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board review > drugs > Flashcards

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

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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

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3
Q

NSAID side effect on boards

pt started on NSAID or B-lactams

now develops fever, eosinophil in urine

A

INTERSTITIAL NEPHRITIS

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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.

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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

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6
Q

prolonged bleeding time will be seen in

on boards

A

pt taking ASA

NSAIDS,

pts with uremia!!!

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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!!!

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8
Q

sulfasalazine

AE

A

agranulocytosis

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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.

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10
Q

tx for tinea (pityriasis) versicolor (malessezia furfur)

1st line

2nd line for recurrent

A

selenium sulfide topical

2nd - ketoconazole

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11
Q

how should you treat tinea capitis caused by any organism

A

not topical

oral : terbinafine or grisiofolvin

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12
Q
A
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13
Q

why can octreotide be used in esophageal varices bleeding?

A

reduces portal venous pressure

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14
Q

salivary gland disorders

sjogrens syndrome

treatment?

and moa

A

cevimeline

its a parasympathomimetic and muscarinic agonist.

affecting M1 and M3 receptors

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15
Q

salivary gland disorders

sjogrens syndrome

treatment?

and moa

A

cevimeline

its a parasympathomimetic and muscarinic agonist.

affecting M1 and M3 receptors

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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.

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17
Q

why does a pt with mumps have elevated serum amylase

A

due to pancreatitis and from parotitis

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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

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19
Q

bleeding into the peritoneum –> involving the inferior surface of diaphragm will present how

A

referred pain to shoulder

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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

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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

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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)

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23
Q

aluminum hydroxide and calcium carbonate (gastric antacid)

sideeffect?

A

constipation

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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)

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25
Q

why is misoprostol

CI in pregnancy

A

bc it can cause abortion

bc prostaglandins inc uterine tone

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26
Q

H2 blockers

side effects

A

cimetidine is a potent inhibitor of CYP 450

also has antiandrogenic effect (gynecomastia and other feminizing effects in men, prolactin release, impotence, dec libido)

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27
Q

long term use of PPI can lead to dec absroption of what vitamin?

A

B12

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28
Q

high yield q on boards

ulcerative colitis pt with RUQ pain and increased LFTs

A

primary sclerosing cholangitis

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29
Q

(Q) metoclopramide

is used to increase Gi perisalsis without increasing gastric secretion.

whats its moa

**SE**?

A

dopamine (D2) receptor antagonist in the enteric NS - myenteric auerbachs) and submucosal (meissners) pleuxs

side effect**** extrapyramidal effects (parkinsonism)

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30
Q

Q on boards

cisapride

serotonin (5-HT4) agnoist in the enteric Ns –> inc ACH –> GI motility

side effect

A

fatal ARRHYTHMIA - due to Long QT syndrome

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31
Q

Q on boards (trick!!!)

UC patient has colonscopy and results show mild dysplasia

what are you going to do?

A

surgery immediately

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32
Q

on the boards

mild cases of UC with no bloody diarrhea start tx with?

A

sulfasalazine (5-aminosalicyclic acid)

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33
Q

Q on boards (trick!!!)

UC patient has colonscopy and results show mild dysplasia

what are you going to do?

A

surgery immediately

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34
Q

on the boards

mild cases of UC with no bloody diarrhea start tx with?

A

sulfasalazine (5-aminosalicyclic acid)

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35
Q

how do you treat amebiasis (entamoeba histolytica) liver abscess

A

metronidazole

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36
Q

for sure on boards

side effects of metronidazole

A

metallic taste

neuropathy

disulfram rxn

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37
Q

what is the hepatic neoplasm associated with each risk factor?

estrogen hormonal therapy (OCPs)

A

hepatic adenoma

(liver cell adenoma)

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38
Q

what is the hepatic neoplasm associated with each risk factor?

vinyl chloride and arsenic exposure

A

hepatic angiosarcoma

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39
Q

what is the hepatic neoplasm associated with each risk factor?

Thorotrast

a form of thorium dioxide (was used as a radiologic contrast)

A

cholangiocarcinoma

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40
Q

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

A

hepatocellular carcinoma

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41
Q

acute fatty liver of pregnancy

(non specific symps, : N/V/ anorexia, jaundice, and fever

is due to?

Q: the only treatment is???

A

due to abnormal B oxidation of fatty acids- during third trimester

only tx is termination of pregnancy

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42
Q

Benzodiazepine overdose tx

A

flumazenil

43
Q

tx of hemochromatosis is

phlebotomy and deferoxamine

what is the side effect of deferoxamine?

