1.Acarbose/Miglitol treatment for type 2 diabetes. inhibits breakdown of complex starches to glucose, slows absorption of glucose into the bloodstream. alpha-glucosidase inhibitor. AE: flatulence, diarrhea, abdominal pain, should not cause hypogylcemia when used as
monotherapy, but if it happens use oral glucose. Caution when using with other meds that lower glucose bc of
hypoglycemia. monitor renal function. 0.5-0.8% lowering A1C, not used as
monotherapy 2.ACE Inhibitors
-hypertension
captopril, lisinopril, ramipril, benazepril. maitenence therapy for CHF.
blocks conversion of angiotensin 1 to ii (vasoconstrictor) and suppresses aldosterone, limiting sodium reuptake in the kidney. treatment of hypertension, CHF, MI. can cause increasing K, hypotension, dizziness, tachycardia, headache, cough, bradykinin
accumulation. vision changes. BBW: do not use in pregnancy
3.Adenosine PSVT, cardiac stress testing. ADE: dyspnea, flushing, temporary asystole, chest pain. short duration half life, parenteral form
4.Albuterol/Levalbuterol/Pirbuterol asthma, COPD, emphysema. B2 adrenergic receptor agonist causes bronchodilation. ADEs: vasodilation, tachycardia, palpitations, tremor, CNS, stimulation. onset of action - 15 min after inhilation. PO and MDI products available. Duration approximately 4 hours. for acute asthma.
Levalbuterol/Pirbuterol - MDI form only. 5.Aldosterone receptor antagonist
-hypertension
spironolactone, eplerenone. blocks aldosterone binding to specific renal receptors. spiro is a K sparing diuretic. hypertension, CHF, edema, hepatic cirrhosis treatment. can cause hyperkalemia. decrease does for renal impairment.
tumorigenic in rats BBW
Pharmacology Exam 2 - Medications
6.Alendronate Prevention and treatment of post menopausal osteoporosis,
treatment of glucocorticoid induced osteoporosis, osteoporosis in men, Paget's disease. Biphosponate drug which decreases the rate of bone resorption, leading to indirect increase in bone mineral density. AE: changes in serum Ca++ and PO4, serious GI side effects, muscle, joint, bone pain, osteonecrosis of jaw, atypical femur fractures. oral daily v weekly. avoid in pts who cant sit upright for 30 min, avoid in renal impairment. food decreases absorption. rare reports of episcleritis, scleritis, and uveitis 7.alteration of cell
membrane
permeability/inhibition of active transport
most antifungals
8.Aminoglycosides inhibition of bacterial protein synthesis by binding principally to 30 and 50S ribosomal subunits. bacteriocidal - eventual cell death through cytoplasmic membrane disruption. limited activity against MSSA but not generally against gram positive. widely for gram negative. no activity against a-typical bacteria or anaerobic effects. gentamicin, tobramycin, neomycin. local irritation. caution with MG bc of slight potential for neuromuscular junction blockade effe ts. swelling of eyelids, face, appearance of rash
9.Amiodarone Class III- atrial fibrillation and ventricular arrhythmias. ADRS: photosensitivity, CNS, GI sxs, thyroid dysfxn, corneal microdeposits >90%, visual disturbances >10%, halo vision, optic neuritis. BBW: pulmonary fibrosis, hepatotoxicity. interacs with macrolides, quinolones, prolong QTc. oral and parenteral. contains iodine, structurally related to thyroxine.
10.amoxicillin effective against streptococci, staphylococci, and listeria. additional effectiveness against a few gram negative rods and cocci. many bacteria have acquired resistance. oral form only. doesn't work against pseudomonas. need to be adjusted in renal
impairment.
11.amoxicillin/clavulanate clavulanate added to restore effectiveness of amoxicillin against some bacteria with resistance. used orally for some strep and staph, some gram negative rods and cocci. does not work against pseudomonas. need to be adjusted in renal impairment. 12.Amphetamines facilitate NE release
13.Angiotensin receptor blockers
losartan, valsartan, irbesartan, candesartan.
blocks angiotensin 2 receptor site to control vasoconstriction. suppresses aldosterone. treatment of hypertension, CHF, MI. hypotension, icreased K, dizziness, conjunctivitis, blurred vision. maitenance therapy for CHF in those who can't tolerate cough from ACEI. BBW: Do not use in pregnancy.
