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Step1 > DIT Drugs and UWorld Drugs > Flashcards

DIT Drugs and UWorld Drugs Flashcards

1
Q

How symp drugs work

A

short preganglionic - AcH, long postganglionic - NE (into SC - then to multiple organs at once) NE R = Adrenergic R’s

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2
Q

A1

A

“aggressive alpha 1”
vascular smooth muscle contraction
Inc TPR/BP/bladder sphincter contraction, mydriasis

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3
Q

A2

A

Negative feedback of NE (onto presynaptic R)
Found: B cells (pancreas), some smooth muscle
decrease NE/insulin release
Tx - some HTN

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4
Q

B1

A

“think heart increase”

Tachycardia / Inc HR / Inc myocardial contract

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5
Q

B2

A

“Dilate everything!”
vasodilation (w resulting inc HR), bronchodilation
dec uterine tone

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6
Q

1 R type predominates body location:

vascular smooth muscle, heart, lungs

A

VSM: B2 > A1
Heart: B1
Lungs: B2

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7
Q

Sympathomimetics - Direct/Indirect

A

Direct - bind adrenergic R
Indirect - release of catecholamines from presynaptic
- inhibit uptake of catecholamines
E, NE, Albuterol/Levalbuterol/Salmeterol, DA, Dobutamine, Phenylephrine, Terbutaline

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8
Q

Epinephrine

A

Direct
A1, A2, B1, B2
Tx: anaphylaxis, severe croup, hypotension

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9
Q

NE

A

Direct
A1, A2, B1
Tx: hypotension, (#1 for) septic/cardiogenic shock (stop vasodilation)

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10
Q

Albuterol/Levalbuterol/Salemterol

A

Direct
B2 (strong), weak B1
asthma

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11
Q

DA

A

Direct
low dose - blood vessels, kidneys
med dose - B1, B2
high dose - A1, A2 “aggressive alpha”

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12
Q

Dobutamine

A

Direct
B1 > B2
stress test
tx: HF

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13
Q

Phenylephrine

A

Direct
A1 > A2
Pupillary dilation
Tx: Nasal decongestion

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14
Q

Terbutaline

A

Direct
B2 (strong), weak B1
(sometimes given subQ for asthma)
tx: bronchospasm, tocolysis (stop premature uterine contraction)

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15
Q

Amphetamines

A

Indirect - release cats

tx: narcolepsy, obesity, ADHD

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16
Q

Ephedrine

A

Indirect - release cats

tx: oral and nasal decongestion, urinary incontinence

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17
Q

Cocaine

A

Indirect - inhibit reuptake of cats

tx: ENT nasal decongestion, local anesthetic

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18
Q

Isoproterenol

A

B1, B2
Causes:
-increase CO
-increase dilation (decrease vascular resistance)

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19
Q

Clonidine

A

Direct
A2
tx: malignant HTN, sedative
SFx = sudden stop - rebound HTN

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20
Q

Sympathetic blockers

A

A nonselective, A1 selective, B nonselective, B1 selective, B1B2 weak agonists, A1/B1 blockers

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21
Q

Prazosin, Doxazosin, Terazosin

A

A1 selective blocker
tx: BPH (#1), HTN
Sfx: Postural hypotension, Reflex tachycardia,
Rebound HTN

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22
Q

Tamsulosin

A

A1(A,D) selective blocker (R only found in prostate)

tx: BPH without HTN

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23
Q

Phenoxybutamine (irrev binds), Phentolamine

A

non-selective A-blocker

tx: acute pheochromcytoma

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24
Q

Propanolol, Timolol, Nadolol

A

nonselective B blocker
Timolol, Nadolol (topical) - tx: Glaucoma
Propanolol - anxiety

