Drugs Flashcards
1
Q
Amifostine
A
prevent nephrotoxicity with cisplatin/carboplatin by scavenging free radicals
2
Q
Aminocaproic Acid
A
TPA OD
3
Q
p450 inhibitors
A
Ciprofloxacin Ritonavir (Protease Inhibitors) Amiodarone Cimetidine Ketoconazole Acute EtOH Macrolides INH Grapefruit Juice Omeprazole Sulfonamides
4
Q
problem with phenytoin or sulfonamide + warfarin
A
displacement off albumin= increased hemorrhage
5
Q
sulfonamide + sulfonylureas
A
displacement of albumin, risk of hypoglycemia
6
Q
pregnancy in woman takin OCP who had a nail fungus
A
griseofulvin induce p450, decreased efficacy of OCP
7
Q
why is aspirin not used in gout
A
competition in renal tubule secretion
8
Q
INH, Halothane
A
Hepatotoxicity
9
Q
Bone marrow suppression
A
chloramphenicol, ganciclovir, zidovudine
10
Q
Bactericidal Antibiotics
A
Penicillin, Cephalosporin, Vancomycin, aminoglycosides, quinolones
11
Q
which opioid receptor responsible for respiratory depression and site of naloxone action?
A
Mu receptor responsible for the scary effects, Kappa for Miosis
Naloxone has effect on mu, kappa, and delta, but most on mu
12
Q
NMDA antagonist with strange dreams
A
Ketamine
13
Q
salmonella, shigella tx
A
TMP-SMX
14
Q
Staph skin infection tx
A
dicloxacillin
15
Q
name the first gen ceph
A
cefazolin, cephalexin-
16
Q
opioid with some antagonistic activity, can precipitate opioid withdrawal
A
pentazocine
17
Q
chagas treatment
A
nifurtimox
18
Q
meperidine, fentanyl, levorphanol
A
mu opiods (fentanyl doesnt induce histamine)
19
Q
Ergot and Non ergot dopamine agonists
A
Ergot: Bromocriptine, Pergolide
Non Ergot: Pramipexole, Ropinerole
20
Q
inhibits 23S of 30S blocking inititation
A
aminoglycosides
21
Q
inhibits binding of all other tRNAs by affecting 30S
A
Tetracyclines
22
Q
inhibits bacterial peptidyl transferase
A
Chloramphenicol
23
Q
Inhibits translocation on 50S
A
Erythromycin (MACROSLIDES)
24
Q
antiviral that increases endogenous dopamine effect helping parkinsons
A
amantadine
25
antiepileptic that is metabolized to phenobarbital
primidone
26
Focal neuro defects after SAH. Cause and prevention?
due to release of substances in SAH which cause vasospasm. Nimodipine (calcium channel blocker) to decrease vasospasm
27
Drugs that inhibit
1) mammalina folate synthesis
2) bacterial folate synthesis
3) protozoan folate synthesis
1) MTX
2) Trimethoprim
3) Pyrimethamine
28
MOA of actinomycin D
DNA binding, inhibit replication
29
cardiomyopathy causing drug that intercalates DNA pairs
doxorubicin
30
1) Ca2+ channel blocker contraindicated in
2) B blocker contraindicated in
3) Thiazides contra
4) ACE_i
1) CHF
2) asthma, acute CHF, diabetes (hypoglycemia masker)
3) Diabetes (hyperglycemia), hypertriglyceride
4) pregnancy
31
Drug that leads to arterial dilation + inhibit platelet aggregation (use for peripheral vascular disease intermittent claudication)
Cilostozol
inhibit PDE= Increased cAMP= inhibit platelet aggregation (Dipyridamole also in this category but not an arterial dilator, Implicated in CORONARY STEAL)
32
diuretic used for calcium kidney stones and diabetes insipidus
thiazides
33
how can angina get worse with nitroglycerin
in high doses, can dilate arterioles= reflex tachycardia
34
orally active nitrate
isosorbide mononitrate (dinatrate undergoes extensive metabolism)
35
used for Prinzmetal's angina
nifedipine
36
how is tpa more selective than streptokinase
only activated plasminogen already bound to fibrin
37
used for digitalis induced arrhythmias
Na/K blocked, so use 1B- Lidocaine
38
entacapone, tolcapone
COMT inhibitors, prevent levodopa peripheral methylation
39
Amrinone, Milrinone
PDE inhibitros that can be inotropic. Amrinone- thrombocytopenia
40
Toxicity of cardiac glycosides is increased by
hypokalemia, alkalosis, hypoxia
41
aminoglycosides + anti-nicotinic drugs
BAD COMBO- will enhance block
42
tubocurarine SE
histamine release= bronchospasm
43
action on which channels cause TCA effect of arrhythmias and hypotension
cardiac fast Na channels
44
drug causes arteriolar dilation, naturesis, and increased renal perfusion. Good for shock, heart failure
Fenoldopam - selective D1 agonist can increase cAMP -cause vascular SM relaxation
little alpha and beta effect
45
antiarrhythmic class that prefers activated and inactivated Na channnels, not resting Na channels. very fast attachment and detachment, decreased AP duration
IB- lidocaine, mexiletine, TOCAINIDE
46
neonate presents with shrill crying, rhinorrhea, small pupils, and seizures to mom who lives on the street. what to give?
