be used whenever Sch I or II drugs are bought, sold or transferred between pharmacies or qualified distributors

DEA Schedule I

-no accepted medical use -extremely high potential for abuse -high potential for psychological and physical dependency -ex. weed, heroin, mdma

NDA Process: New Drug Post Approval Trials: Phase IV

-ongoing/post approval trials -health-care professionals to report any adverse findings -lasts eternally, as long as the drug is on the market

The Bureau of Narcotics and Dangerous Drugs (BNDD)

-predecessor agency of the DEA -BNDD merged into the DEA in 1973

Diuretics

-primarily used to treat hypertension -promote evacuation of water from the body, which decreases the load on the cardiovascular system

Opiod

-provide an analgesic effect by decreasing the perception of pain and increase pain tolerance

BOP (Board of Pharmacy) (each state)

-regulate licensing of pharmacists -regulate licensing of pharmacy technicians -set state laws/ requirements -outline the operating guidelines in the pharmacy -investigate violations of the operating guidelines -determine state regulated controlled substances -state agency

NDA Process: Initial Development: Investigational New Drug Review (IND)

-review of pre-clinical trial results -determination of safety to use on humans -authorization to ship across state lines

Rectal Suppositories

-solid or semi-solid bullet shaped dosage forms -melt at body temperature, dispersing the medicine

Anti-Convulsants

-suppress the rapid firing of neurons in the nervous system -also known as anti-epileptic drugs and anti-seizure drugs

sig

-tells pharm techs how to dispense it -also printed on the prescription it is dispensed in but translated into regular words for the patient

Tablets

-to form a tablet, the drug is combined with fillers and is them compressed into a hard pellet -available in fast acting, slow released, control released, enteric coated, film coated, sublingual, chewable and other formulations -sublingual tablets are placed under the tongue, wafers are placed on the tongue and buccal tablets are placed between the cheek and gum

Dosage From: Injectable Drugs

-usually in the form of solution or powders -mixed with a sterile diluent to render an injectable solution

Capsules

-to form a capsule, the drug is contained in a cylindrically shaped shell

tablets

-to form a tablet, the drug is combined with fillers and is them compressed into a hard pellet -available in fast acting, slow released, control released, enteric coated, film coated, sublingual, chewable and other formulations -sublingual tablets are placed under the tongue, wafers are placed on the tongue and buccal tablets are placed between the cheek and gum

Refills: DEA Schedule III thru V

-up to 5, but only 5 times -if a patient can only afford 50 at a time then they will only get 250 total

National Drug Code (NDC)

-used to identify legend drugs -part of the drug listing act of 1972

Joint Commission on Accreditation of Healthcare Organizations

-watches over healthcare organizations -third party auditors/ regulators for insurance providers

Calcium Channel Blockers

-work by blocking calcium channels in cardiac muscles and blood vessels, thereby slowing down activity in the heart

Drug Interaction Relationship: Potentiation

1 drug increases or prolongs the action of another drug, & the total effect is greater than the sum of the effects of each drug used alone - drug potency is increased.

30mL= ?

1 fl oz

M

1,000

Infant

1-12 months

Child

1-12 yrs

What is the pH levels in the stomach

1-3

Neonate

1-4 weeks

Adolescent

13-18 yrs

allergic drugs

1.penicillin, 2.NSAIDS (aspirin), 3.Sulfonamide drugs- antihistamines, diuretics, oral hypoglycemic

SS

1/2

C

100

Deci-

10^-1

Centi-

10^-2

Milli-

10^-3

micro-

10^-6

Base (grams, liter, meter)

10^0

Deka-

10^1

Hecto-

10^2

Kio-

10^3

Expiration dates: Legend Drugs

12 months

1 tbsp= ?

15mL

2.2 lb= ?

1kg

-ine

1st & 2nd Generation H1 Receptor Antagonist

TDS

3 times a day

Ondansetron

5 HT3 antagonist: decreased vagal stimulation. Powerful central-acting antiemetic (keep on dancing with ondansetron when you feel quesy) Use: control vomiting postoperatively and in patients undergoing chemo.

Ganciclovir

5'monophosphate formed by a CMV viral kinase. Guanosine analong. Tripohsophate formed by cellular kinases. Preferentially inihbits viral DNA polymerase. by chain termination. Use: CMV, espeically in the immunocompromsied. Valganciclover is very similar with better oral bioavailability Toxicity: lekopenia, neutropenia, thrombocytopenia, renal toxicity. More toxic to host enzymes than acyclvir

Sumatriptan

5-HT agonist. Inhibits trigeminal nerve activaiton; prevent vasocating peptide release; induce vasoconsctriton used: acute migraine, cluster headache attacks. Tox: contraindicated in CAD or prizmentals becuase increased risk for vasospasm.

Zileuton

5-lipoxygenase pathway inhibitor competely blocking synthesis of leukotirines form arachidonic acid. SE: hepatotoxic

L

50

D

500

1tsp= ?

5mL

Expiration dates: DEA Sch III thru V

6 months

Kidney develops @

9-36 weeks gestation

acute pancreatitis

80% of the time caused by gallstones and chronic alcoholism. Less common causes account for the other 20%, one of which is hypertriglyceridemia which is toxic to pancreas at levels > 1000 mg/dL.

Absence epilepsy

Absence of convulsions characterized by a sudden 10-30 second loss of consciousness with no falling; formerly called petit mal

Edrophonium

An anticholinesterase (indirect cholinergic agonist) that has traditionally been used to diagnose Myasthenia gravis

Free drug

An active drug or other compound that is not bound to a carrier protein

Culture

An integrated system of beliefs , values, and customs that are associated with a particular group of people.

Cytochrome P-450 substrates

Anti-epileptics Theophylline Warfarin OCPs Always Think When Outdoors

Two drug categories considered safe to use during pregnancy are

A and B

pH and pKa are equal when ...

A and HA are equal

Arteriosclerosis

A common arterial disorder characterized by thickening and loss of elasticity of the arterial walls, resulting in a decreased blood supply, especially to the cerebrum and lower extremeties

Blood dyscrasia

A condition in which any of the blood constituents are abnormal or are present in abnormal quantitiy

Action

A description of the cellular changes that occur as a result of a drug

Adjuvant

A drug added to a prescription to hasten or enhance the action of a principle ingredient

Investigational new drug (IND)

A drug not approved for marketing by the FDA but available for use in experiments to determine its safety and efficacy

Analeptic

A drug used to stimulate the central nervous system, especially with poisoning by CNS depressants

Kartagener Syndrome

A form of primary ciliary dyskinesia characterized by the triad of situs inversus, chronic sinusitis, and brochiectasis. It occurs due to mutations that impair the structure or function of cilia. Cystic fibrosis also causes chronic respiratory infections, but not the situs inversus

Antiandrogen

A gonadotropin-releasing hormone analog that is used to treat prostate cancer

Allergic Response

A hypersensitive reaction to any usually harmless substance that does not normally cause a reaction.

Adverse reaction

A list of possible unpleasant or dangerous secondary effects, other than the desired effect

Atypical antipsychotics

A newer class of antipsychotics with less potential for adverse effects, such as extrapyramidal symptoms and tardive dyskinesia

Flutamide

A nonsteroidal competitive inhibitor of androgen receptors. Used in prostate cancer

Double-blind investigational drug study

A research design in which both of the investigator(s) and the subjects are purposely unaware of whether the substance administered to a given subject is the drug under study or the placebo. This method eliminates bias on the part of both investigator and the subject.

Blinded investigational drug study

A research design in which the subjects are purposely unaware of whether the substance they are administered is the drug under study or the placebo. This method serves to eliminate bias on the part of research subjects in reporting their body's responses to investigational drugs.

selective serotonin reuptake inhibitors (SSRIs)

A selective serotonin reuptake inhibitor (SSRI) is one of the commonly prescribed drugs for treating depression. SSRIs affect the chemicals that nerves in the brain use to send messages to one another. Neurotransmitters that are not taken up by other nerves are taken up by the same nerves that released them. This process is termed "reuptake." SSRIs work by inhibiting the reuptake of serotonin, an action which allows more serotonin to be available to be taken up by other nerves.

Orphan drugs

A special category of drugs that have been identified to help or treat patients with rare diseases.

Dermal atrophy

A topical steroid side effect if used for too long

Atherosclerosis

A type of arteriosclerosis characterized by yellowish plaques of cholesterol, lipids, and cellular debris in the walls of large and medium-sized arteries, resulting in reduced circulation, the major cause of coronary heart disease, such as angina pectoris or myocardial infarction

vascular 5-HT1 receptors (Vascular receptors for 5-hydroxytryptamine)

A type of receptor for serotonin. Serotonin (also known as 5-hydroxytryptamine) is an important neurotransmitter within the central nervous system. After it is released by a neuron, serotonin activates receptors located on nearby neurons. These receptors include 5-HT1A.

ANxiolytics

Antianxiety medications (tranquilizers) used for the short-term treatment of anxiety disorders, neurosis, some psychomatic disorders, and insomnia

Broad spectrum

Antibiotic effective against a large variety o organisms

sometimes, -pril means...

ACE Inhibitor (Angiotensin Converting Enzyme)

Hypertension with diabetes

ACE inhibitors/ARBs are an absolute must Ca2+ channle blockers, thiazide diuretics, beta blockers.

Donepezil, galantamine, rivastigmine, tacrine

AChE inhibitors. Used for Alzheimers

Demelclocycline

ADH antagonist Use: SIADH SE: Nephrogenic DI, photosenstivity, abnormalities of teh bone and teeth

Absorption, Distribution, Metabolism, & Elimination... The Pharmacokinetic Process

ADME

Daclizumab, basiliximab

Monoclonal antibodies: block IL-2R. Used in kidney transplant. tox: edema, tremor.

Controlled substances

Any drugs listed on one of the "schedules" of the Controlled Substance Act (Also called scheduled drugs).

BPH therapy

Drug used to reduce prostate size and associated urinary obstruction and manifestations in patients with BPH

Over the counter drugs

Drugs available to consumers without a prescription.

Drugs in stomach

Acidic and neutral drugs - readily absorbed in stomach Basic drugs are poorly absorbed in low pH

Ethacrynic acid

MOA: essentialy same action as furosemide. use: diuresis in patients allergic to sulfa. Can cause hypeuricemia like furosemide.

Homeostasis

Maintenance of stability in the internal environment of the body.

Vaso-

Blood Vessel

Antacid

Agent that neutralizes gastric hydrochloric acid

Bradycardia

Abnormally slow heartbeat

Bradykinesia

Abnormally slow movement

NRTIs

Abacavir, didanosine, emtricitabine, lamivudine, stavudine, tenofovir, zidovudine (formerly AZT). Competitively inhibit nucletoide binding to reverse transcriptase. Tenofovir is a nucleotide, the others are nucleosides and must be phosphorlyated to be active. Zidovudine is used in general prophylaxis and during pregnancy to reduce transmission. Toxicity: bone marrow supression (prevent with G-CSF), peripheral neuropathyk, lactic acidosis, anemia, pancreatitis (didanosine)

GP IIb/IIIa inhibitors

Abciximab (II x III = 6), eptifibatide, tirofiban Bind to the glycoprotein receptor IIb/IIIa on activated paltelets, preventing aggregation. Use: unstable angina, SE: bleeding, thrombocytopenia

Solubility

Ability of a drug to dissolve in body fluids.

Lipid Solubility

Ability to dissolve in fatty mediums

-Osis

Abnormal Condition

Angioedema

Abnormal accumulation of fluid in tissue.

ADME

Absorption Distribution Metabolism Excretion

alpha-glucosidase inhibitors

Acarbose, Miglitol MOA: inhibit intestinal brush-border glucosidases. This decreases glucose absoprtion (and decreases postprandial hyperglycemia). Use: type II SE: GI disturbances.

Expedited drug approval

Acceleration of the usual investigational new drug approval process by the U.S. Food and Drug Administration (FDA) and pharmaceutical companies, usually for drugs used to treat life-threatening diseases.

1st line therapy for elderly?

Acetaminophen -->do not exceed 3-4 gm/day

Systemic Effect

Action of a drug that has generalized - the all-inclusive effect of the drug on the body.

Local Effect

Action of a drug that is confined to a specific part of the body.

Tetracycline (TCN)

Active against gram- negative and positive Drugs usually ending w/ -line

Pharmacokinetics

Activity of a drug w/i the body over a period of time; includes absorption, distribution, metabolism, & elimination (ADME).

Cytochrome P-450 Inhibitors

Acute alcohol abuse Ritonavir (protease inhibitor) Amiodarone Cimetidine Ketoconazole Sulfonamides Isoniazid (iNH) Grapefruit juice Quinidine Macrolides (except azithromycin) AAA RACKS IN GQ Magazine

Adjunct

Addition to the course of treatment to increase the efficacy

Pregnancy Category A

Adequate and well-controlled human studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).

Antioxidant

Agent that prevents or inhibits oxidation or cell destruction in damages or aging tissues. A compound that fights against the destructive effects of free radical formation

Antineoplastic

Agent that prevents the development, growth, or spreading of malignant cells

Intravenous (IV) & Intra-Arterial

Administration/Dosage routs that do not require absorption.

Adrenergics

Adrenalin (epi), Neosynephrine (phenylephrine

Tesosterone, methyltestosterone

Agonist at androgen receptors Use: hypogonadism and promotes secondary sex characteristics in men. Tox; masculinization in females, gonadal atrophy (decreases LH with negative feeback). Premature closure of epiphseal plates. Increased LDL

Why appropriate prescribing?

Age related changes Multiple co-morbid conditions Guidelines --Beers --Stop and Start

P-Glycoprotein

Aka "P-gp" -->efflux transporter --ATP dependent

Albuminuria

Albumin (proteins) in urine

Rectal pH is ____ in most children

Alkaline

Anaphylaxis

Allergic hypersensitivity reaction of the body to a foreign substance or drug. Mild symptoms include rash, itching, and hives. Severe symptoms include dyspnea, chest constriction, cardiopulmonary collapse, and death.

Pharmacodynamic agent

Alter body function

Alzheimer disease agents

Alzheimer disease is a progressive neurodegenerative disorder, The main neurotransmitter thought to be associated with the decline in memory function is acetylcholine

Class III Antiarrhythmics (potassium channel blockers)

Amiodarone, Ibutilide, Dofetilide, Sotalol (AIDS) Notice that Ibutilide adn Dofetilide both have tilide at their endings (so amiodarone, sotalol and tilides) MOA: increased AP duration, increase ERP, increase QT interval (torsades) Use: a-fib, VT (amioadrone, solatol) Toxicity: torsdaes and also sotalol can cause excessive beta blockade. AMIODARONE: pulmonary fibrosis, hepatotoxicity, hypothryoidism/hyperthroidism (amidodarone is 40% iodine), corneal deposits, blue gray skin, neurolgoic effects, constipation, cardiovascualr effects (bradycardia, heart block, HF) Check PFTs, LFTs, and TFTs when taking Amiodarone.

TCas

Amitryptyline, nortriptyline, imipramine, desipramine, clomipramine (notice all the pramine), amoxapine, doxepin. MOA: block reuptake of NE and 5HT. Use: major depressoni, OCD (clomipramine), migraine prophylaxis (sumatriptan). SE: sedatoin alpha 1 blocking effects including posterual hypotension, and atropine-like side effects (anticholinergic)- tachycardia, uriary retention dry mouth. Can prolong QT internval. amitryptyline has worse side effects than nortripyline. Tri C's: Convulsions, Coma, Cardiotoxicity (arrythmias). Sodium bicarb given to prevent arrythmia

Therapeutic Level

Amount of a drug in the blood @ which beneficial effects occur. The amt. of time required to achieve this can be shortened by administering a loading dose.

Maintenance Dose

Amt of a drug administered at regular intervals to keep the blood concentration @ a therapeutic level. An important factor in determining this, is a drug's clearance rate.

Loading Dose

Amt of a drug that will bring the blood concentration rapidly to a therapeutic level.

Risperidone

An antipsychotic that is used for schizophrenia. It works by inhibiting D2 Dopamine, which in turn leads to hyperprolactinemia as dopamine can't supress it. This can lead to hypogonadism with the inhibition of GnRH form the hypothalamus. In addition, hyperprolactinemia can lead to amenorrhea, galactorrhea and breast soreness.

Adverse reaction

An effect from a drug that is undesired

catechol-O-methyl transferase (COMT)

An enzyme that catalyzes the degradation of catecholamines, including the neurotransmitters dopamine, epinephrine, and norepinephrine. COMT is also important in the metabolism of catechol drugs used in the treatment of hypertension, asthma, and Parkinson disease.

Clomiphene

An estrogen receptor modulator that can allow those who have PCOS to become fertile again. It decreases negative feedback inhibition on the hypothalamus by circulating estrogen, thereby increasing gonadotropin production (FSH and LH)

Placebo

An inactive (inert) substance that is not a drug but is formulated to resemble a drug for research purposes.

Anything w/ -caine

Anesthetic

sometimes, -sartan

Angiotensin II Receptor

Echinocandins

Anidulafungin, capsofungin (notice the fungin), micafungin MOA: inhibits cell wall synthesis by inhibiting syntehsis of beta-glucan Use: invasive aspergillosis, candida. toxicity: GI upset, flushing (histmaine release)

Pregnancy Category B

Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.

Pregnancy Category C

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Adenosine

Another antiarrhythmic. It increases K+ out of cells thus hyperpolarizing the cell and decreasing the flow of calcium out of nodal cells. Drug of choice for diagnosing/abolishing SVT. Very short acting. Adverse effects: flushing, hypotension, chest pain, sense of impending doom, bronchospasm.

Legend drugs

Another name for prescription drugs.

Palivizumab

Anti-RSV F protein Use; RSV prophylaxis for high-risk infants. PaliVIzumab-VIrus

Infliximab, adalimumab

Anti-TNF-alpha monoclonal antibody. Use: IBD, RA, ankylosing spondylitis, psoriasis.

Tourtte syndome

Antisychoitcs, tetrabenazine, clonidine

sometimes, -cin

Antituberculotics

Dextromethorphan

Antitussive (antagonizes NMDA glutmate receptors). Synthetic codeine analog. Naloxone for overdose. Can be abused mildly. May cause serotonin syndrome in combination with other serotonin agents

Contraindication

Any disease, condition, or symptom for which a drug will not be beneficial & may be harmful.

Cephalosporins (Generation I-V)

Anytime you see it beginning with Cef MOA: beta lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillnases. Bactericidal. Organsims typically not covered by cephalosporins are LAME: listeria, atypicals (chlamydia, mycopalsma), MRSA, and Enterococci) - exception is that Ceftaroline covers MRSA Mechanisms of resistance: structural change in penicillin-binding proteins (transpeptidases)

Narcotic

Applied to drugs that produced insensibility or stupor, especially the opioids (e.g., morphine, heroin). The term is currently used in clinical settings to refer to and medically administered controlled substance and in legal settings to refer to any illicit or "street" drug.

Intramuscular advantages

Aqueous - rapid effect Oily - slow effect (more control)

Anastrozole/exemestane

Aromatase inhibitors used in postmenopasual women with ER+ breast cancer.

Insulin, rapid acting

Aspart, Glulisine, lispro as you know, increases glycogen in liver glycogen in muscle, protein sysnthesis and fat storage. Also, increases K+ uptake (think about DKA) Toxicity: as with all insulins, could cause hypoglycemia and very rare hypersensitivity reactions

Advantages of inhalation route

Quick absorbtion - Alveoli has large SA - good pulmonary supply

Protease inhibitors

Atanzanavir, Darunavir, Fosamprenavir, Indinavir, Lopinavir, Ritonavir, Squinavir (anything with a navir). MOA: Assembly of virions through HIV-1 protease (pol gene) is blocked so functional parts cannot be cleaved. Thus new virus is not formed. Note: ritonavir inhibits cytochrome p-450. Navir tease a protease Toxicity: Hyperglycemia, GI intolerance (nausea, diarrhea), lipodystrophy (AIDs fat) Rifmapin is contratinicated because decreases concnetration

Anticholinergics

Atropin, Robinul

Autonomic

Automatic, self-governing, or involuntary nervous system

Macrolides

Azithromycin, clarithromycin, erythromycin MOA: inhibit translocation (Macroslides) by biding to rRNA on 50S. Bacteriostatic USE: atypical pneumonias (mycoplasma, chlamydia, Legionella), STIs (Clamydia), gram-postive occci (streptococcal infections in patients allergic to penicillin) and B pertussis. Toxicity: MACRO: GI Motility issues, Arrhythmia caused by prolong QT, acute Cholestatic hepatitis, Rash, eOsinophillia. Increases serum concentration of theophyllines and warfarin (Always THink When Outdoors). Clarithromycin and Erthromycin inhibit C P450. MOR methylation of 23S rRNA binding site preventing binding

Antifungal therapy

Azoles, Terbinafine, Echinocadins, Amphotericin B, nystatin, flucytosine

Monobactams

Aztreonam MoA prevent peptidoglycan cross-linking by binding to penicillin binding protein 3 (less susceptibe to beta lactamases). Synergistic with aminoglycosides.No cross-reactivty with penicillin Use: gram-negative rods only. NO activity agaisnt gram-positives or anaerobes. Use is for pencillin-allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides Toxicity: none really (GI upset)

Intravenous anesthetics

B.B>KIng on OPIOIDS PROPOses FOOLishly Barbituates, benzos, Ketamine, Opioids, propfol

Clearance

Rate @ which a drug is eliminated from a specific volume of blood per unit of time.

