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Pharm I > B4 Exam > Flashcards

B4 Exam Flashcards

1
Q

{{BLANK}} increase the frequency of Cl- channel opening (GABA)

A

Benzodiazepines

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2
Q

{{BLANK}} increase the duration of Cl- channel opening (GABA)

A

Barbiturates

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3
Q

SSRI increases

A

5-HT

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4
Q

SNRI increase

A

5-HT & NE

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5
Q

TCA increase

A

5-HT & NE

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6
Q

TCA decrease

A

M, alpha-1, H1

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7
Q

For immediate and prolonged anxiolysis you provide a patient with?

A
  • BZD short-term (2-4 wks)
  • SSRI/SNRI long-term
  • After 2-4 wks (SSRI/SNRI) kicks in then taper off of BZD
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8
Q

What is the antidote for benzodiazepines?

A

Flumazenil

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9
Q

Which SSRI works as the others but has anti-cholinergic & NE effects?

A

Paroxetine

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10
Q

Which TCA has the most anti-cholinergic, sedation, and hypotension?

A

Amitriptyline

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11
Q

Which TCA has the most 5-HT boosting properties?

A

Clomipramine

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12
Q

Which TCA displays the largest increase in NE?

A

Desipramine

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13
Q

Why do TCAs cause cardiotoxicity?

A

Na+ channel blocking effects

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14
Q

1st line for phobias?

A

CBT

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15
Q

If OCD has no response to CBT, SSRI or SNRI, you Rx?

A

Clomipramine

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16
Q

Benzodiazepines work on what receptors?

A

BZ1 & BZ2

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17
Q

Why does zolpidem not cause anxiolysis?

A

Works selectively on BZ1 (z drugs)

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18
Q

Which hypnotic works by melatonin receptor agonism (MRA)?

A

Ramelteon

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19
Q

Which hypnotic works by dual orexin receptor antagonism (DORA)?

A

Suvorexant

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20
Q

Mirtazipine should be used for sedation if what comorbidity is present?

A

depression

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21
Q

Trazodone can be used for sedation however it comes with a SE profile that includes?

A

Priapism

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22
Q

What is the MOA for trazodone?

A
  • Increase 5-HT1A
  • Blocks 5-HT2A
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23
Q

What syndrome can occur from using azithromycin, trazodone, and fluoxetine together?

A

5-HT syndrome (agitation, hypertension, flushing, etc.)

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24
Q

Which antidepressant can be used for depression without worry of sexual side effects?

A

Bupropion

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25
Q

Isocarboxazid needs a {{BLANK}} period of {{BLANK}} duration before switching to paroxetine (or other SSRI/SNRI, 5-HT drugs)

A

wash-out period of 2 week duration

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26
Q

Foods containing {{BLANK}} should be avoided when a patient is taking phenelzine

A

tyramine

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27
Q

MAOi are used in {{BLANK}} MDD due to their SE profile

A

resistant MDD

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28
Q

What is the SE profile of mood stabilizers?

A

LiTHIUM
* Low Thyroid
* Heart (ebstein anomaly)
* insipidus (DMI)
* Unwanted Movement (tremor)

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29
Q

What are the (4) notable mood stabilizers?

A
  • Lithium
  • Valproate
  • Carbamazepine
  • Lamotrigine
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30
Q

What is the MOA of Lithium, Valproate, and Carbamazepine?

A

Decreased inositol via PIP2 pathway

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31
Q

{{BLANK}} is the most potent 1st gen antipsychotic

A

Haloperidol

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32
Q

Which 1st gen antipsychotic is most likely to cause dry mouth/eyes, sedation, and hypotension?

A

Chlorpromazine

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33
Q

Which 2nd gen antipsychotic is most likely to cause dry mouth/eyes, sedation, and hypotension?

A

Clozapine

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34
Q

Which 2nd gen antipsychotic is most likely to cause metabolic ADRs?

A

clozapine > Olanzapine > Quetiapine = Risperidone > Ziprasidone = Aripiprazole

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35
Q

Which 2nd gen antipsychotic is most likely to cause an increas in prolactin & gynecomastia?

A

Risperidone

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36
Q

Which 2nd gen antipsychotic is a partial D2 agonist along with 5-HT agonism/antagonism?

A

Aripiprazole

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37
Q

Gonorrhea is treated w/?

