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Pharm Ren,GI,Endo
USCSOM: Pharm: Renal, Endocrine, GI, Autocoids
| Question | Answer |
|---|---|
| Mannitol mechanism/site of action | osmotic diuretic, mild diuresis, filtered by glomerulus; works at proximal tubule and descending loop (h2o permeable sites) |
| Mannitol uses/contraindications | ocular/neurosurgery, increased urine flow; CHF, renal disease, cirrhosis |
| Acetazolamide: mechanism of action | carbonic anhydrase inhibitor; proximal tubule, mild diuresis |
| Acetazolamide: clinical uses and side effects | glaucoma, metabolic alkalosis, acute mountain sickness; metabolic acidosis, hypokalemia, sulfa allergies |
| Furosemide: MoA | inhibit NaK2Cl in ascending limb; most effective diuretic, increased Na excretion, iso-osmotic urine |
| Ethacrynic Acid: MoA | inhibit NaK2Cl in ascending limb; most effective diuretic, increased Na excretion, iso-osmotic urine |
| Furosemide: Uses | manage edema, reduce vascular volume, emergency (pulmonary edema), hypercalcemia |
| Ethacrynic Acid: Uses | manage edema, reduce vascular volume, emergency (pulmonary edema), hypercalcemia |
| Furosemide: side effects | hypo Ca,Mg,Na,K,volemia; hyper uricemia,glycemia; ototoxicity (rev); sulfa allergy |
| Ethacrynic Acid: Side Effects | hypo Ca,Mg,Na,K,volemia; hyper uricemia,glycemia; ototoxicity (irrev) |
| Furosemid/Ethacrynic Acid: drug interactions | potentiate digoxin and Lithium; decrease probenecid activity |
| Thiazide: MoA, Uses | inhibit Na/Cl co transporter in distal convoluted tubule; inc renal PG synth; HTN, treat edema, kidney stones, nephro D.I. |
| Thiazide: Side Effect | hypo Na,K; hyper Ca,uricemia,glycemia; metabolic alkalosis; increased lipids; sexual dysfunction |
| Thiazide: contraindications | potentiate digoxin, Li, loop diuretics; dec activity of OATs; NSAIDS block PG synth; sulfa allergy |
| List potassium sparing diuretics | spironolactone, triamterene, amiloride |
| Spironolactone: MoA | Aldo receptor antagonist, decreased Na resorption and stops lumen negative potential |
| Triamterene and Amiloride: MoA | block Na channel on luen side of principal cells in collecting tubule |
| Spironolactone: Uses, Side Effects | CHF, female hirsutism, hyperaldo; hyperkalemia, metabolic acidosis, anti-andorgenic effects, ACE inhibitors |
| Amiloride: Uses, Side Effects | blocks Li-induced nephrogenic D.I. by blocking H20 channels; hyperkalemia, metabolic acidosis |
| Triamterene: Uses, Side Effects | k-sparing activity with loops/thiazides, HTN, edema; hyperkalemia, metabolic acidosis |
| Nesiritide | BNP agonist; dilation of renal arterioles, inc GFR; for CHF by IV; dose-dependent hypotension |
| Desmopressin | V2 agonist; treat neurogenic D.I.; stimulate H20 channel in collecting tubule |
| Cromolyn Sodium | prevents histamine release; used in prophylactic asmtha and rhinitis |
| Diphenhydramine | H1 receptor antagonist, muscarinic antagonist; use in allergies, sedation, motion sickness, anti-psychotic side effects |
| Fexofenadine | h1 antagonist peripheral only; do not produce sedation bc they don't cross blood-brain barrier |
| Loratadine | h1 antagonist peripheral only; do not produce sedation bc they don't cross blood-brain barrier |
| Cimetidine | H2 receptor antagonist; inhibit gastric acid secretion; used for ulcers, GERD, Hpylori, ZE; side effects inhibit CytP450, anti-androgenic |
| What serotonin channel is ligand-gated? | 5-HT3 |
| Ergotamine | partial 5-HT agonist; treat migrane as soon as system appears; SE:nausea,vomit,gangrene,coronary vasospasm |