LDL

Bad Cholesterol

Drugs in small intestine

Basic drugs readily absorbed Acidic drugs have restricted absorbtion

Glucocorticoids

Beclomethasone, dexamethasone, fludrocortisone (mineralcoriticoid and glucocorticoid activity), hydrocortisone, methlpredinosolone, predinsone, triamcinolone MOA: many effects including metabolic, catabolic, anti-inflammatory, and immunosupressive effects mediated by interactions with glucocorticoid response elements, inhibition of phospholipase A2, and inhibitioin of transcription factors such as NF-KB. Use: Addison disease, inflammation, immunosupression, asthma SE: iatrogenic cushing syndrome (hypertesnion, weight gain, moon facies, trunal obesity, buffalo hump, thinning of skin, striae, osteoporosis, hyperglycemia, amenorrhea, immunosupression), adrenocortical atrophy, peptic ulcers, steroid diabetes, steroid psychosis, adrenal insufficiency when drug stopped abruptly after use

Antihistimine

Benadryl, vistaril

BPH

Benign prostate hypertrophy

Temporary course of benzodiazepines in GAD

Benzos are sometimes used to bridige for the first line SSRI's to kick in.

Direct Agonists of cholinergic receptors

Bethanechol Carbachol Methacholine Pilocarpine

Gastric pH Birth 1 month of life Adult

Birth: 6-8 1 month of life: greater than 4 Adult: 1.3-3 (reached at about 3 years)

Chloroquine

Blocks detoxication of heme into hemozoin. Heme accumulates nad is toxic to plasmodia. Use: tx of plasmodial specieis other than P. falciparum. Resistance occurs due to membrane pump that decreases intracellular concentration of drug. Treat P. falciparum wtih artemether/lumefantrine or atovaquone/proguanil. For life-trehatening malaria, use quinidine. toxicity: pruritus, retinopathy

Hemo-

Blood

Thromb(o)

Blood Clot

Asthma drugs

Bronchoconstriciton is mediated by inflammatory processes and parasympathetic tone. So target these Beta 2 agonists (albuterol, salmeterol), corticosteroids, muscarinic antagnoist, antileukotrienes, omalizumab, and theophylline Methacholine challenge test.

Atypical antidepressants

Buproprion: also used for smoking cessation: increases dopamine and NE. Is contraindicated in anorexic/bulimic patients (can cause seizures). Side effects include stimulant effects. NO SEXUAL SIDE EFFECTS Mirtazapine: alpha 2 antagonist (increases release of NE and 5-HT). Toxicity: sedation (whichmay be desirable if the depressed person has insomnia). Increased appetite, weight gain, dry mouth. Trazodone: blocks 5HT and alpha 1 adrenergic recptors. Used primarily for insomnia. Toxicity: sedation and PRIAPism. Trazobone

Alkylating agents

Busulfan, cyclophosphamide, ifosfamide, and the nitrosoureas

General advantages of injectable route

Bypass difficulties of gut absorbtion

Rituximab

CD20 Use: B-cell non-hodkin, CLL, RA, ITP.

Prophylaxis in HIV patients

CD4 < 200: TMP/SMX- PCP CD4 < 100: TMP/SMX - PCP and toxoplasmosis CD4 < 50 Azirhromycin or clarithromycin - M. Avirum complex

Alemtuzumab

CD52 Use: CLL Alymtuzumab - chornic LYMphocytic leukemia

Appropriate prescribing

CLEAR evidence that supports the use of a medication in a given condition -->expected benefit outweighs the risk

Anesthetics

CNS drugs must be lipid soluble (cross the blood-brain barrier) or be activley transported. Drugs with increased lipid solubility have increased potency which is equal to 1/MAC (the minaml alveolar concentration). Drugs with low lipid solubility are low potent. Drugs with low blood subility are fast induced.

Tolcapone, Entacapone

COMT inibitors in the periphery preventing L-dopa breakdown, but also tolcapone acts centrally to prevent COMT breakdown of dopamine.

Cyclosporine

Calcineurin inhibitor. Binds cyclophillin. Blocks T-cell activation by preventing IL-2 transcriptin. Used in tranplant projection prophylaxis, psoriasis, RA. Tox: nephrotoxicity, gingivial hyperplasia, hirsuitsm

Vlacyclovir, acyclovir, and famciclovir

Can all be used to reduce recurrence of genital herpes.

Combining non-dihydrpyridine calcium channel blockers (verapamil, diltiazeM) with Beta blockers (atenolol)

Can have additive negative chronotropic effects yielding bradycardia and hypotension

Histoplasma capsulatum

Can survive intracellularly within macrophages. It causes a disseminate mycosis in immunocompromised individuals (think histo for HIV). Clinical features include systemic symptoms like weight loss and fever, painful oral ulcers, lymphadenopathy, and hepatosplenomegaly (H for H)

SGL2-inhibitors

Canagliflozin (notice flo is in the name and same with candia- yeast infections) MOA: block reabsorption of glucose in the PCT Use: type II diabetes. Toxicities: glucosuria, UTIs, vaginal yeast infections

Neoplastic

Cancer drugs

ACE inhibitors

Captopril, enalapril, lisinopril, ramipril MOA: inhibit ACE, decreasing ATII and decreasing GFR by prevening constriction of efferent arteirioles. Also prevents inactivation of bradykinin. Use; hypertension, HF, diabetic nepropathy. Prevents unfavorable heart remodleing as a result of chronic hypertension. Decreases intraglomerular pressures, slowing GBM thickening in diabetic nepropathy. Tox: Cough, angioedema, teratogen, (fetal renal malformations), icnreased creatinine (decreased GFR), Hyperkalemia, and hypotension. Must avoid in bilaterla renal stenosis (GFR decreased too much- renal failure)

Cytochrome p450 inducers

Carbamazepine Phenobarbital Phenytoin Rifampin Griseofulvin

Acetazolamide

Carbonic anhydrase inhibitor works in the PCT and decreases total body HC03- stores. Use: Glaucoma, urinary alkalinizaiton, metabolic alkalosis, Tox: Hyperchloremic metabolic acidosis, sulfa allergy, paresthesias

Prevention of postsurgical infection due to S. Aureus

Cefazolin

5th generation cephalopsporins

Ceftaroline - broad gram-positive and gram-negative coverage including MRSA. but does not cover psedomonas

Steriods

Celestone, Decadron, Solumedrol

Cyto-

Cell

Apnea

Cessation of breathing

Methacholine

Challenge test for asthma. Stimulates muscarinic receptors in airway when inhaled, leading to exacerbation of condition.

Interaction

Change in the action of a drug caused by another drug, food, or another substance, such as alcohol or nicotine.

Biotransformation

Chemical changes that a substance undergoes in the body

Histamine

Chemical found in the body tissue that fights environment producing allergies and swelings

Acetylcholine

Chemical mediator of nerve impulses in the parasympathetic system

Barbiturates

Chemicals to treat seizures

H2 blockers

Cimetidine, rantidine, famotidine, nizatidine, Take H2 blockers before you dine. Think "table for 2"- H2 MOA: reversible block of histamine H2-receptors- decreases acid secretoin by parietal cells. Use: peptic ulcer, gastritis, mild GERD Toxicity: Cimtediine is potent inhibitor of Cyotochome-p450. Cimetidine also has antiandrogenic effects (p;rolactine release, gynecomastia, and impotence, decreased libido in males. It also can cross the BBB and cause confusion, diziness, and headache. Both Cimteidine and ranitidine decrease renal excretion of creatinine. The other two don't have these side effects.

Protein Synthesis inhbiitors

Chloramphenicol, clindamycin, Lienzolid, Marcolides, Streptogramins, Aminoglycosides, and Tetracyclines These specifically target smaller bacterial ribosome (70S, made of 30S and 50 S) leaving the human ribosome (80S) unaffected 30 S inhbitors: A = Aminoglycosides (bactericidal) T = Tetracylcines (bacteriostatic) 50 S inhibitors: C = Chloramphenicol, clindamycin (bacteriostatic) E = Erythromycin (macrolides) = bacteriostatic L = Linezolid But AT 30, CCEL at 50

Thiazide diuretics

Chlorthalidone, hydrochlorothiazide MOA: inhibit NaCl reabosrtion in DCT (decrease diluting capcity of neprhon), decrease calcium excretion Use: hypertesnion, HF, idiopathic hypercalciuria, Tox: hypokalemic metabolic alkalosis, hyponatermia, hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia. Sulfa allergy

Alzheimer drugs

Memantine, Donepezil, galantamine, rivastigmine, tacrine Remember that Alzheimer's is characterized by decreased Ach and increased glutamate

CYP 450 inhibitors

Cimetidine Ciprofloxacin Erythromycin Azole Antifungals isoniazid ritonavir grapefruit juice Unlike the CYP 450 inducers, these increase the anticoagulant effects of warfarin.

Hepatic portal circulation

Circulation of blood through the liver

ARTAN

Class: A2RB

PRIL

Class: ACE Inhibitors

AZOSIN

Class: Alpha Blockers

VIR

Class: Anti-viral

PAM

Class: Benzodiazepines (Benzos)

OLOL

Class: Beta Blockers

STATIN

Class: Cholesterol (HMG CoA Reductase Inhibitor)

FLOXACIN

Class: Fluroquinolone Antibiotics

ITIDINE

Class: H2 Antagonist

LAX

Class: Laxatives

ROMYCIN

Class: Macrolide Antibiotics

CILLIN

Class: Penicillin Antibiotics

RAZOLE

Class: Proton Pump Inhibitor

CYCLINE

Class: Tetracycline Antibiotics

Selective estrogen receptor modulators

Clomiphene: antagonist at estrogen receptor in the hypothalamus (prevents normal feeback inhibition, increasing LH and FSH, stimulating ovulation- used in infertility for say PCOS). ould cause hotflashes, ovarian enlargment, mulitple pregnancies, visual distrubances Tamoxifen: antagonist at breast, agonist at bone, uterus. Increased risk of thrombosis and endometrial cancer. Raloxifene: Antatgoinst at breast, uterus. Agonist at bone; increased risk of thromboembolic events but no icnreased risk of endometrial cancer. Used to treat osteoporosis

ADP receptor inhibitors

Clopidogrel, prasugrel, ticagrelor, ticlopidine Inhibit platelet aggregation by irreversibly blockign ADP receptors, preventing expression of glycopretins IIb/IIIa. Use: acute coronary syndrome, coronary stenting. SE: neutropenia (ticlopidine)

Azoles

Clotrimazole, fluconazole, itraconzaole, keotconazole, miconazole, voriconazole. MOA: inhibit fungal sterol (ergosterol) synthesis by inhibitng the cytochrome P0450 enzyme that converts lanosterol to ergosterol. Use: local and less serious systemic mycoses. Fluconazole for chronic suppression of cryptococcal meningitis in AIDS patients and candidal infections of all types. Itraconazole for Blastomyces, coccidiodies, histoplasma.

C-II Drug Examples

Codeine, cocaine, morphine, oxycodone, methadone, amphetamine, meperidine, secobarbital, methylphenidate

C-III Drug Examples

Codeine, hydrocodone, pentobarbital rectal suppositories, and dihydrocodeine combination products

A

Conjugate base Can't be absorbed (charged)

Cachexia

Condition of malnutrition and wasting in chronic conditions such as some malignancies or AIDS

When would IV be useful administration in pediatrics?

Continuous pain relief -->achieves highest serum concentration

Chyclophsophamide, ifosfamide

Corss-link DNA at guanine N-7. Requires bioactivation by liver Use solid tumors, Leuk/lymph. Side effects: myelosupression, HEMORRHAGIC CYSTITIS (can be protected gainst with mesna).

Hormones

Cortisol, Estrogen, Progesterone

C&S

Culture and sensitivity test to identify a causative infectious organism and the specific medicine to which it is sensitive

Dopmaine

D1=D2 >Beta > alpha unstable bradycardia, HF, shock (dopamine increases renal perfusion). Ionotropic and chonotropic effects that predominate at high doses.

Metoclopramide

D2 receptor antagonist. Increased resting tone, contractility, LES tone, motility. Does not influence colon transport time. Use: diabetic and postsurgery gastroparesis, antiemetic SE: parkinsonain effects, tardive dyskinesia. Restlessnes, drowsiness, fatigue, depression. Contraidnicated in pateints with parkinson's

P-gp induced will do what to bioavailability of substrate?

DECREASE

Codeine and Tamoxifen does what in Poor Metaboizers (PMs)

DECREASE Bioactivation and Drug effects

Pediatric UMs of codeine may be risk of....

Death with use of typical post op doses

Glaucoma drugs

Decrease IOP via decreased aqueous humor (decrease synthesiis or secretion of increase drainage)

Tolerance

Decrease in response to the effects of a drug as it continues to be administered.

Gastric emptying is _______ in neonates

Decreased

In neonate and children, affinity of albumin is

Decreased

Ataxia

Defective muscular coordination, especially with voluntary muscular movements (e.g., walking)

Bioavailability

Degree to which a drug or other substance becomes available to the target tissue after administration.

NNRTis

Delavirdine, Efavirenz, Nevirapine Binds to reverse transcritpase at a different site. DO NOT REQUIRE PHOSPHORYLATION TO BE ACTIVE. Toxicity: rash and hepatotoxicity. Vivid dreams and CNS symptoms are common.

Alzheimer's disease

Dementia characterized by a devastating, progressive decline in cognitive function, followed by increasingly severe impairment in social and occupational functioning

US government department that supervises the FDA

Department of health and human services

Addiction

Dependence characterized by a perceived need to take a drug to attain the psychological & physical effects of mood altering substances.

Therapeutic Effect

Desired action of a drug in the treatment of a particular disease , state, or symptom.

Bactericidal

Destroying bacteria

Emphysema

Destruction of the alveolar walls and septae

Insulin, long acting

Detemir, Glargine

Angiogenesis

Development of new blood vessels

Benzodiazapines

Diazepam, lorazepam, tirazolam, temazepam, oxazepam, midazolam, chloridiazepoxide, alprazolam MOA: facilitate GABA action by increasing frequency of Cl- channel opening. Decrease REM sleep. ATOM: alprazolam, traizolam, oxazepam, and midazolam have short half-lives and thus high addictive potential. Use: anxiety, spastiticty, status epilepticus, detoxification (alcohol withdrawal), night terrors, sleep walking, gneral anesthetic, hypnotic (insomnia) Tox: dependence, additive CNS depression with alcohol. Antidote: Flumazenil (compettiive antagonist at GABA receptor)

Calcium Channel Blockers

Dihydropyridines - Amolipine, clevedipine, nicardipine, nifedipine, and nimodipine (notice the pine for the dihydrpyrimidines) Non-dihdyropyridines (act on the heart)- Verapamil, diltiazem. Vascular smooth muscle : Amoldipine = nifedipine > diltiazem, verapamil Heart: Verapmil (V for ventricle) > diltizzem > amolidpine = nifedipine

Cholinomimetics (glaucoma)

Direct- pilocarpine, carbachol MOA: Increased outflow of aqeuous humor via contraciton of ciliary muscle and opening of trabecular network Pilocarpine is great for emergencies. Otherwise physostigmine and echothiophate (inidrect) can be used SE: miosis and cyclospasm

Dementia

Disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning.

pKa

Dissociation constant pH when ionised and unionised 1:1

Donepezil, galantamine, and rivastigmine

Donepizil is used for treatment of Alzheimer's by increasing ACh

Fendolopam

Dopamine D1 receptor agonist (thus increasing vasodilation, especially renal). leads to coronary, peripheral, renal and splanchnic vasodilation, decreasing BP and increasing natriuresis

Metabolism

Drug biotransformation, generally into more polar compounds readily excreted from the body through urine or feces

Inhalation route of adminitration

Drug inhaled e.g. inhaler, smoking (nicotine straight to brain)

U.S Pharmacopiea-National Formulary

Drug standard reference used in the US

First-Order

Drugs for which the rate of elimination is concentration dependent (as opposed to ____ _ _____).

Zero-Order

Drugs for which the rate of elimination is not concentration dependent (as opposed to _____ _ _____).

Hypertensive emergency

Drugs like clevidipine, fenodolopam, labetalol, nicardipine, nitroprusside

General disadvantages of injectable routes

Drugs must be sterile Need to be given by trained staff Exact dose Hard to remove from systemic circulation once administered (ie cant pump stomach) If constant site, can cause infection

Absorption

Drugs must cross barriers to reach tissues

How do drugs easily interact with target cells

Drugs need to get out of plasma to tissues Capillaries pourous and there4 leaky - most drugs move easily into interstital fluid

Antimuscarinics

Drugs that block cholinergic stimuli at muscarinic receptors. A type of anticholinergic. Also called parasympatholytics

Alpha-blockers

Drugs that block the alpha-1 receptors found in smooth muscle in the bladder neck and prostate, causing them to relax

Carbonic anhydrase inhibitors

Drugs that reduce the hydrogen and bicarbonate ions and have a diuretic effect (increasing the excretion of fluids from the body through the urine)

Aminoglycosides

Drugs used in combination with other antibiotics that treat many infections caused by gram-negative and gram-positive bacteria

Erlotinib

EGFR tryosine kinase inhibitor SE: rash

Advantages of oral route of administration

Easy administration No skilled personnel needed Need not be sterile preparation

Prophylaxis

Effect of a drug in preventing infection or disease.

Efficacy vs. Potency

Efficacy is a measure of the maximum pharmacodynamic effect achievable with a drug. Potency refers to the dose of drug that is required to produce a given effect. Drugs that bind their receptors with a higher affinity or are better able to gain access to their target tissues have greater potency (lower ED50)

Fusion inhibitors

Enfuvirtide: binds gp41, inhibiting viral entry Maraviroc: binds CCR-5 on surface of T cells/monotyctes, inhibiting interactino with gp120.

Hemostatic agent

Elfoam, surgicel, Tessel

Drug Legislation - Accelerated Drug Review Regulations (1991)

Enabled faster approval by the FDA of drugs to life threatening illnesses (prompted by the HIV/AIDS epidemic)

Pulmonary hypertension drugs

Endotheliln receptor antagonists: include bosentan- competitively antagonize endothelin-1 receptors (can be hepatotoxic) PDE-5 inhibitors: sildenafil. Inhibit cGMP PDE5 and prolong vasodilatory effects of NO (used for ED too) Prostacyclin analogs: epopropstenol, iloprost. Have direct vasodilatory effects. Also inhibit platelet aggregation SE (flushing, jaw pain)

Alpha agonists (glaucoma)

Epinephrine (alpha 1) - open angle only Brimonidine (alpha 2) MOA: both decrease aqueous humor synthesis Side effecs: mydriasis (epi- bad in closed angle), blury vison, ocular hypercemia, ocular puritus

Dopamine agonists

Ergot: bromocriptine non-ergot: pramipexole, ropinriole

Idiosyncratic reaction

Experiencing a unique/unexpected reaction to a drug

Drug Legislation - Controlled Substance Act (1970)

Established "schedules" for controlled substances; promoted drug addiction education, research, and treatment.

Drug Legislation - Harrison Narcotic act (1914)

Established the legal term narcotic and regulated the manufacturer and sale of habit forming drugs

Local Anesthetics

Esters: procaine, cocaine, tetracaine Amides: lidocaine, mepivacaine, bupivacaine (amides have 2 I's) MOA: blocks Na+ channels by binding to specific receptors. Preferentially binding to activated sodium channels. Amine local aneshtetics penetrate the membrane in uncharged form and bind to ion channels in charged form. Can be given with with vasoconstrictors (epi) to enhance local action In infected (acidic) tissue, alakaline anesthetics are charged and cannot penetrate membrane effectively (need more anesthetic). Order of nerve blockade: small > big diameter. Myelinated > unmyelinated with size being teh most importnat. Order of loss; pain, temp, touch, pressure Use: minor surgical procedures Toxicity: Severe cardiotoxicty (bupvivicaine), hypertesnion, hypotenison, arrhythmias (cocaine), and methemoglobineima (benzocaine)

TNF-alpha inihibitors

Etanercept, infliximab, adalimumab always must check for TB since could reactivate TB

toxicity

adverse drug reaction due to excessive dosing. severe hypoglycemia from insulin

Etoposide, teniposide

Etoposide inhibits TOPOisomerase II- increased DNA degradation SE: myelosupression, GI upset, alopecia

GLP-1 analongs

Exenatide, Liraglutide MOA: increae insulin, decrease glucagon release. side effects: N/V, pancreatitis

Adolescents can do what?

Experimentation -->interact with some meds Compliance -->decreased with unpleasant side effects --peer pressure

First-Pass Effect

Extent to which a drug is metabolized by the liver before reaching full body circulation. This can substantially decrease bioavailability of certain drugs when administered orally, in which case administration by injection is required.

What does the pH and pKa value of a drug affect

Ratio of ionised to non-ionised Whether a drug is absorbed Where absorbtion happens in GI tract

Lipid

Fatty molecule - An important constituent of cell membranes; they generally repel water.

Antiandrogens

Finasteride, flutamide, ketoconazole, Sprionolactone

When does GFR increase rapidly

First 2 weeks of life -->reaches adult values 3-5 months

Ethosuximide

First-line for Abscence seizures It sux to have abscence seizures. MOA: blocks thalmic t-type Ca2+ channles. Side effects: Fatigue, GI distress, headache, itching, Stevens-Johnson syndrome

Class IC antiarrhythmic

Flecainide, Propafenone. Can I have Fries, Please. MOA: significantly prolongs ERP in AV node and accessory bypass tracts with no effect on ERP in purkinje and ventricular tissue. No effect on AP duration. Use: SVTs, including a-fib. Contraindicated post-MI (IC is Contraindicated in structural and ischemic heart disease) .

