3. Pharm Basics Flashcards
What drug regenerates acetylcholinesterases after organophosphate poisoning?
Pralidoxime
Which anticholinesterases are used in the treatment of Alzheimer disease? (3)
- donepezil
- galantamine
- rivastigmine
Which of the muscarinic antagonists can be used to improve FEV1 in a patient with COPD? (2)
- ipratropium
- tiotropium
What anticholinergics are used in the treatment of urge-type urinary incontinence? (4)
- oxybutynin
- tolterodine
- darifenacin, solifenacin
- trospium
On The Darn Toilet
In what patient populations is atropine contraindicated? (5)
- BPH (alrdy have problems with urinary retention)
- hyperthermia
- acute angle glaucoma
- elderly (delirium)
- GI obstruction/ ileus
What medications have anticholinergic side effects? (4)
- first generation H1 blockers (ex. diphenhydramine)
- neuroleptics
- TCA
- amantadine (anti-parkinson)
Which receptors are stimulated by clonidine?
alpha-2
Which receptors are stimulated by dopamine?
low –> dopamine receptor
med –> B1, B2
high –> a1, a2
Which receptors are stimulated by phenylephrine
a1 > a2
Which receptors are stimulated by albuterol
b2 > b1
Which receptors are stimulated by NE
a1 > a2 > b1
Which receptors are stimulated by isoproterenol
b1 = b2
Which receptors are stimulated by epi
b1, b2, a1, a2
Which receptors are stimulated by dobutamine
b1 > b2
Which receptors are stimulated by terbutaline
b2 > b1
Which sympathomimetic is given as a nebulizer for asthma?
- albuterol, levalbuterol
Which sympathomimetic is drug of choice for anaphylaxis?
epi
Which sympathomimetic is the most common first line agent for pts in septic shock
NE
Which sympathomimetic is given subQ for asthma?
terbutaline
- also used for tocolysis (decreasing uterine tone)
Which sympathomimetic is used by ENT to vasoconstrict nasal vessels?
- phenylephrine
- (cocaine)
Which selective a-blocker has less effect on blood pressure?
tamsulosin
selective for alpha-1A,D which is just on prostate. doesn’t affect vascular alpha-1B receptor
What are the common side effects of b-blockers? (3)
which pt population should use caution when taking b-blockers?
SE:
1. bronchospasm (asthma, COPD) - esp with non-selective b-blockers (which can block b2 –> bronchoconstriction)
- lower blood glucose (diabetics; may mask symptoms of hypoglycemia)
- brady, AV block (careful w/ CHF)
Which 3 enzymes are required to convert phenylalanie to dopamine?
- phenylalanine hydroxylase (low in PKU)
- tyrosine hydroxylase
- dopamine decarboxylase
A patient develops paralysis after being bitten by a black widow spider. Is this a spastic or flaccid paralysis? What other autonomic symptoms might be seen?
- spastic [stimulates release of ACh at NMJ]
- salivation, diaphoresis, lacrimation (excess ACh)
what substances inhibit the reuptake of NE? (2)
cocaine
TCA
What substances stimulate the release of NE from neurons? (4)
calcium (normal release)
amphetamine
ephedrine
tyramine
Outline the pathway by which stimulation of a Gs receptor activates protein kinase A
Gs –> adenylyl cyclase –> converts ATP to cAMP –> PKA
What effect will a reversible competitive antagonist have on Vmax and Km?
Vmax unchanged (no change in efficacy) Km increased (decreased potency)
Drug A has therapeutic index of 10:1 while drug B has TI of 2:1. Which drug would be considered safer?
Drug A
Which hepatic phase of metabolism is lost first by geriatric patients? Which phase is mediated by cytochrome p450
both phase 1
What medication inhibits acetaldehyde dehydrogenase?
disulfiram
what medication inhibits alcohol dehydrogenase?
fomepizole
What are the 7 inducers of cytochrome p450?
Griseofulvin Carbamazepine Phenytoin Barbiturate Rifampin St. John's Worts Chronic alcoholism
What are the 11 inhibitors of cytochrome p450?
Cimetidine Ritonavir (protease inhibitor) Amiodarone Ciprofloxacin Ketoconazole
Acute alcohol Macrolides Isoniazid Grapefruit juice Omeprazole Sulfonamides
Which medication overdose can be treated with sodium bicarb?
aspirin (weak acid)
Which medication OD can be treated with ammonium chloride?
amphetamines (weak base)
What medication causes cardiotoxicity and bone marrow suppression? (2)
- doxorubicin
- daunorubicin
(anti-cancer drugs)
–> can cause dilated cardiomyopathy
An African-American man who goes to Africa develops anemia after taking ppx medicine for primary disease prevention. In what enzyme is this patient deficient?
G6PD deficiency
- primaquine (malaria ppx)
A 65 yo male pt taking multiple medications presents with gynecomastia. Which meds can be responsible for this? (2 major ones)
- spironolactone
- ketoconazole
Spironolactone THC (marijuana) Alcohol (chronic use) Cimetidine Ketoconazole Estrogen Digoxin
A patient presents with tinnitus, dizziness, HA, and vision changes. What drug is causing these symptoms? (2)
- quinidine (class 1A anti-arrhythmic)
- quinine
[cinchonism]
What medications are known for causing drug-induced lupus?
Sulfonamides Hydralazine Isoniazid Phenytoin Procainamide
What is the antidote to acetaminophen?
N-acetylcysteine (replenishes glutathione)
What is the antidote to salicylates?
sodium bicarb, dialysis
**note: aspirin OD can lead to tinnitus
What is the antidote to amphetamines?
ammonium chloride
What is the antidote to anticholinesterases, organophosphates
atropine, pralidoxime
What is the antidote to antimuscarinic, anticholinergic agents?
physostigmine
What is the antidote to digoxin?
anti-dig Fab fragments
- K+ and Mg2+ optimization
What is the antidote to iron?
deferoxamine
- fe-
- *note: iron OD –> abd pain, hematemesis, melena, lethargy
What is the antidote to lead?
EDTA
dimercaprol
succimer
penicillamine
**note: lead OD –> dev delay, non-spec GI symptoms
What is the antidote to mercury, arsenic, gold
dimercaprol (BAL)
succimer
-merc-
What is the antidote to copper, arsenic, gold
penicillamine
-copper pennies-
What is the antidote to carbon monoxide?
100% O2
What is the antidote to methemoglobin?
methylene blue, vitamin C
-meth-
What is the antidote to cyanide
nitrite + thiosulfate, hydroxocobalamine
What is the antidote to methanol, ethylene glycol (antifreeze)
fomepizole (inhibits alcohol dehydrogenase)
can also give ethanol, dialysis
What is the antidote to benzo?
flumazenil
*be careful with rapid correction b/c can cause seizures
What is the antidote to TCA
sodium bicarb
What is the antidote to heparin?
protamine sulfate
-prot- (proton…hydrogen…H for heparin)
What is the antidote to t-PA, streptokinase?
aminocaproic acid
What is the antidote to theophylline
beta-blocker
