-
Lipid Solubles?
- ETOH
- Gas Anesthetics
- Barbiturates
Not lipid soluble: ABX
-
UEM
EM
PM
- Ultra
- Extensive Metabolizers
- Poor
-
How many half-lives to reach steady-state?
5
-
MEC
MTC
- Minimum Effective Concentration
- Minimum Toxic
-
Tachyphylaxis
Quick drug tolerance
-
What Vitamin interferes with Coumadin?
Vitamin K found in green leafy vegetables
-
Garlic IXs
- insulin
- hypoGs
- Coumadin
- antiHTNs
- phenelzine
-
Ginseng IXs
- insulin
- hypoGs
- Coumadin
- antiHTNs
- phenelzine
- CNS depressants
-
IXs with CNS depressants
- Ginseng
- Kava
- St Johns
- Valerian
-
-
IXs with anticoags
- Garlic
- Ginseng
- Gingko
- Ginger
- Feverfew
-
Dangerous CAMs
- Chaparral: kidney, lymph
- Comfrey: liver, lung, kidney, GI
- Ephedra: CV
- Kava: liver
- Lobelia: depression, HTN
- Yohimbe: HTN, tachy, dizzy, HA
-
CAMs that inhibit clotting
- chamomile
- dandelion
- dong quoi
- horse chestnut
-
CAMs that cause CNS depression
- hope
- kava
- passion flower
- valerian
-
CAMs that decrease PLT aggregation
- bilberry
- don quoi
- feverfew
- fish oil
- grape seed
- Gs: garlic, ginseng, gingko
-
Nitrates
SE
IX
- HA, flushing, tachy, tolerance
- CCB, Betas, ETOH, VIAGRA
-
Beta Blockers
FX
SE
IX
- -chronotrope, -inotrope, after MI, no tolerance, taper off
- bady, HF, hypoTN, metabolism, dizzy, lethargy, depression, dreams, impotence, wheeze
- diuretics, antiHTNs, phenothiazines, anticholinergics, obscures hypoG sxs
-
CCBs
FX
SE
IX
- arterial dilation, some -inotroope, depress nodes
- flushing, HA, hypoTN, edema, [constipation, confu, drowsy, arrythmias, mood with Dilt and Verapamil]
- betas, dig, grapefruit, STATINS
-
Beat Blockers:
- Atenolol: post MI
- Metoprolol: LA
- Propranolol: not selective, Asians may not metabolize
-
CCBs:
- -dipines
- Diltiazem
- Verapamil
-
-
HMG CoA Inhibitors:
-statins
-
-
Niacin:
Vitamin B3 in large doses
-
Bile Acid Sequestrants
SE
IX
- constipation, heartburn, N, gas (SE diminish)
- lipid solubles (AEDK), dig, coumadin
-
Bile Acid Sequestrants
FX
- increase bile-take cholesterol out of bloodstream
- only work in gut (not as dangerous)
- give with apple juice, FF
-
HMG CoA Inhibitors
FX
lower cholesterol production in the liver
-
Fibric Acid Derivitives
FX
decrease triglycerides
-
Niacin
FX
increase lipase, breaks down cholesterol
-
HMG CoA Inhibitors
SE
IX
- mild GI, rash, HA, Rhabdomyolysis, increased liver panel, teratogenic
- erythromycin, grapefruit, gemfibrozil, niacin (Rhabdo)
-
Niacin
SE
flushing, pruritus, GI distress, hyperG, hyperuremia
-
Thrombolytics:
FX
- convert plasminogen to plasmin, admin within 4-6hrs, no needles
- Streptase: for MIs
- Activase: for strokes
- Tenecteplase
-
Thrombolytics
SE
- allergy, NV, hypoTN
- Streptase: itching
-
Hemostatics:
FX
- Amicar
- Desmopressin
- Thrombin topical
- stop bleeding, help with anemia, hemophilia (dental)
-
Hemostatics
SE
nasal stuffiness, N, A
-
Anti-coags
SE
- NV, HIT (5-10 days after, need plasmaphoresis)
- Heparin: alopecia, osteoporosis (long term)
- Coumadin: purple toe, necrosis
-
Anti-coags
Antidotes:
- Coumadin: Vitamin K
- Heparin: Protamine sulfate
-
Normal PT:
Desired with Coumadin:
-
Normal aPTT:
Desired with Heparin:
-
Normal INR:
Desired with Coumadin:
-
Direct Thrombin Inhibitors:
FX
- -rudin
- -roban
- for HIT, coronary procedures, DVTs
-
Antiplatelet Agents:
- ASA
- ADP Blockers: Plavix, Ticlid, Aggrenox
- Glycoprotein Receptor Blockers: ReoPro, Integrilin, Aggrastat
-
Plavix
SE
GI bleed, flu, HA, bruising, rash
-
Ticlid
SE
NVD, dyspepsia, marrow toxic
-
ReoPro
SE
bleeding, hypoTN, back/chest pain, thrombocytopenia
-
Antidysrythmics:
SE
- Quinidine: D, cinchonism
- Procainamide: V. dysrythmias, lupus syndrome
-
-
Andrenergic Agents:
- Central: Clonodine, Methyldopa, Guanfacine
- Peripheral: Serpasil
- Alpha1 Blocker: Prazosin, Terazosin, Labetolol
- Ganglionic Blocker: Inversine
-
Andrenergic Agents
SE
drowsy, dry, HA, NC, rash, palps, depression
