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Pharm Block 14
KYCOM Block 14
443
Pharmacology
Graduate
02/19/2014

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Term
what are 2 different ways to say coronary artery disease
Definition
ischemic heart disease
athlerosclerosis of epicardial vessels
Term
when does coronary artery disease begin
Definition
begins early in life, manifests middle aged and beyond
Term
what are 5 manigestations of coronary artery disease
Definition
heart failure
arrhythmia
stroke
peripherial vascular disease
acute coronary artery disease
Term
what are the 4 types of coronary artery disease
Definition
angina syndrome
stable (exercise induced) angina
prinzmetal (vasospastic) angina
unstable angina
Term
what is angina syndrome
Definition
describes variation in manigestation of agonia and its symptoms
Term
what are the symptoms of angina due to
Definition
ischemic pain (angina equlivaents) and accumulation of metabolites in striated muscle
Term
where is the pain in angina from most to least common 4
Definition
anterior chest
left upper arm
left lower arm
neck pain
Term
what causes vasospasm in CAD
Definition
imbalance of oxygen use and delivery
Term
what is stable angina
Definition
when myocardial requirement increases (like exercise0 coronary flow does not increase proportionally causing ischemia and pain
Term
what is prinzmetal angina
Definition
oxygen delivery decreased due to reversible coronary vasospasm
not brought on by exertion or emotional stress not relieved by rest
Term
EKG signs of prinzmetal angina
Definition
ST elevation (injury marker)
Term
cause of prinzmetal angina
Definition
altered vasodilators (NO, prostacyclin) or vasoconstrictors (entothelial, ANG II)
Term
what is unstable angina
Definition
change in stable angina or angina at rest
Term
cause of unstable angina
Definition
increased coronary tone or platelet clots on athlerosclerosis
Term
what is the general approach to angina treatment
Definition
tissue ischemia is thwarted using vasodilator or anti-vasoconstrictor drugs
Term
what is the order of treatment and theory behind each in treatment/prevention of stable angina
Definition
1. BB: decrease myocardial O2 demand
2. CCB: vasodilation decreases coronary/peripherial resistance and heart O2 demand
3. nitrates: venodilation decreases proload and myocardial O2 demand
Term
what are the tx of variant angina
Definition
nitrates: relax coronary vessels, reduces spasm
CCB: relax coronary vessels, reducing spasm
Term
tx of unstable angina
Definition
aspirin, heparin
DOC: nitroglycerin
BB
CCB
Term
what is the tx of angina post MI
Definition
BB
Term
what is the tx of angina with DM
Definition
ACEI
Term
what is the tx of angina with LV dysfunction
Definition
ACEI
Term
what is the tx of angina with CAD or LDL>130
Definition
statins
Term
what is the tx of angina with increased platelets
Definition
aspirin
clopidogerl
pasugrel
Term
MOA nitroglycerin
Definition
converte nitrate ions to NO
activates guanylyl cyclase
increases cAMP
increases protein kinase G
activates phosphatases
dephosphyorlyate myosin light chain
vasodilation
Term
how is notroglycerin different at different doses
Definition
moderate: dilates large veins > pooling of blood > decreases proload

all doses: dilate coronary vessels > increased blood to heart muscle
Term
administration and time of onset of nitroglycerin
Definition
sublingual 2 min
transdermal 12h on 12h off prophylaxis
Term
SE of nitroglycerin
Definition
headache: migraine caused by vasodilation
orthostatic hypotension
reflex tachycardia
rolerance/tachyphylaxis (avoid with 6-8h nitrate free interval)
Term
how is isorbide mononitrate and isorbide dinitrate different from nitroglycerin
Definition
oral administration
longer onset and duration
Term
interactions with nitro drugs
Definition
NEVER COMBINE WITH PHOSPHODIESTERASE INHIBITORS (slidenafil, vardenafil, tadalafil)
causes extreme hypotension and death

erectile dysfunction is common in people with CAD
Term
what 3 BB are used for angina
Definition
propranolol
metoprolol
atenolol
Term
what BB are not good for angina, why
Definition
partial agonists (sympathomimetric) are less efective (pindolol, acebutolol)
Term
MOA of BB on angina
Definition
decrease sympathetic tone, HR, contractability
block B1 receptors
reduce frequency and severity of angina
Term
what are the CCB that work on angina and how
Definition
dihydropyridines: work on vessels, causes reflex tachycardia
verapmil and diltiazem: work on heart (preferred)
Term
MOA CCB
Definition
stop influx of Ca via L-Ca channels which stops calmodulin from turning Ca into Ca-calmoulin so it cannot activate myosin LC kinase and thus cannot cause contraction
vasodilation reduces coronary vasospasm and myocardial O2 demand
also used in raynaud's (vasospasm in cold)
Term
MOA ranolazine
Definition
who knows, dosent reduce HR and BP
Term
use of ranolazine
Definition
adjunct therapy to BB, CCB, nitrates
Term
SE ranolazine
Definition
prolonged QT syndrome (causes torsades)
Term
define diuresis
Definition
increase in urine volume
Term
naturesis
Definition
increase in renal Na excretion and thus water excretion (diuretic)
Term
define diuretic and function
Definition
inhibits ion transport and decreases Na transport in nephron

manage fluid retention (edema), tx HTN
Term
MOA mannitol
Definition
filtered in glomerulus and not reabsorbed
causes osmotic attraction of water (not Na) to tubular lumen
Term
mannitol location of action 3
Definition
mostly loop
PCT, CD
Term
administration mannitol
Definition
IV
Term
use of mannitol
Definition
maintain urine flow during toxic ingestion of substances causing renal failure

reduce increased ICP

lower pressure in acute glaucome

rhabdomyolysis: severe muscle injury to eliminate myoglobin
Term
what are the 6 types of K supplements and their adlministration
Definition
K-DUR: KCl tablets
K-LOR: KCl powder
K-LYTE/CL: KCl tablets
K-TAB: KCl tablets
KLOTRIX: KCl tablets
KAO lectrolyte: fluid and electrolyte replacement
Term
what is KAO lectrolyte made of 6, when is it used
Definition
dextrose, Na, K, citrate, calories, phenylalanine

mild/moderate diarrhea/vomiting
Term
4 causes of edema
Definition
hepatic ascites: accumulation of fluid in abdomen

hyperALD: primary, secondary, decreased ability of liver to inactivate

nephrotic syndrome: glomerular membrane damaged and allows protein through decreasing colloid osmotic pressure

premenstural edema: increased estrogen causes loss of fluid into ECF
Term
causes of hepatic ascites
Definition
cirrhosis causes portal system obstruction and decreased colloid osmotic pressure
Term
what are the drugs that work on the PCT 4
Definition
acetazolamide
brinzelamide
dorzolamide
methazelamide
Term
what are the drugs that work on the loop of henle
Definition
loop diruetics-
bumetanide
furosemide
torsemide
etharcynic acid
Term
thiazide diuretics and analogs 4
Definition
hydrochlorathiazide
chlorthalidone
metazone
indapamide
Term
2 K sparing diruetics
Definition
spironolactone
eplerenone
Term
2 Na channel blockers
Definition
triamterene
amiloride
Term
describe the cells of the PCT
Definition
tall
microvili
basla invaginations
interdigitated borders
Term
explain how the PCT regulates acid/base
Definition
CA changes bicarbonate+H from urine into CO2+H2O which can diffuse into the cell
CA turns it back into bicarbonate+H
H is sent back to urine with Na/H antiporter
bicarbonate uses facillitated transport to enter the blood
Term
other than the pumps for acid base regulation, what other transport is happening in the urine
Definition
Na/glucose, AA, lactate, HPO4 symporter from lumen to blood

