Patho/Pharm Exam 1

Prednisone (systemic)

• Steroid

• Oral systemic glucocorticoid medication

• Functions as cortisol

• Anti-inflammatory

• immunosuppressive

• Contraindicated: peptic ulcers, severe infection

• heart failure risk

• peptic ulcer risk (careful with NSAIDS)

• Causes hyperglycemia and hypertension

• Causes moon face, osteoporosis, buffalo back

• Mnemonic: 5 S's side-effects (Sick, Sad, Sex, Salt, Sugar)

• Diuretics increase hypokalemia risk

• Reduces insulin effectiveness

• taper slowly to let the adrenal glands wake back up

• Administer with food to avoid nausea

Fludrocortisone (systemic)

• Steroid

• Most potent oral corticosteroid

• Specifically used for Addison’s disease

• Provides mineralocorticoid activity

Methylprednisolone (systemic)

• Steroid

• Most common IV/IM/intra-articular corticosteroid

• Exogenous cortisol agent

• anti-inflammatory

• immunosuppressive

• Contraindicated: peptic ulcers, severe infections

• taper slowly

• Monitor blood glucose and potassium

Triamcinolone (systemic and topical)

• Steroid

• Medium to high potency

• Treats eczema, skin allergies

• Topical (cream, ointment)

• systemic (P.O., IV/IM, inhaled)

• Systemic Uses: exogenous cortisol for anti-inflammatory and immunosuppressive effects

• Causes hyperglycemia, peptic ulcers (worse with NSAIDs), and hypokalemia (with diuretics)

Temazepam (Restoril)

• Benzodiazepine

• sedative-hypnotic sleep aid

• Schedule IV

• Enhances GABA receptor binding

• Pregnancy Category X

• Contraindicated in narrow-angle glaucoma

• Risk of life-threatening withdrawal

• Severe toxicity with other depressants

• Reversal agent is flumazenil

Suvorexant (Belsomra)

• Orexin receptor antagonist

• Blocks wakefulness neuropeptides (orexin)

• Treats difficulty staying asleep

• 12-hour half-life

• Controlled substance

• Risk: daytime sleepiness

• Risk: unconscious nighttime behaviors

• Side effects: dizziness, headache, diarrhea

Ramelteon (Rozerem)

• Melatonin receptor agonist

• Increases natural sleepiness

• Treats difficulty falling asleep

• Not a controlled substance

• Safe for abuse-risk patients

• Side effects: dizziness, nausea

• Melt into sleep

Zolpidem (Ambien)

• Non-benzodiazepine

• "Z-drug"

• hypnotic

• Schedule IV controlled substance

• increases GABA activity

• Treats difficulty falling asleep

• Short-acting and extended-release forms

• Lower risk than benzodiazepines

• Risk of somnambulism (sleepwalking)

• Black box warning: complex sleep behaviors

• Causes sleep behaviors with amnesia

• short-term use only recommended

Eszopiclone (Lunesta)

• Non-benzodiazepine

• "Z-drug"

• hypnotic

• Controlled substance

• sleep aid

• increases GABA activity

• Treats difficulty falling and staying asleep

• Designed for full 8 hours

• Lower risk than benzodiazepines

• Black box warning: complex sleep behaviors

• Causes sleep behaviors with amnesia

• Recommended for short-term use

Kava

• Herbal sleep supplement and aid

• Uses: anxiety, stress, restlessness, insomnia

• Similar interactions as benzodiazepines

• Contraindicated in liver disease

• Contraindicated in substance use disorder

Valerian

• Herbal sleep supplement aid

• Uses: anxiety, stress, insomnia, menopause, menstrual cramps

• many drug interactions

• Risks with cardiac, renal, and liver disease

Doxylamine (Unisom)

• Over-the-counter antihistamine sleep aid

• Causes central nervous system depression

• Alcohol increases respiratory depression

• Adverse effects: dry mouth, constipation, Decreased urination, blurred vision

• Increased risk of falls

• Risk of paradoxical delirium

• Long-term use: cognitive decline

Diphenhydramine (Benadryl)