A

Ceftriaxone

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38
Q

Chlamydia is treated w/?

A

Azithromycin

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39
Q

What is the HRT Tx of choice in a post-menopausal pt w/ an intact uteri?

A

Estrogen + Progestin (reduced risk of endometrial hyperplasia)

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40
Q

What estrogen supplement is more similar to human estrogen?

A

17B-estridiol

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41
Q

MOA of tamoxifen?

A
  • Agonist: endometrium & bone
  • Antagonist: breast
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42
Q

What is the use of tamoxifene?

A
  • Tx HER2+ breast cancer
  • Breast cancer prevention
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43
Q

What is true regarding tamoxifen metabolism?

A

Prodrug (active = endoxifen)
* needs activated by liver (caution if using fluoxetine or liver disease)

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44
Q

What are SEs of tamoxifen?

A

endometrial cancer (agonism), uterine cancer, thromboembolic event

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45
Q

What is the MOA of raloxifene?

A
  • Agonist: bone
  • Antagonist: breast & uterus
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46
Q

What is the use for raloxifene?

A

Risk reduction in invasive breast cancer in post-menopausal women w/ osteoporosis

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47
Q

What is the box warning for toremifene?

A

QT prolongation

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48
Q

What is the MOA for fulvestrant?

A

estrogen receptor antagonist & selective estrogen down regulator (on cancer cells)

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49
Q

When is fulvestrant used?

A

Post-menopausal female with advanced estrogen positive breast cancer

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50
Q

SERMs, SERDs, and other drugs that decrease estrogen come with the risk of?

A

Thromboembolic events

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51
Q

What are the SEs of clomiphene?

A
  • Multiple births
  • Visual disturbances
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52
Q

What is the MOA of clomiphene?

A
  • Ovulation stimulation
  • Occupies ERs in hypothalamus leading to increased GnRH –> increased FSH & LH –> ovulation
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53
Q

What is a SE of letrozole?

A

Decreased BMD

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54
Q

Which aromatase inhibitor is irreversible?

A

Exemestane

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55
Q

What is the MOA of Progestin contraceptives?

A

Alters the endometrium & impairs implantation

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56
Q

How long do you have to use levonorgestrel (Plan B)

A

72 hours

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57
Q

What is the benefit of using Copper IUDs as emergency contraceptive?

A
  • Can be used within 120-hours
  • can be left in place afterwards for long-term (10-years) contraception
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58
Q

What is the MOA of copper IUDs?

A

Cu ions demobilize sperm

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59
Q

How long do you have to use ulipristal (Ella)?

A

120 hours

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60
Q

What is the use of hydroxyprogesterone?

A

Reduced risk of spontaneous/recurrent preterm birth

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61
Q

What is the MOA of mifepristone? (abortion)

A
  • Competitive inhibiton of progesterone receptor
  • Leads to contration & induction of myometrial activity
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62
Q

What medication is given with mifepristone? (abortion)

A

misoprostol

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63
Q

How long do you have to use mifepristone for abortion?

A

Pregnancy < 70 days

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64
Q

What are boxed warnings of mifepristone?

A
  • Bacterial infection (Clostridium sordelli)
  • Serious bleeding
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65
Q

A progestin only contraceptive would be best in females with?

A
  • Risk of thromboembolic event
  • Smoker > 37 or > 15 cig/day
  • Breast cancer in family
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66
Q

What is the treatment for PMDD & acne?

A

Ethinyl estradiol & drospirenone (Yaz; BeYaz)

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67
Q

What birth control has a warning for decreased efficacy if the patient is over 90kg?

A

Xulane (Ethinyl estradiol & norelgestromin)

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68
Q

Which birth control avoids first pass metabolism with increased efficacy in liver Dx?

A

Depo medroxyprogesterone

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69
Q

You should limit medroxyprogesterone use to {{BLANK}} years due to loss of BMD

A

2-years

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70
Q

Uterine cramping can be problematic for {{BLANK}} IUD

A

levonorgestrel

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71
Q

No hormones are used in {{BLANK}} IUDs

A

Copper IUDs

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72
Q

Extravasation is a notable concern for which treatments of hypocalcemia?

A

Ca chloride/gluconate

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73
Q

What is the MOA for calcitonin?

