Drugs/ Pharm Flashcards by Rachel Rodriguez

Cromolyn sodium

Inhibits mast cell degranulation, preventing the release of chemical mediators of asthma

For prophylaxis of asthma attacks

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Ondansetron (Zofran)

5- HT3 receptor (serotonin) antagonists, highly effective at preventing vomiting , especially for chemo patients

Block vagus nerve mediated nausea AND block vomit center in the CTZ of the medulla

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N- acetylcysteine (NAC)

A mucolytic agent, used for acetominophen overdose

Other uses:

Protect kidneys in pts with renal insufficiency who need IV contrast
mucolytic in Flu, bronchitis, cystic fibrosis

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Leucovorin (Folinic acid)

Treatment of methotrexate overdose

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Filgrastim

A G-CSF (granulocyte colony stim factor) analog used to stimulate granulocytes after myelosuppressive chemotherapy

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Octreotide

Somatostatin analog (use for Growth Hormone adenoma) suppresses the anterior pituitary response to GHRH to stop release of GH

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Bromocriptine

Dopamine agonist– suppresses prolactin (used in pts with a prolactinoma )

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Argatroban – mechanism, use ?

direct thrombin inhibitor, used for Heparin Induced Thrombocytopenia (HIT syndrome) and other times when you need to prevent clotting

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best diabetes med for a pregnant woman?

Insulin

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a drug to both decrease the risk of bone fracture and decrs breast cancer risk in woman

a SERM (ie: Raloxifene) –> estrogen agonist at the bone and antagonist at the breast

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list the P450 inhibitors:

“Florida Grapefruits Can Inhibit Some Key Enzymes”

Fluoroquinolones (Cipro, Levaquin....) 
Grapefruit juice
Cimetidine
Isoniazid
Sulfonamides
Ketoconazole (& other -azoles)
Ethanol (alcohol abuse)

also, Macrolides, Amiodarone & Ritonavir (MAR)

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Enfuvirtide

binds to gp41 on the HIV cell & prevents fusion & penetration into the host cell

“you can’t get “en -fu” there”

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vitamin that helps Psoriasis?

vitamin D (sunlight or creams like Calcipotriene)

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Abciximab mechanism , use?

monoclinal AB that targets the gpIIb/IIIa and inhibits platelet aggregation

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a drug with a high MW, highly bound to plasma protein, highly charged & hydrophilic –> will it have a high or low Vd?

Low volume of distribution –> all those characteristics trap the drug in the plasma compartment

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best treatment for ingestion of Rat Poison?

1st line is to give FFP, then slower acting vitamin K

rat poison is usually coumadin / warfarin & FFP contains all the clotting factors you need to immediately help the bleeding

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Nitrates can cause a reflex tachycardia and hypotension with a subsequent release of catecholamines–> this adverse effect can be prevented by co-administering what type of drug?

a beta blocker –> decreases HR and also blocks the effects of the catecholamines

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What are the Class 1 anti-arrhythmics?

Class 1A = “Double Quarter Pounder”
((Disopyramide, Quinidine, Procainamide))

Class 1B = “Lettuce, Tomato, Mayo”
((Lidocaine, Tocainide, Mexilitine))

Class 1C = “More Fries Please”
((Moricizine, Flecainide, Propafenone))

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Why do patients taking nitrates need to have a ‘nitrate free interval’ every day?

To prevent tolerance

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Which type of drug has been shown to be beneficial for preventing the myocardial remodeling of heart failure as well as lower BP?

ACE inhibitors

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What is the mechanism of Nitrates?

release NO –> increase cGMP–> vasodilates (veins&raquo_space; arteries) – cause a decrease in PRELOAD –> decrs cardiac work

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Side effects of IV infused adenosine?

flushing, burning in the chest, SOB (Adenosin is the drug of choice for a supravenricular tachycardia)

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Where are Beta 1 receptors found?

cardiac tissue & renal JG cells

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Effects of anthracyclines (Doxo- & Daunorubicin) on the heart?

form free radicals in the myocardium and cause dilated cardiomyopathy

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What is the bioavailability of a drug administered IV?

1 (100%)

Formula for Maintenance Dose?

MD = steady state plasma concentration X Clearance / Bioavailability (1 if given IV)

Formula for half life?

Vd x 0.7 / Clearance

Formula for Loading dose?

Vd x Steady state plasma concen / (Bioavailability fraction)

Where do the K+ sparing diuretics work in the nephron?

at the Collecting duct

What are the Class 3 anti-arrhythmics?? (they block K+ efflux / block phase 3 repol , prolonging the QT interval)

"K+ IS BAD" ``` Ibutilide Sotalol Bretylium Amiodarone Dofetilide ``` all put you at risk for Torsades!

