1.  
   1. Insulin lispro -Humalog
   2. Insulin aspart - NovoLog

What is the onset, peak and duration of insulin lispro (Humalog)? When should this insulin be given?

• Onset 15-30 (min)
• Peak 0.5-2.5 (hr)
• Duration 3-6.5 (hr)

Administered right before or after eating.

What is the onset, peak, and duration of Insulin aspart(Novolog)? &

When should this insulin be given?

5 to 10 minutes before meals

1. Humulin R
2. Novolin R

• Onset: 30-60 min
• Peak: 1-5 hr
• Duration: 6-10 hr

Administered:  Injected before meals to control hyperglycemia, infused sub Q to provide basal glycemic control

 ONLY INSULIN THAT CAN BE GIVEN THROUGH AN IV.....

1. NPH (Neutral Protamine Hagedorn) Insulin
2. Insulin Determir (Levemir)

• Onset 60-120 min
• Peak 6-14 hr
• Duration 16-24 hr

Injected twice daily to provide glycemic control between meals and during the night.

• Onset 6-8 min
• Peak12-24 hr
• Duration - Duration is dose dependent

Slower onset, longer the duration than NPH binds to albumin.

Insulin glargine (Lantus) also Levemir at higher doses.

1. Sulfonylureas
2. Meglitinides "Glinides"
3. Biguanides
4. Thiazolidinediones "Glitazones"
5. Alpha-glucosidase inhibitors

What are two types of Sulfonylureas?  What does sulfonylureas do?

What are the adverse effects?

1. Tolbutamide(first generation)
2. Glipizide (Second generation)

Promote insulin secretion by the pancreas, may also increase tissue response to insulin. can only be used in type 2 diabetes.

Excessive lowering blood pressure, hypoglycemia

Duration 6-12 hrs.

Immediate release (Glucotrol) Dur: 10-24 hr

Action: Promotes insulin secretion by the pancrease

Adverse Effect: Hypoglycemia

Drug: Repaglinide(Prandine)

Only for type 2 diabetes

What action does Thiazolidinediones "Glitazones" do?

What are the adverse effects?

What is the drug associated with it?

Action: Decrease insulin resistance, and therby increase glucose uptake by muscle and decrease glucose production by the liver.

Adverse Effects:  Hypoglycemia, but only in the presence of excessive insulin.

Drug: Rosiglitazone (Avandia)

What is the action of Alpha-glucosidase inhibitors?

What are the adverse effects?

What is the drug name?

Action: Inhibit carbohydrate digestion and absorption thereby decreasing the postprandial rise in blood glucose.

Adverse Effect: GI Symptoms- flatulence, cramps, abdominal distention, borborygmus

Drug:  Acarbose(Precose)

What are three local anesthetics?

What are they used for?

• Cocaine
• Bupivicaine(Marcaine)
• LIdocaine

Topical: Applied to the skin to relieve pain, itching and soreness of various causes, including infection, thermal burns, sunburn, diaper rash, wounds, bruises, abrasions, plant poisoning,and insect bites,

Injectable: High risk and must be administered by a anesthesiologist.

Lidocain

Topical or Injectable?

What is the peak, onset and duration?

Amide or Ester?

What does it do?

• Both Topical and Injectable
• Topical Peak: 2-5 min
• Topical Duration: 15-45
• Injectable Onset: Less than 2 min
• Injectable Duration: 0.5-1 hr
• Amide, it is a Local Anesthetic

Cocaine

1. How is it administered (Topical/Injectable)
2. What is the peak and duration?
3. Ester/Amide?
4. Where is it usually used?
5. Adverse Effects?

1. Topical
2. Peak 1-5 min,  Duration 30-60 min
3. Ester
4. Ear, nose, and throat
5. Vasoconstrictor, HTN, Dysrhythmia, Angina, Hypertension

Bupivicaine (Marcaine)

1. Topical/Injectable
2. Onset/Duration
3. Amide/Ester
4. What are the adverse effects?

1. Injectable
2. Onset: 5 min Duration: 2-4 hr
3. Amide
4. __________________________

Whare are preanesthetic drugs (3)?

What is the purpose of these drugs?

