pharmnotecards.csv

Time it takes for amount of drug to fall to half of its value; this is a constant in first order kinetics (majority of drugs)

Relates the amount of drug in the body to the plasma concentration

Plasma concentration of a drug at a given time

The ratio of the rate of elimination of a drug to its plasma concentration

The elimination of drug that occurs before it reaches the systemic circulation

The fraction of administered dose of a drug that reaches systemic circulation

When the rate of drug input equals the rate of drug elimination

This step of metabolism makes a drug more hydrophilic and hence augments elimination

Different steps of Phase I

Inducers of Cytochrome P450 (CYP450)

Inhibitors of CYP450

Products of Phase II conjugation

Type of kinetics when a constant percentage of substrate is metabolized per unit time

Drug elimination with a constant amount metabolized regardless of drug concentration

Target plasma concentration times (volume of distribution divided by bioavailability)

Concentration in the plasma times (clearance divided by bioavailability)

Strength of interaction between drug and its receptor

Selectivity of a drug for its receptor

Amount of drug necessary to elicit a biologic effect

Ability of drug to produce a biologic effect

Ability of a drug to produce 100% of the maximum response regardless of the potency

Ability to produce less than 100% of the response

Ability to bind reversibly to the same site as the drug and without activating the effector system

Class of drugs with ability to decrease the maximal response to an agonist

A hormone whose mechanism of action (MOA) utilizes intracellular receptors

A hormone whose MOA utilizes transmembrane receptors

Class of drugs whose MOA utilizes ligand gated ion channels

Median effective dose required for an effect in 50% of the population

Median toxic dose required for a toxic effect in 50% of the population

Dose which is lethal to 50% of the population

Window between therapeutic effect and toxic effect

Term for a high margin of safety

Term for a narrow margin of safety

Antidote used for lead poisoning

Antidote used for cyanide poisoning

Antidote used for anticholinergic poisoning

Antidote used for organophosphate/anticholinesterase poisoning

Antidote used for iron salt toxicity

Antidote used for acetaminophen (APAP) toxicity

Antidote for arsenic mercury lead and gold poisoning

Antidote used in poisonings: copper (Wilson's disease) lead mercury and arsenic

Antidote used for heparin overdose

Antidote used for warfarin toxicity

Antidote for tissue plasminogen activator (t-PA) streptokinase

Antidote used for methanol and ethylene glycol

Antidote used for opioid toxicity

Antidote used for benzodiazepine toxicity

Antidote used for tricyclic antidepressants (TCA)

Antidote used for carbon monoxide poisoning

Antidote used for digitalis toxicity

Antidote used for beta agonist toxicity (eg. Metaproterenol)

Antidote for methotrexate toxicity

Antidote for beta-blockers and hypoglycemia

Antidote useful for some drug induced Torsade de pointes

Antidote for hyperkalemia

Antidote for salicylate intoxication

Constant proportion of cell population killed rather than a constant number

Treatment with cancer chemotherapy at high doses every 3-4 weeks too toxic to be used continuously

Toxic effect of anticancer drug can be lessened by rescue agents

Drug used concurrently with toxic anticancer agents to reduce renal precipitation of urates

Pyrimidine analog that causes Thymine-less death given with leucovorin rescue

Drug used in cancer therapy causes Cushing-like symptoms

Side effect of Mitomycin

MOA of cisplatin

Common toxicities of cisplatin

Analog of hypoxanthine needs HGPRTase for activation

Interaction with this drug requires dose reduction of 6-MP

May protect against doxorubicin toxicity by scavenging free radicals

Blows DNA (breaks DNA strands) limiting SE is pulmonary fibrosis

Bleomycin+vinblastine+etoposide+cisplatin produce almost a 100% response when all agents are used for this neoplasm

ABVD regimen used for HD but appears less likely to cause sterility and secondary malignancies than MOPP

Regimen used for non-Hodgkin's lymphoma

Regimen used for breast cancer

Alkylating agent vesicant that causes tissue damage with extravasation

Anticancer drug also used in RA produces acrolein in urine that leads to hemorrhagic cystitis

Prevention of cyclophosphamide induced hemorrhagic cystitis

Microtubule inhibitor that causes peripheral neuropathy foot drop (eg. ataxia) and pins and needles sensation

Interact with microtubules (but unlike vinca which prevent disassembly of tubules) it stabilizes tubulin and cells remain frozen in metaphase

Toxicities include nephrotoxicity and ototoxicity leading to a severe interaction with aminoglycosides

Agent similar to cisplatin less nephrotoxic but greater myelosuppression

Converts asparagine to aspartate and ammonia denies cancer cells of essential AA (asparagine)

Used for hairy cell leukemia; it stimulates NK cells

Anti-androgen used for prostate cancer

Anti-estrogen used for estrogen receptor + breast cancer

Aromatase inhibitor used in breast cancer

Newer estrogen receptor antagonist used in advanced breast cancer

Some cell cycle specific anti-cancer drugs

Some cell cycle non-specific drugs

Anti-emetics used in association with anti-cancer drugs that are 5-HT3 (serotonin receptor subtype ) antagonists

Nitrosoureas with high lipophilicity used for brain tumors

Produces disulfiram-like reaction with ethanol

Somatostatin (SRIF) analog used for acromegaly carcinoid glucagonoma and other GH producing pituitary tumors

Somatotropin (GH) analog used in GH deficiency (dwarfism)

GHRH analog used as diagnostic agent

GnRH agonist used for infertility or different types of CA depending on pulsatile or steady usage respectively

GnRH antagonist with more immediate effects used for infertility

Dopamine (DA) agonist (for Parkinson's disease) used also for hyperprolactinemia

Hormone inhibiting prolactin release

ACTH analog used for diagnosis of patients with corticosteroid abnormality

Synthetic analog of ADH hormone used for diabetes insipidus and nocturnal enuresis