Blood-Brain Barrier

Fortified area that prevents many substances from entering the cerebro-spinal fluid from the blood. This area is formed by glial cells that envelope capillaries in the fcentral nervous system. This creates a shield that blocks many water-soluble compounds, but is permeable to lipid-soluble substances.

SSRIs

Fluoxetine, paroxetine, sertraline, citalopram (FLashback PARalyze, SEnior, CITiznes) MOA: seroronin reuptake inhibitors Use: depression, GAD, panic disorder, OCD, bulimia, social phobias, and PTSD SE: Fewer than TCAs. GI distress, SIADH, SEXUAL DYSFUNCTION. Serotonin syndrome wiht any drug that increases serotonin: hypertheia, confusion, myoclonus, cardivoasuclar instability, flushing, diarrhea, seizures. Takes 4-8 weeks to kick in

Corticosteroids for asthma

Fluticasone, budeonside: inactiate NF-Kb (induces production of TNF-alpha) , block cytokine production, 1st-line for chronic asthma

Antigen

Foreign substance that is recognized by the immune system & induces the immune system to produce antibodies to defend against the foreign substance.

QID

Four times a day

Body fat Full term neonate Adult

Full term neonate: 57% water, 35% lipids Adult: 25% water, 70% lipids

Infection caused by

Fungal Bacterial

Loop diuretics

Furosemide, bumetanide, torsemide MOA: Sulfonamides. Inhibits cotransport system (Na+/K+/2CL-) of thick ascending limb. Abolish hypertonicity of medulla, preventing concentraiton of urine. Stimulate PGE relase (vasodilatory effect on afferent arteirole). INCREASE CALCIUM EXCRETION. Use: Edematous states (HF, cirrhosis, nephrotic syndrome, pulmonary edema), hypertension, hypercalcemia Tox: ototoxicty, hypokalemia, dehydration, allergy (sulfa), neprhitis (intersitial), Gout

Etanercept

Fusion protein that is a TNF decoy receptor. Use: RA, psoriasis, anklyosing spondylitits

alpha 1 G-protein linked sympathetic recepetor

G protein class = q Increases vascular smooth muscle contraction, increases pupillary dilator muscle contraction (mydriasis), increases intestinal and bladder spincter muscle contraction

GH

GH deficiency, Turner's syndrome

Adverse drug reactions are more common in older adults with....

GI bleeding HTN Renal impairment

GET SMASHED

Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion Sting, Hypercalcemia, Hyertriglyceridemia, ERCP, drugs (sulfa drugs, NRTIs, protease inhibitors). all can lead to acute pancreatitis.

Doxorubicin, daunorubicin

Generates free radials and intercalates DNA- breaks in DNA- decreased replication. Use: solid tumors, leukemia/lymphoma SE: CARDIOTOXICITY (DILATED CARDIOMYOPATHY), myelosupresiosn. alopecia. Dexrazoxane is an iron chelating agent used to prevent cardiotoxicity.

Oxybutynin

Genitourinary. Used to reduce bladder spasms and urge urinary incontinence (overactive bladder) as a muscarinic antagonist

Amingoglycosides

Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin (mycin but beware because macrolides also have the mycin) Mean (aminoglycoside) GNATS caNNOT kill anaerobes Toxcicity = NNOT: neprotoxicity, neurmouscular blockade, ototoxicity (especially with loop diuretics), teratogen MOA: Bactericidal. Inhibition of hte initiation complex through binding of the 30 S subunit. Requires O2 for uptake, and THEREFORE IS INEFFECTIVE AGAINST ANAEROBES. Use; severe gram-negative rod infecitons. Synergistic with beta lactam antibiotics. Neomycin for bowel surgery MOR: bacterial transferase enzymes inactivate the drug by cetylatoin, phosphorlyation, and adenylation.

Lactulose

Given in hyperammonemia conditons to bind ammoina and have it pooped out

Adrenal

Glands located adjacent to the kidneys that secrete hormones called corticosteriods

Ampule

Glass container with drug for injection, must be broken at the neck to withdraw drug in solution

Phase 2 Pediatric Metabolism

Glucuronidation, Conjugation, Sulfation, Acetylation -->each matures at a different time Sulfation: 5 days Acetlyation: 25 days Glucoronidation: 60 days Conjugation: 90 days

HDL

Good Cholesterol

Expectorants

Guaifenesin: expectorant- thins respiratory secretions; does not surpress cough reflex N-acetylcysteine: mucolytic- can loosen mucus plugs in CF patients by disrupting disulfide bonds. Also used as the antidote in acetaminophen overdose.

acyclovir, famciclovir, valacyclovir

Guanosine analongs. Monophosphorylated by HSV/VZV thymidine kindase and not phosophrylated by unifected cells (few adverse effects). Use: HSV and VZV. Weak activity against EBV. No activity against CMV. Used for HSV-induced mucocuntaneous and genital lesions as well as for encephalitis. Prophylaxis in immunocompromised patients. Valacyclovir, a produg or acyclovir has better oral vioavailablity. Toxicity: obstructive crystalline nephoraphty and acute renal failure if not properly hydrated MOR: mutated viral thymidine kinase

HIV therapy

HAART (highly active antiretroviral therapy) Regimen consists of 3 drugs to prevent resistance: 2 NRTIs and 1 of the following: NNRTI or protease inhibitor or integrase inhibitor

Transtuzumab

HER2/neu Breast cancer

Digoxin clinical use

HF (increased contractility), atrial fib (decreased conduction at the AV node and depression of SA node)

Statins

HMG-CoA reductase inhibitors. Decrease LDL markedly, increase HDL, and decrease triglycerides Shows decreased mortality in patients with CAD Sideeffects: hepatotoxity (increased LFTs), myopathy (especially in conjuciton with fibrates/niacin)

Antipsychotics (Neuroepileptics)

Haloperiodol + the azines Haloperidol., trifuloperazine, fluphenazine, thioridazine, chlopromazine MOA: block Dopamine D2 receptor (increase cAMP) Use: Schizophenia (the positive symptoms), psychosis, acute mania, Tourrettes. SE: highly lipid soluble and stored in fat so very slow to be removed from the body. Has extrapyramidal side effects (4 hr-acute dystonia, 4 days - akathisia (restlessness), 4 weeks- bradykinesia, 4 months- tardive dyskinesia). Treat Also endocrine side effects: hyperprolactinemia- galactorrhea (in women). Also side effects from blockign the muscarinic (dry mouth, constipation), alpha 1 (hypotension), and histamine (sedation) receptors. Prolongs QT (torsades) High potency: Trifuluoperazine, Fluphenazine, haloperiodl (Try to Fly High) - neurologic side effects- like huntignton disease, delirium, extrapyramidal side effects. The low potency drugs hae more fo the non-neurologic side effects (anticholinergic, antihistamine, alpha 1 blockade).

Inhaled anesthetics

Halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, N2O Effects: myocardial depression, respiratory depression, N/V, increased cerebral blood flow Toxicity: hepatotoxcity (Halothane), nephrotoxicity (methoxyflurane), proconvulsant (enflurane), expansion of trapped gas in body cavity (N2O) Most importnatly: can cause malignant hyperthermia: rare lifethreatening hereditary conditon where inhaled anesthetics (except N2O) and succinylcholine induce fever and severe muscle contraction. Treat with dantrolene.

Adverse effects

Harmful unintended reactions to a drug

corticosteroids (fluticasone)

Have the strongest and most predictable effects on the inflammatory component of asthma. Inhaled corticosteroids form the cornerstone of chronic therapy for patients with persistent asthma can reduce the number and severity of acute asthma exacerbations.

Congestive Heart Failure (CHF)

Heart not able to pump enough blood

Anticoagulant

Heparin

C-I Drug Examples

Heroin, LSD, marijuana, peyote, mescaline

C-I Abuse Potential / Medical Use

High abuse potential and no medical use

C-II Abuse Potential / Medical Use

High potential for abuse / Accepted medical use

Urticaria

Hives, itching sensation.

For Adolescents know....

Hormonal influenced physical changes Increased protein binding Bone growth may be decreased by drugs that affect Vitamin D metabolism Serum creatinine concentration varies

Atropine toxicity

Hot as a hare Dry as a bone Red as a beet Blind as a bat Mad as a hatter (decreased ACh has mental effects). Treat with physostigmine.

Drug-Induced Lupus erythematosus drugs

Hydralazine Procainiamide Isoniazid Minocycline Quinidine

Cephalosporins toxciity

Hypersensitivity rxns, autoimmune hemolytic anemia, disulfiram-like reaction (when taken with alcohol blocks acetaldehyde dehydrogenase), vitamin K deficiency. Inreased nephrotoxicity of aminoglycosides. Cross-allergencitiy with penicillins

alpha-methyldopa

Hypertension in pregnancy. SLE-like syndrome and hemolysis are toxicity

Mannitol

an osmotic diuretic that works by increasing plasma or tubular fluid osmolality.

caplet

an oval shaped tablet

P-gp inhibitor will do what to bioavailability of substrate?

INCREASE

Flucytosine

INhibitis DNA and RNA biosynthesis by conversion to 5-FU by cytosine deaminase Use: systemic fungal infecitons (cryptococcus epseically with meningitis) Toxcity bone marrow supression

NSAIDs

Ibuprofen, naproxen, indomethacin, ketorolac, diclofenac MOA; reversibly inhibit COX-1 and COX-2. Blocks prostaglanding synthesis. Use: antipyretic, analgesic, adn anti-inflammatory. Indometahcin is also used to close a PDA Tox: interstitial nephritis

Carbapenems

Imipenem, meropenem, ertapenem, doripenem MOA: broad-spectrum beta lactamase-resistant. Always administered with cilastatin (inhibitor of renal dehydropeptidase I) to decrease inactivation of drug in renal tubules (with impipenem, the kill is lastin' with cilastatin) Use: gram-positive cocci, gram-negative rods, and anaerobes. Wide spectrum, but has signifcant side effects so only used with life-threatening infections or after other drugs have failed Toxicity: GI distress, skin rash, and CNS TOXICITY (SEIZURES) - excpet meropenem.

Fat digestion in neonates and infants is.....

Impaired -->immaturity of secretion and activity of pancreatic fluids -->decreased absorption of fat soluble drugs

Direct Arteriolar Vasodilators

Include Hydralazine and minoxidil are effective antihypertensives. Because they cause significant arterial vasodilaiton, they also cause refelex sympahtetic acitvaiton resulting in tachycardia and edema. To counteract these compesnatory effects, these agents are often given in combination with symphatolytics and diuretics.

Buccal

In the cheek pouch

Antiemetics

Inapsine, Reglan, Zofran

Beta-lactamase inhibitors

Include Clauvulanic Acid, Sulbactam, and Tazobactam CAST

Aldosterone antagonists

Including spironolactone and eplerenone are used to treat hyperaldosteronism (Conn's syndrome) which is manifested by hypertesion, hypokalemia (aldosterone wastes potassium), metabolic alkalosis (aldosterone wastes hydrogen ions), and depressed renin.

Older patients ________ risk for Venous Thrombosis Embolism

Increased

In neonate and children, serum bilirubin does what for binding sites?

Increased competition

Glitazones/Thiazolidinediones

Increased insulin sensitivity in peripheral tissue. Binds to PPAR-gamma nuclear transcription factor pioglitazone and rosiglitazone Use: Type 2 diabetes Side effects: weight gain, edema. Heaptotoxicity, HF, increased risk of fractures

Hydralazine

Increases cGMP leading ot smooth msucle relaxation. Vasodilates arterioles > veins thus causing decreased after load Use: severe hypertension, HF (with organic nitrate). Safe to use in pregnancy. Frequencly used with beta blocker to prevent reflex tachycardia Toxicity: compensatory tachycardia (contraindicated in angina, CAD), fluid retention, headache Lupus Like Syndrome

Cardiotonic

Increasing the force and efficiency of contractions of the heart muscle

Bleomycin

Induces free radical formation - breaks in DNA strand Use: TESTICULAR cancer, Hodkin's. Toxicity: PULMONARY FIBROSIS, skin hyperpigmentation, mucositis.

Sildenafil, vardenafil, tadalafil

Inhibit PDE5, thus increasing cGMP, smooth muscle relaxation in teh corpus cavernosum, increasing blood flow to get erection. Tox: headache, flushing, blue-tined visoin. RISK OF LIFE-THREATENING HYPOTENSION IN PATIENTS TAKING NITRATES

Oseltamivir, zanamivir

Inhibit influenza neeuramaniadse blocking release of progeny virus same thign as tamiflu (needed to be given within 48 hours of symptoms or prophylacitally)

Argatroban, bivaliriduin, dabigatran (direct thrombin inhbitors)

Inhibit thrombin directly. Alternatives to heparin for anticoagulatin patients with HIT.

Bacteriostatic

Inhibiting or retarding bacterial growth

MAO-B inhibitor

Inhibitors of the enzyme monoamine oxidase B. MAO-B helps break down dopamine; inhibiting it prolongs the action of dopamine in the brain. Selegiline is an MAO-B inhibitor.

Vemurafenib

Inhibits BRAF oncogene in melanoma.

Baclofen

Inhibits GABA receptors at the spinal cord level, inducing skeletal muscle relaxation (used in muscle spasms especially BACk pain)

Trimethoprim

Inhibits bacterial dihydrofolate reductase. Bacteriostatic. Use: used in combo with sulfonamides (TMP/SMX) cuasing sequential block of folate synthesis. Combination used for UTIs, Shigella, Salmonella, PCP treatment and prophylaxis, toxoplasmosis prophylaxis. Toxicity: Megaloblastic anemia (makes sense), leukopenia, granulocytopenia (may alleviate with folate supplementation). TMP Treats Marrow Poorly

Methotrexate

Inhibits diihydrofolate reductase thus decreased dTMP and decreased DNA syntehsis Competitive folic acid analog (can be covercome with leucovorin/folinic acid) Use: leukemias, lymphomas, chroiocarcinoma, sarcoma. Alsoo, ectopic pregnancy, medical abortion (with misoprostol), RA, psoriasis, IBD, vasculitis toxicity: myelsupression that is reversible. Hepatotoxicty. Mucositis (mouth ulcers), and pulmonary fibrosis. Note that all the antimetabolites above are S-phase specific

Orlistat

Inhibits gastric and pancreatic lipase - decreases breakdown and absorption of dietary fats. Use: weight loss. Toxicity: steatorrhea, decreased absorption of soluble vitamins.

Irinotecan, topotecan

Inhibtis topo I and prevents DNA unwiding and replication SE: myelosupression and diarrhea

Injection route of administration

Intravenous Sub-cutaneous Intramuscular Intrathecal (into CNS) e.g. insulin, epidural

Pruritus

Itching Sensation.

Butorphanol

Kappa- opiod recept agonist and mu-opioid receptor partial agonist. Use: severe pain, causes less respiratory depression than full agonist

Where most drugs are metabolized

Kidneys

King Harold Destroyed Beiber During Chemistry and Math

Kilo, Hecto, Deka, Base, Deci, Centi, Milli, Micro

Metformin

Lactic acidosis is a potential rare consequence whose risk is increased in underlying renal sufficiency (Creatine needed first)

Diuretics

Lasix, Mannitol, Diuril

Duration Of Action

Length of time a drug gives the desired response/remains at the therapeutic level.

C-IV Dependency Potential

Limited physical or psychological

Class IB antiarrhythmic

Lidocaine, Mexiletine MOA: decrease AP duration, preferentially affecting ISCHEMIC or depolarized Purkinje and ventricular tissue. Use: best to treat acute ventricular arrhythmias post-MI (target ischemic tissue). Also treats digoxin arrythmias toxicity: lower with just CNS stimuation/depression and cardiovascular depression

Bipolar disorder

Lithium, valproic acid, atypical antipsychotics

Primary organ for metabolism

Liver

How does a drug work?

Lock and Key Mechanism

Alcohol withdrawal

Long acting benzos (not ATOM)

2nd generation H-1 blockers

Loratadine, fexofenadine, desloratadine Use: Allergy Tox: far less sedating than 1st generation

Angiotensin II receptors blockers (ARBs)

Lorsartan, candersartan, valsartan Similar to ACE inhibitors except do not block bradykinin degradation so used when intolerance to ACE inhibitors. Cuases same toxic effects: hyperkalemia, decreased renal fucntion, hypotensino, teratogen

Anorexia

Loss of apetite

Amnesia

Loss of memory

Alopecia

Loss or absence of hair

Trough

Lowest level of a drug in the blood.

Stains

Lugals solution, Acetic Acid

Anti-mycobacterial drugs

M. tuberculosis: Prophylaxis with isoniazid and tx with RIPE (rifampin, Isonizaid, pyrazinamide, and Ethambutol) M.avium: prophylaxis with azithromycin (macrolide), rifabutin and tx with azithromycin or clarithromycin + ethambutol. M. leprae: tx for tuberculoid form: dapsone and rifampin. tx for lepromatous form is add clofazimine to the above too.

Isoniazid

MOA: decreases synthesis of mycolic acid. Bacterial catalse-peroxidase (encoded by KatG) needed to activate INH (resistnace is mutation in it) Use: TB tx and prophylaxis toxicity: Neurotoxicity, hepatoxcity. PYRIDOXINE SUPPLEMENTATION CAN PREVENT NEUROTOXICITY INH (Injures Neurons and Hepatocytes)

Metronidazole

MOA forms toxic free radic metabolites that damages DNA. Bactericidal but also anti-protozoal. USE: Treats Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes (Bacteroides, C. difficile). Used with a proton pump inhbiitor and clarithromycin for triple therapy against H. pyrlori GET GAP: Giardia, Entomoeba, Trichomonas, Garnerella vaginalis, Anerobes (c. diff, bacteroides), and H. Pylori. Unlike clindamycin, treats anaerobic infections below the diaphragm. Toxicity: Disulfiram-like reaction (severe flushing, tachcardia, hypotension) with alcohol; headache, metallic taste.

Griseofulvin

MOA interferes with microtubule function, disrutping mitosis. Use: supeficial infectiosn: inhbits growth of dematophyes (tinea, ringworm) Toxicity: teratongenic, cardniogneeic, confusion, headaches, cytochrome P-450 increased so increased warfarin metabolism.

Leuprolide

MOA: GnRH analog with agonist properties WHEN USED IN PULSATILE FASHION. If used continuously, it down regulates the GnRH receptor in pituitary thus decreasing FSH and LH Use: Infertility (pulsatile), prostate cancer (continous with flutamide), uterine fibroids (continous), precocious puberty (continous) Tox: Antiandrogen, N/V

Sulfasalazine

MOA: a combination of sulfapyridine (antibacterial) and 5-aminosalicyclic acid (anti-inflammatory). Activatred by colonic bacteria Use: IBD SE: malaise, nausea, sulfonamide toxicity; reversiblie oligospermia.

Pseudoephedrine, phenylephrine

MOA: alpha adrenergic agonists, used as nasal decogestants Use: nasal congestion, open obstructed eustachina tubes. Pseudoephedrine is used illegally to make meth Tox: hypertension. Can also cause CNS stimualtion/anxiety

Bismuth, Sucralfate

MOA: bind to ulcer base, providing physical protection and allowing HC03- secretion to reestablish pH gradient in the mucus layer Bismuth BINDS to ulcers and allows for more SUCRETIONS Use: ulcer healing, travelers diarrhea

Amphotericin B

MOA: binds ergosterol (unqiue to fungi); forms membrane pores that allow leakage of electrolytes. AmphoTERicin TEARs holes in the fungal membrane forming pores. Use: serious, systemic mycoses. Cryptococcus (may use flucytosine as well), Blastomyces, Coccidiodies, Histoplasma, candida, mucor. Intrathecally for fungal meningitis. Supplement K+ and Mg+ becuase of altered renal tubule permeability toxicity: fevers, chills ("shake and bake"), hypotension, nerphrotoxcity, arrythmias, anemia, IV phelbitis (Amphoterrible). Hydration decreases nephrotoxicity.

Clindamycin

MOA: blocks peptide transfer (translocation) at 50S. Bacteriostatic. Use: anaerobic infections (Bacteroridess, Clostridium perfringens). in aspiration pneumonia, lung abscesses, and oral infection. also effective agaisnt group A strep Treats anaerbobic infections above the diaphragm while metronidazole treats below the diaphragm. Toxicity: Pseudomembranous colitis

Chloramphenicol

MOA: blocks peptidyltransferase at 50S ribosomal subunit. Bacteriostatic Use: menigitis (H. flu, Neisseria meningitiidis, streptococcus pneumoniae) and rocky mountain spotted fever (rickettsia rickettsii) Limited use due to toxcicities Toxicity: Anemia (dose-dependent), aplastic anemia (dose independent), GRAY BABY SYNDROME (in premature infants because they lack liver UDP glucoronyl transferase) MOR: plasmid encoded acetyltranferase inactivates the drug

PTU, methimazole

MOA: blocks thryoid peroxidase, inhibiting the oxidaiton of iodide and the organification (coupling) of iodine, thus inhibiting thyorid hormone synthesis. PTU also blocks 5'-deiodinase. Use: hyperthyroidism. PTU is used in Pregnancy (P for P) SE: skin rash, AGRANULOCYTOSIS (rare), APLASTIC ANEMIA, hepatotoxicity (PTU). Methimazole may be a teratogen (aplasia cutis- abscence of the epidermis)

Ethambutol

MOA: decrased carbohydrate polymerization of the mycobacterium cell wall by blocking arabinoslytranferase. Use: TB toxicity: OPTIC neropathy (red-green color blidness). Pronouce it eyethambutol to remember.

