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My step 1 mnemonics > Basic Pharmacology and Public Health > Flashcards

Basic Pharmacology and Public Health Flashcards

1
Q

Low Volume of distribution

COMPARTMENT & DRUG TYPES

A

Intravascular

Large/charged molecules; plasma protein-bound

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2
Q

Medium Volume of distribution

COMPARTMENT & DRUG TYPES

A

ECF

Small hydrophilic molecules

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3
Q

High Volume of distribution

COMPARTMENT & DRUG TYPES

A

All tissues including fat

Small lipophilic molecules, especially if bound to tissue protein

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4
Q

Types of drug interactions

Additive - EXAMPLE

A

Aspirin and acetaminophen

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5
Q

Types of drug interactions

Permissive - EXAMPLE

A

Cortisol on catecholamine responsiveness

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6
Q

Types of drug interactions

Synergistic - EXAMPLE

A

Clopidogrel with aspirin

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7
Q

Types of drug interactions

Tachyphylactic - EXAMPLE

A

An acute decrease in response to a drug after initial/repeated administration

P - phenylephrine
L - LSD
a
N - Nitrates
N - niacin
e
M' - MDMA
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8
Q

Drug metabolism - Phase I

A

Reduction, Oxidation, Hydrolysis with
cytochrome P-450

Geriatric patients lose phase I first.

R-OH

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9
Q

Drug metabolism - Phase II

A

Conjugation (Methylation, Glucuronidation, Acetylation, Sulfation) usually yields very polar, inactive metabolites (renally excreted).

conjugating MAGS

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10
Q

Therapeutic index

A

TITE: Therapeutic Index = TD50/ED50·

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11
Q

Drugs with lower TI values frequently require monitoring, for example…

A

Warfarin, Theophylline, Digoxin, Antiepileptic drugs, Lithium;

Warning! These Drugs Are Lethal!

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12
Q

Anticholinesterase poisoning - Muscarinic effects:

A

Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Emesis, Lacrimation, Sweating, Salivation.

DUMBBELSS.
Reversed by atropine, a competitive inhibitor. Atropine can cross BBB to relieve CNS symptoms.

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13
Q

Anticholinesterase poisoning - Nicotinic effects

A

Neuromuscular blockade (a mechanism similar to succinylcholine). Reversed by pralidoxime, regenerates AChE if given early.

Pralidoxime (quaternary amine) does not readily cross BBB.

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14
Q

Anticholinesterase poisoning - CNS effects

A

Respiratory depression, lethargy, seizures, coma.

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15
Q

Atropine - ADVERSE EFFECTS

A 
Side effects:
Hot as a hare
Dry as a bone
Red as a beet
Blind as a bat
Mad as a hatter
Full as a flask
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16
Q

Albuterol, salmeterol,terbutaline - ACTION

A

beta2 >beta1

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17
Q

Dobutamine- ACTION

A

beta1 > beta2, alfa

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18
Q

Dopamine- ACTION

A

D1 = D2 >beta > alfa

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19
Q

Epinephrine- ACTION

A

beta > a

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20
Q

Fenoldopam- ACTION

A

D1

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21
Q

lsoproterenol- ACTION

A

betaI = beta2

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22
Q

Midodrine- ACTION

A

a1

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23
Q

Mirabegron- ACTION

A

beta 3

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24
Q

Norepinephrine- ACTION

A

alfa1 > alfa2 >beta1

25
Q

Phenylephrine- ACTION

A

a1 > a2

26
Q

Nebivolol ACTIONS

A

combines cardiac-selective beta 1-adrenergic blockade with stimulation of
beta 3 receptors (activate nitric oxide synthase in the vasculature and dec. SVR)

NebivOlol increases NO

27
Q

Beers criteria Examples include:

A
  • a -blockers (risk of hypotension)
  • Anticholinergics, antidepressants, antihistamines, opioids (risk of delirium, sedation, falls, constipation, urinary retention)
  • Benzodiazepines (risk of delirium, sedation, falls)
  • NSAIDs (risk of GI bleeding, especially with concomitant anticoagulation)
  • PPIs (risk of C difficile infection)

A-alfa blockers
B - BNZ
C - antiCholinergics
D - antiDepressants.

