Testing

H2 Receptor Antagonist

Cimetidine

Proton Pump Inhibitors

Drugs that end in "-prazole

Prostaglandins

Misoprostol

Mucosal Protective Agents

Carafate

Phenothiazines

Phenergan

5-HT3 Receptor Antagonists

Zofran

Substituted Benzamides

Reglan

Butyrophenones

Drugs that end in "Peridol

Benzodiazepines

Xanax

Substance P/Neurokinin 1 Receptor Antagonist

Aprepitant

Antidiarrheals

Diphenoxylate

Adsorbents

Methlcellulose

Stimulant Laxatives

SennaCastor OilBisacodyl

Stool Softners

Docusate SodiumDocusate Calcium

Lubricant Laxatives

Mineral OilGlycerin Suppositories

Chloride Channel Activators

Lubiprostone

Opioid Induced Constipation Drugs

Naloxegol (Movantik)

COX-1 Inhibitors

Aspirin

ADP Inhibitors

Plavix

Direct Thrombin Inhibitors

HeparinPradaxaArgatroban

Indirect Thrombin Inhibitors

LovenoxXareltoArixtra

Vitamin K Antagonsit

Warfarin

Thrombolytics

AlteplaseTNKase

ACTH

CorticotropinCosyntropin

GH

Somatropin

Somatostatins

SandostatinSomavert

GNRH

Leuprolide (Lupron)Goserelin (Zoladex)Nafarelin (Synarel)Histrelin (Vantas)

ADH

Vasopressin (Pitressin)Desmopressin (DDVAP)

Adrenal corticosteroids

Dexamethasone (Decadron)

Aldosterone Antagonists

Spironolactone (Aldactone)Eplerenone (Inspra)Ketoconazole (Nizoral)

Androgen Antagonists

Flutamide (Eulexin)Finasteride (Proscar, Propecia)

Thyroid Hormone Replacements

LevothyroxineThyroglobulin

Rapid-acting Insulin

Insulin Aspart

Short-acting insulin

Regular insulin

Intermediate-acting insulin

Insulin NPH

Long-acting insulin

Insulin glargineInsulin degludec

Inhalation insulin

Afrezza

Non-insulin injection

Amylin AnalogIncretin Mimetics

Sulfonylureas

GlyburideGlipizide

Biguanides

Metformin

Dipeptidyl-peptodase-4 Inhibitors

Januvia

SGLT2 Inhibitors

Invokana

Preferential COX-2

Meloxicam (Mobic)Etodolac

Uricosuric Medications

Probenecid

Xanthine Oxidase Inhibitors

Allopurinol (Zyloprim)Febuxostat (Uloric)

5-HT1D Receptor Agonists (Serotonin Agonists)

TriptansDihydroergotamine

Calcitonin-Gene-Related Peptide Antagonists

Erenumab (Aimovig)

H1 Antihistamines - 1st Generation

BenadrylHydroxyzine (Atarax, Vistaril)

H1 Antihistamines - 2nd Generation

ClaritinAllegra

Calcineurin Inhibitors

CyclosporineTacrolimus

Costimulation Blockers

Belatacept

mTOR inhibitors

SirolimusEverolimus

Immunosuppressive Antimetabolites

Azathioprine (Imuran)Mycophenolate Mofetil (Cellcept)Mycophenolate Sodium (Myfortic)

Antibodies

Antithymocyte GlobulinsBasiliximab

Selective Estrogen Receptor Antagonists

TamoxifenRaloxifeneClomiphene

Biphosphates

Alendronate

Recombinant PTH

Teriparatide (Forteo)

Anorexiants

Phentermine, Diethypropion

Lipase Inhibitors

Orlistat

Phosphodiesterase-5 Inhibitors

Drugs that end in "-afil

5a Reductase Inhibitors

Drugs that end in "-steride

Retinoids - 1st generation

TretinoinIsotretinoin

Retinoids - 3rd generation

Adapalene, Tazarotene

Docusate sodium & Docusate calcium

Mineral oil

H1 Antihistamines

CNS depressants (including alcohol)MAOIsCholinesterase inhibitors (Especially 1st generation)