14.Asprin/NSAIDS asprin reduces risk of AMI, stroke, and TIAs. both aspirin and NSAIDS are used for anti-pyretic/inflammatory and analgesic indications. reduces platelet aggregation via inhibition of COX 1 and 2 which decreases thromboxane A2. also inhibits formation of prostaglandins. liver metabolism. ADEs: GI ulceration, bleeding, may worsen renal fxn. visual disturbances or blurred vision with some NSAIDS. can reduce effects of anti HTN meds. BBW: MI/stroke, GI bleeding. may increase bleeding risk/GI effects
15.Atropine causes mydriasis and cycloplegia. used for amblyopia, treatment of anterior uveitis, and to decrease secretions preoperatively. treatment of GI spasm, symptomatic bradychardia and asystole. treatment of organophosphate poisoning. ADE -excessive cycloplegia/mydriasis, facial flushing, xerostomia, confusion, urinary retention, tachycardia. Contraindicated for NAG. goes to muscarinic receptor -parasympatholytic. 16.Beta adrenergic blocking agents -hypertension
labetalol, carvedilol, propranolol, sotalol, metoprolol, atenolol. competitive blockade of B adrenergic receptors. specific for B1 or B1 and B2. inhibit release of renin. some use for cardiac arrhythmias, angina pectoris, glaucoma, migraine prophylaxis, MI prevention. dryness or eye soreness. orthostatic hypotensio, exacerbate bronchospasm
17.Beta Blockers angina prophylaxis, blocks beta adrenergic receptors in the heart and smooth muscle tissues. ADEs: orthostatic hypotension, dizziness, can cause dry eye or soreness. contraindicated in patients with asthma, DM, severe bradycardia, PVD, and COPD. maitenence therapy for CHF - negative chronotropic activity - prevents changes due to chronic activation of sympathetic NS by decreasing heart rate and inhibiting release of rennin. prevents effects of NE on cardiac muscle fibers
18.binding to DNA interfereing with replication most antivirals 19.Biphosphonate drugs for osteoporosis
AIR - alendronate, ibandronate, risendronate
20.Bipyridine derivatives -milrinone
inotropic support in acute, decompensated congestive heart failure. inhibits enzyme breakdown cAMP, increase in cAMP will increase Ca uptake. increases cardiac contractility and vasodilation. PDE3 inhibitor in cardiac and vascular tissue. ADR: HA, worsening of angina. parenteral administration
21.calcium channel antagonists
angina prophylaxis. blocks calcium ion flow during slow channel exchange, maintaining smooth muscle cells in refractory period for a longer amount of time. ADE's orthostatic hypotension, dizziness, transient blindness with nifedipine. avoid in heart failure
22.Calcium channel antagonists -hypertension
Nifedipine, diltiazem, amlodipine. blocks calcium influx during slow channel exchange, dilates peripheral arterioles,
antiarrhythmic properties, also for angina prophylaxis.
supraventricular tachycardia. transient blindess rarely reported with nifedipine.
23.Canagiflozin (w/met) type 1 or type 2. inhibits sodium glucose cotransporter 2 in the proximal renal tubules, inhibiting the reabsorption of filtered glucose and increasing urinary glucose excretion. can contribute to dehydration, increase risk of yeast infections, UTI. can increase LDL cholesterol. renal function and serum electrolytes should be monitored. contraindicated in pts with severe renal dysfunction, not recommended in those with severe liver impairment.
24.Carbonic Anhydrase Inhibitors
acetazolamide, brinzolamide, dorzolamide. treatment of: edema, acute mountain sickness, glaucoma. inhibits carbonic anhydrase, lowers IOP. ADR: stomach upset, metabolic acidosis, dehydration. transient myopia
25.Cefaclor second generation cephalosporin. generally the same gram positive coverage as first generation but a little more gram negative coverage. does not cover enterococci or pseudomonas.
26.centrally acting adrenergic nerve blockers -antihypertensive
clonidine, guanabenz, guanfacine. alpha 2 agonists, decrease sympathetic outflow from brain to lower blood pressure. orthostatic hypotension, sedation, rebound HTN, blurred vision, conjunctivitis, and dry eye
27.Cephalexin/Cefadroxil first generation. effective against gram positive, not good for gram negative. will not cover anaerobic bacteria, pseudomonas or enterococci. many bacteria have acquired resistance. available in oral form only.
28.Cephalosporins bacteriocidal: inhibit bacterial cell wall synthesis, inhibit bacterial enzymes which assemble peptidoglycan. may need to be dose adjusted for renal impairment. 2-10% of pts allergic to penecillin will also be allergic to cephalosporins. allergies occur in 5% of pts. fatigue, dizziness, vertigo, HA, rash, exfoliative dermatits, N/V/D, hepatic and renal effects rare. eosinophilia, thrombocytopenia, neutropenia, leukopenia 29.Cholestyramine/Colesevelam/colestipol used to treat
elevated LDL cholesterol. anion exchange process which forms insoluble complex with bile salts and then fecally excreted - bile acid binding resin. ADEs: GI problems, gas, constipation, N/V. May decrease absorption of other drugs (statins, warfarin). fat soluble vitamins.
30.Cilostazol treatment of intermittent
claudication. phosphodiesterase III inhibition. increases cAMP in platelets and vasculature. Dilates blood vessels in lower extremities. taking meds with a fatty meal increases absorption. ADEs: palpitations, headache.