acute neonatal opiate withdrawal
give tincture of opium until stabilized
47
recurrence of drug effect without drug, brilliant color hallucinations
LSD ("flashbacks")
48
met-enkephalin
leu-enkephalin
dynorphin
```
met= mu= euphoria, analgesia, respiratory
leu= delta= mood changes
dynorphin=kappa= miosis, sedation
```
49
fentanyl
high potency opiod
50
teenager with sudden arrhythmic movements, aggravated by sleep deprivation. 1st line tx
valproic acid for myoclonic seizures (others 1st line are carbamazepine, phenytoin, and valproic)
51
SE of epilepsy drug: hirsutism, coarse facial features, gingival hyperplasia, Cervical lymphadenopathy
phenytoin
52
how long does response to antidepressants take
3-4 wks
53
inhibitor of serotonin uptake, used for insomnia (5HT2). Gives you priapism
Trazodone
54
low dose vs high dose nicotine
low dose: ganglion stimulating, BP increase
| high dose: ganglion blockade, BP decrease
55
short half life benzos
triazolam, lorazepam
56
why is ampicillin added to ceftriaxone for 2 month old with CSF pleocytosis and irritability
cover for listeria meningitis
57
meclizine
anti histamine used for motion sickness and nausea
58
high MAC
| high blood solubility
low potency, low conc sufficient but onset and termination can be slow.
N2O>enflurane>halothane
59
use for children with febrile seizures
phenobarbital
60
drug of choice for anti-emetic action after chemotherapy, promotes gastric emptying
metoclopramide (D2 block)
| SE: parkinsonian
61
laxatives acting like irritants, increasing motility
senna, castor oil
62
what to give for CV toxicity of TCA (quinidine like QT prolong)
sodium bicarb (alkalinize urine)
63
patient with depressed mood is given a drug. mom had mood disorder. now comes in with grandiose thoughts
TCA given in depressed phase of bipolar can precipitate mania
64
first action in child who has a fever greater than 40 deg C, and hase seizures
cold blankets- need to cool, and give acetaminophen
65
Diphenoxylate, Mepiridine
anti-diarrheals (opiod agonist at mu)
66
patient who is depressed and very sensitive to rejection, with hyperphagia and hypersomnia. Tx
atypical depression- MAO-I (phenelzine, trancyclopromine, Isocarboxazid)
67
patient with knee pain giving analgesic has sudden RUQ pain
morphine opioid- contraction of SMOOTH MUSCLE (sphincter of ODDI) causes buildup behind= painful biliary colic)
68
feared SE of bupropion, esp in bulimia
increased seizures
69
SE of imipenem
seizures
70
mechanism of vasodilation by cholinergic
bind muscarinic receptor on endothelium (note no main effect on bv itself)= increased NO= increased cGMP= decreased MLCK
71
massive hepatic necrosis after surgery
halothane
72
MRSA tx with myopathy and increased CPK
daptomycin
73
nitrate SE
cutaenous flushing and headache
74
Alzheimers choline tx
want to give anti-cholinesterase to increase AcH,- donepezil, rivastigmine, galantamine
75
antidote for organophosphate poisoning
