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USMLE STEP 1 > Drugs > Flashcards

Drugs Flashcards

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USMLE® Step 1 flashcards
1
Q

block cell wall synthesis by inhibition of peptidoglycan cross-linking

A

penicillin, methicillin, ampicillin, pipercillin, cephalosporins, aztreonam, imipenem

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2
Q

block peptidoglycan synthesis

A

bacitracin, vancomycin

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3
Q

block nucleotide synthesis by inhibiting folic acid synthesis

A

sulfonamides, trimethoprim

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4
Q

block DNA topoisomerases

A

fluoroquinolones

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5
Q

block mRNA synthesis

A

rifampin

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6
Q

damage DNA

A

metronidazole

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7
Q

block protein synthesis at 50S ribosomal subunit

A

chloramphenicol, macrolides, clindamycin, streptogramins (quinupristin, dalfopristin), linezolid

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8
Q

block protein synthesis at 30S ribosomal subunit

A

aminoglycosides, tetracyclins

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9
Q

structural analog of D-ala D-ala

A

penicillin

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10
Q

penicillin MOA

A

bind transpeptidases, block transpeptidase cross-linking of peptidoglycan, activate autolytic enzymes

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11
Q

penicillin use

A

gram + (S. pneumonia, S. pyogenes, Actinomyces), N. meningitidis, Treponema pallidum, bactericidal for gram+ cocci, rods, gram - cocci, spirochetes

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12
Q

penicillin toxicity

A

hypersensitivity, hemolytic anemia

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13
Q

penicillin resistance

A

beta lactamases cleave beta lactam ring

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14
Q

D-ala D-ala

A

a.a. sequence on peptidoglycan precursor molecules that is recognized by enzyme transpeptidase

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15
Q

oxacillin, nafcillin, dicloxacillin MOA

A

narrow spectrum, penicillinase resistant )bulky R group blocks access of beta-lactamase to beta lactam ring)

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16
Q

oxacillin, nafcillin, dicloxacillin use

A

S. aureus (except MRSA–>altered penicillin-binding protein target site)

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17
Q

oxacillin, nafcillin, dicloxacillin toxicity

A

hypersensitivity, interstitial nephritis

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18
Q

ampicillin, amoxicillin MOA

A

wider spectrum, penicillinase sensitive; combine with clavulanic acid to protect against beta-lactamase; amoxicillin has greater oral bioavalability

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19
Q

ampicillin, amoxicillin use

A

HELPSS kill enterococci

H. influenza, E. coli, Listeria, Proteus, Salmonella, Shigella, enterococci

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20
Q

ampicillin, amoxicillin toxicity

A

hypersensitivity, ampicillin rash, pseudomembranous colitis

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21
Q

ampicillin, amoxicillin resistance

A

beta-lactamases cleave beta-lactam ring

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22
Q

ticarcillin, pipercillin MOA

A

extended spectrum

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23
Q

ticarcillin, pipercillin use

A

pseudomonas, gram - rods, susceptible to penicillinase, use with clavulanic acid

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24
Q

ticarcillin, pipercillin toxicity

A

hypersensitivity

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25
Q

beta-lactamase inhibitors

A

CAST

clavulanic acid, sulbactam, tazobactam

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26
Q

cephalosporins MOA

A

inhibit peptidoglycan synthesis through blockage of transpeptidation enzymes; bactericidal

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27
Q

organisms not covered by cephalosporins

A

LAME

Listeria, atypicals (chlamydia, mycoplasma), MRSA, enterococci. ceftaroline covers MRSA

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28
Q

1st generation cephalosporins

A

cefazolin, cephalexin

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29
Q

1st generation cephalosporins use

A

gram + cocci;
PEcK
proteus, e. coli, klebsiella.
cefazolin used prior to surgery to prevent S. aureus infection of wound

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30
Q

2nd generation cephalosporins

A

cefoxitin, cefaclor, cefuroxime

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31
Q

2nd generation cephalosporins use

A

gram + cocci
HEN PEcKS
H. influenza, enterobacter, neisseria, proteus, e. coli, klebsiella, serratia