Most common side effects of Verapamil?

Constipation, gingival hyperplasia, bradycardia and heart block!

What antihypertensive drugs are also protective against diabetic nephropathy?

ACE inhibitors

First line for hypertension treatment in pregnant women?

Hydralazine & Methyldopa

Hydralazine mechanism

direct vasodilator (incrs cGMP --->smooth muscle relaxation and vasodilation (esp in arterioles therby reducing AFTERLOAD)

Side effects of Hydralazine

Reflex tachycardia, Lupus like syndrome, N,V, HA...

Calcium channel blockers that are more specific for cardiac than smooth muscle

Verapamil, Diltiazem (Nifedipine is more vessel selective)

Treatments for Malignant HTN?

Nitroprusside Fendolopam Diazoxide

Best drugs for lowering LDL?

Statins (HMG-Coa reductase inhibitors)

Best drugs for increasing HDL?

Niacin (reduces VLDL secretion into blood)

Best for lowering Trigs?

Fibrates (upregulate LPL)

Adverse effect of fibrates and statins (worse when given together)

Myopathy (rhabdomyolysis, myositis...)

Lipid lowering drug with side effects of flushing, hyperglycemia, hyperuricemia (gout exacerbation)

Niacin (flushing can be decreased by taking ASA)

Patients HATE these lipid lowering drugs b/c they taste bad and cause GI upset

Bile acid resins (cholestyramine) -- they prevent the liver from reabsorbing bile acids

Drug for heart failure that inhibits the Na/K ATPase and Na/Ca exchanger, therby increasing intracellular Calcium and increasing contractility

DIGOXIN (used for CHF, also helpful for afib because it stimulates the vagus nerve)

Treatment for Torsades and dig toxicity

Mg++

Class 1 antiarrhythmics block_______ channels

Sodium channels (the phase 0 inward Na+ current in the ventricles) -- also prolong phase 3 & prolog the AP (class 1A the most, 1C next and 1B the least)

Class II antiarrhythmics block_______

these are Beta blockers -- block Beta receptors and decrs cAMP, decr Ca++ in the cell, decrs the slope of phase 4 at the nodes

Which drugs can treat arrhythmia but have the side effect of masking signs of hypoglycemia?

Class 2 antiarrhythmics (B-blockers) --> treat overdose with glucagon

Class III antiarrhythmics block_______

K+ channels -- they block the K+ efflux, prolong phase 3 repol and prolong the QT interval ((*risk for Torsades))

Amiodarone adverse effects

pulmonary fibrosis, hepatotoxicity, thyroid problems ((always check LFTs, PFTs and TFTs) --also blue/gray skin discolor, constipation, bradycardia , heart block

Why would you not give an opiod analgesic for a person in pain from gallbladder problems?

b/c opiods cause contraction of the smooth muscles in the Sphincter of Oddi --> increases pressure in the bile duct & GB and can lead to biliary colic pain *Mepiridine doesn't cause much contraction & is the one to use for GB & panc pain....

mechanism of Zidovudine (for HIV)

nucleoside RT inhibitor, comp binds to RT and is incorporated into the viral genome as a Thymidine analog -AZT doesn't have a 3' -OH group so phosphodiester bond formation is impossible

an acute extrapyramidal symptom (like dystonia) after taking a drug for psychiatric disorder --> which receptor was most likely being antagonized by the drug?

Dopamine (D2) receptors - EPS are a result of an imbalance btw the D2 and Muscarinic receptors in the nigrostriatal tract - they usually balance each other out -- so block one & you get symptoms

the one type of renal stone that is radiolucent (does NOT show up on XRAY)

Uric Acid stone

what mediates the flushing side effects on Niacin?

Prostaglandins -hence you can prevent it with Aspirin

What is the mechanism of the TB drug that can cause optic neuritis as a side effect?

Ethambutol --> inhibits carbohydrate polymerization & thus peptidoglycan synthesis

What is the mechanism of Isoniazid?

inhibits Mycolic acid synthesis

Which TB drug directly inhibits bacterial RNA synthesis and can turn your tears, sweat & other secretions red/ orange?

Rifampin

drug for treating HTN & BPH at the same

alpha-1 blocker

these drugs bind to PPAR-gamma and decrease Insulin-resistance , increase adiponectin

TZD's

severe HTN causes what changes to kidney arterioles?

onion-like concentric thickening of arteriolar walls

Conditions associated w/ avascular necrosis of the femoral head

1- Sickle cell 2- Vasculitis / Lupus 3- Steroids / Alcoholism

What causes the hypercalcemia in sarcoidosis?

macrophages cause increased extrarenal formation of active Vitamin D

A pt on antithyroid meds (PTU or Methimazole) --- what complication should you look out for?