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25
Q

Metoprolol, Atenolol, Esmolol, Nebivolol

A

Selective B1

(N)ebivolol - (N)O action, vasodilation of the periphery

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26
Q

Acebutolol, Pindolol

A

Weak B1B2 agonists (so weak = blockers)

treat patients with HTN + bradycardia

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27
Q

Carvedilol, Labetalol

A

A1/B1 blockers

tx: HTN + tachycardia

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28
Q

B blocker uses

A

HTN, CHF?, angina, MI, coronary artery disease, hyperthyroidism, thyroid storm, migraine prophylaxis, anxiety, SVT, glaucoma (vs aqueous humor),

  • *Tx Aortic Dissection (dec HTN and BP pulse)
  • don’t give to CHF exacerbation patients
  • don’t give for cocaine OD pts
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29
Q

B blocker SFx

A

Bronchospasm - asthma/COPD
Block hypoglycemic Sx - DM
Increase BP - cocaine user
Decrease myocardial contractility, AV block, bradycardia - CHF
abrupt stop: rebound tachycardia, rebound HTN, arrhythmia
*does not cause ED

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30
Q

A-methyldopa

A

tx: pregnancy induced HTN

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31
Q

Hemicholinium

A

Inhibit choline into pre-synapse for Ach

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32
Q

Vesamicol

A

Inhibit choline acetyltransferase / packaging

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33
Q

Black widow spider toxic

A

causes Ach release - spastic paralysis

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34
Q

Botulinum toxin

A

inhibits Ach release - flaccid paralysis (top down)

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35
Q

Metyrosine

A

Inhibits Tyrosine hydroxylase

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36
Q

Guanethidine, Bretylium (K+chan blocker vs arrhythmia)

A

Blocks NE release

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37
Q

Amphetamines, Ephedrine, Tyramine

A

causes NE release

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38
Q

Cocaine, TCAs, SNRIs

A

inhibit NE reuptake

ex: Amitriptyline (TCA)

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39
Q

Angiotensin R

A

causes NE release via presynaptic R

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40
Q

A2 agonist, M2 agonist

A

inhibits NE release via presynaptic R

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41
Q

Reserpine

A

inhibits NE packaging

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42
Q

Acetazolimide

A

tx: idiopathic intracranial hypertension, glaucoma, altitude sickness

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43
Q

Fomepizole

A

Inhibits - Alcohol dehydrogenase
Cure for methanol and ethylene glycol poisioning
Methanol is converted to formaldehyde (metabolic acidosis, retinal damage, blindness)
Ethylene glycol -> oxalic acid (metabolic acidosis, kidney dmg due to oxalate stones, CNS, heart, lung)

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44
Q

Disulfram

A

inhibits - acetylaldehyde dehydrogenase

Stop alcoholics from drinking (hypotension, flush, sweat, headache, n/v)

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45
Q

Disfulfram-like reactions

A 
metronidazole
some cephalosporins
sulfonureals
procarbazine (CA drug to treat HL)
**avoid alcohol while taking
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46
Q

P450 inducers

A

Guiness, Corona, PRBrs induce Chronic alcoholism

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47
Q

P450 inhibitors

A

CRACK AMIGOS

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48
Q

Treat acidic drug OD with…?

A

NaCO3 -> traps acidic drug (as proton) in urine

ex: salicylates) (ex: ASA - a weak acid

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49
Q

Treat basic drug OD with…?

A

NH4Cl -> traps basic drug (as proton) in urine

ex: amphetamines - a weak base

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50
Q

Indomethacin

A

Treat PDA (blocks PG synthesis)

51
Q

Anti-arrhythmics: overall mnemonic

A 
"No Bad Boy KeepsClean"
C1 = Na blockers       mnemonic
C2 = B-blockers        "-olol"
C3 = K blockers       *other*
C4 = Ca channel blockers    "only 2 D/V"
52
Q

