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Pharm Drugs Semester 2 Midterms
Pharm Drugs Semester 2 Midterms (Month 1 weeks 1+2 plus moth 2 week 1)
87
Pharmacology
Graduate
06/10/2018

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Term
Muscarinic receptor blocking drugs
Definition
Atropine(M1=M2=M3), Scopolamine, Pirenzepine (peptic disease, M3), Dicyclomine (peptic disease, hypermotility), Triotropium (asthma), Benztropine (parkinson's), Darifenacin (M1)
Term
Muscarinic receptor blocking drugs adverse effects
Definition
DUMBELLS/Mad Hatter
Term
Antinicotinin non-depolarizing neuromuscular blocking agents drugs
Definition
cistracurium, rocuonium
Term
MOA of cistracurium, rocuonium
Definition
inhibits nicotinic receptor in skeletal muscle end plate -> flaccid paralysis
Term
Ganglion-blocking drugs
Definition
anti-nicotinic, antagonize both parasympathetic an dsympathetic autonomic ganglia. (nonselective for Nm and Nn). Hexamethonium, Mecamylamine, Tetraethylammonium
Term
Atropine indication
Definition
symptomatic bradycardia
Term
Scopolamine indication
Definition
motion sickness
Term
asthma and COPD antimuscarinic drugs
Definition
Tiotropium, ipratropium, aclidnium
Term
Tiotropium, ipratropium, aclidnium MOA
Definition
dec tracheobronchial mucosa stimulation and inc bronchial smooth muscle relaxation
Term
antimuscarinic drugs for cholinergic poisoning
Definition
atropine +/- pralidoxime
Term
antimuscarinic drugs for overactive bladder
Definition
oxybutynin, darifenacin, solifenacin, tolterodine (all more M3)
Term
oxybutynin, darifenacin, solifenacin, tolterodine MOA
Definition
dec urinary voiding through bladder wall smooth muscle relaxation
Term
antimuscarinic drugs for ophlalamologic funduscopic examination
Definition
tropicamide, (can also use phenylephrine from diff class)
Term
a1 selective alpha blocker agents (sympatholytic adrenoreceptor blockers)
Definition
prazosin, terazosin, doxazosin, phenoxygenzamine
Term
a1a selective agent (sympatholytic adrenoreceptor blockers)
Definition
tamulosin
Term
non-selectivew a1+2 agent (sympatholytic adrenoreceptor blockers)
Definition
phentolamine
Term
alpha 2 selective (sympatholytic adrenoreceptor blockers)
Definition
yohimbine
Term
B1 selective beta blocker (sympatholytic adrenoreceptor blockers)
Definition
MEN2AB Metoprolol, esmolol, nebivolol, atenolol, acebutolol,
bisoprolol, betaxolol
Term
non-selective B1+2 and a1 antagonists (sympatholytic adrenoreceptor blockers)
Definition
carvedilol and labetalol
Term
non-selective B1+2 antagonists (sympatholytic adrenoreceptor blockers)
Definition
"everything else" eg propanolol, sotalol (everything besides MEN2A2B and B1+2 and a1 antagonists)
Term
Beta blockers with partial agonist activity
Definition
Acebutolol,carteolol,celiprolol,pindolol,penbutolol
Term
Beta blocker with shortest half-life
Definition
esmolol
Term
beta blockers with local anesthetic action
Definition
• Acebutolol, labetalol, metoprolol, pindolol,
propranolol
• Blocks sodium channels experimentally
Term
adrenoceptor blockers that can cause urinary obstruction
Definition
any a1 blocker or a1a (zosins, tamulosin)
Term
Norepinephrine vs epinephrine vs Isoproterenol beta vs alpha selectivity
Definition
Isoproterenol >B, epinephrine B and a, norepinephrine >a
Term
sympathomimetic drugs w inc DOA and inc CNS penetration
Definition
methoxamine, ephedrine, amphetamine - increased after MAO inhibition
Term
alpha 1 agonist, a1>a2 agent (sympathomimetric drug)
Definition
phenylephrine (IV vasopreessor)
Term
vasopressor
Definition
agonists of a1, inc SVR
Term
inotrope
Definition
agonist of B1, B2, inc CO
Term
mixed alpha and beta sympathomimetic drugs
Definition
Dopamine/NE/EPI (vasopressor + inotropic)
Term
a1>a2>>>>>B
Definition
phenylephrine, methoxamine
Term
a2>a1>>>>>B
Definition
clonidine, methylnorepinephrine
Term
a1=a2, B1>>B2
Definition
norepinephrine
Term
a1=a2, B1=B2
Definition
epinephrine
Term
B1>B2>>>>a
Definition
dobutamine
Term
B1=B2>>>>a
Definition
isoproterenol
Term
B2>>>B2>>>>a
Definition
albuterol, terbutaline, metaproterenol, ritodrine
Term
D!=D2, B>>a
Definition
Dopamine
Term
D1>>D2
Definition
fenoldopam
Term
beta agonists
Definition
dobutamine, oisoproterenol (b1=myocardium, b2=bronchial smooth muscle), IV inotropes
