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Pharm SJSM > Block 4 KISS quiz > Flashcards

Block 4 KISS quiz Flashcards

1
Q

P450 Inducers

“St. Johns Pheny Pheny Mom Never Refuses Greasy Carbs or Chronic alcohol”

A

St.Johns wort
Phenytoin
Phenobarbital
Modanifil
Nevirapine
Rifampin
Griseofulvin
Carbamazepine
Chronic alcohol use

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2
Q

P450 Inhibitors

“SICKFACES.COM when i AM Really drinking Grapefruit juice”

A

Sodium Valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Acute alcohol overuse
Chloramphenicol
Erythromycin/Clarithromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
Amiodarone
Ritonavir
Grapefruit juice

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3
Q

Acetylated drugs
“SHIPPD”

A

Sulfonamide
Hydralazine
INH
Procainamide & Penicillamine
Dapsone

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4
Q

Drugs involved in G6PD deficiency

“Hemolysis is D PAIN”

A

Isoniazid, sulfonamides, dapsone, primaquine,
aspirin, ibuprofen, nitrofurantoin

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5
Q

Macrolides
Azithromycin, clarithromycin, erythromycin

MOA:

MOR:

Clinical uses:

A/E:

A

MOA:
Binds S23rRNA of the 50S subunit

MOR:
Methylation of S23rRNA

Clinical use:
1) Atypical pneumonias
(Mycoplasma, Chlamydia, Legionella)
2) STIs (Chlamydia)
3) strep inf in penicillin allergic patients
4) B pertussis

A/E: “MACRO”
gi Motility issues
Arrythmia (prolonged QT)
acute Cholestatic hepatitis
Rash
eOsinophelia

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6
Q

TCA’s
Tetracycline, doxycycline, minocycline

MOR:

Clinical uses:

A/E:

A

MOA:
30S inhibitor (avoid milk)

MOR:
Efflux pumps

Uses:
1) Borrelia burgdorferi
2) M pneumoniae
3) Rickettsia
4) Chlamydia
5) community-acquired MRSA (Doxycycline)

A/E:
Teeth discoloration
Inhibited bone growth in kids
Photosensitivity

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7
Q

Aminoglycosides
Gentamicin, Neomycin, Amikacin,
Tobramycin, Streptomycin.

MOA:

MOR:

Clinical uses:

A/E:

A

MOA:
30S inhibitor

MOR:
Acetylation, phosphorylation or adenylation or bacterial transferase enzyme

Use:
1) Severe gram ⊝ rod infections
2) Neomycin for bowel surgery

A/E: “NNOT”
- Nephrotoxicity
- Neuromuscular blockade
(avoid in Myasthenia Gravis)
- Ototoxicity
- Teratogen

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8
Q

Tigecycline

MOA:

Clinical uses:

A/E:

A

MOA:
30S inhibitor

Use:
1) MDR (MRSA & VRE)

A/E:
N/V

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9
Q

Chloramphenicol

MOA:

MOR:

Clinical use:

A/E:

A

MOA:
50S inhibitor

MOR:
Plasmid encoded acetyltransferase

Use:
1) Meningitis
(Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae)
2) Rickettsial (Rocky Mountain spotted fever)

A/E:
Anemia & Aplastic anemia
Gray baby syndrome

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10
Q

Clindamycin

MOA:

Clinical use:

A/E:

A

MOA:
50S inhibitor

Use:
1) Aspiration pneumonia & lung abscesses
2) oral infections
3) Invasive group A streptococcal infection.

A/E:
Pseudomembranous colitis
(C difficile overgrowth)
Fever/Diarrhea

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11
Q

Linezolid

MOA:

MOR:

Clinical use:

A/E:

A

MOA:
50S inhibitor

MOR:
Point mutation in rRNA

Use:
Gram ⊕ species & MRSA and VRE

A/E:
Bone marrow suppression
Peripheral neuropathy
Serotonin syndrome

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12
Q

Polymyxins
Colistin (polymyxin E), polymyxin B

MOA:

Clinical use:

A/E:

A

MOA:
Makes cation polypeptides to disrupt cell membrane & cause leaks (cell death)

Use:
1) MDR ⊝ bacteria
(eg, P aeruginosa, E coli, K pneumoniae).

A/E:
Nephrotoxicity
Neurotoxicity
Respiratory failure

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13
Q

Vinca alkaloids
Vincristine, Vinblastine

MOA:

Clinical uses:

A/E:

A

MOA:
Inhibit microtubule formation (via binding B-tubulin)

Use:
Solid tumors
Leukemias,
Hodgkin/non-Hodgkin lymphomas

A/E:
Constipation & Neurotoxicity (Vincristine)
Myelosuppression (Vinblastine

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14
Q

Imatinib, dasatinib, & nilotinib
(-tinib)

MOA:

Clinical uses:

A

MOA:
Inhibits BCR-ABL tyrosine kinase → Prevents phosphorylation of proteins involved in cell cycle regulation.

Clinical uses:
CML, ALL, GISTs

A/E:
Myelosuppression
Increased LFTs,
Edema
Myalgias

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15
Q

Oseltamivir & Zanamivir

MOA:

Clinical uses:

A

MOA:
Inhibit influenza neuraminidase to reduce the release of progeny virus

Uses:
Treatment and prevention of influenza A and B. (within 48 hours)

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16
Q

Acyclovir, famciclovir, valacyclovir

MOA:

MOR:

Clinical uses:

A/E:

A

MOA:
Guanosine analogs

MOR:
Mutated viral thymidine kinase

Uses:
HSV & VZV

A/E:
Obstructive crystalline nephropathy & acute kidney injury if not hydrated

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17
Q

Acute management of asthma ?