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32
Q

3rd generation cephalosporins

A

ceftriaxone, cefotaxime, ceftazidime

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33
Q

3rd generation cephalosporins use

A

gram - infections resistant to other beta-lactams

ceftriaxone: meningitis and gonorrhea
ceftazidime: pseudomonas

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34
Q

4th generation cephalosporins

A

cefepime

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35
Q

4th generation cephalosporins use

A

increased activity against pseudomonas and gram +

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36
Q

cephalosporins toxicity

A

hypersensitivity, vitamin K deficiency, low cross-reactivity with penicillins, increase nephrotoxicity of aminoglycosides

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37
Q

aztreonam MOA

A

monobactam resistant to beta-lactamases
prevents peptidoglycan cross-linking by binding PBP3, synergistic with aminoglycosides, no cross-allerginicity with penicillins

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38
Q

aztreonam use

A

gram - rods only

for penicillin-allergic pts and those with renal insufficiency who can’t tolerate aminoglycosides

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39
Q

aztreonam toxicity

A

occasional GI upset

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40
Q

imipenem/cilastatin, meropenem MOA

A

imipenem: broad-spectrum, beta-lactamase resistant cerbapenem, always administered with cilastatin (inhibitor of renal dehydropeptidase I)

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41
Q

imipenem/cilastatin, meropenem use

A

gram + cocci, gram - rods, anaerobes

meropenem: reduced risk of seizures, stable to dehydropeptidase I

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42
Q

imipenem/cilastatin, meropenem toxicity

A

GI distress, skin rash, CNS (seizures)

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43
Q

vancomycin MOA

A

inhibits cell wall peptidoglycan formation by binding D-ala D-ala; bactericidal

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44
Q

vancomycin use

A

gram + only; MRSA, enterococci, C. difficile

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45
Q

vancomycin toxicity

A

NOT (does not have many problems)

nephrotoxicity, ototoxicity, thrombophlebitis, red man syndrome (pretreat with antihistamines and slow infusion rate)

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46
Q

vancomycin resistance

A

D-ala D-ala change to D-ala D-lac

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47
Q

daptomycin MOA

A

lipopeptide antibiotic limited to gram + (including MRSA)

causes depolarization of bacterial cellular membrane and inhibition of DNA, RNA, amd protein synthesis

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48
Q

daptomycin toxicity

A

increased CPK levels and increased incidence of myopathy

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49
Q

30S inhibitors

A

aminoglycosides (bactericidal), tetracyclines (bacteriostatic)

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50
Q

50S inhibitors

A

chloramphenicol, clindamycin (bacteriostatic)
erythromycin (bacteriostatic)
linezolid (s.e. thrombocytopenia, optic neuritis)

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51
Q

aminoglycosides MOA

A

bactericidal; inhibit formation of initiation complex and cause misreading of mRNA; block translocation; require O2 for uptake (ineffective against anaerobes)

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52
Q

aminoglycosides use

A

severe gram - rod infections; synergistic with beta-lactams

neomycin for bowel surgery

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53
Q

aminoglycosides toxicity

A

nephrotoxicity (especially with cephalosporins), neuromuscular blockade, ototoxicity (especially with loop diuretics), teratogen

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54
Q

aminoglycosides resistance

A

transferase enzymes: acetylation, phosphorylation, adenylation

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55
Q

tetracyclines MOA

A

bacteriostatic; bind to 30S and prevent attachment of aminoacyl-tRNA, limited CNS penetration
doxycycline for pts with renal failure
do not take with milk, antacids, iron-containing preps because divalent cations inhibit absorption

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56
Q

demeclocycline use

A

ADH antagonist; diuretic in SIADH

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57
Q

tetracyclines use

A

borrelia burgdorferi, M. pneumonia; ability to accumulate intracellularly–<effective against rickettsia and clamydia

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58
Q

tetracyclines toxicity

A

GI, discoloration of teeth, inhibition of bone growth in children, photosensitivity. contraindicated in pregnancy

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59
Q

tetracyclines resistance

A

decreased uptake into cells or increased efflux by plasmin-encoded transport pumps

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60
Q

macrolides MOA

A

inhibit protein synthesis by blocking translocation; bind to 23S rRNA of 50S; bacteriostatic

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61
Q

macrolides use

A

atypical pneumonia (mycoplasma, chlamydia, legionella), chlamydia, gram + cocci (strep infections in pts allergic to penicillin)

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62
Q

macrolides toxicity

A

MACRO
motility issues, arrhythmia (prolonged QT), acute cholestatic hepatitis, rash, eosinophilia; increase serum concentration of theophyllines, oral anticoagulants