pralidoxime (need to be given early) + atropine
76
tropicamide, cyclopentate
anti-cholinergics to produce mydriasis
77
oxybutynin, tolterodine, Darifenacin, Trospium
anti-cholinergic for bladder relaxation for urinary incontinence. DONT give in BPH
78
Hemacholinum
prevent choline/Na cotransport into preganglionic cell
79
Vesamicol
prevent choline acetyltransferase mediated Ach storage
80
Metyrosine
Block Tyrosine hydroxylase, cant make dopamine in pre-synaptic neuron
81
Metyrapone
block 11B hydroxylase= used for diagnosis of adrenal insufficiency, and maybe tx hypercortisolism
82
Guanethidine, Bretylium
Inhibit NE release
83
G protein pathways
activated alpha subunit- 2 pathways
1) adenylate cyclase---cAMP---PLA
2) Phospholipase C---IP3/DAG----increase Ca, activate protein kinase C
84
Receptors and their G protein
```
A1-q
A2- i
B1- s
B2-s
M1- q
M2- i
M3-q
D1- s
D2-i
H1-q
H2-s
V1-q
V2-s
```
85
alpha 1
increase bladder sphincter contractions, increase vascular resistance
86
alpha and beta agonist affect on insulin
```
alpha= decrease insulin= hyperkalemia
beta= increase insulin= hypokalemia
```
87
B1 and Alpha 1 Blocker
Carvedilol and Labetalol
88
when do basic drugs get trapped in urine
in acidic env (like NH4+), pH
89
when do acid drugs get trapped in urine
in basic env, pH>pka
90
Anticholinergic side effects
TCA, Amantadine, H1 blockers, Atropine, LOW potency neuroleptics (chlorpromazine and thiordiazine), digoxin
91
Coronary vasospasm side effect
cocaine, sumatriptan, amphetamine (increased NE)
92
cutaneous flushing
Vancomycin
Adenosine
Niacin
Ca channel blocker
93
Torsades
1A (increased QT), III (sotalol), also macrolides, protease, haloperidol
94
Agranulocytosis = 3 Cs
Clozapine, Carbamazepine, Colchicine, also THYROID drugs- PTU, Methimazole, and DAPSONE
95
Aplastic Anemia
Chloramphenicol, NSAID, PTU, Methimazole
96
Thrombocytopenia
Heparin
97
Pulmonary fibrosis
Bleomycin, Busulfan, Amiodarone
98
Massive hepatic necrosis causes a HAVAc
Halothane, Amanita phalloides, VALPROIC acid, Acetaminophen
99
Hypothyroidism SE
amiodarone, lithium, sulfonamides
100
Drug that can cause acute cholestatic hepatitis and jaundice
Erythromycin
101
Direct Coombs positive hemolytic anemia
Methyldopa, peniciilin
102
Drugs that can cause gout
Furosemide, Thiazides, Niacin, Cyclosporine
103
SE of osteoporosis
corticosteroids, heparin
104
Drugs that can cause Steven Johnsons
Seizure drugs (Lamotrigine, Phenyotin, Phenobab, Carbamazepine, Ethosuzimide) also ALLOPURINOL.penicillin
105
,Drugs that can cause DI
Demeclocycline and Lithium (used to tx SIADH)
106
Parkinson like symptoms
antipsychotics, reserpine (block dopamine storage), metoclopromide (D2 antagonist used for post op gastroparesis)
107
Seizure causing drugs
Isoniazid, Bupropion, Imipenem, Tramadol, Enflurane, Metoclopramide (I BITE My tongue)
108
tinnitus, dizziness, headache, GI distress
cinchonism= quinidine, quinine
109
toxicity side effect of tinnitus. Tx?