Na/K ATPase on blood side

60% of H2O diffuses into blood

organic anions and cations diffuse into urine
Term
what organic anions 3 and cations 3 diffuse into urine in PCT
Definition
diuretics
antibiotics
uric acid

creatinine
procanamide
choline
Term
MOA acetazolamide
Definition
carbonic anhydrase inhibitior makes it so bicarbonate cannot form CO2+H2O and diffuse into the cell causing metabolic acidosis

there isnt enough H to run the Na/H pump so Na also stays in the urine and draws water (Weak diuretic)

Cl is retained in the blood causing hyperchloremia
Term
uses of acetazolamide
Definition
DOC chronic glaucoma

acute mountain sickness prophylaxis

seizure adjunct medicing
Term
how is acute mountain sickness treated, what are the symptoms
Definition
5d prior to ascent

prevents weakness, SOB, dizziness, nausea, cerebral and pulmonary edema
Term
SE of acetazolamide
Definition
hyperchloremic metabolic acidosis
renal stones (basic urine favors CaP)
sulfonamide allergies
hypokalemia
Term
what exchange happens in the thin limbs of the loop of henle
Definition
thin limbs do not participate in reabsorption of Na
they are permeable to water which is impaired by mannitol and glucose
Term
what drugs interact with loop diuretics
Definition
aminoglycocides
digoxin (decreases)
Term
what are the channels of the thick loops
Definition
K/Na/2Cl symporter from urine to cell
K leak channel from cell to urine
Na/K antitiporter from cell to blood
K/Cl symporter from cell to blood

Mg+Ca charge driven transport paracellular from urine to blood
Term
MOA loop diuretics
Definition
stop Na/L/Cl channel causing ion and water retention in ascending loop

increase Ca in urine because when Na/K/Cl transport is stopped there is no K build up and no leak which stops positive charge and Mg/Ca dont diffuse into blood
Term
uses ot loop diuretics 5
Definition
acute pulmonary edema (IV rapid onset, powerful)
CHF
HTN
nephrotic system edema
kidney failure edema
Term
SE loop diuretics 6
Definition
ototoxicity: tinnutis, vertigo, deafness, fullness (worse with amnioglucocides and etharynic acid)

hyperuricemial: WA competes for transport in PCT to stay in urine

acute hypovolemia: severe, rapid, shock, arrhythmia

orthostatic hypotension

hypokalemic acidosis

sulfonamide allergy
Term
what is the most powerful diuuretic
Definition
loop
Term
how much Na is reabsorbed in each portion of nephron
Definition
PCT 50%
loop 40%
DCT 10%
CD 5%
Term
what carbonic anhydrase inhibitors are specific to IOP and used in OPEN angle glaucoma
Definition
brinselamide
derzelamide
methazolamide
Term
why use a thiazide analog
Definition
thizade diuretics dont work GFR <40
Term
describe cells of DCT
Definition
simple cuboidal
impermeable to water
Term
MOA thiazide duiretics
Definition
inhibits Na/Cl co-transporter and has some action on Ca in PCT

increased Na/Cl in urine pulls water

causes K loss because they increase delivery of Na to CD and Na/K channel causes K excretion

this alters balance of Na/Ca exchanger and increases Ca in the blood

decreases TPR and BP which can decrease CP and causes hypotension
Term
uses of thiazides 5
Definition
HTN: decreases TPR wo major diuretic effect
CHF: decreases extracellular edema
edema: CHF, cirrhosis, kidney edema
hypercalcuria: good for CaOxylate stones
nephrogenic DI: cause hyperosmloar urine (act like ADH)
Term
SE of thiazides8
Definition
hypokalemic acidosis

hypercalcemia

orthostatic HTN

hyperlipidemia

sexual dysfunction

sulfonamide allergy

hyperuricemia: WA competes with uric A in PCT

hypoglycemia
Term
why do thiazides cause hypoglucemia
Definition
B cells K channels are normally open
diuretic causes loss of K so they stay open longer and dont make much insulin
Term
what are the 4 transporters in the DCT
Definition
Na/Cl synporter from urine to cell
Ca channel from cell to urine
Na/K ATPase on blood side
Na/Ca antiporter with Na going from blood to cell
Term
how is transport in the DCT regulated
Definition
PTH regulates luminal Ca channels and apical Na/Ca antiporter
Term
why do drugs cause K sparing
Definition
they increase Na before the CD/CT and the concerntration sucks the K into the CD/CT when Na tries to get out in the exchanger
Term
what are the channels on the luminal side of the principal cell 3
Definition
Na into cell
N into lumen
water into cell
Term
what are the channels/pumps on the apical side of the principal cell 2
Definition
Na/K ATPase
H2O ALD controlled channels
Term
what pericellular transport is there in the CD
Definition
Cl from lumen to blood
Term
what are the transporters on the intercalated cells
Definition
ATP pump H into urine
Cl/bicarb antiporter putting bicarb into blood
Term
what is the primary site of H secretion
Definition
intercalated cells of the CD
Term
how does ADH regulate the CD
Definition
opens aquporin channels on apical side of cells
Term
how does ALD regulate the CD
Definition
increases activity in luminal Na and K channels buy increasing activity of Na/K ATPase putting K into urine and Na into blood
Term
MOA K sparing diuretics
Definition
ALD receptor antagonists stimulate Na reabsorption into urine without K loss

spironolactone also blocks androgen receptors
Term
uses of K sparing diuretics 4
Definition
duiretic: low efficacy in Na mobalization

secondary hyperaldosteronism: cardiac failure decreases remodeling, cirrhosis, nephrosis

primary hyperaldosteronism: adrenal adenoma

female histurism: spironolactone only due to androgen blocking
Term
SE K sparing diuretics 6
Definition
spironolactone: P450 inducer and prodrug

spironolactone: gynacomastia in males, irregular menses (never give high dose chronically)

hyperkalemia

nausea, letharty, mental confusion
Term
MOA triametrene and amiloride and use
Definition
block Na channels decreasing Na/K ATPase activity and thus retention of K (does not depend on ALD like spironolactone)