Term
catecholamines
Definition
epinephrine, norepinephrine, dopamin,efenoldopam, dopamine agonists, dobutamine
Term
oral vasopressor a1 sympathomimetic
Definition
midodrine
Term
amphetamine derivateives
Definition
amphetamine, modafinil, methylphenidate
Term
special sympathomimetics
Definition
cocaine, ephedrine, tyramine
Term
genitourinary B2 sympathomimetics
Definition
terbutaline inj, ritodrine
Term
sedative central a2 sympathomimetic
Definition
dexmedetomidine
Term
pulmonary B2 sympathomimetic (agonists)
Definition
albuterol, terbutaline inj
Term
ophthalmic a2 sympahomimetic
Definition
brimonidine
Term
nasal a2a sympathomimetic
Definition
oxymetazoline
Term
treatment agents for shock
Definition
• IV vasopressors: epinephrine, norepinephrine, dopamine, phenylephrine
• Exception is cardiogenic shock: IV inotropes (dobutamine, isoproterenol), then vasopressor
Term
tyramine
Definition
substrate of MAO, monoamine oxidase, inc effecxts of MAOIs
Term
types of shock
Definition
NOCASH, Neurogenic, Obstructive, Cardiogenic, Anaphylactic, Septic, Hypovoluemic
Term
ACE inhibitor MOA
Definition
angiotensin-converting enzyme inhibiting class blocks the conversion of angiotensin I to angiotensin II, its active potent vasoconstricting peptide. The main purpose of these medications is to decrease the afterload that the heart has to pump against, which overall will lower blood pressure
Term
ACE inhibitor agents and notes
Definition
Captopril (cat pril )(short-acting, rare leukopenia, contains sulfhydryl, taste disturbances), Quinapril (quinn pril), Lisinopri (list pril)l (5x more potent than captopril, most commonly prescribed), Ramipril (ram it pril), Benazapril (benz pril), Enlarpril (enlarge pril) (analaprilat is IV formulation), Fosinopril (fossil pril) (only ACEI hepaticaxlly cleared)
lcqrbef (liquor beef), pril's
Term
ARB MOA
Definition
angiotensin receptor blockers, block angiotensin II's effect on the actual angiotensin I receptor.
Overall, this decreases the ability for angiotensin II to cause vasoconstriction. So it's an indirect vasodilator, decreases afterload and lowers BP
Term
ARB agents and most common
Definition
Losartan (lost spartan) (most common), Valsarta (val sorta), Irbesartan (herb spartan), Telmisartan (tell me spartan), Candesartan (clandestine spartan), Olmesartan (oh mess spartan)
LIVCOT, a(n)'s
Term
adverse effects of ACEI and ARBs
Definition
hypotension w first dose (bc they have overactive RAS systems- very high levels of circulating renin and angiotensin II), monitor for 1st 30 min, hyperkalemia (interfere w downstream aldosterone reabsorption), elevations in creatinine (prevent angiotensin II's affect) but renal protective over time
ACEI- can cause dry cough (breaks down bradykinin which can irritate the throat)- switch to ARB
-most severe side effect of these medications is angioedema bc of effect on bradykinin (laryngeal vasodilator), tongue can swell- discontinue (10 fold higher risk of this in African Americans), counsel pts to call 911 or present to ER
Term
direct renin inhibitor agent, MOA, adverse effects
Definition
aliskiren (Alaskan), It's mechanism is to directly block the release of renin from the adrenal medulla and delaying the ability for renin to be released from the adrenal medulla prevents downstream formation of ACE conversion to angiotensin II. Again, overall, this decreases afterload, just like the ACEs and ARBs, which works to lower systemic vascular resistance, and therefore lower blood pressure
Adverse effects- diarrhea, hyperkalemia
Term
contraindicated in pregnancy
Definition
aliskiren, ACE, ARB
Term
2 classes of calcium channel blockers and agents w notes
Definition
nondihydropyrodines (relieve angina and atrial fibrillation)- Diltiazem (dialed em) (Immediate release slow disperse over 3 hrs, should not be crushed), Verapamil (very pam ill) (available in immediate, sustained, extended release, and IV formulations) (attracted to more neg charge)

dihydropyroidines- Amlodipine (a lord pine) (takes 3 days to reduce blood pressure), Nifedipine (n-confetti pine), Nicardipine (nicu pine) (available both oral/IV formulations, preferred in pregnancy), Clevidipine (clever pine) (only available IV, ultra short acting)
Term
calcium channel blocker MOA
Definition