Biguanides/Metformin

MOA: decreases gluconeognesisi, increases glycolysis, increases peripheral glucose uptake (increases insulin sensitivty) Use: first line in type 2 diabetes (causes modest weight loss too) Can be used in patients wihtout islet function Toxicity: GI upset, LACTIC ACIDOSIs (contrainidcated in renal insufficiency so check this)

Minoxidil

MOA: direct arteriolar vasodilator Use: androgenetic alopecia. Severe refractor hypertension.

Azathioprine, 6-mercaptopruine (6-MP), 6-thioguanine (6-TG)

MOA: purine (thiol) analogs- decrease de novo purine synthesis. Activated by HGPRT. Azathiopurine is metabolized into 6-MP Use: prevent organ rejection, RH, IBD, SLE toxicity: myelosupression, Gi, liver. INCREASED TOXICITY WITH ALLOPURINOL AND FEBUXOSTAT since both azathioprine and 6-MP are metabolized by xanthine oxidase

Nystatin

MOA: same as amphotericin (holes in ergosterol membrane). Topical use only as too toxic for systemic use Use: "swish and swallow" for oral candiddiasis or diaper rash or vaginal candidiasis.

Piperacillin, ticarcillin (anti-speudomonoals)

MOA: same as penicilin with exteneded spectrum USE: pseudomonas and gram-negative rods. Penicillinase suscteptible so use with beta lactamase inhibitors. Toxicity: hypersentivitiy reactions

Dicloxacillin, nafcillin, oxacillin (penicillinase-resistant penicillins)

MOA: same as penicilin. Narrow spectrum; resistant becuase bulky R group blocks penicillinase access to beta-lactam ring. Use: S. aureus (naf for staph) Toxicity: hypersensitivity rxns, interstitial nephritis

Amoxicillin, ampicillin (aminopenicillins, penicillinase-sensitive penicillins)

MOA: same as penicillin. But has a wider specturm. Can be combined with clavulanic acid to protect agaisnt desruction by beta-lactamase. Ampicillin is an AMPed up penciillin. Amoxicillin has greater oral bioaviailility than ampicillin. Use: H. flu, H. pylori, E. coli, Listeria, Proteus, Salmonella, Shigella HHELPSS kill enterococci Toxicity: hypersensitivity reactions; rash; pseudomembranous colitis Resistance: Beta-lactamase/penicillinase

Danazol

MOA: synthetic androgen that acts as partial agonist at androgen receptors Use: endometriosis, hereditary angioedema tox: weight gain, edema, acne, hirsutism, masculainzaiotn

Levothyroxine (T4), triiodothyronine (T3)

MOA: thyroid hormone replacement. Use: hypothyroidism, myxedema. Used off label as weight loss SE: tachycardia, heat intolerance, tremors, arrythmias

Pyrazinamide

MOA: uncertain Use: TB Toxicity: Hyperuricemia (gout), and hepatoxicity

Interferons

MOAP glycoportiens normally syntehsized by virus-infected cells. Use: IFN-slpha: chronic hepatitis B and c, Kaposi's, hairy cell leukemia, RCC, malignant melanoma IFN-beta: MS IFN-gamma: CGD toxicity: neutropenia, myopathy

Geriatric patients are pharmacologically _____ senstitive to meds given at "usual" recommended doses

MORE

Can opiods be used in elderly patients with pain?

MOST, not all -->chronic use increases tolerance -->can lead to addiction -->can cause constipation

Opioids

MOrpihne, fentanyl used wiht other CNS depressants during general anesthesia

Osmotic laxatives

Magnesium hydroxide, magnesium citrate, polehtylene glycole, lactulose Provides osmotic load to draw water into the GI lumen Use: constipation (also lactulose for hepatic encephlopathy) toxicitiy: diarreha, dehydration; may be used by bulimics.

Duodenum

Major site of absorbtion Large SA

Antipsychotic

Major tranquilizers used to relieve symptoms of psychoses or severe neuroses; sometimes called neuroleptics

Androgens

Male hormones that stimulate the development of male characteristics

Bipolar disorder

Manic-depressive mental disorder in which the mood fluctuates from mania to depression

Plasma protein binding + affect on diffusion

Many drugs bind to plasma proteins Retained in plasma Only unbound active + diffuse into tissues

Epilepsy drugs

Many. Know the first-lines for sure

Analgesic

Medication that alleviates pain

Antidiarrhea

Medication that reduces the number of loose stools

Antitussive

Medication that suppresses coughing

Antidiabetic

Medication to lower blood glucose levels in those with impaired metabolism of carbohydrates, fats, and proteins

Antipyretic

Medication to reduce fever

Asthma treatment

Medication used for prophylaxis and treatment of chronic asthma. Bronchdilators are used for acute asthmatic attacks

Antifungal

Medication used in the treatment of candidal and other specific susceptible fungi

Anti-infective

Medication used in the treatment of infections; includes antibiotics, antifungals, and antivirals

Cardiac glycosides

Medication used primarily in the treatment of heart failure

Anticonvulsants

Medication used to reduce the number and/or severity or seizures in patients with epilepsy

Anti-inflammatory

Medication used to relieve inflammation

Antithyroid

Medication used to relieve the symptoms of hyperthyoidism in preparation for surgical or radioactive iodine therapy

Antidepressant

Medication used to treat patients with various types of depression; sometimes called mood elevators

C-V Drug Examples

Medications generally for relief of coughs or diarrhea containing limited quantities of certain opioid controlled substances

Antihistamines

Medications that provide symptomatic relief of allergic symptoms caused by histamine release

Bronchodilators

Medications that relax the smooth muscles of the bronchial tree, thereby relieving bronchospasm and increasing the vital capacity of the lungs

Antihypertensives

Medications used in the treatment and management of all degrees of hypertension

Antiparkinsonian drugs

Medications used in the treatment of Parkinson's disease to relieve symptoms and maintain mobility, but do not cure the disease

Antiglaucoma drugs

Medications used to lower intraocular pressure

Anticoagulants

Medications used to prevent formation of clots or decrease the extension of existing clots or decrease the extension of existing clots in such conditions as venous thrombosis, pulmonary embolism, and coronary occlusion

Antispasmodics

Medications used to reduce the strength and frequency of contractions of the urinary bladder and to decrease gastrointestinal motility

Antituberculosis agents

Medications used to treat asymptomatic infection, and to treat active clinical tuberculosis and prevent relapse

Antiviral

Medications used to treat viruses, for example, HIV and herpes

What should you avoid in elderly?

Meperidine -->toxic metabolite accumulation

Pharmacokinetic Modeling

Method of describing the process of absorption, distribution, metabolism, & elimination (ADME) of drug w/i the body mathematically.

Dyes

Methylene Blue, Indigo Carmine, Gentian Violet

Stimulants

Methylphenidate, dextroamphematimine, methamphetamine MoA increase catecholamines in synpatic cleft (epsecially NE and dopamine) Use: ADHD, narcolepsy, appetite control

What increases beta blockade in PMs?

Metoprolol Carvedilol Timolol

Class II Antiarrhythmic (beta blockers)

Metoprolol, propanolol (non-selective), esmolol, atenolol, timolol (non-selective), and carvedilol (non-selective alpha and beta) MOA: decrease SA and AV nodal activity by decreased cAMP, supressing slope of phase 4 . AV node is particulary sensitive- increasing PR interval Esmolol is very short-acting. Use: SVT, ventricular rate control in a-fib and atrial flutter Toxicity: impotence, exacerbation of COPD and asthma (especiallialy non-selectives), cardiovascular effects (bradycardia, AV block , HF). CNS effects (sedation, sleep alterations). May mask signs of hypoglycemia (caution in diabetics). Metoprolol can cause dyslipidemia. treat overdose with saline, atropine, and glucagon.

Benzos

Midazolam most common drug used for endoscopy. Could cause postoperative respiratory depressoin and decreased BP

Mifepristone

MoA: Competitive inhibotr of progesterone receptors. Use: termination of pregnancy (use with misoprostol - prostaglandin) tox: heavy bleeding, GI effect (n/v anorexia), abdominal pain

C-III Dependency Potential

Moderate to low physical or high psychological

Opiod analgesics

Morphine, fentanyl, codeine, loperamide, methadone, meperidine, dextromethrophan, diphenoxylate, pentazocine MOA: act as agonists at opiod receptors (mu = morphine, then enkephalin and dynorphin). to modulate synaptic transmisison - open K+ channles, close Ca2+ channels- decreased synpatic transmission. Inhibit release of NE, ACh, 5-HT, and substance P Use: pain, cough depression (extromethrophan), diarrhea (loperamide, diphenoxylate- keep it on DL that I have diarrhea), maitenance programs for heroin addicts (methadone, buprenorphine + naloxone). Tox: addiction, respiratory depression, constipation, miosis. Treat with naloxone or naltrexone (opiod recetpor antagonist)

Absoprtion

Movement of the drug into the bloodstream

Increased absorption of drugs due to contact with what?

Mucosa -->not true for all drugs though

Pyridostigmine

Myasthenia gravis (long-acting) does not penetrate CNS. Increases ACh as an indirect muscarinic agonist Pyridostigmine gets rid of myasthenia gravis

Memantine

NMDA receptor antagonist: helps prevent exicototoxicty Used for Alzeimers

Are there drugs to treat ADRs from other drugs?

NO

Narcotic Antagonist

Narcan

Opiods are...

Narcotics

Affinity

Natural attraction - the strength by which a particular chemical messenger binds to its receptor site on a cell

Haloperidol

Neuroleptic malignant syndrome is possible. think FEVER. Fever, Encephalopathy, Vitals unstable, Enzymes (increased), and Rigidity of Muscles

Huntignton disease drugs

Neurotransmitter changes in Huntigton disease: decreased GABA, decreased ACh, increased dopamine treatment: Tetrabenazine and reserpine: inhibit vesicular monoamine transporter (VMAT); limit dopamine vesicle packaging and release. Haloperidol: D2 receptor antagonist.

Nitrates

Nitroglycerin, isosorbide dinitrate, isosorbide mononitrate. MOA: vasodilator by increasing NO and increasing cGMP Vasodilates veins > arterioles (decreases preload). Use: angina, Acute coronary syndrome, pulmonary edema Can cause reflex tachy (treat with Beta blockers), hypotension, flushing, headache, "Monday disease"

Asymptomatic

No evidence of clinical disease

What forms can be absorbed across lipid membranes?

Non-ionised - hydrophobic easily cross - some small polar molecules e.g. water - large polar molecules don't cross (need transporter molecules)

Atypical antipsychotics

Olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone (It's atypical for old closets to quietly risper form A to Z). Use: Schizophrneia (both positive and negative symptoms), bipolar disorder, OCD, anxiety disorder, depression, mania, Tourrete SE: fewer than typical antipsychotics Olanzapine/clozapine: may cause signficant weight gain (obese curtains) CLOZAPINE MAY CAUSE AGRANULOCYTOSIS (must check neutrophil count) and seizure Risperidoone may increase prolactin leading to lactation and gynecomastia (decreased GnRH, LH, and FSH- fertility issues) All may prolong the QT

Proton Pump inhibitors

Omeprazole, lansoprazole, esomeprazole, pantoprazole, and dexlansoprazole (notice the prazole) MOA: irreversibly inhibits H+/K+ ATPase in stomach parietal cells. USE: peptic ulcer, gastritis, esophageal reflux, ZE syndrome SE: increased risk for C diff, pneumonia. decreased serum Mg2+ with long-term use.

Contrast media

Omnipaque, hypaque, Isovue

Blood-placental barrier

Only lipohilic drugs can cross to foetus

Gabapentin

Only used for partial/focal seizures (both simple and complex) primarily inhibits high-voltage acitvated Ca2+ channels. SE: sedation, ataxia Also used for peripheral neuropahty and postherpetic neuralgia

C-I Dispensing Restrictions

Only with approved protocol

Narcotics-anlgesics

Opiates- morphine, sublimaze, demerol, alfenta

Antagonism

Opposing action of two drugs in which one decreases or cancels out the effect of the other

Therapeutic Range

Optimum Dosage, providing the best chance for achieving the most effective & desired action... Dosing below this range has little effect, while dosing above this level (overdosing) can lead to toxicity & death.

What is most preferred route for children?

Oral

sometimes, -ide

Oral Hypoglycemic Agents

Most common route of drug administration

Oral route

Tetracyclines

are teratogenic and can cause fetal bone growth retardation as well as brown discoloration of the baby teeth.

Phase 1 for Pediatric Metabolism

Oxidation, reduction, hydrolysis -->often CYP450 -->Decreased activity in neonates

Ketamine (Arycyclohexylamines)

PCP analogs that block NMDA receptors. Caridovascular stimulants. Cause disorientation, hallucaiton, bad dreams

Cladribine

PUrine analog (inihbits DNA pol, DNA strand breaks) Use: Hairy cell leukemia SE: myelosupresssion, nephrotoxicity, neurtotoxicty

Mictotubule inhibitors

Paclitaxel, vincristine, vinblastine

Antispasmodic

Papaverine

Absorption

Passage of a substance through a body surface into body fluids or tissues

parkinsonian agents

Parkinson Disease (PD) is a progressive disease, and the goals for treatment are to maintain function and quality of life as well as to avoid drug-induced complication. Drug therapy is focused on decreasing acetylcholine and increasing dopamine.

Penicillin G, V

Penicillin G (IV and IM form), penicillin V (oral). The prototype Beta lactam antibiotics MoA: Bind penicillin-binding proteins (transpeptidases), thus blocking transpeptidase cross-linking of peptidoglycan in the cell wall. Use: Mostly gram-positives (S pneumo, S. pyogenes, actinomyces, Strep agalactiae) Also some gram-neatives (mainly N. meningitiidis) and spirochetes (nameley T. pallidum). Bactericidal Penicillinase sensitive Toxicity: Hypersensitity reacitons, hemolytic anemia Resistance: Penicillinase (a type of Beta lactamase) cleaves the beta lactam ring

Anticonvulsant

Phenobarbital

C-IV Drug Examples

Phenobarbital, chloral hydrate, meprobamate, benzodiazepines (e.g., diazepam, temazepam, lorazepam), pentazocine

Cilostazole, dipyridamole

Phsophodiesterase III inhibitors: incrased cAMP in platelets, resulting in inhibition of platelet aggregation; vasodilators. Use: intermittent claudication, coronary vasodilation, prevention of stroke, agina prophyalxis SE: Nausea, headahce, facial flushing

Who prescribes medications

Physicians

Oxytocin

Pitocin, Ergotrate, Methergin

Vasoconstructors

Pitressin

NSAIDs most commonly used for

Plantar fascitis Neuritis Tendonitis Arthritis Gout Post op pain

Ceiling Effect

Point @ which no clinical response occurs w/ increased dosage of a drug.

4 broad phenotypes

Poor metabolizes-->no activityg Intermediate metabolizes-->low Extensive metabolizes-->normal Ultra rapid meatbolizers-->high -->genetics of CYP2D6

Kale

Potassium

Amylin analongs

Pramlintide decrease gastric emptying, decrease glucagon. Use: type 1 and type II side effects: hypoglycemia, nausea, diarrhea

intraectal

injected into the space surrounding the spinal chord

Total body water Preterm neonate Full term neonate Adult

Preterm neonate: 87% Full term neonate: 75% Adult: 55%

Prophylactic agent

Preventing disease

Vasodilators

Priscoline, Nitroglyserine, Papaverine

Sulfa drugs

Probenecid, furosemide, Acetazolamide, Celecoxib, Thiazides, Sulfonamide antiboitics, Sulfasazlazine, and Sulfonylureas Popular FACTSSS

Inhibition

Process by which a drug blocks enzyme activity & impairs the metabolism of another drug.

Absorption

Process by which a drug enters the circulatory system (blood).

Induction

Process by which a drug increases the concentration of certain enzymes that affect the pharmacologic response to other drugs.

Distribution

Process by which a drug moves from the blood into other body fluids & tissues & ultimately to its site(s) of action.

Metabolism

Process by which drugs are chemically converted to other compounds.

Antipruritic

Products applied topically to alleviate itching

Drug Legislation - Sherley Amendment

Prohibited fraudulent claims for drug products

Dobutamine

beta 1 > beta 2, alpha HF (inotropic > chronotropic) cardiac stress testing

Specificity

Property of a cell receptor that enables it to bind only w/ a specific chemical messenger complementary to the structure of the receptor.

Anticoagulant Antagonist

Protamine Sulfate, Thrombin

Receptor

Protein molecule on the surface of or w/i a cell that recognizes & binds w/ specific molecules, thereby producing some effect w/i the cell.

intraectal

injected into the space surrounding the spinal cord

Antiprotozoan therapy

Pyrimethamine (toxo), suramin and melarsoprol (trypanosma brucei), nifurtimox (T. cruzi), sodium stibogluconate (leishmaniasis)

Cytarbine

Pyrimindine analog - inhibition of DNA polymerase Use: leukemias, lymphoma. CYTarbanine causes panCTYopenia

Dose

Quantity of a drug administered at one time.

Class IA antiarrhythmic

Quinidine, Procainamide, Disopyramide "The Queen Proclaims Diso's Pyramid) MOA: increased AP duration, Increased ERP in ventricular AP, Prolonged QT (hey) Use: both atrial and ventricular arryth, espeically re-entrant SVT and VT Toxicity: Cinchonism: (headache, tinnitus with quinidine). reversible SLE-like syndrome (procainamide), HF (disopyramide), thrombocytopenia, TORSADES DE POINTES (increased QT interval)

Teriparatide

REcombinant PTH analog given subcutaenously daily. Increases OSTEOBLASTIC activity Use: osteoporosis. Causes increased bone growth compared to other therapies. Tox: transeint hypercalcemia. May increase risk of osteosarcoma.

Integrase inihbitors

Raltegravir Inhibits HIV genome integration into host cell by reversibly inhibitng HiV integrase toxicity: increases creatine kinase

Intravenous advantages

Rapid effect Large vol can be used

Appropriate

Reasonable under the circumstances for a specific patient

Pegloticase

Recombinant uricase that conversts uric acid to allatonin (more water soluble)

intradermal

injected into the top layer of the skin at a slight angle

Intestinal transit is ________ in infants

Reduced -->because of increased intestinal motility

Absorption IM for neonates

Reduced skeletal muscle BF Less muscle mass Ineffiecient muscular contractions Higher density of skeletal muscle caps Unpredictable in neonates

Parkinson disease drugs

Remember, parkinsons' is due to loss of domapinergic neurons and excess cholinergic activity Treat with BALSA: bromocriptine, Amantadine (increase dopamine release and decrease dopamine reuptake. Can also be used as antiviral against influenza and rubella) Levodopa (with carbidopa, inhbiiting DOPA carboxylase), Selegiline (inihbits MAO-B, preventing breakdown and COMT inhibitors-tolcapone), and Antimuscarinics (Benztropine- Park my BenZ)

Elimination

Removal of a drug or the drugs metabolites from the body by excretion.

Drug Legislation - FFDA

Required drug manufacturers to list on the drug product label the presence of dangerous and possibly addicting substances; recognized the U.S . Pharmacopeia and National Formulary as printed references standards for drugs.

Drug Legislation - FFDCA

Required drug manufacturers to provide data proving drug safety with FDA review; established the investigational new drug application process (prompted by sulfanilamide elixir tragedy)

intravenous

injected into the vein

Allergic reaction

Response of the body resulting from hypersensitivity to a substance (e.g., rash, hives, and anaphylaxis)

Parkinson's Disease

Results from deficiency of dopamine

intraocular

injected within the eye

H-1 blockers

Reversible inhibitors of H1 histamine receptors 1st generation: diphenhydramine, dimenhydrinate, chlorpheniramine (name contains en/ine or en/ate) Use: allergy, motion sickness, sleep aid tox: sedation, antimuscarinic, anti-alpha-adrenergic

Hepatitis C therapy

Ribavirin: inhibits synthesis of gaunine nucleotides. Use: chronic HCV, also RSV in children toxicity: hemolytic anemia, teratogen (bad) Simeprevir: HCV protease inhibitor, prevents viral replicaiton. Use: chronic HCV in combination with ribavirin Sofusbuvir: inhbits HCV RNA-depdedent RNA polymerase acting as a chain terminator. Use: Chronic HCV with ribavirin.

Rifamycins

Rifampin, rifabutin MOA: inhibit DNA-depdenent RNA pol Use: TB, leprosy. Used for meningococcoal prophyalxis and chemoprophyalxis in contacts of children with H. flu type b toxicity: hepatotoxicity and drug interactions (Ramps up cytochrome P-450)., Red/orange body fluids (non-hazardous side effect), Rifabutin favored in patients with HIV infeciton due to less cytochohrome p-450 interactions. MOR: mutations reduce drug binding toA pol. Monotherapy rapidly leads to resistance.

intracardiac

injected withing the heart

Inappropriate prescribing

Risk of HARM outweighs potential benefit -->Safer or more effective alternative is available

INJ

injection

L-dopa/carbidopa

SE: arrhythimas form increased peripheral formatin of catecholamines. Long-term use can lead to dyskineasia following administration ("on-off" phenomenom) and akineisa between dosese Parkinson drug

Tubular secretion and reabsorption are ____ to mature

SLOW -->reach adult values by 1 yr

Bulimia

SSRIs

Depressoin

SSRIs

GAD

SSRIs, SNRIs

Social phobias

SSRIs, beta blokers

OCD

SSRIs, clomipramine

Panic disorder

SSRIs, venalfaxine, benzos (acutely)

PTSD

SSRIs, venlafaxine

Tamoxifen, raloxifene

Selective estrogen recpetor modulators (SERMs) - receptor antagonists in breast and agonists in bone (so can help with osteoproiss too). Blocks binding of estrogen to ER+ cells Use: breast cancer (tamoxifen only), Raloxifene is sueful to prevent osteoporosis. Toxicity: Tamoxifen is a partial agonist in endometrium- increases risk for endometrial cancer, also hot flashes Raloxifene: no increase in endometrial carcinoma (acutally is an estrogen receptor antagonist down there).

inj.

injection

Side Effect

Secondary response to a drug other than the primary therapeutic effect for which the drug was inteneded.

