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FA - Pharmacology 2

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pujomora's version from 2016-06-09 05:53

Sympathomimetics

Question Answer
epinephrine effects on sympathetic receptors++++ on α1-β2
epinephrine applicationsanaphylaxis, open-angle glaucoma, asthma, hypotension
norepinephrine effects on sympathetic receptors++++ on alpha-1, alpha-2, ++ on beta-1
applications of norepinephrinehypotension (but decreases renal perfusion)
isoproterenol effects on sympathetic receptors++++ on beta-1, beta-2
applications of isoproterenoltorsades (tachycardia decreases QT interval), bradyarrhythmias (but can worsen ischemia)
high dose dopamine on sympathetic receptors+++ on alpha-1, alpha-2
medium dose dopamine on sympathetic receptors+++ on beta-1, ++ on beta-2
low dose dopamine on sympathetic receptors+++ on dopamine receptors
applications of dopamineshock (renal perfusion), heart failure; inotropic and chronotropic
dobutamine effect on sympathetic receptors++++ on beta-1, + on alpha-1, alpha-2, beta-2
applications of dobutamineheart failure, cardiac stress testing; inotropic and chronotropic
phenylephrine on sympathetic receptors+++ on alpha-1, ++ on alpha-2
applications of phenylephrinehypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant)
albuterol, salmeterol, terbutaline effects on sympathetic receptors++++ beta-2, ++ beta-1
terbutaline applicationreduce premature uterine contractions
metaproterenol and albuterol applicationsacute asthma
salmeterol applicationfor long-term asthma or COPD
ritodrine effects on sympathetics++++ beta-2
ritodrine applicationsreduces premature uterine contractions
norepinephrine vs isoproterenol in CV systemNE: alpha-1 mediated vasoconstriction increases MAP, causing reflex bradycardia
Iso: beta-2 mediated vasodilation decreases MAP, increasing heart rate through beta-1 and reflex activity
clonidine actioncentrally acting alpha-2 agonists, decrease central sympathetic outflow
clonidine applicationhypertension, especially with renal disease (no decrease in blood flow to kidney)
alpha-methyldopa actioncentrally acting alpha-2 agonists, decrease central sympathetic outflow
alpha-methyldopahypertension, especially with renal disease (no decrease in blood flow to kidney)
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Indirect sympathomimetics

Question Answer
amphetamine actionindirect general agonist, releases stored catecholamines
amphetamine applicationsnarcolepsy, obesity, ADHD
ephedrine actionindirect general agonist, releases stored catecholamines
ephedrine applicationsnasal decongestion, urinary incontinence, hypotension
cocaine actionreuptake inhibitor
counterindicated medication if cocaine intoxication is suspectedbeta-blocker; unopposed alpha-1 activation and extreme hypertension
cocaine applicationsvasoconstriction and local anesthesia
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Section

ABCDE

 

LabelAnswer
AMetyrosine
BReserpine
CGuanethidine, bretylium
DAmphetamine
ECocaine, TCAs, amphetamine
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α-blockers

Question Answer
phenoxybenzamine actionirreversible, non-selective alpha blocker
phenoxybenzamine applicationspheochromocytoma (before surgical removal)
phenoxybenzamine toxicityorthostatic hypotension, reflex tachycardia
phentolamine actionreversible, non-selective alpha blocker
phentolamine applicationgiven to patients on MAOIs who eat tyramine-containing foods
prazosin, terazosin, doxazosin, tamsulosin actionalpha-1 selective blockers
prazosin, terazosin, doxazosin, tamsulosin applicationshypertension, urinary retention in BPH
prazosin, terazosin, doxazosin, tamsulosin toxicities1st-dose orthostatic hypotension, dizziness, headache
mirtazapine actionselective alpha-2 blocker
mirtazapine applicationdepression
mirtazapine toxicitysedation, increased cholesterol, increased appetite
alpha-blockade of epinephrine vs. phenylephrinephenylephrine is a pure alpha agonist, so administration of phenylephrine under an alpha blockade will produce no response. the beta action of epinephrine will lead to a net depressor response (unopposed beta action)
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β-blockers