not as effective as diuretic so often combine with other diuretic to save K
Term
SE Na channel blocking diuretics 2
Definition
hyperkalemia
leg cramps (triameterene
Term
define hyperlipidemia
Definition
lipoproteins (plasma lipid complexes) are elevated increasing overall TG in the blood
Term
complications of hyperlipidemia
Definition
acute pancreatitis
athlerosclerosis
Term
types of lipids, their optimal amounts
Definition
APO B-100
LDL <100mg/dl
IDL
VLDL
TG/LP (lipoproteins) <150mg/dl
HDL >60mg/dl
lipoprotein liase
Term
function of APO-B100
Definition
convey lipids to the artery wall
Term
function of HDL
Definition
retreive cholesterol from artery wall and inhibit oxidation of lipoporteins
Term
lipoprotein lipase: location, function, regulation
Definition
on endothelial and adipose cells
hydrolysis of TG on chylomicrons/VLDL
controlled by insulin
Term
what fat regulating enzyme is altered in diabetics? what is the result?
Definition
lipoprotein lipase
decreased insulin causes hypertriglyceridiemia
Term
3 ways lipid levels are altered
Definition
diet and exercise
inherited genetic deficits
pharmacologic intervention
Term
how is plaque formed
Definition
foam cells: transformed macrophages that endocytose lipoproteins and ROS

smooth muscle cells filled with cholesterol esters

atheroma: growth of collagen, fibrin, Ca
Term
treatment of athlerosclerosis outcomes
Definition
can slow regression but can allow migration of inflammatory activity of macrophages
Term
8 risk factors for coronary artery disease
Definition
increased age
family history
smoking
hypertension
obesity
sedentary
DM
high LDL
low HDL
Term
MOA niacin
Definition
inhibits lipolysis in IN ADIPOSE decreasing circulating free Fa providing liver with less raw materials to make TG and thus VLDL
Term
overall what fats does niacin raise and lower
Definition
lower: VLDL, LDL, cholesterol, TG
raises: HDL (great extent)
Term
use of niacin 3, why
Definition
tupe IIB, III, IV hyperlipoproteinemia (elevation of VLDL and LDL)
Term
niasin: administration, excretion
Definition
oral
urine
Term
SE niacin 3
Definition
cutaneous flushing and warmpth (reduce with aspirin)

puritis (limits use)

gout/hyperuricemia: inhibits tubular secretion of uric acid
Term
what are the 3 fibrate drugs
Definition
gemfibrozil
fenofibrate
fenofibric
Term
MOA fibrates
Definition
ligands for nuclear transcription receptor peroxisome proliferation activated receptor alpha (PPAR-a)

upregulate lipoprotein lupase and down regulate APO CIII (lipolysis inhibitor)
Term
overall what fats do fibrates raise and lower
Definition
lower VLDL, TG
Term
use of fibrates
Definition
hypertriglyceridemia (decreases TG)
Term
administration of fibrates
Definition
completely absorbed orally
Term
SE fibrates
Definition
N/V (lessens over time)
lithiasis/malignancy (gelfibrozil): gall stones and hepatobilliary neoplasms

muscle: myositis (inflammation of skeletal muscle)
Term
interactions with fibrates
Definition
warfarin (compete for binding on plasma proteins increasing warfarin effects)
Term
3 bile acid binding resins
Definition
cholestryamine, colespipol, colesevelam
Term
MOA bile acid binding resins
Definition
cationic resin binds negative bile salts and interrupts enterohepatic cycle

bile salts excreted in feves and more cholesterol must be used to replace them so the cells upregulate LDL receptors to pull more cholesterol in
Term
use bile acid binding resins 3
Definition
type IIa and IIb hyperlipidemias
often in combination with diets and statins
Term
bile acid binding resins: administration, distribution
Definition
oral
not absorbed
Term
SE bile acid binding resins
Definition
GI: constipation, nausea, flatulence (lessens over time)

absorption: decreased in absorption of fat soluble vitamins, ascorbate, folate
Term
interactions with bile acid binding resins
Definition
tetracycline, phenobarbitol, digoxin, warfarin, aspirin, statins, thiazides

interacts with most drugs absorption so takes 1-2h before 4h after this drug

chloride salts: hyper chloremic metabolic acidosis
Term
6 HMG-CoA Reductase inhibitors
Definition
paravastatin
sinvastatin
atorvastatin
fluvastatin
lovastatin
rosuvastatin
Term
MOA HMG-CoA reductase inhibitor
Definition
HMG-CoA is first enzyme and rate limiting step in sterol synthesis converting 3-hydroxy-3-methylglutarate into cholesterol

inhibition of HMG-CoA reductase: depletes intracellular supply of cholesterol

decrease in LDL and increase in LDL receptors: depletion of intracellular cholesterol causes increase in hepatocyte LDL receptors which picks up more LDL from plasma

increased plasma HDL: decrease risk of coronary artery disease (esp atrovastatin)
Term
pharmacokinetics of HMG-CoA reductase inhibitors
Definition
atorvastatin/sinvastatin: first pass removes 50%
excretion in bile and feces
Term
SE HMG-CoA reductase inhibitors
Definition
liver and muscle: evaluate function every 6mo (minor effects in 5y trial)

teratogenic, contraindicated in teens and kids

diminish visual activity (lens is 50% cholesterol)

less inclined to form osteoperosis
Term
interactions with HMG-CoA reductase
Definition
increase warfarin levels (evaluate prothrombin time frequently)
Term
MOA rosuvastatin
Definition
superstatin HMG-CoA reductase inhibitor (same MOA/SE)
lowers LDL 50% more effective
raises HDL 14% more effective
Term
MOA ezetimibe
Definition
sometimes in combo with simvastatin
blocks absorption of cholesterol in SE
decreases cholesterol by 15% (50% in combination with statins)
Term
SE ezetimibe
Definition
low SE profile
Term
what are the 3 categories of psychomotor stimulants
Definition
methylaxanthines
nicotine
amphetamines
Term
what 2 drugs are methylaxanthines
Definition
caffiene
throphylline
Term
what 8 drugs are amphetamines
Definition
sodium oxybate
modafinil
cocaine
ephedrine
methamphetamine
phentermine
deotroamphetamin
Term
what 3 drugs are used for the same purposes as amphetamines but are not amphetamines
Definition
sibtramine
amoextine
quanfacine
Term
what 2 drugs are methylaxathines
Definition
caffeine
throphylline
Term
MOA nicotine
Definition
stimulates nicotinic receptors in CNS causing depolarization
Term
SE nicotine 6
Definition
euphoria
arousal
improves attention
learning
problem solving
reaction time
Term
where is nicotine absorbed 5
Definition
oral mucosa
lungs
GI mucosa
skin
Term
where is nicotine distributed
Definition
lipid soluble so everywhere
Term
where is noctine metabolized 2
Definition
lung
liver
Term
how is nicotine used in medicine
Definition
smoking cesation
Term
MOA amphetamines
Definition
release of biogenic amines (NE, D, SE) from storage sites in nerve terminals