SE of OCs

Most widely used thyroid drugs such as Synthroid and Levoxyl contain

T3 compound less widely used

Anti-thyroid drugs

Thioamide agents used in hyperthyroidism

Thioamide less likely to cross placenta inhibits peripheral conversion of T4 to T3 in high doses and should be used with extreme caution in pregnancy

PTU (propylthiouracil) MOA

Can be effective for short term therapy of thyroid storm but after several weeks of therapy causes an exacerbation of hyperthyroidism

Dose may need to be increased during pregnancy or with Ocs due to increased TBG in plasma

Permanently cures thyrotoxicosis patients will need thyroid replacement therapy thereafter. Contraindicated in pregnancy

Radio contrast media that inhibits the conversion of T4 to T3

Block cardiac adverse effects of thyrotoxicosis such as tachycardia inhibits the conversion of T4 to T3

Vitamins containing iron should NOT be taken simultaneously with levothyroxine because

Thyroxine dose may need to be increased in hypothyroid patient during pregnancy because

3 zones of adrenal cortex and their products

Pneumonic for 3 zones of adrenal cortex

Used for Addison's disease Congenital Adrenal Hyperplasia (CAH) inflammation allergies and asthma (as a local inhalation)

Short acting glucocorticoids

Intermediate acting glucocorticoids

Long acting glucocorticoids

Mineralocorticoids

Some side effects of corticosteroids

Period of time of therapy after which GC therapy will need to be tapered

Used for Cushing's syndrome (increased corticosteroid)

Inhibits conversion of cholesterol to pregnenolone therefore inhibiting corticosteroid synthesis

Antifungal agent used for inhibition of all gonadal and adrenal steroids

Antiprogestin used as potent antagonist of GC receptor

Diuretic used to antagonize aldosterone receptors

Common SE of spironolactone

Slightly increased risk of breast cancer endometrial cancer heart disease (questionable) has beneficial effects on bone loss

Antiestrogen drugs used for fertility and breast cancer respectively

Common SE of tamoxifen and raloxifene

Selective estrogen receptor modulator (SERM) used for prevention of osteoporosis and prophylaxis in women with risk factors for breast cancer

Non-steroidal estrogen agonist causes clear cell adenocarcinoma of the vagina in daughters of women who used it during pregnancy

Estrogen mostly used in oral contraceptives (OC)

Anti-progesterone used as abortifacient

Constant low dose of estrogen and increasing dose of progestin for 21 days (last 5 days are sugar pills or iron prep)

Oral contraceptive available in a transdermal patch

Converted to more active form DHT by 5 alpha-reductase

5 alpha-reductase inhibitor used for benign prostatic hyperplasia (BPH) and male pattern baldness

Anabolic steroid that has potential for abuse

Anti-androgen used for hirsutism in females

Drug is used with testosterone for male fertility

What do alpha cells in the pancreas produce?

What do beta cells in the pancreas produce?

Where are beta cells found in the pancreas?

What do delta cells in the pancreas produce?

Product of proinsulin cleavage used to assess insulin abuse

Exogenous insulin contains

Endogenous insulin contains

Very rapid acting insulin having fastest onset and shortest duration of action

Rapid acting crystalline zinc insulin used to reverse acute hyperglycemia

Long acting insulin

Ultra long acting insulin has over a day duration of action

Major SE of insulin

Important in synthesis of glucose to glycogen in the liver

Important in muscle and adipose tissue for glucose transport across muscles and TG storage by lipoprotein lipase activation

Examples of alpha-glucosidase inhibitors (AGI)

MOA of AGI's

SE of AGI's

Alpha-glucosidase inhibitor associated with elevation of LFT's

Amino acid derivative active as an insulin secretagogue

MOA of nateglinide

Biguanide

Drugs available in combination with metformin

MOA of metformin

Vascular effects of metformin

Most important potential SE of metformin

Incidence of hyoglycemia with metformin

Meglitinide class of drugs

MOA of repaglinide

First generation sulfonylurea

Second generation sulfonylurea

MOA of both generations

Common SE of sulfonylureas repaglinide and nateglinide

Sulfonylurea NOT recommended for elderly because of very long half life

Thiazolidinediones

Reason troglitazone was withdrawn from market

MOA of thiazolindinediones

SE of Thiazolindinediones

Hyperglycemic agent that increases cAMP and results in glycogenolysis gluconeogenesis reverses hypoglycemia also used to reverse severe beta-blocker overdose and smooth muscle relaxation

Available bisphosphonates

MOA of Bisphosphonates

Only bisphosphonate available IV

Uses of bisphosphonates

Major SE of bisphosphonates

Bisphosphonates that cannot be used on continuous basis because it caused osteomalacia

Used for prevention of postmenopausal osteoporosis in women

Increase bone density also being tested for breast CA prophylaxis

Used intranasally and decreases bone resorption

Used especially in postmenopausal women dosage should be 1500 mg

Vitamin given with calcium to ensure proper absorption

Disease caused by excess ergot alkaloids

Endogenous substances commonly interpreted as histamine serotonin prostaglandins and vasoactive peptides

Syndrome of hypersecretion of gastric acid and pepsin usually caused by gastrinoma; it is associated with severe peptic ulceration and diarrhea

Drug that causes contraction of the uterus

Distribution of histamine receptors H1 H2 and H3

Prototype antagonist of H1 and H2 receptors

1st generation antihistamine that is highly sedating

1st generation antihistamine that is least sedating

2nd generation antihistamines

Generation of antihistamine that has the most CNS effects

Major indication for H1 receptor antagonist

Antihistamine that can be used for anxiety and insomnia and is not addictive

H1 antagonist used in motion sickness

Most common side effect of 1st generation antihistamines

Lethal arrhythmias resulting from concurrent therapy with azole fungals (metabolized by CYP 3A4) and these antihistamines which inhibit the 3A4 iso-enzyme.