• Over-the-counter antihistamine medication

• Used for allergies and insomnia

• Liquid form absorbed fastest

• Premedication option for amphotericin B

• Causes central nervous system depression

• Beers criteria: avoid in older adults

• Adverse effects: anticholinergic symptoms, fall risk

• Risk of paradoxical delirium

• Long-term risk: cognitive decline

Melatonin

• Endogenous sleep-promoting hormone

• Released in darkness by pineal

• Light exposure inhibits release

• Exogenous form of brain substance

• Not FDA approved

• Quality and dosage vary

Sulfonamides (sulfamethoxazole with trimethoprim/Bactrim/Septra)

• Antibiotic

• Combination drug

• Mechanism: Blocks bacterial folic acid synthesis

• Selective toxicity: Human cells consume preformed folate

• High rate of allergic reactions

• Blood risks: Anemia, agranulocytosis, thrombocytopenia

• Assess CBC prior to treatment

• photosensitivity

• Report any rashes immediately

• Drug interaction: Hypoglycemia risk with sulfonylureas

• Contraindicated with celecoxib allergy

• Rare toxicities: Hepatotoxicity, seizures, toxic nephrosis

Penicillins

• Beta-lactam

• bactericidal

• antibiotic

• GI upset

• allergic reaction

• Cross-reactivity with cephalosporins

• Decreases oral contraceptive effectiveness

• Common interaction with warfarin

Cephalosporins (ceftriaxone/Rocephin)

• antibiotic

• allergy to penicillin (true allergy) is contraindication

• Beta-lactam

• bactericidal

• Divided into 5 generations with varying Gram coverage

  • 3rd generation: strongest Gram-negative and some Gram-positive coverage^[3][4]

• Ceftriaxone

• Administered IV or IM with a long half-life

• Crosses blood-brain barrier

• treats CNS infections

Carbapenems (imipenem with cilastatin/Primaxin)

• Beta-lactam

• bactericidal

• antibiotic

• Broadest antibacterial spectrum to date

• Reserved for complicated infections in acutely ill, hospitalized patients

• IV administration only, required to be infused slowly over 60 minutes

• Crosses the blood-brain barrier

• Major drug risks: High risk of seizures and thrombocytopenia

Macrolides (azithromycin, erythromycin)

• Antibiotic

• Inhibits protein synthesis within bacterial cells

• Causes GI upset, especially with erythromycin

• QT prolongation

• Azithromycin ("Z-pack")

Tetracyclines

• Antibiotic

• Teethtracyclines

• Inhibits bacterial protein synthesis

• Doxycycline

• Contraindicated in children <8, pregnant, or lactating women

• Causes permanent tooth discoloration by binding to calcium^[1].

• May retard fetal skeletal development

• Avoid dairy products, antacids, and iron salts

• Photosensitivity and maculopapular rash

• C. difficile colitis, enterocolitis, and vaginal candidiasis

• Doxycycline is also used for malaria prophylaxis/treatment^[3].

Aminoglycosides

• gentamicin

  • trough 0.3-2 mcg/mL

• Broad-spectrum

• antibiotic

• used for severe or life-threatening infections

• Inhibits bacterial protein synthesis

• Serious ototoxicity and nephrotoxicity

• Superinfections, skin rash, headache, dizziness, and paresthesia

Quinolones: ciprofloxacin

• prolonged QT

• Antibiotic

• drug names ending in -floxacin

• Alters bacterial DNA

• bactericidal

• Bacterial resistance is common, particularly when used for UTIs

• Must be taken 1 hour before or after dairy products, antacids, tube feedings, or interacting medications

• Black Box Warning: High risk for tendonitis and tendon rupture

• Can cause peripheral neuropathy, seizures, depression, dizziness, headache, and restlessness

• Risk of hepatotoxicity, rash/urticaria, and increased bleeding risk when taken with warfarin

Metronidazole

• Antibiotic

• Effective against anaerobic bacteria and protozoa

• Severe reaction when combined with alcohol

• Nausea, vomiting, flushing, headache, sweating, and chest pain

• High risk for numerous drug interactions

Linezolid

• Antibiotic

• Broad-spectrum

• coverage against resistant organisms like VRE and MRSA

• ~100% bioavailable

• Risk of serotonin syndrome; avoid taking with SSRIs or other antidepressants

• Risk of hypertensive crisis when taken with tyramine-containing foods

• Hypotension, headache, and myelosuppression

Vancomycin

• VRE

• Vancomycin infusion reaction/flush reaction/red man syndrome

• 10-20 mcg/mL trough

• Treatment of choice for MRSA^[1].