Contraindicated in heart failure. Levels increased by macrolides, diltiazem, omeprazole.
31.class 1 antiarrhythmic sodium channel blockade - reduce phase 0 slope and peak of action potential.
A: moderate - increase APD, increase fERP
B: weak - reduce APD, decrease ERP C: strong - no effect on APD or ERP 32.class 2 antiarrhythmic beta blockade - block sympathetic
activity and reduce rate and conduction
33.class 3 antiarrhythmic potassium channel blockade - delay repolarization and thereby increase action potential duration and effective refractory period 34.class 4 antiarrhythmic calcium channel blockade - block L
type calcium channels - most effective at SA and AV nodes; reduce rate and conduction
35.Clopidogrel/Prasugrel reduction of thrombotic events post MI and Stroke, acute coronary syndrome. blocks platelet aggregatio by binding of ADP to receptor on platelets which inhibits activation of GP IIb/IIIA receptors. prodrugs that require biotransformation to active metabolite. ADEs: bleeding, blood dyscrasias, serum cholesterol changes, nausea. cataracts and conjunctivitis with clopoidogrel. Decreases effect in poor metabolizers for clopidogrel. increased bleeding risk. 36.Cocaine prevents NE uptake 37.Commonly used
NSAIDS
diclofenac, indomethacin,
meloxicam, naproxen, bromfenac, flurbiprofen, ibuprofen, ketorolac, nepafenac, oxaprozin, sulindac, piroxicam, nabumetone
38.Cromolyn prophylaxis of asthma attacks. maitenence therapy only. mast cell stabilizers prevent release of histamine. minimal ADEs - throat irritation and unpleasant taste reported. nubulized soln, oral liquid, may take several weeks to occur. Not effective for treating attacks.
39.Dabigatran prevention of stroke and emboli in patients with non-valvur atrial fibrillation. DVT/PE prevention and treatment. reversible direct thrombin inhibitor. inhibits free and fibrin bound thrombin. inhibits coagulation by preventing thrombin mediated effects. oral capsule with renal dose adjustment needed. ADE: bleeding, GI upset, hematoma, rash, increased ALT. BBW: premature stoppage results in spinal epidural hematoma. NSAIDS, asprin, some herbs, verapamil, ketoconazole, clarithromycin and other antiplatelet thrombolytic agents may increase anticoagulation. estrogens may decrease anticoagulation.
40.Dicloxacillin effective against some streptococci and staphylococci. many bacteria have acquired resistance, limiting its usefulness. oral form only. doesnt work against pseudomonas. doesnt need to be adjusted for renal impairment.
41.Dipyridamole prevention of thromboembolytic
complications of cardiac valve replacement. phosphodiesterase inhibition. increase cellular cAMP which decreases TXA2 which dilates coronary arteries. taken orally. ADEs: N/V, dizziness, headache, chest pain, rash, syncope, GI upset. drug may increase the effects of other anticoagulants and antiplatelet agents.
42.direct vasodilators -hypertension
hydralazine, minoxidil. relaxes arterioles, peripheral vasculature, and or smooth muscles independent of sympathetic effects. usually reserved for hypertensive crisis, accelerated hypertension or advanced cases poorly controlled with other classes. can cause lacrimation.
43.Disopryramide class 1a - atrial arrhythmias and ventricular tachycardia. anticholinergic effects (dry mouth, urinary retention, constipation), blurred vision, dry eyes. interacts with macrolides, quinolones, prolong QTc. available oral only.
44.diuretics -hypertension, edema, CHF
thiazide diuretics currently used as initial medication for hypertension
45.Dobutamine inotropic support in acute, decompensated heart failure. B1 receptor specific agonist. increase force of contraction and heart rate. ADRs: tachycardia, hypotension, nausea, HA, palpitations, dyspnea, ventricular arrhythmia. parenteral administration. 46.Dofetilide Class III - atrial fibrillation. ADR:
proarrhythmic, dizziess, N/D,
respiratory tract/flu like, etc. oral form only
47.Dronedarone class III - persistent or paroxysmal atrial fibrillation. ADR: heart failure,
hepatic/renal effects, plumfibrosis, QTc elongation, N/V/D. BBW:
contraindicated in symptomatic heart failure, atrial fibrillation. interact with macrolines quinolones, prolong QTc. oral form. structuarally related to amiodarone but does not contain iodine. 48.drugs acting nonselectively on a adrenergic receptors -sympathomimetics norepinephrine
49.drugs acting non selectively on all adrenergic receptors
-sympathomimetics
epinephrine and ephedrine
50.drugs acting non selectively on B adrenergic receptors -sympathomimetics isoproterenol 51.drugs on B1 adrenergic receptors -sympathomimetics dobutamine, dopamine, norepinephrine 52.drugs on B2 adrenergic receptors -sympathomimetics
53.Estrogen for hormonal replacement
increased risk of breast cancer and myocardial infarction when taken with medroxyprogesterone. inreased risk of dementia, deep vein thrombosis, pulmonary embolism, stroke, and gall bladder disease. headache, abdominal pain, breast tenderness, irritation, rash, and weight changes. CL intolerance, corneal steepening, and retinal vascular thrombosis.