1. Benzodiazepines
2. Opiods
3. Parasympathetic Blocker(Atropine sulfate)

Reducing anxiety, producing prerioperative amnesia, Relieving properative and postop  pain.

Benzodiazepines (Preanesthetic)

1. What drug is used and how is it given?
2. Adverse Effects
3. ?

1. Midazolam(Versed) IV,
2. _______________________

Opioid (Pre-anesthetic)

1. What is it used for?
2. Adverse Effect?
3. What are the drugs used?

1. Post & Pre op, help suppress cough,
2. Bowel and Urinary tract retention, Risk of post op respiratory distress, may promote vomiting
3. Morphine, Fentanyl

1. What drug is used as a parasympathetic blocker?
2. It is given during surgery to decrease the risk of?

1. Atropine Sulfate
2. Bradycardia

What are 3 inhalation anesthetics drugs?

1. Halothane (Fluothane)
2. Isolfurane (Forance)
3. Nitrous Oxide

Halothane(Fluothane) Inhalation Anesthetic

1. Adverse Reactions
2. How is it used today?

Adverse Reaction: Halothane causes a dose-dependent reduction in blood pressure, Hypertension, respiratory depression, promotion of dysrhythmia, Malignant hypothermia, Hepatotoxicity

NO LONGER IS USE!!!!

Isofluance (Forane)

1. Adverse Effects
2. How is it used to day?
3. What is the MAC index?
4. What type of liquid?

1. Hypotension, supresses uterine contraction, No renel or hepatic toxicity becase elimination it mostly be breath
2. It is the most widely used drug
3. 1.15%
4. Volatile Liquid

Nitrous Oxide Inhalation anesthetic

1. What is it known as?
2. Adverse Effects
3. When is it mostly used?
4. What is the MAC and potency?

1. Laughing gas NO₂
2. No major adverse effect but may cause nausea  and vomitting?
3. Dentistry and during delivery
4. MAC- 105,  very low anesthetic potency, very high analgesic potency.

1. Short Acting barbiturates (Thiopental)
2. Benzodiazepines
3. Ketamine(Ketalar)

IV Anesthetic - Short Acting Barbiturates (Thiobarbiturates)

1. What is the drug?
2. What is the onset and duration?
3. Adverse Reaction

1. Thiopental
2. Has a rapid onset but a short druation.  Onset will usually happen 10-20 seconds but if not followed by a inhalation anesthetic the patient will wake up in about 10 min.
3. Cardiovascular and Respiratory Depression.  Also if given too fast may cause apnea.

IV Anesthetic- Benzodiazepines

1. What are the names of the drugs?
2. Adverse effect
3. What drug is used for consious sedation?

1. Diazepam(Valium), Midazolam(Versed), lorazepam
2. Valium-causes little muscle relatztion and no analgesia, Cardiovascular and respiratory depression are usually only moderate. Versed- dangerous cardiovasular effects, respiratory depression and respiratory and cardiac errest.
3. Valium

IV Anesthetics - Ketamine

1. What is the drug name?
2. What are the adverse effects?
3. What type of anesthetic?
4. How long does it take to recover?
5. What age group is it used in?

1. Ketalar
2. Hellucinations, disturbing dreams, and delirium (may occur days or even weeks after being used)
3. Dissociative anethetic
4. full recovery may take hours
5. used in young children for minor surgeries 

What is a  neuroleptic- opoid  combinations?

What is it known as?

What are the adverse reactions?

1. Droperidol plus Fentanyl
2. neurolept analgesia
3. Cardiac, B/P, Respiratory drespression, Neurolept anesthesia-major surgery, Neurolept Analgesia- quiescence indiferrent to pain.

1. What is a neuromuscular blocking agents?
2. Mixing this will cause?
3. What does this drug do?

1. Succinylcholine
2. Malignant hyperthermia
3. skeletal muscle relaxation.

1. What is a opioid prototype analgesics?
2. What are the adverse effects?
3. What does it do?

1. Morphine
2. Respiraroty Depression, consitipation, orthostatic hypertension, urinary retention, cough suppression, bilary colic, emesis, elevation of intracranial pressurem, euphoria/dysphoria, sedation, miosis, neurotoxicity, hormonal functions and immune function with prolonged use.
3. relief of moderate to sever pain .  The drug can relieve poroperative pain of myocardial infarction and dyspnea associated with left ventircualr failure and pulmonary edema, no longer the drug of choice.

