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High Yield Comlex > Deja Review pharm > Flashcards

Deja Review pharm Flashcards

1
Q

volume of blood cleared of the drug per time

A

Clearance

rate of elimination/plasma concentration

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2
Q

Calculation for half life

A

t1/2= (0.7 x Vd) / Cl

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3
Q

Calculation for loading dose

A

Loading dose= (Vd x steady state concentration) / F (bioavailability)

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4
Q

Calculation for maintenance dose

A

(Cl x steady state concentration x dosing interval) / F

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5
Q

What happens to the loading dose in patients with hepatic or renal failure?

A

Stays the same

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6
Q

What happens to the maintenance dose in patients with hepatic or renal failure?

A

Decrease

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7
Q

Constant rate of elimination regardless of concentration is characteristic of

A

Zero order elimination

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8
Q

Rate of elimination proportional to concentration is characteristic of

A

First order elimination

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9
Q

Stage of drug trial where you look for safety in a small group of healthy individuals

A

Phase 1

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10
Q

Stage of drug trial where you look for efficacy in diseased individuals in small scale trials which can be single or double blind

A

Phase 2

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11
Q

Stage of drug trial where you look for efficacy in diseased individuals in large scale double blind trials

A

Phase 3

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12
Q

Stage of drug trial undergoing post-marketing surveillance

A

Phase 4

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13
Q

2 Agents used to acidify urine

A

NH4Cl and high dose vitamin C

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14
Q

2 agents used to alkalinize urine

A

NaHCO3 and acetazolamide

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15
Q

Inducers of p450

A

phenobarbital (barbituates), rifampin, phenytoin, carbamazepine, St. John’s wort, chronic ethanol inoxication

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16
Q

Inhibitors of p450

A

Erythromycin, ketoconazole, quinidine, cimetidine, chloramphenicol, grapefruit, Acute ethanol intoxication

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17
Q

Intracellular volume makes up what fraction of TBW

A

2/3

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18
Q

Extracellular volume makes up what fraction of TBW

A

1/3

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19
Q

Interstitial volume makes up what fraction of extracellular volume?

A

2/3

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20
Q

Plasma volume makes up what fraction of the extracellular volume

A

1/3

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21
Q

A competitive antagonist does what to the potency and maximal response of the agonist?

A

Decreases potency and does not change maximal response (causes a parallel right shift in dose/response curve)

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22
Q

A noncompetitive antagonist does this to the potency and maximal response of the agonist?

A

Potency does not change

maximal response decreases (causes a non-parallel shift to the right on dose/response curve)

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23
Q

give 2 drugs that are examples of potentiators

A

Benzos and barbituates potentiate the effect of GABA on its receptor

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24
Q

How do you calculate therapeutic index?

A

LD50/ED50

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25
Q

High yield drugs to be aware of with a narrow therapeutic index

A

Warfarin, digoxin, lithium, phenytoin, valproic acid, theophylline, carbamazepine, levothyroxine

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26
Q

Bacteria that become resistant to vancomycin change their D-ala D-ala terminus to what?

A

D-ala D-lactate

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27
Q

Vancomycin typically only treats these types of infections (think broad here)

A

Gram positive organisms

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28
Q

Does vancomycin have good oral bioavailability?

A

No! Usually only given orally for C. diff infections because it stays in the GI tract (poorly absorbed from there)

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29
Q

Biggest side effect of vancomycin and how you treat it

A

“red man” syndrome due to histamine; treat by slow infusion and giving an antihistamine

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30
Q

This antibiotic is only given topically due to its severe nephrotoxicity. It inhibits phosphorylation/dephosphorylation cycling of lipid carriers that transfer peptidoglycan to cell wall

A

Bacitracin

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31
Q

What compound do sulfonamides antagonize?

A

PABA (para-amino benzoic acid)

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32
Q

MOA of sulfonamides

A

Structural analogs of PABA which inhibit dihydropteroate synthase. Stops the 1st step in synthesis of tetrahydrofolic acid

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33
Q

Adverse effects of sulfonamides

A

N/V, phototoxixity, HEMOLYSIS IN G6PD DEFICIENT

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34
Q

Why are sulfonamides contraindicated in neonates?

A

They displace bilirubin from albumin causing kernicterus.

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35
Q

Prototype of the sulfonamide drugs

A

sulfamethoxazole

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36
Q

Antibiotics that work synergystically with sulfonamides by preventing the next step in folate synthesis

A

Trimethoprim or pyrimethamine

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37
Q

MOA trimethoprim

A

Competitive inhibitor of dihydrofolic acid reductase

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38
Q

adverse effects of trimethoprim

A

Leukopenia, granulocytopenia, thrombocytopenia, megaloblastic anemia

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39
Q

The trimethoprim/sulfamethoxazole combo (TMP/SMX) is used mostly for these 2 types of infections

A

UTI and URI

used as prophylaxis/tx in Pneumocystis jirrovechi

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40
Q

What is premarin used for?

A

vasomotor symptoms assoc with menopause; vulvar and vaginal atrophy and abnormal uterine bleeding

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41
Q

What are the therapeutic uses of estrogen?