| Ergonovine | partial 5-HT agonist; postpartum hemorrhage; SE:nausea,vomit,coronary vasospasm |
| Triptans | 5HT1(B,D) agonist; use for migrane attacks, nasal, quick acting, anytime during attack; NO nause,vomit; SE-fatigue,drowsiness |
| Ondansetron | 5-HT3 antagonist; anti-emetic for chemo pts, post-op nausea and vomiting |
| Alosetron | 5-HT3 antagonist; diarrhea-predominant IBS in females who have not responded to other treatments |
| General physiology of eicosanoids | contraction of smooth muscle, vasodilation |
| Carboprost | PGF2 analog; uterine contraction, abortions, inhibit postpartum bleeding; SE:nause,vomit,diarrhea |
| Dinoprostone | PGE2 analog; contract uterus, induce labor; SE:nausea,vomit,diarrhea |
| Alprostadil | PGE1 analog; vasodilation, patent ductus arteriosus, erectile dysfunction |
| Misoprostol | PGE1; Use:prevent NSAID ulcers, first trimester abortion; SE:GI,abortifacient |
| Epoprostenol | PGI2 (ptrostacyclin); vasodilation; used for primary pulmonary hypertension |
| -lukasts/zileuton | leukotriene inhibitor, Lipox inhibitor; treat chronic asthma blocking bronchoconstriction |
| Salicylates | nonselective COX inhibitors; fever, pain, anti-inflammatory,inhibit platelet aggregation |
| Aspirin Side Effects | salicylism: tinnitus, nausea, vomit, Reye's syndrome; hyperventillation to hypoventillation |
| Aspirin and Uricosuria | low doses: high plasma uric acid; high doses: low plasma uric acid |
| Aspirin Drug Interactions | displace plasma proteins; decrease tubular secretion; decrease activity of thiazide and loops |
| Ibuprofen/Naproxen | reversible non-selective COX inhibitors; SE:GI, hypersensitivity, pregnancy, decreased renal, inhibit platelet |
| Ketorolac | superior analgesic effects; given IV/IM; short term management of post-op pain |
| Sulindac | treat gouty arthritis; for pts with renal disease |
| Indomethacin | superior anti-inflammatory and analgesic; treat gouty arthritis; severe GI tox longterm |
| Celecoxib | COX-2 inhibitor; no platelets, noGI; rheumatoid arthritis, pain, dysmenorrhea, FAP; potential CV side effects |
| Acetaminophen | inhibition of brain COX; analgesia, antipyresis; NO Anti-Inflammatory; SE: rash, hepatic necrosis |
| Antimalarial Drugs | chloroquine; suppress T-lymph; treat rheumatoid; SE: ocular |
| Sulfasalazine | anti-inflammatory and immuno suppressive; IBS, juvenile arthritis |
| Methotrexate | cancer chemotherapy; SE: bone marrow suppression, liver fibrosis/cirrhosis |
| Azathioprine | inhibit B/T cell fxn; Crohn's disease; SE: bonemarrow suppression |
| Penicillamine | chelation, immunosuppresive; manage wilson's disease |
| Gold | alter macrophages; contraindicated in pregnancy and impaired liver function |
| Infliximab | anti-TNF-alpha agent; antibody against TNF; Crohn's disease; SE: increased risk of infection, cancer |
| Etanercept | anti-TNF-alpha agent; SE: increased risk of infection, cancer |
| Colchicine | antiinflammatory inhibiting release of LTs; used in acute gouty arthritis; SE: on rapidly proliferating cells, GI, agranulocytosis, alopecia |
| Probenecid/Sulfinpyrazone | block OATs on lumenal side, decrease reabsorption of uric acid; SE:GI, interacts with aspirin and prolongs action of penicillin |
| Allopurinol/Febuxostat | Xanthine oxidase inhibitors; used for hyperuricemia, and over producers of uric acid |
| Allopurinol Side Effects | GI, deadly hypersensitivity, renal stones, increased liver enzymes |
| Omeprazole | pro-drug; irreversible inhibition of H/K ATPase, slow acting, used for PUD, GERD, ZE, NSAID ulcers |
| Sucralfate | viscous, sticky gel binding to ulcers; SE:constipation; used for PUD; needs acidic stomach for activation |