Allopurinol (Zyloprim)Febuxostat (Uloric)

6-mercaptopurineAzathioprineTheophylline

Phosphodiesterase-5 Inhibitors

Organic nitrates (nitroglycerin, isosorbide)Alpha adrenergic antagonists

a1-Adrenergic Antagonists

CYP2D6

Orlistat

Fat-soluble vitaminsAmiodaroneCyclosporineLevothyroxine

Substance P/Neurokinin-1 Receptor Blockers

Other medications metabolized by CYP3A4

Blocks receptors in CTZ, ↑ sensitivity of GI tract to actions of ACh

Metoclopramide (Reglan)

blocks dopamine receptors

Butyrophenones

Broken down into ricinoleic acid

Castor oil

Increase cGMP resulting in chloride and bicarbonate secretion into intestinal lumen

Linaclotide (Linzess)

Inhibition of thromboxane A2 synthesis from arachidonic acid (AA) in platelets

Aspirin

block thyroid hormone release, inhibits thyroid hormone biosynthesis, ↓ size & vascularity of gland

Iodides

Pancreatic islet peptide that decreases postprandial hyperglycemia

Amylin Analog

Activate PPAR gamma receptor to ↓ peripheral insulin resistance

Thiazolidinediones

Slows the inactivation of incretin hormones (works similar to incretin mimetic)

Sitagliptin (Januvia)

TNFα inhibitors ↓ signs and symptoms of RA, ↓ structural damage, and improve physical function

Biologic DMARDS

↓ leukocyte mobility, ↓ phagocytosis in joints, deposition of urate crystals

Colchicine

↑ renal excretion of uric acid by inhibiting renal tubular reabsorption of uric acid in the kidney

Uricosuric Medications(Probenecid)

human monoclonal antibody antagonizes calcitonin gene-related peptide (CGRP) receptor function

Erenumab (Aimovig)

↑ platelet aggregation & vascular tone (vasoconstriction) maintains balance with PGI2

Thromboxane (TXA2)

↓ platelet aggregation and vascular tone (vasodilation)

Prostacyclin (PGI2)

↑ leukocyte chemotaxis and bronchoconstriction

Leukotrienes (LTB, LTC, LTD, etc)

vasodilation, ↑ uterine contractions, ↓ gastric acid secretion, and ↑ gastric mucus production

Prostaglandins (PGE1&2)

↑ uterine contraction, ↑ aqueous humor outflow

PGF2a

After diffusion into T-cell, binds to calcineurin, decreases IL-2

Cyclosporine (Neoral, Sandimmune)

Same as cyclosporine except it binds to FKBP-12 (FK-binding protein)

Tacrolimus

bind to surface of T lymphocytes, antibody-bound cell phagocytosed in the liver and spleen resulting in lymphopenia and impaired t-cell responses

Antithymocyte Globulins (ATGAM, Thymoglobulin)

anti-CD25 antibody binds to the α chain of IL-2 receptor on activated T cells

Basiliximab

Competes with estrogen for receptors in breast tissue

Tamoxifen (Nolvadex)

partial estrogen agonist and interferes with the negative feedback loop of estrogen

Clomiphene (Clomid, Serophene)

Inhibits ovulation, suppresses LH surge. thickens cervical mucus, alters fallopian tube peristalsis

Progestin-only "mini-pills

Decrease osteoclastic bone resorption, resulting in an increase in bone mineral density

Alendronate (Fosamax, Binosto)

Lower estrogen levels after menopause promote proliferation and activation of osteoclasts

Raloxifene (Evista)

↓ bone resorption (less effective than bisphosphonates) for pain associated with osteoporotic fracture

Calcitonin (Fortical, Miacalcin)

Stimulates bone formation by stimulating osteoblastic activity (all others inhibit bone resorption)

Teriparatide (Forteo)

↑ NE and dopamine from nerve terminals and inhibiting reuptake, ↑neurotransmitters in brain

