B4 Exam Flashcards
1
Q
{{BLANK}} increase the frequency of Cl- channel opening (GABA)
A
Benzodiazepines
2
Q
{{BLANK}} increase the duration of Cl- channel opening (GABA)
A
Barbiturates
3
Q
SSRI increases
A
5-HT
4
Q
SNRI increase
A
5-HT & NE
5
Q
TCA increase
A
5-HT & NE
6
Q
TCA decrease
A
M, alpha-1, H1
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
8
Q
What is the antidote for benzodiazepines?
A
Flumazenil
9
Q
Which SSRI works as the others but has anti-cholinergic & NE effects?
A
Paroxetine
10
Q
Which TCA has the most anti-cholinergic, sedation, and hypotension?
A
Amitriptyline
11
Q
Which TCA has the most 5-HT boosting properties?
A
Clomipramine
12
Q
Which TCA displays the largest increase in NE?
A
Desipramine
13
Q
Why do TCAs cause cardiotoxicity?
A
Na+ channel blocking effects
14
Q
1st line for phobias?
A
CBT
15
Q
If OCD has no response to CBT, SSRI or SNRI, you Rx?
A
Clomipramine
16
Q
Benzodiazepines work on what receptors?
A
BZ1 & BZ2
17
Q
Why does zolpidem not cause anxiolysis?
A
Works selectively on BZ1 (z drugs)
18
Q
Which hypnotic works by melatonin receptor agonism (MRA)?
A
Ramelteon
19
Q
Which hypnotic works by dual orexin receptor antagonism (DORA)?
A
Suvorexant
20
Q
Mirtazipine should be used for sedation if what comorbidity is present?
A
depression
21
Q
Trazodone can be used for sedation however it comes with a SE profile that includes?
A
Priapism
22
Q
What is the MOA for trazodone?
A
- Increase 5-HT1A
- Blocks 5-HT2A
23
Q
What syndrome can occur from using azithromycin, trazodone, and fluoxetine together?
A
5-HT syndrome (agitation, hypertension, flushing, etc.)
24
Q
Which antidepressant can be used for depression without worry of sexual side effects?
A
Bupropion
25
Isocarboxazid needs a {{BLANK}} period of {{BLANK}} duration before switching to paroxetine (or other SSRI/SNRI, 5-HT drugs)
wash-out period of 2 week duration
26
Foods containing {{BLANK}} should be avoided when a patient is taking phenelzine
tyramine
27
MAOi are used in {{BLANK}} MDD due to their SE profile
resistant MDD
28
What is the SE profile of mood stabilizers?
LiTHIUM
* Low Thyroid
* Heart (ebstein anomaly)
* insipidus (DMI)
* Unwanted Movement (tremor)
29
What are the (4) notable mood stabilizers?
* Lithium
* Valproate
* Carbamazepine
* Lamotrigine
30
What is the MOA of Lithium, Valproate, and Carbamazepine?
Decreased inositol via PIP2 pathway
31
{{BLANK}} is the most potent 1st gen antipsychotic
Haloperidol
32
Which 1st gen antipsychotic is most likely to cause dry mouth/eyes, sedation, and hypotension?
Chlorpromazine
33
Which 2nd gen antipsychotic is most likely to cause dry mouth/eyes, sedation, and hypotension?
Clozapine
34
Which 2nd gen antipsychotic is most likely to cause metabolic ADRs?
**clozapine** > Olanzapine > Quetiapine = Risperidone > Ziprasidone = Aripiprazole
35
Which 2nd gen antipsychotic is most likely to cause an increas in prolactin & gynecomastia?
Risperidone
36
Which 2nd gen antipsychotic is a partial D2 agonist along with 5-HT agonism/antagonism?
Aripiprazole
37
Gonorrhea is treated w/?
Ceftriaxone
38
Chlamydia is treated w/?
Azithromycin
39
What is the HRT Tx of choice in a post-menopausal pt w/ an intact uteri?
Estrogen + Progestin (reduced risk of endometrial hyperplasia)
40
What estrogen supplement is more similar to human estrogen?
17B-estridiol
41
MOA of tamoxifen?
* Agonist: endometrium & bone
* Antagonist: breast
42
What is the use of tamoxifene?
* Tx HER2+ breast cancer
* Breast cancer prevention
43
What is true regarding tamoxifen metabolism?
Prodrug (active = endoxifen)
* needs activated by liver (caution if using fluoxetine or liver disease)
44
What are SEs of tamoxifen?
endometrial cancer (agonism), uterine cancer, thromboembolic event
45
What is the MOA of raloxifene?
* Agonist: bone
* Antagonist: breast & uterus
46
What is the use for raloxifene?