54.Estrogen for Oral
Contraceptives
increased risk of stroke, MI, deep vein thrombosis, liver and gall bladder problems. nausea, breast tenderness, breakthrough bleeding, appetite and weight changes. CL intolerance, corneal curvature steepening, cataracts, and optic neuritis.
55.Exenatide type 2 diabetes. glucagon like peptide receptor agonist to improve pancreatic beta cell response, moderate glucagon secretion and slow gastric emptying. AE: avoided in pts with renal insufficiency, sever GI disease, or gastroparesis, reports of pancreatitis. dizziness, diarrhea, GI upset, headache, GERD, hypoglycemia. SubQ administration twice daily. not an insulin substitute. 1% reduction in A1C
56.ezetimibe hyperlipidemia. inhibits GI cholesterol absorption, decreases LDL. ADEs: HA, myalgia, hepatic dysfunction, GI disturbances. Caution in hepatic
insufficiency, increases ALT/AST with statins, may increase cyclosporin levels
57.Fenofibrate hypertriglyceridemia. increased VLDL catabolism, increased formation of HDL. Derivative of fibric acid = fibrates.
58.Flecainide class 1 c - atrial arrhythmias and refractory ventricular arrythmias. ADR: may worsen arrhythmias, 16% report visual
disturbances, diplopia and blurred vision. oral.
59.Flunisolide/Fluticasone chronic asthma maitenance. decrease inflammation and edema in the respiratory tract. enhance sympathomimetic bronchodilator activity. usually does not cause systemic corticosteroid effects. increased risk of oral candidiasis. oral inh and oral. blurred vision, change in IOP
60.Fluoroquinolones inhibitiion of DNA gyrase which interferes with bacterial reproduction.effects are bacteriocidal. most are broad spectrum. ciprofloxin, gatifloxacin, moxifloxacin. bacterial
conjunctivitis - use for 7 days. corneal ulcers or keratits - use for 5 to 14 days. Cross allergy between all drugs. may cause white
precipitate of active drug at the site of epithelial defect. renal dose adjustments. photosensitivity, burning/stinging sensation, blurred vision, eye redness and irritation, eye pian, FB sensation, tearing, dry eye. potential caution when taking with blood thinning meds.
62.Glyburide/Glipizide/Glimepiride treatment of type 2 diabetes. sulfonylurea agent to stiumulate acute release of insulin from functional beta cells. may increase insulin
sensitivity in cell targets. AE: hypoglycemia, wt gain, hepatic and renal complications, blood dyscrasias, GI
disturbances, headache, increased cardiac risk. Pt monitored for hepatic and renal function -doses reduced in elderly pts. blurred vision and changes in
accommodation, best effect as monotherapy 1.5% reduction in A1C 63.Glycosides - digoxin used for CHF, atrial
fibrilation, atrial flutter. inhibits Na/K ATPase pump and increases CA influx for inotropic support. increases diuresis by increasing renal perfusion. slows ventricular rate in atrial fibrillation by increasing sensitivity of AV nodes to vagal inhibition. ADRs: Gi signs, dizziness, lathargy, blurred or yellow vision. low potassium levels. caution in renal impairment.
64.Heparin prevention and treatment of venous thrombosis, treatment of pulmonary emboli, acute coronary syndrome, PCI. used during renal dialysis and open heart surgery to prevent clotting. potentiates antithrombin III and inactivates thrombin and clotting factors to prevent conversion of fibrinogen to fibrin. IV or SubQ administration. metabolized hepatically, dosage is regulated and titrated based on PTT results. ADEs: bleeding, necrosis, thrombocytopenia, hematoma. bleeding risk increased when used with aspirin, NSAIDS, anticoagulants. antibiotics can increase effects. doxy and tetra cyclines and some antihistamines can decrease anticoagulant effects. effects reversed by protamine.
