Clinical Pharmacology Flashcards
MOA of abciximab, tirofiban, eptifibatide
binds to the glycoprotein (GP) IIb/IIIa receptor of human platelets and inhibits platelet aggregation by preventing the binding of fibrinogen, von Willebrand factor, and other adhesive molecules
MOA of clopidogrel, ticagrelor, prasugrel
ADP antagonism
MOA of aspirin
cyclo-oxegnase inhibitor
MOA of dipyramidole
phsophodiesterase inhibitor
What drugs cause intracranial hypertension?
tetracycline, amiodarone, OCP and withdrawal of corticosteroids
Pharmacokinetics vs pharmacodynamics
Pharmacokinetics is the study of what the body does to the drug, and Pharmacodynamics is the study of what the drug does to the body
Which antibiotic increases risk of tendon rupture
Levofloxacin
What side effect is noted with nitrofurantoin?
Acute pulmonary reaction
CYP-2D6
TCA, Beta blockers, SSRI, Dihydrocodeine, Ecstacy
CYP-2C8
Omeprazole, diazepam, barbiturates, dapsone(also 2C9)
CYP-2C 18/19
omeprazole, diazepam, TCA, proguanil
Carbimazole side effect
Agranulocytosis, Liver impairment
Amiloride
potassium sparing diuretic
Dihydropyrimidine vs non-dihydropyrimidine CCB
Dihydropyrimide (nifedipine and amlodipine) works on vessels while non-dihydropyridime works on hearts (diltiazem, verapamil)
Why ACEi cause cough?
Accumulation of bradykinin in the lungs due to reduced formation of angiotensin II
What antidepressant interacts with tyramine?
MAOI may cause hypertensive crisis due to increase sympathomimetic reactions of tyramine
Side effect of ethambutol
Visual side effects- optic neuritis. All patients should have eye exams.
Tb drugs and side effects
Isoniazid, Pyrazinamide, Rifampicin-drug-induced hepatitis
Streptomycin- renal dysfunction, vestibular disturbance
What is sumatriptan?
5HT1 agonist used in migraines
What is cisapride
5HT2 agonists which is prokinetic and used in gastroparesis. May cause QT prolongation
What are the uses of 5HT3 antagonist?
Antiemetics such as ondansetron, gransietron
What is clomethiazole?
GAABA mimetic used in alcohol withdrawal
What is chlorpromazine?
Phenothiazines. D2 antagonists used in schizophrenia
What is chlordiazepoxide?
benzodiazepine that may be used in alcohol withdrawal
What cancer does BCG treat?
It is live attenuated vaccine. It is 70-80% protective against severe infection. Protection lasts for 10-15 years. Bladder carcinoma in situ
What antihypertensive causes pericarditis?
Hydralazine
Drugs that prolong QT interval?
floroquinolones, erythromycin, citalopram (SSRI)
Complications of bisphosphonate?
Esophageal perforation, osteonecrosis of the jaw
What anti-HTN causes glucose intolerance?
Thiazide diuretics and beta blockers
Donepezil
cholinesterase inhibitor potentiates the action of cholinergic neurons
Antiretroviral and side effects
Zidovudine- anaemia
Lamivudine- skin rashes, peripheral neuropathy and arthralgia
Abacavir- idiosyncratic hypersensitivity HLA-B5701
Indinavir(protease inhibitors)- renal stones, hyperlipidemia
Tenofovir- renal impairment
Efavirenz- nightmares
Nevirapine, NNRTIs- hepatitis
Stavudine- peripheral neuropathy
Co-trimoxazole
SJS, anaemia, neutropenia
Side effects of gliclazide (sulfonylurea)
weight gain and hypoglycemia
Metformin class of drug
biguanide
Side effects of pioglitazone
increased body mass, reduction in BMD, fluid retention
Which diuretic interacts with lithium to cause increased concentrations?
Thiazide diuretic
Where don each class of diuretic act in the nephron
COLT Pee
Carbonic anhydrase inhibitor- proximal convoluted tubule (acetazolamide)
Osmotic diuretics- loop of Henle
Loop diuretics- loop of Henle (ascending)- inhibits sodium potassium chloride cotransporter
Thiazide diuretics- at the early distal convoluted tubule
Potassium sparing diuretics- distal portion of the distal convoluted tubule
spironolactone (aldosterone antagonist)
Signs and symptoms of amphetamine overdose
Hypertension, tachycardia, mydriasis, pallor, hyperexcitability, hypokalemia
Severe toxicity may present with fever, rhabdomyolysis, AKI, liver failure
Treatment: Benzos
Labetalol if benzes does not reduce BP
How does theophylline work?
Blocks adenosine receptors leading to relaxation of bronchial smooth muscles , constriction of cerebral blood vessels, stimulation of the cardiac pacemaker and stimulation of gastric secretions. It is highly protein bound and is extensively metabolized by the liver therefore a small amount (10%) is excreted unchanged in the urine. It has a narrow therapeutic window.
How to work out drug clearance?
UxV/P (urine concentration x urine volume produced)/plasma concentration
Side effects of simvastatin
Myositis
Causes of hyperprolactinoma
Medications that can cause high prolactin
Antipsychotics: Such as risperidone, haloperidol, chlorpromazine, and perphenazine
Antidepressants: Such as imipramine, amitriptyline, paroxetine, and dothiepin
High blood pressure medications: Such as methyldopa and verapamil
Medications for heartburn and GERD: Such as H2 antihistamines
Medications for menopause symptoms: Such as estrogen therapy
Medications for nausea and vomiting: Such as antiemetics
Pain relievers: Such as those containing opioids
Medications that increase bowel motility: Such as certain gastrointestinal agents
Other possible causes of high prolactin levels include herbal supplements like anise, fennel, or fenugreek seed, and opioid use.
Entacapone
catechol-O-methyltransferase inhibitor which prolongs the effects of levodopa by inhibiting its peripheral degradation
MOA of pioglitazone
to improve insulin sensitivity and decrease hepatic glucose output. It does this by stimulating the peroxisome proliferator-activated receptor gamma (PPARγ) nuclear receptor.
Clopidogrel and omeprazole
Omeprazole is CYP2C19 inhibitor which leads to decreased effects of clopidogrel
Drugs that theophylline interact with?
clarithromycin, ciprofloxacin, cimetdine, OCP, Allopurinol
Rifampicin reduce these levels
Ezetimibe
cholesterol lowering medication that works by blocking the Niemann-Pick C1-Like 1 (NPC1L1) protein, which is responsible for transporting cholesterol from the intestine to the liver
Cholestyramine
anion exchange resins affects fat soluble vitamins and concentrations of drugs digoxin and thyroxine (fat-soluble)
What drugs can worsen psoriasis
beta blockers, antimalarials and lithium. Strep may precipitate guttate psoriasis.