Agranulocytosis (white count < 500)

Drug to give a patient who is having trouble voiding after surgery

Bethanechol (muscarinic agonist)

these drug classes function by irreversibly binding to penicillin-binding-proteins like transpeptidases...

Penicillins & Cephalosporins

What is the 1st area of the brain damaged / most susceptible to global cerebral ischemia?

the hippocampus

Rathke's pouch comes from what embryologic layer?

Surface ectoderm

Low AFP on a triple screen of a pregnant woman might indicate....

Down's syndrome

Rank the different kinds of "bruises" from smallest to largest

petechiae ( 1cm)

prevention for MAC in an HIV + pt

weekly Azithromycin

side effects of Caspofungin

flushing & GI upset

mechanism of Amphotericin B & Nystatin

"tears" holes in Ergosterol membranes

What fungal pneumonia can be stained w/ mucicarmine stain?

Cryptococcus neoformans

What drug is used for asthma challenge test

methacholine

Side effects of -azoles?

Inhibits hormone synthesis (androgens) , can cause gynecomastia in men, hepatotoxicity

What is the most common form of Cryptococcus neoformans infection?

meningitis

What side effect do Gangcyclovir & Zidovudine have in common?

Neutropenia / bone marrow suppression

how do Beta blockers help in treatment of thyrotoxicosis?

1- reduce heart rate , anxiety | 2- decrs the rate of peripheral conversion of T4 to T3

Mechanism of Trimethoprim

inhibits DHFR | same as methotrexate

pt with recent episodes of thrombophlebitis that involve multiple sites

migratory thrombophlebitis (think CANCER) -"Trousseau's syndrome" --> especially adenocarcinomas of the pancreas, colon, or lung

lipid lowering drug that can cause INCREASED trigs

bile acid resins

Nitroprusside is metabolized to _________ & ______ so there is potential for toxicity

Cyanide and N.O

antidote for Cyanide toxicity

Sulfur (in the form of Sodium Thiosulfate)

which ACHe inhibitor can cross the BBB

Physostigmine -- can reverse Atropine toxicity

this anatomical defect is necessary for pyelonephritis to develop

Vesico-ureteral reflux

Atropine can worsen _________ and is therefore contraindicated in pt's with this eye problem

Glaucoma - Atropine causes Mydriasis, can worsen narrowing of anterior chamber angle

long acting alpha-blocker commonly used for Pheochromocytomas

Phenoxybenzamine

highly sedating anti-depressant that can cause priapism

Trazodone

mechanism of Pioglitazone

a TZD -- binds to PPAR-gamma to modify transcription , increases Adiponectin, therby decrs insulin resistance

corticosteroids cause an increase in which type of white blood cell?

Neutrophils (a result of demargination of neutrophils that were attached to vessel walls) -they cause a decrs in all other WBC's

1st line tx for Simple & Complex Partial seizures

Carbamazepine

Tx for Myoclonic Seizures (type of generalized seizure, arrhythmic jerking movements)

Valproic acid

1st line tx for Generalized Tonic Clonic seizures

Phenytoin (then Carbamazepine & Valproate)

Drugs that can cause a Disulfiram like reaction

I Died when I "MET that PRO SURFer at a Certain C-store" - Metronidazole - Procainamide - Sulfonureas (1st gen) - Certain Cephalosporins

Antipsychotic drug that you must beware of Agranulocytosis...

Clozapine (hides granulocytes in the 'closet')

you can develop tolerance to all of the effects of Opiods EXCEPT:

Constipation & Miosis

drug most associated w/ Neuroleptic malignant syndrome

Haloperidol

Oxycodone overdose would cause your pupils to ________

constrict (it is semisynthetic Opioid)

SSRI's (like Paroxetine) can be used to treat premature ejaculation b/c _____

they cause anorgasmia as a side effect!

primarily used to treat spasticity/ UMN symptoms

Baclofen -- activates GABA at muscle spindle

carbonic anhydrase inhibitor that is used to treat glaucoma, seizures, pseudotumor cerebri, altitude sickness, cystinuria, heart failure (diuretic) ..

Acetazolamide

mechanism of Acetazolamide

block Carbonic Anhydrase at the PCT -interferes with bicarbonate (HCO3-) reabsorption in the kidneys, thereby re-acidifying the blood (and thus alkalinizing the urine).

mechanism of the atypical antipsychotic Aripriprazole

Partial agonist at dopamine receptors

Mechanism of Montelukast

blocks the leukotriene receptors