Pharm II Final

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Pharm II Final
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2011-08-27 00:02:14
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Pharm II Final
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  1. Accutane
    • Keratolytic: Isotretinoin
    • Tx: Severe cystic acne
    • PO - inhibits sebaceous gland activity, antikeratinizing, anti-inflammatory
    • SE: teratogenic, peeling, photosensitivity, nose bleeds, links to depression, SI
    • must sign pledge to use 2 forms of BC, 2 tests before then q mo
    • only used in very severe cases now
  2. Acyclovir
    • Most commonly for HSV, not as good w Varicella,
    • CMV is resistant
    • Resistance rare except in immunocompromised
    • HSV-1: PO for active and prophylaxis
    • HSV-2: PO, topical (only initial), IV (if severe) - symptoms dec but virus not gone
    • Safe during Preg: prophylactic to prevent C-section
    • Varicella Zoster: PO, IV(for immunocompromised/resistant) - need higher doses bc doesn't work as well for this
    • SE: N/V, HA, vertigo, stinging/burning (topical), phlebitis, reversible nephrotoxic (IV)
    • use gloves applying topical to prevent spread
  3. Adefovir
    • Hepsera
    • Tx: chronic Hep B
    • SE: nephrotoxic
    • rule out HIV 1st bc incs HIV resistance
    • PO, dose depends on renal func
    • extended tx period, high risk of relapse
  4. Allopurinol
    • Tx: Gout (ongoing prevention in pts w high uric acid)
    • reduces blood levels of uric acid, inhibits production
    • generally well tolerated
    • SE: GI, HA, potentially fatal hypersensitivity reaction (rare)
    • Interactions: inhibits hepatic drug metabolizing enzymes
  5. Amantadine
    • 1st gen Antiviral for flu type A/Dopamine releaser: Symmetrel
    • Tx: Flu, Parkinson's
    • SE: CNS effects (confusion, lightheadedness, anxiety), blurred vision, urine retention, dry mouth, constipation, livedo reticularis (temp skin discoloration)
    • Flu develops resistance easily
    • CDC doesnt rec 1st Gen, dont really use for Parkinson bc effects dont last long
    • promotes release of dopamine and prevents reuptake
    • 2-3 day response time, effects last 3-6mo
  6. Artane
    • Anticholinergic
    • Tx: Parkinson's
    • 2nd line, reduce tremor & rigidity, not bradykinesia
    • SE: anticholinergic effects, may aggravate glaucoma
    • Start w low doses and inc until desired effect
    • Dont D/C abruptly, may intensify symptoms
  7. Benzoyl Peroxide
    • Keratolytic
    • Tx: Acne
    • Slowly & continuously liberates oxygen (most acne caused by anaerobes)
    • improvement in 4-6 wks
    • ranges from 2.5-20% strength
    • Weaker typically OTC, stronger are prescription
    • Bleaches fabric
  8. Betoptic
    • Beta Blocker: Betaxolol
    • Tx: Glaucoma
    • cardioselective
    • lowers IOP by dec production of aqueous humor by ciliary body
    • SE: stinging
  9. Carbamide Peroxide
    • Cerumen Emulsifier
    • follow w Saline flush
  10. Celebrex
    • 2nd Gen NSAID: Celecoxib
    • COX 2 inhibitor
    • Tx: osteoarthritis, RA, dysmenorrhea, acute pain
    • SE & Contraindications: similar to Ibuprofen
    • inc CV risk = last choice, only remaining agent
  11. Cerebrex
    • Fosphenytoin
    • Tx: Epilepsy
    • IV Prodrug converts to phenytoin in blood
    • neutral pH less irritating to veins
    • faster infusion doesnt risk CV collapse
    • Expensive, many places wont buy even though better
  12. Ciprodex
    • Tx: Otitis Externa
    • Ciprofloxacin + Dexamethasone
  13. Cogentin
    • Anticholinergic
    • Tx: Parkinson's
    • 2nd line, reduce tremor & rigidity, not bradykinesia
    • SE: anticholinergic effects, may aggravate glaucoma
    • Start w low doses and inc until desired effect
    • Dont D/C abruptly, may intensify symptoms
  14. Colchicine
    • Tx: acute gouty attack, not responsive to safer meds (NSAIDS and glucocorticoids)
    • prevents release of inflammation glycoprotein from phagocytes - only really txs inflammation, not uric acid level
    • prevention in pts who dont have high uric acid
    • Caution: in cardiac, renal, GI disease
    • SE: N/V/D, abd pain
    • destroys rapidly dividing cells, inc GI
    • 0.6 mg tabs
  15. Comtan
    • COMT inhibitor: entacapone
    • Tx: Parkinson's
    • prolongs half life of Levodopa, extends "ON" times
    • SE: related to inc Levodopa
  16. Cycloplegics
    • Tx: eye exam, surgery, uveitis (inflammation of vascular layer of eye) only!
