drugs Flashcards
calcitonin efficacy is limited to first 48 hours even w/ repeated doses
what is this called
tachyphylaxis
also seen in nitro
pt with SLE and has to be on long term corticosteriods how do you prevent osteoporosis
A. calcitonin
B. bisphosphonates
bisphosphonates
do not pick calcitonin
NSAID side effect on boards
pt started on NSAID or B-lactams
now develops fever, eosinophil in urine
INTERSTITIAL NEPHRITIS
on boards
NSAID side effects
name all
peptic ulceration –> GI bleeding
Prerenal azotemia -> inc BUN and creatinine
interstitial nephritis (fever, eosinophils in urine
nephrotic syndrome.
treatment for aspirin overdose
on boards
sodium bicarbonate
alkalinizes the urine –> ionization of the acids (salicylates) which will be trapped in the renal tubules and excreted
prolonged bleeding time will be seen in
on boards
pt taking ASA
NSAIDS,
pts with uremia!!!
on boards
what drug causes
hemolysis, and retinal damage
sometimes used to treat RA.
what should you do?
hydroxychloroquine
regular eye examinations!!!
sulfasalazine
AE
agranulocytosis
long term prophylaxis for hereditary angioedema
moa?
side effect
danazol
modified testosterone –> inc C1 ESTERASE INHIBITOR PRODUCTION by liver
**** hirtuism!!!
also can treat endometrosis.
tx for tinea (pityriasis) versicolor (malessezia furfur)
1st line
2nd line for recurrent
selenium sulfide topical
2nd - ketoconazole
how should you treat tinea capitis caused by any organism
not topical
oral : terbinafine or grisiofolvin
why can octreotide be used in esophageal varices bleeding?
reduces portal venous pressure
salivary gland disorders
sjogrens syndrome
treatment?
and moa
cevimeline
its a parasympathomimetic and muscarinic agonist.
affecting M1 and M3 receptors
salivary gland disorders
sjogrens syndrome
treatment?
and moa
cevimeline
its a parasympathomimetic and muscarinic agonist.
affecting M1 and M3 receptors
what is the antiviral treatment for mumps
theres not one dumbass
tx conservative treatment.
if pain in testicles from swelling tx? = elevation of the testicles to help with the swelling.
why does a pt with mumps have elevated serum amylase
due to pancreatitis and from parotitis
on boards
pt with erythema, pain, tenderness upon palpation and swelling
plain radiography shows an object in the submandibular gland
diagnosis and most common cause
siadladenitis - stone blocking the gland
most common microorganism staph aureus
bleeding into the peritoneum –> involving the inferior surface of diaphragm will present how
referred pain to shoulder
alendronate
inc risk of what GI adverse effect
1, bleeding due to involvement of the gastroduodenal artery
2. acute pancreatitis
esophagitis
take med with water and stay sitting up /standing for 1 hour
you have a 78 yo pt that is bed ridden
what medication is Ci in this pt for her Osteoporosis
alendronate
bc it can cause esophagitis
antacids
magnesium hydroxide
racts with protons in the lumen of the gut
whats its side effect?
diarrhea why?
strong laxative effect (osmotic laxative)
aluminum hydroxide and calcium carbonate (gastric antacid)
sideeffect?
constipation
pt is on nsaids for osteoarthritis both long time doing well
you want to prevent ulcerations caused by NSAIDS what
med should you add?
misoprostol
(synthetic prostaglandin E1)
why is misoprostol
CI in pregnancy
bc it can cause abortion
bc prostaglandins inc uterine tone
H2 blockers
side effects
cimetidine is a potent inhibitor of CYP 450
also has antiandrogenic effect (gynecomastia and other feminizing effects in men, prolactin release, impotence, dec libido)
long term use of PPI can lead to dec absroption of what vitamin?