Risk reduction in invasive breast cancer in post-menopausal women w/ osteoporosis
47
What is the box warning for toremifene?
QT prolongation
48
What is the MOA for fulvestrant?
estrogen receptor antagonist & selective estrogen down regulator (on cancer cells)
49
When is fulvestrant used?
Post-menopausal female with advanced estrogen positive breast cancer
50
SERMs, SERDs, and other drugs that decrease estrogen come with the risk of?
Thromboembolic events
51
What are the SEs of clomiphene?
* Multiple births
* Visual disturbances
52
What is the MOA of clomiphene?
* Ovulation stimulation
* Occupies ERs in hypothalamus leading to increased GnRH --> increased FSH & LH --> ovulation
53
What is a SE of letrozole?
Decreased BMD
54
Which aromatase inhibitor is irreversible?
Exemestane
55
What is the MOA of Progestin contraceptives?
Alters the endometrium & impairs implantation
56
How long do you have to use levonorgestrel (Plan B)
72 hours
57
What is the benefit of using Copper IUDs as emergency contraceptive?
* Can be used within 120-hours
* can be left in place afterwards for long-term (10-years) contraception
58
What is the MOA of copper IUDs?
Cu ions demobilize sperm
59
How long do you have to use ulipristal (Ella)?
120 hours
60
What is the use of hydroxyprogesterone?
Reduced risk of spontaneous/recurrent preterm birth
61
What is the MOA of mifepristone? (abortion)
* Competitive inhibiton of progesterone receptor
* Leads to contration & induction of myometrial activity
62
What medication is given with mifepristone? (abortion)
misoprostol
63
How long do you have to use mifepristone for abortion?
Pregnancy < 70 days
64
What are boxed warnings of mifepristone?
* Bacterial infection (Clostridium sordelli)
* Serious bleeding
65
A progestin only contraceptive would be best in females with?
* Risk of thromboembolic event
* Smoker > 37 or > 15 cig/day
* Breast cancer in family
66
What is the treatment for PMDD & acne?
Ethinyl estradiol & **drospirenone** (Yaz; BeYaz)
67
What birth control has a warning for decreased efficacy if the patient is over 90kg?
Xulane (Ethinyl estradiol & norelgestromin)
68
Which birth control avoids first pass metabolism with increased efficacy in liver Dx?
Depo medroxyprogesterone
69
You should limit medroxyprogesterone use to {{BLANK}} years due to loss of BMD
2-years
70
Uterine cramping can be problematic for {{BLANK}} IUD
levonorgestrel
71
No hormones are used in {{BLANK}} IUDs
Copper IUDs
72
Extravasation is a notable concern for which treatments of hypocalcemia?
Ca chloride/gluconate
73
What is the MOA for calcitonin?
* Renal Ca excretion
* Inhibition of bone resorption
* Inhibition of osteoclasts
* Stimulation of osteoblasts
* Inhibition of GIT Ca absorption
74
What hormone is opposed by calcitonin?
PTH
75
What is the MOA of sevelamer?
Binds to dietary phosphate in the GIT
76
You test vitamin D levels by evaluation {{BLANK}} level since it is acquired via sunlight (UV) radiation
Cholecalciferol (D3)
77
{{BLANK}} is a type of vitamin D acquired from plants
Ergocalciferol (D2)
78
What is the MOA of alendronate?
* Synthetic analog of pyrophosphate
* Binds to sites of bone remodeling leading to inhibition of bone resorption
* increases BMD
79
What is the use of bisphosphonates?
* Prevention of OA in post-menopausal women
* Treatment of OA
80
What are notable SEs of bisphosphonates?
* GI (e.g., GERD)
* Esophageal erosion/ulcer
81
How should you intruct your patient to take alendronate or risedronate?
* 6-8 oz of water
* stay upright x 30 mins
82
What are CIs to bisphosphonate use?
* 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
What are boxed warning of bisphosphonates?
* Atypical femur fractures
* Esophageal cancer & strictures
* Osteonecrosis of the jaw (mostly in cancer pts)
84
What is the main benefit to zoledronic acid?
Long T1/2; give 1 x year
85
What is the MOA of denosumab?
* Human IG2 monoclonal antibody of OPG
* Binds RANKL to reduce osteoclast function
86
What is the use of estrogen in osteoporosis?
OA prevention (NOT Tx)
87
What is the MOA of teriparatide?
PTH analog
88
When is teriparatide used?
Osteoporosis in high-risk patients
89
What is the limit of use (duration) for teriparatide?
2-years
90
What is the boxed warning for teriparatide?
bone metastasis
91
Too much glucocorticoids can lead to what metabolic effects?