may interfere with re-uptake of NT into neurons
Term
aphmetamines absorption
Definition
absorbed well orally
Term
amphetamines metabolization
Definition
catabolic pathway
excreted in urine
possible Fe trap of weak base
Term
dopamine SE of amphetamines 4
Definition
increased alertness
decreased fatigue
decreased appetite
insomnia
Term
CNS SE of amphetamine OD 8
Definition
restlessness
tenseness
irritability
weaness
insomnia
confusion
delirium
paranoid hallucinations
suicdal/homicidal
Term
CV SE amphetamine OD 6
Definition
headahce
palpitation
arrhythmia
HTN
circulatory collapse
sweating
Term
what organ systems are affected in amphetamine OD 3
Definition
CV
Cns
autonomic - sweating
Term
why are amphetamines abused 2
Definition
tolerance develops to anorexia and wuphoria
psychological dependence with chronic use
Term
why are amphetamines used in medicine 2
Definition
nacrolepsy: uncontrollable desire for sleep
ADHD: hyperactivity in children
Term
SE detroamphetamin
Definition
less central effects
more peripherial effects
Term
SE methamphetamine
Definition
more central effects
less peripherial effects
less euphoria and CNS effect
Term
MOA methamphetamine
Definition
piperdine amphetamine derivative
Term
USE methamphetamine
Definition
narcolepsy
ADHD
Term
MOA phentermine
Definition
acts on adrenergic and dopamine pathways (similar to aphetamine)
Term
USE phentermine
Definition
short term behavorial modification, with diet and exercise in obese (3wk)
Term
SE/interactions with phentermine 2
Definition
contraindicated with CV issues
HTN crisis with MAOI
Term
MOA epherdine
Definition
a and b adrenergic antagonist, enhances NE release
Term
USE ephdrine
Definition
OTC asthma preps
Term
MOA cocaine
Definition
block reuptake of dopamine by inhibiting NT in pre-synaptic neuron
Term
Modafinil MOA
Definition
similar properities to amphetamine
wea dopamine reuptake inhibitor
Term
USE modinifil 2
Definition
narcolepsy
high dose for ADHD
Term
SE modinifil 3
Definition
psychoactive
euphoric
SJS
Term
MOA sodium oxybate
Definition
unspecific CNS depressant
Term
USE sodium oxybate 2
Definition
narcolepsy
cataplexy: muscle weakness
reduces attacks (take at bed time 2.5-4h after falling asleep)
Term
SE sodium oxybate 4
Definition
depression
bedwetting
sleep walking
abuse potential
Term
MOA sibutramine
Definition
inhibits re-uptake of NE and SE and interacts with receptors causing hunger
Term
USE sibutramine
Definition
obesity management
Term
contraindications and interactions with sibutramine 7
Definition
HTN
CV disease
stroke
glaycoma
renal/hepatic disease
cardiac valve disorders
interaction - MAOI
Term
MOA amoextine
Definition
re-uptake inhibitor of NE and SE
Term
USE amoextine
Definition
ADHD
Term
SE amoextine 2
Definition
suicide
liver disease
Term
MOS qhanfacine
Definition
agonist at post synaptic a-2A adrenergic receptors
Term
contraindications quanfacine
Definition
caution with cardiac problems
Term
what are the two main sources of caffiene
Definition
coffee- coffea arbica
cola - cola acuminate
Term
how much caffiene is the effective oral dose, what 3 symptoms
Definition
85-150mg
increased alertness
loss of fatigue
better attention
Term
how much caffiene is OD, what are 3 signs
Definition
>200mg
nervousness
restlessness
tremors
Term
throphylline source
Definition
thea sinesis leaves
Term
MOA throphylline
Definition
phosphodiesterase inhibitor increases cAMP
adenosine A1/2 receptor antagonist
increases neurotransmission amplifying cyclic nucleotide second messengers
Term
where is throphylline absorbed 3
Definition
oral
rectal
parentral
Term
where is throphylline metabolized and how 2
Definition
liver
demythlation
oxidation
Term
wht is throphylline used for, how is it dosed
Definition
high dose: seizure refractory to anti-convulsants
any dose: stimulates resporation, N/B, increase CP and HR (lessens with repeated use)
Term
what is the initial effet of low dose alcohol
Definition
stimulant due to supression of inhibitor systems
Term
what is the effect of high dose alcohol (non chronic) 3
Definition
sedation
impairs recent memory
causes black outs
Term
what is the effect of heavy alcohol consumption on the body 9
Definition
toxic to liver, CV disease, endocrine, GT, malnutrition, CNS dysfunction

tolerance, physical dependence, withdrawl
Term
how much alcohol does it take to be dangerous in the presence with another CNS depressant
Definition
respiratory depression occurs at 200-300mg/dl so at this time
Term
how much alcohol does it take to be dangerous even without another CNS depressant
Definition
>300mg/dl
unconcious
severe respiratory and CV depression
black outs
Term
what is the highest amt of alcohol recorded consumed without death
Definition
>1200 mg/dl
Term
what what amount of alcohol is driving impaired and when is the person unable to drive
Definition
impaired from 0-100mg
inability from 100mg+
Term
what amount of alcohol will someone stagger
Definition
100-200mg/dl
Term
where does alcohol distribute to in the body
Definition
everywhere
even CNS (fetal alcohol syndrome)
Term
explain the metabolism of ethanol
Definition
liver > alcohol DH turns it into acetaldehyde
acetaldehyde DH turns it into acetate
acetate goes to tissues and is odidized into CO2 and water
Term
explain excretion of ethanol
Definition
varies with genetic mix of isoenzymes and blood concentration

leads to limited zero order kinetics metabolism
Term
what do asians ahve a defficiency in
Definition
aldehyde DH
Term
what 3 drugs are used to treat chronic alcoholism
Definition
disulfram
anltrexone
acamprostate Ca
Term
MOA dilsfram
Definition
inhibits ADH and ALDH so acetyaledhyde accumulates
Term
SE dilsulfram 7
Definition
vasodilation
throbbing headache
hypotension
thirst
sweating
CP
vomiting
Term
MOA naltrexone
Definition
opiate antagonist
Term
MOA acamprostate Ca
Definition
in vitro affinity for GABA a and b receptors but dosent share their effects suggesting other MOA

decreases effect of naturally occuring excitatory NT glutamate in the body
Term
SE acamprostate Ca
Definition
decreases plesant high associated with alcohol comsumption
Term
why is ethanol used in medicine, in conjunction with what other procedure
Definition
ethanol competes for ADH and prevents conversion of toxic substances

usually the toxic substance isnt broke down into a toxin and must be removed by hemodialysis
Term
how is methanol broken down in the body
Definition
ADH metablizes it to formaldehyde and formic acid
Term
SE methanol 2
Definition
blindness
severe acidosis
Term
how is ethylene glycol broken down in the body
Definition
ADH metabolizes to glucolic and oxalic acids
causes renal toxicity and severe acidosis
Term
symptoms of parkinsons 9
Definition
50-70yo
15% have family history
bradykinesia: slowness of movement
muscle rigidity: tremor, posture instability
shiffling gait
frequent falls
cognitive impairment
death due to immobility (pulmonary embolism, aspiration pneumonia)
Term
cause of parkinsons
Definition
ROS or diminished antioxidants or both damage nigrostrital dopaminergic area

dopamine can undergo auto-odidative reactions forming H2O2

Fe and H2O2 cause hydroxyl radicals and cellular damage through proteins, lipids, and DNA