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63
Q

macrolides resistance

A

methylation of 23S rRNA

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64
Q

chloramphenicol MOA

A

blocks peptidyltransferase at 50S; bacteriostatic

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65
Q

chloramphenicol use

A

meningitis (H. influenza, neisseria, strep pneumonia)

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66
Q

chloramphenicol toxicity

A

anemia (dose dependent), aplastic anemia (dose independent), gray baby syndrome (lack liver UDP-glucuronyl transferase)

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67
Q

chloramphenicol resistance

A

plasmid-encoded acetyltransferase

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68
Q

clindamycin MOA

A

blocks peptide transfer at 50S; bacteriostatic

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69
Q

clindamycin use

A

anaerobic infections (bacteroides fragilis, C. perfringens) in aspiration pneumonia or lung abscess, gram + cocci

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70
Q

clindamycin toxicity

A

pseudomembranous colitis, fever, diarrhea

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71
Q

sulfonamides MOA

A

PABA antimetabolites inhibit dihydropteroate synthase; bacteriostatic

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72
Q

sulfonamides use

A

gram +, gram -, nocardia, chmamydia; triple sulfas or SMX for simple UTI

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73
Q

sulfonamides toxicity

A

hypersensitivity, hemolysis of G6PD deficient, nephrotoxicity (tubulointerstitial nephritis), photosensitivity, kernicterus in infants, displace other drugs from albumin (warfarin)

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74
Q

sulfonamides resistance

A

altered bacterial dihydroproteroate synthase, decreased uptake, increased PABA synthesis

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75
Q

trimethoprim MOA

A

inhibits bacterial dihydrofolate reductase; bacteriostatic

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76
Q

trimethoprim use

A

in combo with sulfonamides causing sequential block of folate synthesis; combo used for UTI, shigella, salmonella, pneumocystis jirovecii

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77
Q

trimethoprim toxicity

A

TMP: treats marrow poorly

megaloblastic anemia, leukopenia, granulocytopenia (may alleviate with supplemental folinic acid: leucovorin rescue)

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78
Q

fluoroquinolones MOA

A

inhibit DNA gyrase (topoisomerase II) and topoisomerase IV; bactericidal; must not be taken with antacids

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79
Q

fluoroquinolones use

A

gram - rods of urinary and GI tracts (pseudomonas), neisseria, some gram +

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80
Q

fluoroquinolones toxicity

A

GI, superinfections, skin rashes, headaches, dizziness, tendonitis, myalgias; contraindicated in pregnant women and children; prolonged QT; may cause tendon rupture in pts taking prednisone

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81
Q

fluoroquinolone resistance

A

chromosome-encoded mutation in DNA gyrase, plasmid-mediated resistance, efflux pump

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82
Q

metronidazole MOA

A

forms free radical toxic metabolites that damage DNA; bactericidal; antiprotozoal

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83
Q

metronidazole use

A

GET GAP
giardia, entamoeba, trichomonas, gardenella vaginalis, anaerobes, with proton pump inhibitor and clarithromycin against H. pylori

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84
Q

metronidazole toxicity

A

disulfiram-like reactions with alcohol (inhibits alcohol oxidizing enzymes), headache, metallic taste, GI

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85
Q

M. TB prophylaxis

A

isoniazid

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86
Q

M. TB treatment

A

RIPE

rifampin, isoniazid, pyrazinamide, ethambutol

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87
Q

M. avium intracellulare prophylaxis

A

azithromycin

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88
Q

M. avium intracellulare treatment

A

azithromycin, rifampin, ethambutol, streptomycin

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89
Q

M. leprae treatment

A

tuberculoid form: dapsone and rifampin

lepromatous form: add clofazimine

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90
Q

isoniazid MOA

A

decreased synthesis of mycolic acids; bacterial catalase peroxidase (KatG) needed to convert INH to active metabolites

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91
Q

isoniazid use

A

M. TB; different half-lives in fast vs slow acetylators

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92
Q

isoniazid toxicity

A

neurotoxicity, hepatotoxicity. Pyridoxine can prevent neurotoxicity, lupus

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93
Q

rifampin MOA

A

inhibits DNA-dependent RNA polymerase

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94
Q

rifampin use

A

M. TB, delays resistance to dapsone, meningococcal and H. influenza type B prophylaxis

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95
Q

rifampin toxicity

A

hepatotoxicity; enhances P-450, orange body fluids

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96
Q

pyrazinimide MOA

A

acidify intracellular environment via conversion of pyrazinoic acid

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97
Q

pyrazinimide use

A

M. TB

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98
Q

pyrazinimide toxicity

A

hyperuricemia, hepatotoxicity

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99
Q

ethambutol MOA

A

decrease carbohydrate polymerization of mycobacterial cell wall by blocking arabinosyltrabsferase

