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STEP 1 > 01b: Pharmacology > Flashcards

01b: Pharmacology Flashcards

1
Q

Lineweaver Burk: x-int approaches zero, affinity of enzyme to substrate (increases/decreases).

A

Decreases (Km increases)

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2
Q

Competitive inhibitors decrease (efficacy/potency) and noncompetitive inhibitors decrease (efficacy/potency).

A

Potency; efficacy

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3
Q

Small, hydrophilic compounds likely have (large/small) Vd and distributed mainly in (X) compartment.

A

Medium

X = ECF

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4
Q

Large, charged molecules likely have (large/small) Vd and distributed mainly in (X) compartment.

A

Small

X = intravascular (and bound to plasma proteins)

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5
Q

Drug infused at constant rate takes (X) number of half lives to reach steady state.

A

X = 4-5 (90% at 3.3 half lives)

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6
Q

Drugs: Loading dose calculation

A

(Cp)*(Vd)/(F)

Cp = target plasma conc at steady state
F = bioavailability
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7
Q

Drugs: Maintenance dose calculation (not for continuous infusion)

A

(Cp)(CL)(๐‰)/(F)

Cp = target plasma conc at steady state
๐‰ = time between doses
F = bioavailability
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8
Q

Time until drug reaches steady state is (increased/decreased) with increased (loading/maintenance) dose.

A

Independent of these! Depends primarily on half-life

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9
Q

Aspirin and acetaminophen drug interaction is an example of (X) effect

A

X = additive (their effect together is equal to sum of their individual effects)

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10
Q

Cortisol and catecholamine drug interaction is an example of (X) effect

A

X = permissive (cortisol required for full effects/responsiveness of catecholamines)

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11
Q

Clopidogrel and aspirin drug interaction is an example of (X) effect

A

X = synergistic (effects of them together is greater than sum of their individual effects)

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12
Q

Tachyphylactic drug interaction refers to which phenomenon?

A

Acute decrease in response to drug after initial/repeated administration

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13
Q

Zero-order kinetics: constant (X) of drug eliminated per unit time. List three examples of drugs eliminated in this manner.

A

X = amount

PEA (pea is round like 0)
Phenytoin, EtOH, Aspirin

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14
Q

First-order kinetics: constant (X) of drug eliminated per unit time. Applies to most drugs

A

X = fraction

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15
Q

Half-life (decreases/increases) in (zero/first)-order kinetics as concentration of drug decreases.

A

Decreases in zero order;

Remains constant in first-order

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16
Q

Aspirin overdose can be treated with (X), which will (ionize/neutralize) the urine and result in:

A

X = bicarbonate
Ionize (alkalinize)

Ionization of weak acid drugs (salicylate, phenobarbital, methotrexate) will trap it in urine and clear it quickly

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17
Q

What might be used to (ionize/neutralize) the urine and trap drugs that are weak bases, such as (X)?

A

Ammonium chloride;
Ionize (acidify) urine to then ionize and trap weak bases
X = amphetamines, TCAs

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18
Q

List the phases of drug metabolism. Star the one that geriatric patients lose first.

A

Phase I*: CYP450 (metabolites often still active)

Phase II: Conjugation (methylation, glucoronidation, acetylation, sulfation; inactive metabolites)

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19
Q

Why are patients that are slow acetylators at (increased/decreased) risk of drug side effects?

A

Increased

Decreased Phase II of drug metabolism (conjugation)

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20
Q

Drug efficacy is represented by (low/high) (X). Drug potency is represented by (low/high) (Y).

A

High; X = Vmax (max effect)
Low; Y = EC50 (amount of drug needed for given effect)

These two characteristics are unrelated

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21
Q

Give an example of partial agonism at the opioid mu receptor.

A

Morphine (full agonist) and buprenorphine (partial)

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22
Q

List four drugs that must be monitored carefully due to (low/high) therapeutic index.

A

Low (TD50/ED50)
Mnemonic: Warning! These Drugs are Lethal

  1. Warfarin
  2. Theophylline
  3. Digoxin
  4. Lithium
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23
Q

(X) glands are funky in that theyโ€™re part of (sympathetic/parasympathetic) pathway but innervated by (Y) fibers.