Analgesia Fentanyl

1. How can it be admisitered?
2. What are the onset, peak, and duration?

1. IM, IV, transdermal

IM-Onset: 7-8 min, Duration: 1-2 hr

IV: Duration: 0.5-1 hr

Trans: Onset:delayed, Peak: 24-72 min, Duration: 72

Meperidine (Demerol)

1. How is it administed?
2. Adverse effects

1. Parenteral and oral
2. can interact with MAO inhibitors to cause excitation, delirium, hyperexia, and convulsions.  Coma and death can follow.
3. INFO: first line drug for relief of moderate to severe pain. and has a short half life.

Methadone

1. How is it administered?
2. What are the peaks, onsets and duration?

1. PO, IM, IV
2. ..

PO: Onset: 30-60 min, Peak: 90-120, Duration: 4-6^d

IM:  Onest: 10-20min, Peak: 60-120, Duration: 4-5^d

IV: Onset: None, Peak: 15-30 min, Duration: 3-4^d

1. Codeine
2. Oxycodone(Oxycontin

Codiene

1. What does it do?
2. How is it usually administered?

1. Indicated for relief of mild to moderate pain
2. The drug is usually administed by mouth

Butorphanol(Stadol)

1. Agonist or antagonist
2. Adverse effects:
3. How is it administered?

1. agonist at kappa receptors, antagonist at mu receptors
2. increase cardiac work
3. IM or IV and Nasal Spray(to treat migraines)

What is a opiod antagonist?

1. Tramadol(Ultram)
2. Clonidine(Duraclom)

Tramadol (Ultram)

1. What is the mechanism of action
2. Pharmocokinetics?
3. Adverse Effects?
4. Durg Interactions?

1. analog of codiene that relieves pain in part through weak agonist activity at mu opioid receptros.  Works primarily by blocking  uprake of norepinephrine and serotionin activating monaminergic spinal inhibtion of pain.  NAlozone partially blooks  effects.
2. Administered by mouth and reaches peak plasma levels in 2 hrs.  ELiminate is by heaptic metablism and renal exretion.  The HALF LIFE is 5 to 6 hours.
3. Sedation, dizziness, headache, dry mouth, and consitpation. Respritory Depression  is minimal.
4. intensifies  response to CNS depresants and cannot be combined  with these drugs. 

Clonidine (Duraclon)

1. What are the approved applications (2)?
2. Mechanism of action?
3. Analgesic Use?
4. Adverse Effects?

1. Treatment of hypertension and relief of sever pain. 
2. Clonidine is an alpha adrenergic agonist.  The drug appears to relieve pain by binding to presynaptic alpha receptors in the spinal cord.  The result is blockade of nerve  traffic in pathways that transmit pain signals from the brain.  Pain is not blocked.
3. Combined with an opiod analgesic, is approved to treat sever cancer pain.
4. Hypotension, bradycardia, Rebound hyertension, catheter-related  infection.

1. What is the antidepresent of first choice for many patients?
2. What is the thereaputic uses?
3. What is the half life?
4. What are the adverse effects?

1. Tricyclic
2. Depression,  Bipolar Disorder
3. Half lifes are long and variable  and are administered in a daily dose. 
4. Orthostatic hypotension, anticholinergic effect, diaphoresis, sedation, cardiac toxicity, seizures, hypomania, sucide risk.

SSRI's

Selective Serotonin Reupake Inhibitors

SSRI

1. What is one SSRI?
2. What is is the action?
3. What is the therapeutic use?
4. What is the half life?
5. ADR
6. Interactions

1.  Fluoxetine (Prozac)
2. Produces CNS excitation rather than sedation, inhibition of S-HT reuptake, and thereby intensifies transmission at serotonergic synapse.
3. Major Depression 1-3 weeks, OCD, Bulimia, PMDD, panic disorder, PTSD, socail phobia, alcoholism, adhd, bipolar disorder, migraine, obesity
4. 2 days
5. Sexual dysfunction(70% of men), nausea, headache, insomnia, anxiety, weight gain, hyponitremia
6. Should not combine w/MAOI, TCA + lithium - elevates plasma levels.