65.HMG-CoA Reductase Inhibitors -Statins
hyperlipidemia. inhibit cholesterol synthesis, decreased concentration of cholestoral in hepatic cells, decreases LDL. ADEs: myalgia, diarrhea, rhabdomyolysis, HA, rash, GI upset, dizziness. increased risk of hepatotoxicity and rhabdomyolysis with some other lipid lowering drugs. blurred vision, cataract formation, extraocular muscle movement impairment, and ophthalmoplegia have been reported. most reduction in LDL, some increase in HDL. Decreases triglycerides. 66.Homatropine cycloplegic/mydriatic for refraction, treatment
of acute uveal inflammation. ADE - blurred vision, photophobia, local irritation, increased IOP. goes to muscarinic receptor
67.Ibandronate/Risendronate prevention and treatement of post menopausal osteoporosis. Risedronate treats all kinds. biophosphonate drug which decreases the rate of bone reabsorption, leading to indirect increase in bone mineral density. AE: possible serious GI side effects, possible severe muscle, joint and bone pain, osteonecrosis of jaw, atypical femur fractures. Oral/IV dosage. avoid oral in pts who cant sit upright for 60/30 mins. food decreases absorption. iritis, ocular irritation, scleritis, and uveitis for ibandronate.
7% incidence of cataract formation for risendronate. 68.Ibutilide Class III - atrial fibrillation and
flutter. ADR: may worsen arrhythmias. inpatient IV med. parenteral form only
69.inhibition of cell wall synthesis penicillins, cephalosporins, vancomycin, daptomycin 70.inhibition of DNAgyrase or polymerase fluoroquinolones 71.inhibition of nucleic acid
synthesis/replication
sulfonamides, metronidazole, tinidazole
72.inhibition of protein synthesis via inhibition of ribosomal subunit transcription/translation macrolides/ketolides, tetracyclines, glycylcylines, daptomycin, quinu/dalfo, aminoglycosides, clindamycin, linezolid
73.Insulin Aspart onset in 5 to 10 min, peak 1-3 hours, lasts for 3-5 hr
74.Insulin Glulisine 10-15 minute onset, peak at 55 min, duration 3-5 hours 75.Insulin Lispro onset in 15 min, peak within
0.5-1.5 hr, duration 4-5 hours 76.intermediate acting drugs
for diabetes
NPH - onset 1-2 hours, peak after 6-14 hours, duration 18-24 hours
77.Ipratropium/Tiotropium bronchospasm associated with COPD in adults - tio for maitenence use. Muscarinic antagonist, reverses ACh induced bronchospasm. cough, dry mouth, and blurred vision can occur. INH form only. Tio once daily, longer lasting. Ipra every 6 hours. Caution in NAG 78.Isosorbide/mononitrate
- extended release preps
angina prophylaxis. reduces cardiac preload by vasodilation and relieves stress on cardiac wall. ADEs: HA, flushing, orthostatic hypotension, tachycardia, peripheral edema, dizziness, N/V, blurred vision. avoid with phosphodiesterase inhibitors.
79.Levothyroxine hypothyroidism - supplementa, thyroxine (T4) - converted in the peripheral tissues to T3
(triiodothyronine) AE: dose related. chest pain, diarrhea, leg cramps, appetite change, fast/irregular heart rate, tremor, headache, irritability, insomnia, change in sensitivity to heat. slow increase in dosage helps to prevent adverse effects. food, calcium, aluminum decreases absorption. preffered treatment with predictable effects. effects of therapy may take months 80.Lidocaine class 1B - ventricular arrhythmias
only. ADR: CNS stimulation, paresthesia, disorientation, siezures, coma, diplopia and visual changes. used parenterally as IV push or drip. local and topical anaesthetic.
81.Liraglutide type 2 diabetes, increases glucose dependent insulin secretion, decreases inappropriate glucagon secretion, slows gastric emptying increases B cell growth & replication.Glucagon like peptide receptor agonist. Thyroid tumor warning, pancreatitis warning. can cause N/V/D/C, headache, hypoglycemia, rash, and renal problems. SubQ once daily. weight loss. 1% reduction in A1C, not recommended as first line therapy or type 1.
82.long acting drugs for diabetes
removes glucose spikes near meals.
Insulin Glargine - slow release over 24 hours, no peak, lasts 24 hours
Insulin Detemir - slow release over 24 hours, peak after 6-8 hours, lasts 12 - 24 hours depending on dose per rate
83.Loop diuretics
furosemide, torsemide. treatment of edema, CHF, hypertension, hypercalcemia. inhibits electrolyte reabsorption in ascending loop of Henle. decreases K and Mg, increased blood glucose levels and uric acid, ototoxicity. blurred vision. used in pts with low GFR, can be used with other drugs in hypertensive crisis. cross reactivity with sulfa.
84.Macrolides inhibit protein synthesis by binding to 50S ribosomal subunit. activity against some gram positive backteria (strep, listeria) but resistance is an increasing problem. gram negative (niesseria, catarrhalis, influenzae, legionella). good for mycoplasma, chlamydia, rickettsia, and clostridia (not deficile). azithromycin - eyelid infections and chlamydial eye disease. azi doesnt need to be dose adjusted for renal, clarithromycin and erythromycin should be adjusted. hepatits, jaundice, renal complications, GI effects, ototoxicity, allergic reactions. caution with blood thinning meds. monitor for appearance of super infection.
