drugs
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| Organic Nitrates | Nitroglycerin: vasodilator, inc cGMP form; adv. eff.-headache;-orthostatic hyptotension; reflex tachycardia; Toler, depletion of sulfhydryl; drug inter: other hypotensive drugs, sildenafil(viagra) dec cGMP degrad; Beta blockers, verapamil, diltiazem
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| Organic Nitrates prep and routes of admin | Sublingual tablets; sustained-release oral capsules; transdermal delivery systems; translingual spray; transmucosal (buccal) tablets; topical ointment; IV
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| Beta Blockers | (decrease cardiac oxygen demand) Propranolol; adv eff.: bradycardia; decreased AV conduction; reduction of contractility; asthmatic effects; caution with diabetes
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| calcium channel blockers | Verapamil, diltiazem, nifedipine; stable and variant angina; adv. eff. hypotension; reflex tachycardia; bradycardia
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| Revascularization Therapy | coronary artery bypass graft surgery; percutaneous transluminal coronary angioplasty; CABG for multi-vessel disease, after recovery CABG patients fare better
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| Heparin | natural; physio sig. unknown; rapid acting anticoag(IV), ^antithrombin:pulmonary embolism, stroke evolving, vein thrombosis; adv. eff. hemorrhage, heparin-induced thrombocytopenia, hypersensitivity; protamine sulfate for overdose; aPTT: longish
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| Low MW Heparins | preps. composed of molecules that are shorter than those found in unfractionarted heparin; use: prevent of DVT after surgery, treat of estabed DVT, prevent of ishcemic comp; adv effects and inter: bleeding, immune-mediated thrombocytopener, cost
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| Fondaparinux | (arixtra) Syn anticoag; selective inhibit; use: prevent dvt after surgery, treat acute PE, DVT(w/ warfarin); adv eff: bleeding, patient less than 50kg; spinal or epidural hematoma; enoxaparin(lovenox) mult use, STEMI
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| Warfarin | (Coumadin) oral anticoag; antagonist of Vit K; affects syn-factors VII, IX, X, prothrombin; use: long term prophylaxis of thrombosis; adv eff: hemorrhage, contraindicated in pregnancy, lactation; prothrombin time ratio; vit K1 overdose
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| Antiplatelet Drugs | Aspirin inhibit of COOG, GI bleeding; Ticlopidine(ticlid) & Clopidogrel (plavix) ADP receptor antag, prev. aggr: Tirofiban (aggrastat) blocks GP IIb/IIIa recpetors, last step aggr. most effective anti platelet drug
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| Thrombolytic Drugs | Streptokinase(streptase) binds plasminogen ^plasmin, degrades firbrin clots; uses MI, DVT, massive pulm emboli; adv eff: bleeding antibody prod. (foreign protien strepto) hypotension, fever; altepase(tPA) human tissue plaminogen activator; controversial
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| Factor VIII Concentrates | used to treat hemophilia; prod. mehtods and product safety, plasma-derived factor VII, recombinant factor VIII; adv eff: allergic rxn; dosage and admin: on-demand therapy, prophylactic therapy; factor IX conc.
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| Desmopressin | stop or prevent bleeding (mild hemophilia)
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| Antifibrinolytic Agents | used to treat hemophilia; aminocarproic acid, tranexamic acid; inhibit the normal process of fibrin breakdown; control bleeding in mucous membranes; control bleeding caused by dental extractions
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| Factor VII concentrate, activated Factor VII(factor VIIa), Porcine Factor VIII, anti-inhibitor coagulant complex | drus used for hemophilia patients with inhibitors
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| Oral Iron Preparations | Ferrous Sulfate(drug of choice); adv eff GI dist, Staining teeth, toxicity; Interactions: antacids, tetracycline, ascorbic acids, other oral iron salts: ferrous gluconate and ferrous fumarate
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| Cyanocobalamin | v 12 preparations; admin oral, parenteral, intranasal; adv eff hypokalemia (New RBCs); Long-term treatment, with lack of intrinsic facor, v b-12 lifelong
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| Epoerin Alfa | (erytgropoietin) Epogen, procrit) hematopoietic growth facor, rDNA; use: anemia renal failure, HIV taking zidovudine; chemo induced, anema facing surgery; adv eff: hypertension, autoimmune pure red cell aplasia(rare); cardivascular events
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| Filgrastim | (Neupogen) granulocute colony stimulating factor; leukopoietic GF, rDNA; use: cancer, sever chronix neutropenia; adv eff: bone pain, leukosytosis
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| Sargramostim | (Leukine) Sargramostim (granulocyte-macro colony stimulating factor - neutrophils, macr, hematopoietic GF, rDNA; use: adjunct to autologous bone marrow transplant, failed bone marrow trans, acute myelogenous leukemia; adveff leuko-thrombo cytosis
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| Oprelvekin | (interleukin-11) thrombopoietic GF, rDNA; use:w/ Myelosuppressive chemo min. thrombocytopenia & platelet trans; adv eff fluid reten, cardiac dysrhythmias, conjunctival infection, sudden death