MPTP is metabolized to MPP radical which is a neurotoxin causing the disease
Term
how is dopamine nroken down
Definition
AMO degrades into DOPAC and HDO@

H2O2 is broken into OH by Fe or into water by glutathione
Term
chages in the CNS in parkinsons disease
Definition
loss of pigmented dopamine neuronsin substantia nigra (midbrain)

lewy bodies: abnormal cytoplasmic inclusions

loss of nitrostriatal dopamine neurons (no stimulation to D1/2 increases GABA input to cerebral cortex)

increased ACh: dopamine can no longer inhibit release, increased GABA transmission occurs as result
Term
what are the two dopamine receptors and their function
Definition
D1 stimulates direct pathway
D2 inhibits indirect pathway

dopamine acting on either receptor causes excitatory input for the cerebral cortex
Term
what are the 6 categories of parkinsons therapy
Definition
increased dopamine
direct dopamine receptor agonist
dopamine storage uptake/reelease
inhibit MAO-B
anti-cholinergics
inhibit COMT
Term
what drugs increase dopamine 1
Definition
levadopa
Term
what drugs are dopamine receptor agonists 4
Definition
bromoctyptine
perfolide
pramipexole
ropinirole
Term
what drugs are dopaine release/uptake drugs
Definition
amantadine
Term
what drug is a MOA-B inhibitor
Definition
selegiline
Term
what drugs are anti-muscarinic agents 2
Definition
truhexylphenidyl
benzotropine
Term
what drugs are COMT inhibitors 2
Definition
tolcapone
entacapone
Term
MOA levodopa
Definition
meabolic precursor of dopamine
Term
distribution of levodopa
Definition
crosses BBB on active carrier (aromatic AA) so can reach brain but little does
Term
where is levodopa metabolized 3, how
Definition
liver, kidney, GI

formulated with peripheral L-aromatic AA decarboxylase inhibitor (carbidopa)
Term
what are the SE of levodopa no matter how long youve been taking it 3
Definition
decarboxylation to dopamine in dopaminergic neurons in striatum causes SE

nausea and vomiting (less when combined with carbidopa)

on-off phenomenon
Term
what are the early SE of levodopa 5
Definition
N/V
orthostatic hypotension
tachycardia
arrhythmia
dark urine
Term
what are the late SE of levodopa 5
Definition
dyskinesias: choreiform movements
hypersentive receptors
mental disturbance: hallucinations, wild dreams, delusions
Term
what is the on-off phenomenon
Definition
when blood levels of levodopa drop there is an immediate reversal of symptoms (esp in sustained release formula)
deelops 2y into therapy
B6 increases peripherial breakdown and levodopa makes this worse
Term
use of levodopa
Definition
DOC and most effective for parkinsons disease
Term
MOA bromocryptine
Definition
D2 agonist
D1 partial antagonise
may save other dopaminergic neurons from oxidative stress
Term
use bromoctyptine
Definition
often used as adjunct to levodopa to lessen on-off phenomenon
Term
SE bromocryptine 7
Definition
dyslinesias
orthostatic hypotension
mental disturbance: hallucinations, wild, dreams, delusions
pleuropulmonary and retroperitoneal fibrosis (ergot like)
Term
MOA pergolide, SE
Definition
no longer on market
causes heart valve fibrosis due to activation of 5HT 2B receptors
agonist of D1 and D2 receptors
more potent than bromocryptine
Term
MOA pramipexole and ropinirole
Definition
non-ergot dopamine agonist at D2/3 receptors
Term
USE pramipexole and ropinirole 3
Definition
first line or adjunct for parkinsons
in pt who have not had levodopa
may delay need for levodopa

restless leg syndrome
fibromyalgia
Term
SE pramipexole and ropinirole
Definition
less hallucinations and orthostatic hypotension (like ergot agonists)

reward seeking behavior: drinking, smoking, gambling
Term
how is pramipexole elimiated by
Definition
renal
Term
contraindications to primipexole
Definition
cimetidine increases t1/2 by 40%
Term
MOA amantadine
Definition
anti-viral drug alters dopamine release of uptake (uless mass effect) anticholinergic effects
litte effect on tremor
good gainst rigidity and bradkyinesia
Term
USE amatadine 2
Definition
influenza
parkinsons
Term
SE amantadine 3
Definition
orthostatic hypotension
dry mouth
hallucinations
Term
MOA selegiline
Definition
MOA-B is prodominate form in striatum and causes most oxidative metabolism of dopamine that causes harm in parkinsons

low doses do not affect MOA-A bu high doeses will causing severe HTN
Term
SE selegiline
Definition
severe HTN in high dose due to MOA-A mass effect
Term
usE selegiline
Definition
enhance levodopa
Term
MOA trihexylphenidyl and benstropine
Definition
blocks cholinergic transmission to augment dopamine
modest anti-parkinson action
Term
use of trihexylphenidyl and benstropine
Definition
adjunct levodopa
Term
SE trihexylphenidyl and benstropine
Definition
same as high dose atropine
Term
MOA tolcapone
Definition
selective inhibitor of COMT (minor enzyme in pathway of levodopa metabolism)

often combined with carbidopa which blocks peripherial decarboxylase and 3-O-methyldopa is formed that competes with levodopa for active transport in the CnS

inhibition of COMT decreases 3-O-methyldopa increasing central levodopa uptake

helps with on-off phenomenon
Term
SE tolcapone 2
Definition
hepatotoxic: measure heptatic enzymes
blood dyscarcies
Term
t1/2 tolcapone
Definition
long acting
Term
MOA entacapone
Definition
same as tolcapone
Term
SE entacaopne
Definition
not hepatotoxic
no blood dyscrasias
Term
t1/2 entacapone
Definition
short acting (administer with ea dose of levodopa/carbidopa)
Term
cause of alzheimers disease
Definition
loss of cortical and subcortical neurons causes dementia

due to b-amyloid causing ROS attack and loss of cholinergic transmission
Term
3 acetylcholinesterase inhibitors, 1 SE
Definition
tacrin: hepatotoxic
donepezil
rivastigmine
Term
what 2 categories of drugs tx alzheimers disease
Definition
acetylcholinesterase inhibitors
n-methyl-d-aspartate receptor antagonist
Term
what drug is a n-methyl-d-aspartate receptor antagonist
Definition
memantine
Term
MOA memantine
Definition
overstimulation of NMDA receptors by glytamate lets Ca flow freely into the cell