A
  • Renal Ca excretion
  • Inhibition of bone resorption
  • Inhibition of osteoclasts
  • Stimulation of osteoblasts
  • Inhibition of GIT Ca absorption
74
Q

What hormone is opposed by calcitonin?

A

PTH

75
Q

What is the MOA of sevelamer?

A

Binds to dietary phosphate in the GIT

76
Q

You test vitamin D levels by evaluation {{BLANK}} level since it is acquired via sunlight (UV) radiation

A

Cholecalciferol (D3)

77
Q

{{BLANK}} is a type of vitamin D acquired from plants

A

Ergocalciferol (D2)

78
Q

What is the MOA of alendronate?

A
  • Synthetic analog of pyrophosphate
  • Binds to sites of bone remodeling leading to inhibition of bone resorption
  • increases BMD
79
Q

What is the use of bisphosphonates?

A
  • Prevention of OA in post-menopausal women
  • Treatment of OA
80
Q

What are notable SEs of bisphosphonates?

A
  • GI (e.g., GERD)
  • Esophageal erosion/ulcer
81
Q

How should you intruct your patient to take alendronate or risedronate?

A
  • 6-8 oz of water
  • stay upright x 30 mins
82
Q

What are CIs to bisphosphonate use?

A
  • PO x 5 years
  • IV x 3 years
  • High-risk can take up to 10-years
  • Delayed esophageal emptying
  • Can’t stand upright
  • Hypocalcemia
  • Pregnant
83
Q

What are boxed warning of bisphosphonates?

A
  • Atypical femur fractures
  • Esophageal cancer & strictures
  • Osteonecrosis of the jaw (mostly in cancer pts)
84
Q

What is the main benefit to zoledronic acid?

A

Long T1/2; give 1 x year

85
Q

What is the MOA of denosumab?

A
  • Human IG2 monoclonal antibody of OPG
  • Binds RANKL to reduce osteoclast function
86
Q

What is the use of estrogen in osteoporosis?

A

OA prevention (NOT Tx)

87
Q

What is the MOA of teriparatide?

A

PTH analog

88
Q

When is teriparatide used?

A

Osteoporosis in high-risk patients

89
Q

What is the limit of use (duration) for teriparatide?

A

2-years

90
Q

What is the boxed warning for teriparatide?

A

bone metastasis

91
Q

Too much glucocorticoids can lead to what metabolic effects?

A
  • Gluconeogenesis (hyperglycemia)
  • Lipolysis & Lipogenesis
  • Net fat deposition (moon facies & buffalo hump)
92
Q

What are the catabolic effects of glucocorticoids?

A

protein catabolism

93
Q

What are the main anti-inflammatory effects of corticosteroids caused by?

A
  • Inhibition of PLA2
  • Prostaglandin synthesis
94
Q

Aldosterone leads to retention of {{BLANK}} while an increased excretion of K

A

Na

95
Q

{{BLANK}} is a favored replacement for adrenal insufficiency (Addison’s Dx)

A

Fludrocortisone

96
Q

Why do we prefer synthetic corticosteroid analogs?

A
  • Longer T1/2
  • Longer duration of action
  • Reduced Na retention
  • Better lipophilicity (penetration & topical use)
97
Q

What is a major use of betamethasone in pregnancy?

A

Premature infant lung maturation (can be given to baby or mother – crosses placenta)

98
Q

What are some notable SEs of corticosteroid toxicity?

A
  • Iatrogenic Cushing’s
  • Moon facies & buffalo hump
  • Increased growth of fine facial hair, thighs, and trunk
  • Impaired wound healing
  • HTN (Na retention)
99
Q

What is a major use for spironolactone (females)?

A

Hirsutism & PCOS

100
Q

What is a use of spironolactone in females/males?

A

CHF (antagonism of androgen)

101
Q

{{BLANK}} is an anti-fungal that can be given in adrenal cancer patients to decrease steroid synthesis

A

Ketoconazole

102
Q

{{BLANK}} is a competitive inhibitor of glucocorticoid receptor & is useful in Cushing’s syndrome

A

Mifepristone

103
Q

{{BLANK}} is a alpha-1 inhibitor used in PTSD for nightmares

A

Prazosin

104
Q

{{BLANK}} and {{BLANK}} are 5-alpha reductase inhibitors that can Tx BPH & hair loss

A

Finasteride; Dutasteride

105
Q

What is an important note about the initiation of leuprolide or histrelin?