A

Bronchodilators:
Salbutamol & Theophylline
Ipratropium & T

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18
Q

Ganciclovir

MOA:

MOR:

Clinical use:

A/E:

A

MOA:
Guanosine analog formed by a CMV viral kinase

MOR:
Mutated viral kinase

Uses:
CMV

A/E:
Bone marrow suppression
Renal toxicity

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19
Q

Foscarnet

MOA:

MOR:

Clinical uses:

A/E:

A

MOA:
Viral DNA/RNA polymerase inhibitor and
HIV reverse transcriptase

MOR:
Mutated DNA polymerase

Clinical uses:
CMV retinitis
Acyclovir-resistant HSV

A/E:
Nephrotoxicity
Electrolyte abnormalities
Seizures.

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20
Q

Cidofovir

MOA:

Clinical uses:

A/E:

A

MOA:
Inhibits viral DNA polymerase

Clinical uses:
CMV retinitis
Acyclovir-resistant HSV

A/E:
Nephrotoxicity (give with probenecid)

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21
Q

NRTIs
Abacavir (ABC)
Emtricitabine (FTC)
Lamivudine (3TC)
Tenofovir (TDF)
Zidovudine (ZDV,
formerly AZT)

MOA:

Clinical use:

A/E:

A

MOA:
Competitively inhibit reverse transcriptase

Use:
HIV

A/E:
Bone marrow suppression
Peripheral neuropathy
Lactic acidosis
Anemia (ZDV).
HLA-B*5701 mutation causes
hypersensitivity (Abacavir)

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22
Q

NNRTIs
Delavirdine
Efavirenz
Nevirapine

MOA:

Clinical use:

A/E:

A

MOA:
Bind to reverse transcriptase at site different
from NRTI’s

Use:
HIV

A/E:
Rash
Hepatotoxicity
CNS (Efavirenz)

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23
Q

Integrase inhibitors
Bictegravir
Dolutegravir
Elvitegravir
Raltegravir

MOA:

Clinical use:

A/E:

A

MOA:
Reversibly binds HIV integrase to prevent HIV genome from integrating into the host cell

Use:
HIV

A/E:
High creatine kinase

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24
Q

Protease inhibitors
Atazanavir
Darunavir
Lopinavir
Ritonavir

MOA:

Clinical use:

A/E:

A

MOA:
Prevent maturation of new viruses

Uses:
HIV

A/E:
Hyperglycemia
GI intolerance
Lipodystrophy (Cushing-like syndrome).

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25
Q

Entry inhibitors

Enfuvirtide VS Maraviroc

A

Enfuvirtide (Blocks FUSION)
MOA:
Binds gp41, inhibiting viral entry

A/E:
Skin reaction at injection sites.

Maraviroc (Blocks DOCKING)
MOA:
Binds CCR-5 on surface of T cells/monocytes,
inhibiting interaction with gp120

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26
Q

Amphotericin B

MOA:

Clinical use:

A/E: (“amphoterrible”).

A

MOA:
Binds ergosterol to tear holes in the
membrane pores causing leaks

Use:
Serious systemic mycoses.
1) Cryptococcus meningitis)
2) Blastomyces
3) Coccidioides meningitis.
4) Histoplasma
5) Candida & Mucor.

A/E:
Fever/chills (“shake and bake”)
Hypotension
Nephrotoxicity
Arrhythmias
Anemia
IV phlebitis

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27
Q

Nystatin

MOA:

Clinical use:

A

MOA:
Binds ergosterol to tear holes in the
membrane pores causing leaks

Use:
“Swish and swallow”
Oral candidiasis (thrush) or topical for Vaginal candidiasis

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28
Q

Flucytosine

MOA:

Clinical use:

A/E:

A

MOA:
Inhibits DNA and RNA synthesis by preventing conversion to 5-fluorouracil via cytosine deaminase

Clinical use:
Cryptococcus meningitis with Amphotericin B

A/E:
Bone marrow suppression

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29
Q

Azoles
Clotrimazole, fluconazole, isavuconazole, itraconazole, ketoconazole, miconazole, voriconazole

MOA:

Clinical use:

A/E:

A

MOA:
Inhibit ergosterol synthesis by inhibiting the cytochrome P-450 enzyme that converts
lanosterol to ergosterol

Use:
1) Chronic suppression of cryptococcal
meningitis in HIV (Fluconazole)

2) Blastomyces, Coccidioides, Histoplasma, Sporothrix schenckii (Itraconazole)

3) Topical fungal infections (Clotrimazole and
Miconazole)

4) Aspergillus & Candida (Voriconazole)

A/E:
1) Testosterone synthesis inhibition (gynecomastia, especially with ketoconazole)

2) liver dysfunction
(inhibits cytochrome P-450).

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30
Q

Terbinafine

MOA:

Clinical use:

A/E:

A

MOA:
Inhibits fungal squalene epoxidase.

Clinical use:
Dermatophytoses onychomycosis)

A/E:
GI upset, headaches, hepatotoxicity, taste disturbance.

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31
Q

Echinocandins
Anidulafungin, caspofungin, micafungin.

MOA:

Clinical use:

A/E:

A

MOA:
Inhibit cell wall synthesis by inhibiting synthesis of β-glucan

Use:
Invasive aspergillosis & Candida

A/E:
GI upset, flushing (by histamine release).

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32
Q

Griseofulvin

MOA:

Clinical use:

A/E:

A

MOA:
Interferes with microtubule function

Clinical use:
1) Dermatophytes (tinea, ringworm)

A/E:
Teratogenic, carcinogenic, confusion, headaches, disulfiram-like reaction,  cytochrome P-450 and
warfarin metabolism

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33
Q

Antiprotozoal therapy for toxoplasmosis

A

Pyrimethamine (toxoplasmosis)

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34
Q

Antiprotozoal therapy for Trypanosoma brucei

A

suramin and melarsoprol (Trypanosoma brucei)

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35
Q

Antiprotozoal therapy for T cruzi

A

nifurtimox (T cruzi)

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36
Q

Antiprotozoal therapy for leishmaniasis

A

Sodium stibogluconate

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37
Q

Haloperidol

MOA:

Use:

A/E:

A

MOA:
D2 antagonist → Reduced dopamine neurotransmission.