85.Metformin treatment of type 2 diabetes - combo drug with glyburide, glipizide, lina-,saxa-, sita, alogliptin, pioglit, rosiglit, repaginide, canagliflozin. potentiates the effect of endogenous insulin. may work by decreasing hepatic glucose production and improving insulin sensitivity. (doesnt promote secretion).
AE: N/V/D, flatulence, rash, weakness, hypoglycemia, lactic acidosis, myalgia, blood dyscrasias, chest discomfort.
caution with other drugs because of hypoglycemia. Drug usually discontinued in renal dysfunction. med held before surgeries and use of contrast media. Best effect is 1-2% reduction in A1C.
86.Mexiletine class 1 B - ventricular only. ADR: may worsen arrhythmias, hepatic ADEs, CNS effects, blurred vision, nystagmus. oral only.
87.mixtures of
intermediate/rapid acting diabetes drugs
humalog mix - 75% insulin lispro protamine/25% insulin lispro onset under 30 minutes, peak 1-6.5 hours, duration up to 24 hours Novolog - 70% insulin aspart protamine/30% insulin aspart. onset under 30 minutes, peak 1-4 hours, effective 15-18 hr, up to 24 hours
88.mixtures of
intermediate/short acting diabetes drugs
humulin - 70% NPH/30% regular. Novalin - 70% NPH/30% regular onset after 30-60 minutes. peak 1.5-16 hours. effective 10-16 hours, max up to 18-24 hours
89.MOA hormone that controls the storage
and metabolism of carbohydrates, protein, and fats. subsitutes for endogenous insulin in patients with type 1 diabetes, possibly type 2. AE: hypoglycemia, weight gain, and rarely edema and
lipohypertrophy. 90.Monoamine oxidase
inhibitors
prevent NE biotransformation. 91.Montelukast chronic asthma
prevention/maitenance. leukotriene receptor antagonist, HA, GI puset, increase in liver enzymes. new CNS/psych warnings. PO forms, once or BID. increase in respiratory infections in elderly.
92.Nateglinide/Repaglinide (combo w/ met)
type 2 diabetes. stimulates the release of insulin from functioning beta cells. meglitinide derivative. AE: hepatic function impairment, hypoglycemia, upper respiratory infections, blood dyscrasias, blood pressure changes, cardiac complications. Not used as monotherapy. take with or 30 min prior to meal. meds which increase blood glucose levels may lessen the efffects
93.Niacin (combo w/ statins)
hyperlipidemia. may reduce VLDL synthesis and increase VLDL catabolism. Increase HDL. ADEs: HA, itch, flushing, peptic ulcer disease, impair glucose tolerance, increase insulin resistence, increase uric acid, hepatotoxicity. blurred vision, cystoid macular edema, toxic amblyopia. Ethanol can impact liver/HA, flushing. caution with anticoagulants and statins.
94.Nitrogylcerin sublingual tablets, patches, IV - acute angina, prophylaxis, unstable angina, heart failure, MI. reduces cardiac preload by vasodilation and dilates large myocardial arteries. relieves stress on myocardial wall. ADEs: HA, flushing, orthostatic hypotension, tachycardia, peripheral edema, N/V, blurred vision. avoid with
phosphodiesterase inhibitors. 95.Oral acyclovir and
valacyclovir
herpes zoster. inhibit DNA replication. cross sensitivity occurs. can cause renal failure. ADEs: blood dyscrasias, coagulation problems, hepatic complications, severe skin reactions, visual changes, GI disturbances, headache, encephalopathy, agitation, confusion, dizziness, myalgia,
parethesias, liver function. use with caution and monitoring.
96.Osmotic diuretics mannitol. uses in acute glaucoma, diuresis, reduce intracranial pressure, reduce renal toxicity with some chemo drugs. osmosis effects to inhibit Na and water absorption. ADR: headache, N/V, dehydration, dizziness. can cause blurred vision. used more for PCOL actions than diuretic. cross reactivity with sulfa.
97.Parasympatholytics that act on
muscarinic receptors
atropine, scopolamine, homatropine, oxybutinin, flavoxate, tolterodine, benztropine
98.Penicillins inhibit bacterial cell wal synthesis, inhibit bacterial enzymes which assemble peptidoglycan and activate autolysis. bacteriocidal
99. Phenylephrine induces mydriasis but not cycloplegia. mydriasis prior to ocular surgery. non prescription strength to relieve eye redness but shouldn't be used longer than 72 hours. caution if used w/i 21 days of MOA inhibitor. ADEs: increased BP, headache, dizziness. a1 adrenergic receptors -sympathomimetic. 100.Pioglitazone (combo w/ met, glimepiride, alogliptin)
treatment of type 2 diabetes. decreases insulin resistance at peripheral sites and in the liver. AE: caution in pts with edema or heart failure due to fluid retention. avoid in hepatic impairment. can cause edema, wait gain, induce CHF, tooth disorders,
headache, myalgia, sinusitis, anemia, newer bladder cancer warning. can contribute to hypoglycemia with other drugs. rare reports of decreased VA, macular edema. 0.5-1.4% reduction in A1C. used in monotherapy and in combo 101.Polymyxin
and Bacitracin
bacterialcidal agent that works by binding to cytoplasmic membranes, disrupting the structure and altering membrane
permeability. mostly against gram negative bacteria. Bacitracin works by binding to bacterial cell membranes and interfering with cell wall synthesis - gram +. not for long term treatment. local adverse effects 102.Potassium
Sparing Diuretics
spironolactone, amiloride, triamterene. treatment of edema, hypertension, cirrhotic ascites, CHF. promotes Na excretion, spares K. Spiro antagonizes aldosterone.ADR: hyperkalemia possible, Na or water depeletion. other than spiro, not as effective as other diuretics when used alone.