A
  • GnRH agonists
  • Reduce LH secretion (neg. feedback)
  • Will cause initial tumor flare – give flutamide to antagonize androgen receptors & prevent ADR
106
Q

What are some GnRH antagonists? What is their benefit?

A
  • Ganirelix, Abarelix, Degarelix
  • No testosterone surge
107
Q

What is the MOA of sildenafil, tadalafil, or vardenafil?

A

PDE-5 inhibition –> Increased cGMP –> vasodilation –> erection

108
Q

Which PDE-5 inhibitor is most likely to cause visual disturbances?

A

sildenafil

109
Q

Which erectile dysfunction Tx is most likely to cause priapism?

A

Alprostadil

110
Q

Which PDE-inhibitor is most likely to cause an arrythmia?

A

Vardenafil

111
Q

Why should PDE-5 inhibitors not be given with a nitrate?

A

increased hypotension (decreased BP) & reflexive tachycardia

112
Q

What is the MOA of alprostadil?

A

PG E1 analog –> increased cAMP –> vasodilation –> erection

113
Q

What med should be given to reverse alprostadil priapism?

A

Phenylephrine

114
Q

What is a benefit of alprostadil?

A

Given locally to prevent systemic SE/ADR

115
Q

{{BLANK}} inhibits microtubule synthesis & blocks glucose uptake

A

Albendazole

116
Q

What are (2) important ADRs for albendazole?

A
  • Pancytopenia
  • Hepatoxicity
117
Q

What is the use of albendazole?

A
  • Giant round, pin, spiral thread-whip w/ hook
  • neurocystericercosis, hydatid
118
Q

{{BLANK}} covers all (4) plasmodium spp but has a risk of resistance

A

Chloroquine

119
Q

What are ADRs to chloroquine use?

A
  • Hemolysis
  • decreased hearing
  • retino/neuropathy
120
Q

What medication covers Plasmodium vivax & ovale in the liver?

A

Primaquine

121
Q

Why do you give chloroquine + primaquine?

A

Relapse protection (kills plasmodium in liver)

122
Q

{{BLANK}} works by ferredoxin reduction creating free radicals

A

Metronidazole

123
Q

{{BLANK}} can tx giardia but can lead to a disulfiram-like reaction if given w/ EtOH

A

Metronidazole

124
Q

What does metronidazole tx?

A

GET
* Giardia
* Entomoeba
* Trichomosis

125
Q

Which (2) anti-TB agents can be given for up to 6-months?

A

RIF & INH

126
Q

{{BLANK}} works by inhibiting RNA polymerase

A

RIF

127
Q

{{BLANK}} can cause hepatoxicity & red-orange body secretions

A

RIF

128
Q

Which TB drug induces CYP?

A

RIF

129
Q

Which TB drug inhibits CYP?

A

INH

130
Q

{{BLANK}} can tx TB but should be given w/ Vit B6 to prevent neuropathy

A

INH

131
Q

What is the MOA of INH?

A

Inhibition of InhA & KasA leads to decreased mycolic acid synthesis

132
Q

What is the MOA of oseltamivir?

A

Inhibits neuraminidase –> blocks release of new viruses

133
Q

What strains does oseltamivir Tx?

A

Flu A & B

134
Q

What is the MOA of acyclovir?

A

Inhibition of DNA polymerase leading to chain elongation termination

135
Q

What are the notable SEs of acyclovir?

A
  • CNS (tremor/seizures)
  • nephrotoxic (kidney stones) – pt should increase H2O intake
136
Q

{{BLANK}} is a treatment for CMV

A

foscarnet

137
Q

What is the MOA for foscarnet?

A

Inhibition of DNA polymerase

138
Q

What are the notable SEs of foscarnet?

A
  • nephrotoxic
  • electrolyte imbalances
  • seizures
139
Q

What does acyclovir Tx?

A
  • HSV-1/2
  • VZV
140
Q

What drug is used in HIV as a prokinetic (pharmacokinetic booster)?

A

Ritonavir

141
Q

What class is Ritonavir?

A

Protease inhibitor (PI)

142
Q

What are the notable ADRs of ritonavir?

A
  • lipodystrophy
  • hyperglycemia
143
Q

What class is raltegravir?

A

integrase inhibitor

144
Q

Notable SE of raltegravir?