Use:
Schizophrenia
Acute psychosis
Tourette syndrome

A/E:
EPS
Tardive dyskinesia
NMS
QT prolongation

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38
Q

Chlorpromazine

MOA:

Use:

A/E:

A

MOA:
D2 antagonist with anticholinergic effects.

Use:
Schizophrenia
Manic phase BPD

A/E:
Anticholinergic effects
Sedation
EPS
QT prolongation

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39
Q

Clozapine

MOA:

Use:

A/E:

A

MOA:
D2 and 5-HT2A antagonist

Use:
1) Treatment-resistant schizophrenia
2) Suicidality in schizophrenia/schizoaffective disorder.

A/E:
Agranulocytosis

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40
Q

Risperidone

MOA:

Use:

A/E:

A

MOA:
5-HT2A and D2 antagonist

Use:
Schizophrenia
BPD 1
Irritability in autism.

A/E:
EPS at higher doses
Hyperprolactinemia
QT prolongation.

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41
Q

Olanzapine

MOA:

Use:

A/E:

A

MOA:
5-HT2A and D2 antagonist with histaminergic & anticholinergic actions.

Use:
Schizophrenia
BPD 1

A/E:
Significant weight gain
Diabetes
Dyslipidemia.

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42
Q

Quetiapine

MOA:

Use:

A/E:

A

MOA:
5-HT2A and D2 antagonist with action on histamine and adrenergic receptors.

Use:
Schizophrenia
BPD
MDD

A/E:
Sedation
Weight gain
Less EPS risk.

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43
Q

Aripiprazole

MOA:

Use:

A/E:

A

MOA:
Partial agonist at D2 and 5-HT1A antagonist

Use:
Schizophrenia
BPD
MDD
Irritability associated with autism.

A/E:
Slight weight gain
Headache
Anxiety
Insomnia,

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44
Q

Acute dystonia

What is it?

How do you treat it?

A

within 4hrs
“MUSCLE”

Rigidity (without fever)

Treat with:
Benztropine (anticholinergic)
OR
Diphenhydramine or Chlorpheniramine
(H1 blockers)

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45
Q

Acute dystonia

What is it?

How do you treat it?

A

Within 4 days

Akathisia
“RUSTLE”
restlessness

Treat with propranolol (B-blocker)

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46
Q

Parkinsonism/Akinesia

What is it?

How do you treat it?

A

Within 4 weeks
HUSTLE
Akinesia, Bradykinesia (pin rolling)

Treat with:
Amantidine

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47
Q

Tardive Dyskinesia

What is it?

How do you treat it?

A

Within 4 months
Lip/tongue movements

Treatment:
Stop the antipsychotic & give an atypical drug

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48
Q

Benzodiazepines
Diazepam, Lorazepam, Alprazolam

MOA:

Use:

A/E:

Toxicity:

A

MOA:
Facilitate GABA(A) activity by increasing the frequency of Cl- channel opening → CNS depression

Use:
Anxiety
Seizures (especially status epilepticus)
Insomnia
Alcohol withdrawal

A/E:
Sedation, Dizziness, Ataxia, Cognitive dysfunction

Toxicity:
Flumazenil (GABA receptor antagonist)

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49
Q

Barbiturates
Phenobarbital, Thiopental, Pentobarbital

MOA:

Use:

A/E:

Toxicity:

A

MOA:
Facilitate GABA(A) activity by increasing the duration of Cl- channel opening → CNS depression

Use:
Sedation
Induction of anesthesia (Thiopental)
Seizure control (Phenobarbital)
Euthanasia

A/E:
Respiratory depression, Sedation, Dependence, CYP450 induction

Toxicity:
Sodium bicarbonate

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50
Q

Treatment of Tonic-Clonic Seizures:

Clinical Presentation: Characterized by sudden muscle rigidity (tonic phase) followed by synchronous muscle jerks (clonic phase), loss of consciousness.

A

1 Valproate

Phenytoin
Carbamazepine
Lamotrigine

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51
Q

Valproate

MOA:

Use:

A/E:

A

MOA:
Na+ channel inhibitor that inhibits GABA transaminase to increase GABA concentration

Use:
Tonic-Clonic, Absence, & Myoclonic seizures
Status Epilepticus

A/E:
Hepatotoxicity, Pancreatitis, Teratogenicity.

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52
Q

Phenytoin

MOA:

Use:

A/E:

A

MOA:
Na+ channel inhibitor

Use:
Tonic-Clonic & Partial/Focal seizures

A/E:
Gingival hyperplasia, Hirsutism, Teratogenicity, Ataxia.

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53
Q

Carbamazepine

MOA:

Use:

A/E:

A

MOA:
Na+ channel inhibitor

Use:
Clonic-Tonic & Partial/Focal seizures

A/E:
Bone marrow suppression, SIADH, Rash.

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54
Q

Lamotrigine

MOA:

Use:

A/E:

A

MOA:
Voltage-gated Na+ channel blockers that inhibit glutamate release and reduce neuronal excitability.

Use:
Tonic-Clonic & Partial/Focal seizures

A/E:
Stevens-Johnson syndrome.

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55
Q

Levetiracetam

MOA:

Use:

A/E:

A

MOA:
SV2A inhibitor SAFE IN PREGGOS

Use:
Partial/Focal seizures
Status epilepticus

A/E:
Behavioral changes, Psychosis.

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56
Q

Partial (Focal) Seizures

Clinical Presentation: Symptoms depend on the brain region involved; may have motor, sensory, autonomic, or psychic symptoms without loss of consciousness (simple partial) or with impairment (complex partial).

Treatment options

A

1Carbamazepine

Phenytoin
Lamotrigine
Levetiracetam

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57
Q

Absence seizures

Clinical Presentation: Brief, sudden lapses in attention and activity, often described as “staring spells.”

