Medulla Secretes catecholamines

Glucocorticoid Acts as a transcription factor to turn genes on or off; anti-inflammatory

Receptors And immunosuppressive activities
Cortisol Principal human glucocorticoid
Mineralocorticoids Control fluid status and concentration of electrolytes
Corticosteroids Used in replacement therapy and in the treatment of severe allergic reactions,
asthma, rheumatoid arthritis, other inflammatory disorders, and
Some cancers
Addison Disease Caused by adrenal cortex dysfunction -- lack of response to ACTH administration
Hydrocortisone The goal of this regimen is to mimic the normal diurnal variation in cortisol levels
Fludrocortisone A potent synthetic mineralocorticoid with some glucocorticoid activity
Cushing Syndrome Caused by hypersecretion of glucocorticoids
Dexamethasone Used to diagnose Cushing syndrome; suppresses cortisol release in normal
individuals
Congenital Adrenal Group of diseases resulting from an enzyme defect in the synthesis of one or more
Hyperplasia of the adrenal steroid hormones
(CAH)
Fluticasone Treatment of allergic rhinitis and asthma
Respiratory Distress A problem in premature infants
Syndrome
Fetal Cortisol Regulator of lung maturation
Beta/Dexamethasone Administered intramuscularly to the mother within the 48 hours proceeding
premature delivery can accelerate lung maturation in the fetus
Prednisone Minimizes steroid effects on the fetus
Osteoporosis Most common adverse effect of long-term corticosteroid therapy
Ketoconazole An antifungal agent that strongly inhibits all gonadal and adrenal steroid
Spironolactone Useful in the treatment of hirsutism in women
Eplerenone Avoids the side effect of gynecomastia that is associated with the use of
spironolactone

Hyperaldosteronism is treated with spironolactone.

ADVERSE REACTIONS:
Obesity due in part to an energy imbalance
Phentermine increasing the release of norepinephrine and dopamine from the
nerve terminals
Diethylpropion
anorexiants Controlled substances due to the potential for dependence or abuse
Orlistat pentanoic acid ester that inhibits gastric and pancreatic lipases;
Lorcaserin used for chronic weight management; newer serotonin agonist
Phentermine, topiramate For long-term use in the treatment of obesity
Topiramate a weak carbonic anhydrase inhibitor; reduce the efficacy
of oral contraceptives

Adverse effects (ORLISTAT): Adverse effects (LORCASERIN):

Oily spotting Nausea

Flatulence with discharge Headach
Fecal urgency Dry mouth
Increased defecation Dizziness
Constipation
Lethargy.

Asthma Chronic disease characterized by hyperresponsive airways

Allergic rhinitis Characterized by itchy, watery eyes, runny nose, and a nonproductive
cough
β2-adrenergic agonists Relax airway smooth muscle; for the quick relief of asthma symptoms
Short-acting β2 agonists Have a rapid onset of action (5 to 30 minutes); for symptomatic
(SABAs) treatment of bronchospasm
Salmeterol, formoterol Providing bronchodilation for at least 12 hours
long-acting β2 agonists Useful adjunctive therapy for attaining asthma control
(LABAs)
ICS Drugs of choice for long-term control in patients with any degree of
persistent asthma, reduce the hyperresponsiveness of the airway
smooth muscle
Zafirlukast, montelukast Selective antagonists of the cysteinyl leukotriene- 1 receptor
Cromolyn Alternative therapy for mild persistent asthma; prophylactic anti-
inflammatory agent
Cholinergic antagonists Block vagally mediated contraction of airway smooth muscle and
mucus secretion
ipratropium Offers additional benefit when used with a SABA
Theophylline A bronchodilator that relieves airflow obstruction in chronic asthma
and decreases its symptoms
Omalizumab Recombinant DNA-derived monoclonal antibody; treatment of
moderate to severe persistent asthma
COPD Irreversible obstruction of airflow;
Bronchodilators The foundation of therapy for COPD
Roflumilast Oral phosphodiesterase-4 inhibitor used to reduce exacerbations in
patients with severe chronic bronchitis
Metered-dose inhalers eject the active medication from the canister
Spacers A large-volume chamber attached to an MDI; reduces the velocity of
the aerosol
Rhinitis An inflammation of the mucous membranes of the nose
Antihistamines (H1- For the management of symptoms of allergic rhinitis;
receptor blockers)
Coughing Important defense mechanism of the respiratory system to irritants
Codeine Decreases the sensitivity of cough
Dextromethorphan Synthetic derivative of morphine
Guaifenesin An expectorant, is available as a single-ingredient formulation
benzonatate Suppresses the cough reflex through peripheral action

MOST EFFECTIVE MEDICATIONS FOR TREATMENT OF ALLERGIC RHINITIS:

beclomethasone, budesonide, fluticasone, ciclesonide, mometasone, and triamcinolone.