    • Paralysis of ciliary muscle
    • Dec visual acuity
    • may precipitate Angle Closure Glaucoma
  17. Dantrolene
    • Peripherally Acting Spasmolytic: Dantrium
    • Tx: Malignant hyperthermia, upper motor neuron d/o, spasticity from SCI, MS, CP, stroke
    • interferes w intracellular Ca movement
    • SE: muscle weakness (common), hepatotoxic
    • Contraindication: when spasticity used to maintain upright posture & balance (CP)
  18. Darbepoetin Alfa
    • Hemat Growth Factor: Aranesp
    • Same as Epoietin Alfa but longer half life
    • 1/wk to bring up, 1/mo to maintain
  19. Depakote
    • Valproic Acid
    • Tx: Epilepsy (all major types), Bipolar, Migraine
    • Suppression of Na & Ca influx, potentiation of GABA
    • Therapeutic level: 50-150 mg/mL
    • SE: GI, Hepatotoxic &Pancreatitis (rare but serious), teratogenic
    • Interactions: Dec phenobarb metab, displaces phenytoin (toxicity)
  20. Diamox
    • Carbonic Anhydrase Inhibitor: Acetazolamide
    • Tx: Glaucoma, angle closure long term mgmt
    • PO, systemic
    • reduces production of aqueous humor
  21. Efavirenz
    • NNRTI: Sustiva
    • SE: Rash (~50%, mild to SJS), CNS (altered mood, sleep, anxiety), Teratogenic
    • Interactions: Induces P450 (St Johns Wart may reduce levels)
  22. Enbrel
    • Tumor Necrosis Factor Blocker: Enteracept
    • Tx: mild to mod RA
    • Binds to TNF (cytokine involved inflammation)
    • delays progression of damage and suppresses S/S
    • SQ
    • SE: site reactions, infection (avoid live vaccines)
  23. Epoetin Alfa
    • Hematopoietic Growth Factor: Epogen, Procrit
    • Tx: chronic renal failure, HIV pts on zidouvudine, chemo for nonmyeloid CA, anemic having surgery
    • need sufficient Fe, folic acid and vits
    • human erythropoietin reproduced w recombinant DNA
    • SE: HTN, autoimmune red cell aplasia, CV (CVA, MI, thrombotic events if hgb >12gm/dL or inc >1 in 2 weeks)
    • may take up to 3 mo to work
    • SQ or IV - 3/wk to raise, 1/wk to maintain
    • Dont shake!