Treatment options?

A

1 Ethosuximide

Valproate

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58
Q

Ethosuximide

MOA:

Use:

A/E:

A

MOA:
T-type Ca2+ channels inhibitor
(in thalamic neurons)

Use:
Absence seizures

A/E:
GI distress, Fatigue, Headache.

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59
Q

Myoclonic Seizures

Clinical Presentation: Sudden, brief, involuntary muscle jerks.

Treatments?

A

1 Valproate

Levetiracetam (preggos)
Topiramate

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60
Q

Topiramate

MOA:

Use:

A/E:

A

MOA:
Voltage-dependent Na+ channels inhibitor that enhances GABA activity but antagonizes AMPA/kainate subtype of the glutamate receptor, and inhibits carbonic anhydrase

Use:
Myoclonic seizure

A/E:
Weight loss, Paresthesia, Cognitive slowing

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61
Q

Status Epilepticus

Clinical Presentation: A seizure lasting more than 5 minutes or two or more seizures within a 5-minute period without the person returning to normal between them.

Treatments?

A

1 Benzodiazepines (Lorazepam, Diazepam)

Phenytoin
Valproate
Levetiracetam

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62
Q

Esters
Procaine, Benzocaine (Note that these have one “i” in their generic name.)

MOA:

Uses:

A/E:

A

MOA:
Na+ channel inhibitors

Uses:
Procaine: Infiltration anesthesia, nerve block.
Benzocaine: Topical anesthesia for skin and mucous membrane.

A/E:
Allergy

63
Q

Amides
Lidocaine, Bupivacaine, Ropivacaine (Note that these have two “i” in their generic name.)

MOA:

Uses:

A/E:

A

MOA:
Na+ channels inhibitor that get metabolized in the liver.

Uses:
Lidocaine: Topical, infiltration, nerve block, epidural, and IV for cardiac arrhythmias.

Bupivacaine: Epidural, spinal, and peripheral nerve blocks; longer duration than lidocaine

Ropivacaine: less cardiotoxicity; used for surgical anesthesia and pain management.

A/E:
1) CNS toxicity (e.g., seizures)
2) Cardiovascular toxicity
(arrhythmias & arrest)

64
Q

NO

USE

PRO VS CON

A/E

A

Nitrous Oxide (NO)

MAC: ~105% (High MAC, Low Potency)
Advantages: Minimal cardiac effects, rapid onset and recovery.

Disadvantages: Low potency, must be used with other anesthetics.

Clinical Uses: Analgesia, minor surgical procedures.

HY S/E: Expansion of trapped gas in body cavities.

65
Q

Halothane

USE

PRO VS CON

A/E

A

Halothane

MAC: 0.75%
Advantages: Potent with smooth induction.

Disadvantages: Hepatotoxicity, sensitization to catecholamines.

Clinical Uses: Mostly pediatric anesthesia.

HY S/E: Malignant hyperthermia, hepatotoxicity.

66
Q

Isoflurane

USE

PRO VS CON

A/E

A

Isoflurane

MAC: 1.15%
Advantages: Potent, muscle relaxing, stable hemodynamics.

Disadvantages: Pungent, can cause respiratory irritation.

Clinical Uses: Maintaining anesthesia.

HY S/E: Mild respiratory irritation.

67
Q

Desflurane

USE

PRO VS CON

A/E

A

Desflurane

MAC: 6.0%
Advantages: Very rapid onset and emergence.

Disadvantages: Airway irritation, requires special vaporizer due to high vapor pressure.

Clinical Uses: Rapid adjustment of anesthetic depth.

HY S/E: Coughing, laryngospasm, especially upon induction

68
Q

Thiopental

USE

PRO VS CON

A/E

A

Thiopentone Sodium (Thiopental)

Clinical Uses: Induction of anesthesia, short surgical procedures.

Advantages: Rapid onset, short duration.

Disadvantages: Poor analgesic properties, respiratory and cardiovascular depression
.
HY S/E: Respiratory depression, hypotension.

69
Q

Propofol

USE

PRO VS CON

A/E

A

Propofol
Clinical Uses: Induction and maintenance of anesthesia, sedation for procedures.

Advantages: Rapid onset and recovery, antiemetic properties.

Disadvantages: Pain on injection, respiratory and cardiovascular depression.

HY S/E: Propofol Infusion Syndrome (rare but serious).

70
Q

Ketamine

USE

PRO VS CON

A/E

A

Ketamine
Clinical Uses: Induction of anesthesia, especially in patients with risk of hypotension and asthma.

Advantages: Preserves airway reflexes, stimulates heart rate and blood pressure.

Disadvantages: Emergence reactions (hallucinations), increased intracranial pressure.

HY S/E: Emergence reactions, increased secretions.

71
Q

Opioids (e.g., Fentanyl)

USE

PRO VS CON

A/E

A

Opioids (e.g., Fentanyl)

Clinical Uses: Analgesia during and after surgery, component of general anesthesia.

Advantages: Potent analgesia, stable hemodynamics.

Disadvantages: Respiratory depression, nausea, pruritus.

HY S/E: Respiratory depression, risk of opioid addiction.

72
Q

Benzodiazepines (e.g., Midazolam)

USE

CON

A/E

A

Benzodiazepines (e.g., Midazolam)

Clinical Uses: Pre-anesthetic sedation, induction of anesthesia, procedural sedation
.
Advantages: Anxiolysis, anterograde amnesia, muscle relaxation.

HY S/E: Sedation, amnesia.

73
Q
A

Barbiturates (e.g., Phenobarbital)
Clinical Uses: Rarely used for anesthesia due to better alternatives; used in controlling certain types of seizures.
Advantages: Seizure control.
Disadvantages: Respiratory depression, cardiovascular effects.
HY S/E: Respiratory depression, dependency.

