Study Pharm 3

What are the Cell cycle phases and what are they for?

G0-post mitotic resting

G1-growth phase

S-RNA is synthesized

G2-cell prepares for mitosis, little activity

M-mitosis

What are cell cycle phase specific drugs?

active during division

continuous dosing or divided doses

What are cell cycle non-specific drugs?

resting or dividing state

single bolus injection or oral

What chemo regiment began in the 1940's?

Nitrogen mustard for lymphoma

What is a thrombolytic agent?

breaks down clots that have already formed

emergency situation

embolic myocardial infarction

What happened in the chemo world in 1948?

Sidney Farber used antifolate to treat leukemia in children

What act:

Banned OTC sales of ingredients commonly used to make methamphetamine 'meth'

Pseudoephedrine

Limit its sale in large quantitates

Stored and sold only in limited quantities

3.6 g/ day or 9 g/month

Pharmacies limited in amounts they can sell per day

Nexafed and Zephrex-D

Combat methamphetamine epidemic act of 2005

What happened in the chemo world in 1949?

methotrexate was made

What happened in the chemo world in 1950's?

Heidelberger made 5-FU

For which drug should pts not eat or drink grapefruit?

calcium channel blockers-significant adverse effects

What are the 9 major groups of antineoplastic agents?

Antimetabolites (S)

Alkylating Agents (NS)

Mitotic Inhibitors (S)

Antitumor Antibiotics (NS)

Hormone and hormone modifiers

biologic therapies

targeted cancer therapies

vaccines

radioactive isotopes

What cells are most affected by Antimetabolites?

Cells with high rate of turnover are most sensitive

Hair follicles, buccal mucosa, GI lining, fetal cells, and bone marrow

Which type of drug smells like rotten eggs?

mucolytics

Which antineoplastic drug type has a rescue agent drug and how does it work?

Antimetabolites

Leucovorin-used as rescue agent after methotrexate to reduce hematologic and GI toxicity

Which antineoplastic agent is chemically similar to mustard gas?

Alkylating agents

What is an RPT?

radiopharmaceutical therapy

use of radioactive isotopes for tx

I 131 for thyroid cancer

What are theranostics?

combined diagnostic and therapeutic approach using matched radiopharmaceuticals

Ga-68/Lu-177 PMSA pair for prostate cancer

what is the clinical importance of beta-adrenergic blockers

lung conditions can cause bronchospasm

stress testing

What are the three hormone/hormone modifiers categories?

Corticosteroids: suppressant effect

antiestrogens: block estrogen from binding (SERMs)

Antiandrogen: block androgens from binding

contraindications/interactions are: no important interactions

contra: 2nd/3rd degree heart block or symptomatic bradycardia

adenosine

Contraindications are:

Do not use in head injury or impaired CNS

Avoid in patients with narcotic addictions

Do not use in productive coughs

Suppressing productive coughs can be hazardous

Coughing expels mucus and foreign material from upper respiratory tract

Eliminates secretions from the respiratory tract

antitussives

Contraindications: Asthma Prophylaxis, Leukotriene Inhibitors, Mast Cell Stabilizers

Avoid in patients with hepatotoxicity

Monitor liver function

Can cause neuromuscular problems/ gait

Take at same time of day

Do not stop abruptly

Drug interactions: Aspirin, Erythromycin and theophylline, Warfarin and zafirlukast, Phenobarbital and rifampin

Interactions are:

calcium channel blockers

other antihypertensives

antiadrenergic agents

Contraindications/interactions with:

digoxin

some stomach acid meds can counteract effect

calcium channel blockers

Antilipemic agents explained

50% of US has high cholesterol

low density lipoproteins carry largest amnt of cholesterol in blood and deposit it on arterial wall

triglycerides can also lead to atherosclerosis and CAD

high density lipoproteins carry cholesterol from wall of arteries to liver for excretion