A

X = sweat (trying to remember these makes me sweat)
Sympathetic
Y = cholinergic

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24
Q

Botulinum toxin affects (muscarinic/nicotinic) ACh receptors. Repetitive nerve stimulation (can/cannot) increase compound muscle action potential

A

Both (since decreases ACh release from nerve terminals; cleaves SNARE proteins)

Can

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25
T/F: Myasthenia gravis only affects nicotinic ACh receptors.
True
26
Activation of (X) receptor increases pupillary dilator muscle.
X = alpha1 (Gq class)
27
Activation of (X) adrenergic receptor(s) (increases/decreases) contraction of bladder and intestinal sphincters.
X = alpha1 (Gq class) | Increases
28
(X) adrenergic receptor plays important role in (increasing/decreasing) platelet aggregation.
X = alpha2 (Gi class) | Increasing
29
(X) adrenergic receptors play opposite roles in regulating aqueous humor production. They play similar roles in regulation of (Y).
``` X = beta2 (increases) and alpha2 (decreases) Y = insulin secretion and lipolysis ```
30
(X) adrenergic receptors play role in (increasing/decreasing) renin release.
X = beta1 | Increasing
31
List the key receptors that work by Gq-protein-linked second messenger
Mnemonic: HAVe 1 M&M H1, alpha1, V1 (vasopressin); M1, M3
32
List the key receptors that work by Gi-protein-linked second messenger
Mnemonic: MAD 2's (trying to inhibit cAMP) M2, alpha2, D2
33
Which vasopressin receptor works on kidney?
V2 (two for collecting TUbules)
34
Which dopamine receptor works on kidney?
D1 (relaxes renal vasculature smooth muscle)
35
(X) histamine receptor (increases/decreases) gastric acid secretion via which G-protein second messenger system?
X = H2 | Gs (increases)
36
Pyridostigmine primarily used to treat:
Myasthenia gravis (anticholinesterase; increases ACh) PyRIDOstiGMine (gets RID O' MG)
37
List the meds that are used in AD to (increase/decrease) ACh.
Increases (anti-cholinesterases) "AD patients GALLANTly swim DOwN the RIVer" 1. Galantamine 2. Donepezil 3. Rivastigmine
38
Cholinesterase inhibitor poisoning is often due to (reversible/irreversible) action of (X). Symptoms?
Irreversible X = organophosphates (insecticide) DUMBBELSS
39
Organophosphate poisoning antidote:
Anticholinergics: atropine (competitive inhibitor) AND pralidoxime (regenerates AChE if given early)
40
Scopolamine is primarily used for:
Motion sickness treatment; muscarinic (M1-R) antagonist in vestibular nuclei
41
Patient with myasthenia gravis is experiencing classic side effects of (X) drug. Which agent can be given to reduce these side effects?
X = pyridostigmine (AChE inhibitor) Scopolamine (blocks M1-R and decreases muscarinic side effects without impacting therapeutic nicotinic effects)
42
Farmer comes in with diarrhea, miosis, excess sweating and tearing, and muscle weakness. After administration of therapeutic agent, all symptoms resolve except muscle weakness. What was he likely given?
Only atropine (muscarinic antagonist); if pralidoxime not given as well, nicotinic ACh effects remain
43
"Gardner's pupil" is the result of (X) ingestion and treated with (Y).
``` X = Jimson weed (plant alkaloids/muscarinic antagonists resulting in mydriasis) Y = physostigmine (gets into CNS) ```
44
(Epi/NE) would be given for bronchoconstriction.
Epi (significantly stronger at beta2 effect than NE) ex: asthma, anaphylaxis
45
Patient with hypotension and shock is immediately given IV solution of (X). Around the IV site, you notice whitening and hardening of the skin. You immediately administer (Y) because:
``` X = NE Y = phentolamine (in NaCl solution) ``` Blanching of vein due to NE extravasation into tissue around IV can cause severe alpha1 constriction and result in necrosis
46
List three examples of indirect sympathomimetics
1. Amphetamines 2. Cocaine 3. Ephedrine
47
(X) drug should never be administered if cocaine intoxication suspected as it will cause unopposed (Y) adrenergic response.
``` X = beta blocker Y = alpha1 vasoconstriction (extreme HT) ```
48
Beta2 receptor effect on vasculature
Vasodilation
49
Isoproterenol (increases/decreases) HR, (increases/decreases) CO, and (increases/decreases) MAP via actions primarily on (X) receptors.
Significantly increases HR and CO (reflex tachycardia); decreases MAP X = beta (1 and 2)
50
NE (increases/decreases) HR, (increases/decreases) CO, and (increases/decreases) MAP via actions primarily on (X) receptors.
Decreases (reflex bradycardia); No change on CO Increases X = alpha1
51
Phenoxybenzamine: (reversible/irreversible) drug used primarily for...