• PO form Used to treat C. difficile

• Risk for nephrotoxicity and ototoxicity

• Slow down the infusion rate and administer an antihistamine

Acyclovir (Zorivax)

Ganciclovir (Cytovene)

Oseltamivir (Tamiflu) & zanamivir (Ralenza)

Ribavirin (Virazole)

Amphotericin B

• amphoterrible

• needs PADS

  • prophylactic, acetaminophen, diphenhydramine, steroids

• Nausea

• Vomitting

• Diarrhea

Fluconazole

• Antifungal

• Treats systemic fungal infections, yeast infections, and cryptococcal meningitis

• Nausea, vomiting, and abdominal pain

• can cause increased liver enzymes

• cautious use in patients with renal or hepatic dysfunction

Nystatin

• Antifungal

• Used to treat Candida (yeast) infections

• Available as a cream or powder

• Oral forms:

  • Troche: Dissolves slowly in the mouth

  • "Swish and swallow"

  • Nausea, vomiting, diarrhea, anorexia, and rash

  
  

Chloroquine & hydroxychloroquine

• Antimalarial medication with anti-inflammatory properties

• Autoimmune indications: Treatment of systemic lupus erythematosus (SLE) and rheumatoid arthritis

• Can cause serious vision issues and retinal damage

• Requires routine eye exams 1 to 2 times per year

• Nausea, vomiting, diarrhea, abdominal pain, and loss of appetite

HIV medications: (ART, goal of antiretroviral therapy for AIDS/ HIV treatment, how to know if the

Aspirin

• NSAID

• OTC

• non-selective COX-1 and COX-2 inhibitor

• Inhibits COX enzyme activity in platelets and decreases thromboxane production to prevent platelet aggregation

• Possesses analgesic, antipyretic, anti-inflammatory, and antiplatelet/antithrombotic effects

• First-line emergency treatment administered as chewable aspirin for angina or a suspected myocardial infarction (MI)

• Unlike all other NSAIDs, low-dose aspirin is not included in the black box warning for cardiovascular thrombotic events

• Strictly contraindicated in children and teenagers with viral illnesses due to the risk of Reye's syndrome (a severe condition causing encephalopathy and liver failure)

• Significantly increases the risk of bleeding when taken with anticoagulants like warfarin

• Taking another NSAID concurrently can impede aspirin's antiplatelet aggregation effect

• inhibits protective prostaglandins, leading to increased risks of gastric ulcers, GI bleeding, and renal impairment

Ketorolac

• NSAID

• Good high pain relief alternative to opiods

• non-selective NSAID (inhibits COX-1 and COX-2)

• Powerful analgesic effects comparable to opioids; works well alongside opioids or as a substitute

• Administered for acute pain, trauma, injuries, and infections

• Oral tablets, IV/IM injections and eye drops

• Restricted to short-term use for a maximum of 5 days

• Toxic to the kidneys, posing a severe risk for renal impairment

• Should not be combined with other NSAIDs, and carries standard NSAID black box warnings for GI bleeding/ulcers and cardiovascular events

Celecoxib

• NSAID

• Selective COX-2 inhibitor

• decreased risk of peptic ulcers and GI bleeding compared to non-selective NSAIDs

• Contraindicated in patients with a sulfa allergy due to cross-reactivity

• Black box warning: Carries the standard NSAID black box warning for increased risk of serious cardiovascular events (myocardial infarction and stroke)

• Remains nephrotoxic and poses a risk of renal impairment similar to other NSAIDs