LDL is primary target of antilipemic agents

Types of Antilipemic agents

HMG-CoA reductase inhibitors 'statins'

bile acid sequestrants

nicotinic acid

fibric acid derivatives

cholesterol absorption inhibitors

omega-3 fatty acids

Contraindications/interactions are: NSAIDs antagonize, increase renal deterioration in renal failure

antacids decrease absorption

digoxin may cause toxicity

ACE Inhibitors

Contraindications/interactions:

avoid in pts with hypertension, cad, history of stroke

use caution in diabetics, can cause ketoacidosis

avoid caffeine

theophylline can cause CNS toxicity

do not use cerebrovascular disease

bronchodilators

Contraindications:

Do not use in acute bronchospasm

Do not mix with other drugs in nebulizer

mucolytics

Contraindications:

Caution in elderly and renal disease

Not used for persistent/ chronic coughs smoking/ COPD

expectorants

contraindications:

Caution for abuse

Do not use longer than 3 - 5 days

Rebound congestion

Avoid in hypertension, CAD, glaucoma

Do not mix with other OTC cold/flu/allergy products

decongestants

What type of technique is necessary for chemotherapy?

aseptic

Which drug has a precaution of patients with lupus or renal disease?

peripheral vasoldilators

Which drug can cause long term bone marrow damage that can lead to acute leukemia 5-10 years later?

Alkylating Agents

Which drug is an anticoagulant and antiplatelet?

antithrombotic

preventing a thrombus

What drug needs EKG monitoring and AED/defibrilator

Lidocaine

Interactions of coronary vasodilators

alcohol, PDE inhibitors (viagra/cialis)

Interactions of warfarin

food high in vitamin k

grapefruit

herbal supplements

many interactions check before giving new meds

how many alveoli are there?

500 million 80m^2 surface area

What are the classifications of sympathomimetic bronchodilators?

short acting beta 2 agonists (SABAs)

long acting beta 2 agonists (LABAs)

what are goblet cells?

produce mucus

Classifications of antitussives?

narcotic

non-narcotic

what are the local effect types of corticosteroids?

inhaled: asthma

intranasal: hay fever, allergy, nasal conditions

what are the systemic effect types of corticosteroids

oral and injectible

what is the possible flow rate of nasal cannula?

1-6 L/min

what is the possible flow rate for oxygen mask?

6-12 L/min

long term prophylactic management of asthma

reduces exacerbations, improves control of symptoms, lung functions and reduces hospital administrations and death

Administered with MDIs, DPIs

inhaled corticosteroids

Intranasal corticosteroids

Relieve stuffy nose, irritation, discomfort of hay fever, other allergies and nasal conditions

First-line therapy for most noninfectious rhinitis types

Reduce congestion, edema, and inflammation

Aerosols more irritating to nasal mucous

What are the administration methods of bronchodilators

MDIs-metered dose inhaler

DPIs- dry powder inhaler

SVNs- small-volume nebulizer

What are the classifications of bronchodilators?

sympathomimetics (adrenergic)-dilate bronchioles

parasympatholytics (anticholinergic)-block bronchospasm

xanthine derivatives-dilate bronchioles

cautions for t-PAs

internal bleeding arrhythmia

Which drug has pregnancy as a contraindication?

lidocaine

Indications are:

cardiac failure pts

narrow therapeutic index bc of toxicity

cardiac glycosides

Indications:

Prevent/ suppress coughing: Cough suppressants

Dry nonproductive cough: Fatigue, insomnia, pain - pleurisy and fractured rib and Short-term cold & coughs

Combined aspirin or acetaminophen to treat fever and pain

antitussives

Indications:

adenosine, lidocaine-used to stop, slow, or prevent life threatening arrhythmias-top drawer of crash cart

beta blockers-heart rate control, bp control, afib control

ca channel blockers-ventricular arrythmias, bp control

antiarrhythmic agents

Indications:

relax smooth m of bronchial tree

dilate breathing passages

symptomatic tx of asthma, copd, allergic rxns, cough/congestion

bronchodilators

Indications:

relieves inflammation, reduce swelling, decreases bronchial hyper-responsiveness to triggers

suppress symptoms for pts with asthma, copd, pneumonia, allergic rxns, cystic fibrosis, ards

corticosteroids

Indications:

prevention of exercise-induced bronchoconstriction

tx of chronic asthma

used in pts chronic asthma, allergies, rhinitis

asthma prophylaxis

Indications:

Antagonize histamine receptor sites

Provide symptomatic relief of allergic symptoms caused by histamine release causing inflammation, rash, sneezing, runny nose, airway narrowing.

