Pharmacology Test 2 study guide:

Finally the test two study guide is here. The list has information the was given to us as well as supplementary info that I think is important. There are drugs on this list that have more information than others and that is in concurrence with how important or complex that drug or concept is and hopefully how important it is. This list may have errors so please comment with any additions or subtractions that you see, and I will edit the post as soon as I get a chance. Thank you so much for reading and happy studying!

-Peter

ACE Inhibitor

  • Angiotensin converting enzyme inhibitors
    • stops RAAS system stop hypertension
    • step 1 for HTN meds
    • African population tend to respond poorly to ACE inhibitors

adenosine (Adenocard)

      • slows AV node conduction
  • for PSVT Paroxysmal supra ventricular tachycardia
    • rate of delivery is over 3 seconds by an MD, Very unique

Alpha blocker

  • Block the Alpha receptors which cause vessels to dilate
    • Lower BP

alprazolam (Xanax)

  • Anti anxiety
    • schedule IV, pregnancy class D
    • S/E: Dizzy, Lethargy, Drowsiness, CNS depression
    • grapefruit increases increases effects and the measurable levels of the drug

amiodarone (Cordarone)

  • Group III K channel blockers: delay repolarization
    • delays ventricular repol at qt
    • prolongs action potential
    • increases effective refractory period
  • Pulmonary toxicity
  • grapefruit interaction
  • Side effects: thyroid issues, blue grey skin,
  • D/D interactions: increase effect Digoxin, anticoags, statins, dilantin
  • life threatening dysrhythmias

Angiotensin Receptor Blocker

  • for HTN
  • blocks angiotensin II receptor from binding and causing vasoconstriction
  • ex.
    • Losartan (Cozaar)
      • Actions – more specific than ACE

Antacids

Antacids that can be bought over the counter (the goal is to bring pH of the stomach to about 3.5): Tums, Caltrate, OsCal, Viactiv(not w/ coumadin), Citracal (not w/ KD)

  • Action: increase stomach pH
  • indications: Peptic ulcer, GERD, hernia
  • ADME:
    • onset: 20-40 min (give 1-3hr before meal + night)
    • not meant to absorb, just buffer the acid
    • excreted in the feces
  • reduces Absorption of other drugs (chelation) due to the raise in stomach pH
  • S/E: constipation, bone deg, increased acid secretion, Kidney failure, Diarrhea
    • increased Ca, K and NA, decreased Mg
    • Kidney failure in chronic use

Antibiotics

  • used to treat H.pylori with bismuth and proton pump inhibitors
    • lasts for 2, and then the Antibiotics and bismuth drop off and the PPI is prescribed for 4 more weeks, about 90% of people are recovered after this treatment.
    • antibiotic- induced Diarrhea for the elimination of C. diff with the antibiotic fidaxomicin (Dificid)

antidysrhythmic drugs

Antidysrhythmic drug classes or group (listen to heart for 1 min)

  • I – quck Na channel blockers (broken up into three classes, but do not need to know that for the test
    • Ia – quinidine
      • procainamide (more side effects)
    • Ib – lidocaine
    • Ic – flecainide  
  • II – Beta Blockers
    • Propanolol
    • metoprolol
  • III – K channel blockers
    • Amiodarone
  • IV – Ca channel blockers
    • Verapamil
    • Dilitiazem
  • V – variable mechanism
    • Adenosine
    • Digoxin
    • Magnesium sulfate

Antiemetics

  • Action: Block CTZ (chemoreceptor trigger zone)
    • relieve nausea and vomiting
  • Anticholinergic: Scopolamine (Transderm-Scop)
    • for motion sickness
    • Side effects: Blurred vision, dry mouth and CNS depression
  • Antihistamines
    • Diphenhydramine (Benadryl)
    • Dimenhydrinate (Dramamine)
      • H1 blocker (antihistamine), CNS depression
  • Phenothiazine:
    • Prochlorperazine (compazine)
      • similar to atropine
  • Dopamine receptor blocker
    • Metoclopramide (Reglan)
      • Drousie, extrapyramidal effects, Diarrhea
  • Cannabinoid
    • Dronabinol (Marinol)
      • Made from THC

Anti-inflammatory

  • NSAID’s
  • Steriods
  • C-reactive protein levels reflect inflammation
    • high levels associated w/ increased risk of CV problems

Antiseasickness pills

Antiemetics will help, but not all.

