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PharmFinal1
| Question | Answer |
|---|---|
| NSAID | inhibit COX, CYP3A or CYP2C metabolism |
| Aspirin/Salicylates | can cross BBB and placenta -low doses is analgesia -high doses is anti-inflammatory |
| Aspirn | weak organic acid |
| Aspirin | irreversible inhibits both COX |
| Diflunisal | NSAID |
| Diflunisal | weal organic acid |
| Diflunisal | reversibly inhibits both COX |
| Diflunisal | used by dentists |
| Olsalazine | pro-drug |
| Olsalizine | NSAID |
| Olsalazine | metabolized to 5-aminosalicylic acid |
| Olsalazine | retained in colon for ulcerative colitis |
| Proprionic Acid Derivatives | Profens & Naproxen |
| Proprionic Acid derivatives | reversible inhibitor of both COXs -inhibit PG synthesis but not leukotrienes |
| Proprionic acid side effect | tinnitus |
| Naproxen | better tolerated than aspirin |
| Indolacetic acids | Indomethacin, Sulindac, Etodlac |
| Indomethacin | more potent; inhibits both COX, can have anti-inflammatory effects at normal doses |
| Indomethacin | usually prescribed for gout or premature labor - suppresses uterine contractions |
| Sulindac | less potent than indomethacin |
| Sulindac | Sulfoxide prodrug |
| Etodlac | safer than Indomethacin & sulindac |
| Etodlac | may increase blood levels and toxicity of digoxin, lithium, methotrexate and cyclosporine |
| Fenamate | mefenamic acid and meclofenamate have no real avantage over other NSAIDS |
| Fenamate side effect | diarrhea, hemolytic anemia |
| Fenamate | used for menstrual cramps |
| Diclofenac | accumulates in synovial fluid; safe and effective |
| Ketorolac | given IM for post-op pain |
| Ketorolac | never be used for more than 5 days in outpatient; go into renal failure |
| Piroxicam & Meloxicam | NSAID good for compliance |
| Acetaminophen | inhibits PG synthesis, less effect on COX |
| Acetaminophen | used in pt with gastric probs, drug of choice for children, gestational |
| Anti-arthritic | Celecoxib |
| Anti-arthritic | Hydroxychloroquin |
| Anti-arthritic | Leflunomide |
| Anti-arthritic | Sulfasalazine |
| Anti-arthritic | Gold Salts |
| Celecoxib | selective for COX2, metabolized by CYP2C, doesnt inhibit platelets |
| Celecoxib | contraindicated in pt allergic to sulfa |
| Celecoxib | interacts with flucanazole, beta blockers, antidepressents |
| Hydroxychloroquin | selective for COX2 |
| Hydroxychloroquin side effects | decreased accomodation, hemolysis in GCPD deficient pts |
| Hydroxychloroquin | 1st line for rheumatoid arthritis |
| Leflunomide | prodrug |
| leflunomide | not for renal impaired or gestational |
| Sulfasalazine | contraindicated in urinary or GI obstruction |
| Gold Salts side effets | bone marrow depression, diarrhea, ulcers, jaundice |
| Gold Salts | indicated in active rheumatoid arthritis unresponsive to NSAIDS |
| Narcartic Opiods | hydromorphone, oxycodone, hydrocodone, levorphanol, oxymorphone |
| Opiods | -Morphone, -Codone |
| Morphine | Opiate, inhibits pain nerve cells |
| Morphine side effects | pinpoint pupils, antitussive, parasympathetic like |
| Drug of choice for severe pain MI | Morphine |
| Morphine | contraindicated in head/brain trauma |
| Opiod | less potent than morphine; mod to severe pain, better absorbed orally than morphine, useful in outpatient |
| Meperidine | synthetic opiod for acute pain |
| Meperidine | contraindicated for cough/diarrhea |
| Meperidine | overdose causes convulsions due to metabolite normeperidine |
| Mepereidine | doesent cause pinpoint pupils but dilates due to atropine-like activity |
| Meperidine | interacts with MAO inhibitors causeing severe CNS excitation, resp depression, hypotension |
| Methadone | full morphine like actions, weaker sedative, less euphoria |