H2 blocker that causes the most interactions with other drugs

Clinical use for H2 blockers

Receptors for serotonin (5HT-1) are located

5HT-1d agonist used for migraine headaches "

Triptan available in parenteral and nasal formulation

H1 blocker that is also a serotonin antagonist

Agents for reduction of postpartum bleeding

Agents used in treatment of carcinoid tumor

5HT-3 antagonist used in chemotherapeutic induced emesis

5HT-3 antagonist that has been associated with QRS and QTc prolongation and should not be used in patients with heart disease

DOC to treat chemo-induced nausea and vomiting

Drug used in ergot alkaloids overdose ischemia and gangrene

Reason ergot alkaloids are contraindicated in pregnancy

SE of ergot alkaloids

Ergot alkaloid used as an illicit drug

Dopamine agonist used in hyperprolactinemia

Peptide causing increased capillary permeability and edema

Mediator of tissue pain edema inactivated by ACE and may be a contributing factor to the development of angioedema

Drug causing depletion of substance P (vasodilator)

Prostaglandins that cause abortions

Difference between COX 1 and COX 2 "

Drug that selectively inhibits COX 2

Inhibitor of lipoxygenase

Major SE of zileuton

Inhibitor of leukotrienes (LTD4) receptors and used in asthma

Used in pediatrics to maintain patency of ductus arteriosis

Approved for use in severe pulmonary HTN

Prostaglandin used in the treatment of impotence

Irreversible nonselective COX inhibitor

Class of drugs that reversibly inhibit COX

Primary endogenous substrate for Nitric Oxidase Synthase

MOA and effect of nitric oxide

Long acting beta 2 agonist used in asthma

Muscarinic antagonist used in asthma

MOA action of cromolyn

Methylxanthine derivative used as a remedy for intermittent claudication

MOA of corticosteroids"

SE of long term (>5 days) corticosteroid therapy and remedy

MOA of quinolones

MOA of penicillin

Drug used for MRSA

Vancomycin MOA

Type of resistance found with vancomycin

Meningitis prophylaxis in exposed patients

Technique used to diagnose perianal itching and the drug used to treat it

and mebendazole"

Two toxicities of aminoglycosides

DOC for Legionnaires' disease

MOA of sulfonamides

Penicillins active against penicillinase secreting bacteria

Cheap wide spectrum antibiotic DOC for otitis media

Class of antibiotics that have 10% cross sensitivity with penicillins

PCN active against pseudomonas

Antibiotic causing red-man syndrome and prevention

at a slow rate and antihistamines"

Drug causes teeth discoloration

MOA of tetracycline

Drug that causes gray baby syndrome and aplastic anemia

Drug notorious for causing pseudomembranous colitis

DOC for tx of pseudomembranous colitis

Treatment of resistant pseudomembranous colitis

Anemia caused by trimethoprim

Reason fluoroquinolones are contraindicated in children and pregnancy

DOC for giardia bacterial vaginosis pseudomembranous colitis and trichomonas

Treatment for TB patients (think RIPE)

Metronidazole SE if given with alcohol

Common side effect of Rifampin

MOA of nystatin

Neurotoxicity with isoniazid (INH) prevented by

Toxicity of amphotericin

SE seen only in men with administration of ketoconazole

Topical DOC in impetigo

DOC for influenza A

DOC for RSV

DOC for CMV retinitis

SE for ganciclovir

Anti-viral agents associated with Stephen Johnson syndrome

HIV antiviral class known to have severe drug interactions by causing inhibition of metabolism

Antivirals that are teratogens

Antivirals associated with neutropenia

HIV med used to reduce transmission during birth

Drug used for African sleeping sickness

Drug used in Chagas disease

Cephalosporins able to cross the BBB

Drug used for N. gonorrhea in females

Cephalosporin causes kernicterus in neonates

SE of INH

Aminoglycoside that is least ototoxic

Drug used in exoerythrocytic cycle of malaria

Oral antibiotic of choice for moderate inflammatory acne

Drug of choice for leprosy

DOC for herpes and its MOA

Anti-microbials that cause hemolysis in G6PD-deficient patients

MOA of erythromycin

Anti-biotic frequently used for chronic UTI prophylaxis

Lactam that can be used in PCN allergic patients

SE of imipenem

Anti-viral with a dose limiting toxicity of pancreatitis

Common side effect of hypnotic agents

Occurs when sedative hypnotics are used chronically or at high doses

The most common type of drug interaction of sedative hypnotics with other depressant medications

Benzodiazepines used to promote sleep

Benzodiazepine used for anxiety

Non-benzodiazepine used as an anxiolytic

Non-benzodiazepine used for sleep

Major effect of benzodiazepines on sleep at high doses

Neurologic SE of benzodiazepines

Reason benzos are used cautiously in pregnancy

Main route of metabolism for benzodiazepines

Benzodiazepine that undergo extrahepatic conjugation (which are useful in older or hepatically impaired)

"MOA for benzodiazepines

Antidote to benzodiazepine overdose (antagonist that reverses the CNS effects)

Benzodiazepine with useful relaxant effects in skeletal muscle spasticity of central origin

Benzodiazepine that has efficacy against absence seizures and in anxiety states such as agoraphobia

Benzodiazepines that are the most effective in the treatment of panic disorder

"Benzodiazepine that is used for anesthesia

DOC for status epilepticus

Longer acting benzodiazepines used in the management of withdrawal states of alcohol and other drugs