A

Contraception, hormone replacement therapy, female hypogonadism, dysmenorrhea, acne, osteoporosis

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42
Q

How do estrogens affect serum lipids?

A

Increased triglycerides and HDL

Decrease LDL

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43
Q

How is estrogen useful in preventing osteoporosis?

A

Decreases bone resorption

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44
Q

What are the adverse effects of estrogen?

A

N/V, headache, breast tenderness, endometrial hyperplasia, cholestasis, increased coagulation, endometrial cancer risk, increased breast cancer risk

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45
Q

Estrogen is contraindicated in which settings?

A

History of DVT, PE, recent MI or stroke, Breast cancer, pregnancy, hepatic dysfunction

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46
Q

Why does estrogen work as a contraceptive?

A

Suppresses ovulation

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47
Q

Fertility drug that is an antiestrogen; it induces ovulation by shutting down negative feedback to hypothalamus thus increasing FSH and LH. Biggest side effect is multiple births and hot flashes

A

Clomiphene

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48
Q

Therapeutic uses of progestins

A

contraception, HRT w/ estrogens, control of uterine bleeding, dysmenorrhea, suppression of postpartum lactation, endometriosis

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49
Q

Adverse effects of progestins

A

edema, depression, glucose intolerance, acne, hirsutism, breakthrough bleeding, decreased HDL and increased LDL

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50
Q

Progesterone antagonist used for abortion, adverse effects are cramping, bleeding, infection, ectopic pregnancy

A

Mifepristone RU486

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51
Q

How do progestins work as contraceptives?

A

prevents implantation to endometrium, increases thickness of cervical mucus

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52
Q

Two SERMS (selective estrogen receptor modulator)

A

Raloxifene and Tamoxifen

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53
Q

What is raloxifene used for?

A

prevent and tx postmenopausal osteoporosis by acting as an estrogen agonist in bone (antagonist in breast and uterus)

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54
Q

What is tamoxifen used for?

A

Breast cancer; acts as an estrogen antagonist in the breast (partial agonist in uterus thus increasing endometrial cancer risk)

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55
Q

suffix of floroquinolone antibiotics

A

-floxacin

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56
Q

Why are floroquinolone abx contraindicated in kids?

A

They hinder cartilage development, causing tendon rupture

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57
Q

4 main classes of beta lactam antibiotics

A

Penicillins, Cephalosporins, Carbapenems, Monobactams

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58
Q

Most common mechanism for beta lactam resistance

A

Beta lactamases which cleave the B lactam ring

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59
Q

Which class of Beta lactams is resistant to Beta Lactamases?

A

Monobactams

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60
Q

Most common example of a monobactam

A

Aztreonam

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61
Q

In the treatment of enterococcal and pseudomonal infections, penicillins are synergistic with what other class?

A

Aminoglycosides (penicillins alter the cell wall so they can enter)

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62
Q

3 Beta lactamase inhibitors that can be used with penicillins

A

Clavulanate, sulbactam, tazobactam

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63
Q

First generation cephalosporins (5)

A

Cefazolin, cephalexin, cefadroxil, cephapirin, cephadrine

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64
Q

Second generation of cephalosporins are different from 1st in what way?

A

Increased gram negative coverage

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65
Q

Second generation cephalosporins (5)

A

Cefuroxime, cefotetan, cefaclor, cefoxitin, cefprozil

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66
Q

How are 3rd generation cephalosporins different than 2nd?

A

Continued gram negative coverage and better able to cross BBB

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67
Q

Third generation cephalosporins (3)

A

Cefotaxime, Ceftazidime, Ceftriaxone

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68
Q

How are 4th generation cephalosporins different than 3rd/

A

increased beta lactamase resistance

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69
Q

Only representative drug of 4th generation cephalosporins

A

Cefepime

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70
Q

What is the mechanism of action of aminoglycosides?

A

Bind to 30s ribosomal subunit to prevent formation of the initiation complex, incorporating incorrect amino acids in the peptide chain

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71
Q

Examples of aminoglycosides (5)

A

Gentamycin, tobramycin, streptomycin, amikacin, neomycin

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72
Q

Side effects of aminoglycosides

A

Nephrotoxicity (ATN) and ototoxicity

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73
Q

Mechanism of action of clindamycin

A

Binds 50s ribosomal subunit to inhibit translocation of t-RNA from acceptor site to donor site

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74
Q

Major adverse effect of clindamycin

A

C. diff

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75
Q

MOA of macrolides

A

Binds to 50s subunit to inhibit translocation of t-RNA (like clindamycin)

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76
Q

Examples of macrolide antibiotics (3)

A

Erythromycin, Azithromycin, Clarithromycin

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77
Q

Why is 1 dose of Azithromycin just as effective of a 7 day course of doxycycline for treating chlamydia?

A

Azithro has a very long half life (68 hrs)

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78
Q

MOA of tetracyclines

A

Binds to 30s subunit to inhibit attachment of aminoacyl t-RNA to its acceptor site

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79
Q

What is the tetracycline demeclocycline used for?