aspirin! alkalinize urine with sodium bicarbonate
110
tx for B-blocker or Ca channel blocker
glucagon (regenerate cAMP), calcium, atropine
111
what stimulates, inhibits desmolase
stimulated by ACTH, inhibited by ketoconazole
112
Sitagliptin, Saxagliptin, Linaglibtin
inhibit DPP-IV which usually metabolize GLP1. so end up with increased insulin action
113
Exenatide, Liraglutide
GLP-1 analog- mimcrs incretins, decrease glucagon, increase insulin
SE: pancreatitis
114
Pramlintide
amylin analoexag, decreases GLUCAGON (only used in pts taking insulin)
115
potential hepatotoxic diabetic drugs
TZDs, metformin
116
Diabetic drug that is not associated with weight gain, also has risk of lactic acidosis, esp with renal dysfunction
Metformin (should not be used with elevated creatinine clearance), also helps lower TG and LDL
117
liver disease associated with obesity
NASH- insulin resistance at liver allows lipid accumulation, can progress to HCC, cirrhosis. Chronically elevated LFTs seen
118
Tx of restless leg syndrome
pramipexole, ropinerole (dopamine agonists)
119
drugs used to shorten N3 sleep (enuresis)
benzodiazepines, imipramine
120
Hexamethonium
acts in autonomic ganglia by binding mostly in or on the NN receptor, no effect on muscarinic
121
HIV drug causing pancreatitis
didanosine (nRTI)
122
alkylating agent requiring activation in liver, how is its toxicity prevented
cyclophosphamide, give mesna to prevent hemorrhagic cystitis
123
ursodial
tx of PBC- delays damage
124
Aldesleukin
IL2 useful for renal cell carcinoma and melanoma
125
decrease of Il2 via binding FKBP
Tacrolimus, Sirolimus (inhibit MTOR)
126
affects TNFa, SE: of phocomelia
Thalidomide
127
abdy that binds to CD3 on T cells
Muromonab
128
Daclizumab
binds IL-2 receptor
129
inhibits IMP dehydrogenase
Mycophenolate mofetil
130
Metabolized by XO, increased toxicity with allopurinol
6-MP, Azathioprine
131
tx of PNH, block complement mediated lysis
eculizumab
132
Navirs side effects
GI intolerance, inhibit cyp 450 (ritonavir)
pancreatitis-Ritonavir
Kidney stones- idinavir, atazanavir
HYPERLIPIDEMIA, LIPODYSTROPHY (buffalo hump)
133
nRTI with hepatic steatosis
didanosine (also pancreatitis), stavudine
134
Nevirapine, Efavirenz, Delavirdine
neuro sx + teratogenic
135
NRTI vs Tenofovir
NRTI= nucleoside, tenofovir= nucleotide inhib
136
HIV drug SE: megaloblastic anemia, bone marrow suppression
zidovudine (used in preventing maternal transmission)
137
Tx for neonatal infection (think meningitis)
ampicillin (listeria)+ gentamycin
138
bacteria not responsive to cephalosporins
Listeria
Atypicals
MRSA
Enterobacter
139
anti-cancer drug that needs to be activated
cytarabine via phosphorylation
140
drug always given with imipenem
cilastatin
141
Prophylaxis of MAC complex (CD4<50), tx?
Prophylaxis: azithryomycin
tx: clarithromycin + ethambutol
142
H, influenza and meningitis
Rifampin
143
diuretic used for psuedotumor cerebri
acetazolamide
144
MOA of linezolid
bind 23S of 50S
145
avoid taking these with teracyclines
antacids, iron containing foods- ions interfere with absorption
146
Quinupristin/Dalfopristin
streptogramins, bind peptidyltransferase of 50S (like chloramphenicol). uses: MRSA, VRE, staph and strep infections
147
abx with detergent like action which inactivates bacterial endotoxin. for resistant gram negatives
polymyxins
148
nephrotoxic esp with cephalosporins, ototoxicity esp with loop diuretics
aminoglycosides
149
general dx treated by macrolides
PUS= pneumonia (atypical), URI, STD
150
Eptifibatide, tirofiban
along with abciximab, inhib Gp2b/3a
151
anticancer drug for choriocarcinoma, hydatidiform mole
MTX
152
anticancer drug used topically for basal cell cancer, actinic keratosis
5FU
153
intercalated DNA, produces free radicals, cardiotoxic
doxyrubicin, daunorubicin
154
DNA alkylating agents used in brain cancer
nitrosureas
155
cyproheptadine
first gen antihistamine used as appetite stimulant, also has anti 5HT= for serotonin syndrome
156
meclizine
antihistamine used for vertigo
157
enfuvirtide
fusion inhib fror HIV- interfere with gp41
158
Maraviroc
anti-CCR5 for HIV, prevent initial infection
159
antihypertensive- vasodilation, also slows/stops hair growth
minoxidil- opens K+ channels, hyperpolarize smooth muscle
160
anti-hypertensive with dry mouth, sedation, severe rebound HTN
clonidine
161
can ARBs still be implicated in angioedema?