B12
high yield q on boards
ulcerative colitis pt with RUQ pain and increased LFTs
primary sclerosing cholangitis
(Q) metoclopramide
is used to increase Gi perisalsis without increasing gastric secretion.
whats its moa
**SE**?
dopamine (D2) receptor antagonist in the enteric NS - myenteric auerbachs) and submucosal (meissners) pleuxs
side effect**** extrapyramidal effects (parkinsonism)
Q on boards
cisapride
serotonin (5-HT4) agnoist in the enteric Ns –> inc ACH –> GI motility
side effect
fatal ARRHYTHMIA - due to Long QT syndrome
Q on boards (trick!!!)
UC patient has colonscopy and results show mild dysplasia
what are you going to do?
surgery immediately
on the boards
mild cases of UC with no bloody diarrhea start tx with?
sulfasalazine (5-aminosalicyclic acid)
Q on boards (trick!!!)
UC patient has colonscopy and results show mild dysplasia
what are you going to do?
surgery immediately
on the boards
mild cases of UC with no bloody diarrhea start tx with?
sulfasalazine (5-aminosalicyclic acid)
how do you treat amebiasis (entamoeba histolytica) liver abscess
metronidazole
for sure on boards
side effects of metronidazole
metallic taste
neuropathy
disulfram rxn
what is the hepatic neoplasm associated with each risk factor?
estrogen hormonal therapy (OCPs)
hepatic adenoma
(liver cell adenoma)
what is the hepatic neoplasm associated with each risk factor?
vinyl chloride and arsenic exposure
hepatic angiosarcoma
what is the hepatic neoplasm associated with each risk factor?
Thorotrast
a form of thorium dioxide (was used as a radiologic contrast)
cholangiocarcinoma
what is the hepatic neoplasm associated with each risk factor?
Aflatoxin (from aspergillus mold)
chronic HBV, HCV
hereditary hemchromatosis
primary biliary cirhosis
alpha antitrpsin def
alcoholcirrhosis
hepatocellular carcinoma
acute fatty liver of pregnancy
(non specific symps, : N/V/ anorexia, jaundice, and fever
is due to?
Q: the only treatment is???
due to abnormal B oxidation of fatty acids- during third trimester
only tx is termination of pregnancy
Benzodiazepine overdose tx
flumazenil
tx of hemochromatosis is
phlebotomy and deferoxamine
what is the side effect of deferoxamine?
pain and sweeling at the injection site
Topiramate
an anticonvulsant
sideeffect to know
calcium phosphate nephrolithiasis
(kidney stone)
best anticonvulsant during pregnancy
lamotrigene
can cause SJS
picks disease (frontotemporal dementia)
pt has personality changes (behavioral disturbances) and inappropriate/aggressive.
what will be seen on biopsy
intracellular tau protein
rounded aggregates inside cerebral neurons
triptans
like sumatriptan moa
selective serotonin receptor agonist
triptans (sumatriptan)
the most serious side effect is ?
coronary artery vasospasm
alheimers tx
1st line
donepezil
Q
tacrine (anticholinergic) used for alheimers tx
sideeffect
hepatotoxicity
Q on boards
pt diagnosed with alzhiemers is started on a medication .
pt is getting better for 3-4 months, then her physician increases the close.
one week later pt is in ER with syncope why?
donepezil is a central ach esterase inhibitor that causes
increased vagal tone –> bradycardia –> atrioventricular block
alzheimers tx
for boards
know that ginkgo biloba
does or does not imporove the global function in pts with alzheimers
does NOT
on the boards
(inhaled anesthetics)
which one increases the tissue response to high PCO2 –> increase cerebral blood flow –> increased ICP
isoflurane
(inhaled anesthetics)
which on increases coronary blood flow - beneficial in pts with CAD
isoflurane
(inhaled anesthetics)
causes convulsions
enflurane
hy Q
(inhaled anesthetics)
halothane side effect
hepatoxicity (massive hepatic necrosis)
due to direct hepatocyte toxicity and autoantibodies agaiinst liver proteins
Q
(inhaled anesthetics)
methoxyflurane
side effect
nephrotoxicity
!Q (inhaled anesthetics)
which to are bronchodilators
recommeneded for asthmatics
halothane
sevoflurane
(inhaled anesthetics)
all the inhaled anesthetic
can cause ______
except for NITROUS OXIDE
MALIGNANT HYPERTHERMIA
(side effects for boards for neuromuscular blocking drugs)
Q
malginant hyperthermia and rhabdomyolysis.