Cincalcet

Sensitizes Ca2+ receptor (CaSR) in parathryoid gland to circulating calcium, leading to decrease in PTH Use: hypercalcemia due to primary or secondary hyperparathryoidism SE: hypocalcemia.

Metabolic Pathway

Sequence of chemical steps that convert a drug tinto a metabolite.

Drugs administered by a non IV route must cross....

Several membranes before entry into systemic circulation

Anaphylactic Reaction

Severe allergic response resulting in immediate life-threatening respiratory distress, usually followed by vascular collapse & shock accompanied w/ hives.

Angina pectoris

Severe chest pain resulting from decreased blood supply to the heart muscle

C-I Dependency Potential

Severe physical and psychological

C-II Dependency Potential

Severe physical and psychological

Intravenous disadvantages

Side effects - fast delivery to heart

Natr

Sodium

Wheals

Slightly elevated, red areas on the surface of the body.

Disadvantages of oral route

Slow effects May be incomplete absorbtion Some drugs can't be given orally - too large to be absorbed - ionised - destroyed by gut acid, enzymes - destroyed by liver

A drug taken on an empty stomach will be

Slowly absorbed

Class I antiarrhythmitcs

Sodium-channel binding strench in order is 1C>1A>1B

K+ sparing diuretics

Spironolactone, eplerenone, trimaterene, amiloride Sprionolactone and eplerenone are competitive aldosterone receptor antagonists. Triamterene and amiloride work at the colecting tubule by blocking Na+ cannles in the cortical collecting duct. Use; hyperaldosteronism, K+ depletion, HF Tox; hyperkalmeia, endocrine effects of spironolactone (gynecomastia)

Dependence

State in which a person's body has adapted physiologically & psychologically to a drug & cannot function w/o it.

ADHD

Stimulants (methylphenidate)

Buspirone

Stimulates 5-HT receptors. Use: GAD SE; does not cause sedatoin, addiction, or tolerance but takes 1-2 weeks to take effect (not effective for acute panic attacks) Does not interact wth alcohol I'm always anxious if the bus will be on time, so I take buspirone.

Oxytocin

Stimulates labor, uterine contractions, milk let-down

Calculus

Stone

Pregnancy Category X

Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigation or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

Metabolite

Substance into which a drug is chemically converted in the body.

Allergen

Substance of a usually harmless nature that produces an abnormal hypersensitive reaction.

Antimetabolite

Substance produced during drug metabolism, altering enzymes in the liver

Adsorbent

Substance that leads readily to absorption

Antidote

Substance that neutralizes poisons or toxic substances

Antiseptic

Substances that inhibit the growth of bacteria

Sulfonamides

Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine MOA: inhibits folate synthesis by inhibiting dihydropteroate synthase (PABA was precursor) Bacteriostatic (except when combine with TMP). Dapsone used to treat leprometaous leprosy, is a simialr drug that also inhibits folate synthesis Use; gram positives, gram-negatives, Nocardia, Clhlamyida. UTIs Toxicity: hypersensitivity rxns, hemolysis if G6PD deficiency, neprhotoxicty (tubulointerstitial nephritis), photosensitivity, Kernicterus in infants, dispalce other drugs from albumin (warfarin) MOA: altered enzyme (bacterial dihydropterorate synthase), decrased uptake, or increased PABA synthesis

Antibiotics to avoid in Preganncy

Sulfonamides: kernicterus aminoglycosides: ototoxicity Fluroquinolones: cartilage damage Clarithromycin: Embryotoxic Tetracyclines: discolored teeth, inhibition of bone growth Ribavirin (antiviral): teratogenic Griseofulvin (antifungal): teratogenic Chloramphenicol: Gray baby syndrome SAFe Children Take Really Good Care

Abbreviations

Symbols used for medication errors

Adrenergic

Sympathomimetic drug that mimics the action of the sympathetic nervous system

Antiglatulent

Symptomatic treatment of gastric bloating or GI gas pain

T or F: antibiotics and antifungals have many drug drug interactions

T; need to monitor

For Neuropathic pain, what would you use? ***check this again

TCAs -->highly anticholinergic Gabapentin -->renal dosing required -->start low and titrate -->sedation, dizziness, confusion (ADRs)

Tetracyclines

Tetracycline, doxycycline, minocycline MOA: bacteriostatic. Bind to 30S and prevent attachment of aminoacyl-tRNA. Limited CNS penetration. Doxycycline is fecally elminiated and can be used in renal failure patients. Do not take with milk (Ca2+), antacids (Ca2+ or Mg2+) or irion containing preparations because divalanet cations inhibit drugs' absorption in gut. Use; Borellia burdorferi (lyme disease), M. pneumoninaie. Drugs ability to accumulate intracellularly makes very effective against Rickettsia and Chlamyida (obligate intracellular). Also used to treat acne Toxicity: GI distress, DISCOLORATION OF TEETH and inhibition of bone growth in children. Photosensivity. Contraindicated in preganncy. MOR: decreased uptake or increased efflux through bacterial pumps

Drug Enforcement Administration

The federal agency responsive for controlled substances

Ascites

The abnormal accumulation of fluid in the pleura or peritoneal cavity

Drug Interaction Relationship: Antagonism

The action of 1 drug negates the action of a 2nd drug.

Drug Interaction Relationship: Addition

The combined effect of 2 drugs is equal to the sum of the effects of each drug taken alone.

Drug Interaction Relationship: Synergism

The combined effect of 2 drugs is more intense or longer in duration than the sum of their individual effects. Drugs that work in combination like this are usually prescribed together.

Antagonstic effect

The effect produced by the contrasting actiactions of two (or more) chemical groups (Cancels an effect)

How does the degree to which a drug binds to protein affect its efficiency?

The less bound a drug is, the more efficiently it can traverse cell membranes or diffuse

Bioavailability

The percentage of a drug dose that actually reaches the blood

Low-molecular-weight heparins

The risks and benefits to both mother and child need to be balanced, and low molecular weight heparin such as enoxaparin is a good choice in thecase of a venous thrombolytic event (remember pregnancy increases risk of these)

SCID

The second most common cause of SCID is due to autosomal recessive deficiency of adenosine deaminase, which helps remove deaminase from cells. Toxic levels of adenosine accumulate in lymphocytes leading to death and a resultant cellular and humoral deficiency. Bone marrow transplant is treatment

New drug application

The type of application that a drug manufacturer submits to the FDA following successful completion of required human research studies

Therapeutics

The use of drugs to diagnose disease conditions, prevents disease, or treat a disease

Pregnancy Category D

There is positive evidence of human fetal risk based on adverse reaction data from investigation or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Anticholinergic side effects

These include pupillary dilation, dry mouth, urinary retention, and constipation.

Stimulants for ADHD

They are first-line and work by increasing the availability of NE and dopamine in the prefrontal cortex.

First generation H1-histamine receptor antagonists

This drug class includes diphenhydramine, chlorpheniramine, and hydroxyzine. They can cause signficiant sedation and should be avoided with other medications that suppress the CNS like benzos like diazepam.

TID

Three times a day

Half-Life

Time necessary for the body to eliminate half of the drug in the body @ any 1 time (written as T 1/2).

Beta blockers (glaucoma)

Timolol, betaxolol, carteolol decrease aqueous humor synthesis

Peak

Top or upper limit of a drug's concentration in the blood.

Epithelial route of administration

Topical - skin, e.g. steroid creams Corneal e.g. eye ointment Nasal e.g. sprays

Monoamine Oxidase inhibitors

Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAOB inhibitor) MAO Takes Pride In Shanghai. Use: atypical depression, anxiety Tox: hypertensive crises when eating tyramine containing food (wine and cheese) Also don't use SSRIs or TCAs- serotonin syndrome.

Malignant

Tumor is life threatening

BID

Two times a day

Enzymes, Nucleic Acids, Receptors, & Transport Proteins

Types of specific body molecules that drugs can combine w/.

Imatinib

Tyrosine kinase inhibitor of BCR-ABL (CML) and c-kit (common in GI stromal tumors) Use: CML, GI stromal tumors SE: fluid retention

Ultra metabolizes vs normal? Codeine ex

Ultra will pull in more codeine than normal -->morphine like adverse effects in UMs

Rectal route of administration

Up rectum Avoids fast metabolism

Uric Acid

Urine

Drug Abuse

Use of a drug for purposes other than those prescribed &/or in amounts that were not directed. This is often linked to addiction.

Conivaptan, tolvaptan

V-2 receptor antagonists used in the treatment of SIADH. Notice the VAP in the name- sounds like vapor.

Drug polymorphism

Variation in response to a drug because of a patient's age, gender, size, and/or body composition.

SNRIs

Venlafaxine, duloxetine Inhibit 5HT and NE reuptake Use: depression. Venlafaxine also for GAD, panic disorder, PTSD. Duloxetine is indicated for diabetic peripheral neuropathy. Tox: increased BP, sedation, nausea

Antiarrhythmics- calcium channel blockers (Class IV)

Verapamil and dilitiazem MOA: decreased conduction velocity, increased ERP, increased PR interval (specifically in SA node and AV node) use: SVT, rate control in a-fib Toxicity: constipation, flushing, edema, cardiovascual effects (HF, AV block, sinus node depression)

Tramadol

Very weak opioid agonist. Also inhibits 5-HT and NE reuptake (tram it all tramadol) Use: chronic pain Toxicity: decreases seizure threshold, serotonin syndrome.

Sildenafil

Viagra. Dont use in patients taking nitrates.

Foscarnet

Viral DNA/RNA polymerase inhibitor and HIV reverse transcriptase inhibitor. DOES NOT require activation by viral kinase. Binds to pyrophosphate-binding site of enzyems (Foscarnet = pyrofosphate analog) Use: CMV retinits in immunocompromised when ganciclovir fails; acyclovir-resistant HSV Toxicity: nephrotoxicty, electrolyte abnormalities (hypo-or hypercalcemia, hypo- or hyperphsohpatemia, hypokalemia, hypomagnesemia), can lead to SEIZURES. MOR: mutated DNA pol

When would rectal be useful for administration in pediatrics?

Vomiting Unable to take

Most drugs are ______ electrolytes e.g. _____ or _____

weak acids bases

What should you make sure of in pediatric dosing?

WEIGHT --do no estimate Check dose everytime Pediatric meds have upper limit

HA

weak acid Can be absorbed (uncharged)

Drug Interaction

When a drug is affected in some way by another drug, foods, or other substances, such as when enzymes that metabolize the drug are induced or inhibited.

Hemolytic disease of the newborn revisited

With maternal blood types A and B, this does not happen because anti-A and B antibodies are of the IgM subtype and therefore cannot cross the placenta. In contrast in type O mothers, antibodies are predominantly IgG and can cross the placenta to cause fetal hemolysis.

Informed consent

Written permission obtained from a patient consenting to the performance of a specific procedure (e.g. receiving and investigational drug), after the patient has been given information regarding the procedure deemed necessary for the patient to make a sound or "informed" decision.

Nonbenzodiazepine hypnotics

Zolpidem, Zaleplon, exZopiclone. "ALL ZZZs put you to sleep." MOA: act via BZ1 subtype of GABA receptor. Effects reversed by flumazemnil Use: insomnia SE: ataxia, headaches, confusion. Short duration. Decreased depdence risnk like bneozs and only modest daf-after pscyhomoter depression

Finasteride

a 5 alpha reductase inhibitor that suppresses peripheral conversion of testosterone to dihydrotesterosterone. It is used for treatment of benign prostatic hyperplasia and androgenetic alopecia (baldness)

Finasteride

a 5 alpha reductase inhibitor. Useful in BPH and male pattern baldness

Misoprostol

a PGE1 analog. Increases production and secretion of gastric mucous barrier, decreased acid production. Use: prevention of NASIAD-incuded peptic ulcers; mainitencae of PDA. and off lable for induction of labor (abortion) SE: diarrhea

butalbital-containing products

a barbiturate with an intermediate duration of action. Butalbital is often combined with other medications, such as acetaminophen (paracetamol) or aspirin, and is commonly prescribed for the treatment of pain and headache. The various formulations combined with codeine are FDA-approved for the treatment of tension headaches.

Triazolam

a benzodiazepine that can be useful for treating insomnia/anxiety in those with mission-critical positions, as it has the shortest half life thus minimizing side effects.

Schedule II

a category of drugs considered to have a strong potential for abuse or addiction but that also have legitimate medical use. Included are opium, morphine, and cocaine

Schedule I

a category of drugs not considered legitimate for medical use. Included are heroin, lysergic acid diethylamide (LSD), and marijuana.

Schedule III

a category of drugs that have less potential for abuse or addiction than Schedule I or II drugs and have a useful medical purpose. Included are short-acting barbiturates and amphetamine

Agonist

a chemical that binds to a receptor and activates the receptor to produce a biological response

Amiodarone

a class III antiarrhthmic that causes lengthening of cardaic action potential by prolonging phase 3 (inhibit potassium channels so slower repolarization), which manifests as prolonged QT. in contrast to other drugs, very little risk of torsades de pointes even though the QT interval is prolonged.

acetylcholine

a compound that occurs throughout the nervous system, in which it functions as a neurotransmitter.

intermittent claudication

a condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries

hyperventilation

a condition in which you suddenly start to breathe very quickly

Amlodipine

a dihydropyridine calcium channel blocker commonly used as monotherapy or with other agents to treat hypertension. Major side effects include headache, flushing, dizziness, and peripheral edema.

Bethanechol

a direct cholinergic agent activates bowel and bladder smooth muscle used for postoperative ileus, neurogenic ileus, and urinary retention Bethany, call (bethanecol) to activate your bowels and bladder

Acetazolamide

a diuretic that works by inhibiting carbonic anydrase reactoins necessary for NaHCO3 reabsorption in the proximal tubule. This results in urinary bicarbonate wasting. Azetazolamide is also used for glaucoma to relieve pressure.

agranulocytosis

a dramatic decrease in white blood cells

Parenteral

a general term for any route other than the alimentary canal

N-methyl-D-asparate (NDMA)

a glutamate receptor and ion channel protein found in nerve cells. ... It is activated when glutamate and glycine (or D-serine) bind to it, and when activated it allows positively charged ions to flow through the cell membrane.

Serotonin syndrome

a group of symptoms that may occur following use of certain serotonergic medications or drugs. The degree of symptoms can range from mild to severe. Symptoms include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea.

dihydroergotamine (DHE)

a hydrogenated derivative of ergotamine that is used in the treatment of migraine.

Digoxin toxicty

a lot (narrow therapeutic window) Cholinergic: nausea, vomitting, diarrhea, blurry yellow vision, arrthymias, AV block (remember digoxin activates Vagus nerve) Can lead to hyperkalemia (blocking the Na+/K+ pump) Antidote: normalize K+, anti-digoxin Fab fragments, Mg2+

Drug purity

a measure of the amount of API present in a sample compared to those of related substances, impurities, residual solvents

Schedule V

a medically useful category of drugs that have less potential for abuse or addiction than those of Schedules I through IV. Included are antidiarrheals and antitussives with opioid derivatives

Schedule IV

a medically useful category of drugs that have less potential for abuse or addiction than those of Schedules I, II, and III. Included are diazepam and chloral hydrate.

First-pass effect

a phenomenon of drug metabolism whereby the concentration of a drug is greatly reduced before it reaches the systemic circulation

multiple sclerosis agents

a progressive neurological disorder affecting the brain and spinal cord. The myelin sheath that covers the neurons degenerates causing a disruption of nerve transmission. The disease is complex causing symptoms to be treated only as they appear. Corticosteroids are used to reduce inflammation, muscle relaxers are used to decrease muscle spasms, and urinary antispasmodics are used to treat over active bladder symptoms.

Receptor

a protein molecule that receives chemical signals from outside a cell

octreotide

a somatostatin analog that suppresses GH release in acromegaly

pharmacotherapeutics

a study of beneficial and adverse effects of drugs

antiproliferative

a substance used to prevent the spread of cells into surrounding tissue

Octreotide

a synthetic somatostatin analong used to control the symptoms of carcinoid syndrome

Capsaicin (Zostrix)

a topical agent used for the treatment of neuropathic pain from a substance found in hot peppers. This works by depleting substance P from the nerves, thus topping the transmission of pain from one nerve to another.

Dysrhythmia

abnormal heart rhythm

hypertension

abnormally high blood pressure.

bradycardia

abnormally slow heart action

Thionamides (methimazole and propylthiouracil)

act as antithyroid medications by decreasing formation of thryoid hormones via the inhibition of thyroid peroxidase. PTU additionally prevents peripheral conversion of T4 to T3.

Heparin

activates antithrombin; decreases thrombin and factor Xa. Short half-life Use: immediate anticoag for PE, ACS, MI, DVT. Can be used during pregnancy (does not cross placenta). Follow PTT SE: bleeding, thrombocytopenia (HIT), osteoprosis, Reversal: proamine sulfate LMWH: enoxaparin, dalteparin and fondaparinux act more on Xa, have better bioavailability and longer half life, but not as easily reversible.

antihistamine

acts to prevent the action of histamine (allergies) (Allegra, Benadryl, Dimetane)

Neuroleptic malignant Syndrome

adverse reaction to antipsychotic medication characterized by severe "lead-pipe" rigidity, hyperthermia, autonomic instability, and mental status changes. Although symptoms overlap with those of serotonin syndrome, patients with NMS do not exhibit hyperreflexia and clonus characteristic of serotonin syndrome.

PC

after a meal

p.c. (post cibum)

after meals

analgesic

agent that relieves pain without causing loss of consciousness (Tylenol, Advil, Motrin)

Sublingual route of administration

aka buccal dissolves in mouth e.g. bongela

albuterol, salmetrol

albuterol is used acutely for asthma salmetrol for long-term control of COPD and asthma B2>B1

Beta 2 agonists for Asthma

albuterol- releaxes bronchial smooth muscle in acute exacerbation Salmeterol, formoterol- long acting agents for prophylaxis. Could cause tremor and arrhythmia

After gall stones

alcohol abuse is the second most common cause of acute pancreatitis. Macrocytosis and an AST:ALT ratio >2 would be indicators of chronic alcohol consumption. Alcohol-related macrocytosis can occur indepedently of folate deficiency.

Bisphosphonates

alendronate, any other DRONATE Pyrophosphate analogs: binds hydroxyapatite in bone; inhibiting osteoclast activity. Use: osteoporosis, hypercalcemia, paget disease of the bone. Tox: corrosive esophagitis (patients are advised to take with water and remain upright for 30 minutes).

Phenylephrine

alpha 1 > alpha 2 Hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinits (decongestant) .

Clonidine

alpha 2 agonist thereby inhibit sympathetic funciton. Used in hypertesnive urgency adn does not decrease renal blood flow (good for patients with renal disease Used in ADHD and tourretes. Toxicity: CNS depression, brachycardia, hypotension, resipartory depression, miosis

Mirtazapine

alpha 2 blocker- used to treat depresson (more catecholamines get released in blocking alpha 2)

Tamsulosin

alpha-1 antagonist used to treat BPH by inhibiting smooth muscle contraction. It is selective for prostate receptors (not vascular)

Norepi

alpha1 > alpha 2 > Beta 1. Notice no Beta 2 action here. Used for hypotension (decreases renal perfusion though since beta 2 cannot vasodilate)

antiepileptic agents

also known as anticonvulsants, they are used to reduce the frequency of seizures. This is done by reducing the excitability of the nerve cells of the brain.

amt

amount

amp

ampule

Desmopressin

an ADH analog that can be given in Central diabetes Insipidus.

Ataxia-telangiectasia

an AR disease due to defect in DNA repair enzymes. The DNA of these patients is hypersensitive to ionizing radiation. Manifestations include cerebella ataxia (and atrophy, telangiectasias, repeated sinopulmonary infections, and an inreased incidence of malignancy. Defect in the ATM gene.

Heparin

an anticoagulant

Clopidogrel (plavix)

an antiplatelet agents that works by inhibiting platelet surface ADP receptor. It works just as well as aspirin and can be used in combination or when aspirin allergy occurs.

Omalizumab

an effective and acceptable add-on therapy for patients with severe allergic asthma. It works by binding IgE and preventing its binding to mast cells.

Edrophonium

an extremely short acting acethylcholinesterase and was traditionally used to diagnose Myasthenia gravis by its administration improving muscle function. Now we diagnose with anti-AChR Ab.

Tacrolimums

another Calcinuerin inhibor that works by blocking FK506 protein. Blocks T cell activation by preventing IL-2 transcription. Use to prevent transplant rejection. Tox: neprhotoxicity, diabetes, neurotoxciity, but no hirsuitsm or gingival hyperplasia

-ium

antacid (substance which neutralizes stomach acidity, which relieves heartburn)

Omalizumab

anti-IgE monoclonal antibody. Used in resistant asthma

Omalizumab

anti-IgE used for severe allergic asthma

Denosumab

anti-RANKL inhibits osteoclast maturation in osteoprosis

Bevacizumab

anti-VEGF Use: colorectal cancer, renal cell carcinoma

Ranibizumab, bevacizumab

anti-VEGF. Used in age-related macular degeneration.