Irreversible (non-competitive) alpha blocker; Pheochromocytoma (pre-op)
52
Why is orthostatic hypertension a Sx of (X) adrenergic drugs?
X = alpha blockers Body can't increase SVR/sympathetic tone reflexively after standing up
53
After administering phentolamine, the Epi BP response goes from net (increase/decrease) in BP to net (increase/decrease).
Increase (the alpha response); decrease (the beta2 response) Note: both come into play prior to blockade
54
Selective beta blockers:
Mostly go from A-M (selective to beta1; 1 = first half of alphabet): Acebutolol, atenolol, betaxolol, bisoprolol, esmolol, metroprolol
55
Non-selective beta blockers:
Mostly go from N-Z (Non-selective include beta2; 2 = second half of alphabet): Nadolol, pindolol, propranolol, timolol
56
Non-selective alpha AND beta antagonists:
Carvedilol and labetalol (note: modified endings, don't end with "-olol" like beta-blockers)
57
Pufferfish: (X) toxin with which MOA?
X = tetrodotoxin Binds fast voltage-gated Na channels (cardiac/nerve tissue), preventing depolarization
58
List some examples of drugs that meet the Beers criteria and should be avoided in (X).
X = geriatric patient population 1. Anticholinergics, anti-His, benzos, opioids, anti-depressants (side effects like delirium, falls, sedation, etc.) 2. PPIs (C dif infection) 3. NSAIDs (GI bleeding) 4. Alpha-blockers (hypotension)
59
Acetaminophen toxicity should be treated with (X), which functions to (Y).
``` X = N-acetylcystine Y = replenish glutathione ```
60
Pesticide ingestion leads to (X) toxicity and should be treated with (Y).
``` X = arsenic Y = Dimercaprol (chelator; increases urinary secretion of heavy metals) ```
61
Benzo toxicity Rx:
Flumazenil
62
Cu toxicity Rx:
"Cu PENny" | Penicillamine
63
Cyanide toxicity Rx:
Nitrite (Met-Hgb formation to sequester CN) and thiosulfate (sulfur donor to promote excretion)
64
Pt presents with abdominal pain, vomiting, watery diarrhea, and garlic breath. You treat with:
Dimercaprol (arsenic poisoning)
65
MetHgb toxicity treated with:
METhylene blue
66
Rat poison toxicity is due to (X) compound and treated immediately with:
X = super-warfarin | FFP
67
List some drugs that cause cutaneous flushing
VANNCE makes me blush 1. Vanco 2. Adenosine 3. Nitrates 4. Niacin 5. CCBs 6. Echinocandins
68
List some drugs that cause torsades de pointes
ABCDE prolong dat QT 1. anti-Arrhythmics (class IA, III) 2. antiBiotics (macrolides) 3. anti-"C"ychotics (haloperidol) 4. anti-Depressants (TCAs) 5. anti-Emetics (odansetron)
69
List some drugs that have hyperglycemia as side effect
"Taking Pills Necessitates Having glucose Checked" 1. Tacrolimus 2. PIs 3. Niacin 4. HCTZ 5. Corticosteroids
70
Grey baby syndrome is due to (X) drug accumulation in neonate due to lack of:
X = chloramphenicol glucoronidation (conjugation) Sx: hypothermia, flaccidity, shock
71
List drugs that cause hemolysis in G6PD deficiency.
"Hemolysis IS D PAIN" 1. Isoniazid 2. Sulfonamides 3. Dapsone 4. Primaquine 5. Aspirin 6. Ibuprofen 7. Nitrofurantoin
72
In addition to glucocorticoids, which class of drugs has fat redistribution as a side effect?
Anti-retrovirals (esp protease inhibitors) "fat PiG = PI and glucocorticoids"
73
List the main drugs that can cause Steven Johnson Syndrome
"Steven Johnson has epileptic ALLergy to sulfa drugs and penicillin" 1. anti-epileptics (esp lamotrigine) 2. Allopurinol 3. Sulfa drugs 4. Penicillin
74
List key drugs that can cause Parkinson-like syndrome.
"Cogwheel rigidity of the ARM" 1. Antipsychotics 2. Reserpine 3. Metoclopromide
75
List key drugs that cause seizures
"with seizures I BITE my tongue" 1. Isoniazid 2. Buproprion 3. Imipenem/cilastatin 4. Tramadol 5. Enflurane
76
Key CYP450 inducers
"Chronic alcoholics STeal PHEN-PHEN and NEver Refuse GReasy CARBs" 1. Chronic alcohol use 2. St. John's wort 3. Phenytoin 4. Phenobarbitol 5. Nevirapine 6. Rifampin 7. Griseofulvin 8. Carbamazepine
77
Phenytoin is (inducer/inhibitor/substrate) of CYP450.
Substrate (broken down, along with other anti-epileptics) and inducer
78
List some key CYP450 substrates.
CYP "Substrates Worry About Other Therapeutics" 1. Statins 2. Warfarin 3. Anti-epileptics 4. OCPs 5. Theophylline
79
List some key CYP450 inhibitors
"Grapes@SICKFACES.COM" 1. Grapefruit juice* 2. Acute alcohol abuse 3. Sodium valproate 4. Isoniazid 5. Cimetidine* 6. Ketoconazole 7. Fluconazole 8. Amiodarone* 9. Ciprofloxacin 10. Erythromycin 11. Sulfonamides * 12. Chloramphenicol 13. Omeprazole 14. Metronidazole

STEP 1 (21 decks)

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