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| Short duration: rapid acting insulin | insulin lispro(humalog), insulin aspart(Novolog)
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| Short duration : slower acting insulin | regular insulin (humulin R, Novolin R, Exubera
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| Intermediate duration insulin | Neutral protamine Hagedom (NPH) insulin
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| Long Duration insulin | Insulin glargine (lantus)
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| 1st Generation Sulfonylureas | Acetohexamide(dymelor) Chlorpropamide(Diabinese) Tolazamide(Tolinase) Tolbutamide(orinase); oldest oral antidiab, stim B cell, less potent than 3nd gen, less tol; inexpen gen, adv eff, hypoglycemia(w/ norm. BS),worse lipid, cause wgt, fluid reten.DI:lots
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| Non-Sulfonylurea Secretagogues | Meglitinides,repaglinide (Prandin) and Nateglinide (starlix, MOA of Sulfonylureas, shorter acting; take with meals(1st bite); prandin 5xday. Sideff: hypoglycemia(not as bad sulfons), headache; DI: many , metab CYP450-2c9 and 3A4; Gemifibrozil(Lopoid)
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| Biguanides | Phenformin-precursor(lactic acidosis, 1977) Metformin (Glucophage, Glucophage XR, Riomet; MOA dec. hepatic Glucose prod70%; sensitizes cells to glucose, renal elim. A.E.: GI effects, dec app, bloat, metal taste, \/ B12
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| Thiazolidinediones | (Glitazones);Troglitazone(rezulin) withdrawn, liver damage Rosiglitazone (Avandia) & Pioglitazone (actos)MOA sensitize periphery insulin; dec insulin resist, SE gen mild, wgt, mild anem, perip edma, inc LDLc
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| Alfa-Glucosidase Inhibotors | Acarbose (precose) and Miglitol (Glyset)MOA: slows the breakdown and absorb of carbs in SI, SE: GI effect very common - fart, diarrhea, titrate does upward very slowly, no drug interactions
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| 2nd Gen Sulfonylureas | Glimepiride(amaryl), Glipizide(Glucotrol), Glyburide-non-micronized(Diabeta, Micronase), Glyburide-Micronized(Glynase) Same MOA as 1st; better tol; most expensive
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| Levothyroxine | (Synthroid, Levothroid, others) syn prep of T4, conv. T3, 1/2life 7days, hypothyroidism; adv. eff tachycardia, angina, tremors; inter: drugs dec abs(colestid, questran), inc metab(phenytoin, AED), Warfarin(reduce dose of anti coag), Catechols(^cardiac res
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| Synthroid | formally drug of choice, relatively expensive (twice), bioequivalent to other preps; use caution when switching to another prep
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| Armour Thyroid | Very inexpensive, one of 1st agents on market, inconsistent levels, pig tg, rarely prescribed for new patients
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| Liothyronine | Cytomel; exogenous T3 - syn prep; lower dose, 1/2 of T4; rapid onset; shorter duration & 1/2life, $, not for long term
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| Liotrix | (thyrolar) Best, 4:1 ration(T4:T3) comparable to plasam
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| Hyperthyroid products | Methimazole (Tapazole)- longer half-life, 1/day; Propylthiouracil (PTU) – 3 doses/day, Indicated for short term therapy, Inhibits binding of I¯ to Thyroid globulin, PTU Inhibits peripheral conversion of T4, PTU preferred in pregnancy, placenta
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| Radioactive Iodine-131 (131I) | Radioactive isotope, emits gamma and beta rays; 1/2life 8days, active uptake by the thyroid, produces, clincal remission with destruction of thryoid gland, not very accurate, people usually develop hypothyroidism
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| Adjunctive Therapies for Hyperthyroidism | beta_blockers: slow body down, proprandolol(inderal) rapid effects, tachycardia; hypnotics - ambien (zolpidem)
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| Octreotide | (Sandostatin) syn analog of somatostatin; suppress GH release; dose-SC=3/day, IM=1/month; $$$; adv eff: GI, usually subside; Gallstones, usually asymptomatic
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| Somatrem | (Protropin)Growth hormone ; adv eff: hyperglycemia, hyperthyroidism(5%), antibody form. to GH(rarely V effective). omteractopm woth glucocorticoids(V effective)
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| Antidiuretic Preparations | Diabetes Insipidus: Vasopressin (ADH),(best) Desmopressin(mulit delivery), Other uses: Nocturnal enuresis, hemophilia A (^clotting factor VIII); adv eff intoxication, vasoconstriction
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| Hydrocortisone | Syn syteroid; uses: adrenal inusfficiency, allergy, inflammation, cancer chemo; adv eff: adrenal supp, cushing's syndrome
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| Fludrocortisone | (Florinef) Potent mineralcorticoid; Uses: Addison's Disease, Primary Hypoaldosteronism, congenital adrenal hyperplasia; Adv eff: hypertension, hypokalemia, edema, cardiac enlargement
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| Glucocorticoids - Physiologic Effects | Carb, protein, fat metabolism, CV, skeletal muscle, CNS, stress, resp in neonates
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