Agents having active metabolites long half lives and a high incidence of adverse effects

Barbiturates may precipitate this hematologic condition

Barbiturates decrease the effectiveness of many other drugs via this pharmacokinetics property

Barbiturates MOA

Barbiturate used for the induction of anesthesia

Site of action for zaleplon and zolpidem

Good hypnotic activity with less CNS SE than most benzodiazepines

Agent that is a partial agonist for the 5-HT1A receptor

Drug of choice for generalized anxiety disorder NOT effective in acute anxiety

Agent that is metabolized to acetaldehyde by alcohol dehydrogenase and microsomal ethanol-oxidizing system (MEOS)

Agent with zero-order kinetics

Rate limiting step of alcohol metabolism

System that increases in activity with chronic ethanol exposure and may contribute to tolerance

Enzyme that metabolizes acetaldehyde to acetate

Agents that inhibit alcohol dehydrogenase

Agent used in the treatment of alcoholism if alcohol is consumed concurrently acetaldehyde builds up and results in nausea headache flushing and hypotension

The most common neurologic abnormality in chronic alcoholics

Agent that is teratogen and causes a fetal syndrome

Agent that is the antidote for methanol overdose

Drug that inhibits alcohol dehydrogenase and is used in ethylene glycol exposure

Most frequent route of metabolism

Mechanisms of action for Phenytoin Carbamazepine Lamotrigine

MOA for benzodiazepines and barbiturates

MOA for Ethosuximide

MOA for Valproic acid at high doses

Drugs of choice for generalized tonic-clonic and partial seizures

DOC for febrile seizures

Drugs of choice for absence seizures

Drug of choice for myoclonic seizures

Drugs of choice for status epilepticus

Drugs that can be used for infantile spasms

Anti-seizure drugs used also for bipolar affective disorder (BAD)

Anti-seizure drugs used also for Trigeminal neuralgia

Anti-seizure drugs used also for pain of neuropathic orgin

Anti-seizure agent that exhibits non-linear metabolism highly protein bound causes fetal hydantoin syndrome and stimulates hepatic metabolism

SE of phenytoin

Anti-seizure agent that induces formation of liver drug-metabolism enzymes is teratogen and can cause craniofacial anomalies and spina bifida

Agent that inhibits hepatic metabolism is hepatotoxic and teratogen that can cause neural tube defects and gastrointestinal distress

Laboratory value required to be monitored for patients on valproic acid

SE for Lamotrigine

SE for Felbamate

Anti-seizure medication also used in the prevention of migraines

Carbamazepine may cause

Anti-seizure drugs used as alternative drugs for mood stabilization

MOA of general anesthetics

Inhaled anesthetic with a low blood/gas partition coefficient

Inversely related to potency of anesthetics

Inhaled anesthetics metabolized by liver enzymes which has a major role in the toxicity of these agents

Most inhaled anesthetics SE

Inhaled anesthetics are myocardial depressants

Inhaled anesthetic causes peripheral vasodilation

Inhaled anesthetic that may sensitize the myocardium to arrhythmogenic effects of catecholamines and has produced hepatitis

Inhaled anesthetic less likely to lower blood pressure than other agents and has the smallest effect on respiration

Fluoride released by metabolism of this inhaled anesthetic may cause renal insufficiency

Prolonged exposure to this inhaled anesthetic may lead to megaloblastic anemia

Pungent inhaled anesthetic which leads to high incidence of coughing and vasospasm

DOC for malignant hyperthermia that may be caused by use of halogenated anesthetics

IV barbiturate used as a pre-op anesthetic

Benzodiazepine used adjunctively in anesthesia

Benzodiazepine receptor antagonist it accelerates recovery from benzodiazepine overdose

This produces dissociative anesthesia is a cardiovascular stimulant which may increases intracranial pressure and hallucinations occur during recovery

Opioid associated with respiratory depression but is used in high risk patients who may not survive full general anesthetia

State of analgesia and amnesia produced when fentanyl is used with droperidol and nitrous oxide

Produces both rapid anesthesia and recovery has antiemetic activity and commonly used for outpatient surgery may cause marked hypotension

MOA of local anesthetics (LA's)

This may enhance activity of local anesthetics

This may antagonize activity of local anesthetics

Almost all local anesthetics have this property and sometimes require the administration of vasoconstrictors (ex. Epinephrine) to prolong activity

Local anesthetic with vasoconstrictive property favored for head neck and pharyngeal surgery

Longer acting local anesthetics which are less dependent on vasoconstrictors

These LA's have surface activity

Most important toxic effects of most local anesthetics

Commonly abused LA which has cardiovascular toxicity including severe hypertension with cerebral hemorrhage cardiac arrhythmias and myocardial infarction

LA causing methemoglobinemia

Structurally related to acetylcholine used to produce muscle paralysis in order to facilitate surgery or artifical ventilation. Full doses lead to respiratory paralysis and require ventilation

These drugs strongly potentiate and prolong effect of neuromuscular blockade (NMB)

These prevent the action of Ach at the skeletal muscle endplate to produce a surmountable blockade effect is reversed by cholinesterase inhibitors (ex. neostigmine or pyridostigmine)

Agent with long duration of action and is most likely to cause histamine release

Non-depolarizing skeletal muscle antagonist that has short duration

Skeletal muscle agent that can block muscarinic receptors

Skeletal muscle agent that undergoes Hofmann elimination (breaks down spontaneously)

One depolarizing blocker that causes continuous depolarization and results in muscle relaxation and paralysis causes muscle pain postoperatively and myoglobinuria may occur

During Phase I these agents worsen muscle paralysis by succinylcholine but during phase II they reverse the blockade produced by succinylcholine