A

SIADH because it inhibits ADH receptors in the collecting ducts

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80
Q

Some adverse effects of tetracyclines

A

Phototoxicity, hepatotoxicity, vestibular toxicity

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81
Q

Why are tetracyclines contraindicated in kids?

A

Tooth enamel dysplasia, permanent tooth discoloration, decreased bone growth via chelation with calcium salts

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82
Q

Oral absorption of tetracyclines can be impaired by what 4 minerals?

A

Iron, calcium, magnesium, aluminum

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83
Q

MOA of chloramphenicol

A

binds 50s subunit and inhibits peptidyl transferase

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84
Q

Adverse effects of chloramphenicol

A

Grey baby syndrome (ashen appearance, hypotension, vomiting, flaccidity)
Aplastic anemia

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85
Q

MOA of linezolid and what does it treat?

A

Binds 50s subunit and prevents formation of the initiation complex
treats MRSA and VRSA

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86
Q

MOA of rifampin

A

Inhibits DNA dependent RNA polymerase

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87
Q

MOA of isoniazid

A

inhibits mycolic acid synthesis

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88
Q

Adverse effects of rifampin

A

Red discoloration of tears, sweat and urine
hepatitis, elevated LFT’s
thrombocytopenia

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89
Q

Adverse effects of Isoniazid

A 
Drug induced SLE
Peripheral neuropathy (give B6!)
hemolytic anemia in G6PD deficiency
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90
Q

Adverse effect of pyrizinamide

A

Phototoxicity, hepatitis, arthralgias

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91
Q

Adverse effects of ethambutol

A

red-green color bliindness, optic neuritis, decreased visual acuity

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92
Q

2 Polyene antifungals that bind to ergosterol and disrupt membrane permeability.

A

Amphotercin B and nystatin. (amphotercin B must be given intrathecally for CNS infections)

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93
Q

Mechanism of action of the -azole antifungals

A

Prevent synthesis of ergosterol by inhibiting cyp 450 dependent demethylation

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94
Q

Adverse effect of ketoconazole also associated with spironolactone

A

gynecomastia

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95
Q

The absorbtion of ketoconazole is increased by what and decreased by what?

A

Increased by phosphoric acid (colas) and decreased by antacids.

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96
Q

What will happen to the INR of a patient on warfarin who goes on an -azole?

A

Increased INR because azoles inhibit p450, decreasing the metabolism of warfarin and increasing blood levels.

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97
Q

antifungal only active against dermatophytes that deposits in newly formed keratin and disrupts the microtubule structure

A

griseofulvin: AE= hepatotoxicity

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98
Q

viral enzyme that adds phosphate to acyclovir to make it active

A

viral thymidine kinase

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99
Q

MOA of acyclovir

A

competes for viral polymerase, incorporated into viral DNA and terminates the chain

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100
Q

DOC for acyclovir-resistant HSV and VZV and ganciclovir-resistant CMV

A

Foscarnet (pyrophosphate analogue that inhibits viral RNA and DNA polymerase)

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101
Q

Amantidine is the DOC for what virus?

A

Influenza A only

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102
Q

Amantidine is used in what non-infectious disease process?

A

Parkinson Disease, drug induced extra-pyramidal symptoms, increases dopammine levels

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103
Q

Neuraminidase inhibitors that treat Influenza A and B

A

Zanamivir and Oseltamivir

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104
Q

Ribavirin is the DOC in what virus and what is its black box warning?

A

Treats RSV in infants but it is Pregnancy category X and extremely teratogenic

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105
Q

List the NRTI’s, and their main adverse effect

A

Zidovudine (AZT), Stavudine, Lamivudine, Didanosine, Abacivir and Emtricitabine. Main adverse effect is lactic acidosis.

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106
Q

If hypersensitivity is suspected, which NRTI should you immediately stop and never use again?

A

Abacavir

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107
Q

Antiretroviral agent that can cause Fanconi syndrome?

A

Tenofovir

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108
Q

NNRTI that causes abnormal dreams, impaired concentration and dizziness

A

Efavirenz

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109
Q

MOA is inhibiting fusion of HIV 1 and CD4 by blocking gp41 required for entry

A

Enfurvitide

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110
Q

Examples of protease inhibitors and major adverse effects

A

Atazanavir, lopinavir, ritonivir. Adverse effects are hepatotoxicity and fat redistribution

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111
Q

MOA of metronidazole and adverse effects

A

inhibit protein synthesis and cause DNA strand breakage. Adverse effects are N/V, disulfram reaction

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112
Q

Drug of choice for relapsing forms of Plasmodium vivax and ovale

A

Primaquine (causes hemolytic anemia in G6PD def patients)

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113
Q

Adverse effect of quinidine

A

Cinchonism

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114
Q

DOC for trematode (fluke) infections

A

Praziquantel

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115
Q

DOC for nematode (roundworm) infections

A

Mebendazole/Albendazole or Pyrantel Pamoate

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116
Q

DOC for African river blindness (Onchocerca volvulus)

A

Ivermectin

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117
Q

Toxicity of Doxorubicin and how you prevent it

A

Dilated Cardiomyopathy, prevent with Dexrazoxane

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118
Q

Toxicity of Bleomycin

A

pulmonary fibrosis

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119
Q

Toxicity of Cyclophosphamide and how you prevent it

A

Hemorrhagic cystitis and prevent with Mesna

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120
Q

Toxicity of Cisplatin

A

Nephrotoxic and prevent with Amifostene

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121
Q

Toxicity of vincristine

A

peripheral neuropathy

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122
Q

Drug used to prevent megaloblastic anemia in patients taking Methotrexate

A

Leucovorin, replenished folic acid in normal cells

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123
Q

6 MP levels are increased in patients also taking this drug

A

Allopurinol. 6 MP is metabolized by xanthine oxidase.