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100
Q

ethambutol use

A

M. TB

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101
Q

ethambutol toxicity

A

optic neuropathy (red-green color blindness)

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102
Q

meningococcal prophylaxis

A

ciproflaxacin, rifampin for children

103
Q

gonorrhea prophylaxis

A

ceftriaxone

104
Q

syphilis prophylaxis

A

benzathine penicillin G

105
Q

recurrent UTIs prophylaxis

A

TMP-SMX

106
Q

endocarditis with surgical or dental procedures

A

penicillins

107
Q

pregnant woman carrying group B strep

A

ampicillin

108
Q

prophylaxis of strep pharyngitis in a child with prior rheumatic fever

A

oral penicillin

109
Q

prevention of post-surgical infection due to S. aureus

A

cefazolin

110
Q

prevention of gonococcal or chlamydial conjunctivitis in newborn

A

erythromycin ointment

111
Q

CD4<200 prophylaxis

A

TMP-SMX, pneumocystis

112
Q

CD4<100 prophylaxis

A

TMP-SMX, pneumocystis and toxoplasmosis

113
Q

CD4<50prophylaxis

A

mycobacterium avium complex

114
Q

MRSA treatment

A

vancomycin

115
Q

VRE treatment

A

linezolid and streptogramins (quinupristin/dalfopristin)

116
Q

amphotericin B MOA

A

binds ergosterol and forms membrane pores

117
Q

amphotericin B use

A

systemic mycoses, cryptococcus, blastomycoses, hitoplasma, candida. supplement K and Mg because of altered renal tubule oermeability

118
Q

amphotericin B toxicity

A

fever/chills, hypotension, nephrotoxicity, arrhythmias, anemia, IV phlebitis
hydration reduces nephrotoxicity
liposomal amphotericine reduces toxicity

119
Q

nystatin MOA

A

same as amphotericin; topical form

120
Q

nystatin use

A

oral candidiasis, diaper rash, vaginal candidiasis

121
Q

azole MOA

A

inhibit fungal ergosterol synthesis by inhibiting P-450 that converts lanosterol to ergosterol

122
Q

azoles use

A

fluconazole: chronic suppression of cryptococcal meningitis in AIDS and candidal infections
itraconazole: blastomyces, coccidiodes, histoplasma
clotrimazole and miconazole for topical fungal infections

123
Q

azoles toxicity

A

testosterone synthesis inhibition (gynecomastia, esp ketokonazole); liver dysfunction

124
Q

flucytosine MOA

A

inhibits DNA and RNA synthesis by conversion to 5-fluorouracil by cytosine deaminase

125
Q

flucytosine use

A

systemic fungal infections (Esp Cryptococcus) in combination with amphotericin B

126
Q

flucytosine toxicity

A

bone marrow suppression

127
Q

capsofungin, micafungin MOA

A

inhibits cell wall synthesis by inhibiting synthesis of beta glucan (polysaccharide)

128
Q

capsofungin, micafungin use

A

invasive asperigillosis, candida

129
Q

capsofungin, micafungin toxicity

A

GI, flushing (histamine release)

130
Q

terbinafine MOA

A

inhibits squalene epoxidase–> decreases ergosterol synthesis

131
Q

terbinafine use

A

dermatophytoses (esp. onychomycosis)

132
Q

terbinafine toxicity

A

abnormal LFT, visual disturbances

133
Q

griseofulvin MOA

A

interferes with microtubule function; disrupts mitosis; deposits in keratin-containing tissues

134
Q

griseofulvin use

A

oral treatment of superficial infections, inhibits growth of dermatophytes

135
Q

griseofulvin toxicity

A

teratogenic, carcinogenic, confusion, headaches, encahnces P-450 and warfarin metabolism

136
Q

anti-toxoplasmosis therapy

A

pyrimethamine

137
Q

anti-trypanosoma brucei therapy

A

suramin and melarsoprol

138
Q

anti-T. cruzi therapy

A

nifurtimox

139
Q

anti-leishmaniasis therapy

A

sodium stibogluconate

140
Q

chloroquine MOA

A

blocks detoxification of heme into hemozoin–>heme accumulates and is toxic to plasmodia