| Bismuth subsalicylate | Pepto; protective coating, antimirobial; SE:black tongue/feces; used for PUD Hpylori, mild GERD, diarrhea |
| 3-2-1 | 3 drugs (2Abs + PPI), 2 twice daily, 1 week (for 2 weeks) |
| Antacids | calcium carbonate, MgOH, AlOH; Ca/Al may give constipation; Mg may give diarrhea |
| Metoclopramide | D2 receptor antagonist; inc Ach release, inc LES tone, esophageal clearance, gastric emptying; used for GERD, anti-emetic, migrane |
| Ulcerative colitis properties | confined to the colon; chronic superficial inflammatory; rectal bleeding |
| Crohn's disease properties | all GI tract; focal inflammation of all layers; associated with abcesses and fistuae |
| Sulfasalazine | 5-ASA inhibits COX and LOX; SE:leukopenia,rev male infertility, GI, headache; Used:UC, CD of colon |
| Olsalazine | 5-ASA without side effects; used for UC in patients with sulfa allergy |
| Mesalamine | same as Olsalazine; given rectally and orally; used in UC and CD |
| Azathioprine/6-mercaptopurine | suppress lymphocyte proliferation; slow onset, steroid sparing; used for chronic CD management |
| Somatropin | Growth Hormone; treat children with GH deficiency, increase elderly muscle mass; SE:hyperglycemia,edema,muscle/jointpain |
| Octreotide acetate | somatostatin analogue; dec GH, dec 5-HT; used in acromegaly, carcinoid, variceal bleeding |
| Bromocriptine | dopamine antagonist, inhibit prolactin and GH release; use in acromegaly, prolactinomas, Parkinsons; SE:nausea,vomit,dizzy |
| Menotropins | contain FSH and LH; stimulate follicle; induce ovulation; SE: multiple births, ovarian enlargement |
| Leuprolide | GnRH agonist; increase then decrease of LH and FSH; treat prostate cancer, endometriosis, precocious puberty |
| Ganirelix Acetate | GnRH antagonist; inhibits LH release; LH suppression in IVF; SE: abdominal pain, overian hyperstimulation |
| Oxytocin | milk ejection, uterine contraction; sustain labor, postpartum uterine hemorrhage; SE: hypotension, uterine hypercontraction |
| Vasopressin | V2-antidiuretic, V1-vasopressor; use in controlling GI bleeding and treating D.I. |
| Desmopressin | vasopressin analogue; antidiuretic activity ONLY; treat nuerogenic DI and bed wetting; SE:hyponatremia |
| TRH | released from hypothalamus, stimulates TSH |
| Levothyroxine | synthetic T4, long stability and long half-life; replacement therapy, cretinism |
| Liothyronine | synthetic T3, emergency situation, quck acting |
| Propylthiouracil (PTU) | inhibit thyroid peroxidase, inhibit peripheral deiodination; slow onset, use in young Grave's, prep for thyroid; SE:rash, agranulocytosis |
| Methimazole | inhibit thyroid peroxidase; slow onset; treat Grave's in young, prep for thyroid sx; SE:rash,agranulocytosis |
| Iodide | inhibit thyroglobulin, rapid onset; use in thyroid storm, prep for thyroid surgery; SE:rash, swollen glands, ulcerations, fever, bleeding |
| 131 Iodide | oral, destroys thyroid cells; treat refractory Grave's; SE: hypothyroidism, advantage over Sx |
| Propranolol | beta antagonist, inhibits peripheral deiodinase; treat thyroid storm |
| Hydrocortisone | short acting, low potency; equal anti-inflammatory and sodium retaining; treat Addison's |
| Prednisone | intermediate-acting, medium potency; anti-inflammatory > sodium retention; prodrug in liver |
| Dexamethasone | long acting, high potency; anti-inflammatory >> sodium retention |
| Fludrocortisone | mineralcorticoid; reabsorption of NA, HTN; treat Addison |
| Effects of Glucocorticoids | hyperglycemia, catabolic effects, osteoporosis, inhibits PLA2, immunosupressants |
