drugs Flashcards
1
Q
calcitonin efficacy is limited to first 48 hours even w/ repeated doses
what is this called
A
tachyphylaxis
also seen in nitro
2
Q
pt with SLE and has to be on long term corticosteriods how do you prevent osteoporosis
A. calcitonin
B. bisphosphonates
A
bisphosphonates
do not pick calcitonin
3
Q
NSAID side effect on boards
pt started on NSAID or B-lactams
now develops fever, eosinophil in urine
A
INTERSTITIAL NEPHRITIS
4
Q
on boards
NSAID side effects
name all
A
peptic ulceration –> GI bleeding
Prerenal azotemia -> inc BUN and creatinine
interstitial nephritis (fever, eosinophils in urine
nephrotic syndrome.
5
Q
treatment for aspirin overdose
on boards
A
sodium bicarbonate
alkalinizes the urine –> ionization of the acids (salicylates) which will be trapped in the renal tubules and excreted
6
Q
prolonged bleeding time will be seen in
on boards
A
pt taking ASA
NSAIDS,
pts with uremia!!!
7
Q
on boards
what drug causes
hemolysis, and retinal damage
sometimes used to treat RA.
what should you do?
A
hydroxychloroquine
regular eye examinations!!!
8
Q
sulfasalazine
AE
A
agranulocytosis
9
Q
long term prophylaxis for hereditary angioedema
moa?
side effect
A
danazol
modified testosterone –> inc C1 ESTERASE INHIBITOR PRODUCTION by liver
**** hirtuism!!!
also can treat endometrosis.
10
Q
tx for tinea (pityriasis) versicolor (malessezia furfur)
1st line
2nd line for recurrent
A
selenium sulfide topical
2nd - ketoconazole
11
Q
how should you treat tinea capitis caused by any organism
A
not topical
oral : terbinafine or grisiofolvin
12
Q
A
13
Q
why can octreotide be used in esophageal varices bleeding?
A
reduces portal venous pressure
14
Q
salivary gland disorders
sjogrens syndrome
treatment?
and moa
A
cevimeline
its a parasympathomimetic and muscarinic agonist.
affecting M1 and M3 receptors
15
Q
salivary gland disorders
sjogrens syndrome
treatment?
and moa
A
cevimeline
its a parasympathomimetic and muscarinic agonist.
affecting M1 and M3 receptors
16
Q
what is the antiviral treatment for mumps
A
theres not one dumbass
tx conservative treatment.
if pain in testicles from swelling tx? = elevation of the testicles to help with the swelling.
17
Q
why does a pt with mumps have elevated serum amylase
A
due to pancreatitis and from parotitis
18
Q
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
A
siadladenitis - stone blocking the gland
most common microorganism staph aureus
19
Q
bleeding into the peritoneum –> involving the inferior surface of diaphragm will present how
A
referred pain to shoulder
20
Q
alendronate
inc risk of what GI adverse effect
1, bleeding due to involvement of the gastroduodenal artery
2. acute pancreatitis
A
esophagitis
take med with water and stay sitting up /standing for 1 hour
21
Q
you have a 78 yo pt that is bed ridden
what medication is Ci in this pt for her Osteoporosis
A
alendronate
bc it can cause esophagitis
22
Q
antacids
magnesium hydroxide
racts with protons in the lumen of the gut
whats its side effect?
A
diarrhea why?
strong laxative effect (osmotic laxative)
23
Q
aluminum hydroxide and calcium carbonate (gastric antacid)
sideeffect?
A
constipation
24
Q
pt is on nsaids for osteoarthritis both long time doing well
you want to prevent ulcerations caused by NSAIDS what
med should you add?
A
misoprostol
(synthetic prostaglandin E1)
25
why is misoprostol
CI in pregnancy
bc it can cause **abortion**
bc prostaglandins **inc uterine tone**
26
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)
27
long term use of PPI can lead to dec absroption of what vitamin?
**B12**
28
high yield q on boards
ulcerative colitis pt with **RUQ pain** and **increased LFTs**
**primary sclerosing cholangitis**
29
**(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)**
30
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
31
Q on boards (trick!!!)
UC patient has colonscopy and results show **mild dysplasia**
what are you going to do?