Question Answer
effect of beta-blockers in angina pectorisdecrease HR and contractility, decreased O2 consumption
B-blockers in MIdecrease mortality
B-blockers used in SVTmetoprolol, esmolol; decrease AV conduction velocity (class II antiarrhythmic)
B-blockers in hypertensiondecrease CO, decrease renin secretion (B1 blockade on JGA cells)
B-blockers in CHFslows progression of chronic failure
B-blocker used in glaucomatimolol; decreased secretion of aqueous humor
use B-blockers with caution indiabetics
adverse cardiac effects of B-blockersbradycardia, AV block, CHF
adverse CNS effects of B-blockersseizures, sedation, sleep alteration
adverse effects of B-blockersimpotence, exacerbation of asthma
B1-selective antagonists are advantageous inpatients with comorbid pulmonary disease
B1-selective partial agonistacebutolol
short acting B1-selective antagonistesmolol
B1-selective blockersA BEAM
acebutolol (partial agonist), betaxolol, esmolol (short acting), atenolol, metoprolol
non-selective beta blockersPropranolol, Timolol, Nadolol, and Pindolol (Please Try Not being Picky)
non-selective (vasodilatory) alpha and beta blockerscarvedilol, labetalol
partial beta agonistsPindolol, Acebutolol
β-blocker that is a class III antiarrhythmicsotalol
Blocks K channels → prolongs the QT
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Toxicities and side effects

ToxinAntidote/treatment
acetaminophenN-acetylcysteine (replenishes glutathione)
salicylatesNaHCO3 (alkalinize urine), dialysis
AmphetaminesNH4Cl (acidify urine)
acetylcholinesterase inhibitors, organophosphatesatropine, pralidoxime
antimuscarinic, anticholinergic agentsphysostigmine salicylate, control hyperthermia
B-blockersglucagon
digitalisnormalize K, Lidocaine, Anti-dig Fab fragments, Mg (KLAM)
Irondeferoxamine, deferasirox
LeadCaEDTA, dimercaprol, succimer, penicillamine
mercury, arsenic, golddimercaprol (BAL), succimer
copper, arsenic, goldpenicillamine
cyanidenitrate + thiosulfate, hydroxocobalamin
methemoglobinmethylene blue, vitamin C
carbon monoxide100% O2, hyperbaric O2
methanol, ethylene glycolfomepizole > ethanol, dialysis
opioidsnaloxone/naltrexone
benzodiazepinesflumazenil
TCAsNaHCO3 (plasma alkalinization)
Heparinprotamine
warfarinvitamin K, fresh frozen plasma
tPA, streptokinase, urokinaseaminocaproic acid
theophylline
Adenosine
beta-blocker
Theophylline and caffeine
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CV drug reactions

Question Answer
drugs causing coronary vasospasmcocaine, sumatriptan, ergot alkaloids
drugs causing cutaneous flushingVancomycin, Adenosine, Niacin, Ca channel blockers (VANC)
drugs causing dilated cardiomyopathydoxorubicin (adriamycin), daunorubicin
drugs causing torsadesClass III and class IA antiarrhythmics
Cocainecoronary vasopasm
sumatriptancoronary vasopasm
ergot alkaloidscoronary vasopasm
vancomycincutaneous flushing
adenosinecutaneous flushing
niacincutaneous flushing
Ca channel blockerscutaneous flushing
Doxorubicindilated cardiomyopathy
Class III & IA antiarrhythmicstorsades
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Hematologic drug reactions

Question Answer
drugs causing agranulocytosisclozapine, carbamazepine, colchicine, propylthiouracil, methimazole, dapsone (Agranulocytosis Could Certainly Cause Pretty Major Damage)
aplastic anemiachloramphenicol, benzene, NSAIDs, propylthiouracil, methimazole
direct coombs-positive hemolytic anemiamethyldopa, penicillin
gray babychloramphenicol
hemolysis in G6PD-deficient patientsIsoniazid, Sulfonamides, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin (hemolysis IS PAIN)
megaloblastic anemiaphenytoin, methotrexate, sulfa drug (have a blast with PMS)
thrombotic complicationsOCPs
clozapineagranulocytosis
carbamazepineagranulocytosis
colchicineagranulocytosis
propylthiouracilagranulocytosis & aplastic anemia
methimazoleagranulocytosis & aplastic anemia
dapsoneagranulocytosis
chloramphenicolaplastic anemia
benzeneaplastic anemia
NSAIDsaplastic anemia
methyldopadirect combs-positive hemolytic anemia
penicillindirect combs-positive hemoltyic anemia
chloramphenicolgray baby syndrome
isoniazidhemolysis in G6PD
sulfonamideshemolysis in G6PD
primaquinhemolysis in G6PD
aspirinhemolysis in G6PD
ibuprofenhemolysis in G6PD
nitrofurantoinhemolysis in G6PD
phenytoinmegaloblastic anemia
methotrexatemegaloblastic anemia
Sulfa drugsmegaloblastic anemia
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Respiratory and GI drug reactions

Question Answer
coughACE inhibitors
pulmonary fibrosisbleomycin, amiodarone, busulfan
acute cholestatic hepatitis, jaundiceerythromycin
focal to massive hepatic necrosishalothane, amanita phalloides, valproic acid, acetaminophen
hepatitisisoniazid
pseudomembranous colitisclindamycin, ampicillin
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Repro/endocrine drug reactions