sustained over exposure of the cells causes cellular degeneration
Term
what symptomatic tx can be used in alzheimers disease
Definition
depression - SSRI (citalopram, paroxetine, sertaline, fluoxetine, edcitalopran)

psychosis/agitation: atypical anti-psychotics (risperidone, olanzapine, queitapine)
Term
5 drugs that treat bleeding
Definition
aminocarpoic acid
factor VIII
factor IX
protamine sulfate
vitamine K
Term
MOA aminocarpoic acid
Definition
inhibit plasminogen activation and stops bleeding
Term
factor VIII use
Definition
hemophilia
Term
factor IX use
Definition
hemophilia
Term
protamine sulfate: origin, composition
Definition
derived from fish sperm testes
high arginine (basic)
Term
MOA protamine sulfate
Definition
positive protein interacts with negative heparin antagonizing effects
interacts with platelts and fibrinogen stopping bleeding
Term
vitamine K MOA
Definition
interferes with anticoagulant activity of warfarin (response takes 24h) causing bleeding
Term
4 drugs to treat anemia
Definition
iron
folic acid
cyanocobalamin B12
erythropoietin
Term
SE Fe deficiency 3
Definition
stops growth
mensturation
pregnancy
Term
tx Fe deficiency 2, what the difference
Definition
ferrous sulfate - oral
ferrous gluconate - oral, less GI upset
Term
6 causes of folic acid deficency
Definition
increased demand: pregnancy, lactation
SI pathology
alcoholism
dihydrofolate reductase inhibitors: methotrexate, trimethoprim
Term
cause of B12 deficiency 4
Definition
diet, poor absorption no intrinsic factor (pernicious anemia), loss of reuptake inhibitos
Term
administration of B12
Definition
oral or SQ
life long if has pernicious anemia
Term
use of erythropoietin
Definition
treat anemia due to end stage renal disease, HIV, cancer
Term
5 categories of blood thinners
Definition
direct thrombin inhibitors
indirect thrombin inhibitors
platelet aggregation inhibitors
GP IIb/IIIa receptor blockers
thrombolytic drugs - not technically anticoagulants
Term
4 indirect thrombin inhibitors
Definition
heparin
enoxaprin
warfarin
rivaroxban
Term
2 direct thrombin inhibitors
Definition
lepirudin
dibigatran
Term
6 platelet aggregation inhibitors
Definition
aspirin
copidogrel
parsugrel
ticagrelor
cilostazol
dipyridamole
Term
3 GP IIb/IIIa receptor blockers
Definition
triofiban
efitfibatide
aciximab
Term
4 thrombolytic drugs
Definition
streptokinase
urokinase
antistreplase
altelpase (t-PA)
Term
where does heparin come from
Definition
hg intestinal mucosa or beef tongue
Term
what is heparin made of
Definition
glycoasmine and hucoronic / iduronic acid
acetylated/sulfated lucosamine
unsulfated hydroxyl groups
Term
MOA heparin
Definition
arginine binds lysing on serine protease anti-thrombin III (a clotting inhibitor)
Term
what does high dose heparin inhibit 4
Definition
thrombin
Xa
XIIa
XIIIa
Term
what does low dose heparin inhibit
Definition
Xa
Term
what does chronic or intermittent dose heparin inhibit
Definition
reduces AT-III activity
increasing thrombosis
Term
5 SE of heparin
Definition
IV administration: binds proteins causing hematoma

increased half life in kidney or liver failure

hemorrhage: monitor bleeding time

thrombocytopenia: after 8d therapy can develop anti-platelet antibodies
Term
signs of heparin hypersensitivity 4
Definition
chills
fever
prophylaxis
uticaria
anaphylaxis
Term
contrindications of heparin 5
Definition
bleeding disorders
alcoholids
hypersensitivity
surgery to brin, eye, spinal cord

does not cross placenta but shows 13-20% still birth in last trimester
Term
heparin administration 4
Definition
deep SC or IV
short term use (days)

acute anticoagulation: IV volus then continous influsion
Term
where is heparin metabolized
Definition
reticuloendothelial system (liver cirrhosis and kidney failure increase t1/2)
Term
use of heparin 6
Definition
DVT
pulmonary embolism
acut eMI
aurgical prophylaxis
dialysis prophylaxis

DOC: pregnancy women with prosthetic valve or venothromboembolism
Term
MOA enoxaprin
Definition
low molecular weight heparin
longer anticoagulation
Term
explain the reactions and clotting factors used in clotting with vitamin K
Definition
(factors II, VII, IX, X: glutamic acid) + (VitK) + (vitamin L epoxide reductase) + (CO2 carboxylation) -->

(factors II, ViI, ix, I: glytamic-COOH/carbodyglutamicA) + (epoxide) -->

binds Ca and causes cell membranes to stick for clotting
Term
MOA warfarin
Definition
blocks vit K epoxide reductase and cofactors for clotting are not activated
Term
SE warfarin
Definition
hemorrhage: monitor clotting time
Term
what substances increase activity of warfarin 5
Definition
chronic alcohol
barbituates
gluthemide
grisofulvin
rifampin
Term
what substances decrease activity of warfarin 8
Definition
acute alcohol
cimetidine
chloramphenicol
cortimoxazole
disulfiram
metronidazole
phenylbutazone
aspirin - not directly
Term
what 2 health conditions are contraindicated with warfarin
Definition
hepatic disease
vitamin K dericiency
augment response
Term
administration o warfarin 2
Definition
oral
IV
Term
how is warfarin distributed
Definition
99% bound to albumin
prevents spread to CSF, placenta, milk
Term
how is warfarin excreted
Definition
8-12h in urine
Term
MOA rivarobxban
Definition
factor Xa inhibitor
Term
SE rivaroxban
Definition
anticoagulation perdictable and does not require clotting monitoring
Term
administration rivaroxban
Definition
oral
Term
origin of lepirudin
Definition
recombinate from leech saliva made in yeast
Term
MOA lepirudin
Definition
irreversible thrombin antagonist
1 lepirudin: 1 thrombin
Term
use of lepirudin
Definition
HIT
Term
MOA dibigatran
Definition
reversible thrombin antagonist
Term
SE dibigatran
Definition
may cause MI
Term
use of dibigatran 2
Definition
venous thrombosis
artial fibrillation
Term
MOA aspirin
Definition
irreversibly block thromboxane A2 synthesis from arachadonic acid in platelets
Term
SE aspirin 3
Definition
prolonged bleeding
hemorrhagic stroke
GI bleeds
Term
metabolism of aspiring timing
Definition
effects life span of plate ets 7-10d
Term
USE aspirin 3
Definition
prophylaxis of stroke, MI, infarcts
Term
MOA copidogrel
Definition
selective inhibitor of ADP binding to platelet receptor (synergistic to aspirin
Term
use copidogrel
Definition
prophylaxis: stroke, MI, post-MI infarcts
Term
parsugrel MOA
Definition
inhibit ADP pathway involved in fibrinogen and platelet binding (prodrug)
Term
SE parasugrel
Definition
platelet inhibition of ADP induced platelet aggregation
Term
metabolism of parasurgel
Definition
fastest onset of platelet aggregation inhibitors
Term
ticagrelor MOA
Definition
inhibit ADP pathway in fibrinogen and platelet aggregation and vasodilation
Term
cilostazol SE 2
Definition
increased HR
ventricular tachycardia
Term
administration cilostazol
Definition
co-administration with aspirin 23-33% inhibition of AD{
Term
use of cilostazol
Definition
intermittent claduication
Term
dipyridamole MOA
Definition
increased cAMP inhibiting cyclic neculotide phosphodiesterase in platelets
Term
administration of dipyridamole 2
Definition
within warfarin: inhibits embolism from prosthetic valves