* Gluconeogenesis (hyperglycemia)
* Lipolysis & Lipogenesis
* Net fat deposition (moon facies & buffalo hump)
92
What are the catabolic effects of glucocorticoids?
protein catabolism
93
What are the main anti-inflammatory effects of corticosteroids caused by?
* Inhibition of PLA2
* Prostaglandin synthesis
94
Aldosterone leads to retention of {{BLANK}} while an increased excretion of K
Na
95
{{BLANK}} is a favored replacement for adrenal insufficiency (Addison's Dx)
Fludrocortisone
96
Why do we prefer synthetic corticosteroid analogs?
* Longer T1/2
* Longer duration of action
* Reduced Na retention
* Better lipophilicity (penetration & topical use)
97
What is a major use of betamethasone in pregnancy?
Premature infant lung maturation (can be given to baby or mother -- crosses placenta)
98
What are some notable SEs of corticosteroid toxicity?
* Iatrogenic Cushing's
* Moon facies & buffalo hump
* Increased growth of fine facial hair, thighs, and trunk
* Impaired wound healing
* HTN (Na retention)
99
What is a major use for spironolactone (females)?
Hirsutism & PCOS
100
What is a use of spironolactone in females/males?
CHF (antagonism of androgen)
101
{{BLANK}} is an anti-fungal that can be given in adrenal cancer patients to decrease steroid synthesis
Ketoconazole
102
{{BLANK}} is a competitive inhibitor of glucocorticoid receptor & is useful in Cushing's syndrome
Mifepristone
103
{{BLANK}} is a alpha-1 inhibitor used in PTSD for nightmares
Prazosin
104
{{BLANK}} and {{BLANK}} are 5-alpha reductase inhibitors that can Tx BPH & hair loss
Finasteride; Dutasteride
105
What is an important note about the initiation of **leuprolide** or **histrelin**?
* GnRH agonists
* Reduce LH secretion (neg. feedback)
* Will cause initial tumor flare -- give **flutamide** to antagonize androgen receptors & prevent ADR
106
What are some GnRH antagonists? What is their benefit?
* Ganirelix, Abarelix, Degarelix
* No testosterone surge
107
What is the MOA of sildenafil, tadalafil, or vardenafil?
PDE-5 inhibition --> Increased cGMP --> vasodilation --> erection
108
Which PDE-5 inhibitor is most likely to cause visual disturbances?
sildenafil
109
Which erectile dysfunction Tx is most likely to cause priapism?
Alprostadil
110
Which PDE-inhibitor is most likely to cause an arrythmia?
Vardenafil
111
Why should PDE-5 inhibitors not be given with a nitrate?
increased hypotension (decreased BP) & reflexive tachycardia
112
What is the MOA of alprostadil?
PG E1 analog --> increased cAMP --> vasodilation --> erection
113
What med should be given to reverse alprostadil priapism?
Phenylephrine
114
What is a benefit of alprostadil?
Given locally to prevent systemic SE/ADR
115
{{BLANK}} inhibits microtubule synthesis & blocks glucose uptake
Albendazole
116
What are (2) important ADRs for **albendazole**?
* Pancytopenia
* Hepatoxicity
117
What is the use of **albendazole**?
* Giant round, pin, spiral thread-whip w/ hook
* neurocystericercosis, hydatid
118
{{BLANK}} covers all (4) plasmodium spp but has a risk of resistance
Chloroquine
119
What are ADRs to chloroquine use?
* Hemolysis
* decreased hearing
* retino/neuropathy
120
What medication covers Plasmodium vivax & ovale in the liver?
Primaquine
121
Why do you give chloroquine + primaquine?
Relapse protection (kills plasmodium in liver)
122
{{BLANK}} works by ferredoxin reduction creating free radicals
Metronidazole
123
{{BLANK}} can tx giardia but can lead to a disulfiram-like reaction if given w/ EtOH
Metronidazole
124
What does metronidazole tx?
GET
* Giardia
* Entomoeba
* Trichomosis
125
Which (2) anti-TB agents can be given for up to 6-months?
RIF & INH
126
{{BLANK}} works by inhibiting RNA polymerase
RIF
127
{{BLANK}} can cause hepatoxicity & red-orange body secretions
RIF
128
Which TB drug induces CYP?
RIF
129
Which TB drug inhibits CYP?
INH
130
{{BLANK}} can tx TB but should be given w/ Vit B6 to prevent neuropathy
INH
131
What is the MOA of INH?
Inhibition of InhA & KasA leads to decreased mycolic acid synthesis
132
What is the MOA of oseltamivir?
Inhibits neuraminidase --> blocks release of new viruses
133
What strains does oseltamivir Tx?