A

Increased CPK

145
Q

What is a notable ADR of Efavirenz?

A
  • SJS/TENS
  • Hepatotoxicity
146
Q

What class is efavirenz?

A

NNRTI

147
Q

Which class of anti-HIV drugs does not need activation unlike their counterpart?

A

NNRTI (efavirenz)

148
Q

What is notable about the pharmacology regarding lamivudine & zidovudine?

A

NRTI (need activation)

149
Q

What are notable ADRs of zidovudine & lamivudine?

A
  • Pancreatitis
  • Hepatotoxicity
  • Lipodystrophy
  • BMS (zidovudine)
150
Q

{{BLANK}} should be given in a liposomal package to minimize ADRs (nephrotoxicity)

A

Amphotericin B

151
Q

What is the MOA of amphotericin B?

A

Binds ergosterol to disrupt membrane

152
Q

What ADR can occur due to admin of amphotericin B?

A

Histaminergic reaction (fever, flushing, chills)

153
Q

{{BLANK}} is an azole that crosses the BBB & can tx cryptococcal meningitis

A

Fluconazole

154
Q

What is the MOA of fluconazole

A

blocks synthesis of ergosterol to disrupt membrane

155
Q

{{BLANK}} is synthetic analog of somatostatin used in acromegaly or gigantism to inhibit release of GH

A

Octreotide

156
Q

{{BLANK}} is an ADH analog used in diabetes insipidus

A

Desmopressin

157
Q

{{BLANK}} is synthetic T4 used in hypothyroidism

A

Levothyroxine

158
Q

{{BLANK}} inhibits thyroid peroxidase to decrease iodination of tyrosine residues. Used in hyperthyroidism

A

Methimazole

159
Q

What is the MOA of I-131?

A

beta radiation mediated destruction of thyroid cells (take up iodine – local effect)

160
Q

{{BLANK}} is a meal-time rapid acting insulin

A

Lispro

161
Q

Lispro has an onset of {{BLANK}} and duration of {{BLANK}}

A
  • onset: 15 mins
  • duration: 3 hours
162
Q

{{BLANK}} is a long-acting basal insulin

A

glargine

163
Q

glargine has an onset of {{BLANK}} & duration of {{BLANK}}

A
  • onset: 1-2 hrs
  • duration: 24 hrs
164
Q

{{BLANK}} is a sulfonylurea that blocks ATP sensitive K+ channels in pancreatic beta cells

A

Glipizide

165
Q

What is a notable SE of glipizide that limits its usage in elderly T2DM patients?

A

Hypoglycemia

166
Q

What are the CIs/warnings of metformin?

A
  • CI: CrCl < 30 mL/min
  • CHF
  • Hold dose for 48-hrs for IV contrast
167
Q

What are the notable SEs of metformin?

A

lactic acidosis

168
Q

What is the MOA of metformin?

A
  • Gluconeogensis
  • Glycogenolysis
  • Decreased GIT absorption of CHO
  • Increased insulin sensitivity
169
Q

What class is Pioglitazone?

A

thiazolidinedione

170
Q

What female (only) Dx can metformin help with?

A

PCOS (helps ovulation)

171
Q

What is the MOA of pioglitazone?

A

PPAR gamma

172
Q

SE of pioglitazone?

A
  • Edema
  • Decreased TGs
173
Q

What is CI/Warning of pioglitazone?

A
  • CI: CHF
  • Monitor LFTs
174
Q

What is the MOA of liraglutide?

A
  • Incretin mimetic
  • GLP-1 agonist
  • glucose-dependent insulin secretion
175
Q

What is a notable SE of liraglutide for which it is favored today?

A

weight loss

176
Q

What is a dangerous SE of liraglutide warranting D/C if develops?

A

pancreatitis

177
Q

What is a CI for liraglutide?

A

Thyroid c cell cancers (FMH or PMH)

178
Q

What are protective effects of liraglutide?

A
  • Renal protective
  • cardioprotective
179
Q

What class is sitagliptin?

A

DPP-4 (dipeptidase) inhibitor

180
Q

What is the MOA of sitagliptin?

A

Inhibits breakdown of GLP-1 via inhibition of DPP-4

181
Q

What is the CI/warning of sitagliptin?

A

Pancreatitis

Pharm I (1 decks)

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