  24. Filgrastim
    • Granulocyte colony stim factor: Neupogen
    • Tx: chronic neutropenia, CA pts
    • SE: bone pain (~50%), leukocytosis
    • SQ, IV - dont shake
    • Contraindication: myeloid CA
  25. Flexeril
    • Centrally Acting Muscle Relaxant: Cyclobenzaprine
    • Tx: localized spasm from muscle injury
    • SE: CNS depression, hepatotoxic, anticholinergic effects
    • physical dependence, w/d over 2 weeks if on long-term
    • PO
  26. Fuzeon
    • Fusion Inhibitor: Enfuvirtide
    • Tx: HIV
    • blocks HIV envelope from fusing w CD4 cell membrane
    • SQ bid
    • SE: site reactions
    • only for resistant types
  27. Ganciclovir
    • Antiviral: Cytovene, Vitrasert
    • Tx: Herpes, CMV
    • not as safe as acyclovir, but treats CMV
    • doesnt get metabolized
    • give proph. in im.comp to prevent CMV retinitis
    • tx indefinite, resistance can develop
    • SE: Granulocytopenia (stop ANC <500), Thrombocytopenia (stop plt <25,000)
    • Zidovudine can exacerbate SE, risk for im.comp
    • Monitor CBC
    • Teratogenic/Embryotoxic: avoid preg 90 days, pos. infertility
  28. Gold Salts
    • Auranofin
    • relieve pain/stiffness, stop joint degeneration
    • 4-6 mo onset
    • SE: bone marrow suppression, GI, rashes, pruritus, stomatitis, nephrotoxic, hypotension
    • last line bc bad SE
  29. Ibuprofen
    • 1st Gen NSAID: Motrin
    • Tx: fever, mild-mod pain, dysmenorrhea, promotes closure of ductus arteriosus in preterm infants
    • less GI bleeding and inhibition of plt aggregation
  30. Imuran
    • Cytotoxic/Im.Supp: Azathioprine
    • non-specific - suppresses cell-mediated & humoral immune responses
    • SE: bone marrow suppression, teratogenic, neoplasms
    • only when safer agents dont work
  31. Interferon Alfa
    • Tx: Hep B&C
    • SQ
    • pegylated means its long acting (give 1/wk)
    • regular - give q 3 days
    • SE: flu-like syndrome, neuropsych effects (depression, SI), GI, Alppecia, pain/reaction at site, MVD, bone marrow suppression
  32. Keppra
    • Levetiracetam
    • Tx: Epilepsy (partial & tonic-clonic)
    • unknown action
    • doesnt interact w other meds
  33. Lamictal
    • Lamotrigine
    • Tx: Epilepsy (adjunct partial & tonic-clonic), bipolar
    • SE: aseptic meningitis, SJS/fatal rashes
  34. Lamivudine
    • EpivirHBV
    • Tx: Hep B&C, form for HIV
    • minimal SE
    • high risk of relapse
  35. Lioresal
    • Centrally acting Spasmolytic: Baclofen
    • Tx: MS, traumatic spinal cord lesions, CP
    • Not effective in Parkinson's & Huntington's
    • mimics GABA, suppresses hyperactive reflexes
    • Caution: pts w seizure d/o
    • SE: CNS depression, anticholinergic effects
    • Toxicity: coma, resp depression
    • need to w/d
    • PO, interthecal infusion
  36. Methotrexate
    • DMARD
    • Tx: RA, Gout, CA, abortion
    • 1st choice, rapid acting 3-6 weeks
    • admin 1/wk
    • SE: GI ulceration, bone marrow suppression, hepatic fibrosis, toxicities
    • Monitor: kidney & liver func, CBC
    • contraindicated in pregnancy
  37. Mirapex
    • Dopamine Agonist: Pramipexole
    • Tx: Parkinson's
    • nonergot
    • SE: N/V, compulsive shopping and gambaling
    • may be alone in early stages and later w levodopa/carbadopa
  38. Mydriatics
    • Tx: eye exam, surgery, uveitis (inflammation of vascular layer of eye)