**surgery** immediately
32
on the boards
mild cases of UC with **no bloody diarrhea** start tx with?
**sulfasalazine (5-aminosalicyclic acid)**
33
Q on boards (trick!!!)
UC patient has colonscopy and results show **mild dysplasia**
what are you going to do?
**surgery** immediately
34
on the boards
mild cases of UC with **no bloody diarrhea** start tx with?
**sulfasalazine (5-aminosalicyclic acid)**
35
how do you treat amebiasis (entamoeba histolytica) liver abscess
**metronidazole**
36
for sure on boards
side effects of **metronidazole**
**metallic taste**
**neuropathy**
**disulfram rxn**
37
what is the hepatic neoplasm associated with each risk factor?
estrogen hormonal therapy (OCPs)
**hepatic adenoma**
**(liver cell adenoma)**
38
what is the hepatic neoplasm associated with each risk factor?
**vinyl chloride** and **arsenic exposure**
hepatic **angiosarcoma**
39
what is the hepatic neoplasm associated with each risk factor?
**Thorotrast**
a form of thorium dioxide (was used as a radiologic contrast)
**cholangiocarcinoma**
40
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
41
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**
42
Benzodiazepine overdose tx
**flumazenil**
43
tx of hemochromatosis is
**phlebotomy** and **deferoxamine**
what is the side effect of **deferoxamine?**
**pain** and **sweeling** at the **injection site**
44
**Topiramate**
an anticonvulsant
sideeffect to know
calcium phosphate **nephrolithiasis**
**(kidney stone)**
45
best anticonvulsant during pregnancy
**lamotrigene**
can cause SJS
46
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
47
triptans
like **sumatriptan** moa
**selective serotonin receptor agonist**
48
triptans (sumatriptan)
the most serious side effect is ?
**coronary artery vasospasm**
49
alheimers tx
1st line
**donepezil**
50
Q
tacrine (anticholinergic) used for alheimers tx
sideeffect
**hepatotoxicity**
51
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
## Footnote
**increased vagal tone --\> bradycardia --\> atrioventricular block**
52
alzheimers tx
for boards
know that **ginkgo biloba**
does or does not imporove the global function in pts with alzheimers
**does NOT**
53
on the boards
(inhaled anesthetics)
which one **increases** the tissue response to high PCO2 --\> **increase cerebral blood flow --\> increased ICP**
**isoflurane**
54
(inhaled anesthetics)
which on **increases coronary blood flow - beneficial** in pts with **CAD**
**isoflurane**
55
(inhaled anesthetics)
causes **convulsions**
**enflurane**
56
**hy Q**
(inhaled anesthetics)
**halothane** side effect
**hepatoxicity (massive hepatic necrosis)**
due to direct hepatocyte toxicity and autoantibodies agaiinst liver proteins
57
Q
(inhaled anesthetics)
**methoxyflurane**
side effect
**nephrotoxicity**
58
!Q (inhaled anesthetics)
which to are **bronchodilators**
recommeneded for asthmatics
**halothane**
**sevoflurane**
59
(inhaled anesthetics)
all the inhaled anesthetic
can cause \_\_\_\_\_\_
except for **NITROUS OXIDE**
**MALIGNANT HYPERTHERMIA**
60
(side effects for boards for neuromuscular blocking drugs)
Q
**malginant hyperthermia** and rhabdomyolysis.
succinylcholine
61
(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
62
first sign of malignant hyperthermia
**contraction of the jaw muscles (trimus)**
63
(side effects for boards for neuromuscular blocking drugs)
which one causes
**HISTAMINE** release --\> hypotension, reflex tachycardia, bronchospasm and **cutaneous flush**
**atracurium**
64
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.**
65
Q
what do you give for opioid intoxication
what do you give for alcohol dependence and opioid dependence
**IV NALOXONE**
not oral
**ORAL naltrexone**
66
**methadone** is a **long acting** strong ____ ?
## Footnote
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.
67
**acute arsenic poisoning**
(insectcides)
Gi symp : N/V/ abd pain, diarrhea
decrease lv of consciousness, hypotension, tachycardia
look for a **garlic odor**
tx
**DIMERCAPROL**
## Footnote
**which displaces arsenic ions from sulfhydryl grps of enzymes**
68
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.