P - PPI
H - antiHistamins
O - Opioids
N - NSAIDs
e
28
Q

Specific toxicity treatments - Acetaminophen

A

N-acetylcysteine (replenishes glutathione)

29
Q

Specific toxicity treatments - AChE inhibitors, organophosphates

A

Atropine> pralidoxime

30
Q

Specific toxicity treatments - Antimuscarinic, anticholinergic agents

A

Physostigmine, control hyperthermia

31
Q

Specific toxicity treatments - Benzodiazepines

A

Flumazenil

32
Q

Specific toxicity treatments - beta-blockers

A

Atropine, glucagon, saline

GAS

33
Q

Specific toxicity treatments - Carbon monoxide

A

100% O2, hyperbaric O2

34
Q

Specific toxicity treatments - Copper

A

penicillamine, trientine

35
Q

Specific toxicity treatments - Cyanide

A

Nitrite + thiosulfate, hydroxocobalamin

THiN

36
Q

Specific toxicity treatments - Digitalis (digoxin)

A

Digoxin-specific antibody fragments

37
Q

Specific toxicity treatments - Heparin

A

Protamine sulfate

38
Q

Specific toxicity treatments - Iron

A

Deferoxamine, deferasirox, deferiprone

39
Q

Specific toxicity treatments - Methanol, ethylene glycol (antifreeze)

A

Fomepizole > ethanol, dialysis

40
Q

Specific toxicity treatments - Methemoglobin

A

Methylene blue, vitamin C (reducing agent)

41
Q

Specific toxicity treatments - OpiOids

A

NalOxOne

42
Q

Specific toxicity treatments - Salicylates

A

NaHCO3 (alkalinize urine), dialysis

43
Q

Specific toxicity treatments - TCAs

A

NaHCO3 (stabilizes cardiac cell membrane)

44
Q

Specific toxicity treatments - Warfarin

A 
Vitamin K (delayed effect), PCC/FFP
(immediate effect)
45
Q

Specific toxicity treatments - Dimercaprol, succimer TREAT

A

Lead
Arsenic
Mercury

LAMe

46
Q

Specific toxicity treatments - Lead

A

Calcium disodium EDTA, Dimercaprol, succimer, penicillamine

47
Q

Cytochrome P-450 interactions - Substrates

A

Warfarin
Anti-epileptics
Theophylline
OCPs

War Against The OCPs

48
Q

Cytochrome P-450 interactions - Inducers

A 
Modafinil
Chronic alcohol use
St. John's wort
Phenytoin
Phenobarbital
Nevi rapine
Rifampin
Griseofulvin
Carbamazepine

Most chronic alcoholics Steal Phen-Phen and Never Refuse Creasy Carbs

49
Q

Cytochrome P-450 interactions - Inhibitors

A 
Sodium valproate
lsoniazid
Cimetidine
Ketoconazole
Fluconazole
Acute alcohol abuse
Chloramphenicol
Erythromycin/clarithromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
Amiodarone
Grapefruit juice

SICKFACES.COM (when I Am drinking Grapefruit juice)

50
Q

-umab ending means

A

hUman monoclonal Ab

51
Q

-zumab ending means

A

hUmaniZed mouse monoclonal Ab

52
Q

-ximab ending means

A

CHImeric human-mouse monoclonal Ab

53
Q

Informed consent

A 
A process (not just a document/signature) that requires:
• Disclosure
• Understanding
• Capacity
• Voluntariness

DUC-V

54
Q

Exceptions to informed consent

A
  • Waiver
  • Incompetent (Legally)
  • Privilege (Therapeutic)
  • Emergency situation

WIPE

55
Q

Decision-making capacity Components:

A
  • Goals - Decision is consistent with the patient’s Values and Goals
  • Informed - Patient is Informed (knows and understands)
  • Expression - Patient Expresses a choice
  • Mental status/Mood - The decision is not a result of altered Mental status (eg, delirium, psychosis, intoxication), Mood disorder
  • Stable- Decision remains Stable over time
  • Age - Patient is 18 years of age (or older) or otherwise legally emancipated

GIEMSA

56
Q

Advance directives

A

Written advance directive
Oral advance directive
Do not resuscitate order
Medical power of attorney

WOD-power

57
Q

Changes in the elderly

A

R- recomposition (inc. fat, dec. muscle)
E - ejaculation/erection (slower, longer RP)
V - vaginal shortening, thinning, drying.
I - immune response dec.
S - suicide rate inc.
I - intelligence does not change.
O - organ function dec. (GI, renal, pulmonary)
n -nothing
S - Sleep patterns: dec. REM and slow-wave sleep; inc. sleep onset latency; inc. early awakenings.
S - sensory (vision and hearing dec.)

58
Q

Confidentiality - General principles for exceptions to confidentiality:

A
  • Potential physical harm to others is serious and imminent
  • Alternative means to warn or protect those at risk is not possible
  • Self-harm is likely
  • Steps can be taken to prevent harm
59
Q

Confidentiality - Examples of exceptions

A
  • Suicidal/homicidal patients
  • Abuse (children, elderly, and/or prisoners)
  • Victim - Duty to protect: State-specific laws that sometimes allow the physician to inform or somehow protect potential Victim from harm.
  • Epileptic patients and other impaired automobile drivers.
  • Diseases (Reportable)

The physician’s good judgment SAVED the day

My step 1 mnemonics (19 decks)

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