103.Pramlintide type 1 and type 2. slows rate of food absorption, modulates gastric emptying. helps prevent post meal rise in blood glucose and increases satiety. synthetic analog of amylin. AE: Severe hypoglycemia with insulin. N/V, abdominal pain,
arthralgia, cough, headache, hypoglycemia, fatigue, dizziness. SubQ administration prior to meals. Contraindicated in pts with gastroparesis.
104.Procainamide class 1A - atrial and ventricular
arrhythmias. ADR: can cause arrhythmias, V/B, allergic rxns, hepatic and renal ADEs. BBW: lupus like syndrome, blood
dyscrasias. interacts with macrolides, quinolones, prolong QTc. metabolized to NAPA (class III). oral and parenteral forms available.
105.Propafenone class 1c - atrial or ventricular arrhythmias. ADR: may worsen arrhythmias. blurred vision. oral only. 106.Propranolol/Metoprolol class 11 - sinus
tachycaardia, atrial arrhythmias. oral and parenteral form.
107.Propylthiouracil/Methimazole hyperthyroidism - inhibits synthesis of thyroid hormone within thyroid gland. AE: fever, blood dyscrasias, skin rash/itch, arthralgia, peripheral neuropathy, dizziness, loss of taste, N/V, stomach pain, renal and hepatic
complications. Watch for bleeding episodes. given in divided doses every 8 hours.
108.Rapid acting drugs for diabetes
take in relation to meal. -log. insulin aspart, insulin ispro, insulin glulisine, regular
109.Regular insulin onset 30-60 min, peak after 2-4 hours, onset 5-7+ hours
110.Rivaroxaban/Apixaban prevention of post operative thromboemboli, prevention of stroke and emboli in patients with non-valvular atrial fibrillation, treatment of DVT/PE. inhibits platelet activation and fibrin clot formation by inhibiting factor Xz. oral tablet renal adjustment or avoidance with severe liver
impairment. ADEs: bleeding, GI upset HA. BBW: premature stoppage results in spinal epidural hematomas. NSAIDS, aspirin, some herbs, macrolid antibiotics and other antiplatelet agents may increase anticoag effect. estrogens may decrease anticoag effect.
111.Salmeterol (combo w/ fluticasone)
maitenence in chronic asthma, COPD. long acting B2 adrengergic receptor agonist. ADE: vasodilation, tachycardia, palpitations, tremor, CNS stimulation, nasopharyngitis, HA, cough. Asthma related death and increased hospitalization. INH form only -powder. BID - duration is 12 hours. Not for acute attacks.
112.Scopolamine cycloplegia and mydriasis. used
transdermally to prevent N/V. associated with xerostomia, confusion, increased body temp, facial flushing, urinary retention, tachycardia. contraindicated in NAG. goes to muscarinic receptor - . parasympatholytic 113.selective
alpha adrenergic antagoists -hypertension
prazosin, doxazosin. competitve blockade of alpha 1 receptors. hypertension, dox for BPH. orthostatic hypotension, vision abnormalities (blurred vision), conjunctivitis
114.Sitagliptin/Saxagliptin/Linagliptin (w/met)
type 2 diabetes. inhibits
dipeptidylpeptidase, and enzyme that breaks down incretin hormones. increases in incretins leads to a rise in insulin levels and a corresponding decrease in blood glucose levels. use with caution in pts with renal dysfunction, monitor for appearance of pancreatitis. can contribute to hypoglycemia. weight gain, upper respiratory tract infections, sore throat, diarrhea, headache rash - sitagliptin abdominal pain, peripheral edema, UTI - saxagliptin linagliptin - type 1 or type 2
115.Sotalol Class III - used for
ventricular tachycardia. ADE: proarythmia, fatigue, dyspnea, visual disturbance in 5% of pts. BBW: renal impairment. interacts with macrolides, quinolones, prolong QTc. oral form only. and racemic mixture.