First-generation antihistamines, such as diphenhydramine and chlorpheniramine.

The second-generation antihistamines such as fexofenadine, loratadine,

desloratadine, cetirizine, and intranasal azelastine

Symptoms of COPD include cough, excess mucus production, chest

tightness, breathlessness, difficulty sleeping, and fatigue.

Adverse effects, such as tachycardia,

hyperglycemia, hypokalemia, and hypomagnesemia

Histamine Chemical messenger mostly generated in mast cells; a neurotransmitter in the

brain; is an amine formed by the decarboxylation
H1 Receptors Important in producing smooth muscle contraction
Older First- Widely used because they are effective and inexpensive; treatment of
Generation insomnia
Second-Generation Made polar mainly by adding carboxyl groups
Cyproheptadine Serotonin antagonist on the appetite center
Ophthalmic Treatment of allergic conjunctivitis
Antihistamines
Antimuscarinic Most effective agents for prevention of the symptoms of motion sickness
Agent
H2-Receptor Inhibitors of gastric acid secretion

ADVERSE EFFECTS OF ANTIHISTAMINES:

 Drowsiness
 Urinary retention
 Tachycardia
 Hypotension
 Vertigo
 Dry mouth
 Increased appetite
 Helicobacter Pylori, Two main causes of peptic ulcer disease
Use Of Nsaid’s
Gastric Acid Stimulated by acetylcholine, histamine, and gastrin
Secretion
Cimetidine First histamine H2-receptor antagonist
Gastroesophageal Effective for the treatment of heartburn
Reflux Disease
(Gerd)
Ppis Suppress the secretion of hydrogen ions into the gastric lumen
Prostaglandin E Inhibits secretion of acid and stimulates secretion of mucus and
bicarbonate
Misoprostol For the prevention of NSAID-induced gastric ulcers
Antacids For symptomatic relief of peptic ulcer disease and GERD
Sucralfate Creates a physical barrier that protects the ulcer from pepsin and acid
Bismuth Component of quadruple therapy to heal peptic ulcers
Subsalicylate
Phenothiazines First group of drugs shown to be effective antiemetic agents
Prochlorperazine Act by blocking dopamine receptors
5-Ht3 Receptor Important in treating emesis linked with chemotherapy
Blockers
Benzodiazepines Treating anticipatory vomiting
Aprepitant Targets the neurokinin receptor in the brain
Droperidol Most often for sedation in endoscopy and surgery
Metoclopramide Prokinetic drug for the treatment of GERD
Antimotility Agents Decrease peristalsis
Adsorbents Act by adsorbing intestinal toxins
Bismuth Decreases fluid secretion in the bowel
Subsalicylate
Laxatives Accelerate the movement of food through the GI tract
Senna Widely used stimulant laxative
Bisacodyl Potent stimulant of the colon
Castor Oil Increases peristalsis
Bulk Laxatives They form gels in the large intestine, causing water retention
Saline Cathartics Hold water in the intestine by osmosis
Emollient Laxatives Used for prophylaxis rather than acute treatment
Or Surfactants
Mineral Oil And Facilitating the passage of hard stools
Glycerin
Suppositories
Lubiprostone Activating chloride channels to increase fluid secretion

Commonly used antacids are: ADVERE EFFECTS OF PPI’s;

 aluminum hydroxide  nausea
 magnesium hydroxide  diarrhea
 headache
 GI disturbance
 Bone fractures
 CHAPTER 32: Drugs for Urologic Disorders

Erectile dysfunction Inability to maintain penile erection

Benign prostatic Nonmalignant enlargement of the prostate
hyperplasia (BPH)
Avanafil Has the quickest onset of action
Alprostadil Synthetic prostaglandin E1
Prazosin Α-blocker that is used off-label in the treatment of BPH
Finasteride, Responsible for converting testosterone to the more active
dutasteride dihydrotestosterone
Tadalafil Allows for vasodilation and relaxation of the smooth muscle of the prostate
and bladder