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

antidepressant medications that act upon neurotransmitters in the brain that affect a person's mood. SNRIs are utilized in the treatment of depression and chronic pain.

Azatrhioprine

antimetabolite precursor of 6-metacaptopurine, blocking lymphocyte proliferation (can't synthesize nucleotides). Use: transplant rejection prophylaxis, RA, Chrons. Tox: leukopenia, anemia, thromboctyopenia (blocking nucleotide synthesis remember?) note: increased toxicity by allopurinol (6-MP degraded by xanthine oxdiase)

Class IA antiarrhythmics

are sodium channel blocking agents that slow phase 0 of the ventricular myocyte action potential and prolong repolarization as well as refractory period.

drug

any chemical affecting the process of living organism

Mycoses

any disease caused by fungus

triptans

any of a class of drugs (such as sumatriptan) that bind to and are agonists of serotonin receptors and are used to treat migraine attacks

Direct factor Xa inhibitors

apiXaban, rivaroXaban MOA: bind to an directly inhbiit factor Xa Use: tx and prophylaxis for DVT and PE. Stroke prophylaxis in patients with a-fib. toxciity: bleeding (no reversle agent)

topical

applied to the skin surface or mucus membrane

FDA Market Withdrawal

appropriate when a product has a minor violation that would be not subject to FDA legal action. the manufacture must remove the product from distribution markets or correct the violation. "a product removed from the market due to tampering, without evidence of manufacturing or distribution problems, would be a market withdrawal"

bromocriptine and cabergoline

are dopamine agonists used agianst prolactinoma

Muscarinic antagonists

are drugs that block the affects of acetylcholine so they mimic the sympathetic nervous system effects some of the drugs ends in tropine

B1 receptors

are found in cardiac tissue and renal juxtaglomerular tissues, but not on vascular smooth muscle. Blockage of beta 1 receptor leads to decreasing cAMP levels in cardiac and renal cells.

Fibrates (Gemfibrozil)

are most effective in treating hypertriglyceridemia (can cause acute pancreatitis)

HS

at bedtime

h.s. (hora somni)

at bedtime

Appendicits

at first causes dull visceral pain at the umbilicus due to afferent pain fibers. Progressive inflammation irratiates the parietal peritoneum and abdominal wall and causes more severe somatic pain that then shifts to Mcburnery point.

Shizophrenia

atypical antipsychotics

Cisplatin, carboplatin

cross-link DNA Use: testicular, bladder, ovary, and lung carcinomas. Toxicity: nephrotoxicty, ototoxicity. Prevent nephrotoxicity with amifostine and chloride diuresis.

a

before

AC

before a meal

a.c. (ante cibum)

before meals

ac

before meals

Colchicine

besides NSAIDs and glucocorticoids, one of the acute gout drugs. Binds and stabilizes tubulin to inhibit microtubule polymerzation, impairing neutorphil chemotaxis and degranulation. Side effects: N/V, diarrhea Aspirin is not given for gout-- depresses uric acid clearance.

Terbutaline, ritodine

beta 2 agonist that relaxes the uterus, decreasing contractions during labor

Vinicristine, vinbalstine

bind beta tubulin and inhibit its polymerziation into microtubules- prevent mitotic spindle formation (M-phase arrest) Use: Hodgkins (vinblastine, Non-hodkins (vincristinee), also leukemias and solid tumors SE: Vincristine: neurotoxicity (areflexia, peripheral neurtitis) Vinblastine blasts bone marrow (supression)

Progestins

bind progesterone receptors, decrease growth and increase vascularization of the endometrium. Used in oral contraceptives and to treat endometrial cancer.

Sirolimus

binds to the immunophillin FKBP in the cytoplasm, forming a complex that binds mTOR. Inhibition of mTOR signaling blocks IL-2 transduction and prevents cell cycle progression and lymphocyte proliferation.

NE extravasation

blanching of a vein into which NE is being infused together with induration and pallor of the tissues surrounding suggest this and its resulting vasoconstriction. Tissue necrosis is best prevented by local injection of an alpha 1 blocking agent, like phentolamine.

Montekulast, Zarfirlukast

block leukotriene receptors. Really good for aspirin induced asthma

Digoxin

blocks Na/K+ ATPase causing indirect inhibition of Na+/Ca2+ exhanger leading to increased intracellular Calcium- increased inotropy. ALSO stimulates the vagus nerve leading to decreased HR

Fomepizole

blocks alcohol dehydrogenase and is used an an antidote for methanol or ethylene glycol poisoning

Disulfiram

blocks aldehyde dehydrogenase, thus increasing the effects of a hangover

anticholinergic

blocks parasympathetic nerve impulses; decreases oral and respiratory secretions (atropine, Artane)

anticholinergic

blocks parasympathetic nerve impulses; decreases oral and respiratory secretions (atropine, Artane)\

-emia

blood condition

AU

both ears

OU

both ears

OU

both eyes

encephalo-

brain

mucolytic

breaks chemical bonds in mucus (Mucomyst)

p.o. (per os)

by mouth

PO

by mouth, oral

PO

by mouth/oral

Antacid use

can affect absorptin, bioavialbitility, or urinary excreiton of other durgs by altering gastric and urinary pH or by delaying gastric emptying. All cause hypokalemia Overuse: Aluminum hydroxide: constipation and hypophosphatemia; proximal muscl eweakness, osteodystrophy, seizures Calcium carbonate: Hypercalceima, rebound acid Magnesium hydroxide: diarrhea (Mg = must go to bathroom).

enteric coated

covered with material so the drug dissolves in the intestines protects drugs stomach acid. protects stomach from irritation drugs

Topiramate

can be used for focal or generalized tonic clnioc seizurs it blocks Na+ channles and increases GABA action. SE: sedaiton, mental dulling, kidney stones Also used first line in migraine prevention

Digoxin

can be used for ventricular rate control in a-fib as it dereases atroventricular nodal conduction by increasing parasympathetic tone. It can also be used in HF for its positive inotropic effect (blocking Na/K pump leading to greater contractility)

Benzoate or phenylbutyrate

can be used to bind AA's in hyperammonemia diseases

ACE Inhibitors

can cause angioedema rarely due to bradykinin buildup (a potent vascular permeability chemical). Symptoms include tongue, eyelid and lip swelling. Discontinue the ACE inhibitor, potentially serious.

Succinylcholine-induced hyperkalemia

can causes significant potassium release and life-threatening arrhythmias in patients at high risk for hyperkalemia, including those with burns, myopathies, crush injuries, and denervating injuries or diseases. (because it activates to high degree the acetylcholine receptor at the motor end plate- potassium can come out).

Valproic acid

can e used as first-line for tonic-clonic but also any of the other seizures is possible. It increases Na+ channel inactivation but also increases GABA concentration by inihbitng GABA transaminase Used for myoclonic seizures as well and also BIPOLAR DISORDER. SE: rare but fatal hepatoxicity (measure LFTs), neural tube defects, termor, weight gain, contraindicated in pregnacy

SIADH

can give demeclocycline which blocks ADH

Tricyclic antridepressants like Amitriptyline

can have antimuscarinic (anticholinergic) side effects that may mimic atropine toxicity like fever, cutaneous flushing, dry oral mucosa, dilated poorly reactive pupils and confusion "hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter)

First generation antihistamininics side effects

can have antimuscarininc, anti-aslpha adrenergic and anti-serotonergic effects.

Niacin

can lead to acute gout with hyperuricemia. Other side effects are facial flushing and warmth. It improves hyperlipidemia by decreasing hepatic synthesis of TAGs and VLDL.

Ergonovine

can provoke coronary artery vasospasm in the attempt to diagnose Prinzmetal's angina ,characterized by episodic, transient attacks of coronary vasopasm, typically occurring at rest and at night. Produce temporary ST elevations.

CAP

capsule

cap

capsule

caps

capsules

extended release

capsules/ tablets filled with tiny spheres that contain actual drug. The sphere dissolves at variable rates and allows steady release of drug throughout the day

Scombroid poisoning

caused by consuption of dark-meat fish stored at warm temperature. Bacterial histidine carboxylase converts histidine to histamine which is not destroyed by cooking Thus results in an allergic/analphalatic like response treat with epi and anti-histamines

Lateral epicondylitis (tennis elbow)

caused by the overuse of extensor carpi radialis brevis and is characterized by angiofibroblastic tendinosis at its origin on the lateral epicondyle.

DiGeorge syndrome

causes an extreme deficiency in the number of mature T lymphocytes, leading to poor development of the lymph node paracortex. It is due to maldevelopment of the third and 4th pharyngeal pouch Clinical manifestions: thymic shadow on Xray, hypocalcemic tetany from abscence of parathyroids, cleft palate, aortic arch abnormalities

Theophylline

causes bronchodilation via increased cAMP by blocking phosphodiesterase. SE: narrow therpeutic index (cardiotoxicty - arrhythmias and nerotoxicity- seizures). It is metabolized by cytochrome p-450. Also, it blocks the action of adenosine.

Pyruvate kinase deficiency

causes hemolytic anemia due to failure of glycolysis and resultant failure to generate sufficient ATP to maintain erythrocyte structure.

antimigraine

causes vasoconstriction in large intracranial arteries\

antimigraine

causes vasoconstriction(constriction of blood vessels, which increases blood pressure) in large intracranial (within skull) arteries

-oporo

cavity

1st generation cephalosporins

cefazolin, cephalexin Use: gram-positive cocci + proteus, E. coli, and Klebsiella (PEcK). Cefazolin used prior to surgery to prevent S. aureus wound infections.

4th generation cephalosporins

cefepime serous gram-negative infections resistnat to other Beta-lactams with increased activity against Pseudomonas and other gram-positive organsims

2nd generation cephalosproins

cefoxitin, cefaclor, cefuroxime Cover Gram positive Cocci, H. flu, enterobacter (enterodactyl), Neisseira, proteus miriablis, E. coli, Klebsiella, Serratia HEN PEcKS. Or could think of as the sketchy for serratia, enterobacter, and klebsiella + proteus, E. coli and H. flu and neiseria.

3rd generation cephalosporins

ceftriaxone, cefotaxime, cefuroxime Used for serous gram-negative infections resistant to other eta lactams. Ceftriaxone: meningitis, gonorrhea, disseminated lyme disease Ceftazidime- pseudomonas

cm

centimeter

Cyclobenzaprine

centrally acting skeletal muscle relaxant. Structurally related to TCAs, simialr anticholinergic side effect. Use: muscle spasms.

maintenance therapy

chronic pain

Cocaine withdrawal

characterized by development of acute depression fatigue, vivid dreams, hypersomina, and hyperphagia. Key being relatively mild physical symptoms compared to the others.

X-linked Agammaglobulinemia

characterized by low or absent circulating CD19+ and CD20+ B cells and pan-hypogammaglobulinemia. Patient would be a boy with pyogenic bacterial infections and Giardia possibly due to lack of IgA and opsonizing antibodies. primary lymphoid follicles and germinal centers will not form in the lymph nodes due to no B ccells.

Cholestasis

characterized by pale grey color in stools and dilate bile cannaliculi with green-brown plugs. It can cause malaborsption and nutritional deficiencies of the fat soluble vitamins so osteomalacia from vit d deficiency could result.

Diffuse esophageal spasm

characterized by periodic, simultaneous, non-peristaltic contractions due to impaired myenteric plexus inhibition (need to inhibit what's in front of bolus). Would have solid/liquid dysphagia with chest pain.

BUCCAL

cheek, gum

BUCCAL

cheek/gum

Penicillamine

chelation therapy for wilson's disease to remove excess copper from the body.

tricyclic antidepressants (TCA)

chemical compounds used primarily as antidepressants. TCAs were first discovered in the early 1950s and marketed later in the decade. They are named after their chemical structure, which contains three rings of atoms.

Diagnostic agent

chemical substances used to reveal, pinpoint, and define the localization of a pathological process.

Monoamine oxidase inhibitors (MAO-Is)

chemicals that inhibit the activity of the monoamine oxidase enzyme family. They have a long history of use as medications prescribed for the treatment of depression. They are particularly effective in treating atypical depression.[1] They are also used in the treatment of Parkinson's disease and several other disorders.

Fluoroquinolones

ciprofloxacin, norfloxacin, levofloxacine, ofloaxin, moxifloxacin, gemifloxacin, adn enoxacin. MOA: inhibit prokarytoic enzymes topiosomerase II (DNA gyrase) and topoisomerase IV. Bactericidal. Must not be taken with antacids. Use: gram-negative rods of urinary and GI tracts (including pseudomonas), Neisseria, Toxicity: GI upset, superinfecitons, skin rash, headache, dizinessl Less commonly can cause leg cramps and myalgias. Contraindicated in pregnancy and children < 18 because can cause damage to cartilage. Some may prolong QT. May cause tendonitis or tendon rupture in people > 60 (HOBBS) and in patients taking prednisone. Fluroquinolones hurt attachments to your bones MOR: mutations in DNA gyrase, efflux pumps

Reactive arthritis

classically presents in a triad of nongonococcal urethritis, conjunctivitis, and arthritis. It is an HLA-B27 assoicated arthropathy that occurs within several weeks following a geniturinary or enteric infection. It is one of the seronegative arthropathies and can cause sacroiliitis in 20% of patients. Often also forms a rash on the palms and soles called keratoerma blennorhagicum

antiviral

combats a specific viral disease (e.g. herpes) (Denavir, Famivir, Relenza, Retrovir, Tamiflu, Zovirax)\

antiviral

combats a specific viral disease (ex. herpes) (Denavir, Famivir, Relenza, Retrovir, Tamiflu, Zovirax)

synergistic effect

combination of two drugs producing a pharmacological effect that is greater than the sum of the two drugs.

antagonist effect

combined effect is less than the effect produced by the active drug alone, second drug eliminates or diminishes activity of the first drug

Hemo

combining form

palliative care

comfort measure...treat symptoms not diseases

Lithium

commonly used to treat bipolar disorder. Its use during pregnancy is associated with Ebstein's anomaly (apical displacement of the tricuspid valve leaflets, decreased right ventricular volume, and atrilization of the right ventricle.

Statins

competitively inhibit HMG-CoA reductase (for cholesterol synthesis).

comp

compound

-sis

condition

-tic

condition of

ADH antagonists

conivaptan, tolvaptan Use: SIADH, block action of ADH at V-2 receptors.

Anti-Rh(D) immune globulin

consists of IgG anti-D antibodies that opsonize Rh+ fetal erthrocytes, preventing maternal Rh sensitization. Usually given at 28 weeks and immediately post-partum if the woman is Rh-negative

Elixirs

contain between 5-40% alcohol

elixers

contain between 5-40% alcohol

-clonic

contraction and relaxation

antidysrhythmic

controls and prevents cardiac dysrhythmias(abnormal rhythm)

antidysrhythmic

controls and prevents cardiac dysrhythmias\

antiarrhythmic

controls cardiac arrhythmias (lidocaine HCl, Xylocaine, Inderal)

antiarrhythmic

controls cardiac arrhythmias (lidocaine HCl, Xylocaine, Inderal)\

antispasmodic

controls hypermotility in IBS\

hemostatic

controls or stops bleeding (Amicar, Humafac, vitamin K)

hemostatic

controls or stops bleeding (Amicar, Humafac, vitamin K)\

kerat-

cornea of the eye

Chloropromazine

corneal deposits

A permissive effect

cortisol exerts a permissive effect on many hormones to help improve the response to a variety of stressors.

bronchodilator

dilates the bronchi (Proventil, Isuprel)

peripheral neuropathy

damage of nerves other than the brain and the spinal cord

d

day

Niacin

decrease LDL, increase HDL (the most), decrease TGs Inhibits lipolysis (hormone sensitive lipase) in adipose tissue as well as reduces VLDL synthesis Toxicity: red, flushed face (prevented with NSAIDs/asprin), hyperglycemia, hyperuricemia (acute gout)

Ezetimibe

decrease LDL, not anything else Prevent cholesterol absorption at the small intestine toxcicity: rare (increase in LFTs), diarrhea

Thiazolidinediones (TZDs)/glitazones

decrease insulin resistance by binding to PPAR- gamma, a transcriptional regulator of genes involved in decreasing insulin resistance. Becuase gene transcription is required, can take several weeks to work ex. Piaglitazone

dil

dilute

Antibacterial Drugs on Elderly

diminished renal functional capacity so hesitant to prescribe drugs

Rifaximin

decreases colonic ammoniagenic bacteria

Acetazolamide (glaucoma)

derease aqueous humor synthesis by inhbition of carbonic anydrase

chemical name

describes a drug chemical composition and molecular structure

antibiotic

destroys or inhibits growth of microorganisms (Kelfin, Rocephin, Pentids, penicillins, Augmentin)

antiprotozoal

destroys protozoa( single-celled microscopic animal)

antiprotozoal

destroys protozoa\

Blood/gas partition coefficient

determines the solubility of a gas in anesthetic in the blood which in turn determines the onset of action of the drug. Drugs with high coeffcients are more soluble in the blood, demonstrate slower equilibration in teh brain, and have longer onset times.

physical dependence

develops with long term use of certain drugs such as opioid, alcohol, barbiturates, and amphetamines. If drug is discontinued the body will exhibit abstinence syndrome

contraceptive

device, method or agent that prevents conception(fertilization)

contraceptive

device, method or agent that prevents conception\

thrombolytic

dissolves an existing thrombus (clot) when administered soon after its occurence (Abbokinase, Activase, Eminase, Kabikinase, Streptase)

nystagmus

dizziness

cocaine intoxiciation

do not use beta blocker as could lead to unopposed alpha 1 activation which causes hypertensive emergency

Thiopental/barbituate like elimination

does not occur due to actual metabolism of the drug but rather redistribution

dr

dram

GTT

drop

gtt

drops

DEA

drug enforcement agency

IM

drug inject muscular tissue, only barrier to absorption is the capillary wall......can administer poorly soluble drug..depot preparations,,absorbed slowly decreasing frequency...discomfort and inconvenience

SQ

drug injected into adipose tissue ,less blood flow

enteral

drug is absorbed into the systemic circulation through the oral or gastric mucosa, the small intestine

hepatotoxicity

drugs are the leading cause of acute liver failure, combing hepatotoxic drugs with certain other drugs may cause the risk of liver damage....lipid lower drugs..oral hypoglycemic, anti-seizure drugs, anitfungals, anti tubercular, immune suppressants, antiretovirals, acetaminophen and alcohol

classification

drugs may be classified in a number of different ways. Typically the classification provide information about the chemical nature, pharmacologic action, or pharmacotherapeutic use of drugs

teratogenic effect

drugs that cause abnormal fetal development when give to pregnant women

cardiotoxcity

drugs that interfere with electrical conduction or mechanical function of the heart

Anticonvulsants

drugs that prevent or stop seizures

carcinogenic effect

drugs used to treat cancer have the greatest carcinogenic potential

xer-

dry

Acute Dystonic Reaction

due to the D2 blockade in the nigrostriatal pathway caused by high potency antipscyhotics (haloperidol, fluphenazine). Other extrapyramdial symptoms that can ocur are akathisia and parkinsonism.

gr

grain

Magnesium

effective in torsades de pointes and digoxin toxicity.

Selective Cox-2 inhibitors

eg. celecoxib. Cox-2 is an inducible enzyme that is unregulated to increase synthesis of pro-inflammatory arachidonic acid metabolites (prostaglandins). Selective Cox-2 inhibitors decrease inflammation by inhibiting Cox-2 but have no effect on Cox-1 (minimizing the gastroduodenal toxicity).

vasopressor

elevates BP; used to treat allergic reactions (Aramine, Levophed)

alpha 1 selective blockers

end in osin Prazosin, terazosin, doxazosin, tamsulosin urinary symptoms of BPH (makes easier to pee); PTSD and hypertension. hypoteniosn, dizinnes, heachache can result.

Prevention of gonococcal conjuctivitis in a newborn

erthromycin ointment

Oral contraception

estrogens and progestins inhibit LH/FSH thus prevent the estrogen surge. Progestins also thicken the cervical mucus- blocking sperm entry. Progstins inhibit endometrial proliferation too (less susceptible to implantation of embryo). Contraindications: smokers > 35, history of thromboembolisms or estrogen dependent tumor.

Estrogens

ethinyl estradiol, DES, mestranol MOA: binds estrogen receptors Use: hypogonadism or ovarian failure, mensural abnormalities, postmenopasual women hormone replacement. Prostate cancer (androgen depedent) Tox: increased risk for endometrial cancer, clear cel adenomcaridnoma of vagina in females exposed to dES in utero. Increased risk of thrombi. Contraindicated in ER positive breast cancer and history of DVTs

q

every

q. (quaque)

every

q.2h.

every 2 hours

Gm., g, gm

gram

q__*

every __ hours

q__H

every __ hours

q___*

every ___ hours

q___H

every ___ hours

qHS

every bedtime

q.d. (quaque die)

every day

qD

every day

qHS

every day

qPM

every evening

q.h. (quaque hora)

every hour

qH

every hours

qMO

every month

q.a.m.

every morning

qAM

every morning

aPM

every night

q.o.d.

every other day

qOD

every other day

qWK

every week

generic name

everyday, official (nonproprietary) name given to a drug by manufacturer who first develops the drug. longer and more complicated than the trade name.....ibuprofen, acetaminophen, digoxin

Thiazolidinediones

exert their glucose-lowering effect by decreasing insulin resistance. TZDs activated PPAR- gama receptor, a nuclear receptor that alters the transcription of genes involved in glucose and lipid metabolism. They decrease insulin resistance.

cardiac glycoside

exerts a positive inotropic effect on the heart; increases strength and force of contractions and slows heart rate (Digitalis preps)\

expectorant

facilitates removal of secretion from broncho-pulmonary mucous membrane (Robitussin, Mucinex)

pyr/e

fire or heat

Sulfonylureas

first generation: Chlorpropamide, Tolbutamide Second: Glimepiride, Glipizide, Glyburide MOA: close K+ channel on Beta cell, thus cell depolarizeds and insulin is released with increased calcium influx (requires some islet cell funciton to work- useless in type I) Side effects: increased risk of hypoglycemia in renal failure.