Allergies

Cold

Flu

Rash

antihistamines

indications:

Constrict blood vessels in the respiratory tract

Relieve nasal congestion and mucous discharge

Reduce swelling, inflammation and mucus formation in the nasal passages

Colds, allergies, hay fever, rhinitis, sinusitis

Short term use

Oral, spray, topical

decongestants

Indications:

hypertension-strong association btwn high bp and cvd

Antihypertensives

Indications:

hypoxia

decreases workload of heart and resp system

heart disease, copd, smoke inhalation, carbon monoxide or cyanide poisoning, cns conditions

oxygen

Mechanism of action

Interfere with DNA synthesis, repair, and cellular replication and are used to treat various malignancies, especially those rapidly proliferating neoplasms

Antimetabolites

S

Mechanism of action: increase diameter of airways by reducing swelling

inhibit inflammatory cascade by inhibiting cells involved in the inflammatory response-white blood cells

corticosteroids

Mechanism of action: Alpha-1 agonists, acts directly on adrenergic receptors and indirectly releases norepinephrine

Decreases blood flow and causes shrinkage of swollen mucous membranes

Opens nasal passages

decongestants

Mechanism of action:

Prevent mast-cell degranulation and mediator release

basically leukotrienes are inflammatory from the histamine cells (baso,eos,mast) and cause lungs to be inflamed and no breathe-this drug prevents this process of asthma (acute attacks and symptoms)

Asthma Prophylaxis, Leukotriene Inhibitors, Mast Cell Stabilizers

Mechanism of action: Heparin-IV-indirectly acts on thrombin preventing clots, rapid action, ensure IV flushes are dilute heparin

Lovenox- subcutaneous in abdomen-fragments of heparin, low molecular weight heparin, more long term and not as fast acting, used for maintenance of DVT or pulmonary embolism

heparin and derivatives

Mechanism of action: rapid onset 5-10 minutes

relief in 4-6 hrs

acute asthma attacks/rescue meds

2 days/week or less

SABAs

Mechanism of action: slower onset of action

relief in 12 hours

long acting/prevention of asthma attacks

LABAs

Mechanism of action: Break down molecules in mucus to help it be less viscous

Conditions with excessive or thickened mucous: COPD, cystic fibrosis, infections, chronic bronchitis, colds

mucolytics

Mechanism of action: Body exposed to allergens

Histamines produced in the body

Cause nasal tissue to swell

Block the histamine-1 receptor sites to reduce effect of histamines in the body

Combat increased capillary permeability and edema, inflammation, and itch caused by histamine release

antihistamines

mechanism of action: increase oxygen sat of hemoglobin

pulmonary vasodilator

oxygen

Mechanism of action: inhibits aggregation of platelets which inhibits clot formation and inhibits release of thromboplastin

used for prevention of stroke, MI, or other vascular clotting disease

can cause gastric irritation/ulcers with prolonged use

aspirin

Mechanism of action: block the growth and spread of cancer by interfering with specific molecules involved in tumor growth and progression

spare normal tissue by targeting the cancer cell

STI

targeted therapies

Mechanism of action: prevent cell growth by damaging DNA needed for reproduction

Alkylating Agents

ns

Mechanism of Action: inhibits angiotensin converting enzyme in lungs which prevents angiotensin 1 converting into angiotensin 2 which in turn reduces vasoconstriction and is very good for heart failure wo altering cardiac output

ACE Inhibitors

what is the drug sequence for acute asthma attack

1.Albuterol (SABA)