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124
Q

MOA of Vincristine/Vinblastine

A

Vinca alkaloids that inhibit polymerization of tubulin so microtubules cannot form

125
Q

MOA of Paclitaxel

A

Binds to tubulin and stabilizes the microtubule, preventing depolymerization.

126
Q

Neuronal release of Acetylcholilne into the synapse is inhibited by what toxin?

A

Botulism

127
Q

Muscarinic receptor located on heart

A

M2 (Gi coupled, inhibits cAMP)

128
Q

Muscarinic receptor located on smooth muscle, glands, GI tract, eye, bladder.

A

M3 (Gq coupled, IP3/DAG)

129
Q

Effect of Ach on the eye

A

Contracts the ciliary muscle to increase accomodation, contracts the circular muscle of the iris to constrict the pupil.

130
Q

Examples of muscarinic agonists

A

Bethanechol (urinary retention), carbachol, pilocarpine (both for lowering IOP in glaucoma)

131
Q

Reversible Acetylcholinesterase inhibitors

A

Neostigmine, pyridostigmine, physostigmine, edrophonium, rivastigmine, donezipil, galantamine (these last 3 cross the BBB and are used to increase acetylcholine levels in the brain in Alzeheimer’s)

132
Q

Short acting AChE inhibitor used to diagnose Myasthenia Gravis

A

Edrophonium (tensilon)

133
Q

What do you give for an Atropine overdose?

A

Physostigmine

134
Q

Examples of IRREVERSIBLE Acetylcholinesterase inhibitors

A

Echothiophate, sarin, malathion, parathion (Organophosphates)

135
Q

Drugs used to treat Organophosphate poisoning

A

Atropine and Pralidoxime. Atropine binds the muscarinic receptors and outcompetes the ACh. Pralidoxime reactivates inhibited AChE.

136
Q

What plant does Atropine come from?

A

Belladonna, “deadly nightshade”. Previously used to make girls look pretty by dilating their eyes and flushing their cheeks.

137
Q

Therapeutic indication of Scopalamine

A

Motion sickness

138
Q

Anticholinergic agents used to treat asthma and COPD

A

Ipratropium and tiotropium

139
Q

Most commonly used Neuromuscular blocking drug

A

Succinylcholine. Used for endotracheal intubation because its fast onset and short duration.

140
Q

Adverse effect of succinylcholine

A

Malignant hyperthermia (rigidity, increased CO2, tachycardia and hyperthermia)

141
Q

Tx malignant hyperthermia

A

Dantrolene - inhibits calcium release from the SR of muscle cells, relaxing tone and reducing heat production.

142
Q

MOA of reserpine

A

inhibits the transport of Norepi from the cytoplasm into the synaptic vesicles.

143
Q

How does cocaine increase Norepi levels in the synaptic cleft?

A

inhibits the reuptake of Norepi back into the presynaptic neuron.

144
Q

examples of alpha 2 agonists

A

Clonidine and alpha methyldopa

145
Q

What is dobutamine used for?

A

Increases cardiac output in CHF without affecting the renal blood flow.

146
Q

Drugs used for alpha blockade before and during removal of a pheochromocytoma

A

Phentolamine and phenoxybenzamine

147
Q

selective alpha 1a antagonist used to treat BPH that has less cardio side effects than traditional alpha 1 antagonist

A

Tamulosin (less reflex tachycardia)

148
Q

mixed alpha1/beta antagonists

A

Carvedilol and labetalol

149
Q

Beta blockers with Intrinsic sympathomimetic activity

A

Acebutolol and pindolol

150
Q

why are beta blockers used with caution in diabetics?

A

they can mask the symptoms of hypoglycemia

151
Q

IFN alpha is used to treat what?

A

Chronic Hepatitis C (with ribavirin), Chronic Hep B, melanoma

152
Q

IFN beta is used to treat what?

A

MS

153
Q

DOC for H. pylori ulcer

A

PPI and 2 antibiotics (Clairthromycin and amoxicillin) If initial therapy fails, give PPI, bismuth sulfate, tetracycline and metronidazole.

154
Q

DOC for acute variceal bleeding

A

Octreotide (somatostatin) decreases portal pressure and splanchnic flow. Next step in therapy is band ligation if this doesn’t work. Also used to treat acromegaly, carcinoid syndrome and glucagonoma.