Carbamzepine

first line for simple, complex and tonic clonic seizures Increase Na+ channel inactivation SE: diploplia, ataxia, agranulocytosis/aplastic anemia, teratogeneis, induction of P-450 enzymes, SiADH, Steven Johnson syndrome Also first line for trigeminal neuralgia

Benzodiazapines (diazepam, lorazepam)

first line for status epilepticus works by increaes GABA action. SE: sedation, tolerance, dependence, respiratory depression. May also be used in ecclampsia seizures although first line is Magnesium sulfate there

Modafinil

first line treatment for narcolepsy. Amphetamines are second line therapy.

Piolglitazone

fluid retion with resulting weight gain and edema is a common side effect.

FDA

food and drug administration

QID

four a day

q.i.d. (quarter in die)

four times a day

Fibrates

gemFIBROzil, clofFIBRATE, BEZAFIBRATE, fenoFIBRATE decrease LDL, increase LDL, REALLY DECREASE TAGS Upregulate LPL, increased TG clearace. Also activates PPAR-alpha to induce HDL synthesis. Toxicity: myopathy (with statins espeically), cholesterol gallstones.

Mitoxantron (novantrone)

given by IV infusion to reduce neurologic disability and frequency of relapses in secondary, chronic progressive, relapsing remitting MS.

Natalizumab (tysabri)

given by IV infusion to treat relapsing forms of MS to delay disease progression and prevent exacerbations; used when inadequate response or intolerance to other agents

Interferon--1a (avonex)

given by intramuscular injection to treat relapsing of MS to slow disease progression and prevent exacerbations

Interferon--1b (betaseron)

given by subcutaneous injection for the treatment of relapsing forms of MS and to prevent exacerbations

glatiramer acetate (copaxone)

given by subcutaneous injection to reduce the frequency of relapses in relapsing remitting MS

Lidocaine

has a predilection for ischemic myocardium and is the agent of choice to prevent post-myocardial infarction arrhythmias.

Tetrodotoxin

highly potent toxin that binds fast voltage-gated Na+ channels in cardiac and nerve tissues. Poisoning can result from ingesiton of poorly prepared puffer fish

-trophin

hormone

h, hr

hour

routes

how the drug is given..oral parenteral, topical

M2 G-protein receptor

i decrease heart rate and contractility of the atria (at the AV node)- essentially think of the vagus and glossophargeal nerves doing this.

alpha 2 G-protein linked sympathetic receptor

i decreases sympathetic outflow, decreases insulin release, decreases lipolysis, increases platelet agreggation, decreases aqueous humor production (sup glacuoma)

Dopamine D2 G-protein receptor

i modulates NT release, especially in the brain

iatrogenic disease

iatros-physicaian...genic-to produce...it is a disease produced by a physician or by treatment. renal toxicity with aminoglycosides, blood dyscrasias with chemotherapy

sos

if necessary

STAT

immediately

stat

immediately

allergic reaction

immune response related to prior exposure to the drug, re-exposure triggers an allergic response. Can range from mild itching to severe rash to anaphylaxis. Anaphylaxis is a life-threatening response characterized by broncho-spasm, laryngeal edema, and drop in BP

Sulfonoureas (Glyburide)

improves blood glucose levels in patients with T2DM by increasing secretion of insulin (and C-peptide therefore) from pancreatic B-cells. C-peptide is useful as a marker of endogenous Beta-cella insulin secretion.

Latangoprost (PGF) for glaucoma

increase outflow of aqueous humor. Can cause darkenign of Iris

Choliomimetric agents

increase secretions (parasympathetic + sweating although techically sympathetic- ACH) Direct agonists and indirect agonists (ACHe inhibitors)

Phenobarbital

increases GABA action (by increasing duration of Cl- channel opening) could be used for focal seziurs or generalized tonic-clonic. SE: sedation, tolerance, depedence, induction of P-450, cardiorespiratory depression. 1st-line in neonates

thyroid hormone

increases basic metabolic rate

cardiac glycoside

increases strength and force of contractions and slows heart rate (Digitalis preps)

diuretic

increases the excretion of urine (Diuril, Lasix, Osmitrol)\

diuretic

increases the excretion of urine, they also increase sodium (Diuril, Lasix, Osmitrol)

-suric

increasing excretion

Atropine

indicated for treatment of severe bradycardia as it decreases the influence of SA and AV nodes. A common side effects is increased intraocular pressure, which may precipitate acute closed-angle glaucoma.

trade/proprietary/brand name

indicated that the drug is registered and that its use is restricted to the owner of the drug. legally on record for 17 years. Having multiple trade names for a single generic drug can impair recognition and increase possibility of drug errors

Beta blockers

indidcated in angina, MI, SVT (class II antiarrthymatic), Hypertension, HF, and glaucoma (timolol) Side effects include CV adverse effects (bradycarida, AV block, and HF). seizures sedation, sleep alateraiton, dyslpidemia (metropolol) and asthma/COPD exacerbations (through beta 2 blockade)

Statins

inhibit HMG-CoA reductase. This leads to enchanced hepatic LDL receptor recycling and increased LDL clearance from circulation. Statin-induced myopathy (myalgia, elevated creatine kinase) is the most common complication of statin use

Glucocorticoids

inhibit NF-kB, supressing both B- and T-cell function and decreasing transciriptn of cytokines. Use; transplant rejection propylaxis, many autoimmune disorders, inflammation. tox: cushings.

Combination oral contraceptives (OCPs)

inhibit ovulation by decreasing synthesis of FSH and LH in the anterior pituitary. Their effects on cervical mucus and endometrium play a minor role.

COX-2 Inhibitor

inhibits cyclooxygenase (COX-2) enzyme found in joints and other areas affected by inflammation

COX-2 Inhibitor

inhibits cyclooxygenase (COX-2) enzyme found in joints and other areas affected by inflammation\

Terbinafine

inhibits fungal enzyme squalene epoxidase (prevents formation of the rgosterol synthesis Use: Dermatophytoses (especially onhcomycosis- fungal infection of finger or toe nails) Toxicity: GI upset, headaches, hepatotoxcity, taste distrubance

antigout

inhibits production of uric acid(a product of the metabolic breakdown of purine nucleotides)

antigout

inhibits production of uric acid\

Probenecid

inhibits reabsorption of uric acid in the PCT. May increase risk for uric acid calculi

HYdroxurea

inhibits ribonucleotide reductase, decreasing DNA synthesis (s- phase specific) Use: melanoma, CML, Sickle cell disease (increases HbF)

Sprinolactone

inhibits steroid binding, 17 alpha hydroxylase and steroid synthesis. Used in PCOS. May cause gynecomastia and amenorrhea.

Ketoconazole

inhibits steroid synthesis. Use: PCOS to recude the androgenic symptoms. May cause gyencomastia and amenorrhea.

platelet inhibitor

inhibits the ability of platelets to adhere to each other; similar to coagulant

platelet inhibitor

inhibits the ability of platelets to adhere to each other; similar to coagulant\

grapefruit juice

inhibits the metabolism of the drugs and raise drug level. Inhibition of the CYP3A4 continues for 3 days after drinking grapefruit...CC, caffeine, estrogen, benzodiazepines, statins, cyclosporine

serotonin nonselective reuptake inhibitor (SNRI)

inhibits the reuptake of both serotonin and norepinephrine (Effexor)

Colchicine

inhibits tubulin polymerizaiton into microtubules (cytoskeleton), thus disrupting chemotaxis and phagocytosis and can be used for acute treatment and prophylaxis of gout. Important side effects include nausea, abdominal pain, and diarrhea.

Allopurinol

inhibits xanthine oxidase Also used in lymphoma and leukemia to prevent utmor-lysis-assoicated urate nephropathy. It increaes concentrations of 6-MP and azathioprine Febuxostat works in a very similar way

Epidural

injected into the dural matter of the spinal cord

subcutaneous

injected into the fatty layer under the skin

intracardiac

injected into the heart

intra-articular

injected into the joint

intramuscular

injected into the muscle

IV

instant absorbtion since the drug is injected into bloodstream...rapid onset...cost inconvenience, irreversibility, complications

Warfarin

intefers with gamma-carboxylation of vitamin-k dependent clotting factors. Effects intrinsic pathway and monitored with PT/INR Use: chornic anticoagulation (prevetion of stroke in a-fib). Not to be used in pregnant women. SE: bleeding, teratogenic, skin/tissue necrosis (because c and S ahve shortest half-lives so initially we have a hypercoagulable state- why the heaprin bridge happens) , drug-drug interactions (C-P-450 metabolized). Reversal: Vitamin K (slow), Rapid (fresh frozen plasma)

Metonidazole

interacts with alcohol causing acetaldehyde to accumulate (like a disulfiram-like reaction when mixed with alcohol). It is often used to treated trichomonas vaginitis and BV

Dactinomycin (actinomycin d)

intercalates in DNA Use: Wilms tumor, Ewings sarcoma, rhabdomyosarcoma. Used for the childhood tumors (children ACT out) SE: myelosupression

I.U.

international unit

IC

intra cardiac

IM

intramuscular

IV

intravenous

Muscarinic antagonists for astham

ipratropium: competitively blocks muscarinic recepors, preventing bronchoconstriciton. Also used for COPD. Tiotropium is long lansting

Aspirin

irreversibly inihbits COx-1 and Cox-2 enzyme by covalanet acetylation. Platelets annot synthesize new enzyme, so effect lasts until new platelets are produced. Increased bleeding time, decreased Thomboxane A2 and Prostaglnadins. No effect on PT or aPTT Use: antipyretic (never in children, except Kayasakus), analgesic, anti-inflammatory, antiplatelet (decreased aggregation) Toxicity: gastric ulcers, tinnitus. Chronic use can lead to renal fialure, interstrial nephritis, upper GI bleed. Also Reye syndrome in children with viral infection. Overodes initially cuases hyperventilation and a respiratory alkalosis (salicyclates early) but eventually causes a mixed metabolic acidosis- repsiratory alkalosis

Isoproterenol

is a beta 1 and beta 2 adrenergic receptor agonist that causes increased myocardial contractility (beta 1) and decreased systemic vascular resistance (beta 2)

Flutamide

is a non-steroid anti-androgen that works as a competitive inhibitor of testosterone receptors. It is used in combination with long-acting gonadotropin-releasing hormone agonists for the treatment of prostate cancer Remember, prostate cancer is dependent on testosterone to grow.

Fenoldopam

is a selective dopamine-1 receptor agonist that causes arteriolar dilation and natriuresis leading to decreased systemic vascular resistance and blood pressure reduction. It is the only intravenous agent for emergent hypertensive patients that also increases renal perfusion

Anastrozole

is a selective inhibitor of aromatase, the enzyme responsible for the conversion of androgens to estrogens.

Nitroprusside

is a short-acting balanced venous and arterial vasodialtor that decreases both preload and afterload. Since things are balanced, stroke volume is maintained. Often used in hypertensive HF

Wilson's disease

is an autosomal recessive disorder characterized by toxic accumulation of copper within organ tissues (the liver, brain (basal ganglia atrophy), and eye). Absorbed copper is used to form ceruloplasmin, which normally accounts for 90-95% of circulating copper. Excess copper and ceruloplasmin are secreted into the bile and excreted in the stool (how we remove it). Wilson's disease is partly the result of inadequate excretion.

Hepatic encephalopathy

is caused by increased levels of ammonia and other neurotoxins in the circulation that lead to increased GABA and decreased excitatory NTs. It is frequently preceptiated by a stressor that alters the ammonia balance (GI bleed for example where colonic bacteria break down heme and produce increased ammonia)

highly active antiretroviral therapy (HAART) for HIV

is commonly assoicated with body fat redistribution. Subcutaneous lipoatrophy invovling the face and extrememties may occur with nucleoside reverse transcriptase inhibitors (loss from face for example) and central fat accumulation occurs witha any regimen.

Positive predictive value

is proporitonal to the prevalence of disease while negative predictive value is inversely proportional. sensitivity and specificity are not affected however.

The carboxy (end) terminal of the FC portion of IgG

is the site that binds to Fc receptors on neutrophils and macrophages for opsonization and phagocytosis.

ergotamine derivatives

is used for: Preventing or treating acute migraine headache with or without aura (flashing lights, wavy lines, dark spots). Ergotamine is an ergot derivative. It works by narrowing blood vessels in the brain, which helps to relieve migraine headaches.

Regular insulin

is used to treat DKA IV. When given subcutaneously, regular insulin works within 30 minutes, peaks in 2-4 hours, and lasts 5-8 hours.

Phentolamine

it is a reversible antagnoist of alpha receptors. So this lowers binding affinity for catecholamines. Used to treat MAO inhibtor patietns who eat tyramine contianing foods.

liver damage symptoms

jaundice, dark urine, light colored stools, N/V, malaise, abnormal discomfort, loss of appetite

arthralgia

joint pain

nephron-

kidney

anti-infective

kills and inhibits growth of bacteria

anti-infective

kills and inhibits growth of bacteria\

antifungal

kills or inhibits growth of fungi (Diflucan, Lamisil, Lotrimin, Monistat, Nizoral, Terazol)

kg

kilogram

loading dose

large initial dose to achieve steady state (plateau)

Phosphodiesterase inhibitors

lead to increased contractility (positive ionotropic effect) via increased intracellular cAMP concentration. cAMP promotes increased intracellular calcium in cardiac myocytes and is normally digested by phosphodiesterase. In vascular smooth muscle it increases cAMP causing vasodilation, a side effect (may not be approariate for hypotensive patients)

Live attenuated oral Sabin Poliovirus

leads to a stronger mucosal secretory IgA immune response in comparison to the inactivated salk vaccine. This would offer protection at the site of viral entry by inhibiting attachment to intestinal epithelial cells

AS

left ear

OS

left eye

Aspartame aminotransferase (AST) Alanine aminotransferase (ALT)

levels are normally low but rise with liver damage

Neuroleptic malignant Syndrome

life-threatening adverse reaction to antipsychotic medications with diffuse muscle rigidity, hyperthermia, autonomic instability, and altered sensorium. Dantrolene is give to reduce muscle rigidity (it blocks ryanodine receptors and prevents calcium release from SR).

antacid

neutralizes acid (Amphojel, Gelusil, Mylanta, Milk of Magnesia)

L

liter

hepato-

liver

laxative

loosens and promotes normal bowel elimination; relieves constipation (Dulcolax, Metamucil)

laxative

loosens and promotes normal bowel elimination; relieves constipation (Dulcolax, Metamucil)\

topical

lotions, trans dermal patches, ophthalmic and otic drops

Dopamine

low doses stimulate D1 receptors in the renal vasculature resulting in increased blood flow there. higher doses increasee cardiac contractility by stimulatin of beta 1 receptors, and even higher doses cause generalized vasoconstriction by an alpha 1 aderengeric effect.

Fibrates

lower triglyceride levels by activvating PPAR- alpha, which leads to decreased hepatic VLDL production and increased lipoprotein lipase activity. r

hypoglycemic

lowers blood glucose level (Diabinese, insulin)

hypoglycemic

lowers blood glucose level (Diabinese, insulin)\

lipid-lowering agent

lowers cholesterol\

antacid

neutralizes acid (Amphojel, Gelusil, Mylanta, Milk of Magnesia)\

Sirolimus (Rapamycin)

mTOR inhibitor (a growth factor); binds FKBP. Blocks T-cell actvaiton and B-cell differenation by preventing response to IL-2. Used in kidney tranplants (the kidney sirvives). Tox: anemia, thrombocytopenia, leukopenia. INsulin resitance, hyperlipidemia. synergistic with cyclosporine, also used in drug elduing stents

Volume Of Distribution

mathematical relationship betw. the blood concentration attained & the amt. of drug administered.

FDA Recall Class III

may be used in a situation in which use of a violative product is not likely to cause adverse health consequence, but has violated some FDA regulation

Laxative Use by Elderly

may become dependent

disease-modifying antirheumatic drugs (DMARDs)

may influence the course of disease progression of rheumatoid arthritis (Arava, Cuprimine, Cytoxan, Rheumatrex, Ridaura)

disease-modifying antirheumatic drugs (DMARDs)

may influence the course of disease progression of rheumatoid arthritis (Arava, Cuprimine, Cytoxan, Rheumatrex, Ridaura)\

Biotransformation

metabolism

AM, am

morning

Hemolytic disease of the newborn (erythroblastosis fetalis)

most commonly occurs due to maternal sensitization to Rh antigens during a prior pregnancy with Rh(D)+ fetus. In subsequent Rh(D)+ pregnancies, maternal anti-Rh(D) IgG antibodies cross the placenta and cause fetal hemolysis. Clinical findings include anemia, jaundice, generalized edema (hydrops fetalis), nucleated erythrocytes, and extramedullary hematopoiesis

Benztropine

muscarinic antagnoist used in Parkinson's (Park my Benz) works on the CNS

myo-

muscle

myalgia

muscle pain

G-protein linked 2nd messengers for autonomic nervous system

must know these. Qiss and Qiq till you're siq or sqs (super kinky sex) More or less, Gi inhibits and decreases whereas Gq and Gs increase

Nonselective beta antagonists (B1 = B2)

nadolol, pindolol (partial agonist), propranolol and timolol. Nonselective (beta 2) go from N to Z - the second half of the alphabet. nonselective alpha and beta antagnoissts- are carvedilol and labetalol (the have altered suffixes compared to the typical olol).

NG

naso gastic

NF

national formulary

Drugs to treat Neuropathic Pain

neuropathic pain may be due to the persistent stimulation of nerve fibers, or nerve damage in the central or peripheral nervous system. Agents used to treat this are topical agents, antidepressants, and antiepileptic's instead of opioid analgesics.

Expiration dates: DEA Sch II

no expiration

Refills: DEA Schedule II

no refills allowed

Anuria

not able to produce urine

Liver function test LFT

obtained as a baseline and periodically 3 months throughout therapy

Acute Cardiac transplant rejection

occurs a couple-few weeks folliwng transplantation and is primarily a cell mediated process. On biopsy, would see a dense mononuclear lymphocytic infiltrate. Treatment with immunosupressive drugs is meant to avoid this rejection

Cholinesterase inhbiitor poisoning

occurs from organophosphates like parthion that is often used in insectisides (think farmers). Patient would present with the irreversible inhbiition of AChE, which would cause diarrhea, urination, miosis, bronchospasm, bradycardia, excitaiton of skeletal muscle, lacrimiation, sweating, and salivation. Treat with atropine and pralidoximine (only works if given early but regenerates AChe

Majority of water reabsortion

occurs in the proximal convoluted tubule, regardless of hydration status

Iron absorption

occurs predominantly in the duodenum and proximal jejunum. Bypass of this segment of small bowel by gastrojejunostomy results in iron deficiency anemia. Malabsorption of vitamin B12, folate, fat-soluble vitamins (especially vitamin D), and calcium may also be observed following gastric bypass procedures.

AA

of each

prototype

often the first drug developed in a particular class that can be used to present other drugs

oint., ung

ointment

epi-

on

ss

one-half

oz

ounce

Nitrites (eg. amyl nitrite)

oxidizing agents that are effective in the treatment of cyanide poisoning due to the ability to cause methemoglobinemia (which rapidly binds the cyanide). Sodium thiosulfate may also be used

pH =

pKa + log (A/HA)

For acidic drug with pKa of 4, what is ionization state (is it asorbed or not) in small intestine

pKa of 4 therefore weak acid when env pH increases, ionisation increases pH around 7/8 Therefore high ionisation Little drug absorbed

For acidic drug with pKa of 4, what is ionization state (is it asorbed or not) in stomach

pKa of 4 therefore weak acid when environment pH increases, ionisation increases pH in stomach is 2 (low) Therefore low ionization/mainly uncharged Drug easily absorbed

antineoplastic

prevents the replication of neoplastic cells; used to treat tumors (Myleran, Cytoxan)

Nitrate tolerance

patients need to have a nitrate-free period every day to avoid tolerance of the drug

Barbituates

phenobarbital, pentobaribital, thiopental (for anesthesia) MOA: facilate GABA action by increasinsg duration of Cl- channel opening, thus decreased neuron firing. Use: anxiety, seizures, insomina, inducation of anesthesia (thiopental) SE: respiratory and cardiovascualr depression. CNS depression with alcohol use. Drug-drug interacitons (c-P45o). No overdose drug so supportie care

Non-selective alpha blockers

phenoxybenzmaine (irreversible for pheo) and phentolamine (reversible) - used for MAO inhibitors hypertensive crisis after eating tyramine-containing foods both could cause orthostatic hypotension and reflex tachycardia.

steady state

physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed with each dose, After about 5 half lives, steady state is achieved. Once an individual reached steady state they have consistent levels of drugs in the body that correspond to maximum therapeutic benefits. Drugs with a short half-life require more frequent dosing

Albumin

plasma protein

Abciximab

platelet glycoproteins IIb/IIIa inhibitor. IIxIII = 6

Eosinophils

play an importnat role during parasitic infection. IgG and IgE are bound to the organism and activate eosinohils via antibody-dependent cell-mediated cytotoxicity to release enzymes to destroy the parasite. They are also involved in type I hypersensitivity

Pilocarpine

potent stimulator of sweat, tears, and saliva Used for both closed angle and open angle glaucoma Constricts cilliary muscle of the eye (open angle) and pupillary sphincter (closed angle) "You cry, drool and sweat on your pilow

NDA Process: Initial Development: Pre Clinical

pre-clinical (animal) testing

RX

prescription

Cardiac tamponade

presents clincially with hypotension, tachycardia, and an elevated central venous pressure that produces JVD. Heart sounds may be muffled and pulsus paradoxus may also be present.