yes,arbs stil can have angioedema, dont have cough
162
fixes atropine overdose
Physostigmine
163
why should hydralazine be avoided in person with coronary disease, but can be used for HTN in pregnancy, emergency
has huge effect on lowering BP- will increase HR---increased demand if have coronary disease= more ischemia
164
antihypertensive to avoid in bilateral renal stenosis
ACE-I, ARBS which decrease ang2- so actually will increase creatinine more
165
difference between Nitrates and Ach/Alpha 2 agonist/serotonin/histamine mediated vasodilation
both have same end effect
Bradykinin/Alpha 2 agonist/Histamine/Serotonin act on ENDOTHELIAL cell- increase NO production from arginine, which then can go to smooht muscle cell- activated cGMP- activate myosin PHOSPHATASE
Nitrates and LPS directly upregulate NO on smooth muscle cell. Sildenafil prevents cGMP breakdown
166
meds for acute heart failure
LMNO= loop diuretic, morphine, nitrates, oxygen, also digoxin
167
swan ganz catheter sites
right IJ>left SC>right SC>left IJ
168
Antiarrhythmics- 1A
| Increase AP duration, work on active phase 0
Disopyramide, Quinidine, Procainamide
SE of quinine: cinchonism
-procainamide used for WPW, SE: SLE
169
1B blockers
| decrease AP duration
Lidocaine, Tocainide, Mexilitine, PHENYTOIN
used for acute ventricular tach, POST MI tachycardia
170
1C blockers
| no change AP duration
Fleicanide, Propaffenone
171
which drugs would decrease slope of phase 4 of pacemaker of heart
B blocker
172
Fetilide, Sotalol, Amiodarone , DOFETILIDE, BRETYLIUM
class 3, elongate QT and AP duration
173
drugs for WPW
procainamide, amiodarone
174
patient with SVT comes in. He is given a drug that stops his heart for 10 seconds, and then his heart starts back again at a slower rate.
its effects can be stopped by which drugs?
Adenosine
- K+ out= hyperpolarization
effects stopped by theophylline
175
Rhythm and rate control of chronic afib
rate control: B blocker, digoxin, calcium channel blocker
rhythm control: amiodarone, sotalol
176
SE: erosive esophagitis and osteonecrosis of jaw
bisphosphonates
177
Acne tx
1) hyperkeratosis
2) Sebum
3) P. acnes
1) isoretinoin
2) spironolactone
3) erythromycin, tetracycline
178
what kind of meds should never be given in psoriasis
oral steroids
179
calcipotriene
vitamin D3 analog, inhibits epidermal cell proliferation. single agent of choice for psoriasis
180
tx of ADHD
methylphenidate, dextroamphetamine
| atomexetine= NE reuptake inhib
181
weak opiod used for chronic pain control
tramadolol - works on all NTs (tram it all!)
182
high potency neuroleptics
haloperidol, flupherazine, loxapine, trifluoperazine- more EPS signs
183
low potency neuroleptics, deposit locations
```
chlorpromazine= corneal deposits
thioridazine= retinal deposits
```
can be anticholinergic, anti-histamine, anti-alpha
184
atypical antipsychotics
wt gain effects, for + and - sx
| -olanzapine (wt gain), clozapine, queti, reisperidone, aripiprazole
185
Fever, encephalopathy, vitals unstable, elevated enzymes, rigid muscles
neuroleptic malignant syndrome= FEVER
| tx: dantrolene
186
sertraline, citalopram, paroxetine
SSRI (fluoxetine is the well known one)
| dont confuse sertraline and selegeline!
