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pharm final

Terms in this set (59)

drug of choice for pulmonary edema
morphine
effect of opioids on the pupils
pinpoint pupils
what is the diacetyl derivative of morphine with enhanced capacity to enter the CNS?
heroin; schedule 1 drug
What is the use for methadone?
given orally for replacement therapy in patients addicted to heroin; due to its long duration it does not produce the peaks and valleys of responce
Repeated injections of this are used for reversal of opioid overdose
naloxone
This does not cross the BBB and is used in opioid-induced constipation, 1-2 hr duration of action given through IV
naloxegol
K agonist with weak mu antagonist property; major effects on CNS and GI; schedule IV drug
pentazocine
half life of methadone
24 hrs
what is the cause of many of the adverse effects of TCA's?
they bind to a-adrenergic, histaminergic, and cholinergic receptors
anticholinergic effects
Anti-SLUD (anti salivation, lacrimation, urination, defecation)
TCA's
imipramine, amitriptyline
SSRI's
fluoxetine, paroxetine, citalopram, sertraline
SNRI's
venlafaxine, duloxetine
more useful in patients with anxiety
DNRI
bupropion
What is used for suicidal refractory depression?
NMDA anatogonists- esketamine(nasal spray)
MOA of NMDA receptor antagonists
increases BDNF rapidly to relive depression in minutes/hr and inc dopamine in the brain
what are the two types of side effects caused by antipsychotic agents?
Extrapyramidal (EPS) and Neuroleptic malignant syndrome (NMS)
Early/middle onset EPS side effects of chlorpromazine (antipsychotic agent used for schizo)
pseudoparkinsonism, acute dystonia, akathisia
late-onset EPS side effects of chlorpromazine
tardive dyskinesia, tardive dystonia, tardive akathisia
neuroleptic malignant syndrone
due to dopamine blockade; characterized by hyperthermia, muscular rigidity, autonomic instability, and altered consciousness
treatment of NMS
muscle relaxant and dopamine antagonist
atypical (non-traditional) antipsychotic agents
risperidone, quetiapine, olanzapine, aripiprazole
What is the most effective AED against tonic-clonic and partial seizures?
phenytoin; also carbamazepine
phenytoin
Given PO(crummy) and IV; highly PP bound, MOA through Na+ and Ca++ channels, has antiarrhythmic activity
why does phenytoin have many interactions?
it is a potent inducer of many liver enzymes
Drug of choice for absence seizures?
Ethosuximide

PO, metabolized through liver, reduces the low-threshold calcium current in neurons, reduces discharge from thalamic neurons
What is the broadest spectrum AED?
valproate
uses of valproate
absence seizures, atypical absence seizures, migraines, bipolar disorder
Gabapentin MOA
does not act on GABA receptor; binds to calcium channels to downregulate neurotransmission
AED's
phenotoin, ethosuximide, carbamazepine, valproate, gabapentin, and lamotrigine
aspirin is rapidly absorbed and converted to what?
salicylic acid
why are platelets particularly sensitive?
they do not have the capability to synthesize new cyclo-oxygenase
major disadvantage of salicylates?
aspirin interferes with the ability of the gastric mucosal cells to resist penetration by acid and lead to gastric irritation and distress
phenylpropionic acid derivatives
ibuprofen, naproxen, ketoprofen
what does methotrexate inhibit?
dihydrofolate reductase
where does insulin function?
liver, muscle, adipose
what does insulin do?
promotes growth and storage of energy and stops depletion of energy stores
how often is long-acting insulin administered?
once a day to maintain basal level of insulin in circulation
what does insulin therapy lead to?
decreased glycated hemoglobin and dec complicatons of diabetic nephropathy, diabetic retinopathy, and diabetic neuropathy
example of hyperthyroidism
Graves disease
What are the drugs of choice for acid-peptic disorders?
proton pump inhibitors; esomeprazole
inspiration and expiration is dependent on the
atmospheric pressure, intra-alveolar pressure, and intra-pleural pressure
transpulmonary pressure is the difference between the
intra-pleural and intra-alveolar pressures
What is the optimum particle size for drug delivery to the lungs?
1-5um
DPI (dry powder inhalers)
dont require as much coordination with inhalation however can be irritant and not good for children; good for systemic delivery of peptides/proteins
what are nebulizers good for?
acute exacerbation of asthma/COPD or in severe airway obstruction; good for infants
What is asthma characterized by?
decreases in expiratory outflow
What is COPD characterized by?
progressive, largely irreversible airflow, obstruction, characterized by loss of elastic recoil and increased air resistance
Emphysema
the alveolar walls or alveoli are fragmented or destroyed, forming large air spaces that are ineffective in oxygenating or removing CO2 from the blood
COPD treatment
bronchodilators; COPD is often corticosteroid resistant
Do bronchodilators work by affecting the CNS or ANS?
ANS
what is the endogenous ligand for cholinergic receptors?
acetylcholine
are anticholinergic drugs better for COPD or Asthma?
COPD; vagal tone plays a more important role in COPD
systemic side effects of corticosteroids
CUSHINGOID:
Cataracts
Ulcers
Striae, skin thinning
Hypertension, Hirsutism
Immunosupp, Infections
Necrosis of femur head
Glucose elevation
Osteoporosis, Obeisity
Impaired woundhealing
Depression
What protein is responsible for converting arachidonic acid to leukotrienes?
5-lipoxygenase
cells involved with asthma/allergies
mast cells and eosinophils
allegies: binds mast cells to basophils
cells involved with COPD
neutrophil/macrophages
antileukotriene drugs
zileuton and zafirlukast EFFECTIVE ORALLY
anti-histamines for the treatment of allergies should target
H1 receptors
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