155
Q

DOC for hepatic encephalopathy

A

lactulose: lowers pH of the bowel and changes ammonia to ammonium which is excreted.

156
Q

drug used to prevent recurrent variceal bleeding

A

propranolol

157
Q

DOC for diabetic gastroparesis

A

Erythromycin or metoclopramide

158
Q

Initial therapy for Crohn disease

A

mesalamine derivatives which best deliver 5-ASA to the affected area. (Asacol, Pentasa, Sulfasalazine). If it is not controlled, add the oral steroid budesonide or azahioprine.

159
Q

1st line tx for Barrett esophagus

A

PPI

160
Q

elevated liver enzymes, antimitochondrial antibodies point to Primary Biliary Cirrhosis which is best treated with what?

A

Ursodeoxycholic acid

161
Q

Halothane, Nitrous oxide and Isoflurane are examples of what type of anesthetic?

A

Inhaled

162
Q

What do inhaled anesthetics do to the cerebral vascular flow?

A

increase the flow

163
Q

Which inhaled anesthetic is most closely associated with malignant hyperthermia?

A

Halothane (it also slows the heart rate)

164
Q

Propofol, Ketamine, Fentanyl, Midazolam, Thipoental and Etomidate are examples of what type of anesthetic?

A

IV

165
Q

Type of amnesia caused by midazolam

A

Anterograde amnesia

166
Q

If you are allergic to these 2 foods, you cant have Propofol

A

Eggs and Soy

167
Q

What type of amnesia is caused by Ketamine?

A

Dissociative amnesia (also vivid dreams and hallucinations)

168
Q

IV anesthetic with antiemetic properties

A

Propofol

169
Q

Examples of Amide local anesthetics

A

Lidocaine, Buprivicane, prilocaine, Mepivacaine (Amide locals all have 2 i’s)

170
Q

Examples of Ester local anesthetics

A

Cocaine, Benzocaine, Procaine (Ester locals have 1 i)

171
Q

What do opioids do to the pupils?

A

Constrict them - except Meperidine. (common sign of overdose)

172
Q

Opioid analgesic used to prevent withdrawal symptoms in patients discontinuing heroin

A

Methadone. Also clonidine, a central alpha 2 agonist can help.

173
Q

What do Benzodiazepines do to the chloride ion channels?

A

Increase the frequency they are open

174
Q

What do Barbituates do to the chloride ion channels?

A

Increase the duration they are open

175
Q

Which Benzodiazepine is also known as the “date rape drug?”

A

Flunitrazepam (rohypnol)

176
Q

Longest acting Benzodiazepine

A

Diazepam (valium)

177
Q

Adverse effects of benzodiazepines

A

Cnfusion, sedation, ataxia, cognitive impairment, amnesia, respiratory depression

178
Q

What is phenobarbital commonly used to treat?

A

Generalized tonic clonic and partial seizures

179
Q

Barbituates cause a lot of drug-drug interactions because they do this to P-450

A

Induce it

180
Q

Adverse effects of barbituates

A

Sedation, impaired cognition, nausea, dizziness, increased heme synthesis, coma, respiratory depression, cardiovascular depression, addiction

181
Q

Drug class used to prevent barbituate withdrawal

A

long acting benzos

182
Q

Partial agonist at 5-HT 1A receptors, effective in treating generalized anxiety disorder

A

Buspirone

183
Q

Mechanism of action of MAO inhibitors and 3 examples

A

Inactivate MAO therefore increasing levels of Serotonin, dopamine and Norepi in presynaptic neurons. Examples are Phenelzine, Isocarboxazid, and Tranylcypromide (treat atypical depression)

184
Q

What life threatening event can happen if you take an MAOI with an SSRI?

A

Serotonin syndrome (rigidity, diaphoreis, hyperthermia, seizures, myoclonus)

185
Q

MOA of Tricyclic (amitryptyline, doxepin, clomipramine and imipramine

A

Inhibits reuptake of 5HT and NE into presynaptic neurons and increase their levels in the synaptic cleft

186
Q

TCA used to prevent nocturnal enuresis

A

imipramine

187
Q

Adverse effect of TCA’s and how you treat its toxicity

A

Xerostomia, blurry vision, urinary retention, cardiac arrhythmias, seizures, sedation. Treatment of toxicity is Sodium Bicarb, activated charcoal to absorb from the GI and phenytoin for the seizures

188
Q

What is the biggest adverse effect with Trazodone?

A

Priaprism

189
Q

MOA of Buproprion

A

inhibits DA, 5HT and NE reuptake. Used in smoking cessation and OCD.

190
Q

What class of drugs is Duloxetine (cymbalta) and Venlafaxine (effexor)?

A

SNRI (inhibits reuptake of only serotonin and norepi)

191
Q

Which class of drugs is Fluoxetine (prozac), Paroxetine (paxil), Sertraline (zoloft), Citalopram (celexa), Escitalopram (lexapro)?