AA - C1 - Na channel blockers - mnemonic

A

“Double Quarter Pounder, Mayo, Lettuce, Tomato, Fries, Please
myocytes, Phase 0, inc EPR and inc QT interval
1A: disopyramide, quinidine (SFx cinchonism, thrombocytopenia, torsades), procainamide (WPW, SFx SHIPP)
1B: mexiletine, tocainide, lidocaine (tx: acute VTach, digitalis arrhythmias, tachys-post MI)
1C: flecainide, propafenone (tx: VTach going to AFib, SFx: pro-arrhythmogenic)

53
Q

AA - C2 - B blockers

A

“-olol”
mech: dec cAMP, dec calcium currents
pacemaker cells, decrease phase 4 slope
propranolol, esmolol, metoprolol, atenolol, timolol
Tx: VTach, SVT, A-fib/A-flutter
SFx: exac CHF/asthma, bradycardia, AV block, mask hypoglycemia
Tx OD -olol = glycogen

54
Q

AA - C3 - K blockers

A

phase 3, inc ERP, in QT interval
sotalol, ibutilide, bretylium, dofetilide, amiodarone
Tx: rhythmic control w/ AFib
SFx: Torsades
Amiodarone SFx: “check PFTs (pulm fibrosis), LFTs (hepatotoxicity), TFTs (drug is 40% iodine), sight (SAT for photo), CV

55
Q

AA - C4 - CCB

A

pacemaker cells, phase 0, inc ERP
2 types CCB: (not here = dihydropyridine)
here: non-dihydropyridine (heart)
verapamil, diltiazem
SFx: flushing, edema, CV: sinus node depression, ablocks, HF, torsades
be careful mixing with giving to HF pts -> H block

56
Q

Adenosine – anti-arrhythmic

A

increase K efflux (keep baseline/hyperpolarize)
Tx: SVT
SFx/toxic: flushing, hypotension, chest pain
toxic tx: theophylline (3rd line asthma tx)

57
Q

Digitalis toxic tx

A

optimize K (4), Mg (2-nrm lvl) (Mg also for torsades)

58
Q

Methotrexate

A

inhibits dihydrofolate reductase
Tx: Cancers: leukemias (ALL), lymphomas, choriocarcinoma, sarcomas. Non-neoplastic: ectopic pregnancy, medical abortion (with misoprostol), rheumatoid arthritis, psoriasis, IBD, vasculitis.
SFx: Myelosuppression, which is reversible with leucovorin “rescue.” Hepatotoxicity. Mucositis (eg, mouth ulcers). Pulmonary fibrosis.

59
Q

Drugs that prolong QT

A 
macrolides, chloroquine
haloperidol, risperidone
methadone
-navirs (anti-protease HIV)
antiarrhythmics: Class 1A, Class 3
60
Q

N-Acetylcysteine

A

acetaminophen OD
mucolytic (intubated pts)
prevent contrast neuropathy

61
Q

Cholinergic Direct Agonists (bind musc R) - Parasympathetic activation (receptor 2)

A 
"-chol"
bethenachol - urinary retention
carbachol - glaucoma
pilocarpine - sweat, tear, saliva
methacholine - asthma Dx test bc causes bronchospasm
62
Q

Cholinergic Indirect Agonists (anti-acetylcholinesterases)

A

“-stigmine”
neogstigmine - postop, urinary retention
edrophonium - myasthenia gravis Dx test (auto-Ab)
pyridostigmine - LT MG tx
physostigmine - antichol or atropine toxicity
echothiophate - glaucoma
donepezil - AD

63
Q

AD drugs - mnemonic

A

“Grandma Can’t Remember”

galatamine, donepezil, rivastigmine

64
Q

Cholinergic direct antagonists (competitive inhibitors) (muscarinic R 2 antagonists)

A

atropine - bradycardia, organophosphate poisoning
tropicamide “topical” - pupil dilation/mydriasis
benztropine - PD, decrease anti-psych SFx
glycopyrrolate - dec mucosal secretions (anesthesia)
hyoscyamine, dicyclome - “help digest”, antispasmotics vs IBS
scopolamine - motion sickness, dec secretions
ipratropium, triotropium - bronchodilators
“triumph” = bronchod”i”la”t”or
*psych drugs have anticholinergic effects (benadry, TCA) + amandadine