74
Q

Malignant hyperthermia

What is it & how do you treat it?

A

Triggers: Certain anesthetics (e.g., halothane) and muscle relaxants (e.g., succinylcholine) can induce abnormal calcium release from the sarcoplasmic reticulum in muscle cells.

Clinical Features: Hyperthermia, Muscle Rigidity, Tachycardia, Acidosis, Hyperkalemia, Rhabdomyolysis (Breakdown of muscle tissue, releasing myoglobin into the blood.)

Treatment is DANTROLENE
(inhibits Ca2+ release from SR)

75
Q

Neuroleptic Malignant Syndrome

What is it & what’s the treatment?

A

Presentation
1) Hyperthermia: Elevated body temperature.
2) Muscle Rigidity: “Lead pipe” rigidity, severe muscle stiffness.
3) Autonomic Dysregulation: Fluctuating blood pressure, tachycardia, diaphoresis.
4) Altered Mental Status: Confusion, agitation, delirium.

Trigger:
Antipsychotics → Dysregulation of dopamine pathways.

Treatment:
Discontinue the antipsychotic & give DANTROLENE & BROMOCRIPTINE OR AMANTADINE

76
Q

Lithium

MOA:

Uses:

A/E:

Avoid which medications?

A

MOA:
Inhibition of phosphoinositol cascade → Reduced recycling of inositol phosphates and modulation of second messenger systems.

Uses:
BPD
Treatment-resistant depression

A/E:
Low hypothyroidism
Insipidus (diabetes)
Tremor (ataxia)
Heart (Epstein’s anomaly)
i
u
Nephrogenic

Drug-drug interaction: Avoid thiazide diuretics
(low Na+ cause lithium toxicity)

77
Q

Selective Serotonin Reuptake Inhibitors (SSRI)
Fluoxetine, Sertraline, Citalopram

MOA:

Uses:

A/E:

A

MOA:
Inhibit serotonin (5-HT) reuptake

Uses:
Depression
Anxiety disorders (OCD, PTSD, PMDD)
Bulimia nervosa

A/E: “Sex, Stomach, & Sleep”
GI distress, Sexual dysfunction, Serotonin syndrome (with overdose or interaction), Mild anticholinergic effects, Sleep disturbance (insomnia)

77
Q

Serotonin-Norepinephrine Reuptake Inhibitors (SNRI)
Venlafaxine, Duloxetine

MOA:

Uses:

A/E:

A

MOA:
Inhibits serotonin and norepinephrine reuptake

Uses:
Depression
GAD
Diabetic neuropathy (Duloxetine)
Chronic pain disorders

A/E: “Sex, Stomach, & Sleep”
GI distress, Sexual dysfunction, Increased blood pressure (especially Venlafaxine at high doses), Sleep disturbances

78
Q

Tricyclic Antidepressants (TCA)
Amitriptyline, Nortriptyline, Clomipramine

MOA:

Use:

A/E:

A

MOA:
Block reuptake of norepinephrine (NE) and serotonin & block cholinergic, histamine, and alpha-1 adrenergic receptors

Use:
Depression
Neuropathic pain
Fibromyalgia
Migraine prophylaxis
OCD (Clomipramine)

A/E:
Anticholinergic effects
Orthostatic hypotension
Cardiotoxicity (arrhythmias)
Sedation
Weight gain

79
Q

Monoamine Oxidase Inhibitors (MAOi)
Phenelzine, Tranylcypromine, Selegiline

MOA:

Use:

A/E:

A

MOA:
Phenelzine, Tranylcypromine:
Non-selectively inhibits monoamine oxidase (MAO) enzyme from breaking down NE, serotonin, and DA

Selegiline:
Selectively inhibits MAO-B at lower doses, affecting primarily dopamine breakdown.

Use:
Treatment-resistant depression
Atypical depression
Anxiety disorders
Parkinson’s disease (Selegiline)

A/E:
1) Hypertensive crisis (tyramine-rich foods)
2) CNS stimulation
3) Orthostatic hypotension
4) Weight gain

Selegiline-specific: Insomnia

80
Q

Serotonin Syndrome

Triggers
Medications: SSRIs, SNRIs, MAOIs, TCAs, Triptans, St. John’s Wort, Illicit drugs (e.g., MDMA, LSD), and others when combined → Increase serotonin levels.

Diagnosis:
High levels of urinary 5-HIAA

What is it & what is the treatment?

A

confusion, agitation, headache, hallucinations, hyperthermia, rapid heartbeat, high blood pressure, sweating, nausea, diarrhea, tremors, muscle stiffness, and increased reflexes.

Treatment
Discontinue Serotonergic Agents

Cyproheptadine
(A serotonin antagonist → Reduces serotonin effects)

81
Q

Cheese Reaction with TCAs leads to a Hypertensive crisis

What is the treatment?

A

1 Phentolamine

(A non-selective alpha-adrenergic blocker, can be used to counteract the vasoconstriction)

Nitroprusside: A vasodilator, for severe cases to rapidly reduce blood pressure.

82
Q

Wilsons disease treatment (copper accumulation)

A

Penicillamine (copper chelator)

83
Q

Pill-rolling” tremor
Resting Tremor: Often
“Lead pipe” rigidity
Bradykinesia
Postural Instability
Shuffling Gait

What’s the diagnosis?

What’s the 1st line treatment?

Other treatments?

A

1Levodopa/Carbidopa

Parkinsons

Others:
Dopamine Agonists (Pramipexole, Ropinirole)
MAO-B Inhibitors (Selegiline, Rasagiline)
COMT Inhibitors (Entacapone)
Anticholinergics (Benztropine)
Amantadine

84
Q

Levodopa/Carbidopa (1st line)

MOA:

Use:

A/E:

A

MOA:
Increases brain dopamine concentrations

Use:
#1 Parkinsons

A/E:
Dyskinesias
‘on-off’ phenomena
neuropsychiatric effects.