A

SSRI
(sorry for the trade names if you’re studying this but it helps me remember the classes)
(only affects serotonin reuptake)

192
Q

Fluoxetine is used in these other clinical settings? (3)

A

Bulimia, panic disorder, PMDD

193
Q

Adverse effects of SSRI’s (3)

A

Sexual dysfunction, agitation, anxiety

194
Q

SSRI FDA approved for PTSD, social anxiety disorder

A

Paroxetine

195
Q

DOC for treating Bipolar disorder (manic-depression)

A

Lithium

196
Q

Adverse effects of lithium (7)

A

Acne, seizures, ataxia, visual disturbances, Drug induced nephrogenic diabetes insipidus, hypothyroidism, tremor

197
Q

Drug to treat lithium induced nephrogenic DI

A

Amiloride (normally you give Thiazide diuretics for nephrogenic DI but not for lithium induced)

198
Q

What enzyme does lithium inhibit to cause hypothyroidism?

A

5-deiodinase

199
Q

Congenital heart defect associated to babies born to mothers taking lithium

A

Ebstein anomaly (malformation of tricuspid valve)

200
Q

Other medications (mood stabilizers) that can be used to treat bipolar disorder (5)

A

Carbamazepine, valproic acid, benzos, gabapentin, topiramate

201
Q

MOA of “typical” antipsychotics

A

inhibition of D2 receptors in mesolimbic system

202
Q

MOA of “atypical” antipsychotics

A

Inhibition of 5-HT2 receptors

203
Q

Examples of typical antipsychotics (4)

A

Haloperidol, chloropromazine, thioridazine, fluphenazine

204
Q

Examples of atypical antipsychotics (4)

A

Clozapine, risperidone, olanzapine, quietapine

205
Q

Medications used to treat antipsychotic-induced EPS (2)

A

Benztropine, amantidine

206
Q

How do antipsychotics cause prolactinemia?

A

Inhibit Dopamine receptors in the anterior pituitary leading to unapposed prolactin

207
Q

What is a potential life threatening adverse effect of antipsychotics?

A

Neuroleptic malignant syndrome. (Hyperthermia, rigidity, altered mental status, cardiovascular instability)

208
Q

Treatment for Neuroleptic malignant syndrome

A

Dantrolene and Bromocriptine

209
Q

2 antimuscarinic drugs used in the treatment of Parkinson’s (decrease acetylcholine)

A

Benztropine and Trihexyphenidyl

210
Q

MAOb inhibitor used as a first line treatment in PD

A

Selegline (inhibits Dopamine metabolism in presynaptic neurons)

211
Q

MOA of tolcapone and entacapone

A

Inhibit peripheral COMT thereby increasing the CNS uptake of L-dopa

212
Q

MOA of carbidopa

A

Inhibits peripheral dopa-decarboxylase thereby increasing the amount of L-dopa available to CNS, allowing for lower doses of Levodopa needed.

213
Q

What dietary restrictions should a patient on levodopa have?

A

Low intake of leucine and isoleucine (compete in GI for absorption) and no Vit B6 (pyridoxine) supplements because it enhances peripheral metabolism of levodopa.

214
Q

MOA of phenytoin

A

Inhibit axonal sodium channels in the inactivated state to produce membrane stabilization

215
Q

Adverse effects of phenytoin

A

Diplopia, ataxia, gingival hyperplasia, Steven Johnson, Nystagmus and teratogenic causing cleft lip and palate

216
Q

Congenital defects caused by carbamazepine

A

Neural tube defects and craniofacial abnormalities

217
Q

MOA of valproic acid

A

Inhibits axonal sodium channels and T type Calcium channels

218
Q

Adverse effects of Valproic acid

A

Hepatotoxic, pancreatitis, photosensitivity, tinnitus, alopecia neural tube defects

219
Q

Antiepileptic safe to treat partial and tonic-clonic seizures in pregnancy

A

Phenobarbital

220
Q

Newer antiepileptic also used in migraines and neuropathic pain that inhibits carbonic anhydrase

A

topiramate (inhibits glutamate AMPA receptors and increases GABA effects)

221
Q

MOA of Sumatriptan

A

5-HT 1D agonist which causes vasoconstriction in cranial arteries (don’t use in angina patients)

222
Q

Class 1a antiarrhythmics (3)

A

quinidine, procainamide, disopyramide

223
Q

class 1b antiarrhythmics (3)

A

Lidocaine, mexiletine, phenytoin

224
Q

Class 1c antiarrhythmics (2)

A

Flecainide, propafenone

225
Q

Class II antiarrhythmics (class)

A

Beta blockers (propranolol, esmolol)

226
Q

Class III antiarhythmics (3)

A

Amiodarone, sotalol, dofelitide

227
Q

Class IV antiarrhythmics (2)

A

Verapamil and diltiazem

228
Q

3 antiarrhythmic drugs that do not fit into this classification

A

Adenosine (SVT, PSVT), digoxin (A-fib and flutter), magnesium (TdP)

229
Q

Drugs that can cause Drug induced Lupus

A

Procainamide, Hydralazine, Isoniazid, sulfasalazine, methyldopa

230
Q

What type of arrhythmia is lidocaine useful in?

A

Ventricular. Does not treat atrial.