    • Action: Block CTZ (chemoreceptor trigger zone)
      • relieve nausea and vomiting
  • Anticholinergic: Scopolamine (Transderm-Scop)
  • for motion sickness
  • Side effects: Blurred vision, dry mouth and CNS depression
  • Antihistamines
    • Diphenhydramine (Benadryl)
    • Dimenhydrinate (Dramamine)
      • H1 blocker (antihistamine), CNS depression

Atorvastatin (Lipitor)

  • Class: HMG-CoA reductase inhibitors
    • Action:block the synthesis of cholesterol
      • inhibits HMG-CoA reductase: so the pathway for cholesterol synthesis is blocked.
    • Indications: Hypercholesterolaemia, Coronary heart disease, Stroke, MI and chest pain
    • S/E: Rhabdomyolysis (ask about muscle pain and tell the patient to report any pain or weakness), Angioneurotic edema
    • stronger than simvastatin, not as strong and Rosuvastatin

Atropine

  • Anticholinergic/antiarrhythmic
    • Action: blocks vagal stimulation, which increases (HR) SNS
      • blocks Acetylcholine at prostaglandin sites
      • Tachy arrhythmias, Pulmonary edema, physostigmine is the antidote for an OD
      • side effects: red as a beet, mad as a hatter, hot as a hare,

Benzodiazepine drugs

    • for insomnia, anxiety, seizures, alcohol withdrawals
  • for acute use not chronic (does not cure Dx, can develop tolerance and dependence)
  • 14 days tops
      • schedule IV (most)
      • may be related
      • patho: increases the effect of GABA, calming, sedative
          • GABA receptors are dense in the limbic system, which messes with your emotions
  • abnormal non-REM sleep
        • BZ1 receptor: cerebellum: controls anxiety
        • BZ2 receptor: basal ganglia, and hippocampus: MM relaxation
      • side effects and interactions: Smoking decreases effectiveness, parental rout can cause cardiovascular issues and must adhere strictly to the rate, hypotension depression of RR(with IV), and CNS, Pregnancy risks.
  • IV, give slowly, needs to be monitored
      • make resp issues worse
    • will not cure, or meant to cure the symptoms
    • used for conscious sedation (colonoscopy)
    • Withdrawal: starts in 1 to 3 days and peaks in 1 to 2 weeks (depends if short or long acting drug)
      • weight loss, anxiety, weakness, insomnia, and tremors
    • ex: diazepam (Valium),
      • used for: Calms a person down so they don’t puke as much before chemo, alcohol withdrawal
      • the metabolites can collect over time and cause CNS depression
        • Resp. ↓ and hypotension
      • when given IV the vessel gets irritated  
        • burns in IV so dilute or slow down the rate of admin
      • #1 drug in the US
    • ex: lorazepam (Ativan)
      • similar to diazepam
      • for status epilepticus
      • dosing too fast can lead to bradycardia, RR depression, and apnea about 2 mg/min

Beta blockers

  • reduces heart rate and force of contraction and therefore O2 demand
  • long term only
  • makes vasospastic angina worse (prinzmetal)
  • Non-selective – decrease Cardiac contractility, drops bp and renin release
    • HTN, tachycardia, and angina
  • Some are more lipid soluble and more water soluble
  • Education – don’t change the regimen
    • OTC cold meds with pseudoephedrine/ phenyleprine
    • HR <45 don’t give
    • orthostatic hypotension
  • don’t stop the regime or the opposite effects happen, HTN, rapid HR

Bile acid sequestrants

  • Colesevelam (Welchol)
    • binds bile acid so it cannot reabsorb
    • does not decrease vitamin absorption and not many other meds
    • Not absorbed
    • for hyperlipidemia and high LDL
    • take with lots of fluids
  • cholestyramine (Questran)
    • Binds bile so it cannot be reabsorbed
    • used with statins
    • take with lots of fluids

Bismuth subsalicylate (Pepto-Bismol)

  • Antidiarrheal
    • promotes absorption in the intestines to decrease diarrhea  
    • bismuth is not absorbed, subsalicylate is
    • S/E constipation, grey stool,
    • OTC
    • if taken with ASA increases toxicity risk

Bulk-laxatives

psyllium (metamucil)

  • encreases stool size and softens by absorbing water, this increases the size of the bolus and pushes against the wall of the intestine to stimulate peristalsis
  • takes 12hr -3 days work
  • excreted in stool
  • NEED fluid for it to work!

