Pharmacology Master Exam Study Guide

Comprehensive vocabulary flashcards covering drug classifications, mechanisms, critical dosage limits, safety red flags, and nursing considerations based on the Pharmacology Master Exam Study Guide.

Acetaminophen (Tylenol / APAP)

A non-opioid analgesic

inhibits central prostaglandin synthesis in the CNS and acts on the hypothalamus to reduce fever, lacking anti-inflammatory or antiplatelet activity.

Daily limits are $4{,}000\,mg/day$ for healthy adults, $3{,}000\,mg/day$

severe hepatotoxicity and acute hepatic necrosis.

Acetylcysteine

The antidote for acetaminophen overdose

administered within $10\,hours$ of ingestion, noted for having a foul, rotten-egg odor.

Tramadol Hydrochloride (Ultram)

• Drug Class: Centrally Acting Dual-Action Analgesic.

• Mechanism of Action: Weakly binds to mu-opioid receptors and inhibits the reuptake of norepinephrine and serotonin.

Carries an increased risk of seizures (especially with SSRIs, tricyclics, or MAOIs) and causes CNS depression and somnolence.

Lidocaine Transdermal (Lidoderm)

Drug Class: Topical / Local Anesthetic Patch

Mechanism of Action: Blocks nerve signal conduction locally without causing systemic anesthesia.

$$12\,hours\text{ ON} / 12\,hours\text{ OFF}$$

Allopurinol (Zyloprim)

Drug Class: Antigout Maintenance Agent

Mechanism of Action: Inhibits xanthine oxidase to block the production of uric acid.

used for chronic gout prevention

Colchicine

• Drug Class: Anti-Inflammatory Antigout Agent (Acute Crisis Agent).

• Mechanism of Action: Reduces the inflammatory response to urate crystal deposits within joint tissue.

• Acute gout flare-ups

Probenecid

• Drug Class: Uricosuric Agent (Probenecid) / Xanthine Oxidase Inhibitor (Febuxostat).

• Mechanism of Action: Inhibits the renal reabsorption of uric acid to increase urinary uric acid excretion.

The "3 A's" of NSAIDs

Analgesic

Anti-inflammatory

Antipyretic

Cyclooxygenase Enzymes (COX-1 vs. COX-2)

• Mechanism of Action: Inhibits Cyclooxygenase (COX) enzymes.

  • COX-1: Protects the stomach mucosal lining and regulates platelet aggregation.

  • COX-2: Triggers pain and inflammation.

NSAID Black Box Warnings

(1) High risk of severe GI ulceration, bleeding, and perforation

(2) increased risk of serious CV thrombotic events, MI, and stroke

(3) renal toxicity (nephrotoxicity/fluid retention).

Aspirin (Acetylsalicylic Acid / ASA)

• Drug Class: Salicylate NSAID / Antiplatelet Agent.

• Mechanism of Action: Irreversibly inhibits COX-1 and COX-2; blocks thromboxane A2 to prevent platelet aggregation for the lifespan of the platelet.

• Indications: Mild pain, fever, inflammatory conditions, and cardioprotection (MI and stroke prevention at 81–325 mg/day).

Toxicity Sign (Salicylism): Tinnitus (ringing in the ears)

Reye's Syndrome

Encephalopathy and liver failure

DON’T administer aspirin to children or teenagers with viral illnesses like flu or chickenpox.

Salicylism

Aspirin toxicity

Tinnitus (ringing in the ears)

Ketorolac (Toradol)

• Drug Class: Acetic Acid NSAID (Potent Systemic Analgesic).

• Mechanism & Potency: Potent COX inhibitor that provides morphine-level analgesia without opioid sedating effects.

NEVER EXCEED 5 DAYS TOTAL THERAPY; beyond 5 days causes severe acute renal failure and fatal GI bleeding.

Ibuprofen (Advil / Motrin)

Ibuprofen (Advil / Motrin) & Naproxen (Aleve)

• Drug Class: Propionic Acid NSAIDs.

• Mechanism of Action: Inhibits both COX-1 and COX-2 enzymes.