Anorexiants

Pentanoic acid ester that inhibits gastric and pancreatic lipases, ↓ breakdown of dietary fat into smaller molecules

Orlistat

Selectively activates 5-HT2C receptors, ↑ POMC, melanocortin receptor activation

Lorcaserin

↑ nitric oxide, ↑ cGMP = smooth muscle relaxation and inflow of blood to corpus cavernosum

Drugs that end in "-afil

inhibit 5α reductase which converts testosterone to dihydrotestosterone (DHT) (more active)

Drugs that end in "-steride

topical skin whitening agent that inhibits tyrosinase enzyme required for melanin synthesis

Hydroquinone

inhibits cell proliferation and promotes cell differentiation of epithelial cells

Methoxsalen

Inhibit keratinocyte proliferation and ↑ keratinocyte differentiation

Vitamin D Analogs

High levels of DHT cause hair follicle to miniaturize and atrophy

Finasteride (5 α-reductase inhibitor)

Which has opioid-like actions on the gut?

Diphenoxylate

PPI's increase risk of fractures and lower B12 levels

TRUE

Warfarin (Coumadin) requires monitoring of INR levels on a regular basis.

TRUE

Which oral medication class works by slowing the inactivation of incretin hormones?

DPP4 Inhibitors

Which is likely to cause glucose to be present in the urine when taking?

SGLT2 Inhibitors

Low molecular weight heparin

Enoxaparin (Lovenox)

Recombinant versions of tPA and urokinase

Thrombolytics

Most common oral iron supplement - low cost with good effectiveness and tolerability

Ferrous sulfate (Feosol)

20% elemental iron

Ferrous sulfate (Feosol)

12% elemental iron

Ferrous gluconate (Fergon)

used to differentiate between primary and secondary adrenal insufficiency

Corticotropin

used for diagnosis of adrenal insufficiency

Cosyntropin

Major prolactin-inhibiting factor

Dopamine

Insulin typical units?

100 U per mL

Never mix any insulin in the same syringe with what meds?

insulin glargine or insulin detemi

Primary precursor of prostaglandins

arachidonic acid

Commonly used to bridge time until DMARDs are effective

Glucocorticoids

Triple therapy for H. pylori

PPI + amoxicillin + clarithromycinMetronidazole can be used in PCN allergic patientsDo not use single antibiotic therapy

Most antiemetic activity

serotonin antagonistsubstituted benzamidephenothiazine

Least antiemetic activity

antihistamineanticholinergicbenzodiazepine

activation of thrombin and formation of fibrin

Thromboxane A2 (TXA2)

occurs in medium-sized vessels; platelet-rich clots (white clots)

Arterial thrombosis

rich in fibrin with fewer platelets (red clot)

Venous thrombosis

extrinsic pathway is inhibited by?

clotting factor VII

intrinsic pathway is inhibited by?

clotting factor XII

degrades fibrin and dissolves fibrin clots, ↑ blood flow

Plasmin

Necessary for RBC production

Iron, folic acid and vitamin B-12

Inherited red blood cell disorder in which RBCs contain abnormal hemoglobin S that causes them to dehydrate and become hard and sticky and to take on the shape of a farmers' sickle

Sickle cell disease

what increases the amount of hemoglobin F in RBC's?

Hydroxyurea

emergency hypothyroid condition

Myxedema Coma

treatment for thyroid storm

beta-blockers, IV fluids, PTU and Iodides

Results in absolute deficiency of insulinAll patients require insulin

Type 1 Diabetes

mimic pancreatic secretion of insulin throughout the day

Basal

mimic pancreatic response to glucose load (food)

Bolus

What have largely replaced colchicine in the treatment of acute gouty attacks?

NSAIDs

What should you avoid with gout?