succinylcholine
(side effects for boards for neuromuscular blocking drugs)
HYPERkalemia
due to its effects on acetylcholine receptors –> keep the receptors open –> flow of K into the extracellular space.
drug?
succinylocholine
it can cause fatal arrythmias
first sign of malignant hyperthermia
contraction of the jaw muscles (trimus)
(side effects for boards for neuromuscular blocking drugs)
which one causes
HISTAMINE release –> hypotension, reflex tachycardia, bronchospasm and cutaneous flush
atracurium
Q (side effects for boards for neuromuscular blocking drugs)
prolonged neuromuscular blockade of vecuronium
is associated with preoperative use of
(pt admitted to hospital w/ gram negative infection and treated with gentamicin)
gentamicin.
Q
what do you give for opioid intoxication
what do you give for alcohol dependence and opioid dependence
IV NALOXONE
not oral
ORAL naltrexone
methadone is a long acting strong ____ ?
at opioid mu receptors
its used to treat pts with heroin addicition.
agonist.
prolonged half life of methadone will supress the withdrawal symps in heroine addicitve.
acute arsenic poisoning
(insectcides)
Gi symp : N/V/ abd pain, diarrhea
decrease lv of consciousness, hypotension, tachycardia
look for a garlic odor
tx
DIMERCAPROL
which displaces arsenic ions from sulfhydryl grps of enzymes
Q
guy working construction an has glucose in urine but always normal glucose at last 5 visits. why does he have high glucose
lead toxicity causing nephrotoxicity –> fanconi syndrome - type 2 renal tubular acidosis (Type 2 RTA)
also see loss of bicarb in urine.
High yield
pt around 50-60 that has blood lead level of 45ug/dl or higher and symptoms of encephalopathy.
what do you treat them with.
A. succimer
B. EDTA
succimer
not EDTA !!! why (bc it does not cross the BBBB and may lead to exacerbation of lead encephalopathy)
on thee boards
pt using oxidzing drugs (nitrates, sulfonamides, or antimalarial therapy)
presents with cyanosis, hypoxia, chocolate color of the arterial blood and remember that although the pulse ox reading is low, the arterial blood gas PaO2 will be normal
TX and diagnosis
methemoglobinemia
tx: methylene blue
- a reducing agent that converts iron in heme from the Fe3 to Fe2 state.
also vit D
Q
cyanide toxicity is due to?
inactivation of the mitochondrial cytochrome oxidase –> blokcing the cellular aerobic metabolism even in the presence of adequate oxygen stores
loops cause
what electrolyte abnormality to K and MG
hypo kalemia
hypomagnesemia
loss of water and Na in urine.
cisplatin
for boards the main electrolytes you need to know
**1. hypomanesemia
2nd hypokalemia
- hypocalcemia.
what are the meds that cause HYPOKALEMIA
know is
ampohtericin B
cisplatin
loops
thiazide
what drugs can cause HYPERKALEMIA
ace inhibitors and ARBS
K sparing
Nsaids (ibuprofen)
cyclosporin and tacroimus
Pentamidine (used in HIV)
Q
HIV pt treated for SJS with pentamidine
what electrolyte innbalance do you expect?
hyperkalemia
amphotericin B
can cause what type of RTA
type 1 renal tubular acidosis
inc distal tubular membrane permeability –> hypokalmeia and hypomagnesemia
allopurinol, cimetidine
boards love to ask you about these two drugs that can cause?