S/NRI

1. What is one drug used?
2. What is the action?
3. Therapeutic Use?
4. Half-Life?
5. ADR?
6. Dose

1. Venlafaxine (Effexor)
2. Neuronal reuptake of sertonin + norepinephrine
3.  Major depression, genererlized anxiety, sexual phobia
4. 5 hours
5. Nausea, headache, anorexia, nervousness, sweating, somnolence, insomnia, Dose related diastolic hypertensin, sexual dysfunction hyponutremia
6. 75 m/day

S/NRI

1. Name of the second drug?
2. Action?
3. Pharmacokinetics?
4. Therapeutic Use?
5. ADR
6. Dose

1. Duloxitine
2. Inhibitor of serotinen +NE reuptake, reduces depression sypmtoms +reduce physical pain associated w/depression(backache),
3. Food reduces absorption, bound to albumin
4. Used for pain of diabetic neuropathy
5. Nausea, dry mouth, insomnia, somnolence, constipation, reduced appetite fatigue, increased sweating blurred vision.
6. 40 mg/day

MAOI

1. Drug name?
2. Action?
3. Thereputic Use?
4. ADR?
5. Drug Interactions?
6. Dose?

1. Tramylcipramine(Parnate)
2. Inhibit intraneural MAO-A, increasing amount of NE, irreversible, inhibtion
3. Depression-MAOI's only for prs w/atypical depression
4. CNS stimullation,orthostatic hypotension, hypotension crisis from dietary tyramine.
5. sympathomimetic agents- hypotensive crisis, TCA's + MAOI can cause hypotension, anti-hypertensive-combined w/MAOI can cause hypertencion
6. 10mg

Atypical Antidepressants

1. Drug?
2. Action?
3. ADR?
4. Drug Interactions?

1. Buproprion(Wellbutrin)
2. Stimulant action &  appiete supression, action begins 1-3 weeks.  It may be related to blockade of dopamine uptake.
3. Seizures, agitiation, headache, dry mouth, constipation, tremor, insomina, blurred vission, tachycardia, GI upset
4. MAOI's incrase the risk of bupropion toxicity.  Should end MAOI's 2 weeks prior.

Sedatives/Hypnotics

1. What are 3 benzodiazepines?
2. Action
3. Pharmacokinetics?
4. Thereputic Use?
5. ADR?
6. Drug Interactions?
7. Acute Toxicity?

1. Diazepan(Valium), Lorazepam(Ativan), Midazolam(Versed)
2. Mimick GABA action by binding to chloride channel complex
3. Highly lipid soluble, cross BBB readily
4. Anxeity, isnomina, seizures, muscle spasms, alcohol withdrawlal, panic disorder
5. CNS depression, anterograde amnesia, sleep related behaviors, respiratory depression, abuse,
6. Do not accelerate metabolism of other drugs.
7. Oral Overdose- notlikely, IV toxicity- hypotension, respiratory arrest, cardiac arrest

Benzodiazephines-like drug

1. Drug name?
2. Therapeutic Use?
3. Half Life?
4. ADR?
5. Action?

1. Eszoplicone(Lunesta)
2. Insomnia-increasing sleep time + equality
3. 6 hours, peak 1-2 hours
4. Bitter aftertaste, headache, sominolence, dissiness, dry mouth
5. BInds to benzodiazepine receptors on GABA receptro chloride channel complex.  Enhances depression actions of endogenous GABA

Melatonin Agonists

1. Drug?
2. Action?
3. Therapeutic Use?
4. Pharmakokinetics?
5. ADR?
6. Drug Interactions?

1. Ramelteon(Rozaparam)
2. Sleep promotion derives from MT + MT₂ receptors, selectivity for MT & MT₂ receptors explain why remelteon is superior to melitonin itself for treating insomnia
3. Rapid onset 30 min & short duration, good for induction sleep
4. Absorption is rapid: food can reduce rate & extent of absorption
5. Somnolence, dizziness, fatigue, decreased libido, amconorrhea
6. Fluoxamine, alcohol intensifies sedation  & increase more than 50 should be avoided .  Avoid w/moderate heptic impairment.