    • Dilates pupil
    • Dec visual acuity
    • May precipitate Angle Closure Glaucoma
  39. Naproxen
    • 1st Gen NSAID
    • prolonged half-life
  40. Neurontin
    • Gabapentin
    • Tx: Epilepsy (partial)
    • adjunctive therapy, enhances GABA release
    • pretty well tolerated, causes drowsiness
    • May also tx bipolar, neuropathic pain, leg cramps, migrraines
  41. Oprelevkin
    • Thrombopoietic Growth Factor: Interleukin-11, Neumega
    • Tx: chemo pts
    • minimizes thrombocytopenia and need for plt transfusion
    • SE: fluid retention (Na&H2O), dysrhythmias, conjunctiva redness, sudden death
    • SQ
    • want pts >50,000
  42. Orthoclone OKT3
    • Monoclonal Im.supp: Muromonab-CD3
    • blocks all T-cell fun
    • Tx: pre-bone marrow transplant, prevents acute rejection
    • SE: fever, chills, dyspnea, chest pain, anaphylaxis
    • premedicate IV glucocorticoids, acetaminophen, diphenhydramine - have intubation equip
  43. Oseltamivir
    • Antiviral for Flu A&B, 2nd Gen
    • Tamaflu
    • dec length by up to 2 days, depending on when started
    • PO, can be prophylactic
    • few SE, less risk of resistance
  44. Oxymetazoline
    • Ocular Decongestant: Visine, OcuClear
    • Tx: allergic conjunctivitis
    • vasoconstriction to dec redness and edema
    • prolonged use may cause rebound congestion
  45. Parlodel
    • Dopamine Agonist: Bomocriptine
    • Tx: Parkinson's
    • Ergot derivate
    • alone in early stages, in combo w levodopa later
    • SE: dose limiting psych reactions, cumpulsive shopping and gambaling
  46. Pegfilgrastin
    • Long Acting Granulocyte Colony Stimulating Factor
    • one dose injection
    • prevention of febrile neutropenia in nonmyeloid CA chemo pts
  47. Phenobarbitol
    • Barbituate
    • Tx: Epilepsy
    • suppreses seizure at mod dosage by potentiating GABA
    • PO, IM, IV
    • SE: drowsiness, physical dependence (severe), teratogenic, CNS depression
    • Toxicity: Nystagmus, ataxia, gen CNS depression, death
    • Interactions: hepatic drug metabolizing enzymes
  48. Pilocarpine
    • Cholinergic Agonist
    • Tx: Glaucoma
    • IOP dec by contracting ciliary muscle - wider space w/in trabecular meshwork
    • SE: visual changes, retinal detachment (not common)
  49. Plaquenil
    • Hydrooxychloroquine
    • Tx: RA and Gout, Antimalarial
    • 3-6 mo onset
    • early use can improve long term outcomes
    • used w methotrexate
    • SE: Retinal damage, eye apts before start and q 6 mo
  50. Probenecid
    • Tx: Gout (prevention in pts w high uric acid)
    • acts on renal tubules to inc excretion of uric acid
    • SE: GI disturbances, renal injury, hypersensitivity
  51. Prograf
    • Immunosuppressant: Tacrolimus
    • Tx: proph of organ rejection (kidney and liver)
    • use w glucocorticoids
    • toxicity problems, may have to d/c
    • SE: same as cyclosporin but more likely to occur
    • PO, can be IV or topical for autoimmune
    • Interactions: grapefruit juice, nephrotoxic meds
  52. Prostigmin
    • Reversible Cholinesterase Inhibitor: Neostigmine
    • Tx: MG
    • prevents acetylcholine inactivation
    • increases muscle strength
    • can have skeletal muscle weakness from too much or too little
  53. Rapamune
    • Immunosuppressant: Sirolimus
    • Tx: proph kidney rejection only!