| methadone | treat morphine addiction due to lower euphoria therefore develop less psych dependence |
| Phenylpiperidines | fentanyl, sufentanil, alfentanil |
| fentanyl | more potent than morphine; preop use in anesthesia, no tolerance/dependence |
| fentanyl | transdermal or transmucosal (child w/cancer) |
| sufentanil | more potent than fentanyl |
| alfentanil | less potent than fentanyl |
| Phenanthrenes | codeine or buprenorphine |
| Opiod phenanthrene | codeine |
| mixed agonist-antagonist phenanthrene | buprenorphine |
| Codiene | prodrug converted to morphine |
| codeine | higher oral efficacy than morphine; good antitussive |
| mixed agonist-antagonists | pentazocine and buprenorphine |
| pentazocine | moderate pain; may be used prep; mixed with naloxone |
| buprenorphine | new drug to treat opiod addiction |
| drugs to treat opiod addiction | methadone, buprenorphine** |
| buprenorphine | works like morphine in naive pt |
| Tramadol | non-opiate synthetic analgesic |
| tramadol | reduces uptake of norepi and serotonin |
| tramadol | less resp depression than opiates and less platelet toxicity than NSAIDS |
| tramadol | induced miosis limits pupil exam in trauma pt |
| tramadol | class II controlled substance |
| pure antagonists | naloxone and naltrexone |
| naloxone | blocks opiod receptors; no effect in narcotic free pts |
| naloxone | given IV, short half life |
| Naltrexone | given orally, longer duration, can block effects for up to 48 hrs |
| naltrexone | indicated in tx of alcoholism |
| Migraine drugs | sumatriptan |
| sumatriptan | serotonin agonist |
| sumatriptan | causes vasoconstriction of cranial arteries; not given IV |
| butalbital | used before triptans |
| butalbital | short acting barbiturate with anticonvulsant and sedative properties |
| butalbital | indicated for tension headache |
| isometheptene | controlled substance |
| Migraine drug | butalbital |
| migraine drug | isometheptene |
| isometheptene | indicated for tension headache |
| isometheptene | contraindicated in glaucoma, severe renal, cardiace, HTN or hepatic disease |
| Acute gout | cholchicine to decrease movement of granulocytes into effected area and NSAIDS to decrease pain and inflammation |
| cholchicine | anti-inflammatory |
| cholchicine | alleviates pain of gout within 12 hrs; may be combined with probenecid |
| cholchicine side effects | diarrhea*** 1st sign to stop |
| chronic gout | allopurinol, probenecid |
| allopurinol | reduces production of uric acid |
| allopurinol | inhibits xanthine oxidase |
| allopurinol | low incidence of side effects but may exacerbate gout attacks, cause GI upset, rash and Stevens-Johnson syndrome |
| Probenecid | uricosuric that blocks proximal tubular reabsorption of uric acid |
| Probenecid side effects | may exacerbate gout attacks, accumulate with repeated dose, cause headache, dizziness, sore gums*** |
| Asthma | Beta-adrenergic agonists |
| beta-adrenergic agonists | mild asthma |
| short-acting beta adrenergic agonist | albuterol |
| short-acting beta | pirbuterol |
| short acting beta | terbutaline |
| short-acting beta adrenergic agonists | rescue agents, no anti-inflammatory, never used alone |
| long-acting beta | salmetrol xinaoate |
| long-acting beta | formoterol fumarate |
| long0acting beta | levalbuterol |
| salmeterol xinaoate | chemical analog of albuterol; long duration |
| salmeterol xinaoate | slow onset of action, never used in acute attacks |
| formoterol fumerate | maintenance of asthma and prevention of bronchospasm in reversible obstructive airway disease |
| levalbuterol | single isomer albuterol; preservative free for children |
| corticosteroids | mod to severe asthma who require inhaled beta 2 agonists more than once daily |
| severe asthma | systemic glucocorticoids for short term |