116.Sulfonamides static - structural analogs of PABA that inhibit bacterial enzyme that forms folic acid. bacteria cant synthesize amino acids and DNA. broad spectrum. some resistance.
Sulfamethoxazole and trimethoprim may be very effective against MRSA. used for bacterial conjunctivitis, trachoma, chlamydial. causes stinging/burning, cross reactivity with other sulfa drugs. dermatologic rxns from swelling to hives and rash. 117.sympatholytics - a1 prazocin, terazocin
118.sympatholytics - a2 none
119.sympatholytics - b1 beta blockers like atenolol that are cardioselective 120.sympatholytics - b2 none 121.sympatholytics -nonselectively on a receptors phentolamine 122.Sympathomimetics acting on a2 adrenergic receptors
inhibit NE release in CNS - clonidine, guanfacine, guanabenz
local vasoconstrictive effects -naphazoline, oxymetazolone 123.Sympathomimetics that act on a1 adrenergic receptors phenylephrine, pseudoephrine 124.symptholytics -non selective
non cardio selective like propranolol 125.Systemic
corticosteroids
acute asthma and COPD
exacerbation. decrease inflammation and edema in respiratory tract, enhance sympathomimetic bronchodilator activity. Na+/water retention, elevate blood glucose, can alter electrolytes, GI irritation, CNS effects. blurred vision. IOP changes. PO/IV/IM administration. acute situations, not controlled with bronchodilators. taper as soon as possible to avoid adrenal suppression. increases IOP, PSC, caution in
126.Teriparatide for pts with high risk of fracture; treatment of post menopausal, glucocorticoid induced, treatment of primary or hypogonadal in men. parathyroid hormone analog, stimulates osteoblast function and can increase bone mineral density, mass, and strength. increased risk of osteosarcoma. dont use longer than 2 years. subQ. Ocular ADEs - lacrimation and vitreous detachment.
127.Testosterone male hypogonadism, delayed male puberty. promotes growth and development of male sex organs in delayed male puberty, maintains
secondary sex characteristics in androgen deficient males. AE: deep vein thrombosis, CNS changes, hirsutism, rash, pruritis, appetite and weight changes,
hyperlipidemia, prostatic hyperplasia, prostatic carcinoma, liver dysfunction, anemia, increased HgB, increased SCr. Injectable forms, topical patches, pallets, gels. Virilization of persons following secondary exposure. Lacrimation, vitreous detachment.
128.Tetracyclines inhibit bacterial protein synthesis by binding to 30S ribosomal subunit. bacteriostatic effects against some gram positive. relaible against listeria. some gram negative like neisseria and legionella. mycoplasma, chlamydia and rickettsia. doesnt work against c. difficile.
photosensitivity, GI effects (pseudomonas colitis, N/V, abdominal pain) pancreatitis, hepatic effects. avoid use in pregnancy and children
129.Thiazide diuretics
hydrochlorothiazide, metolazone, chlorthalidone. for edema, hypertension, CHF. inhibits Na and Cl reabsorption in distal renal tubule. ADR causes loss of Na, Cl, K, and other electrolytes. increases blood glucose, cholesterol and uric acid levels. decreases urinary ca. transient myopia. caution in pts with diabetes, history of gout, hypercholesterolemia. allergic cross reactivity with sulfa. 130.Tricyclic
antidepressants
prevent NE reuptake
131.Trifluridine herpes simplex keratitis and
keratoconjunctivitis. incorporating in place of thymidine into viral DNA weakening its ability to infect tissue. kept refrigerated. can cause hyperemia, epithelial keratopathy, increased IO{P, dry eye, irritation. can cause
burning/stinging with application 132.Vasodilators
- isosorbide, dinatriate, hydralazine
treatment of CHF, angina. increases venous capacitance/decreases preload. hydralazine decreases systemic arteriolar resistance, decreases afterload. parenterally in decompensated CHF
133.Verapamil Class IV - atrial flutter and tachycardia, PSVT. ADE: gingival hyperplasia, constipation, headache, plured vision, rotary nystagmus <1%. several possible interactions, macrolides and azole antifungal decrease metabolism, rifampin decreases serum levels. PO and pareteral form.
134.Warfarin used for DVT, atrial fibrillation, pulmonary emboli. after heart valve replacement and in some pts with rheumatic or ischemic heart disease. interferes with hepatic synthesis of vitamin K (antagonizes). administered orally, highly protein bound, long half life,
metabolized hepatically. ADEs: bleeding, necrosis, GI upset. Effects reversed by use of vitamin K
135.Warfarin drug interactions
NSAIDS, aspirin, several antibiotics, heparin and other drugs can increase bleeding risk. increased intake of green leafy veggies (high in vitamin K) decreases effect
136.which diuretics cause transient myopia?
thiazide, carbonic anhydrase inhibitors. administered parenterally. 137.Which meds have BBW for causing spinal epidural hematomas?