Calcium carbonate (TUMS)

  • Action: increase stomach pH
  • indications: Peptic ulcer, GERD, hernia
  • ADME:
    • onset: 20-40 min (give 1-3hr before meal + night)
    • not meant to absorb, just buffer the acid
    • excreted in the feces
  • reduces Absorption of other drugs (chelation) due to the raise in stomach pH
  • S/E: constipation, bone deg, increased acid secretion, Kidney failure, Diarrhea
    • increased Ca, K and NA, decreased Mg
    • Kidney failure in chronic use

CCBs

  • Diltiazem (Cardizem)
  • Verapamil (Calan)
  • Calcium channel blockers
    • used in stable vasospastic angina, Arrhythmias, HTN
    • Slows HR

Cimetidine (Tagamet)

  • Peptic ulcer Drug
  • Acid-Neutralizing Drugs
  • H2 receptor blocker

digoxin

– positive inotropic, negative chronotrope, neg dromotrope

  • increased cardiac contractility
  • decreased conduction
  • indications: CHF, AFIB
  • use loading doses
  • SE: bradycardia, av block, anorexia, vision issues, green- yellow tint, halo around lights, gynecomastia with long term use.

dopamine (Intropin)

  • catecholamine (sympathomimetic)
    • increase BP, CO, vasoconstriction (B1, A2)
    • Very toxic to tissues
    • need large bore IV
    • For Cardiogenic shock primarily and vasoconstriction (neurogenic shock)

epinephrine

  • catecholamine (sympathomimetic)
  • Bronchodilation, vasoconstriction
  • A1, vaso constriction
  • Beta1, increase BP
  • can have a paradoxical bronchospasm

Eszopiclone (Lunesta)

  • Benzo-like drug
    • for sleep only, not anxiety
    • for increasing the duration of sleep
    • S/E sleepwalking, driving and such
      • Bitter after taste

Flumazenil

  • Benzo antagonist
    • no effect on a person not on a benzodiazepine
    • antidote for benzo OD or excessive effect
    • short half life so it is given through a drip or multiple IVP
    • S/E: hypotension, decreased respers, and cardiac arrest

H2 Blockers

  • Cimetidine (tagamet)
  • ranitidine (Zantac) fewer side effects and strogerew
    • Better value to prevent ulcer than PPI
    • Action: Lowers H2 secretion by stopping histamine from stimulating H2 receptors
    • Prevents PUD, acid reflux, hypersecretion

IV fluids

Lactulose

  • Osmotic Laxatives
  • and milk of magnesia
    • sugar, and salt that don’t absorb well and then attract water to induce peristalsis.
    • ↓serum Ammonia in people with chronic liver disease
    • works in 1-3 days and not much is absorbed into the body

Lidocaine (Xylocaine)

  • Group IB Na channel blockers
    • ↓ depol of mm contraction (decreases the time of action potential)
      • monitor on EKG
    • works first on the tissues with the issues
    • for Ventricular dysrhythmias acutely  
    • narrow therapeutic range
      • the maximum dose is 3mg/kg
    • Side effects – CARDIAC ARREST, confusion, tremors, twitching, blurry vision, tinnitus, dizziness, fainting, Bradycardia
    • D/D interactions with propranolol and cimetidine increase the drug levels

Lovastatin (Mevacor)

  • HMG-CoA reductase inhibitors
  • Stops the pathway for the synthesis of cholesterol
    • for hyperlipidemia when diet is not enough
    • Side effects: MYALGIA, can lead to mm damage, Kidney injury
      • more risky when taken w/ niacin or gemfibrozil
    • Grapefruit interaction, increase the level of the med

Melatonin

  • remelton (Rozerem)
    • activates melatonin receptors
    • hypnotic, for falling asleep
    • effect in 30mins, ok for chronic use
    • no dependence symptoms when stopped
    • safe for long term use

Metoclopramide ( Reglan)

Dopamine receptor blocker

  • gastric stimulant
    • Drousie, extrapyramidal effects, Diarrhea
    • S/E: Gynecomastia, bone marrow suppression

Misoprostol (Cytotec)

  • Prostaglandin
    • cytoprotective agent
    • PG E1 analog – ↓Acid secretion, ↑ Bicarb (HCO3) and mucus secretion
    • Category X, miscarriage
    • Prevents NSAID ulcers

Mylanta or Maalox liquids

  • Aluminum and magnesium antacid
    • neutralizes acid in the stomach increasing pH
    • may affect absorption of some drugs and foods

Narcan

  • Opiate Antagonist
    • Antidote for opiates
      • reverses the CNS and Respiratory effects of opioids
    • S/E V. fib

Niacin

  • nicotinic agent, lipid lowering agent
    • coenzymes for lipid metabolism
    • increased risk of myopathy with Statins
    • Flushing occurs
    • Vitamin B 3