65
Q

Regenerate AchE

A

parlidoxine

66
Q

anticholinergics for urge urinary incontinence - mnemonic

A 
"Off The Darn Toilet Seat"
oxybutynin
tolterodine
darifenacin
trospium
solifenacin
67
Q

atropine

A

tx - bradycardia, organophosphate poisoning

  • don’t give to BPH, hyperthermic, GI obstruction, Eldery
  • *never acute angle glaucoma
68
Q

tacrolimus, pimecrolimus

A

calcineurin inhibitors
inhibits secretion of IL-2 and other cytokines
result: blocks T-cell activation and B-cell differentiation

69
Q

Skin tx - Vit A derivatives “noin”

A

hyperkeratosis

70
Q

skin tx sebum overproduction

A

isotretinonin, spironolactone, OCPs

71
Q

skin tx P acnes

A

abx - “mycin” “cyclin”, benzoylperoxide

72
Q

Danazol

A

synthetic androgen - neg feedback to AP and hypothal, dec FSH and LH
tx - endometriosis, fibrocystic breast Dz, hereditary angioedema
Sfx - masculine effects

73
Q

leuprolide

A

mech: GnRH analog - continued use (non-pulsatile) causes neg feedback AP = dec FSH, LH
tx: leiomyomas, endometriosis, central precocious puberty, advanced prostate CA, infertility

74
Q

Tertbutaline

A

tocayltic, asthma, secretions destroy

selective B2 agonist - also found in uterus, causes muscle to relax

75
Q

mifepristone (RU-486) and Methotrexate

A

Progestin R antagonist, Glucocorticoid antagonist
abortion -necrosis of the uterine decidua
give with misoprostol

MTX - used for abortion of ectopic pregnancy - folic acid antagonist

76
Q

misoprostol

A

prostaglandin E1 agonist
causes cervical softening and uterine contractions
(early - abortion, late - induce labor)

77
Q

Tamoxifen

A

SERM
Estrogen R antagonist - breast tissue
agoinst - endometrial tissue (CA risk)

78
Q

Raloxifine

A

SERM
estrogen antagonist - breast (*no risk endometrial CA)
agonist at bone (vs osteoporosis)

79
Q

Paget Dz of breast

A

see eczema on areola

HISTO - dark nuclei with perinuclear clearing “halo”

80
Q

invasive lobular carcinoma

A

ER + PR +
signet ring cells, cells line up in single lines
inactivation of e-cadherin genes

81
Q

invasive ductal CA

A

immobile, firm, hard

HISTO: “stellate” star-like border tumor

82
Q

DCIS

A

eventually malignant/met

includes paget dz of breast

83
Q

LCIS

A

signet ring cells
ER+ PR+
DONT HAVE TO TAKE OUT - low malignancy

84
Q

phyllodes tumor

A

“leaf-like” HISTO

large, bulky

85
Q

cromolyn

A

block mast cell degranulation

86
Q

Filgrastin, Sargrastim

A

granulocyte stimulating factors

87
Q

Rx INF alpha

A

tx: genitar warts, hep b and c, kaposisarcoma, hairy cell leukemia, melanoma

88
Q

Rx INF B

A

tx MS

89
Q

Rx INF y

A

chronic granulomatis Dz

stimulate macrophages to make NADPH oxidase

90
Q

cyclosporin

A 
binds cyclophilins in cytosol of T cells
complex inhibits calcineurin -> no IL 2 
Result: Blocks T-cell activation
Tx - AI Ds (psoriasis, RA)
Sfx - nephrotoxicity
91
Q

tracolimus, primecrolimus

A

mech: bind FK binding prs -> dec calcineuria -> dec IL2

Sfx - hepatotoxicity

92
Q

azathioprine

A

precursor 6-mercaptopurine
mech - interfere with synth of nucleic acids
Tx -txx, RA, AI dz
Sfx - metabolized by xanthine oxidase (don’t give to allopurinol pts), BM suppression