with aspirin: mild increase in aspirin effects
Term
use of dipyridamole 2
Definition
increase effects of aspirin

prophylaxis: embolization from prosthetic valves (with warfarin)
Term
MOA tiofiban
Definition
mimic arginine-glycine-aspartic acid on fibrinogen
Term
administration triofiban
Definition
IV adjunct to percutaneous coronary intervention
Term
use triofiban
Definition
prophylaxis: cardiac ischemia complications
Term
efitfibatide MOA
Definition
antagonist of receptors
Term
administration efitfibatide 2
Definition
usually with aspirin and heparin

IV adjunct to percutaneous coronary intervention
Term
how long does efitfibatide last
Definition
platelet function returns in 6-12h
Term
use of efitfibatide
Definition
prophylaxis: cardiac ischemia complication
Term
MOA aciximab
Definition
monoclonal Ab aginst receptor blocks fibrinogen binding
Term
administration aiximab
Definition
IV adjunct to percutaneous intrvention
Term
how does aciximab last
Definition
platelet function returns in 24-48h
Term
use of axicimab
Definition
prophylaxis: cardiac ischemia complications
Term
MOA streptokinase
Definition
activates plasmin which breaks down fibrin
degrades fibrinogen factors V and VII
Term
SE streptokinase 2
Definition
increased plasmin may cause bleeding by dissolving platelet plugs

hypersensitivity to BCS
Term
signs of streptokinase hypersensitivity 3
Definition
rash, fever, anaphylaxis
Term
streptokinase administration
Definition
must give enough to overwhelm antibodies to avoid hypersensitivity

give within 4h of MI then infuse for 1h
Term
t1/2 streptokinase
Definition
<0.5h
Term
use of streptoinase7
Definition
DVT
pulmonary embolism
MI
peripherial arterial
thrombosis/emboli
unclotting cathetcs and shunts
Term
urokinase origin
Definition
human cultures of fetal renal cells
Term
MOA urokinase
Definition
enzyme degrades fibrinenzyme degrades fibrin
Term
SE urokinase
Definition
bleeding
Term
use urokinase
Definition
only use when pr is sensitive to streptokinase
Term
MOA antistreplase
Definition
streptokinase and noncovalent 1:21 complex plasminogen

acetylates catalytic site of plasminogen so its inactive until fibrin binds
Term
SE of antistreplase
Definition
antigenic
Term
metabolism of antistreplase
Definition
de-acetylation lengths thrombolytic effect after IV injection