AlcoholHigh purine foods - liver, gracy, game meats, herring

Unilateral headache lasting 2-72 hours that is aggravated by physical activity

Migraine without aura

Headache preceded by visual, sensory, and/or speech or motor disturbances

Migraine with aura

headache that is bilateral in band around head

Tension type headache

body's ability to recognize infectious disease and protect the body from them

Immunity

any foreign substance that can stimulate an immune reaction

Antigen (Ag)

Y-shaped protein that binds to antigen marks for phagocytosis, stimulates immune system

Antibody (Ab)

primary cell of immune system that interacts with antigens

Lymphocyte

signals the lymphocyte to reproduce making more of the same Ab specific for that Ag

Ag/Ab Complex

T cell trigger at CD# receptor complex by an antigen on the surface of an antigen-presenting cell

Signal 1

CD80 and CD86 on surface of APC engage CD28 on T-cells

Signal 2

Stimulus for T-cell proliferation

Stimulus 3

progressive loss of bone mass and skeletal fragility

Osteoporosis

bone remodeling that results in disorganized bone formation and enlarged or misshapen bone

Paget Disease

softening of the bones mostly attributed to Vitamin D deficiency (called Rickets in children)

Osteomalacia

cells which break down bone (aka bone resorption)

Osteoclasts

cells which build bones

Osteoblasts

still widely used due to effectiveness & low cost; CNS penetration - Cause sedation

1st generation antihistamines:Diphenhydramine (Benadryl)Hydroxyzine (Atarax, Vistaril)

1st IV maintenance immunosuppressant; dosed in 2 phases

Belatacept (Nulojix)

Mostly replace azathioprine in therapeutic use

Mycophenolate Mofetil (Cellcept) and Mycophenolate Sodium (Myfortic)

most commonly used contraceptive

Synthetic estrogen + synthetic progestin

same tablet taken every day (same strength of estrogen/progestin in each tablet)

Monophasic

tablets alter the strength of progestin to more closely mimic the natural hormone cycle

Triphasic

Used when estrogen is contraindicated

Progestin-only "mini-pills":NorethindroneDrospirenone

more potent and causes greater decrease in DHT than finasteride

Dutasteride

Proton Pump Inhibitors

Gastric ulcers↓ risk of GI bleeds from Aspirin or NSAIDs

Oxytocin

Stimulate uterine contractionsInduction/ reinforcement of labor (IV)Reduction of postpartum bleedingEjection of breast milk (nasal spray)

Desmopressin (DDAVP)

Diabetes InsipidusNocturnal enuresis

Glucocorticoids (Cortisol)

Metabolism action and resistance to stressAnti-inflammatory action

Alprostadil

EDKeep ductus arteriosus open in neonates with congenital heart conditions

Levothyroxine

Hypothyroidism

Methimazole (Tapazole)

Hyperthyroidism

Propylthiouracil (PTU)

Pregnant with hyperthyroidism

Dexamethasone (Decadron)

Cushing's syndrome

Misoprostol

Chronic NSAID useLabor induction

5-HT1D Receptor Agonists

Treatment of acute migraine (not prophylaxis)

Cyclosporine

Prevention of allogeneic transplants

Allopurinol (Zyloprim)

urinary stones or impaired renal function

Tacrolimus

Prevents liver and kidney rejection and treats severe atopic dermatitis

Azathioprine (Imuran)

1st widespread use in organ transplant

Corticosteroids

Mainstay to use once rejection to a transplant is happening

Raloxifene (Evista)

Postmenopausal women intolerant to bisphosphonates Prevention and treatment of osteoporosis

3rd generation retinoids

First-line therapy for comedonal and inflammatory acne

Adrenal corticosteroids

Adrenocortical insufficiencyCushing's syndrome - Dexamethasone (Decadron)

Antithymocyte Globulins (ATGAM, Thymoglobulin)

Used at time of transplantation; prevents allograft rejection or corticosteroid-resistant acute rejection

Argatroban

Prophylaxis or treatment of VTE in patients with HIT

Benzoyl Peroxide

1st line agent for mild to moderate acne with no inflammation

Calcitonin (Fortical, Miacalcin)

osteoporosis in women who are at least 5 years postmenopausal

Colchicine

Recurrent gout attacks

Dabigatran (Pradaxa)

Stroke and systemic embolism with nonvalvular afibCaution in patients >75 years old