Agents acting in the CNS or in the skeletal muscle used to reduce abnormally elevated tone caused by neurologic or muscle end plate disease

Facilitates GABA presynaptic inhibition

GABA agonist in the spinal cord

Similar to clonidine and may cause hypotension

DOC for malignant hyperthermia by acting on the sacroplasmic reticulum or skeletal muscle

Agent used for acute muscle spasm

Irreversible condition resulting from the use of antipsychotics reserpine at high doses and MPTP (by-product of illicit meperidine analog)

Agent used in drug therapy of Parkinson's instead of Dopamine which has low bioavailability and does not cross the BBB

This is combined with L-dopa inhibits DOPA decarboxylase (active only peripherally) which allows lower effective doses of L-dopa and allows for fewer SE's (GI distress postural hypotension and dyskinesias)

Clinical response that may fluctuate in tx of Parkinson's dx

Anti-Parkinson's drug which increases intraocular pressure and is contraindicated in closed angle glaucoma

Ergot alkaloid that is a partial agonist at D2 receptors in the brain used for patients who are refractory or cannot tolerate levodopa causes erythromelalgia

Non ergot agents used as first-line therapy in the initial management of Parkinson's

Enhances dopaminergic neurotransmission SE's include CNS excitation acute toxic psychosis and livedo reticularis

Inhibitor of MAO type B which metabolizes dopamine used adjunct to levodopa or as sole agent in newly diagnosed patients

Inhibitors of catechol-O-methyltransferase (COMT) used as adjuncts in Parkinson's dx and cause acute hepatic failure (monitor LFT's)

Agent decreases the excitatory actions of cholinergic neurons. May improve tremor and rigidity but have LITTLE effect on bradykinesia. Atropine-like side effects

Agent effective in physiologic and essential tremor

Agents used in Huntington's Disease

Agents used in Tourette's dx

Chelating agent used in Wilson's disease

Extrapyramidal dysfunction is more common with these agents which block this subtype of dopamine receptor

MOA of neuroleptics

Side effects occuring in antipsychotics that block dopamine

Antipsychotics that reduce positive symptoms only

Newer atypical antipsychotics that also improve some of the negative symptoms and help acute agitation

Antipsychotic used in the treatment of psychiatric symptoms in patients with dementia

Atypical antipsychotic causing high prolactin levels

Newer atypical antipsychotic used for bipolar disorder known to cause weight gain and adversely affect diabetes

Agent more frequently associated with extrapyramidal side effects that can be treated with benzodiazepine diphenhydramine or muscarinic blocker

Drug used in neuroleptic malignant syndrome

Agents may exacerbate tardive dyskinesias (may be irreversible and there is no treatment)

Antipsychotic having the strongest autonomic effects

Antipsychotic having the weakest autonomic effects

Only phenothiazine not exerting antiemetic effects can cause visual impairment due to retinal deposits and high doses have been associated with ventricular arrhythmias

Agent having no effect on D2 receptors blocks D4 reserved for resistant schizophrenia and can cause fatal agranulocytosis

Anti-psychotic not shown to cause tardive dyskinesia

Anti-psychotics available in depot preparation

Reduced seizure threshold

Orthostatic hypotension and QT prolongation

Increased risk of developing cataracts

Major route of elimination for Lithium

Patients being treated with lithium who are dehydrated or taking diuretics concurrently could develop

Drug increases the renal clearance hence decreases levels of lithium

Lithium is associated with this congenital defect

DOC for bipolar affective disorder

Concern using lithium

SE of lithium

Example of three antidepressants that are indicated for obsessive compulsive disorder

Neurotransmitters affected by the action of antidepressants

Usual time needed for full effect of antidepressant therapy

Population group especially sensitive to side effects of antidepressants

All antidepressants have roughly the same efficacy in treating depression agents are chosen based on these criterion

Well-tolerated and are first-line antidepressants

Most useful in patients with significant anxiety phobic features hypochondriasis and resistant depression

Condition will result from in combination of MAOI with tyramine containing foods (ex. wine cheese and pickled meats)

MAOI should not be administered with SSRI's or potent TCA's due to development of this condition

Sedation is a common side effect of these drugs they lower seizure threshold uses include BAD acute panic attacks phobias enuresis and chronic pain and their overdose can be deadly

Three C's associated with TCA toxicity

Agents having higher sedation and antimuscarinic effects than other TCA's

TCA used in chronic pain a hypnotic and has marked antimuscarinic effects

TCA used in chronic pain enuresis and ADD

TCA with greatest sedation of this group and marked antimuscarinic effects used for sleep

TCA used in obsessive compulsive disorder (OCD) most significant of TCA's for risk of seizure weight gain and neuropsychiatric signs and symptoms

Secondary amines that have less sedation and more excitation effect

Side effects seen with tricyclic antidepressants

Antidepressant associated with neuroleptic malignant syndrome

Antidepressant associated with seizures and cardiotoxicity

Antidepressant having stimulant effects similar to SSRI's and can increase blood pressure

Antidepressant inhibiting norepinephrine serotonin and dopamine reuptake

Antidepressant also used for sleep that causes priapism

Antidepressant which is inhibitor of CYP450 enzymes and may be associated with hepatic failure

Heterocyclic antidepressants least likely to affect sexual performance used for management of nicotine withdrawal SE's include dizziness dry mouth aggravation of psychosis and seizures

Antidepressant with MOA as alpha 2 antagonist has effects on both 5-HT and NE blocks histamine receptors and is sedating

SE of mirtazapine

Except for these agents all SSRI have significant inhibition of CytP450 enzymes

Side effects frequently seen with SSRIs

Antidepressants with no effect on BP no sedation

SSRI with long T1/2 and can be administered once weekly for maintenance not acute tx