231
Q

Pulmonary fibrosis, arrhythmias, Hypo/hyperthyroidism, SIADH, optic neuritis, hepatotoxicity, blue skiin discoloration are all side effects of what antiarrhythmic?

A

Amiodarone

232
Q

What type of arrhythmia should verapamil never be given in?

A

WPW syndrome because it causes an AV block leading to unopposed accessory pathway

233
Q

What effects does digoxin have on contractility, heart rate and AV conduction velocity?

A

Increases contractility, Decreases rate and conduction velocity

234
Q

adverse effects of digoxin

A

arrhythmias, blurred vision, haloes around light sources, n/v/ha

235
Q

Drugs that can increase digoxin concentration

A

Quinidine, amiodarone, erythromycin, verapamil

236
Q

Drugs that can decrease digoxin concentrations

A

diuretics, steroids

237
Q

2 Beta blockers with specific indications for CHF

A

Metoprolol and Carvedilol (mixed alpha/beta blocker)

238
Q

What will thiazide diuretics do to the serum calcium?

A

Increase it.

239
Q

What do loop diuretics do to serum calcium?

A

Decrease it

240
Q

Adverse effects of Thiazides (7)

A

Hypercalcemia, hyperuricemia, hypokalemia, alkalosis, hyperlipidemia, hypomagnesmia, hyperglycemia

241
Q

Adverse effects of loop diuretics (6)

A

Hypocalcemia, hypokalemia, hypomagnesimia, alkalosis, hyperuricemia, ototoxicity

242
Q

MOA of carbonic anhydrase inhibitors

A

increases excretion of sodium and bicarbonate (used to treat altitude sickness and glaucoma)

243
Q

Adverse effects of beta blockers (6)

A

Hypotension, lipid abnormalities, rebound HTN upon withdrawal, sexual dysfunction, fatigue, hyperglycemia, depression

244
Q

Adverse effects of ACE inhibitors

A

Hypotension, dry cough, angioedema, hyperkalemia

245
Q

ACE inhibitors are contraindicated in what 2 settings?

A

Pregancy and bilateral renal artery stenosis

246
Q

Adverse effects in CCB’s (block L type Ca channels)

A

Headache, constipation, (reflex tachy and peripheral edema in DHP’s and AV block in NDHP’s)

247
Q

Adverse effects of statins

A

Increased LFT’s, rhabdomyolysis, myalgia, contraindicated in pregnancy

248
Q

Drug used to increase HDL

A

Niacin (b3-nicotinic acid)

249
Q

Drug used to mainly decrease Triglycerides

A

fibrates (activate lipoprotein lipase) can cause cholelithiasis

250
Q

Drugs that inhibit platelet aggregation by blocking ADP receptors (2)

A

Clopidogrel and Ticlopidine

251
Q

MOA of heparin

A

Binds to antithrombin III to inactivate intrinsic system of clotting cascade. Measure heparin by the PTT

252
Q

Drug that selectively inhibits factor Xa

A

Fondaparinaux

253
Q

MOA of Warfarin

A

inhibits synthesis of vitamin K dependent clotting factors II, VII, IX and X, protein C and S (extrinsic system, measure by PT/INR)

254
Q

MOA of abciximab, tirofiban and epifibatide

A

Blocks glycoprotein IIb/IIIa thus inhibiting platelet aggregation

255
Q

Drug that can counteract TPA

A

Aminocaproic acid

256
Q

How do corticosteroids treat asthma?

A

decrease production and release of cytokines, decrease vascular permeability, decrease mucus production, decrease inflammatory cell activation, recruitment and infiltration

257
Q

How do mast cell stabilizers treat asthma? (cromolyn)

A

prevent mast degranulation, decreasing release of histamines and leukotrienes

258
Q

How do 5-lipoxygenase inhibitors treat asthma? (Zileuton)

A

inhibits leukotriene production from arachodonic acid, preventing bronchoconstriction

259
Q

1st line for COPD treatment

A

Inhaled anticholinergics (ipratropium)

260
Q

DOC for cough suppression

A

Dextramethorphan (no analgesia or addiction)

261
Q

medications that can be used to accelerate fetal lung maturity

A

Glucocorticoids, TRH

262
Q

How does N-acetylcysteine reduce accumulation of viscous mucus in CF patients?

A

breaks disulfide bonds in mucoproteins thereby lowering viscosity

263
Q

MOA of metoclopramide

A

D2 antagonist that increases LES pressure and accelerates gastric emptying in GERD treatment
Also blocks centrally in the CTZ to act as an antiemetic

264
Q

Adverse effects of PPI’s

A

bacterial overgrowth in GI, association with hip fractures

265
Q

3 mediators that can stimulate gastric acid secretion from parietal cells

A

Gastrin, Acetylcholine, Histamine

266
Q

Treatment of NSAID induced peptic ulcers

A

Prostaglandins (because they also stimulate secretion of bicarb and mucus to protect the lining) (misoprostol)

267
Q

Sulfasalazine (aminosalicyclate) is cleaved by colonic bacteria into what 2 compounds?

A

Sulfapyridine (antibiotic) and Mesalamine (5-ASA)

268
Q

5-ASA is first liine in treating what?