interstitial nephritis
classic Question on the boards*****
chronic use of what analgesic ( not used in US)
can cause renal papillary necrosis
Phenacetin
what are the two important drugs (on boards) that cause
post renal azotemia
acyclovir
indinavir
high yield question
pt with magnesium ammonium phosphate (struvite stones)
TX?
antibiotic (quinolones)
surgery is NOT always done
side effect of azathioprine
(used in renal transplant)
bone marrow suppression
causing leukopenia and thrombocytopenia
pt on azathioprine
for renal transplant and now has a gouty arthritis
you want to give allopurinol
what should you do
cut dose of azathioprine by 1/2
bc 6-MP is metabolized by xanthine oxidase enzyme.
most common
side effect of
mycophenolate mofetil
used in renal transplant
diarrhea
trick question
cyclosporine and tacrolimus
are calcinuerin inhibitors that
A. reduce the number of T cells
B. reduce the release of cytokine (IL-2) from T cells
prevent IL-2 transcription
preventing activation of T cells!
he said (inhibit T cell proliferation)
DOES NOT REDUCE the number of T cells
on boards
cyclosporine side effect
nephrotoxicity - renal vasoconstriction (usually immmediately after starting tx –> renal ischemia)
hepatotoxicity
neurotoxicity
hirsutism, gingival hyperplasia
does cyclosporine
effect bone marrow causing bone marrow suppressioni
HELL NO
its azathioprine
tacolimus can also
danazol
used for hereditary telangiectasia and endometriosis
side effect
hirsutism
dilitiazem
errythromycin
ketoconazole
grape fruit
are all
potent cyp3A INHIBITORS!!!
Thus significant toxicity of cyclosporine.
.pt is started on a immunosuppressant for renal transplant
now he has hyperglycemia
and is diabetic
which drug
tacrolimus (FK506)
pt is started on thiazide (hydrochlorothiazide, chlorthalidone, metolazone)
the serum level of what will most likely be elevated?
cholesterol
also
hyperucremia, hypercalcemia, hyperglycemia
for the boards
what diuretic should be avoid in diabetes
HCTZ
what diuretic can be used in place of spironolactone
bc of its selective aldosterone receptor inhibitor –> minimal anti androgenic effect
eplerenone
a pt after trauma is treated with a drug to decrease the pts inc ICP. now the pt presents with pulmonary edema and dies
what drug
mannitol
ace inhibitors
will cause
inc or dec in K and Creatinine
hyperkalemia
inc creatinine
on boards
tx of minimal change disease
A. prednisone
B. prednisone and cyclophosphamide
prednisone
high yield what is the moa of the drug used in PCOS to induce ovulation
CLOMIPHENE
estrogen antagonist that increases secretion of gonaotropins and stimulates ovulation
it may inc the incidence of pregnancy with multiple fetuses
question
spironolactone is used in PCOS to treat hirsutism
how does it tx this
dec production of testosterone
testosterone receptor blocker
most common ovarian tumors are originating from the surface epithelium and not the germ cells ( like folliicles)
so know this for origin
leuprolide is used for
advanced prostate cancer in men
endometriosis
fibroid tumors
tx of acute endometritis
(fever, abnormal uterine bleeding, pelivc pain)
iv clindamycin + gentamicin
valproic acid
use during pregnancy will inc risk for neural tube defects due to inhibition of?
inhibition of folic acid absorption
from the intestine
pt exposed to any of these can develop
moldy hay (thermophilic actinomycetes)
grain dust
birds
hypersensitivity pneumonitis
(Birds Fancier disease or farmers lung)
(type III/IV HSR)
if asymptomatic pt comes to your office for initial prenatal visit and found to have bacteriuria
what should your managment be
treat asymptomatic bacteriuria w?
ampicillin
cephalaxin
or
nitrofurantoin.
remember fluoroquinolone and sulfa are CI in pregnancy