A

pain and sweeling at the injection site

44
Q

Topiramate

an anticonvulsant

sideeffect to know

A

calcium phosphate nephrolithiasis

(kidney stone)

45
Q

best anticonvulsant during pregnancy

A

lamotrigene

can cause SJS

46
Q

picks disease (frontotemporal dementia)

pt has personality changes (behavioral disturbances) and inappropriate/aggressive.

what will be seen on biopsy

A

intracellular tau protein

rounded aggregates inside cerebral neurons

47
Q

triptans

like sumatriptan moa

A

selective serotonin receptor agonist

48
Q

triptans (sumatriptan)

the most serious side effect is ?

A

coronary artery vasospasm

49
Q

alheimers tx

1st line

A

donepezil

50
Q

Q

tacrine (anticholinergic) used for alheimers tx

sideeffect

A

hepatotoxicity

51
Q

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?

A

donepezil is a central ach esterase inhibitor that causes

increased vagal tone –> bradycardia –> atrioventricular block

52
Q

alzheimers tx

for boards

know that ginkgo biloba

does or does not imporove the global function in pts with alzheimers

A

does NOT

53
Q

on the boards

(inhaled anesthetics)

which one increases the tissue response to high PCO2 –> increase cerebral blood flow –> increased ICP

A

isoflurane

54
Q

(inhaled anesthetics)

which on increases coronary blood flow - beneficial in pts with CAD

A

isoflurane

55
Q

(inhaled anesthetics)

causes convulsions

A

enflurane

56
Q

hy Q

(inhaled anesthetics)

halothane side effect

A

hepatoxicity (massive hepatic necrosis)

due to direct hepatocyte toxicity and autoantibodies agaiinst liver proteins

57
Q

Q

(inhaled anesthetics)

methoxyflurane

side effect

A

nephrotoxicity

58
Q

!Q (inhaled anesthetics)

which to are bronchodilators

recommeneded for asthmatics

A

halothane

sevoflurane

59
Q

(inhaled anesthetics)

all the inhaled anesthetic

can cause ______

except for NITROUS OXIDE

A

MALIGNANT HYPERTHERMIA

60
Q

(side effects for boards for neuromuscular blocking drugs)

Q

malginant hyperthermia and rhabdomyolysis.

A

succinylcholine

61
Q

(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?

A

succinylocholine

it can cause fatal arrythmias

62
Q

first sign of malignant hyperthermia

A

contraction of the jaw muscles (trimus)

63
Q

(side effects for boards for neuromuscular blocking drugs)

which one causes

HISTAMINE release –> hypotension, reflex tachycardia, bronchospasm and cutaneous flush

A

atracurium

64
Q

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)

A

gentamicin.

65
Q

Q

what do you give for opioid intoxication

what do you give for alcohol dependence and opioid dependence

A

IV NALOXONE

not oral

ORAL naltrexone

66
Q

methadone is a long acting strong ____ ?

at opioid mu receptors

its used to treat pts with heroin addicition.

A

agonist.

prolonged half life of methadone will supress the withdrawal symps in heroine addicitve.

67
Q

acute arsenic poisoning

(insectcides)

Gi symp : N/V/ abd pain, diarrhea

decrease lv of consciousness, hypotension, tachycardia

look for a garlic odor

tx

A

DIMERCAPROL

which displaces arsenic ions from sulfhydryl grps of enzymes

68
Q

Q

guy working construction an has glucose in urine but always normal glucose at last 5 visits. why does he have high glucose

A

lead toxicity causing nephrotoxicity –> fanconi syndrome - type 2 renal tubular acidosis (Type 2 RTA)

also see loss of bicarb in urine.

69
Q

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

A

succimer

not EDTA !!! why (bc it does not cross the BBBB and may lead to exacerbation of lead encephalopathy)

70
Q

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

A

methemoglobinemia

tx: methylene blue

  • a reducing agent that converts iron in heme from the Fe3 to Fe2 state.

also vit D

71
Q

Q

cyanide toxicity is due to?

A

inactivation of the mitochondrial cytochrome oxidase –> blokcing the cellular aerobic metabolism even in the presence of adequate oxygen stores

72
Q

loops cause

what electrolyte abnormality to K and MG

A

hypo kalemia

hypomagnesemia

loss of water and Na in urine.

73
Q

cisplatin

for boards the main electrolytes you need to know

A

**1. hypomanesemia

2nd hypokalemia

  1. hypocalcemia.
74
Q

what are the meds that cause HYPOKALEMIA

know is

A

ampohtericin B

cisplatin

loops

thiazide

75
Q

what drugs can cause HYPERKALEMIA

A

ace inhibitors and ARBS

K sparing

Nsaids (ibuprofen)

cyclosporin and tacroimus

Pentamidine (used in HIV)

76
Q

Q

HIV pt treated for SJS with pentamidine

what electrolyte innbalance do you expect?