SSRI indicated for premenstrual dysphoric disorder

Some of SSRIs' therapeutic effects beside depression

SSRI less likely to cause a withdrawal syndrome

Inhibit synaptic activity of primary afferents and spinal cord pain transmission neurons

Activation of these receptors close Ca2+ ion channels to inhibit neurotransmitter release

Activation of these receptors open K+ ion channels to cause membrane hyperpolarization

Tolerance to all effects of opioid agonists can develop except

All opioids except this agent (which has a muscarinic blocking action) cause pupillary constriction

SE of these drugs include dependence withdrawal syndrome sedation euphoria respiratory depression nausea and vomiting constipation biliary spasm increased ureteral and bladder tone and reduction in uterine tone

Strong opioid agonists

Opioids used in anesthesia

Opioid used in the management of withdrawal states

Opioid available trans-dermally

Opioid that can be given PO by epidural and IV which helps to relieve the dyspnea of pulmonary edema

Use of this opioid with MAOI can lead to hyperpyrexic coma and with SSRI's can lead to serotonin syndrome

Moderate opioid agonists

Weak opioid agonist poor analgesic its overdose can cause severe toxicity including respiratory depression circulatory collapse pulmonary edema and seizures

Partial opioid agonist considered a strong analgesic has a long duration of action and is resistant to naloxone reversal

Opioid antagonist that is given IV and had short DOA

Opioid antagonist that is given orally in alcohol dependency programs

These agents are used as antitussive

These agents are used as antidiarrheal

Inhalant anesthetics

Toxic to the liver kidney lungs bone marrow peripheral nerves and cause brain damage in animals sudden death has occurred following inhalation

Cause dizziness tachycardia hypotension and flushing

Causes acne premature closure of epiphyses masculinization in females hepatic dysfunction MI and increases in libido and aggression

Readily detected markers that may assist in diagnosis of the cause of a drug overdose include

Most commonly abused in health care professionals

This route is associated with rapid tolerance and psychologic dependence

Leads to respiratory depression progressing to coma and death

Lacrimation rhinorrhea yawning sweating weakness gooseflesh nausea and vomiting tremor muscle jerks and hyperpnea are signs of this syndrome

Treatment for opioid addiction

This agent may cause more severe rapid and intense symptoms to a recovering addict

Sedative-Hypnotics action

Additive effects when Sedative-Hypnotics used in combination with these agents

Common mechanism by which overdose result in death

Date rape drug

The most important sign of withdrawal syndrome

Treatment of withdrawal syndrome involves

These agents are CNS depressants

Withdrawal from this drug causes lethargy irritability and headache

W/D from this drug causes anxiety and mental discomfort

Treatments available for nicotine addiction

Chronic high dose abuse of nicotine leads to

Tolerance is marked and abstinence syndrome occurs

Amphetamine agents

These agents are congeners of Amphetamine

Overdoses of this agent with powerful vasoconstrictive action may result in fatalities from arrhythmias seizures respiratory depression or severe HTN (MI and stroke)

Most dangerous of the currently popular hallucinogenic drugs OD leads to nystagmus marked hypertension and seizures presence of both horizontal and vertical nystagmus is pathognomonic

Removal of PCP may be aided

THC is active ingredient SE's include impairment of judgment and reflexes decreases in blood pressure and psychomotor performance occur

Muscarinic agonists or parasympathomimetic

This agent has greater affinity for muscarinic receptors and used for postoperative and neurogenic ileus and urinary retention

Only direct acting agent that is very lipid soluble and used in glaucoma

This agent used to treat dry mouth in Sj�gren's syndrome

Indirect-Acting ACh Agonist alcohol short DOA and used in diagnosis of myasthenia gravis

Carbamate with intermediate action used for+A1170 postoperative and neurogenic ileus and urinary retention

Treatment of atropine overdose and glaucoma (because lipid soluable). Enters the CNS rapidly and has a stimulant effect which may lead to convulsions

Treatment of myasthenia gravis

Antiglaucoma organophosphate

Associated with an increased incidence of cataracts in patients treated for glaucoma

Scabicide organophosphate

Organophosphate anthelmintic agent with long DOA

Toxicity of organophosphate:

The most frequent cause of acute deaths in cholinesterase inhibitor toxicity

The most toxic organophosphate

Treatment of choice for organophosphate overdose

This agent regenerates active cholinesterase and is a chemical antagonist used to treat organophosphate exposure

Prototypical drug is atropine

Treat manifestations of Parkinson's disease and EPS

Treatment of motion sickness

Produce mydriasis and cycloplegia

Bronchodilation in asthma and COPD

Reduce transient hyper GI motility

Cystitis postoperative bladder spasms or incontinence

Toxicity of anticholinergics

Another pneumonic for anticholinergic toxicity

Atropine fever is the most dangerous effect and can be lethal in this population group

Contraindications to use of atropine

Limiting adverse effect of ganglion blockade that patients usually are unable to tolerate

Reversal of blockade by neuromuscular blockers

Tubocurarine is the prototype pancuronium atracurium vecuronium are newer short acting agent produce competitive block at end plate nicotinic receptor causing flaccid paralysis

Only member of depolarizing neuromuscular blocker causes fasciculation during induction and muscle pain after use; has short duration of action

Chemical antagonists that bind to the inhibitor of ACh Estrace and displace the enzyme (if aging has not occurred)

Used to treat patients exposed to insecticides such as parathion

Pneumonic for beta receptors

This is the drug of choice for anaphylactic shock

Phenylisopropylamines that are used legitimately and abused for narcolepsy attention deficit disorder and weight reduction

Alpha agonist used to produce mydriasis and reduce conjunctival itching and congestion caused by irritation or allergy it does not cause cycloplegia