| oral inhaled steroids | -IDE or -ASONE |
| oral inhaled steroids | flunisolide, mometasone, fluticasone, budesonide, beclomethasone |
| most popular corticosteroid | fluticasone bc beta 2 and steroid |
| corticosteroids | decrease inflammation, reduce cytokine production, dont relax airways, reduces hyperresponsiveness to triggers |
| corticosteroid side effects | thrus, osteoporosis, cataracts, headache, pharyngitis |
| Mast cell inhibitors | inhibit release histamine |
| mast cell inhibitors | prophylactic anti-inflammatory, prevention |
| mast cell inhibitors | not useful in acute attack bc not direct bronchodilators |
| mast cell inhibitor | cromolyn |
| cromolyn | fine powder inhalation or aerosolized solution |
| cromolyn | anti-inflammatory; pretreatment blocks allergen & exercise induced bronchoconstriction |
| cromolyn side effects | poorly absorbed so minimal side effects but caution in pregnancy |
| cholinergic antagonists | reduce secretions, also used for pt who cannot tolerate beta 2 agonist |
| cholinergic antagonists | -IUM or theophylline |
| cholinergic antagonist | ipratropium |
| cholinergic antagonist | tiotropium |
| cholinergic antagonist | theophylline |
| ipratropium | derivative of atropine |
| ipratropium | most popular; minimal side effects |
| ipratropium | not used in children, caution in preg and glaucoma |
| tiotropium | long term maintenance of bronchospasm due to chronic bronchitis and emphysema |
| tiotropium | inhaler or dry poweder caplets to be inhaled |
| tiotropium | not used in children or acute attacks; caution in pregnancy and glaucoma |
| theophylline | direct bronchodilator with some anti-inflammatory activity |
| theophylline | well absorbed in GI tract *****pill***** |
| theophylline side effects | constriction of cerebral vessels |
| theophylline | narrow therapeutic index; toxicity may cause seizures or fatal arrythmias; caution in pregnancy and glaucoma |
| anti-leukotriene drugs | new, reversible inhibitors of the cysteinyl leukotriene 1 receptor thus blocking effects of cysteinyl leukotrienes |
| anti-leukotriene drugs | prophylactic tx of asthma |
| anti-leukotriene drugs | -KAST |
| anti-leukotriene | zafirlukast |
| anti-leukotriene | montelukast |
| zafirlukast | inhibit CYP-450 thus increase serum warfarin levels; too many drug interactions |
| montelukast | dont inhibit CYP-450 |
| zafirlukast & montelukast | in addition to low dose inhaled steroids/cromolyn in mild persistant asthma |
| zafirlukast & montelukast | orally active, highly protein bound & drug interactions |
| Allergic rhinitis | 1st line agents are antihistamines and decongestants |
| antihistamines | h1 receptor blockers |
| h1 receptor blockers | diphenhydramine, chlorpheniramine, cetirizine, clemastine, azelastine |
| non-sedating h1 receptor blockers | loratidine & fexofenadine |
| alpha-adrenergic agonists | phenylephrine & oxymetazoline |
| phenylephrine & oxymetazoline | constrict arterioles in nasal mucosa & reduce airway resistance |
| pehnylephrine & oxymetazoline | normally in aerosol form and have rapid onset of action; not used in long term therapy due to rebound nasal congestion after discontinuance |
| corticosteroid nasal sprays | full effects may not be evident for 1-2 weeks; -IDE or -ASONE |
| anticholinergic nasal sprays | ipratropium |
| ipratropium | dries nasal secretions; use caution in glaucoma and pregnancy |
| mast cell stabilizers | cromolyn |
| cromolyn | nasal spray stops hypersensitivity reactions; caution in pregnancy & nursing |
| antitussives | not indicated for productive coughs |
| most efficacious class of antitussives | codeine & hydrocodone |
| OTC antitussive | dextromethorpan |
| dextromethorpan | no potential for dependence, no side effects |
| expectorants | increase bronchial secretions, reduce thickness/viscosity |
