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Drugs Flashcards

1
Q

What are the names of the antipsychotics (neuroleptics)?

A

Haloperidol + “azines”

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2
Q

What is the origin of EPS side effects with neuroleptics?

A

The D2 blockade results in an imbalance of muscarinic and dopaminergic signaling in the striatum (via M1 receptors); Rx with benztropine (anticholinergic)

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3
Q

What causes side effects with low potency neuroleptics?

A

They have anticholinergic, antihistamine, and alpha-1 blockade effects

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4
Q

What are the atypical antipsychotics?

A

Olanzapine, Clozapine, quietiapine, risperidone, aripiprazole, ziprasidone

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5
Q

What are “mood stabilizers” and what are they used for?

A

Lithium, Valproate, and Carbamazepine are mood stabilizers used in the treatment of manic episodes/bipolar disorder

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6
Q

What is Buspirone used for and why?

A

It is used for Generalized Anxiety Disorder; it does not have the hypnotic, euphoric, or addictive properties of other anxiolytics such as benzodiazepines or barbiturates. It does not interact with EtOH.

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7
Q

What is a possible side effect when starting any depressant?

A

Mania!

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8
Q

How can you identify the name of a TCA?

A

All TCAs end in “-iptyline” or “-ipramine” except for doxepin and amoxapine.

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9
Q

What are the “Three C’s” of TCA toxicity?

A

Convulsions, Coma, Cardiotoxicity. These are all related to the anticholinergic properties of these drugs.

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10
Q

What are the names of the MAOIS?

A

Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline, (MAO Takes Pride In Shanghai)

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11
Q

What side effects of Mirtazapine might be desirable in some patients?

A

Sedation in those with insomnia; appetite stimulation and weight gain in those with anorexia or in the elderly.

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12
Q

What is Varenicline?

A

It is a partial agonist of the nicotinic receptor and it is used for smoking cessation. Helps to decrease cravings and blunts the pleasurable effects

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13
Q

What nitrate is 100% orally bioavailable?

A

Isosorbide mononitrate

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14
Q

What two drugs, when used with statins, increase the risk of Rhabdo?

A

Niacin and Fibrates

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15
Q

What medication increases risk of gallstones with fibrates?

A

Bile acid resins.

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16
Q

What electrolyte abnormality causes increased toxicity for all Class I antiarrhythmics?

A

Hyperkalemia!

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17
Q

What are the non-selective alpha and beta antagonists?

A

carvedilol and labetalol (not the different suffix than the standard -olol)

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18
Q

What is special about Nebivolol?

A

It is B1 selective and stimulates B3 leading to NO synthesis and vasodilation

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19
Q

What population of patients is beta blockers contraindicated in?

A

Cocaine users due to unopposed alpha1-mediated vasoconstriction

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20
Q

What is Ribavirin used for?

A

RSV and HepC, inhibits IMP dehydrogenase (no G)

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21
Q

What is Acyclovir, famiciclovir, and valacyclovir used for?

A

HSV/VZV only as it needs to be phosphorylated by viral thymidine kinase. No CMV effectivness. Low SFX profile, G analog. Famiciclovir is for VZV

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22
Q

What is Ganciclovir used for?

A

It is used against CMV (needs CMV viral kinase). G analog. More toxic to host enzymes and can cause leukopenia/neutropenia/thrombocytopenia.

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23
Q

What is foscarnet used for?

A

Ganciclovir resistant CMV and acyclovir resistant HSV. Inhibits viral DNA polymerase

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24
Q

What is cidofovir used for?

A

CMV and acyclovir-resistant HSV as it does not require phosphorylation by viral kinase. Nephrotoxic so co-administer with probenecid and IV saline.