• Indications: Rheumatoid arthritis, osteoarthritis, dysmenorrhea, gout, dental pain, and acute musculoskeletal pain.

• Dosage Limits (Ibuprofen): Maximum OTC dose = 1,200 mg/day

Celecoxib (Celebrex)

Drug Class: Selective COX-2 Inhibitor NSAID.

Mechanism of Action: Selectively blocks COX-2 while sparing gastroprotective COX-1 mucosa, resulting in fewer GI ulcers.

SULFA ALLERGY CONTRAINDICATION: Strictly contraindicated in patients with a Sulfa Allergy (contains a sulfonamide chain)

Indomethacin (Indocin)

• Drug Class: Acetic Acid NSAID.

• Indications: Highly potent NSAID used for acute gouty arthritis, rheumatoid arthritis, osteoarthritis, preterm labor, and closing a patent ductus arteriosus (PDA) in infants.

Morphine Sulfate

• Drug Class: Full Opioid Agonist (Schedule II) — Prototype Opioid.

• 30 mg Oral Morphine = 10 mg IV Morphine

• RENAL TOXICITY WARNING

• Nursing Considerations: Do NOT crush or chew extended-release forms (MS Contin).

Morphine-6-glucuronide (M6G)

The active metabolite of morphine that accumulates in renal failure

Hydromorphone (Dilaudid)

Hydromorphone (Dilaudid / Exalgo)

• Drug Class: Full Opioid Agonist (Schedule II).

• POTENCY WARNING (HIGH ALERT): (7 times more potent than IV morphine!)

• Exalgo: Osmotic extended-release oral tablet designed to be crush-proof and deter abuse.

Exalgo

An osmotic extended-release oral tablet formulation of hydromorphone engineered to be crush-proof and extraction-resistant to deter abuse.

Fentanyl

• Drug Class: Full Opioid Agonist (Schedule II).

• External heat over transdermal patches is strictly avoided to prevent accelerated absorption and fatal overdose, and used patches must be flushed down the toilet.

Meperidine (Demerol)

Drug class: full opioid agonist

Post-operative shivering; not recommended for chronic pain because its neurotoxic metabolite, normeperidine, accumulates and causes tremors and seizures.

Methadone (Dolophine)

Drug class: full opioid agonist

opioid detoxification, maintenance, and severe chronic pain, possessing a long half-life of up to $59\,hours$

Codeine Sulfate

Drug class: 2 WHO ladder opioid agonist

For mild-to-moderate pain and cough suppression, its most common side effects are GI distress and nausea.

Mixed Opioid Agonists-Antagonists

Drug class: Schedule IV analgesics

Analgesic ceiling effect: they displace the full agonist, cancel analgesia, and precipitate acute opioid withdrawal.

Naloxone HCl (Narcan)

Drug class: opioid antagonist

Used for acute respiratory depression whose half-life ($\approx 64\,min$) is shorter than most opioids

Naltrexone (ReVia)

Drug class: oral pure opioid antagonist

Long-term addiction maintenance and relapse prevention.

Beta- Lactam Subclasses

P-C-C-M “Please care carefully mom”

-Penicillin

-Cephalosporins

-Carbapenems

-Monobactams

Amoxicillin (Amoxil / Augmentin)

Drug class: beta-lactam antibiotic

Mechanism: bacterial cell-wall synthesis inhibition at penicillin-binding proteins, leading to cell lysis

Side effects: Anaphylaxis (hives, rash, swelling

Decreased fever, redness, inflammation, WBC elevation

Penicillin

Drug class: Beta-lactam antibiotic

Mechanism: Binds penicillin-binding proteins and interrupts cell wall synthesis; bactericidal by cell lysis

Cefazolin

Drug class: Cephalosporin; beta-lactam antibiotic

Mechanism: Bactericidal cell-wall agent, structurally/pharmacologically related to penicillins.

Cephalexin (Keflex)

Drug class: Cephalosporin; beta-lactam

Bactericidal: The cephalosporin class is related to penicillins and affects cell wall synthesis.

