Pharmacology III

Glucagon

Counterregulatory hormone DKA

Activates liver to break down glycogen

Inc glucose in blood stream

Catecholamines

Counterregulatory hormone DKA

Activates pancreas to release glucagon

Decreases tissue absorption of glucose

Inc glucose in the bloodstream

Cortisol

Counterregulatory hormone DKA

Release CHO from pancreas, liver, muscle, fat cells

Inc glucose in the bloodstream

HHS + DKA anion gap

> 20 meq/L

Anion gap indicates

Ketoacidosis

Normal anion gap

8 - 12 meq/L

GH

Counterregulatory hormone DKA

Inc gluconeogenesis

Inc glucose in the bloodstream

Glycogen

Stored glucose in liver + muscle

meglitinides prefix/suffix

-glinide

Similarity sulfonyureas + meglitinides

Inc pancreatic release of insulin

Causes weight gain

Thiazolidinediones prefix/suffix/memorization

-glitazone

Glucose uptake, dec production

Liver toxicity

Inc fluid retention, inc ovulation

Triglyceride inc

opioid agonist antagonist purpose, adverse

Selectively stimulate and block opioid receptors

Depends on affinity

Puts ceiling on respiratory depression

Those w addiction can have withdrawal

Diacetylmorphine name, desc, adverse

Heroine

Strong agonist of opioid receptor

Short ½ life —> need more —> tolerance

Adverse:

CNS depression
Respiratory depression
Constricted pupils

NARCAN

Naxolone (Narcan) moa, adverse

Competitive to u receptor

K + o receptor reverse respiratory depression

Adverse:

Anxiety, aggression

Diaphoresis

Tachycardia

Hypertension

Abdominal pain

HORRENDOUS HA

Ketamine moa, adverse

Analgesia, dissassociative anesthesia

Block glutamate —> red pain signal in spine

Minimal respiratory depression

Loading bolus, then repeat

K for killer mood:

Hallucination (scary)

Dissociative symptoms of memory

DYSPHORIA - unease/happy

Dysphoria

Unease/happy

Ketamine

Neurontin tx

Gold standard for neuropathic pain

Restless leg syndrome

Depression

Seizures

Fibromyalgia

Anxiety

ETOH withdrawal

Neurontin adverse

Everything down

Ataxia

Somnolence

Depression/suicide

SJS —> skin reaction

Almost all DMARDs have

Myelosuppression

Infliximab type + prefix/suffix

-mab

DMARD II

Monoclonial antibody infusion

Infusion for RA

Infliximab (renmicade)

Cyclosporine

Xanthine oxidase

Inc uric acid

Gout allopurinol dec xanthine oxidase —> dec uric acid

Allopurinol adverse

Myelosuppression

Rash

Allopurinol and cohicine intervention

Compliance for gout attacks

Monitor myelosuppression

With food to lower risk GI issue

Combination drugs for GOUT

Cochicine + probenecid

GOUT tx

Cochinine

Allopurinol

Probenecid

First line tx SLE

Hydroxychloroquine

SLE tx

Hydroxychloroquine

Immunosuppressant - methotrexate

Belimumab - monoclonal antibody

Pregabalin tx + important adverse

Fibromyalgia

Drowsiness

Dizziness

Rhabdomyolysis

Angioedema

Calcium adverse + 2 interventions

Constipation

Hypercalcemia - bones, stones, groans, psychological overtones (lethargy)

Don’t double dose

Get sunlight/vitamin D

Pregabalin moa

Reduce calcium influx —> fever GABA involved in pain release

Pregaba —> GABA

Propofol start, adverse (4)

