Drugs

Question 1

Sulfonylureas

Answer 1

Glipizide, Glyburide
Mech: close K+ channel in the beta membrane, causing insulin release

AE: hypoglycemia, esp in renal failure, weight gain

First generation drugs (chlorpropamide, tolbutamide) had disulfiram-like AE

Question 2

Metformin

Answer 2

Mech unknown, increases insulin sensitivity

Benefits: oral, first line therapy, modest weight loss/weight neutral

AE: lactic acidosis, ctindicated in renal insufficiency

Question 3

Bisphosphonates

Answer 3

Pyrophosphate analog, inhibit osteoclast

Alendronate = PO

Tx corrosive esophagitis (ctindicated in reflux), osteonecrosis of Jaw

Zoledronic acid = IV, may use with reflux

Question 4

Teriparatide

Answer 4

recombinant PTH, subq, stimulates osteoblasts

used with severe osteoporosis, T

Question 5

GLP1 agonist

Answer 5

Exenatide, liraglutide
Second line after metformin failure
modest H1c reduction but low hypoglycemia risk and wright loss

AE nausea, vomiting, pancreatitis

Question 6

thiazolidinediones/glitazones

Answer 6

AE: weight gain, edema, CHF, bone fracture, bladder cancer

Increases insulin sensitivity in peripheral tissue

Can use in renal insufficiency

Question 7

DPP4 inhibitors

Answer 7

Sitagliptin
Weight neutral
Can use in renal insufficiency

Question 8

Amiodarone - name adverse effects in 7 organ systems

Answer 8

• QT prolongation, heart block
• chronic interstitial pneumonitis
• elevated LFTs
• hypo or hyper T
• optic neuropathy
• blue/gray skin discoloration
• peripheral neuropathy

Question 9

Ethylene glycol toxicity

Answer 9

Anion gap metabolic acidosis
Calcium oxalate crystals in urine

sx flank pain, hematuria, oligur,a CN palsy, tetany

Question 10

Methanol toxicity

Answer 10

Anion gap metabolic acidosis

Visual blurring, central scotomata, APD, AMS

Question 11

Isopropyl alcohol ingestion

Answer 11

High osmolar gap but NO anion gap or metabolic acidosis

CNS depression, disconjugate gaze, absent ciliary reflex

Question 12

How does acyclovir damage the kidney?

Answer 12

In urine, it precipitates as crystals in renal tubules, causing obstruction and tubular toxicity in 1-7 days. Prevent and treat with volume repletion.

Question 13

Which drugs can cause hyperkalemia?

Answer 13

Beta-blockers
ACE-i
ARB
K-sparing diuretics
Digitalis
Cyclosporine
Heparin
NSAIDs
Succhinylcholine

Question 14

What drugs can treat fibromyalgia?

Answer 14

SNRI - duloxetine, milnacepran

Pregabalin (gabapentin)

Question 15

What is the treatment for Raynaud’s?

Answer 15

Dihydropyridine Calcium Channel blocker (amlodipine)

Question 16

TNF alpha inhibitors

Answer 16

Enteracept, infliximab, adalimumab

Second line for RA when not controlled by MTX

Question 17

AE of loop diuretics

Answer 17

Ototoxicity
Hypokalemia
Hypocalcemia
Hypomagnesemia
Gout
Dehydration
Alkalosis

• -> vtach
• -> potentiate digoxin side effects

Question 18

AE of thiazide diuretics

Answer 18

Hypokalemia
Alkalosis
Hyopnatremia
Hyperglycemia
Hyperlipidemia
Hyperuricemia
Hypercalcemia

Question 19

AE of K sparing diuretics

Answer 19

Hyperkalemia, gynecomastia, sexual dysfunction

Question 20

AE of mannitol

Answer 20

pulmonary edema. contraindicated in auria and CHF

Question 21

AE of acetazolamide

Answer 21

Hyperchloremic metabolic acidosis
neuropathy
NH3 toxicity
sulfa allergy

Question 22

What are side effects of thyroid drugs?

Answer 22

Thionamides - agranulocytosis
Methimazole: cholestasis, teratogen in first trimester
PTU: hepatic failure, ANCA vasculitis

Question 23

Digoxin: mechanism and toxicity

Answer 23

Na pump inhibitor (slow HR while increase BP) to tx afib

nausea, vomiting, diarrhea, abdominal pain, headache, dizziness, confusion, delirium, vision disturbance (blurred or yellow vision).