2.Ipratropium (short acting anticholinergic)

3.Budesonide (corticosteroid)

Mechanism of action: ca influx causes cardiac m and vascular mm to contract to prevent influx to an extent to help relax and decrease bp

Calcium Channel Blockers

Mechanism of action: Increases secretions, reduce viscosity, help cough up mucus

Non-productive coughs for upper respiratory tract infections

Asthma, chronic bronchitis, COPD, influenza, cold

Not as effective as mucolytics

expectorants

Mechanism of Action:

statins

Considered the front line and most powerful antilipemic drugs

HMG CoA reductase inhibitors

mechanism of action: stimulate kidneys to excrete excess fluid and electrolytes

reduce fluid volume in blood, thus reducing bp

pts will have to pee frequently

thiazide diuretics

Mechanism of action: inhibit sympathetic nerve receptors

membrane stabilization in cardiac m to reduce heartrate

relax smooth m to reduce tension in vascular walls (vasodilation)

beta-adrenergic blockers

Mechanism of action: Block mitosis

vinca and periwinkle plants

Mitotic inhibitors

S

Mechanism of action: designed to repair, stimulate, or enhance a cancer pts natural immune system to more effectively recognize and attack cancer

active or direct

passive or indirect

biological therapies (Immunotherapy)

Mechanism of action: strong bronchodilators relax smooth mm in the lungs

binds to beta2 receptors in lungs

sympathomimetic bronchodilators

Mechanism of action: natural peptide that initiates fibrinolysis and dissolves fibrin clots quickly

t-PA

Mechanism of action: disrupt DNA transcription, originate from microbial fermentation, meds can only be used for a set period of time

Antitumor antibiotics

NS

Mechanism of action: extreme hemorrhage warning

interferes with vit k synthesis in liver which is needed for clot formation

slower than heparin-long term tx

warfarin

Mechanism of action: increases camp to relax smooth m of bronchial airways and pulmonary blood vv

long term control

oral and injectable

COPD pts who don't respond to LABA

regular blood draws to monitor theophylline blood lvls

methylxanthines

Mechanism of action: acts on myocardial cells to increase contraction wo increasing o2 consumption, lower epinephrine levels elevated during heart failure that are toxic to failing heart, decrease edema with diuretics

cardiac glycosides

Mechanism of action: blocks action of acetylcholine receptors that causes airway constriction so the passage remain dilated

copd, rhinitis, asthma (off-label)

inhaled or intranasal

parasympatholytic bronchodilators

Mechanism of action: Inhibits cough reflex by direct effect on brainstem cough center

narcotic antitussives

Mechanism of action: tx of acute pain from angina

when coronary blockage or spasm decreases blood flow to cardiac tissue these relax the smooth m of coronary aa, dilating them to relieve the pain from blockage/spasm

if chest pain continue 5 min after admin call EMS

coronary vasodilators

mechanism of action: boost immune system natural ability to protect body against foreign invaders mainly infectious agents

preventative and tx

only 2 FDA approved

vaccines

Mechanism of action: restores sinus rhythm by slowing conduction at AV node

beware of heart block

emergency cardio inversion

vasodilation

decreases heart rate and o2 consumption

adenosine

Mechanism of action:

much like ACE Inhibitor

block angiotensin receptors thus decreasing vasoconstriction and bp

lower incidence of cough than ace inhibitors

used in individuals with intolerance to ACE

Angiotensin Receptor Blocker (ARBs)

Mechanism of action:

by blocking these: we prevent norepi tightening of mm and relax smooth m vascular walls

antiadrenergic agents

alpha adrenergic blocking agents

Mechanism of action: dilate smooth m in peripheral nn

larger vessel lumens decreases pressure

peripheral vasodilators

mechanism of action: local anesthetic

membrane stabilization and antiarrythmic effects when given IV

numbs cardiac muscle to erratic impulses

lidocaine

Methotrexate (Rheumatrex, Trexall) is what type of drug?

Antimetabolite