| expectorants | guaifenesin |
| mucolytics | acetylcysteine |
| acetylcysteine | via inhalation |
| acetylcysteine | used to directly loosen thick, viscous bronchial secretions as in cystic fibrosis |
| acetylcysteine | antidote for acetaminophen |
| rapid acting insulin preparations | insulin glulisine |
| rapid acting insulin prep | lispro |
| rapid acting insulin prep | insulin aspart |
| insulin glulisine | 15 min before or within 20 min of starting meal; peak 60 min |
| lispro | not normally used alone |
| lispro | 15 min before meal; onset 15 min later; peak 60 min; duration: 3-4 hrs |
| insulin aspart | s. cerevisiae |
| insulin aspart | onset: 15 min, peak 1-3hrs, duration 3-5 hrs |
| short insulin prep | regular insulin |
| regular insulin/short acting | novalin R |
| regular insulin/short acting | Humulin R |
| Humulin/Novalin R | soluble, crystalline zinc |
| Humulin/Novalin R | peak 50-120 min; duration 4-5 hrs |
| humulin/novalin R | given SC but may be given IV (only one) |
| humulin/novalin R | safely used in pregnancy |
| intermediate-acting insulin | NPH, Humulin, Novalin N |
| Humulin/novalin N | absorption and onset delayed by combining appropriate amounts of insulin and protamine |
| humulin/novalin N | onset 2-5 hrs, duration 4-12 hrs; crystals release insulin slower |
| prolonged acting insulin | insulin glargine |
| prolonged acting insulin | insulin detemir |
| two insulins not with E.colie | Insulin aspart (rapid) and insulin detemir (prolonged) |
| insulin glargine | new, peakless, used for background |
| insulin glargine | onset: 1 hr, no peak, duration 24 hrs |
| insulin detemir | s. cervisiae |
| insulin detemir | onset 1 hr, no peak duration 24 hrs |
| insulin secretagogue | sulfonylurea |
| insulin secretagogue | repaglinide, nateglinide |
| sulfonylureas | stimulate insulin release |
| sulfonylureas | glyburide & glipizide |
| sulfonylureas | glimepiride |
| glyburide & glipizide | bind to serum proteins, metabolized by liver |
| gestational diabetes | insulin regular only |
| glyburide & glipizide | contraindicated in pt w/hepatorenal insufficiency; pregnancy |
| glimepiride | new 2nd generation sulfonylurea - 1st to be approved for concurrent use w/insulin |
| sulfonylurea | oral hypoglycemic agents |
| repaglinide | binds to ATP-sensitive K channels of beta cells causing release of insulin |
| nateglinide | works well with metformin |
| biguanides | metformin |
| metformin | 1st line agent |
| metformin | not bound to serum proteins and is not metabolized |
| metformin | inhibits gluconeogenesis; less risk of hypoglycemia |
| alpha-glucosidase inhibitors | acarbose |
| acarbose | inhibits alpha-glucosidase in intestines thus decreases absorption of starch and disaccharides |
| acarbose | used as adjunct |
| thiazolidinediones | -LITAZONES |
| thiazolidinediones | pioglitazone & rosiglitazone |
| pioglitazone & rosiglitazone | insulin sensitizers; counteract insuin resistance |
| pioglitazone & rosiglitazone side effects | URI,MI |
| Dipeptidyl peptidase-4 inhibitors | -GLIPTINS |
| dipeptidyl peptidase 4 inhibitor | sitagliptin |
| dipeptidyl peptidase 4 inhibitor | saxagliptin |
| dipeptidy peptidase 4 inhibitor | linagiptin |
| sitagliptin | bioavailability over 85% |
| sitagliptin | peak 1-4hrs, half life 12 hrs |
| sitagliptin | if used with sulfonylureas may need to adjust dose downward to prevent hypoglycemia |
| sitagliptin side effects | URI |
| saxagliptin | given orally |
| saxagliptin | peak 2-4 hrs, half life 2.5 hrs |
| saxagliptin | hypoglycemia if used with sulfonylureas |
| saxagliptin side effects | URI |
| saxagliptin | peripheral edema if used with thiazolidinediones |
Created by:
jjohrden16
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