Nitrates

Nitroglycerin SL, ointment, patch (NTG)

  • Organic Nitrate Vasodilators
    • nitroglycerin
      • both short and long term
      • vasodilates peripheral and coronary arteries
        • does not dilate the atherosclerotic vessels (so the elderly may not respond well)
        • Hypotension Fall risk
        • will get a headache and that’s OK
        • taken sublingual(minutes), ointment (half hour to hour and can cause tolerance)
      • wear gloves when applying the patch to avoid headache
  • Use for chest pain emergency
      • one SL wait 5mins
      • if after second dose pain is still happening call 911
      • take no more than 3 doses
    • Capsules
      • sustained release
    • Ointment
      • apply to hairless chest wall and cover with plastic
    • transdermal patch
      • don’t soak in water
  • rotate placement of patch
  • 10-12 hr time w/out patch
    • D/D interactions: any hypertension meds
      • nicotine
      • Phosphodiesterase
    • Light and heat will break down the drug and make it ineffective
  • Others for chronic angina
    • Beta blockers
      • reduces heart rate and force of contraction and therefore O2 demand
      • long term only
      • makes vasospastic angina worse (prinzmetal)
    • Calcium channel blockers
      • used in stable vasospastic angina

NSAIDs

  • Non steroidal anti inflammatory
    • Ibuprofen, ASA, acetaminophen
    • can cause ulcers
      • misoprostol and sucralfate can prevent these ulcers

Omega 3 fatty acids

    • fish oil
    • RX is Lovaza
    • not complete evidence in: dementia, Diabetes

Omeprasole (Prilosec)

  • Proton pump inhibitor
  • better at repairing ulcers than H2 blocker
  • Blocks acid secretion
    • Blocks ATPase at the parietal cells that would produce H2
    • treats: esophagitis from GERD, Duodenal ulcer, long term HTN
    • quick onset, 2h to peak, and ends effectiveness at 3-4 days
    • Side effects are: Heartburn, weakness, dizziness, C.diff risk increases, also cannot absorb Ca as efficiently
  • Ulcers can heal in a matter of weeks

Ondansteron (Zofran)

  • Block serotonin 5 HT3 receptors, antiemetic
    • D-D interaction with apomorphine causing hypotension
    • monitor EKG in patients with hypoK and Mg, HF, brady arrhythmias
    • can be hepatotoxic over 8mg for day  

Osmotic laxatives

  • lactulose and milk of magnesia
    • sugar, and salt that don’t absorb well and then attract water to induce peristalsis.
    • ↓serum Ammonia in people with chronic liver disease
    • works in 1-3 days and not much is absorbed into the body
  • polyethylene glycol (Golytely) (Glycerin sup in children)
    • draws water into intestine (sugar, salt, and PEG)
    • Cleansing before colonoscopy
    • (Other) metoclopramide (Reglan)
  • ↑ ACH, stim PSNS
  • ↑secretions, and motility
  • for GERD, risk of ileus, and to eliminate barium
  • Contra indicated in patient with intestinal blockage

Oxygen

Pancreatic enzymes (Prancrelipase)

    • ind: Pancreas insufficiency (pancreatitis, cystic fibrosis, Pancreatectomy)
    • Act: increased digestion in GI (enzymatic)
    • Enteric coated
    • S/E all abdominal, Fibrosing
    • hold if NPO, give before meals (dose based on calories)

Phenobarbital

    • Barbiturate
    • patho: increases the effect of GABA, calming, sedative
    • used in addition to anesthesia
    • for insomnia, seizures, anxiety (acutely)
  • develop tolerance to the therapeutic effect, but not to the side effects
  • liver makes more enzymes to break down the drug, and lowers the therapeutic half life.
    • used to treat neonatal kiddos to use this increased metabolic effect w/ hyperbilirubinemia.
  • S/E: ↓ CNS, cardiovascular function, and RR.
    • hangover, porphyria (werewolf?), suicide
  • withdrawal: seizures (if they have epilepsy), anorexia, weakness, chills, poor sleep
    • This is called abstinence syndrome

Phenothiazine antiemetics

  • Prochlorperazine (compazine)
    • antiemetic
    • management of nausea and vom.
    • depresses the CTZ, changes the effect of dopamine  
    • S/E: Neuroleptic malignant syndrome, and med leads to Reye’s syndrome in kids younger than 16
      • dry eyes and mouth, pink or reddish brown urine, agranulocytosis
  • similar to atropine

Phenytoin (Dylantin)