Flu A & B
134
What is the MOA of acyclovir?
Inhibition of DNA polymerase leading to chain elongation termination
135
What are the notable SEs of acyclovir?
* CNS (tremor/seizures)
* nephrotoxic (kidney stones) -- pt should increase H2O intake
136
{{BLANK}} is a treatment for CMV
foscarnet
137
What is the MOA for foscarnet?
Inhibition of DNA polymerase
138
What are the notable SEs of foscarnet?
* nephrotoxic
* electrolyte imbalances
* seizures
139
What does acyclovir Tx?
* HSV-1/2
* VZV
140
What drug is used in HIV as a prokinetic (pharmacokinetic booster)?
Ritonavir
141
What class is Ritonavir?
Protease inhibitor (PI)
142
What are the notable ADRs of ritonavir?
* lipodystrophy
* hyperglycemia
143
What class is raltegravir?
integrase inhibitor
144
Notable SE of raltegravir?
Increased CPK
145
What is a notable ADR of Efavirenz?
* SJS/TENS
* Hepatotoxicity
146
What class is efavirenz?
NNRTI
147
Which class of anti-HIV drugs does not need activation unlike their counterpart?
NNRTI (efavirenz)
148
What is notable about the pharmacology regarding lamivudine & zidovudine?
NRTI (need activation)
149
What are notable ADRs of zidovudine & lamivudine?
* Pancreatitis
* Hepatotoxicity
* Lipodystrophy
* BMS (zidovudine)
150
{{BLANK}} should be given in a liposomal package to minimize ADRs (nephrotoxicity)
Amphotericin B
151
What is the MOA of amphotericin B?
Binds ergosterol to disrupt membrane
152
What ADR can occur due to admin of amphotericin B?
Histaminergic reaction (fever, flushing, chills)
153
{{BLANK}} is an azole that crosses the BBB & can tx cryptococcal meningitis
Fluconazole
154
What is the MOA of fluconazole
blocks synthesis of ergosterol to disrupt membrane
155
{{BLANK}} is synthetic analog of somatostatin used in acromegaly or gigantism to inhibit release of GH
Octreotide
156
{{BLANK}} is an ADH analog used in diabetes insipidus
Desmopressin
157
{{BLANK}} is synthetic T4 used in hypothyroidism
Levothyroxine
158
{{BLANK}} inhibits thyroid peroxidase to decrease iodination of tyrosine residues. Used in hyperthyroidism
Methimazole
159
What is the MOA of I-131?
beta radiation mediated destruction of thyroid cells (take up iodine -- local effect)
160
{{BLANK}} is a meal-time rapid acting insulin
Lispro
161
Lispro has an onset of {{BLANK}} and duration of {{BLANK}}
* onset: 15 mins
* duration: 3 hours
162
{{BLANK}} is a long-acting basal insulin
glargine
163
glargine has an onset of {{BLANK}} & duration of {{BLANK}}
* onset: 1-2 hrs
* duration: 24 hrs
164
{{BLANK}} is a sulfonylurea that blocks ATP sensitive K+ channels in pancreatic beta cells
Glipizide
165
What is a notable SE of glipizide that limits its usage in elderly T2DM patients?
Hypoglycemia
166
What are the CIs/warnings of metformin?
* CI: CrCl < 30 mL/min
* CHF
* Hold dose for 48-hrs for IV contrast
167
What are the notable SEs of metformin?
lactic acidosis
168
What is the MOA of metformin?
* Gluconeogensis
* Glycogenolysis
* Decreased GIT absorption of CHO
* Increased insulin sensitivity
169
What class is Pioglitazone?
thiazolidinedione
170
What female (only) Dx can metformin help with?
PCOS (helps ovulation)
171
What is the MOA of pioglitazone?
PPAR gamma
172
SE of pioglitazone?
* Edema
* Decreased TGs
173
What is CI/Warning of pioglitazone?
* CI: CHF
* Monitor LFTs
174
What is the MOA of liraglutide?
* Incretin mimetic
* GLP-1 agonist
* glucose-dependent insulin secretion
175
What is a notable SE of liraglutide for which it is favored today?
weight loss
176
What is a dangerous SE of liraglutide warranting D/C if develops?
pancreatitis
177
What is a CI for liraglutide?
Thyroid c cell cancers (FMH or PMH)
178
What are protective effects of liraglutide?
* Renal protective
* cardioprotective
179
What class is sitagliptin?
DPP-4 (dipeptidase) inhibitor
180
What is the MOA of sitagliptin?
Inhibits breakdown of GLP-1 via inhibition of DPP-4
181
What is the CI/warning of sitagliptin?
Pancreatitis
