Pharmacology Exam 1

Salicylates

Aspirin (acetylsalicylic acid)

COX‑1 & COX‑2 inhibitor; analgesic, antipyretic, anti‑inflammatory, antiplatelet. Adverse: GI ulcers, bleeding, tinnitus (salicylism). Contra: children w/ viral illness (Reye’s), renal impairment.

Acetaminophen

Tylenol

analgesic & antipyretic (hypothalamus). NOT anti‑inflammatory. Adverse: hepatotoxicity, rash. Max 4 g/day. Overdose antidote: acetylcysteine (Mucomyst).

First‑Generation NSAIDs

Ibuprofen

Naproxen

Ketorolac

Indomethacin

Diclofenac

COX‑1 & COX‑2 inhibitors; analgesic, antipyretic, anti‑inflammatory. Adverse: GI ulcers, renal impairment, ↑ BP, bleeding risk. Contra: PUD, renal disease, post‑CABG.

Second‑Generation NSAIDs (COX‑2 inhibitors)

Celecoxib (Celebrex)

COX‑2 selective; ↓ GI risk but ↑ CV risk (BBW). Contra: sulfa allergy, renal impairment.

Mitotic Agent (Anti‑gout)

Colchicine

inhibits WBC migration to uric acid crystals; used for acute gout. Adverse: severe GI upset, bone marrow suppression, hepatotoxicity.

Xanthine Oxidase Inhibitor (Anti‑gout)

Allopurinol

prevents uric acid formation. Adverse: rash (STOP immediately), Stevens‑Johnson syndrome, bone marrow suppression.

Anti‑Migraine Combo (OTC)

Excedrin (Acetaminophen + Aspirin + Caffeine)

analgesic + anti‑inflammatory + vasoconstriction. Adverse: caffeine (tachycardia, insomnia), aspirin GI effects.

Ergot Alkaloids

Ergotamine

vasoconstriction of cranial vessels. Adverse: chest pain, hypertension, numbness, muscle pain, N/V. Risk of ergotism toxicity. Avoid in pregnancy.

Triptans

Sumatriptan

serotonin receptor agonist → vasoconstriction. Adverse: chest pain, hypertension, injection‑site irritation, bad taste (intranasal). Teratogenic.

Inhaled General Anesthetics

Isoflurane

Nitrous Oxide

amplify GABA → CNS depression. Uses: hypnosis, amnesia, muscle relaxation. Adverse: respiratory depression, hypotension, malignant hyperthermia.

IV General Anesthetics

Propofol

rapid hypnosis; adverse: hypotension, bradycardia, injection‑site burning, infection risk.

Ketamine

dissociative anesthesia; adverse: hallucinations, ↑ BP, ↑ HR.

Neuromuscular Blockers: Non‑depolarizing

Vecuronium

Pancuronium

block ACh at NMJ → paralysis. Adverse: hypotension, apnea. Reversal: neostigmine.

Neuromuscular Blockers: Depolarizing

Succinylcholine

depolarizes then paralyzes. Adverse: hyperkalemia, malignant hyperthermia, rhabdomyolysis. BBW: sudden cardiac arrest in children.

Local Anesthetics

Lidocaine

blocks sodium channels → loss of sensation. Adverse: LAST (CNS excitation → depression), arrhythmias, bronchospasm.

Glucocorticoids

Prednisone

Hydrocortisone

Methylprednisolone

Dexamethasone

block arachidonic acid → ↓ inflammation. Adverse: hyperglycemia, infection risk, fluid retention, hypokalemia, mood changes, osteoporosis, ulcers. Teaching: take in morning, taper slowly (to avoid adrenal insufficiency), avoid crowds, high K+/low Na+ diet.

Opioid Agonists

Morphine

Fentanyl

Hydromorphone

Oxycodone

Hydrocodone

Codeine

Methadone

activate mu/kappa receptors → analgesia, sedation. Adverse: respiratory depression (BBW), constipation, N/V, urinary retention, CNS depression. Reversal: naloxone.

Opioid Agonist‑Antagonists

Butorphanol

Nalbuphine

kappa agonist, mu antagonist. Less respiratory depression; ceiling effect. Can precipitate withdrawal in opioid‑dependent patients.

Opioid Antagonists

Naloxone (Narcan)

Naltrexone

block opioid receptors; reverse overdose. Adverse: return of pain, tremors, sweating, hypertension. May need repeated doses.