Danazol

Endometriosis Fibrocystic breast disease

Dexamethasone

Cushing's syndrome

Estrogens

NEVER use alone unless have had hysterectomyPost-menopausal hormone replacement therapy (HRT)Decrease risk of osteoporosisNOT to be used for prevention of osteoporosis↓ frequency of "hot flashes"Reverses postmenopausal arophy of the vulva, vagina, urethra, and trigone of the bladder

Ferrous sulfate (Feosol)

Most common oral iron supplement

H2 Receptor Antagonists

Aspiration pneumonitisGERD symptom relief, Prophylaxis of ulcer recurrence

Linaclotide (Linzess)

Irritable bowel syndrome with constipationChronic idiopathic constipationDo not use in pediatric patients <6 year of age or with known or suspected mechanical GI obstruction

Lubiprostone (Amitiza)

Chronic idiopathic constipationDo not use with known or suspected mechanical bowel obstruction

Metoclopramide (Reglan)

5HT3 receptor antagonistic effectsOpioid-induced nauseaNausea due to gastroparesis

Methotrexate (MTX)

PsoriasisRA

Mucosal Protective Agents

Duodenal ulcers

Mupirocin Retapamulin

Impetigo

NSAIDs

Inflammation & accompanying pain

Permethrin

lice and scabies

Phentermine and Topiramate (Qsymia)

Long term treatment of obesity

Radioactive Iodides

Do not give anti-thyroid medications afterWait at least 3-7 days to prevent interference

Retinoids

Severe cystic acne

Rivaroxaban (Xarelto)

DVT and PE

Synergized pyrethrins

Pediculosis

Tadalafil

BPH

Thrombolytics

MI, acute ischemic stroke and PE

Xanthine Oxidase Inhibitor

Chronic Gout

Parenteral Iron Therapy

Fe deficiency anemiaUnable to tolerate PO ironDo not respond to PO iron supplementation

H2 Receptor Antagonists

Minimal, but medications that require very acidic gastric environment for absorption

MeglitinidesColchicineWarfarinCimetidine

CYP 450

PPIs

Clopidogrel

Antacids

↓absorption of acidic drugs↑ absorption of basic drugsMetal ions chelate other drugs

Tadalafil

Avanafil

Naloxegol (Movantik)Aprepitant (Emend)Alprostadila1-Adrenergic Antagonists

CYP3A4

Docusate sodium & Docusate calcium

Mineral oil

Aspirin

protein bindingOther antiplateletsEthanol

Warfarin (Coumadin)

Foods high in vitamin K content - dark green leafy veggies

Warfarin (Coumadin)

FAB5 - Flagyl, Fluoroquinolones, Azole Antifungals, Amiodarone, Bactrim

Mucosal Protective Agents

H2 blockersPPIsAntacids

Iron

Fluoroquinolones, Tetracyclines, PhenytoinSeparate the interacting drugs by 2-4 hours

LevothyroxineCyclosporineCimetidine

MANY DRUG INTERACTIONS

NSAIDsIndomethacin (Indocin)

Anticoagulants & AntiplateletsCorticosteroids, bisphosphonatesAntihypertensives

H1 Antihistamines

CNS depressants (including alcohol)MAOIsCholinesterase inhibitors (Especially 1st generation)

Allopurinol (Zyloprim)Febuxostat (Uloric)

6-mercaptopurineAzathioprineTheophylline

Synthetic estrogen + synthetic progestin

AntibioticsBarbituratesBenzodiazepinesPhenytoin (Dilantin)Sulfonamides

Phosphodiesterase-5 Inhibitors

Organic nitrates (nitroglycerin, isosorbide)Alpha adrenergic antagonists

a1-Adrenergic Antagonists

CYP2D6

Mycophenolate Mofetil (Cellcept) Mycophenolate Sodium (Myfortic)

Concomitant admin with antacids (Mg, Al) or cholestyramine

Orlistat

Fat-soluble vitaminsAmiodaroneCyclosporineLevothyroxine

Substance P/Neurokinin-1 Receptor Blockers

Other medications metabolized by CYP3A4