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25
What organisms are typically not covered by cephalosporins?
LAME = Listeria, Atypicals, MRSA, Enteroccoci
26
What is the clinical activity of Aztreonam?
GNR, no GP or anaerobic coverage. Good for penicillin allergic patients and those who can't tolerate aminoglycosides
27
What are carbapenems used for?
GPC, GNR, Anaerobes, but lots of side effects so not first line treatment (e.g. seizures)
28
What is the mechanism of action of aminoglycosides?
They inhibit the formation of the initiation complex. | Note: cephalosporins increase nephrotoxicity
29
What is the mechanism of action of tetracyclines?
They bind the 30S and inhibit attachment of aminoacyl-tRNA
30
What is the mechanism of action of macrolides?
They inhibit translocation at 50S | Use for atypicals and GPC
31
What is the mechanism of action of chloramphenicol?
Blocks peptidyltransferase activity at 50S
32
What is the mechanism of clindamycin?
Blocks peptide transfer (translocation) at 50S
33
What is the common ending of H2 blocker names?
"-dine"
34
What H2 blockers have the most side effects?
Cimetidine and ranitidine. Both can decrease renal Cr excretion Famotidine and nizatidine have fewer side effects
35
What are side effects associated with long-term use of PPIs?
Hip fractures and hypomagnesemia
36
What are the names of direct thrombin inhibitors?
Argatroban and bivalirudin
37
Which ADP receptor inhibitor is associated with netropenia?
Ticlopidine
38
What are cilostazol and dipyridamole?
PDE inhibitors that inhibit platelet aggregation. Rx: intermitten claudication, prevention of stroke/TPA, angina prophylaxis
39
What are eptifibatide and tirofiban?
GP IIb/IIIa inhibitors
40
What is the log-kill hypothesis?
A given does of chemo kills the same fraction of cells regardless of tumor size. It accounts for better chemo results when tumor burden is low
41
What is the difference between vinca alkaloids and paclitaxel?
Vinca Alkaloids - Inhibit microtubule formation | Taxanes - Inhibit microtubule dissasembly "It is taxing to Stay polymerized"
42
What compounds can be used for an overdose-rescue with 5-FU?
Uridine can be given (leucovorin is not effective)
43
What tumors is Dactinomycin typically used for?
Childhood tumors = Wilm's Tumor, Ewing's Sarcoma, Rhabdomyosarcoma
44
What is used to prevent cardiotoxicity from doxorubicin?
Dexrazoxane (iron chelating agent)
45
What is used to prevent nehprotoxicity from cisplatin?
Amifostine (free radical scavenger) and chloride diuresis
46
What enzyme is inhibited by irinotecan and topotecan?
topoisomerase I / DNA Gyrase
47
What enzyme is inhibited by Etoposide and teniposide?
Topoisomerase II
48
What is a key side effect of rituximab?
Increased risk of PML
49
What are two key toxicities of bisphosphonates?
Corrosive esophagitis and osteonecrosis of the jaw
50
What is the prefered glaucoma drug for emergencies?
Pilocarpine - opens trabecular meshwork
51
What is the action of mu receptors?
Open K+ channels, Close Ca2+ channels
52
What opioids are used for diarrhea?
Loperamide and Diphenoxylate
53
What opioid receptor causes miosis?
Kappa Receptors
54
Why is meperidine prefered in pancreatic and biliary pain?
Causes less contraction of the sphincter of odi
55
What is Butorphanol used for?
Severe pain. Partial mu agaonist so causes less respiratory depression but can lead t withdrawal symptoms if on other opioids
56
What is Tramadol used for?
Chronic pain. It is a weak opioid agonist. Inhibits 5-HT and NE reuptake
57
What is the toxicity of Tramadol?
Seizures, Serotonin Syndrome
58
What is first line treatment for Eclampsia seizures?
MgSO4
59
What is the first line treatment for partial seizures?
Carbamazepine
60
What are the kinetics of Phenytoin metabolism?
Zero-Order Kinetics
61
What is first line treatment for trigeminal neuralgia?
Carbamazepine
62
What seizure drug is associated with SIADH?
Carbamazepine
63
What are second line treatments for absence seizures?
Valproic Acid and lamotrigine
64
What two seizure drugs are only indicated for partial seizures?