    • use w cyclosporin and glucocorticoid (prednisone)
    • nephrotoxic
  54. Retin-A
    • Keratolytic: Tretinoin
    • Tx: Acne and diminish changes from sun damage
    • Stimulates turnover of epidermal cells, incs fibroblasts & collagen
    • reduces fine wrinkles
    • topical - causes photosensitivity
  55. Ribavirin
    • Broad Spectrum Antiviral: Bebetol, Copegus
    • Tx: Hep B&C, RSV in kids (aerosol form)
    • action unknown
    • used in combo w peginterferon alfa
    • PO 24-48 wk tx
    • SE: Flu-like syndrome, Neuropsych (depression), hemolytic anemia, Birth defects (cat X)
    • relapse is high when med stopped, even w long tx
  56. Rimantidine
    • 1st gen Antiviral for flu type A
    • SE: CNS effects
    • develops resistance easily
    • CDC doesnt recommend 1st Gen
  57. Sandimmune
    • Calcineurin inhibitor im.supp: Cyclosporine
    • Tx: organ rejection, autoimmune (RA, MG, psoriasis)
    • SE: infection, nephrotoxic, tremor, hirsutism, htn, hyperk, hepatotoxic, lymphona
    • Interactions: grapefruit juice (toxicity), nephrotoxic agents
    • used in combo w glucocorticoids
    • Microemulsion has better bioavail
    • many form, not all are =
  58. Selegiline
    • MAO-B Inhibitor: Eldepryl, Carbex
    • Tx: Parkinson's
    • suppresses destruction of dopamine
    • may delay progression of disease
    • SE: insomnia
    • Interaction: initially intensifies Levodopa effects
    • 2nd or 3rd line drug
    • not related to MAOIs (no HTN crisis)
  59. Sinemet
    • Tx: Parkinson's
    • Levodopa + Carbidopa (no effects of its own)
    • inhibits decarboxylation of levodopa in intestine and periphery, more gets to brain
    • Carbidopa can reduce SE of Levodopa (CV, B6, postural hypotension, N/V)
  60. Sulfasalazine
    • Azulfidine
    • Tx: RA, Gout, IBD
    • slows progression of joint deterioration
    • onset w/in 1 mo
    • SE: GI upset, rash, urticaria
    • Contraindicated: sulfa allergy
  61. Tegretol
    • Carbamazepine
    • Tx: Epilepsy (not absence, myoclonic or atonic), bipolar, trigeminal &glossopharyngeal neuralgias
    • inhibits Na channels
    • absorption is delayed and variable
    • SE: nystagmus, diplopia, blurred vision (these 3 @ begining of tx), low blood counts, teratogenic
    • monitor CBC before tx and during
    • give most of med HOS to minimize effects
    • Interactions: hepatic drug-metabolizing enzyme, dec effect of BC, warfarin, glucocorticoids - Phenytoin and Phenobarb inc its metab
    • PO, give w food
  62. Timoptic
    • Beta Blocker: Timolol
    • Tx: Glaucoma
    • nonselective
    • lowers IOP by dec production of aqueous humor by ciliary body
    • SE: Stinging
    • Contraindications: Asthma, COPD
  63. Toradol
    • 1st Gen NSAID: Ketorolac
    • powerful analgesic, min antiinflammatory properties
    • short term use
    • IM or IV
  64. Tylenol
    • Cyclooxygenase Inhibitor: Acetominophen
    • Tx: fever, pain
    • no anti-inflammatory effect, only works in CNS
    • Contraindications: hepatic disease
    • Caution: ETOH abuse
    • OD: N/V/D, sweating, abd discomfort, then hepat injury/necrosis (jaundice, clay colored stool, orange/yellow urine)
    • OD Tx: acetylcysteine (acetadote) IV or Mucomyst PO
  65. Valium
    • Benzodiazepine: Diazepam
    • Tx: muscle relaxant acuetly, anxiety
    • physical & psych dependence, need to w/d
    • small risk of abuse, controlled sub
  66. Xalatan
    • Prostaglandin Analog: Latanoprost
    • Tx: Glaucoma
    • incs outflow of aqueous humor by relaxing ciliary muscle
    • SE: permanent inc brown iris pigment
    • as effective as beta blockers, no systemic effects
  67. Zanamivir
    • Antiviral for Flu A&B, 2nd gen
    • inhaled
    • SE: few, may cause Bronchospasm
    • need to start w/in 2 days of onset
    • less risk of resistance
  68. Zidovudine
    • NRTI: Retrovir, AZT
    • unpleasant but effective, not curative
    • gets build into chain
    • PO, IV
    • SE: anemia, neutropenia, lactic acidosis (from mitochondria damage), severe hepatomegaly, N/V/D, abd pain, dyspepsia, anorexia, CNS
    • Monitor: ABG, CBC
    • Interactions: myelosuppressie, nephrotoxic, toxic to blood cell meds, Bactrim, dapsone, ampho B, flucytosine, vincristine, vinblastine
    • not mono therapy bc resistance

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