• Prescribed for arthritis, chronic pain, and post-operative pain

• Available by prescription only in oral pill form

Meloxicam

• non-selective NSAID

• Used to treat acute and chronic pain, fever, and inflammatory conditions such as arthritis

• Black box warnings: Carries standard NSAID warnings for increased risk of serious cardiovascular thrombotic events (myocardial infarction and stroke) and severe gastrointestinal bleeding, ulceration, or perforation

• Nephrotoxic effect causes renal vasoconstriction and decreased renal blood flow, posing a significant risk for acute kidney injury or worsening chronic kidney disease

• GI upset (nausea, vomiting, abdominal pain), fluid retention/edema, and elevated blood pressure

• Higher risk of bleeding when taken with anticoagulants (e.g., warfarin) and increased risk of renal damage when combined with ACE inhibitors or ARBs

• Contraindicated in patients with active GI bleeding or ulcers, severe renal impairment, history of MI or stroke, pregnancy, or known aspirin/NSAID allergies

Ibuprofen

• non-selective NSAID

• Short half-life (~2 hours), requiring dosing every 4 to 6 hours

• Available over-the-counter (OTC) in oral forms

• Safe for children 6 months and older using weight-based dosing

• contraindicated in infants under 6 months due to kidney development risks

• Black box warnings & risks: Carries standard NSAID warnings for serious gastrointestinal bleeding/ulcers, cardiovascular thrombotic events (MI/stroke), and nephrotoxicity^[4]

Naproxen

• NSAID

• OTC

• non-selective NSAID

• Longer half-life (12–17 hours), allowing for twice-daily dosing

• Possesses a better overall adverse effect profile than ibuprofen and is safer to use with ACE inhibitors

• Commonly prescribed for arthritis, muscle pain, and gout

• Black box warnings & risks: Non-selective COX inhibitor that carries risks of GI bleeding, acute kidney injury, and standard NSAID black box warnings for cardiovascular events

Misoprostol (Cytotec)

• Synthetic prostaglandin

• Replaces protective prostaglandins to increase gastric mucus and bicarbonate production

• Co-administered with NSAIDs to prevent or decrease the risk of NSAID-induced peptic ulcers

• Administered vaginally for cervical ripening and labor induction

• Strictly contraindicated during pregnancy (Pregnancy Category X) outside of intended labor induction, as it can induce premature labor or uterine contractions

Acetaminophen (and its reversal acetylcysteine)

• OTC

• not an NSAID

• Does not reduce inflammation

• Antipyretic

• Analgesic

• Provides pain relief and lowers fever

• does NOT inhibit platelet aggregation

• Inhibits central prostaglandin synthesis differently than NSAIDs

• Does NOT cause nephrotoxicity or gastrointestinal bleeding

• High risk of hepatotoxicity in overdose or when combined with alcohol

• antidote: N-acetylcysteine

• Assess for alcohol use or liver dysfunction, and monitor liver function tests

Codeine

• Opioid

• Constipation

• Schedule V controlled substance when combined in low doses (e.g., Tylenol with codeine)^[6][7]

Fentanyl

• Only in hospital

• Small doses

• Opioid agonist

• Schedule II

• high potency

• Crushing, chewing, or ingesting a fentanyl patch floods the bloodstream and causes fatal respiratory arrest

Morphine Sulfate, MS Contin

• standard opioid agonist used for acute and palliative pain management

Hydromorphone

• Opioid

• Schedule II high-potency opioid agonist

Methadone hydrochloride

• Schedule II opioid agonist with an extended half-life exceeding 24 hours, guiding its dosing frequency

Oxycodone

• Can be addictive

• Schedule II oral opioid agonist

Naloxone

• Opioid reversal

• Opioid receptor antagonist that acts as the priority antidote to reverse opioid toxicity and respiratory depression

• No pain relief from previous opioid when administered

Tramadol

• Schedule IV centrally acting analgesic that weakly binds to opioid receptors

• lower risk profile than Schedule II opioids

Lidocaine transdermal

• Local anesthetic patch

• applied directly to the skin

• interferes with nerve impulse transmission for superficial layer pain relief without altering consciousness