A

IBD

269
Q

MOA of infliximab (which treats IBD)

A

binds to TNF alpha

270
Q

MOA of Odansetron, dolasetron, granisetron

A

5-HT3 receptor antagonists

271
Q

Other than blood glucose regulation, insulin can be used to treat what?

A

Hyperkalemia because it causes K to move into cells.

272
Q

MOA and side effects of sulfonylureas (tolbutamide, glyburide, glimerpiride)

A

Block ATP dependent K channels which depolarizes beta cells causing a calcium mediated insulin release. Adverse effects are hypoglycemia and weight gain.

273
Q

MOA and side effects of Thiazolidinedones (rosiglitazone, pioglitazone)

A

Bind to PPAR gamma which increases sensitivity to insulin and upregulates insulin receptors. Side effects are edema, CHF, weight gain, hepatotoxicity, bone fractures.

274
Q

MOA and side effects of biguanides (metformin)

A

Decrease hepatic gluconeogenesis and increase sensitivity to insulin. Adverse effects are diarrhea, lactic acidosis and decreased B12

275
Q

MOA and side effects of alpha glucosidase inhibitors (Acarbose and miglitol)

A

Inhibit intestinal amylase and alpha glucosidase, delaying carbohydrate breakdown and glucose absorbtion. (only good for postprandial) Side effects are flatulence, bloating and cramping

276
Q

Drug with positive inotrope and chronotrope activity used to stimulate the heart during Beta Blocker overdose

A

Glucagon

277
Q

What are some drugs that can cause Nephrogenic Diabetes insipidus?

A

Lithium, demeclocycline, vincristine, amphotercin B

278
Q

DOC for central DI

A

Desmopressin (DDVAP)

279
Q

SE of desmopressin

A

Water intoxication, hyponatermia, headache

280
Q

DOC for SIADH

A

demeclocycline

281
Q

DOC for hyperthyroidism

A

PTU and methimazole; PTU in pregnancy

282
Q

Drug used to diagnose adrenal insufficiency

A

ACTH (cosyntropin)

283
Q

Which drug inhibits glucocorticoid synthesis by inhibiting 11 hydroxylase?

A

Metyrapone

284
Q

Antifungal that can also be used to lower cortisol levels in cushings disease and could cause gynecomastia

A

Ketoconazole

285
Q

Androgen receptor blocker that is used in the treatment of prostate cancer

A

Flutamide

286
Q

MOA of clomiphene

A

induces ovulation by inhibiting negative feedback of estrogen on the hypothalamus and pituitary leading to more LH and FSH release

287
Q

MOA of tamoxifen

A

Estrogen agonist in bone and uterus, estrogen antagonist in breast (used for breast cancer)

288
Q

Difference between tamoxifen and raloxifene

A

Raloxifene is an antagonist in the uterus and does not cause endometrial hyperplasia and increase endometrial cancer risk

289
Q

PGE1 analog used for impotence

A

Alprostadil

290
Q

PGF2a analogs promoting bronchiolar and uterine smooth muscle contraction

A

Carboprost and dinoprost

291
Q

PGI2 analog (prostacyclin) that is used for pulmonary HTN

A

Epoprostenol

292
Q

MOA of acetamminophen

A

inhibits prostaglandins via COX 3 in CNS

293
Q

Metabolite of acetaminophen that is hepatotoxic

A

NAPQI; gluthianone is responsible for its removal

294
Q

3 medications known to cause gingival hyperplasia

A

Cyclosporine, Phenytoin, Nifedipine

295
Q

MOA of cyclosporine

A

complexes with cyclophilin to inhibit calcineurin which decreases IL-2 thereby T cell activation

296
Q

MOA of tacrolimus

A

Inhibits calcineurin by binding to FK binding protein, also inhibiting IL-2

297
Q

Immunosuppressant that acts by inhibiting inosine monophosphate dehydrogenase thereby inhibiting de novo guanine synthesis

A

Mycophenolate mofetil

298
Q

Why was the weight loss drug fen-phen taken off the market?

A

Pulmonary HTN

299
Q

suffix of bisphosphonate drugs

A

-dronate

300
Q

MOA of bisphosphonates

A

Inhibition of osteoclast mediated resorption of bone

301
Q

MOst common side effect of allopurinol

A

Skin rash

302
Q

Treatment of acute gout

A

Colchicine and an NSAID

303
Q

MOA of isotretinoin (accutane)

A

decreases sebaceous gland size and decreases sebum production

304
Q

antidote for arsenic, gold, alopecia, lead and mercury

A

dimercaprol

305
Q

antidote for iron poisoning

A

deferoxamine

306
Q

Signs and symptoms of arsenic poisoning

A

Rice water stools, seizures, pallor, skin pigmentation, stocking glove neuropathy

307
Q

Signs and symptoms of mercury poisoning

A

ataxia, hearing loss, visual loss, chest pain, renal failure, n/v

308
Q

Signs and symptoms of TCA poisoning

A

Hyperthermia, coma, convulsions, cardiotoxicity, dilation of pupils, constipation, prolonged QT

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