Antagonize L-type voltage gated calcium channels, decreases afterload and contractility, prevent vasocontriction peripherally

DHP: Vasodilates vascular smooth muscle
Non-DHP: Depresses cardiac conduction at atrioventricular (AV) and sinoatrial node (SA) node
Term
calcium channel blocker adverse effects
Definition
non-DHP: bradycardia, heart block
DHP: pedal edema
Term
alpha 2 stimulation in the brain stem
Definition
by methyldopa or clonidine (or guanfacine), as I mentioned, down-regulates the effect of other adrenergic receptors. So it delays conduction across the ganglion
Term
alpha 1 blockers agents, MOA, SE
Definition
doxazosin, prazosin, used to be used to treat HTN. block endogenous epinephrine and norepinephrine on alpha 1 receptors in the vascular smooth muscle (prevent peripheral vasoconstriction/indirectly vasodialte), decrease afterload. SE: postural hypertension and dizziness
Term
alpha 2 agonists MOA, agents, indication
Definition
bind alpha 2 peripherally or centrally and cause down regulation of adrenergic receptor activity. most common = clonodine (also methyldopa and guanfacine). not that effective for HTN
Term
beta blockers MOA, utility, contraindicated in, SEs
Definition
down-regulate cardiac output or lower contractility, block cardiac conduction activity across AV node and slow HR, doesn't affect SVR so not that good at lowering BP, commonly used for heart attack treatment, contraindicated in anyone who has developed an allergy to another beta blocker or anyone who develops severe heart failure as cardiogenic shock or pts w resting HR <50pbm, pts w second or third degree heart block unless they have a pacemaker. SE: bradycardia, AV nodal block, hypotension, dizziness and in asthmatic pts bronchospasm (can also block beta 2), also fatigue that can go away and depression that can last
Term
Nonselective -ISA Beta Blocker Agents
Definition
Nadolol, Propanolol, Sotalol, Timolol
Term
Nonselective +ISA Beta Blocker Agents
Definition
Pindolol, Penbutolol
Term
Selective -ISA Beta Blocker Agents
Definition
Atenolol, Betaxolol Bisoprolol, Esmolol, Metoprolol, Nebivolol
Term
Selective +ISA Beta Blocker Agents
Definition
Acebutolol.
Term
B-adrenergic blockers w a-blocking activity
Definition
Labetalol, Carvedilol (slight) (alpha blocking prevents vasoconstriction) (beta blockers slow HR)
Term
most commonly prescribed medicine for cardiac concerns such as atrial fibrillation or heart failure
Definition
metoprolol (cardio-selective beta blocker with no intrinsics and pathomimetic activity)
Term
Intrinsic Sympathomimetic Activity
Definition
a beta blocker has ISA if it acts as a partial agonist at the beta 1 receptor (a minimally effective agonist, so ineffective that it blocks adrenaline from doing its job and activating beta 1- ceiling effect- prevents bradycardia)-- so acebuterol may be a good agent for someone w a resting HR of 50-60 bc it would prevent brandycardia. most nonselective beta blockers are rarely used for HTN or cardiac conditions, ex timolol eye drop medication is used for glaucoma and intraocular HTN, nadolol and propanolol are used for performance anxiety
Term
Direct acting vasolilators- arterial vasodialating agents, MOA, Adverse effects, SE
Definition
hydralazine and minoxidil (Rogaine), MOA- perform direct vasodialatory actions on arterial smooth muscle. sensitive for dilating arteries- decreases SVR/afterload- unfortunate physiological consequence of this is rebound tachycardia (do not prevent physiologic response to inc HR to balance out anti-HTN effects), Rogaine SE of unwanted hair growth- used today to alleviate male pattern baldness
Term
HTN combination medication, agent, indication, SE
Definition
isosorbide dinitrate w hydalazine (fixed dose combination) (BiDil), treats heart failure w reduced ejection fraction in African-American patients, SE: hypotension, strong feelings of headache and weakness, rebound chest pain
Term
Diuretics that work at PCT
Definition
Acetazolamide, or a carbonic anhydrase inhibitor, osmotic diruetics
Term
diruetics that works at loop of henle
Definition
loop diuretics, furosemide
Term
diuretics that work at dct
Definition
thiazide-like diuretics
Term
diuretics that work at the collecting duct
Definition
potassium-sparing diuretics, or aldosterone antagonists