ADVERSE EFFECTS OF NON-SELECTIVE a-BLOCKERS:

 Vertigo
 Orthostatic hypotension
 Sexual dysfunction
 Tachycardia

CHAPTER 33: DRUGS FOR ANEMIA

Anemia Below-normal plasma hemoglobin

Iron Stored in the intestinal mucosal cells, liver, spleen, and bone marrow as
ferritin
Iron Deficiency Negative iron balance
Megaloblastic Large-sized red blood cells
Anemia
Cyanocobalamin
Hydroxocobalamin
Erythropoietin Regulates red blood cell proliferation
Human Treatment of anemia caused by end-stage renal disease; target hemoglobin
Erythropoietin Concentrations more than 11 g/dl
(Epoetin Alfa)
Darbepoetin Long-acting version of erythropoietin
Sargramostim Stimulate granulocyte production in the marrow
Pegfilgrastim Pegylated form of G-CSF;
Hydroxyurea Reduce the frequency of painful sickle cell crises
Pentoxifylline “Rheologic modifier”; increases the deformability of red blood cells

Folate deficiency may be caused by:

1) increased demand
2) poor absorption caused by pathology of the small intestine
3) alcoholism
4) treatment with drugs that are dihydrofolate reductase inhibitors
 CHAPTER 34: DRUGS FOR DERMATOLOGIC DISORDERS

Skin Largest organ system of the body

Epidermis Defense against pathogens
Dermis Composed of connective tissue
Acne Vulgaris Common skin disorder that is characterized by pimples, comedones,
pustules, and sometimes nodules and scarring
Retinoids Highly effective in the treatment of acne
Benzoyl Peroxide First-line agent for mild to moderate acne with no inflammation
Salicylic Acid Treatment for mild acne
Azelaic Acid Normalizes keratinization and is anticomedogenic
Dapsone Synthetic sulfone
Bacitracin Prevention of skin infections after burns or minor scrapes
Mupirocin Useful in treating impetigo
Polymyxin B Disrupts the bacterial cell membrane of gram-negative organisms
Neomycin Treats Pseudomonas, E. Coli, and Klebsiella sp. Infections
Ectoparasites Parasites that live on the skin of animals
Pediculus Capitis Cause lice infestations
Sarcoptes Scabiei Cause scabies
Pediculus Corporis Body louse
Pthirus Pubis Pubic or crab louse
Lindane An effective pediculicide (kills lice) and scabicide
Permethrin Effective in 5% concentration by prescription to treat scabies
Pyrethrins Are pesticides
Piperonyl Butoxide Prevents the lice from metabolizing the pyrethrins
Hydroquinone Reduces hyperpigmentation; topical skin whitening agent
Methoxsalen Photoactive substance;
Tazarotene Treatment of plaque psoriasis
Acitretin Treatmentof pustular forms of psoriasis
Coal Tar Inhibits excessive skin cell proliferation
Minoxidil Treatment of androgenic alopecia (“male pattern baldness”)
Finasteride Decreases scalp and serum DHT concentrations

3rd GENERATION: (first line therapy)

1ST GENERATION: (for the management of  Adapalene
acne)  Tazarotene
 Tretinoin
 Isotretinoin
CHAPTER 35: DRUGS FOR BONE DISORDERS

Osteoporosis Progressive loss of bone mass and skeletal fragility

Paget Disease Disorder of bone remodeling
Osteomalacia Softening of the bones
Rickets Osteomalacia in children
Osteoclasts Cells that break down bone
Bisphosphonates Decrease osteoclastic bone resorption
Raloxifene For the prevention and treatment of osteoporosis
Calcitonin For the treatment of osteoporosis in women who are at least 5 years
postmenopausal
Denosumab Treatment of postmenopausal osteoporosis in women at high risk of fracture
Teriparatide First approved treatment for osteoporosis that stimulates bone formation
 CHAPTER 36: Anti-inflammatory, Antipyretic, and Analgesic Agents

Inflammation response to tissue injury

Arachidonic acid primary precursor of the prostaglandins and related compounds.
Cyclooxygenase-1 responsible for the physiologic production of prostanoids
(COX-1)
cyclooxygenase-2 elevated production of prostanoids
(COX-2)
Prostaglandins major role in modulating pain, inflammation, and fever