93
Q

infliximab/adaliximab

A

bind TNF a
tx: seronegative spondylosying arthropathires
PAIR

94
Q

enterecept

A

vs TNF a receptor

95
Q

Rituximab

A

bind CD20 on b cells, lyse them

tx - NHL (most b cell)

96
Q

omalizumab

A

vs IgE

tx - severe asthma pts

97
Q

abliximab

A

vs IIbIIIa R on platelets

tx - angioplasty, stent, MI

98
Q

trastuzimab

A

vs ERBB2 (HER2/neu) breast CA

99
Q

sirolimus

A

binds FK binding pr-12 -> inhibits mTOR
blocks T cell response to IL 2
Sfx - NO nephrotoxicity

100
Q

mycophenolate

A

inhibits inosine monophosphate dehydrogenase
-> inhibits guanine synthesis -> prev lymphocyte proliferation
tx - txx, SLE
sfx - teratogenic, HTN, high sugar, lymphoma

101
Q

thalidomide

A

mech - suppress TNF a production, increases NK and IL2 –NK kills cells
tx - Hansen dz, multiple myeloma
sfx: phocomelia - teratogent

102
Q

SJS -Rx SFx

A

Steve Jobs made APPLE PCs

Allopurinol
Penicillin 
Phenytoin
Lamotrigine
Ethosuximide

Phenobarbital
Carbamazepine

103
Q

Phenytoin SFx

A 
"Phenytoin Has Given MDs Frustration"
Hirisitism
Gingival hyperplasia
Megaloblastic anemia
SJS
Fetal hydentoin syndrome

+SHIPP

104
Q

Rx that cause agranulocytosis

A 
"C's"
carbamazepine
clozapine
colchicine
PTU
miconazole
105
Q

Haptotixic antiepileptics

A

valproic acid

carbamazepine

106
Q

anti-seizure drugs

Block Na+ channels

A 
phenytoin
carbamazepine
lamotrigine
topirimate
valproic
107
Q

anti-seizure drugs

increase GABA activity

A

“barbital”
valproic acid
benzodiazepine
gabapentin

108
Q

anti-seizure drugs

block T-type Ca2+ channels

A

gabapentin
ethosuximide
phenytoin

109
Q

Levadopa / Carbidopa

A

Levadopa - cross BBB, precursor DA
Sfx - DA in periphery (HTN, hallucinations)
Carbidopa - stops peripheral conversion Levadopa

110
Q

Other Rx to increase DA - BALSA

A

bromocriptine - inc DA and BP
Amantadine - enhance edogenous DA (& dec tremor)
Levodopa/Carbidopa
Selegiline - vs COMT/MAOB
**treat MPTP exposure
antimuscarinic (bc PD has inc Ach) - benztropine/trihexyphenidyl

111
Q

dantrolene

A

blocks RYR
no Ca2+ release from sarcoplasmic ret.
Tx - malignant hyperthermia (+succinyl choline)

112
Q 
Insomnia tx
melatonin
antihistamines
antidepressents
benzos
zolpidem, zalepon
eszopiclone
ramelteon
orexin R antagonists
A 
melatonin
antihistamines
antidepressents
benzos
zolpidem, zalepon   - sfx - sleep walk
eszopiclone - sleep maintenance
ramelteon
orexin R antagonists - block RAS
113
Q

narcolepsy, cataplexy tx

A

suppress REM

fluoxetine, venlafaxine, atomoxetine

114
Q

Sleep stages:

including old and depressed pts

A

awake - open eyes = alpha, closed eyes = beta
N1 = theta
N2 = sleep spindles, k complexes
N3 = delta waves (sleep walk, night terrors, bed wet)
-decrease with benzos/alcohol
REM = beta waves, REM bc PPRF

old:
dec N3, dec REM, inc REM latency
depressed:
dec N3, inc REM, dec REM latency

115
Q

Restless leg syndrome - check what major lab?