Newer alpha 2 agonist (apraclonidine and brimonidine) treat glaucoma by acting to

Short acting Beta 2 agonists that is drug of choice in treatment of acute asthma but not recommended for prophylaxis

Longer acting Beta 2 agonist is recommended for prophylaxis of asthma

These agents increase cardiac output and may be beneficial in treatment of acute heart failure and some types of shock

These agents decrease blood flow or increase blood pressure are local decongestants and used in therapy of spinal shock (temporary maintenance of blood pressure which may help maintain perfusion

Shock due to septicemia or myocardial infarction is made worse by

Epinephrine is often mixed with a local anesthetic to

Chronic orthostatic hypotension can be treated with

Beta 2 agonist used to suppress premature labor but cardiac stimulatory effects may be hazardous to mother and fetus

Sympathetic agent which stimulates heart rate and can dilate vessels in skeletal muscle at low doses

Mast cells to reduce release of hisamine and inflammatory mediators

Agent used in shock because it dilates coronary arteries and increases renal blood flow

Agent which stimulates cardiac contractile force more than rate with little effect on total peripheral resistance

Long acting sympathomimetic sometimes used to improve urinary continence in children and elderly with enuresis

Alpha 1 agonist toxicity

Beta 1 agonist toxicity

Beta 2 agonist toxicity

The selective agents loose their selectivity at

Nonselective alpha-blocking drug long acting and irreversible and used to treat pheochromocytoma. Blocks 5-HT so occasionaly used for carcinoid tumor. Blocks H1 and used in mastocytosis

Nonselective alpha-blocking drug short acting and reversible used for rebound HTN from rapid clonidine withdrawal and Raynaud's phenomena

Selective Alpha 1 blocker used for hypertension BPH may cause first dose orthostatic hypotension

Selective Alpha-1A blocker used for BPH but with little effect on HTN

Selective Alpha 2 blocker used for impotence (controversial effectiveness)

SelectiveB1 Receptor blockers that may be useful in treating patients even though they have asthma

Combined alpha and beta blocking agents that may have application in treatment of CHF

Beta blockers partial agonist activity (intrinsic sympathomimetic activity) cause some bronchodilation and may have an advantage in treating patients with asthma

This beta blocker lacks local anesthetic activity (a property which decreases protective reflexes and increases the risk of corneal ulceration) and used in treating glaucoma

This parenteral beta blocker is a short acting (minutes)

This beta blocker is the longest acting

These beta blockers are less lipid soluble

This beta blocker is highly lipid soluble and may account for side effects such as nightmares

Clinical uses of these agents include treatment of HTN angina arrhythmias chronic CHF and selected post MI patients

Toxicity of these agents include bradycardia AV blockade exacerbation of acute CHF; signs of hypoglycemia may be masked (tachycardia tremor and anxiety)

Cholinomimetics that increase outflow open trabecular meshwork and cause ciliary muscle contraction

Nonselective alpha agonists that increases outflow probably via the uveoscleral veins

Selective alpha agonists that decreases aqueous secretion

These Beta blockers decrease aqueous secretion

This diuretic decreases aqueous secretion due to lack of HCO3- ion. Causes drowsiness and paresthesias alkalinization of the urine may precipitate calcium salts hypokalemia acidosis

This agent cause increased aqueous outflow

Inhibit angiotensin-converting enzyme (ACE)

Captopril and enalapril (-OPRIL ending) are

SE of ACE inhibitors

ACE inhibitors are contraindicated in

Losartan and valsartan block

Angiotensin receptor blockers do NOT cause

Agents that block L-type calcium channel

CCB contraindicated in CHF

CCB with predominate effect on arteriole dilation

SE of CCB

Agents that reduce heart rate contractility and O2 demand

B-blockers that are more cardioselective

Cardioselective Beta 1-blockers

Beta-blockers should be used cautiously in

Non-selective Beta-blocker also used for migraine prophylaxis

SE of beta blockers

Alpha 1selective blockers

Non-selective Alpha1blockers use to treat pheochromocytoma

For rebound HTN from rapid clonidine withdrawal

A1a-selective blocker with no effects on HTN used for BPH

SE of alpha blockers

Presynaptic Alpha 2 agonist used in HTN and acts centrally

SE of methyldopa

Methyldopa is contraindicated in

SE of clonidine

Direct vasodilator of arteriolar smooth muscle

SE of hydralazine

Arterial vasodilator that works by opening K+ channels

SE of minoxidil

IV Drug used Hypertensive Crisis

Nitroprusside vasodilates

Toxicity caused by nitroprusside and treatment

Carbonic anhydrase inhibitor

Diuretic used for mountain sickness and glaucoma

SE of acetazolamide

MOA of loop diuretics

Site of action of loop diuretics

SE of loop (furosemide) diuretics

Aminoglycosides used with loop diuretics potentiate adverse effect

Loops lose and thiazide diuretics retain

MOA of thiazide diuretics

Site of action of thiazide diuretics

Class of drugs that may cause cross-sensitivity with thiazide diuretics

SE of thiazide (HCTZ) diuretics

Potassium sparing diuretics inhibit

Diuretic used to treat primary aldosteronism

SE of spironolactone

Osmotic diuretic used to treat increased intracranial pressure

ADH agonist used for pituitary diabetes insipidus

Used for SIADH

SE of demeclocycline

MOA of class I A (eg. Procainamide) class IB (eg. Lidocaine) and class IC (eg. Flecainide) antiarrhythmics

SE of procainamide

Limiting side effect of Quinidine

Other side effects of Quinidine

Major drug interaction with Quinidine

DOC for management of acute ventricular arrhythmias

DOC for digoxin induced arrhythmias

SE of phenytoin

Class of anti-arrhythmics that has a pro-arrhythmic effect (CAST trial) therefore are used as last line agents