187
venlafazine, duloxetine
snri
188
-typtiline or -pramine
TCA
| weird one- doxepin
189
Tranylcypromine, Phenelzine, Selegeline, Isocarboxazid
Tranny stole my Phen-Phen and was SELLING it in a boxcar
MAO-I
190
a2 antagonist=increase NE. Weight gain and sedation
Used for depressed patient with insomnia
Mirtazapine
191
TCA overdos
C= convulsions, coma, cardiotoxicity
192
which substance needed for active secretion of organic anion
alpha -ketoglutarate
193
metolazone, chlorthalidone
thiazide diuretics
194
K+ shift out of cells
beta blockers, acidosis, digoxin, cell lysis
195
K+ into cells
insulin, B-agonist, alkalosis
196
treatment for lithium induced nephrogenic DI
amiloride (can block Enac so Li cant be taken in)
197
tx of eclampsia
IV magnesium sulfate for seizures
198
how is estrogen helpful with heart disease but bad with strokes?
increases HDL, decreases LDL
| but also increases liver synthesis- so increased clotting factors
199
Medroxyprogesterone
IM every 3 mos, assoc with long term bone density loss
200
Danazol
androgen derivative that may be used in endometriosis to inhibit HPA
201
clomiphene
bind estrogen receptor in hypothalamus= decreased negative feedback so increase gnRH
202
Anastrozole/Exemestane
Aromatase inhibitors used in breast cancer, PCOS
203
most common cause of increased AFP on amniocentesis
incorrect pregnancy dating!
204
OB safe meds: Categories
A= safe, B= safe based on animal studies, C= no studies show adverse studies D=risk, but benefit may outweigh, X=contraindicated
205
Mifepristone
antagonist at progesterone= abortificant. given with misoprostol
206
tx of hyperammonemia
benzoate, phenylbutyrate, lactulose
207
Palivizumab
against paramyxovirus F protein that causes fusion of epithelial cells and latency. for rsv in children
208
HIV integrase inhibitor
Raltegravir (SE: hypercholesterolemia)
209
cyclosporine toxicity
nephrotoxic, gingival hyperplasia, hirsutism
210
cholinomimetic resistant to AchE
Pilocarpine (sweat, drool)- used for glaucoma
211
glycopyrorolate
post op reduction of airway secretions
212
terbutaline, ritodrine
B2 agonist- reduce uterine contractions
213
diazoxide
K+ channel blocker- can hyperpolarize and vasodilate
SE: reduces insulin release leading to hyperglycemia
214
why are Pindolol and Acebutol contraindicated in angina
PAPA- have partial B agonist activity- would increase heart demand even more
215
reasons for using Thiazides, Indomethacin, amiloride in DI
Thiazide, Amiloride- act in distal parts of nephron, so actually increase PCT water reabsorption
indomethacin counters prostaglandin mediated decreased ADH action
216
prevent daunorubicin/doxorubucin toxicity
dexrazoxane (iron chelator)
217
IV anesthetic associated with rapid onset and recovery but high TG content= risk of pancreatitis
propofol
218
decreased blood flow- good anesthetics for brain surgery
opiods
219
how to reverse pancuronium block
=non depolarizing block antagonized with neostigmine (ache inhib= increased Ach)
220
Sumatriptan contraindicated in
Prinzmetal's angina, coronary artery disease
221
methotrexate SE
stomatitis- painful mouth ulcers , hepatotoxicity. myelosuppression
222
sulfasalazine SE
reversible oligospermia
223
ticlopidine
neutropenia, ADP inhib
224
cancer drug- neurotoxicity, paralytic ileus
vincritsine
225
vemurafinib
anti-BRAF
226
brimonidine
alpha agonist used in open angle glaucoma to cause vasoconstriction= decreased aqueous humor production
227
cholinergics used in glaucoma
carbachol, pilocarpine, physostigmine- will open up trabecular meshwork to increase outflow of humor
228
Latanoprost for glaucoma
prostaglandin analong increase outflow of humor
229
butorphanol
partial opiod agonist, lesser resp depression. can act as antagonist in presence of full agonist
230
vigabatrin
epilepsy drug, inhibit gaba transaminase
231
Zolpidem, Zaleplon, esZopiclone
at benzo receptor, for sleeping, less dependence
232
tx of Huntington
| low ACH and Gaba, high dopamine
Tetrabenazine- VMAT inhib= decrease dopamine
| reserpine- prevent dopamine packaging
233
which psych diseases should SSRI not be used in?
Schizophrenia and Bipolar- can exacerbate mania
234
ariprazole
lesser EPS sx for atypical antipsychotic- partial dopamine agonist
235
wt gain atypical antipsychotics
olanzapine and clozapine
236
clomipramine
TCA used for OCD
237
toxicity of mannitol
pulmonary edema, contraindicated in CHF
238
how can loop diuretics dilate afferent arteriole
induce pge release