Most used IV anesthetic

Start: 60 secs

Lasts: 3 - 5 mins

Respiratory depression

Hypotension

Bacteremia

High triglycerides

Etomidate

Anesthetic no analgesic

Rapid start

Lasts: 5 minutes

Repeated use: Hypotension, e- disturbances, post-op N/V

Inhaled anesthesia adverse

Respiratory and cardiac depression

Aspiration

Malignant hyperthermia

Sensitization of heart to catecholamines

Volatile Liquids

-flurane

Volatile Liquids moa + adverse

High anesthetic

Low analgesic

Low muscle relaxer

Rapid onset

Emergence <_ 20 mins

Respiratory depression

Hypotension

Oliguria

Types Inhaled anesthesia

Volatile liquids

Nitrous oxide

Nitrous Oxide

Laughing gas

Low anesthetic

High analgesic

Neuromuscular blocking agents moa + prefix/suffix

-ronium

Relax skeletal muscles

Lidocaine moa + desc

Local anesthetic

Block Na channel

With epinephrine to prolong duration

Topical 3 - 5 mins onset

1st line alcohol withdrawal

Benzodiazepines

Makes alcohol disguisting

Disulfuram

Banana bag moa + content

ETOH withdrawal

Thiamine

Folate

Multivitamin isotonic saline w 5% DSW

Raloxifene tx, adverse, important intervention

Estrogen receptor —> inc osteoblast, inh osteoclast

Against breast cancer

PE/DVT

Hot flash

Stop before surgery or inc bed rest

No sedentary

Biphosphate prefix/suffix, moa, adverse, important intervention

Dec # + action of osteoclast post menopause osteosclerosis

Phosphate is bad for stomach

Gastritis/esophagitis

Necrosis of jaw

GI ulcer

Can’t eat without seeing (visual disturbance)

Eats the bone (femoral fracture)

Sit up + ambulate 30 minutes after taking it

See dentist before Zoldronic

Liquids med —> stomach

Calcitonin tx, adverse, intervention (2)

Osteoporosis inh activity of osteoclast + inc renal Ca

Hypocalcemia

Monitor Chvostek sign - facial n

Bone density scan

Tylenol adverse

Hepatotoxicity

Nephrotoxicity

Tylenol dosage (day, dose, liver issue)

Day:

Tylenol overdose intervention

Monitor LFTs q4 - 6

Gastric lavage

Activated charcoal or cholestyramine

> 200 in 4 hours, > 100 in 8 hours

Mucomyst - reduce hepatic necrosis

Tylenol overdose meds

NSAID moa, adverse

Anti-inflammatory cox-1 + cox-2 inhibitor

GI bleeding

Nephropathy

HA/dizziness

Alternate NSAID + tylenol

q3 - 4 hours

Aspirin tx, adverse

MI, stent application, analgesic, anti-pyretic

GI bleed

Intracranial bleeding

Reye-syndrome

Reye-Syndrome

Aspirin + virus —> fulminant hepatitis + cerebral edema —> altered LOC, behavior change, N/V, jaundice

Narcotic Toxidrome

CPR - 3H

Coma

Pinpoint pupils

Respiratory depression

Hypothermia

Hypotension

Hyporreflexia

Codeine

Mild —> moderate acute pain

CO for cough

CYPD26 dependent on individual

Not as effective as non-opioids

Tramadol

Moderate acute/chronic pain

CYP450

Tram = scam of false + on PCP drug test

Hydrocodone

Moderate —> severe chronic pain

Cough

Depress cough reflex in medulla

Mneumonic for opioids

C THOse DMs

Percocet

Moderate —> severe acute/chronic pain

Oxycodone + acetaminophen

Oxycodone/oxycontin

Moderate —> severe acute/chronic pain

Oxycodone - immediate release

Oxycontin - sustained release (continues later)

Demerol

Moderate —> severe acute/chronic pain

DeNerol

Inhibits DET (dopamine) + NET (norepinephrine)

Morphine

Moderate —> severe acute/chronic pain

Standard opioid others measure against

Histamine release

Morphine + benadryl

Euphoric effect risk

Dilaudid vs morphine

5 - 10x morphine

Serotonin syndrome + Torsad’s

Methadone adverse effect

Methadone tx, moa, intervention (2)

DONE with METH

Opioid use disorder

Narcotic blockade stops euphoric effect

Torsad’s syndrome

Serotonin syndrome - high fever, rapid HR/BP, shivering, seizure

Fentanyl tx, duration, adverse

Intubation + procedure

Rapid onset: 3 - 5 minutes

Duration: 30 - 60 minutes

Respiratory depression

HIGH LIPID SOLUBLE

GH moa, adverse

ADH prefix/suffix

-pressin

Hyperpiturism medsprefix/suffix

-reotide

ADH

Hyperpiturism

Cortisol fxn

Inc gluconeogenesis

Dec Ca absorption

Inc response to catecholamines (epinephrine)

Suppress inflammation + immune response

Glucocorticoids prefix/suffix

-sone

Glucocorticoids tx + adverse

Inflammation

Andrenocortical insufficiency - ADDISON’s

Allergic rxn

Cushing syndrome

Osteopenia/osteoporosis

Reduced growth

Too much Na

Infection

CHO inc

O

Suppressed adrenal

Too much weight gain

Ebdominal pain/PUD/gastritis

Reduced K

O

Insomnia

Dysrhythmia from K

Mineralcorticoids example

Fludrocortisone

Mineralocorticoids tx, adverse

Mimic aldosterone

ADDISON’S

Improvement in BP

HTN

Edema

HF

Hypokalemia