141
Q

chloroquine use

A

treatment of plasmodium species other than P. falciparum

142
Q

chloroquine resistance

A

membrane pump

143
Q

chloroquine toxicity

A

retinopathy

144
Q

P. falciparum treatment

A

artemether/lumifantrine or atovaquone/proguanil; for life-threatening use quinidine or artisunate

145
Q

schistosoma treatment

A

praziquantel

146
Q

zanamivir, oseltamivir MOA

A

inhibit influenza neuraminidase, decreasing the release of progeny virus

147
Q

zanamivir, oseltamivir use

A

treatment and prevention of influenza A and B

148
Q

rebavirin MOA

A

inhibits synthesis of guanine nucleotides by competitively inhibiting IMP dehydrogenase
enhances TH1 and decreased TH2 responce

149
Q

rebaririn use

A

RSV, chronic hepatitis C

150
Q

ribavirin toxicity

A

hemolytic anemia, teratogen

151
Q

acyclovir MOA

A

monophosphorylated by HSV/VZV thymidine kinase; guanosine analog; triphosphate formed by cellular enzymes; preferentially inhibits viral DNA polymerase by chain termination

152
Q

acyclovir use

A

HSV and VZV, weak against EBV, no activity against CMV; genital lesions, encephalitis
valacyclovir: prodrug, better oral bioavailability

153
Q

acyclovir toxicity

A

can cause crystalline nephropathy if adequate hydration is not provided

154
Q

acyclovir resistance

A

mutated viral thymidine kinase

155
Q

herpes zoster treatment

A

famciclovir

156
Q

ganciclovir MOA

A

5-monophosphate formed by CMV viral kinase; guanosine analog; triphosphate formed by cellular kinases; preferentially inhibits viral DNA polymerase

157
Q

gancilcovir use

A

CMV

valganciclovir: prodrug, better oral bioavailability

158
Q

ganciclovir toxicity

A

leukopenia, neutropenia (increased with zidovudine), thrombocytopenia, renal toxicity

159
Q

ganciclovir resistance

A

mutated CMV DNA polmerase or lack of viral kinase

160
Q

fascarnet MOA

A

viral DNA polymerase inhibitor that binds to pyrophosphate-binding site; does not require activation by viral kinase

161
Q

foscarnet use

A

CMV retinitis in immunocompromised when ganciclovir fails; acycloovir-resistant HSV

162
Q

fascarnet toxicity

A

nephrotoxicity; electrolyte abnormalities (can lead to hypocalcemia and hypomagnesemia, generalized seizures)

163
Q

foscarnet resistance

A

mutated DNA polymerase

164
Q

cidofovir MOA

A

preferentially inhibits viral DNA polymerase; doesn’t require phosphorylation by viral kinase

165
Q

cidofovir use

A

CMV retinitis in immunocompromised; acyclovir-resistant HSV; long half-life

166
Q

cidofovir toxicity

A

nephrotoxicity (coadminister with probenecid and IV saline)

167
Q

medication-induced body fat redistribution syndrome

A

associated with HIV protease inhibitors and glucocorticoids

168
Q

HAART

A

initiated when pts have CD4<500 or high viral load

2 NRTI + NNRTI or protease inhibitor or integrase inhibitor

169
Q

protease inhibitors

A

-navir (lopinavir)

170
Q

protease inhibitors MOA

A

prevent maturation of new viruses

ritonavir: inhibits P-450

171
Q

protease inhibitors toxicity

A

hyperglycemia, GI, lipodystrophy, nephropathy, hematuria (indinavir)

172
Q

NRTIs

A

tenofovir, abacavir, emtricitabine, lamivudine, zidovudine, stavudine, didanosine

173
Q

NRTIs MOA

A

competitively inhibit nucleotide binding to reverse transcriptase and terminate DNA chain
tenofovir: nucleotide analog, doesn’t have to be activated (others are nucleoside analogs and need to be phosphorylated)
ZDV (zidovudine): used for general prophylaxis and during pregnancy

174
Q

NRTIs toxicity

A

bone marrow suppression (Can be reversed with G-CSF an erythropoietin), peripheral neuropathy, lactic acidosis (nucleosides), rash (non-nucleosides), anemia (ZDV)
ZDV: can inhibit mamalian cellular and mitochondrial beta and gamma DNA polymerases
didanosine: pancreatitis