  • For tonic clonic seizures
    • blocks Na channels selectively
    • take often (tid)
    • low therapeutic index
      • half life is variable even in the same patient: 8-60 hr
    • S/E: gingival hyperplasia, CV effects, cognition issues, steven johnson syndrome and toxic epidermal necrolysis (like being burned inside out)
    • screws up Vitamins: deficiencies Folic acid, D and k

Pravastatin (Pravachol)

  • HMG-CoA reductase inhibitor, lipid lowering agent
    • Blocks synthesis of cholesterol
    • additive med for the prevention of CV disease in people that already have CHD
    • S/E: Rhabdomyolysis,
    • least impactful to most impactful
      • Lova-, Prava-, Simva-, Atorva-, Rosuva-
      • rosuvastatin newest, strongest, most side effects
      • HDL changes start at simvastatin

Promethazine (Phenergan)

  • Antiemetic
    • CTZ depression,  changes the effect of dopamine
    • S/E: agranulocytosis, neuroleptic malignant syndrome
      • dry eyes and mouth, blurry vision, and constipation

Propranolol

  • propranolol(only one that is not beta 1 selective), acebutolol, esmolol, sotalol
    • Decreases contractility, automaticity in SA, and slows conduction
    • cardioprotective for post MI and HF? this is now uncertain, and may not be true
    • slows conduction, HR, renin, BP,
    • increases cardiac output

Proton Pump Inhibitors (PPIs)

omeprazole (Prilosec) -prazole

  • better at repairing ulcers than H2 blocker
  • Blocks acid secretion
    • Blocks ATPase at the parietal cells that would produce H2
    • treats: esophagitis from GERD, Duodenal ulcer, long term HTN
    • quick onset, 2h to peak, and ends effectiveness at 3-4 days
    • Side effects are: Heartburn, weakness, dizziness, C.diff risk increases, also cannot absorb Ca as efficiently
  • Ulcers can heal in a matter of weeks

Ramelteon (Rozerem)

  • Hypnotic
    • melatonin agonist (activates receptors)
    • for insomnia, works in 30mins
    • more selective and effective than supplement of melatonin
    • D/D interactions: Fluvoxamine, Liver Dx’s, and alcohol
    • S/E: basically getting too sleepy, also amenorrhea

Ranitidine (Zantac)

ranitidine (Zantac) fewer side effects and strogerew

  • H2 receptor blocker
  • Better value to prevent ulcer than PPI
  • Action: Lowers H2 secretion by stopping histamine from stimulating H2 receptors
  • Prevents PUD, acid reflux, hypersecretion

Rosuvastatin (Crestor)

  • Strongest Statin
    • this means that it also has the most severe side effects
    • HMG-CoA reductase inhibitors

Sildenafil (Viagra)

    • erectile dysfunction and vasodilation
      • can treat pulmonary artery HTN
  • contraindicated use with Nitrates (nitroglycerin)
  • causes hypotension
    • S/E: MI, hepatic toxicity

Sodium Nitroprusside (Nipride)

  • vasodilation
    • breaks down into Nitrous oxide

Statins

  • HMG-CoA reductase inhibitors
  • Not all statins are alike
    • least impactful to most impactful
      • Lova-, Prava-, Simva-, Atorva-, Rosuva-
      • rosuvastatin newest, strongest, most side effects
      • HDL changes start at simvastatin

Stimulant laxatives

bisacodyl (Dulcolax)

  • stimulate peristalsis by affecting the muscle and mucus secreting cells
  • works in 6-8hr
  • can cause fluid loss (watery discharge), cramping, and dependence

Stool softeners

  • Docusate sodium
    • absorbent, water is pulled into fecal matter
    • causes the retention of water and electrolytes not letting them be absorbed into the body
    • takes 12 hours to 3 days

Sucralfate (Carafate)

  • anti ulceral, GI protectant
  • Protects ulcer by forming a barrier with the ulcer cells from acid in the stomach.
  • For PUD, and protect other ulcers from forming. (NSAID’s)

Tetanus

  • Caused muscle spasms including high HR and HTN
    • vaccination is Tdap

Zaleplon (Sonata)

  • Benzo-like drug
    • for sleep only, not anxiety
    • for falling asleep
    • S/E: sleepwalking, driving and such
    • rebound insomnia after tolerance is built over a time of longer than a week
    • Motor Paralysis “locked in”

Zolpidem (Ambien)

  • Benzo-like drug
    • for sleep only, not anxiety
    • for falling asleep and asleep and staying asleep
    • S/E: sleepwalking, driving and such
    • rebound insomnia after tolerance is built over a time of longer than a week
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