Term
carbonic anhydrase inhibitors, ex, MOA, uses
Definition
acetazolamide, inhibit formation of carbonic anhydrase- major buffering enzyme in PCT that controls our formation of bicarb which buffers pH and H+ conc. by preventing bicarb formation, have pH sensitive volume reduction in PCT-> inc's Na reabsorpiton at loop of henle so overall not that good at reducing fluid reabsorption and lowering BP, instead mostly have intraocular uses- glycoma or intraocular HTN- acetazolamide or Diamox. prevents metabolic alkalosis (SE from over diuresis w loop diuretics), can alkalinize urine (hereditary cystinuria
Term
thiazides or thiazide-like diuretics, MOA, main effect, agents, SEs
Definition
act on DCT and prevent Na reabsorption, mainly effect vasodilation (takes several months), dec SVR, most common is hydrochlorothiazide, or HCTZ (Also chlorthalidone and metolazone). inhibits sodium and chloride cotransporter. hyponatremia is common SE also sodium and potassium wasting, hyperglycemia
Term
loop diuretics, use, agents, MOA, SE, delivery, aka
Definition
exert a lot of Na excretion into the lumen and remove the most fluid but not particularly effective for HTN, but useful for pts w acute ehart failure or hypercalcemia, furosemide/Lasix (most common), bumetanide (most potent), torsemide, ethacrynic acid. inhibit Na, K, Cl transporter on the apical end of the thick ascending loop of Henle. SE: hypkalemia, hyponatremia, dec mg, dec calcium, cramping esp of leg and calves, hypotension. give w normal saline or sodium chloride, aka high ceiling diuretics (deep dose response curve, may have to inc dose 10x to see an effect- high ceiling for efficacy, safety and toxicity). most of the diuretic response occurs within the first 1-2 hrs, IV is faster for acute congestive failure
Term
loop diuretic to give for pt w sulfa allergy
Definition
ethacrynic acid
Term
K-spacing diuretic agents, use, MOA
Definition
spironolactone (most common), eplerenone (hear failure), triamterene, amilodride, only used to treat resistant HTN, act predominantly in the ENaC pathway or the sodium potassium current. They exchanged sodium excretion for retaining potassium, only Na is excreted across the cotransporter and K stays in lumen.block aldosterone-mediated sodium/potassium antiporter. SE: hyperkalemmia esp w ACEI/ARB, gynecomastia (discontiniue)
Term
Vasopressin antagonists usage, agents
Definition
acute heart failure when volume resistance happens on therapy with various other diuretics , Tolvaptan is by far the most commonly prescribed (also conivaptan). MOA: blockvasopressins endogenous effect on the V2 receptor in the collecting duct. They are really only used to ever treat hyponatremia, as they cause aquaresis, or simply, water excretion in the urine. SE: serious, hepatotoxicity and hypernatremia, an excessive thirst (discontinue), monitor BMP 2x day
Term
osmotic diruetics, agent, use, MOA, SE
Definition
mannitol, used for intraocular pressure, intracranial pressure. draws water into the lumen of the nephron, which is then used to lower volume response because electrolytes will follow that water and you'll diurese electrolytes as well as water to the urine. SE: hypervolemia, and may crystallize at room temperature (keep in fridge), also directly nepherotoxic, can cause some very irritating side effects in the skin, which can appear red, angry, and painful
Term
diabetes insipidus
Definition
common in pts who are HTN, due to anti-diuretic hormones' resistance that's endogenous in patients. The symptoms include polyuria, hypernatremia, and hypovolemia. Often, hypercalcemia is one of the precipitating factors in diabetes insipidus. So use of loop diuretics is not advised.. treat w low salt and low protein diets, thiazide and K-sparing diuretics are preferred , NSAIDS are useful, may need exogenous anti-diuretic, DDVAP (analog of anti-diuretic, it reverses the resistance to anti-diuretic hormone because it is chemically modified to agonize the receptor with a much higher affinity) it also is used for prevention of bleeding, in patients with uremia or nocturia to prevent overnight urination. SE: hyponatremia, water intoxication, as well as headache, allergies
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