175
Q

NNRTIs

A

nevirapine, efavirenz, delavirdine

176
Q

NNRTIs MOA

A

bind to reverse transcriptase; do not require phosphorylation

177
Q

NNRTIs toxicity

A

same as NRTIs

nevirapine and efavirenz: Steven-Johnson syndrome and toxic epidermal necrolysis

178
Q

integrase inhibitors

A

raltegravir

179
Q

integrase inhibitors MOA

A

inhibits HIV genome integration into host chromosome by reversibly inhibiting HIV integrase
impaired mRNA transcription

180
Q

integrase inhibitors toxicity

A

hypercholesterolemia

181
Q

intefrerons MOA

A

glycoproteins synthesized by virus infected cells; block replication of DNA and RNA viruses

182
Q

interferon alpha use

A

chronic hepatitis B and C, Kaposi’s sarcoma

183
Q

interferon beta use

A

MS

184
Q

interferon gamma use

A

NADPH oxidase deficiency

185
Q

interferons toxicity

A

neutropenia, myopathy

186
Q

enfuviritide MOA and use

A

prevents viral entry into target cells
antiretroviral fusion inhibitor
used for HIV

187
Q

antibiotics to avoid in pregnancy

A

SAFe Children Take Really Good Care

sulfonamides, aminoglycosides, fluoroquinolones, clarithromycin, tetracyclines, ribavirin, griseofulvin, chloramphenicol

188
Q

sulfonamides during pregnancy

A

kernictures

189
Q

aminoglycosides during pregnancy

A

ototoxicity

190
Q

fluoroquinolones during pregnancy

A

cartilage damage

191
Q

clarithromycin during pregnancy

A

embryotoxic

192
Q

tetracyclines during pregnancy

A

discolored teeth, inhibition of bone growth

193
Q

ribavirin during pregnancy

A

teratogenic

194
Q

griseofulvin during pregnancy

A

teratogenic

195
Q

chloramphenicol during pregnancy

A

gray baby

196
Q

direct cholinergic agonists

A

bethanecol, carbachol, pilocarpine, methacoline

197
Q

bethanecol MOA

A

activates bowel and bladder smooth muscle; resistant to AChE

198
Q

bethanecol use

A

postoperative ileus, neurogenic ileus, urinary retention

199
Q

carbachol MOA

A

carbon copy of ACh

200
Q

carbachol use

A

glaucoma, pupillary contraction, relief of intraocular pressure

201
Q

pilocarpine MOA

A

contracts ciliary muscle of eye (open angle glaucoma), pupillary sphincter (closed-angle glaucoma), resistant to AChE

202
Q

pilocarpine use

A

stimulator of sweat, tears, and saliva

open and closed-angle glaucoma

203
Q

methacoline MOA

A

stimulates muscuranic receptors in airway when inhaled

204
Q

methacoline use

A

challenge test for diagnosis of asthma

205
Q

indirect cholinergic agonists

A

neostigmine, pyridostigmine, edrophonium, physostigmine, donepezil

206
Q

neostigmine MOA

A

increases endogenous ACh

no CNS penetration

207
Q

neostigmine use

A

postoperative and neurologic ilues, urinary retention, myasthenia gravis, reversal of neuromuscular junction blockade

208
Q

pyridostigmine MOA

A

increases endogenous ACh, increases strength

209
Q

pyridostigmine use

A

myasthenia gravis (long-acting), doesn’t penetrate CNS

210
Q

edrophonium MOA

A

increases endogenous ACh

211
Q

edrophonium use

A

diagnosis of myasthenia gravis (extremely short-acting)

212
Q

physostigmine MOA

A

increases endogenous ACh, fixes atropine overdose

213
Q

physostigmine use

A

anticholinergic toxicity (crosses BBB)

214
Q

donepezil MOA

A

increases endogenous ACh

215
Q

donepezil use

A

alzheimers

216
Q

cholinomimetic agents possible exacerbation

A

COPD, asthma, peptic ulcers

217
Q

can you use beta blockers in cardiogenic shock?