69
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**
## Footnote
not EDTA !!! why (bc it does not cross the BBBB and may lead to exacerbation of lead encephalopathy)
70
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**
71
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
72
loops cause
what electrolyte abnormality to K and MG
**hypo kalemia**
**hypomagnesemia**
loss of water and Na in urine.
73
**cisplatin**
for boards the main electrolytes you need to know
**\*\*1. hypomanesemia**
2nd hypokalemia
3. hypocalcemia.
74
what are the meds that cause **HYPOKALEMIA**
know is
**ampohtericin B**
**cisplatin**
**loops**
**thiazide**
75
what drugs can cause **HYPERKALEMIA**
**ace inhibitors** and **ARBS**
**K sparing**
**Nsaids (ibuprofen)**
**cyclosporin** and **tacroimus**
**Pentamidine** (used in HIV)
76
Q
HIV pt treated for SJS with **pentamidine**
what electrolyte innbalance do you expect?
**hyperkalemia**
77
**amphotericin B**
can cause what type of RTA
**type 1 renal tubular acidosis**
inc distal tubular membrane permeability --\> hypokalmeia and hypomagnesemia
78
**allopurinol, cimetidine**
boards love to ask you about these two drugs that can cause?
**interstitial nephritis**
79
classic Question on the boards\*\*\*\*\*
chronic use of what analgesic ( not used in US)
can cause **renal papillary necrosis**
**Phenacetin**
80
what are the two important drugs (on boards) that cause
**post renal azotemia**
**acyclovir**
**indinavir**
81
high yield question
pt with **magnesium ammonium phosphate** (struvite stones)
**TX?**
**antibiotic (quinolones)**
surgery is NOT always done
82
side effect of **azathioprine**
| (used in renal transplant)
**bone marrow suppression**
causing leukopenia and thrombocytopenia
83
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.
84
most common
side effect of
**mycophenolate mofetil**
used in renal transplant
**diarrhea**
85
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**
86
on boards
cyclosporine side effect
**nephrotoxicity -** renal vasoconstriction (usually immmediately after starting tx --\> renal ischemia)
hepatotoxicity
neurotoxicity
**hirsutism, gingival hyperplasia**
87
does cyclosporine
effect bone marrow causing bone marrow suppressioni
**HELL NO**
**its azathioprine**
tacolimus can also
88
**danazol**
used for hereditary telangiectasia and endometriosis
side effect
**hirsutism**
89
**dilitiazem**
**errythromycin**
**ketoconazole**
**grape fruit**
are all
potent **cyp3A INHIBITORS!!!**
Thus significant toxicity of cyclosporine.
90
.pt is started on a immunosuppressant for renal transplant
now he has **hyperglycemia**
and is **diabetic**
which drug
**tacrolimus (FK506)**
91
pt is started on thiazide (hydrochlorothiazide, chlorthalidone, metolazone)
the serum level of what will most likely be elevated?
**cholesterol**
also
**hyperucremia, hypercalcemia, hyperglycemia**
92
for the boards
what diuretic should be avoid in diabetes
**HCTZ**
93
what diuretic can be used in place of spironolactone
bc of its selective aldosterone receptor inhibitor --\> minimal anti androgenic effect
**eplerenone**
94
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**
95
**ace inhibitors**
will cause
inc or dec in K and Creatinine
**hyperkalemia**
**inc creatinine**
96
on boards
tx of minimal change disease
**A. prednisone**
**B. prednisone** and **cyclophosphamide**
**prednisone**
97
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
98
question
**spironolactone** is used in PCOS to treat hirsutism
how does it tx this
**dec production of testosterone**
**testosterone receptor blocker**
99
most common ovarian tumors are originating from the surface epithelium and not the germ cells ( like folliicles)
so know this for origin
100
leuprolide is used for
**advanced prostate cancer in men**
**endometriosis**
**fibroid tumors**
101
tx of acute endometritis
(fever, abnormal uterine bleeding, pelivc pain)
**iv clindamycin + gentamicin**
102
**valproic acid**
use during pregnancy will inc risk for neural tube defects due to **inhibition** of?
**inhibition** of **folic acid absorption**
from the intestine
103
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)**
104
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