t1/2 90min
Term
use of antistreplase 6
Definition
DVT
pulmonary embolism
MI
peripherial arterial
thrombosis/emboli
unclotting cathetcs and shunts
Term
MOA altelpase (t-PA)
Definition
low affinity for plasminogen but rapidly binds plasminogen bound to fibrin in thrombus (fibrin selective at low dose)
Term
SE altelpase
Definition
bleeding
Term
use of altelpase 7
Definition
DVT
pulmonary embolism
MI
peripherial arterial
thrombosis/emboli
unclotting cathetcs and shunts
DOC for older clots
Term
name 2 ACEI
Definition
catopril
lsinopril
Term
use of ACEI 3
Definition
HTN
CHF
in diabetic renal benifit
Term
SE of ACEI 2
Definition
cough
angioedema: rapid sewlling of face after 1st dose
Term
contraindications of ACEI 1
Definition
pregnancy
Term
4 BB and their MOA
Definition
propranolol - no selective
desmolol, atenolol, metoprolol - B1 selective
Term
which BB are prefered in cardiac conditions
Definition
B1 selective
Term
contraindications to BB 3
Definition
asthma
diabetes
peripherial vascular disease: vasospastic angina
Term
SE BB 4
Definition
slows heart down
decreased CO
fatigue
never abruptly DC
Term
Use BB 4
Definition
HTN
CHF
anti-arrhythmic SVT class 2
angina
Term
use esmolol, why
Definition
BB only used in arrhythmia
short t1/2 10 min
Term
name one ARB and it MOA
Definition
losartin
block ANG II receptor, benifits similar to ACEI
Term
use of ARB 3
Definition
HTN
CHF
renal benifit in diabetes
Term
SE of ARB
Definition
no cough
Term
contraindications of ARB 2
Definition
pregnancy
hyperkalemia
Term
1 vasodilator
Definition
hydralazine
Term
MOA hydralazine
Definition
vasodilates using NO with specificity for arterioles
Term
MOA nitrates
Definition
work through NO with sepcificity to VEINS
Term
use hydralazine 2
Definition
HTN
CHF - back up if unable to use ACEI/ARB
Term
SE hydralazine
Definition
drug most likley to cause drug induced lupus in slow acetylators
Term
central A2 agonist 1
Definition
methyldopa
Term
MOA methyldopa
Definition
main effect inside CNS
stimulates A2 inhibitory recetors decreasing sympathetic output
Term
SE methyldopa 2
Definition
fatigue
hemolytic anemia
Term
use methyldopa
Definition
HTN, esp in pregnancy
Term
MOA carvedilol
Definition
A and B blocker
Term
use carvedilol 2
Definition
HTN
CHF
Term
MOA slidenafil
Definition
block PDE5 increasing cGMP and NO which causes vasodilation
Term
use slidenafil 2
Definition
pulmonary HTN
erectile dysfunction
Term
contraindications slidenafil
Definition
never use with nitrates, both work in same pathway too much dilation occurs
Term
3 CCB
Definition
verapamil
diltaziam
amidopine
Term
MOA verapamil
Definition
cardiodepressant
blocks L type Ca channels on heart
Term
MOA ditilaziam
Definition
cardiodepressant
blocks L type Ca channels on heart mostly
Term
MOA amlodipine
Definition
vasodilates, drops BP
blocks L type Ca channels on vessels
Term
use of verapamil 3
Definition
HTN
angina
arrhythmia SVT class 4
Term
SE cerapamil
Definition
constipation
Term
use ditilaziam 3
Definition
HTN
angina
arrhythmia SVT class 4
Term
use of amlodipine 3
Definition
HTN
angina
Term
SE amlodipine 2
Definition
reflex tachycardia
gingival hyperplasia
Term
MOA digoxin
Definition
positive inotrope
inhibits Na/K ATPase on cardiac myosites
when Na goes up Ca does too and gets stored in sarcoplasmic reticulum so not it releases more causing positive inotropic effect
Term
use digoxin
Definition
arrhythmia SVT
Term
SE digoxin 2
Definition
low theraputic index
arrhythmia
blurry yellow vision
Term
contraindications of digoxin
Definition
hypokalemia can enhance digoxin toxicity
digoxin and K bind same site on Na/K ATPase
Term
4 drugs used for ventricular tachycardia
Definition
procanamide
lodicaine
sotalol
amiodarone
Term
4 types of drugs used for SVT
Definition
CCB
BB
adenosine
digoxin
Term
2 drugs used to ventricular tachycardia and SVT
Definition
satolol
amiodarone
Term
2 drug only used for SVT
Definition
adenosine
Term
Procanamide: type, MOA, use
Definition
1A
block Na and K
ventricular arrhythmia
Term
lidocainel type, moa, use
Definition
1B
BB
ventricular arrhythmia
Term
satolol: type, MOA, use
Definition
3
block K and BB
any arrhythmia
Term
amioderone: type, MOA, use
Definition
3
block Na, K, Ca, BB
any arrhythmia
Term
SE procanamide 2
Definition
lupus in slow acetylators
torsades
Term
SE of sotalol
Definition
torsades
Term
SE amiodarone4
Definition
torsades - low risk
liver damage
pulmonary fibrosis
thyroid problems - due to iodine
Term
MOA adenosine
Definition
stimulate adenosine receptors (Gi coupled so still inhibitory(
short half life 8s
Term
2 Na channel blocker anti convulsants
Definition
phenytoin
carbamazepine
Term
MOA lamotrigine
Definition
Na channel blocker
glutamate inhibitor
Term
MOA ethosuxamide
Definition
block T type Ca channels
Term
MOA lerazepam
Definition
status epilepticus
Term
SE phenytoin 4
Definition
teratogenic
gingival hyperplasia
p450 inducer
zero order kinetucs
Term
SE carvamazepine 2
Definition
teratogenic
p450 inducer
Term
SE valproic acid 3
Definition
liver problems
hyperammonemia
teratogenic
Term
use ethosuxamide
Definition
absence seizure
Term
use lorazepam
Definition
status epilepticus
Term
use lamotrigine
Definition
most seizures
Term
SE lamotrigine
Definition
DC if any sign of rash could be SJS
Term
3 opioids
Definition
morphine
meperidine
buprenorphine
Term
MOA morphine
Definition
mu agonist
Term
MOA merperidine
Definition
mu agonist
Term
MOA burenophine
Definition
Mu partial agonist
Term
signs of morphine OD 4
Definition
meiosis
depressed respiratory - fatal
decreased GI/GU
gall bladder spasms
Term
SE meperidine 2
Definition
decreased respiration
serotonin syndrome
Term
SE buprenorphine
Definition
when you put it with a full Mu agonist it causes withdrawl
Term
MOA naloxone
Definition
mu antagonist
IV antidote to quickly reverse opioid action
Term
MOS sumatriptan
Definition
5HT1D agonist
vasoconstriction
Term
use sumatriptan
Definition
acute migraine
Term
before you treat metabolic acidosis what do you need to consider
Definition
if they have ketoacidosis or lactic acidosis they may restore bicarbonate on their own in hours and may not need to be treated

hyperchloremic (diarrhea) will be unable to regenerate bicarbonate and kidney will take days to compensate so need alkali therapy
Term
how do you treat metabolic acidosis 2
Definition
sodium bicarbonae
tromethamine
Term
what are the benifits of using sodium bicarbonate to treat metabolic acidosis
Definition
fluid, electrolute and pH replacement
increase cardiac funtion, perfusion, oxygenation, and lactate metabolism
Term
what are SE of sodium bicarbonate treatment 5
Definition
IV: CO2 generated diffuses better across cell membranes into myocardial and CSF cells which can DECREASE pH more there

shift of Hb saturation curve LEFT impairs oxygen release

sodium and water overload

decreased ionized Ca and thus myocardial contractability

bicarbonate overshoot causes alkalosis if administered too fast
Term
tromethaline: MOA
Definition
alkaline Na free organic amine proton acceptor combines with ions to form carbonic acid to form bicarbonate

osmotic diuretic ability increases urine flow, pH, and excretion of acids, CO2, and electrolytes
Term
what do you need to think about before you treat metabolic alkalosis
Definition
begin with focus on treating cause, if that dosent work then correct the values

increase tubular bicarbonate threshold: decrease ECF, hypochloremia, hypokalemia, duiretics, Ng suction
Term
how do you treat NaCl responsive metabolic alkalosis 4
Definition
expand intravascular volume and replenish NaCl stores......
NaCl and K solutions
acetazolamide
hydochloric acid
ammonium chloride
Term
how do you treat NaCl resistant metabolic alkalosis 3
Definition
spironolactone
amiloride
triametrine
Term
when to use acetazolamide, why
Definition
volume expanded or intolerant to Na pt only because it its less effective as bicarbonate levels fall
Term
MOA ammonium chloride
Definition
converted by liver to urea and free hydrochloric acid
Term
MOA spironolactone
Definition
limits DCT H inhibition of ALD stimulated Na reabsorption
blocks ALD effect on H ion secretory pump
Term
MOA amiloride and trimetrene
Definition
Na channel blockers
Term
if the pt has decreased pH, increased CO2 what do they have
Definition
respiratory acidosis
Term
if the pt has decreased pH and normal (or slight decrease) CO2 what do they have
Definition
metabolic acidosis
Term
if the pt has increased pH and normal (or slight increase) CO2 what do they have
Definition
metabolic alkalosis
Term
if the pt has increased pH and decreased CO2 what do they have
Definition
respiratory aklalosis
Term
if the pH and CO2 move in opposite directions and they acidic what do they have
Definition
respiratory acidosis
Term
if the pH and CO2 move in same direction and their acidic what do they have
Definition
metabolic acidosis
Term
if the pH and CO2 move in the opposite direction and their basic what do they have
Definition
respiratory alkalosis
Term
if the pH and CO2 move in the same direction and their basic what do they have
Definition
metabolic alkalosis
Term
how do you treat respiratory acidosis 2
Definition
establish airway
give oxygen or ventilation
Term
how do you treat respiratory aklalosis 5
Definition
if pH <7.5 no tx

if pH >7.5 paper bag, control hyperventilation, oxygen therapy for hypothermia, mechanical ventilation if severe
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