Tiagabine (inhibits GABA reuptake) and Vigabatrin (inhibits GABA degradation)
65
What three compounds all bind the GABAa receptor?
Benzos, barbs, EtOH
66
What are the three short acting benzodiazepines?
Triazolam, Oxazepam, Midazolam
67
What are the medium acting benzodiazepines?
Estazolam, Lorazepam, Temazepam
68
What are the long-acting benzodiazepines?
Chlordiazepoxide, Clorazapam, Diazepam, Flurazepam
69
What drug can reverse the effects of non-benzo hypnotics?
Flumazenil
70
What non-inhaled drugs can cause malignant hyperthermia?
Succinylcholine
71
What is the most commonly used drug for endoscopy?
Midazolam
72
What receptor does Propofol work on?
GABA a
73
Why do you need more anesthetic in infected tissues?
The tissue is acidic - charges alkaline anesthetics, can't penetrate membrane
74
What factor is more important in anesthetic action, fiber size or myelination?
Fiber size (small blocked before large)
75
What are the two classes of local anesthetics?
Esters and Amides (have two I's in the name)
76
What local anesthetic has severe cardiotoxicity?
bupivicaine
77
True or false, neuromuscular blocking drugs affect autonomic nicotinic receptors?
False
78
What patients are particularly at risk for succinylcholine induced hyperkalemia?
Burn and Crush patients, and those with myopathies and denervation injuries (e.g. quadripalegics)
79
When reversing a nondepolarizing blockade with neostigmine, why must atropine also be given?
To prevent overstimulation of muscarinic effects (e.g. bradycardia)
80
What are the key components of Parkinson's Treatment?
B - Bromocriptine/Other agonists A - Amantadine L - Levodopa/Carbidopa S - Selegiline C - COMT inhibitors (entacapone, tolcapone) A - Antimuscarinics (benztropine, trihexyphenidyl)
81
What can long term levodopa use lead to?
"On-Off Phenomenon" of dyskinesia following administration
82
What are the key Alzheimer drugs?
Memantine (NMDA antagonist) and Donepezil (AChE inhibitor. Also galantamine or rivastigmine)
83
What drug is tolterodine, fesoterodine, and trospium similar to?
Oxybutynin/Darifenacin/solifenacin (reduce bladder spasm)
84
What is the result of blocking D2 receptors intracellularly?
Increased cAMP concentrations (recall D2 is a Gi coupled receptor)
85
What is used to treat EPS symptoms from typical antipsychotics?
Benztropine or diphenhydramine (M1/H1 and H1 blocking agents)
86
What side effects result from blocking histamine receptors in the brain?
Sedation
87
Why do EPS symptoms occur with D2 blockers?
No D2 opposition of excitatory M1 in the striatum - treat with benztropine or diphehydramine
88
What is the mnemonic for neuroleptic malignant syndrome?
FEVER = Fever, Encephalopathy, Vitals Unstable, Enzymes, Rigidity
89
What are the side effects of Lithium?
``` L - Lithium M - Movement (tremor) N - Nephrogenic DI O - HypOthyroidism P - Pregnancy Problems ```
90
What receptor does buspirone act on?
5-HT 1a
91
What receptor does metoclopramide act on?
D2 - antagonist 5-HT 3 - antagonist 5-HT 4 - agonist
92
What are the symptoms of serotonin syndrome?
``` Hyperthermia Confusion Myoclonus CV collapse Flushing/Diarrhea Seizures ```
93
What are the SNRIs?
Venlafaxine and Duloxetine
94
What 3 antidepressents can cause SIADH?
MAOIs, SSRIs and TCAs
95
Which TCAs have more anticholinergic effects?
Tertiary ones like amitryptiline compared to secondary (e.g. nortriptyline)
96
What two opiates can cause serotonin syndrome?
Meperidine and Dextromethorphan
97
What two receptors is mirtazapine an antagonist at?
5-HT2 and 5-HT3
98
What receptor does trazodone block?
5-HT2 and alpha1. Use for insomnia
99
What receptor does cyproheptadine act on?
5-HT2 antagonist
100
What is the names of the 1st gen H1 blockers?
Diphenhydramine, dimenhydrinate, chlorpheniramine
101
What are the names of the 2nd gen H1 blockers?
Loratadine, fexofenadine, desloratadine, cetirizine
102
What is guaifenesin?
Expectorant, thins mucous
103
What is tetrabenazine and what is it used for?
It is a VMAT inhibitor used with reserpine (also VMAT inhibitor) in HD

USMLE Step 1 (4 decks)

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