| Cosyntropin | synthetic ACTH; tests adrenal responsiveness, stimulates release of cortisol, aldo, androstenedione |
| Dexamethasone Suppression Test | 1 mg overnight, 8mg in 24 hrs; Cushings responds to 8mg test; ectopic/adrenal responds to neither |
| Addisons disease | adrenocortical insufficiency; treat with hydrocortisone + fudrocortisone |
| Cushings Syndrome | glucocorticoid excess; specifically from the pituitary gland; treat with metyrapone |
| Fluticasone Propionate/Beclomethasone | nasal spray for allergic rhinitis, glucocorticoids with no ACTH effects |
| Metyrapone | inhibits synthesis of cortisol; treat Cushing's prior to Sx; SE:HTN, |
| Spironolactone | K sparing diuretic; aldo antagonist; anti-androgen; treat hyperaldo, CHF, hirsutism; SE:hyperkalemia |
| Diethylstilbesterol | oral estrogen analogue; morning after pill, replacement therapy; contraindicated in pregnancy |
| Ethinyl estradiol | oral estrogen analogue; in oral contraceptives |
| Medroxyprogesterone | oral progestin analogue; maturation and secretion of endometrium |
| Norethindrone | oral progestin analogue; maturation and secretion of endometrium |
| Levo-norgestrel | oral progestin analogue; maturation and secretion of endometrium; androgenic activity |
| Desogestrel | new progestin; more potent and less androgenic than older progestins |
| Clomiphene | estrogen agonist/antagonist; induction of ovulation, first fertility drug used |
| Tamoxifen | SERM, estrogen antagonist; used in estrogen receptor positive breast, osteoporosis; SE:hot flash, DVT |
| Raloxifene | SERM, estrogen antagonist; used in ER positive breast cancer; does not increase risk of endometrial cancer |
| Mifepristone | progestin antagonist, abortifacient; SE:excessive bleeding |
| Testosterone enanthate | testosterone, muscle growth, inc height, weight gain; hypogonadal boys |
| Oxandrolone | anabolic steroid; anabolic >> androgenic; muscle building; SE:virilizing, hepatic impairment, suppress spermatogenesis |
| Finasteride | inhibits conversion to DHT; treat BPH; treat male pattern baldness; teratogenetic actions |
| Anastrozole | inhibit estrogen production peripherally; treat ER positive breast cancer; SE:hot flashes, bone loss, vaginal dryness |
| Regular insulin | short acting, rapid onset |
| Lispro/Aspart insulin | short-acting, rapid onset |
| Lente insulin | zinc ions, acetate, intermediate acting, medium onset |
| Neutral Protamine Hagedorn insulin | NPH, protamine, intermediate acting, medium onset |
| Ultralente insulin | long-acting, slow onset |
| Glargine insulin | insulin analog with long duration of action |
| Chlorpropamide | 1st gen sulfonylurea receptor; stimulate insulin release; treat non-insulin dependent diabetes; long acting; SE:hypoglycemia,inc ADH |
| Glyburide | 2nd gen sulfonurea receptor in pancreas cell; treat non-insulin dependent diabetes; quick acting |
| Repaglinide | stimulate insulin release at ATP/K channel; fast onset, short duration |
| Metformin | decrease hepatic glucose; diahrrea and lactic acidosis; used in combination therapy |
| Acarbose | inhibit glucosidase in intestines; reduce GI glucose absorption, FLATULENCE |
| Rosiglitazone | reduce insulin resistance; decrease AICs; increased insulin-induced hypoglycemia |
| Exenatide | glucagon-like peptide 11; enhance glucose dependent insulin secretion; suppress glucagon secretion |
| Sitagliptin | inhibits DPP-4, which degrades GLP-1; prolongs the activity of GLP-1 |
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jlellerm
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