85
Q

Dopamine Agonists (Pramipexole, Ropinirole)

MOA:

Use:

A/E:

A

MOA:
Mimic dopamine at the receptor

Use:
Parkinsons

A/E:
Impulse control disorders, nausea, dizziness.

86
Q

MAO-B Inhibitors (Selegiline, Rasagiline)

MOA:

Use:

A/E:

A

MOA:
Prevent dopamine breakdown.

Use:
Parkinsons

A/E:
Insomnia, nausea, risk of serotonin syndrome.

87
Q

COMT Inhibitors (Entacapone)

MOA:

Use:

A/E:

A

MOA:
Prolong levodopa effect by reducing its metabolism.

Use:
Parkinsons

A/E:
Diarrhea, urine discoloration, dyskinesias.

88
Q

Anticholinergics (Benztropine)

MOA:

Use:

A/E:

A

MOA:
Counteract excessive acetylcholine activity.

Use:
Parkinsons

A/E:
Dry mouth, blurred vision, constipation, confusion.

89
Q

Amantadine

MOA:

Use:

A/E:

A

MOA:
May increase dopamine release and block NMDA receptors.

Use:
Parkinsons

A/E:
Livedo reticularis, ankle edema, confusion.

90
Q

Memory Loss
Cognitive Decline
Behavioral Changes
Disorientation
Difficulty Recognizing Familiar People and Objects

What is the condition & the treatments?

A

Alzheimers

1) Cholinesterase Inhibitors
Donepezil, Rivastigmine, Galantamine

2) NMDA Receptor Antagonist
Memantine

91
Q

Cholinesterase Inhibitors
Donepezil, Rivastigmine, Galantamine

MOA:

Uses:

A/E:

A

MOA:
Inhibit acetylcholinesterase

Uses:
Alzheimer’s

A/E:
Nausea, diarrhea, bradycardia, muscle cramps

92
Q

NMDA Receptor Antagonist
Memantine

MOA:

Uses:

A/E:

A

MOA:
Regulates glutamate activity to prevent excitotoxicity, protecting nerve cells from excessive stimulation.

Uses:
Alzheimer’s

A/E:
Dizziness, headache, constipation, confusion

93
Q

Progressive Neurodegenerative Disease: Affects motor neurons in the brain and spinal cord.

Key Symptoms: Muscle weakness, spasticity, difficulty speaking/swallowing, respiratory dysfunction

What is the condition & the treatments?

A

ALS

Treatments:
1) Riluzole
2) Baclofen
3) Edaravone

94
Q

Riluzole

MOA:

Use:

A/E:

A

MOA:
Inhibits glutamatergic neurotransmission, which may help slow down neuronal damage.

Use:
ALS

A/E:
Dizziness, gastrointestinal disturbances, elevations in liver enzymes.

95
Q

Baclofen

MOA:

Use:

A/E:

A

MOA:
GABA_B receptor agonist → Reduces muscle spasticity by inhibiting spinal reflexes

Use:
ALS

A/E:
Muscle weakness, drowsiness, fatigue, nausea.

96
Q

Edaravone

MOA:

Use:

A/E:

A

MOA:
Acts as a free radical scavenger, reducing oxidative stress in neurons.

Use:
ALS

A/E:
Bruising, gait disturbances, headaches, skin irritation at the injection site.

97
Q

ADHD

Characterized by: Inattention, hyperactivity, impulsivity

Treatment options:

A

1) Stimulants
Methylphenidate, Amphetamines (e.g., Adderall, Lisdexamfetamine)

2) Guanfacine (extended release)

3) Clonidine (extended release)

98
Q

Stimulants
Methylphenidate, Amphetamines (e.g., Adderall, Lisdexamfetamine)

MOA:

Uses:

A/E:

A

MOA:
Increase dopamine and norepinephrine in the brain by inhibiting their reuptake and increasing their release.

Uses:
ADHD

A/E:
Insomnia, decreased appetite, weight loss, increased heart rate and blood pressure, potential for abuse.

99
Q

Guanfacine (extended release)
Clonidine (extended release)

MOA:

Uses:

A/E:

A

MOA:
Alpha-2 adrenergic agonists → Reduce hyperactivity and improve attention by modulating prefrontal cortex activity

Uses:
ADHD

A/E:
Drowsiness, hypotension, fatigue, dry mouth.

100
Q

Succinylcholine

MOA:

Uses:

A/E:

A

MOA:
Acts as a depolarizing neuromuscular blocker. It mimics acetylcholine at the neuromuscular junction, causing muscle cells to depolarize. The persistent presence of succinylcholine prevents repolarization, leading to paralysis.

Use:
Rapid sequence intubation (RSI)
Short surgical procedures
Emergency airway management

A/E:
Hyperkalemia
Malignant Hyperthermia (Dantrolene)
Bradycardia

101
Q

MOR of penicillin’s

A

Beta lactamase
Mutated PBP

102
Q

MOR of Vancomycin

A

Efflux pumps
Mutated Peptidoglycan cell wall

103
Q

MOR of Quinolones

A

Mutated DNA gyrase
Efflux pumps

104
Q

MOR of Aminoglycosides

A

Mutated ribosomal subunit
AG modifying enzymes

105
Q

MOR of TCA’s

A

Efflux pump

106
Q

MOR of Rifamycins

A

Mutated RNA polymerase

107
Q

Methanol toxicity

Signs & Treatment?