Ceftriaxone

Drug class: cephalosporin; beta-lactam antibotic

Mechanism: Bactericidal cell-wall therapy; third-generation agents have strong Gram-negative and relatively reduced Gram-positive activity per chapter.

Doxycycline (Vibramycin)

Drug class: Tetracycline antibiotic; primarily bacteriostatic.

Mechanism: Inhibits bacterial protein synthesis

Side effects: Tooth discoloration and interference with fetal skeletal development

Vancomycin (Vancocin)

Drug class: Glycopeptide, bactericidal antibiotic

Mechanism: MRSA and oral treatment for severe C. difficile. Must be infused IV over at least $60\,minutes$ to avoid Red Man Syndrome;

Red Man Syndrome

A reaction from flushing an IV vancomycin too quickly, preventable by infusing over at least $60\,minutes$.

Ciprofloxacin (Cipro)

Drug class: Fluoroquinolone (quinolone), bactericidal antibiotic

Mechanism: Disrupts bacterial DNA; excellent oral absorption, but decreased by antacids/mineral preparations.

Tendonitis/tendon rupture black-box risk

Metronidazole (Flagyl)

Drug class: antiprotozoal-antibacterial antibiotic

Mechanism: anaerobic infections, C. difficile, GI/gynecologic infections

Isoniazid (INH)

Drug class: First-line antitubercular agent

Mechanism: Acts against Mycobacterium; metabolized in the liver by acetylation

Rifampin

Drug class: First-line rifamycin antitubercular agent

Mechanism: Included among agents affecting bacterial protein synthesis

It causes benign red-orange-brown discoloration of body secretions (permanently staining soft contact lenses)

Diphenhydramine (Benadryl)

Drug: first-generation sedating H1-antihistamine

Mechanism: Competes with histamine at unoccupied H1 receptors; acts centrally and peripherally; notable anticholinergic and sedating effects.

Anticholinergic properties (dry mouth, urinary retention, constipation)

Loratadine (Claritin)

Drug class: second-generation non-sedating H1-antihistamine

Mechanism: Competes with histamine at H1 sites, chiefly peripherally, limiting allergic mediator effects; longer duration.

Oxymetazoline (Afrin)

Drug class: topical nasal decongestant.

Mechanism: nasal vasoconstrictor decongestant; constricts small blood vessels around the nasal sinuses; swollen mucous membrane shrinks and drains.

Rebound congestion after several days of continued topical use; systemic adrenergic toxicity with excessive doses.

Benzonatate (Tessalon Perles)

Drug class: Nonopioid antitussive (cough suppressant)

Mechanism: Numbs stretch receptors in the respiratory tract, blocking reflex stimulation of the medullary cough center.

DRY COUGH

Guaifenesin (Mucinex)

Drug class: Antitussives

Mechanism: expectorant that thins/loosens mucus; should be taken with a full glass of water.

WET COUGH

Photosensitivity

-sulfonamides

-tetracylines

-quinolones

Kindey & Ear Toxicity

-Aminoglycosides

-Vancomycin (Red Man Syndrome)

Avoid dairy, antacids and iron

-Tetracylcines

-Quinolones

Tooth discoloration

-Tetracyclines

-Nitrofurauntion

MRSA fighters

-Vancomycin (Red man syndrome)

-Ceftaroline

-Linezolid

Sulfonamids

Blocks folic acid needed to make new DNA

Effects:

-photosensitivity

-crystalluria

-SJS (separation of dermis and epidermis)

Inhibition of cell wall synthesis

-Prevents bacteria from building its outer wall

-beta-lactam

-vancomycin

Inhibition of protein synthesis

-Blocks ribosomes so they can’t make vital proteins

-aminoglycosides

-tetracycline

-macrolides

Inhibition of nucleic acid replication

-Inhibits DNA so it doesnt replicate/synthesis

- quinolones

-metronidazole

-rifamipin

Antimetabloite Action

-Blocks folic acid needed to make DNA

-sulfonamides

trimetheoprim