-
ARBs:
SE
- -sartan
- HA, dizzy, fatigue
-
Vasodilators:
SE
- HA, NVD, dizzy, tachy, anxiety
- Diazoxide
- Hydralazine
- Minoxidil
- Nitroprusside
-
-
Hydralazine
SE
edema, dyspnea, dyscrasias, hepatitis, congestion
-
Minoxidil
SE
pericardial effusion, angina, breast tenderness, thrmobocytopenia
-
Nitroprusside
SE
brady, decreased PLTs, cyanide toxicity
-
ACE Inhibitors:
FX
- -pril
- Decrease Na, prevent Angio I-Angio II, prevent bradykinin
-
ACE
SE
IX
- fatigue, HA, taste, cough, dyscrasias, mood, rash, angioedema (blacks)
- NSAIDs, diuretics, antiHTNs
- used often with CCBs and diuretics
-
Cardiac Glycoside:
SE
Antidote
- Digoxin
- dysrythmias, NVAD, fatigue, confu, conv, depression, vision
- digibind, K+
-
-
Loop Diuretics
FX
- Lasix, Bumex, Demadex, Edecrin
- Most potent, reduce Na and Cl, also vasodilate
-
Loop Diuretics
SE
IX
- orthostatic, lytes, tinnitus, glucose tolerance, dyscrasias, SJS, neuro/nephro toxic,
- Increase uric acid (gout), liver panel, glucose
- gentamycin, Dig, NSAIDs
-
Thiazide Diuretics:
FX
- Hydrochlorothiazide, Chlorthalidone, Indapamide (sulfas)
- Excrete Na, Cl, some K, also dilate arterioles, takes 3-4 weeks
-
Thiazide diuretics
SE
IX
- orthostatic, lytes, glucose tolerance, HA, rash, GI, libido
- Dig, oral hypoGs (2 hours)
-
K Sparing Diuretics:
FX
- Aldactone, Eplerenone, Dyrenium, Midamor
- act in distal tubule
-
K Sparing Diuretics
SE
IX
- anemia, dizzy, sore, dry, menses, hirsutism, impotence
- hyperK: N, fatigue, weak, brady, dysrythmias
-
Osmotic Diuretics:
FX
- Mannitol, Colace, Ureaphil
- in proximal tubule, used often for RF and ICP, lose many solutes
-
Osmotic Diuretics
SE
Conv, thrombophlebitis, pulmonary congestion, HA, CP, tachy, fever, blurry
-
Carbonic Anhydrates:
FX
- -amide
- short term (3-4 days), for glaucoma, epilepsy, altitude sickness
-
Carbonic Anhydrates
SE
- -amide
- acidosis, drowsy, A, parasthesias, hematuria, urticaria, photo, melena
-
Counter Regulatory to insulin:
-
Rapid Acting Insulins:
Onset
Peak
Duration
- Lispro, Humalog, Aspart, Nvolog
- 5-20 minutes
- 1-3 hours
- 3-5 hours
-
Short Acting Insulin:
Onset
Peak
Duration
- Regular
- 30-60 minutes
- 2-4 hours
- 6-10 hours
-
Intermediate Acting Insulins:
Onset, Peak, Duration
- NPH, Lente
- 1-4 hours
- 6-12 hours
- 18-28 hours
-
Long Acting Insulins:
Onset, Peak, Duration
- Lantus, Glargine
- 1 hour
- None
- 24 hours
-
What factors may decrease insulin absorption:
-
Take more insulin with which drugs:
- Steroids
- Thyroids
- Contraceptives
-
Take LESS insulin with which drugs:
- ETOH
- Anabolics
- MAOIs
- Betas
- Salycilates
- theophyllines
-
Sulfonylureas:
FX
- Diabenase, Glyburide, Glipizide, Amaryl
- Stimulate pancreatic insulin production, increase receptors
-
Sulfonylureas
SE
IX
- hypoG, agranulo, hemolytic, thrombocytopenia, rash, photo, jaundice, NV, fullness
- Many IX (ETOH and Diabenase)
-
Biguanides:
FX
SE
- Metformin
- reduces intestinal absorption and production of glucose
- NVDA, metallic taste, lactic acidosis! (weak, aches, dizzy, brady)
-
A-Glucosidase Inhibitors:
FX
SE
- Precose, Glyset
- delays digestion
- gas, abd pain, D, increased liver panel
-
Meglitinides:
FX
SE
- Nateglinide, Repaglinide
- stimulate insulin secretionhypoG, joint pain, URI
-
Glitazones:
FX
SE
- -glitazone
- improve use of insulin
- infection, myalgias, HA, edema, cholesterol, hepatotoxic
-
Polypeptide Analogs:
FX
SE
- Symlin
- increases satiety, slows gastric emptying
- severe hypoG (3hrs after), NV, HA, joint pain, cough
- DO not mix with insulin (site)
-
Incretins:
IX
- Byetta
- Januvia
- cocoa, rosemary
-
Byetta
SE
- NV, allergy, HA, dyspepsia, GERD, restless, pancreatitis, RF possible
- From Hela monster
-
Januvia
SE
HA, D, nasopharyngitis
-
Glucagon
SE
IX
- NV, hyperG, BP changes +/-
- Increases Coumadin levels
- Betas decrease Glucagon
-
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