Class II antiarrhythmics are

Antiarrhythmic that exhibits Class II and III properties

Side effect of sotalol

Used intravenously for acute arrhythmias during surgery

Anti-arrhythmics that decrease mortality

MOA of class III antiarrhythmics

Class III antiarrhythmic that exhibits properties of all 4 classes

Specific pharmacokinetic characteristic of amiodarone

Antiarrhythmic effective in most types of arrhythmia

SE of Amiodarone

MOA of class IV antiarrhythmics

Life threatening cardiac event that prolong QT leads to

Agent to treat torsades de pointes

Drug used supraventricular arrhythmias

DOC for paroxysmal supraventricular tachycardia (PSVT)

Adenosine's MOA

Anti-arrhythmic with 15 second duration of action

MOA of sildenafil (Viagra)

Drugs used in the management of angina

Aspirin reduces mortality in unstable angina by

MOA of nitrates

Nitrate used for acute anginal attacks

Nitrate used to prevent further attacks

Nitrate free intervals are needed due to

SE of nitrates

CCB are DOC for

Beta blockers are used for which type of anginal attack

MOA of Cardiac glycosides (eg. digoxin)

Digoxin is used in

Digoxin toxicity can be precipitated by

Antidote for digoxin toxicity

Phosphodiesterase inhibitors that increase mortality and have been found to have NO beneficial effects

SE of amrinone

Beta 1 agonists used in acute CHF

Diuretics work in CHF by

Beta blockers work in CHF by

Peptide drug used to treat CHF

"MOA of nesiritide

SE of nesiritide

Agent used in CHF that is a selective alpha and nonselective beta blocker

Agent used in acutely decompensated CHF resembling natriuretic peptide

Vitamin K dependent anticoagulant

Warfarin is contraindicated in

Anticoagulant of choice in pregnancy

Heparin (PTT) increases activity of

Route of administration of warfarin

Routes of administration of heparin

SE of both warfarin and heparin

SE of heparin

Alternative anticoagulant used if HIT develops

Antidote to reverse actions of warfarin

Antidote to reverse actions of heparin

MOA of aspirin

Agent used to treat MI and to reduce incidence of subsequent MI

SE of Aspirin

Antiplatelet drug reserved for patients allergic to aspirin

SE for ticlopidine

Effective in preventing TIA's

Prevents thrombosis in patients with artificial heart valve

Block glycoprotein IIb/IIIa involved in platelet cross-linking

MOA of thrombolytics

Thrombolytics are used for

Thrombolytic that can cause allergic reaction

Thrombolytic used for acute MI and ischemic (non hemorrhagic) CVA

SE of tPA

Antidote for thrombolytics

Agent to treat hypochromic microcytic anemias

Chelating agent used in acute iron toxicity

Agent for pernicious anemia

Agent used for neurological deficits in megaloblastic anemia

Agent used for megaloblastic anemia (but does NOT reverse neurologic symptoms) and decrease neural tube defects during pregnancy

Agent used for anemias associated with renal failure

Agent used neutropenia especially after chemotherapy

Treatment of patients with prior episodes of thrombocytopenia after a cycle of cancer chemotherapy

Drugs decrease intestinal absorption of cholesterol

Cholestyramine and colestipol are

Major nutritional side effect of bile acid-binding resins

MOA of lovastatin (STATIN)

HMG CoA reductase inhibitors are contraindicated in

MOA of drug or foods (grapefruit juice) that increase statin effect

SE of HMG COA reductase inhibitors

Monitoring parameter to obtain before initiation of STATINS

Decreases liver triglycerol synthesis

SE of niacin

Cutaneous flush and be reduced by pretreatment with

Fibrates (gemfibrozil) increase activity of

Most common SE of fibrates

Fibrates are contraindicated in

Concurrent use of fibrates and statins increases risk of

New class of drugs that works by inhibiting absorption of intestinal cholesterol and can be given concurrently with the Statins

MOA of NSAIDS

Difference between aspirin and other NSAIDS

Four main actions of NSAIDS

Agent used for closure of patent ductus arteriosus

Aspirin is contraindicated in children with viral infection

SE of salicylates

NSAID also available as an ophthalmic preparation

NSAID available orally IM and ophthalmically

NSAID that is used for acute condition such as pre-op anesthesia and has limited duration (<5 days) of use due to nephrotoxicity

Newer NSAID that selectively inhibits COX-2

COX 2 inhibitors may have reduced risk of

COX 2 inhibitors should be used cautiously in pts with

Acetaminophen only has

SE of acetaminophen

Antidote for acetaminophen toxicity

DMARDs are slow acting drugs for

Initial DMARD of choice for patients with RA

Drug ofter used in combination with TNF - alpha inhitors for RA

Causes bone marrow suppression

SE of penicillamine

Interferes with activity of T-lymphocytes

Anti-malarial drug used in rheumatoid arthritis (RA)

SE of hydroxychloroquine

MOA of Leflunomide (newer agent)

Proteins that prevent action of tumor necrosis factor alpha (TNF-alpha)

Anti-rheumatic agent also used for ulcerative colitis

Anti-rheumatic agent also used for Chron's disease

NSAID used in gout

NSAID contraindicated in gout

MOA of colchicine (used in acute gout)

SE of colchicine

Agent used to treat chronic gout by increasing uric acid secretion and excretion

Allopurinol treats chronic gout by decreasing uric acid production by inhibiting

Rapid acting insulins that do not self-aggregate

Peakless ling acting insulin

DOC for paroxysmal supraventricular tachycardia; has high efficacy and short duration of action