• Adjuvant medications

• Medications originally intended for non-pain indications that provide targeted relief for specific pain types

Malignant hyperthermia

• Family factor

• Ask before surgeries

• Contraindication for Succinylcholine

• Hyperthermia

Dantrolene

• Direct-acting

• muscle relaxant

• serves as the specific priority antidote for malignant hyperthermia alongside cardiorespiratory support

Topical anesthetics (EMLA cream)

• Applied topically to render superficial skin or mucous membrane layers insensitive to pain before minor invasive procedure

Dexmedetomidine

• adrenergic agonist

• provides sedation and anxiolysis

• no respiratory depression

• short half-life

• widely used for ICU patients on mechanical ventilation

Ketamine

• Hallucinogen

• Kids have different reaction than adults

• Fast-acting

• anesthetic

• minimal adverse impact on cardiovascular or respiratory function

• disturbing hallucinatory emergence reactions

Propofol

• Milky white

• Lipid-based

• intravenous sedative-hypnotic

• used for anesthesia induction and ICU mechanical ventilation sedation

• high risk of profound CNS depression, respiratory depression, and hypotension

Succinylcholine

• Neuromuscular blocker

• Risk of no pain relief

• Risk of no sedation

• binds acetylcholine receptors to induce complete skeletal muscle paralysis required for intubation

  • provides NO sedation and NO pain relief

  • paralyzed patients remain fully conscious if sedatives are omitted

  • Major pharmacological trigger for malignant hyperthermia

Rocuronium, vecuronium

• Non-depolarizing

• NMBD

• block skeletal muscle contraction

• paralyze respiratory muscles

• artificial mechanical ventilation is mandatory

Benzodiazepines:

• Schedule IV

• CNS depressants

• enhance GABA binding to decrease neuronal excitability

Diazepam

• Benzodiazapine

• anxiety

• muscle spasms

• seizure control

Midazolam

• Short-acting agent

• used in moderate sedation

• induces amnesia and anxiolysis

• requires immediate access to airway equipment due to respiratory arrest risk

Flumazenil

• Benzodiazepine reversal

Pentobarbital

• Short-acting barbiturate and central nervous system (CNS) depressant

• Works within the reticular formation in the brainstem by potentiating the action of GABA, inhibiting nerve impulse transmission in the cerebral cortex

• Has a low / narrow therapeutic index

• sedation, anesthesia induction, seizure management, and controlling increased intracranial pressure

• No Antidote

• Vasodilation and hypotension

• Respiratory depression and cough

• lethargy, vertigo, and decreased REM sleep

• Contraindicated during pregnancy and in patients with severe renal or hepatic impairment^[4].

Phenobarbital

• Long-acting barbiturate

• primarily prescribed for seizure prevention and management

Cyclobenzaprine

• Centrally acting skeletal muscle relaxant

• CNS depressant

• decrease muscle spasm activity^[1].

• Prescribed for the management of acute skeletal muscle spasms

• Works most effectively when combined with physical therapy

• Shares risks with other CNS depressants, notably sedation and respiratory depression

Baclofen

• acts on the spinal cord and central nervous system to decrease the number and severity of muscle spasms, improving movement and reducing pain

• Available as oral tablets, oral solutions/suspensions, dissolvable oral granules, or as an intrathecal injection delivered via a surgical spinal pump

• Drowsiness or sleepiness

• Dizziness and lightheadedness

• Muscle weakness

• Nausea or fatigue

Carisoprodol

• muscle relaxer

• Centrally-acting skeletal muscle relaxant

• Schedule IV controlled substance in the U.S. due to potential for abuse and dependence

Methocarbamol

• Centrally-acting skeletal muscle relaxant (non-controlled substance)

• Short-term relief of muscle strains, sprains, injuries, and neuromuscular manifestations of tetanus (when given via injection).

• It is used alongside rest and physical therapy.

• Slows down activity in the nervous system to relax stiff or overactive skeletal muscles

WBC

5,000-10,000

BUN

10-20

Creatinine

male 0.6-1.2, female 0.5-1.1

CD4

800-1200 (below 200 = aids)