Digoxin toxicity

presents with cardiac arrhthmias, nonspecific Gi complaints, neuro complaints, and visua symptoms. Elevated potassium is another sing (inhibits NAK pump)

Paclitaxel

prevents anaphase with microtubule mess up (they are polymerzied) Use: ovarian and breast carcinomas SE: myelosupression, alopecia

anti-inflammatory

prevents inflammation (Advil, Motrin, Naprosyn)

antihypertensive

prevents or controls high blood pressure (Catapres, Aldomet, Lopressor)

antihypertensive

prevents or controls high blood pressure (Catapres, Aldomet, Lopressor)\

antianemic

prevents or cures anemia

antianemic

prevents or cures anemia\

anticoagulant

prevents or delays blood clotting (heparin, warfarin, Coumadin)

antianginal

prevents or relieves angina attacks\

antianginal

prevents or relieves angina(condition marked by severe pain in the chest) attacks

anticonvulsant

prevents or relieves convulsions / seizures (Tegretol, Zarontin, Dilantin)

anticonvulsant

prevents or relieves convulsions / seizures (Tegretol, Zarontin, Dilantin)\

antitussive

prevents or relieves cough (codeine, dextrometorphan)

antitussive

prevents or relieves cough (codeine, dextrometorphan)\

antidiarrheal

prevents or relieves diarrhea (Keopectate, Lomotil, Pepto-Bismol)

antidiarrheal

prevents or relieves diarrhea; inhibits peristalsis and reduces fecal volume (Keopectate, Lomotil, Pepto-Bismol)\

antiemetic

prevents or relieves nausea and vomiting (Dramamine, Marinol, Phenergan, Reglan, Tigan)

antidepressant

prevents or relieves symptoms of depression (Tofranil, Marplan, Nardil)

5-FU

pyimidine analog bioactivatede to 5F-dUMP which covalent compelxes folic acid, thus inhbiting thymdiylate synthase- decrased dTMP and thus decreased DNA synthesis Use: colon cancer, pancreatic cancer, topical for basal cell carcinoma SE: myelsupression that is not reversible with leucovorin (folinic acid)

M1 G-protein receptor

q CNS, eneteric nervous system (not that importnat)

M3 G-protein receptor

q increase exocrine gland secretion (lacrimal salivary, gastric acid), increased gut peristalsis, increased bladder contraction (pee pee time), bronchoconstriction, increased pupillary spinchter muscle contraction (miosis), ciliary muscle contraction (accomodation)

Histamine H1 G-protein receptor

q increase nasal and bronchial mucus production, increased vascular permeability, contraction of brochioles, puritis, pain.

Vasopressin V1 G-protein recepotr

q increase vascular smooth muscle contraction

QS

quantity sufficient

QS

quantity suffiecient

first-pass effect

rapid hepatic inactivation of certain oral drugs

Thioridazine

reTinal deposists

incompatibilities

reaction occurs when two parenteral drugs or solutions are mixed together, resulting in chemical deterioration of the least one of the drugs

PR

rectally

Arrhythmias

reduce heart rate

ACE inhibitors and ARBs

reduce the risk of chronic kidney disease in patients with hypertension and diabetes. ACE inhibitors raise the level of bradykinin and can cause a nonproductive cough. If can't be tolerated, replace with an ARB like Valsartan in a diabetic patient.

antipyretic

reduces fever (Tylenol, aspirin)

antipyretic

reduces fever (Tylenol, aspirin)\

decongestant

reduces nasal congestion and/or swelling (Afrin, Sudafed)

decongestant

reduces nasal congestion and/or swelling; produces vasoconstriction (Afrin, Sudafed)\

geriatic

referring to old people

Adhernce

refers to whether patients take their medications as prescribed (eg, twice daily), as well as whether they continue to take a prescribed medication

Insulin, short acting

regular insulin Used in Type I, II, GDM, DKA (IV), hyperkalemia (+glucose)

antianxiety

relieves anxiety and muscle tension (Librium, Valium)

antianxiety

relieves anxiety and muscle tension (Librium, Valium)\

antiflatulent

relieves gas and bloating in GI tract

antiflatulent

relieves gas and bloating in GI tract\

Celecoxib

reversibly inhibts CoX-2 specifically spares Cox-1, sparing the gastric mucosa. Also spares platelet function as TXA2 is depdendent on Cox-1 Use: RA, osteoarthritis Tox: increased risk fro thrombosis, also SULFA ALLERGY

Acetaminophen

reversibly inihbits COX, mostly in the CNS Use: antipyretic, analgesic, but not anti-inflammatory. Used instead of aspirin to avoid Reyes sydnroem in children with viral illness. Tox: overdose produces hepatic necrosis; acetaminophen metabolite (NAPQI) depletes glutathione and forms toxic tissue byproducts. N-acteylcysteine is antidote- regenerates glutathione.

Vasopressin V2 G-protein receptor

s Increase H20 permeability and reabsorption in collecting tubules of kidney (v2 is found in 2 kidneys) hey!

Dopamine D1 G-protien receptor

s Relaxes renal vasculature smooth muscle

Beta 2 G-protein receptor

s Vasodilation, bronchodilation (why beta 2 blockers are contraindicated in COPD and asthma), increased lipolysis, increased insulin release, decreased uterine tone, ciliary muscle relaxation, increased aqueous humor production.

Histmaine H2 G-protein receptor

s increase gastric acid secretion

Beta 1 G-protien receptor

s increases heart rate, increases contractility, increases renin release, increases lipolysis

Isoproterenol

see earlier

antitumor necrosis factor

seems to slow if not halt altogether the destruction of joints by disrupting the activity of tumor necrosis factor (TNF) (Enbrel)\

selective serotonin reuptake inhibitors (SSRIs)

selectively inhibits serotonin reuptake and results in potentiation of serotonergic neurotransmissions (Luvox, Paxilo, Prozac, Zoloft)

cross-sensitivity

sensitivity to one substance that predisposes an individual to sensitivity to other substances that are related in chemical structure

Anaphylactic Reaction

severe, life-threatening allergic reaction to a drug

-gonado

sex

Nitroprsside

short acting; increase cGMP via direct release of NO. Can cause cyanide toxicity (releases cyanide)

contraindication

situations when drug use should be avoided or alternative strongly considered. Most drugs are contraindicated in pregnancy and lactation. May be absolute (allergy) or relative.

Antiarrhythmics (Class I) (sodium channel blockers)

slow or block conduction (especially in depolarized cells). Decreases the slope of phase 0 depolarization. They are state dependent- they selectively depress tissue that is frequently depolarized- tachycardia for example

-suppression

slowing of function

antitumor necrosis factor

slows or stop the destruction of joints by disrupting the activity of tumor necrosis factor ( protein that can cause the destruction of tumors) (TNF) (Enbrel)

-malacia

softening

Adalimumab, infliximab

soluble TNF-alpha inhibitors Use: IBD, RA, ankylosing spoindylitis, psoriasis. etarnercept is a decoy TNF-alpha receptor ALWAYS CHECK FOR TB FIRST

sol

solution

Octreotide

somatostatin analog can be used for acromegly, also carcinoid syndrome, gastrnoma, esophageal varcies

Epinephrine

stimulates beta greater than alpha at low doses and is more specific for Beta 1. At high doses, alpha effects predominate. significantly stronger at Beta 2 then NE (why epi is used for anaphlactic shock, not NE) clinical use is Anaphylaixs (beta 2 and hypotension), asthma (beta 2), open-angle (only) glaucoma

pharmacokinetics

study of drug transit (or activity) after administration (What the body does to the drug)

pharmacodynamics

study of the drug mechanisms that produce biochemical or physiologic changes in the body (what the drug does to the body)

SQ

sub-cutaneous

SL

sub-lingual

Mu opioid analgesics

such as morphine can cause contraction of smooth muscle cells in the sphicnter of Oddi. leads to increased pressures in the common bile duct and gall bladder.

Acute Pain

sudden or brief pain, can also mean 'severe'

Pharmacy technicians

supply medicines to patients, whether on prescription or over the counter

SUPP

suppositiory

supp.

suppository

Azoles

supress the synthesis of ergosterol (e), an essential component of the fungal cell membrane. They also inhibit the activity of the CP450 and thus drug-drug interactions.

gastric acid-pump inhibitor

supresses gastric acid secretions; also used for gastroesophageal reflux disease (GERD) (Aciphex, Prevacid, Prilosec, Protonix)

gastric acid-pump inhibitor

supresses gastric acid secretions; also used for gastroesophageal reflux disease (GERD) (Aciphex, Prevacid, Prilosec, Protonix)\

corticosteroid

supresses inflammation and modifies normal immune response

corticosteroid

supresses inflammation and modifies normal immune response\

liquids

syrups, elixirs, suspensions, powers, capsules, tablets

Thrombolytics

tPA, rPA, streptokinase, tenecteplase (TNK-tPA) convert plasminogen to plasmin, which cleaves thrombin and fibrin clots. Use: early MI, ischemic stroke, direct thrombolytics for extreme, severe PE SE: bleeding (a lot), contraindicated in patients with active bleeding, including intracranial bleeds. Toxicity treatment: aminocaproic acid. Also fresh forzen plasma and cryoprecitipiate cna be used to correrect for factor deficiencies

TAB

tablet

tab.

tablet

Filtration

takes place in kidney

Antidepressants

targeting the fact that in depression, NE, serotonin, and dopamine are depressed. SSRIs, SNRIs, TCAs, MAO inhibitors, atypicals (buproprion, trazodone, and Mirtazapine

Natalizumab

targets alpha4 integrin Use: MS, chrons disease increases risk for PML in patients with JC virus

Eculizumab

targets complement protein C5 Use: PNH

TO

telephone order

plasma drug levels

the amount of drug present in the blood can predict whether or not the drug is going to be therapeutic or toxic

pharmocognosy

the branch of knowledge concerned with medicinal drugs obtained from plants or other natural sources

vasoconstriction

the constriction of blood vessels, which increases blood pressure

TDS

three times a day

For weak bases, when pH of environment increases ...

the ionisation decreases

For weak acids, when pH of environment increases ...

the ionisation increases

duration of action

the length of time that a drug concentration in the blood or tissue is sufficient to elicit a therapeutic response

Drug efficacy

the maximum response achievable from an applied or dosed agent, for instance, a small molecule drug

Posology

the part of medicine concerned with dosage

Route of administration

the path by which a drug, fluid, poison, or other substance is taken into the body

Diffusion

the process to get even distribution of fluids

Bioavailability

the proportion of a drug or other substance that enters the circulation when introduced into the body and so is able to have an active effect

dosage

the quantity or concentration of drug to be given. Safe dosage is the appropriate amount of the drug taken to ones age and size

pharmacology

the science or study of drug and interactions with living things

Mealtime insulin analogs

the short -acting ones (lispro, aspart, and glulisine) have rapid onset of action

pharmacogenics

the study of how genes affect a person's response to drugs

pharmacodynamics

the study of what the drug does to the body

pharmacokinetics

the study of what the drug does to the body AMDE

myelosuppression

the suppression of white blood cell and platelet production from the bone marrow

t.i.d. (ter in die)

three times a day

peak effect

the time it takes for a drug to reach maximum therapeutic response in the body ( the time the drug is doing the best it can)

Half-life effect

the time it takes for a substance (drug, radioactive nuclide, or other) to lose one-half of its pharmacologic, physiologic, or radiological activity (Half of its concentration eliminated)

onset of action

the time it takes for the drug to elicit a therapeutic response( time the drug starts working)

antidepressants

these can also be used for the treatment of neuropathic pain. Tricyclic antidepressants cause inhibition by blocking reuptake of norepinephrine and serotonin. These are also used to treat mood disorders and divided into several classes.

The role of ACE inhibitors and angiotensin II blockers

these drugs (aka lisinopril) in combination with glycemic control help reduce the progression of diabetic neuropathy in patients with proteinuria.

Long-acting sulfonylureas

these work by increasing insulin secretion indepdendent of glucose concentraiton. The long-acting ones (glyburide, and glimepiride) have increased risk of hypoglycemia, especially in the elderly.

Sarcoidosis

think African Amercian female with hilar adenopathy, pulmonary infiltrates, and non-caseating lung granulomas. Granuloma formation is a manifestation of cell-mediated immunity driven by Th1 CD4+ helper T cells through IL-2 and IFN-gamma which stimulates more T cell production and macrophage activation respsectively

Barbituates (intravenous anesthetics)

thiopental- high potency, high lipid solubility, rapid entry into brain. Used for induction of anesthesia. Effect terminatetd by reapid redistribution into tissue (skeletal muscle) and fat. Decreases cerebral blood flow

Mefloquine

this along with chloroquine can be used against infection with Plasmodium (malaria)

nursing consideration

this relates the nursing process to the medication

TID

three a day

half life

time it takes for one half of the original amount of a drug in the body to be removed by 50 % . After about 5 half lives the most drugs are considered to be removed from the body 97% of the drug is removed

qt interval

time it takes for the ventricles of the heart to contract and relax. Cardiotoxic drugs will length the qt interval and lead to life threatening arrhythmia....antidysrhythmics, antibiotics, anticancer drugs, anti-psychotics, ACE inhibitors, calcium channel blockers (CCB)

X__D

times __ days

X___D

times ___ days

tinct.

tincture

expectorate

to cough up or spit

capsules

to form a capsule, the drug is contained in a cylindrically shaped shell

Distribution

to the movement of a drug to and from the blood and various tissues of the body (for example, fat, muscle, and brain tissue) and the relative proportions of drug in the tissues

glott-

tongue

bone resorption inhibitor

treat and prevent osteoporosis

bone resorption inhibitor

treat and prevent osteoporosis\

immunosuppressant

treat and prevent rejection of transplanted organs

immunosuppressant

treat and prevent rejection of transplanted organs\

-tussive

treat cough

otic preparations

treat ear conditions

otic preparations

treat ear conditions\

ophthalmic anti-infective

treat eye infections

ophthalmic anti-infective

treat eye infections\

hormone replacement (HRT)

treat vasomotor symptoms of menopause

hormone replacement (HRT)

treat vasomotor symptoms of menopause\

Primary hypertension

treat with thiazide diuretics, ACE inhibitors, ARBs, dihydropyridine calcium channel blockers

drugs to treat headaches/migraines

treatment of headaches includes acute (abortive) therapy, which involves treating the current headache pain and preventative therapy.

Statins

treatment with statins causes hepatocytes to increase their LDL receptor density, leading to increased uptake of circulating LDL

Rx

treatment; prescription

electrolyte replacement

treats or prevents electrolyte depletion\

electrolyte replacement

treats or prevents electrolyte from decreasing

neoplasm-

tumor

BID

twice a day

b.i.d. (bis in die)

twice a day

bid

twice a day

oral

two barriers to absorption, GI tract epithelial and capillary walls ...easy convenient....variability, inactivation, patient must be able to swallow, local irritation

side effects

unavoidable secondary drug effect produced at therapeutic doses..drowsiness with antihistamines..predictable and intensity is dose dependent

idiosyncratic effect

uncommon drug response resulting from a genetic predisposition. Occurs the first time a drug is given

U

unit

USP

united states pharmacopoeia

Refills: Legend Drugs

up to 12 months worth

Desmopressin

use: central diabetes insipidus

Succimer

used for chelation in kids with lead poisoining (sux to be a kid who eats lead)

Physostigmine

used for gluacoma and atropine overdose Physostigmine "phyxes" atropine overdose

ACE Inhibitor, Angiotensin

used for hypertension

Dimercarpol, EDTA

used for lead poisoning. Also for Arsenic poisoning.

HRT

used for relief of menopausal symptoms. Unopposed increases risk of endometrial cnacer so progesterone is added. Possible increased cards risk

antiparkinsonian

used for relieving pain of major symptoms of Parkinson disease (L-Dopamine, Requip, Symmetrel, Tasar)

Propofol

used for sedation in ICU, rapid aneshtesia induction, short procedures. Less post-operative nausea than thiopental. Potentiates GABA.

leukotriene receptor antagonist blocker

used for treatment and management of asthma (Singulair, Zyflo, Accolate)

leukotriene receptor antagonist blocker

used for treatment and management of asthma (Singulair, Zyflo, Accolate)\

antimanic

used for treatment of manic episode of manic-depressive and bipolar disorder (lithium)

Niacin

used in the treatment of hyperlipidemia. It increases HDL levels and decreases TGs and LDL. It can cause cutaneous flushing, which is mediated by prostaglandins and can be diminshed with pre-treatment with aspirin.

antiulcer

used in treatment of active duodenal ulcer and for pathological hypersecretory; controls stomach acid (Axid, Pepcid, Tagamet, Zantac)\

antiulcer

used in treatment of active ulcer and for pathological hypersecretory; controls stomach acid (Axid, Pepcid, Tagamet, Zantac)

antituberculosis

used in treatment of tuberculosis; inhibits growth of mycobacteria (INH, Myambutal, Mycobutin, Priftin, PZA, Rifadin, Streptomycin)

antituberculosis

used in treatment of tuberculosis; inhibits growth of mycobacteria (INH, Myambutal, Mycobutin, Priftin, PZA, Rifadin, Streptomycin)\

FDA Medical Device Safety Alert

used only for medical apparatus equipment. this is when a medical device may present an unreasonable risk of substantial harm. in some cases, these situation also are considered recalls.

Neostigmine

used priamarily for post-operative and nuerogenic ileus and urinary retention, myasthenia gravis, and reverseal of the NMJ blockade (post-operative). It increases ACh as an indirect agonist (anticholinesterase) and does not penetrate the CNS Neo = No CNS

emetic

used to induce vomiting (Apomorphine HCl, Ipecac syrup)

emetic

used to induce vomiting (Apomorphine HCl, Ipecac syrup)\

antihyperlipidemic

used to lower abnormally high blood levels of fatty substances (lipids). (Lipitor, Lopid, Mevacor, Nicobid, Zocor)\

antihyperlipidemic

used to lower abnormally high chlosterol levels of fatty substances (lipids). (Lipitor, Lopid, Mevacor, Nicobid, Zocor)

antiretroviral

used to manage HIV infections

antiretroviral

used to manage HIV infections\

antidiabetic

used to manage diabetes

antidiabetic

used to manage diabetes\

smoking deterrent

used to manage nicotine withdrawl

weight control agent

used to manage obesity

antispasmodic

used to relieve/control spasm of involuntary muscle

anti-impotence

used to treat erectile dysfunction

anti-impotence

used to treat erectile dysfunction\

antipsychotic

used to treat psychotic disorders

antipsychotic

used to treat psychotic disorders\

Rituximab

used to treat the vasculitities

anthelmintics

used to treat worm infections

anthelmintics

used to treat worm infections\

5-HT3 receptor antagonists (eg. ondansetron)

useful for the treatment of visceral nausea due to GI insults, like gastroenteritis, chemo, and general anesthesia. Antihistamines and anticholinergics are useful for vestibular nausea. Dopamine antagonists are useful for migraine nausea.

sometimes, -one

usually Glucocorticoids & Corticosteroid Inhibitors

Chronic Granulomatous disease

usually due to X-linked mutation in NADPH oxidase. Deficiency results in an inability to form the oxidative burst in neutorphils results in infection with Catalase positive organisms Dx can occur by either ntiroblue tetrazolium test negativity or dihydrorhodamine flow cytometry

PV

vaginally

-phleb

vein

VO

verbal order

Sedatives-hypnotics

versed, valium, ativan

Nitrates

via conversion to NO activate guanylate cyclase and increase intracellular levels of cGMP, which leads to decreased activity of myosin light chain kinase (less calcium), thus leading to mysoin light chain dephosphorylation, resulting in vascular smooth muscle relaxation. Often used during a hypertensive crisis.

ag

water

mechanism of action (MOA)

way that a drug produces a therapeutic effect. There are many different ways that a drug work

additive effect

when 2 drugs with similar actions are giving together and allows a more therapeutic effect with fewer side effects due to smaller doses of each drug. opioid & non-opioid, anti hypertensive with diuretic

interactions

when the action of one drug is affected by the action of another drug, As number of drugs taken at one time increase, the risk of interaction also increase

therapeutic index/range

when the amount of the drug in the plasma is above the minimum effective concentration (MEC) and below the toxic concentration. Some drugs have a narrow therapeutic range like lithium

- c

with

C

with

c

with

s

without

Anti-HBc and anti-HBs

without detection of viral antigens would indicate recovery from acute hepatitis B infection (if it was just vaccination, patient would only have anti-HBs). Chronic hepatitis B would be indicated by persistnet levels of HBsAg and HBV DNA in the serum

Scopolamine

works at CNS to prevent motion sickness as a muscarinic antagonist

FDA Recall Class I

would be used in a case where there is a probability that the use of or exposure to a violative product will cause serious adverse health consequences or death

Phenytoin

zero-order kinetics (PEA) increases Na+ channel inactivation Use: first-line for tonic-clonic seizures, but may also be used in partial simple and complex seizures SE: nystagmus, diploplia, gingival hyperplasia, hirsutism, peripheral neuropathy, teratgenesis, SLE-like syndrome, induction of cytochrome P-450 , megaloblastic anemia. Steven-Johnsons