A

no

218
Q

protective against diabetic nephropathy

A

ACE inhibitors

219
Q

Ca channel blockers

A

nifedipine, diltiazem, verapamil, amlodipine

220
Q

Ca channel blockers MOA

A

block voltage-dependent L-type Ca channels–>reduce muscle contractility
smooth muscle: amlodipine, nifedipine
geart: verapamil> diltiazem

221
Q

Ca channel blockers use

A

hypertension, angina, antiarrhythmic (not nifedipine), Prinzmetal’s angina, Raynaud’s

222
Q

Ca channel blockers toxicity

A

cardiac depression, AV block, peripheral edema, flushing, dizziness, constipation

223
Q

hydralazine, diazoxide MOA

A

increase cGMP–>smooth muscle relaxation, vasodilates arterioles–>afterload reduction

224
Q

hydralazine, diazoxide use

A

severe hypertension, CHF. 1st line for hypertension in pregnancy (with methyldopa). Often administered with beta blockers to prevent reflex tachycardia

225
Q

hydralazine, diazoxide toxicity

A

compensatory tachycardia, fluid retention, nausea, headache, angina, SLE

226
Q

nitroprusside MOA

A

short-acting

increases cGMP via direct release of NO–> arterial and venous vasodilator

227
Q

nitroprusside use

A

malignant hypertension

228
Q

nitroprusside toxicity

A

cyanide (treat with sulfur)

229
Q

fenoldopam MOA

A

D1 receptor agonist–>coronary, peripheral, renal, splanchnic vasodilation

230
Q

fenoldopam use

A

malignant hypertension

decreased BP and increases natriuresis

231
Q

nitroglycerin, isosorbide dinitrate MOA

A

vasodilate by releasing NO–>increase in cGMP and smooth muscle relaxation
dilate veins, decrease preload

232
Q

nitroglycerin, isosorbide dinitrate use

A

angina, pulmonary edema

233
Q

nitroglycerin, isosorbide dinitrate toxicity

A

reflex tachycardia, hypotension, flushing

pts taking daily nitrates need to have a nitrate-free period every day to avoid tolerance

234
Q

isosorbide mononitrate

A

nearly 100% bioavailable when taken orally

235
Q

partial beta agonists contraindicated in angina

A

pindolol, acebutolol

236
Q

statins MOA

A

inhibit HMG-CoA reductase
inhibit conversion of HMG-CoA to mevalonate
pravastatin: not metabolized by P450

237
Q

statins use

A

decrease LDL, increase HDL, decrease TG

238
Q

statins toxicity

A

hepatotoxicity, rhabdomyolysis: can lead to acute renal failure

239
Q

niacin use

A

increase HDL, decrease LDL, decrease TG

240
Q

niacin MOA

A

inhibits lipolysis in adipose tissue, reduces hepatic VLDL secretion
potentiates effects of some anti-hypertensive meds

241
Q

niacin toxicity

A

red, flushed face (decreased by aspirin or long-term), hyperglycemia, hyperuricemia

242
Q

bile acid resins

A

cholestyramine, colestipol, colesevelam

243
Q

bile acid resins MOA

A

prevent intestinal absorption of bile acids

244
Q

bile acids use

A

decrease LDL, slightly increase HDL and TG

245
Q

bile acids toxicity

A

pts hate it, decreases absorption of fat-solubel vitamins, cholesterol gallstones

246
Q

ezetemibe MOA

A

prevent cholesterol reabsorption in small intestine

247
Q

ezetemibe use

A

decreases LDL

248
Q

ezetimibe toxicity

A

rare increase LFT, diarrhea

249
Q

fibrates MOA

A

upregulates LPL–>increase TG clearance

250
Q

fibrates use

A

decrease TG, decrease LDL, increase HDL

251
Q

fibrates toxicity

A

myositis, hepatotoxicity, cholesterol gallstones

combination with statins increases risk of myopathy

252
Q

digoxin MOA

A

direct inhibition of Na/K ATPase–>indirect inhibition of Na/Ca exchanger–>increased intracellular Ca–>positive inotropy
decreases HR

253
Q

digoxin uses

A

CHF, atrial fibrillation

254
Q

digoxin toxicity

A

cholinergic: nausea, vomiting, diarrhea, blurry yeallow vision
increased PR, shortened QT, ST scooping, T-wave inversion, arrhythmia, AV block
hyperkalemia–>poor prognostic indicator
factors predisposing to toxicity: renal failure, hypokalemia, quinidine (displaces digoxin from tissue-binding sites)

USMLE STEP 1 (21 decks)

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