A

hyperkalemia

77
Q

amphotericin B

can cause what type of RTA

A

type 1 renal tubular acidosis

inc distal tubular membrane permeability –> hypokalmeia and hypomagnesemia

78
Q

allopurinol, cimetidine

boards love to ask you about these two drugs that can cause?

A

interstitial nephritis

79
Q

classic Question on the boards*****

chronic use of what analgesic ( not used in US)

can cause renal papillary necrosis

A

Phenacetin

80
Q

what are the two important drugs (on boards) that cause

post renal azotemia

A

acyclovir

indinavir

81
Q

high yield question

pt with magnesium ammonium phosphate (struvite stones)

TX?

A

antibiotic (quinolones)

surgery is NOT always done

82
Q

side effect of azathioprine

(used in renal transplant)

A

bone marrow suppression

causing leukopenia and thrombocytopenia

83
Q

pt on azathioprine

for renal transplant and now has a gouty arthritis

you want to give allopurinol

what should you do

A

cut dose of azathioprine by 1/2

bc 6-MP is metabolized by xanthine oxidase enzyme.

84
Q

most common

side effect of

mycophenolate mofetil

used in renal transplant

A

diarrhea

85
Q

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

A

prevent IL-2 transcription

preventing activation of T cells!

he said (inhibit T cell proliferation)

DOES NOT REDUCE the number of T cells

86
Q

on boards

cyclosporine side effect

A

nephrotoxicity - renal vasoconstriction (usually immmediately after starting tx –> renal ischemia)

hepatotoxicity

neurotoxicity

hirsutism, gingival hyperplasia

87
Q

does cyclosporine

effect bone marrow causing bone marrow suppressioni

A

HELL NO

its azathioprine

tacolimus can also

88
Q

danazol

used for hereditary telangiectasia and endometriosis

side effect

A

hirsutism

89
Q

dilitiazem

errythromycin

ketoconazole

grape fruit

are all

A

potent cyp3A INHIBITORS!!!

Thus significant toxicity of cyclosporine.

90
Q

.pt is started on a immunosuppressant for renal transplant

now he has hyperglycemia

and is diabetic

which drug

A

tacrolimus (FK506)

91
Q

pt is started on thiazide (hydrochlorothiazide, chlorthalidone, metolazone)

the serum level of what will most likely be elevated?

A

cholesterol

also

hyperucremia, hypercalcemia, hyperglycemia

92
Q

for the boards

what diuretic should be avoid in diabetes

A

HCTZ

93
Q

what diuretic can be used in place of spironolactone

bc of its selective aldosterone receptor inhibitor –> minimal anti androgenic effect

A

eplerenone

94
Q

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

A

mannitol

95
Q

ace inhibitors

will cause

inc or dec in K and Creatinine

A

hyperkalemia

inc creatinine

96
Q

on boards

tx of minimal change disease

A. prednisone

B. prednisone and cyclophosphamide

A

prednisone

97
Q

high yield what is the moa of the drug used in PCOS to induce ovulation

A

CLOMIPHENE

estrogen antagonist that increases secretion of gonaotropins and stimulates ovulation

it may inc the incidence of pregnancy with multiple fetuses

98
Q

question

spironolactone is used in PCOS to treat hirsutism

how does it tx this

A

dec production of testosterone

testosterone receptor blocker

99
Q

most common ovarian tumors are originating from the surface epithelium and not the germ cells ( like folliicles)

A

so know this for origin

100
Q

leuprolide is used for

A

advanced prostate cancer in men

endometriosis

fibroid tumors

101
Q

tx of acute endometritis

(fever, abnormal uterine bleeding, pelivc pain)

A

iv clindamycin + gentamicin

102
Q

valproic acid​

use during pregnancy will inc risk for neural tube defects due to inhibition of?

A

inhibition of folic acid absorption

from the intestine

103
Q

pt exposed to any of these can develop

moldy hay (thermophilic actinomycetes)

grain dust

birds

A

hypersensitivity pneumonitis

(Birds Fancier disease or farmers lung)

(type III/IV HSR)

104
Q

if asymptomatic pt comes to your office for initial prenatal visit and found to have bacteriuria

what should your managment be

A

treat asymptomatic bacteriuria w?

ampicillin

cephalaxin

or

nitrofurantoin.

remember fluoroquinolone and sulfa are CI in pregnancy

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