Question Answer
adrenocortical insufficiencyglucocorticoid withdrawal (HPA suppression)
gynecomastiaSpironolactone, Digitalis, Cimetidine, chronic alcohol use, estrogens, Ketoconazole (Some Drugs Create Awkward Knockers)
hot flashestamoxifen, clomiphene
hyperglycemianiacin, tacrolimus, protease inhibitors, HCTZ, corticosteroids
hypothyroidismlithium, amiodarone, sulfonamides
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MSK & Connective tissue drug reactions

Question Answer
fat redistributionglucocorticoids, protease inhibitors
gingival hyperplasiaphenytoin, verapamil
goutfurosemide, thiazides, niacin, cyclosporine
myopathiesFibrates, Niacin, Colchicine, Hydroxychloroquine, Interferon-alpha, Penicillamine, Statins, Glucocorticoids (Fish N CHIPS Give myopathies)
osteoporosiscorticosteroids, heparin
photosensitivitysulfonamides, amiodarone, tetracycline (SAT for a photo)
stevens-johnsonPenicillin, Ethosuximide, Carbamazepine, Sulfa drugs, Lamotrigine, Allopurinol, Phenytoin, Phenobarbital (bad rash after a PEC SLAPP)
SLEhydralazine, Isoniazid, procainamide, phenytoin
teeth (kids)tetracycline
tendonitis, tendon rupture, cartilage damageflouroquinolones
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Renal/GU drug reactions

Question Answer
diabetes insipiduslithium, demeclocycline
fanconi's syndromeexpired tetracycline
hemorrhagic cystitiscyclophosphamide, ifosfamide (prevent with mesna)
interstitial nephritismethicillin, NSAIDs, furosemide
SIADHcarbamazepine, cyclophosphamide
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Neurologic

Question Answer
cinchonismquinidine, quinine
parkinson-like syndromeantipsychotics, reserpine, metoclopramide
SeizuresIsoniazid, Bupropion, Imipenem/cilastin, Tramadol, Enflurane, Metoclopramide (I BITE My tongue)
tardive dyskinesiaantipsychotics
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Multiorgan

Question Answer
Antimuscarinicatropine, TCAs, H1-blockers, neuroleptics
Disulfiram-like reactionsmetronidazole, some cephalosporins, procarbazine, 1st gen sulfonylureas
nephrotoxic/ototoxicaminoglycosides, vancomycin, loop diuretics, cisplatin
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P450 interactions

Question Answer
P-450 inducers mnemonicMomma Barb Steals Phen-phen and Refuses Greasy Carbs Chronically
modafinilP-450 inducer
barbituratesP-450 inducer
S. John's wortP-450 inducer
phenytoinP-450 inducer
rifampinP-450 inducer
griseofulvinP-450 inducer
carbamazepineP-450 inducer
chronic alcoholP-450 inducer
P-450 inhibitors mnemonicMAGIC RACKS in GQ
macrolidesP-450 inhibitor
amiodaroneP-450 inhibitor
grapefruit juiceP-450 inhibitor
isoniazidP-450 inhibitor
cimetidineP-450 inhibitor
ritonavirP-450 inhibitor
acute alcohol abuseP-450 inhibitor
ciprofloxacinP-450 inhibitor
ketoconazoleP-450 inhibitor
sulfonamidesP-450 inhibitor
gemfibrozilP-450 inhibitor
quinidineP-450 inhibitor
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Sulfa drugs

Question Answer
sulfa drugsprobenecid, furosemide, acetazolamide, celecoxib, thiazides, sulfonamide antibiotics, sulfasalazine, sulfonylureas (Popular FACTSSS)
cutaneous manifestations of sulfa allergiespruritic rash, stevens-johnson, uticaria
hematologic manifestations of sulfa allergieshemolytic anemia, thrombocytopenia, agranulocytosis
general manifestations of sulfa allergiesfever, urinary tract infection
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Antimicrobial drugs

Question Answer
-azoleantifungal
-cillinpenicillin
-cyclineantibiotic, protein synthesis inhibitor
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CNS drugs

Question Answer
-triptan5-HT(1B/1D) agonist (migraine)
-aneinhalational general anesthetic
-cainelocal anesthetic
-operidolbutyrophenone (neuroleptic)
-azinephenothiazine (neuroleptic, antiemetic)
-barbitalbarbiturate
-zolambenzodiazepine
-azepambenzodiazepine
-etineSSRI
-ipramineTCA
-triptylineTCA
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Autonomic drugs

Question Answer
-ololbeta-blocker
-terolbeta-2 agonist
-zosinalpha-1 blocker
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Cardiovascular drugs

Question Answer
-oxincardiac glycoside (inotrope)
-prilACE inhibitor
-afilerectile dysfunction
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Other drugs

Question Answer
-tropinpituitary hormone
-tidineH2 antagonist
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