A

**check iron levels!!!

pramiprexole, porimvole

116
Q

Inhaled anesthetics:
factors that effect potency
drugs

A

lipid soluble - increase = cross BBB = inc potency
blood soluble - dec = inc potency
Minimum alveolar concentration - MAC
-amt to get 50% pain response

NO: Low blood, low blood (rapid)
Halothane: hepatotoxicity
Sevoflurane, desflurane: low blood, high lipid #1 used
Isoflurane: mod blood, mod soluble

117
Q 
IV anesthetics:
Propofol
Ketamine
Barbiturates
Benzodiazepines
Opioids
A

= sedation hypnotics, NO ANALGESIA
Propofol -inc GABA, fast, high triglyceride content
Ketamine - dissociative anesthetic, hallucinations, increase cerebral blood flow

Barbiturates
-“tol” “ital”
“don’t want to the bars to close early, less lines (CSF)”
work on GABA, Cl- channels =inc duration open
decreases cerebral BF (brain Sxx - Thiopental)
-phenobarbital = inc liver enzyme tx Crigler-Najjar

Benzodiazepines
"azalam" "azapram"
inc frq Cl- channels open
midazolam - short procedures, conscious sedation
chloridazopoxide - tx alcoholism
*safe than Barbs
Tx OD - flumazenil

Opioids - analgesia
mu - beta endorphin
delta - encephalin
kappa - dynorphin
1 - non-depolarizing competitive inhibitors nicotinic Ach Receptors, can reverse with ChE inhibitor
“curium” “curonium” “curarine”
2 - Depolarizing (binds Ach R, initial muscle but none after)
*succinylcholine
phase 1 - rapid onset/recovery, no reversal
phase 2 - large dose, can be reversed
**succinylcholine + inhaled anesthetic in RYR1 MT pt = malignant hyperthermia == TX with Dantrolene!
SFx succinylchole:
Brady or tachycardia
malignant hyperthermia
severe hyperkalemia

118
Q

Local anesthetic

A

block Na+ channels
lidocaine
1 - worse with acid/inf
2 - small myelinated (sensory) > small unmyelinated (SNS) > large myelinated (motor)
size most important factor
3 - give with local vasoconstrictor (Epi)
-dec blood out, dec blood take away (not at closed areas*)

119
Q

PD tx - direct agonists

A

bromocriptine - ergot derivative, inc DA and BP
sooo, give… nonergot derivatives
pramipexole and ropinirole

120
Q

Nitrates

A

isosorbid dinitrate
tx - sx relief angina
sfx - headaches, cutaneous flushing, hypotension
DONT Give To: HCM, RVentricular infarct, PDE inhibs

121
Q

Primary pulmonary HTN tx

A

Bonsentan (-sentan),
PG - prost
sildenafil
nifedipine (smooth muscle relaxor bc gene MT GMBRT MT proliferation of smooth muscle)

122
Q

Theophylline

A

=methylxanthine like caffeine
Sfx - seizures and tachyarrythmias
antidote - charcoal, BB (arrhythmias), Benzodiazepines for seizures

123
Q

Decrease cardiac demand in pt having an MI - Tx (3)

A

NO - reduce preload
ACEI/ARB - reduce afterload
BB - dec heart contractility

124
Q

Digoxin - mechs of action

A

1 - direct inhibitor Na/K ATPase -> dec Na/Ca exchanger
2 - Inc intracellular Ca -> positive inotropy
3 - Stimulates vagus nerve -> dec HR

Used for VFib bc it decrease AV nodal conduction

Step1 (23 decks)

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