A

Respiratory failure
Severe AG met acidosis
Ocular damage

Treatment:
Fomepizole

108
Q

Acetaminophen toxicity

A

N-Acetylcysteine

109
Q

Organophosphate toxicity

A

Atropine & Pralidoxime

110
Q

Atropine toxicity

A

Physostigmine

111
Q

Arsenic poisoning

A

Dimercaprol

112
Q

Cyanide toxicity

A

Hydroxocobalamin & Sodium nitrite

113
Q

Heparin toxicity

A

Protamine sulfate

114
Q

TCA toxicity

A

Sodium bicarbonate

115
Q

Morphine toxicity

A

Naloxone

116
Q

Perioral tremor (“Rabbit syndrome”)

A

Perioral tremors Months-Years of antipsychotic therapy

Treatment:
Amantadine

117
Q

Tamsulosin

MOA:

Use:

A

MOA:
α1 antagonist

Use:
BPH

118
Q

Aromatase inhibitors
Anastrozole, letrozole, exemestane

MOA:

Use:

A

MOA:
Inhibit peripheral conversion of androgens to estrogen

Uses:
ER ⊕ breast cancer in postmenopausal females.

119
Q

Selective estrogen receptor modulators

Clomiphene

MOA:

Uses:

A

MOA:
Antagonist at estrogen receptors in hypothalamus increasing the release of LH and FSH from pituitary, which stimulates ovulation.

Uses:
treat infertility (eg, PCOS)

120
Q

Selective estrogen receptor modulators

Tamoxifen

MOA:

Uses:

A/E:

A

MOA:
Antagonist at breast, partial agonist at uterus, bone

Uses:
Treat and prevent recurrence
of ER/PR ⊕ breast cancer and to prevent gynecomastia in patients undergoing prostate cancer

A/E:
Risk of thromboembolic events
(especially with tobacco smoking), and endometrial cancer.

121
Q

Selective estrogen receptor modulators

Raloxifene

MOA:

Uses:

A/E:

A

MO:
Antagonist at breast, uterus; agonist at bone

Uses: osteoporosis.

A/E:
Risk of thromboembolic events (especially
with tobacco smoking), but NO increased risk of endometrial cancer

122
Q

Chronic gout

All painful flares are preventable.

Treatments?

A

Allopurinol
Pegloticase
Febuxostat
Probenecid
Sulfinpyrazone

123
Q

Allopurinol

MOA:

Use:

A

MOA:
Competitive inhibitor of xanthine oxidase

Use:
Chronic gout

124
Q

Pegloticase

MOA:

Use:

A

MOA:
Recombinant uricase catalyzing uric acid to
allantoin (a more water-soluble product)

Use:
Chronic Gout

125
Q

Febuxostat

MOA:

Use:

A

MOA:
Inhibits xanthine oxidase. Think, “febu-xo-stat
makes Xanthine Oxidase static.”

Use:
Chronic gout

126
Q

Probenecid

MOA:

Use:

A

MOA:
Inhibits reabsorption of uric acid in proximal
convoluted tubule. Can precipitate uric acid calculi.

Use:
Chronic gout

127
Q

Acute gout drugs?

A

NSAIDs
Glucocorticoids
Colchicine

128
Q

NSAIDs

MOA:

Uses:

A

MOA:
Any NSAID. Use salicylates with caution (may
decrease uric acid excretion, particularly at
low doses).

Use:
Acute gout

129
Q

Glucocorticoids

MOA:

Uses:

A

MOA:
Oral, intra-articular, or parenteral.

Uses:
Acute gout

130
Q

Colchicine

MOA:

Uses:

A

MOA:
Binds and stabilizes tubulin to inhibit
microtubule polymerization, impairing
neutrophil chemotaxis and degranulation.

Uses:
Acute gout

A/E:
1) GI & neuromyopathic side effects
2) Myelosuppression
3) Nephrotoxicity.

131
Q

Mark the effects of these drugs:
Enfuvirtide

Zidovudine/Efavirenz

Oseltamivir

-gravir(s)

Amantadine

A

A: Enfuvirtide

B: Zidovudine/Efavirenz

C: Oseltamivir

D: -gravir(s)

E: Amantadine

132
Q

Octreotide

MOA:

Use:

A/E:

A

MOA:
Long-acting somatostatin analog; inhibits secretion of various splanchnic vasodilatory hormones

Use:
Acute variceal bleeds
Acromegaly
VIPoma
Carcinoid tumors

A/E:
Nausea, cramps, steatorrhea. Risk of cholelithiasis due to CCK inhibition.

133
Q

Loperamide

MOA:

Use:

A/E:

A

MOA:
Agonist at μ-opioid receptors; slows gut motility. Poor CNS penetration (low addictive potential).

Use:
Diarrhea

A/E:
Constipation, nausea.

134
Q

Proton pump inhibitors
Omeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole.

MOA:

Uses:

A/E:

A

MOA:
Irreversibly inhibit H+/K+ ATPase in stomach parietal cells

Uses:
Peptic ulcer
Gastritis
GERD
Zollinger-Ellison syndrome
H pylori
stress ulcer prophylaxis.

A/E:
Risk of C difficile infection
Pneumonia
Acute interstitial nephritis
Vitamin B12 malabsorption

135
Q

HMG-CoA reductase inhibitors
Atorvastatin,
simvastatin

MOA:

Labs

A/E:

A

MOA:
Inhibit conversion of HMG-CoA to mevalonate, a cholesterol precursor;

Labs:
Very low LDL
high HDL
Low TG

A/E:
Hepatotoxicity ( LFTs),
myopathy (esp when
used with fibrates or
niacin

136
Q

Niacin

MOA:

Labs

A/E:

A

MOA:
Inhibits lipolysis (hormone-sensitive lipase)

Labs
Very low LDL
Very high HDL
Low TG

A/E:
Flushed face
Hyperglycemia
Hyperuricemia

137
Q

Fibrates
Gemfibrozil,
bezafibrate,
fenofibrate

MOA:

Labs

A/E:

A

MOA:
Activate PPAR-α
to upregulate LPL & TG

Labs:
Low LDL
High HDL
Very low TG

A/E:
Myopathy

138
Q

Acute asthma treatment

A

Bronchodilator

Albuterol
Salmeterol, formoterol

139
Q

ACE inhibitors have which levels
-PRIL

bradykinin
renin
AGT 1
AGT 2
Aldosterone

A

Increased bradykinin
High renin
High AGT 1
Low AGT 2
Low aldosterone

140
Q

ARBS inhibitors have which levels
SARTANS

bradykinin
renin
AGT 1
AGT 2
Aldosterone

A

No change bradykinin
High renin
High AGT 1
High AGT 2
Low Aldosterone

141
Q

Disulfiram-like reaction

Sorry pals, can’t go mingle

A

1st-generation sulfonylureas, procarbazine,
certain cephalosporins, griseofulvin,
metronidazole

142
Q

Receptor Tyrosine Kinase

A

Insulin

143
Q

Biguanides
Metformin

MOA:

Use:

A/E

A

MOA:
Increase insulin sensitivity VIA Inhibiting mGPD to inhibit of hepatic gluconeogenesis and the action of glucagon

Use:
Diabetes mellitus (2)

A/E:
GI upset, lactic acidosis (use with caution in
renal insufficiency), vitamin B12 deficiency.
Weight loss (often desired).

144
Q

Loop diuretics
Furosemide, bumetanide, torsemide

MOA:

Uses:

A/E:

A

MOA:
Inhibit cotransport
system (Na+/K+/2Cl−) of thick ascending limb
of loop of Henle

Loops lose Ca2+

Uses:
Edematous states (HF, cirrhosis, nephrotic
syndrome, pulmonary edema)
Hypertension,
Hypercalcemia.

A/E: OHH DAANG
Ototoxicity, Hypokalemia, Hypomagnesemia,
Dehydration, Allergy (sulfa), metabolic
Alkalosis, Nephritis (interstitial), Gou

145
Q

Acetazolamide

MOA:

Uses:

A/E:

A

MOA:
Carbonic anhydrase inhibitor, reduces NaHCO3 in the body

Uses:
Glaucoma
metabolic alkalosis
altitude sickness
intracranial hypertension.

A/E:
Proximal renal tubular acidosis
paresthesias, NH3
toxicity, sulfa allergy,
hypokalemi

146
Q

Thiazide diuretics
Hydrochlorothiazide, chlorthalidone, & metolazone

MOA:

Uses:

A/E:

A

MOA:
Inhibit NaCl reabsorption in early DCT to reduce Ca2+ excretion

Uses:
Hypertension, HF, idiopathic hypercalciuria,
nephrogenic diabetes insipidus, osteoporosis

A/E:
Hypokalemic metabolic alkalosis,
hyponatremia, hyperglycemia, hyperlipidemia,
hyperuricemia, hypercalcemia. Sulfa allergy

147
Q

Potassium-sparing
diuretics
Spironolactone, Eplerenone, Amiloride,
Triamterene.

MOA:

Uses:

A/E:

A

MOA:
Spironolactone and eplerenone are competitive aldosterone receptor antagonists in cortical collecting tubule

Triamterene and amiloride
block Na+ channels at the same part of the
tubule

Uses:
Hyperaldosteronism, K+ depletion, HF, hepatic
ascites (spironolactone), nephrogenic DI
(amiloride), antiandrogen (spironolactone).

A/E:
Hyperkalemia
gynecomastia, antiandrogen

148
Q

Heparin

MOA:

Use:

A/D:

A

MOA:
Activates antithrombin, which reduce action primarily of factors IIa (thrombin) and Xa

Use:
Pulmonary embolism (PE)
Acute coronary syndrome
MI
DVT
(SAFE in Preggos)

A/D:
Bleeding (reverse with protamine sulfate), heparin-induced thrombocytopenia (HIT), osteoporosis
drug-drug interactions

149
Q

Warfarin

MOA:

USE:

A/E:

A

MOA:
Inhibits vitamin K epoxide reductase by competing with vitamin K. Causes inhibition of vitamin K–dependent γ-carboxylation of clotting factors II, VII, IX, and X and proteins C and S.

Uses:
Chronic anticoagulation
(eg, venous thromboembolism prophylaxis and prevention of stroke in atrial fibrillation)

A/E:
Bleeding,
teratogenic effects,
skin/tissue necrosis A ,
drug-drug interactions (metabolized by
cytochrome P-450 [CYP2C9]).

150
Q

Nitrates
Nitroglycerin, isosorbide dinitrate, isosorbide mononitrate

MOA:

Use:

A/E:

A

MOA:
Vasodilate by increasing NO in vascular smooth muscle to increase cGMP and smooth muscle relaxation.
Dilate veins&raquo_space; arteries increases preload.

Use:
Angina, acute coronary syndrome, pulmonary edema.

A/E:
Reflex tachycardia (treat with β-blockers), hypotension, flushing, headache, “Monday disease”

151
Q

Folic Acid

MOA:

Uses:

A/E:

A

MOA:
precursor of an essential donor of methyl groups used for synthesis of amnio acids, purines and deoxynucleotides

Uses:
folic acid deficiency (megaloblastic anemia), prevention of congenital neural tube defects

A/E:
can mask vitamin B12 deficiency in large amounts

152
Q

Epoetin alfa (Erythropoietin)

MOA:

USES:

A/E:

A

MOA:
agonist of erythropoietin receptors expressed by red cell progenitors

USES:
anemias especially in chronic renal failure, HIV infection, cancer, prematurity –– prevention of need for transfusions

A/E:
hypertension, thrombotic complications, pure red cell aplasia

153
Q

Enoxaparin
Classification: low-molecular weight heparin

MOA:

Use:

A/E:

A

MOA:
bind ATIII –– have same inhibitory effect on factor Xa as the unfractioned heparin-ATIII complex –– longer half-life than standard heparin

Use:
anticoagulation –– does not need laboratory monitoring (more predictable mechanism of action)

A/E:
ame as heparin, but less likely to experience thrombocytopenia and thrombosis
Contraindicated in renal failure

Pharm SJSM (23 decks)

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