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Pharmacology > EXAM #5: REVIEW > Flashcards

EXAM #5: REVIEW Flashcards

1
Q

List the vehicles that should be used on the scalp and hairy areas.

A 
Lotion 
Solution 
Gel 
Aerosol 
Foam
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2
Q

List the vehicles that should be used on interriginous areas.

A

Lotion
Solution
Cream

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3
Q

List the vehicles that are good for drying.

A

Powder
Paste
Tincture
Aerosol

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4
Q

What bacteria can be treated with Azelaic acid?

A

P. acnes and S. epidermidis

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5
Q

Describe the MOA of Azelaic acid.

A

1) Reduces inflammation
2) Reduces keratinization
3) Keratolytic and induces desquamation

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6
Q

What side effects are associated with Azeliac acid?

A

1) Lightening of the skin

2) Skin dryness

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7
Q

What is the MOA of benzoyl peroxide?

A

Release ROS that are harmful to anaerobic bacterial species

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8
Q

What type of bacteria is benzoyl peroxide effective against?

A

Anaerobic

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9
Q

How is benzoyl peroxide commonly administered?

A

In combination with Erythromycin or Clindamycin

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10
Q

List the indications for the retinoid drugs.

A

1) Acne
2) Psoriasis
3) Skin aging
4) Skin cancer

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11
Q

List two side effects associated with the retinoid drugs.

A

1) TERATOGEN

2) Photosensitivity and increased risk of sunburn

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12
Q

What is the MOA of Tretinoin?

A

1) Reduces cohesiveness of comodomes
2) Codomolytic
3) Reduces keratinization

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13
Q

What is the MOA of Adapalene?

A

1) Reduced cellular proliferation
2) Reduced inflammation
3) Comedolysis

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14
Q

What is the MOA of Isotretinoin?

A

Induces apoptosis of sebum producing cells in sebaceous glands

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15
Q

What is the MOA of Tazarotene?

A

1) Decreases inflammation

2) Reduces epidermal inflammation

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16
Q

What are the clinical indications for Tazarotene?

A

Acne and Psoriasis

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17
Q

What is the clinical indication for Acritretin?

A

Severe, reluctant psoriasis

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18
Q

What is the clinical indication for Calcipotriene?

A

Psoriasis

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19
Q

What is the MOA of Calcipotriene?

A
  • Binds Vitamin D receptor

- Gene transcription changes are beneficial in PSORIASIS

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20
Q

List five adverse effects of topical corticosteroids.

A

1) Epidermal atrophy
2) Acne
3) Enhanced fungal infection
4) Delayed wound healing
5) Hypopigmentation

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21
Q

List the Psoralen drugs. What is the MOA of these drugs?

A

Methoxsalen
Trioxsalen

Administered topically or orally; activated by light; intercalate with DNA

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22
Q

List four indications for the Psoralen drugs.

A

1) Alopecia
2) Cutaneous T-cell Lymphoma
3) Eczema
4) Psoriasis

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23
Q

List the long-term adverse effects of the Psoralens.

A

1) Photoaging
2) Actinic keratoses
3) Nonmelanoma skin cancer

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24
Q

List the three primary locations of H2 receptors.

A

1) GI parietal cells
2) Cardiac muscle
3) CNS neurons

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25
Q

What are the three general functions of histamine in the CNS?

A

1) Release of pituitary hormones
2) Wakefullness
3) Appetite/Satiety

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26
Q

List five clinical indications for a first generation antihistamine.

A

1) Allergic rhinitis
2) Allergic conjunctivitis
3) Urticaria
4) Motion sickness
5) Anti-emetic

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27
Q

What is the MOA of the H1 antihistamines?

A

“INVERSE AGONIST”

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28
Q

List five major side effects of the first generation antihistamines and the receptor association with that effect.

A
  • CNS depression (H1)
  • Dry mouth and urinary retention (M – anticholinergic)
  • Increased appetite and weight gain (5-HT)
  • Dizziness and postural hypotension (Alpha-1)
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29
Q

List the four H1 antihistamines with the strongest anti-emetic effects.

A

Diphenhydramine
Promethazine
Hydroxyzine
Meclazine

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30
Q

List the three H1 antihistamines with the strongest sedative effects.

A

Diphenhydramine
Promethazine
Hydroxyzine

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31
Q

What H1 antihistamines have the strongest anticholinergic effects?

A

Diphenhydramine

Promethazine

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32
Q

What H1 antihistamines is the strongest alpha-1 antagonist?

A

Promethazine

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33
Q

List second generation antihistamines.

A 
Foxofenadine 
Loratadine 
Desoloratadine 
Citrizine 
Levocitrazine
Azelastine
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34
Q

What are the clinical pearls the remember with Foxfenadine administration?

A

1) Decrease dose with renal dysfunction

2) Don’t combine with antacids

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35
Q

What is the MOA of Cromolyn and Nedocromil?

A

Stabilization of mast cells to prevent degranulation

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36
Q

What are the three clinical indications for Cromolyn and Nedocromil?

A

1) Allergic rhinitis
2) Allergic conjunctivitis
3) Exercise induced asthma

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37
Q

List two indications for Omalizumab.

A

1) Chronic urticaria

2) Asthma

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38
Q

What is Doxepin?

A

TCA used to treat chronic urticaria

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39
Q

What is Ketotifen?

A

H1 antihistamine with additional mast cell stabilizing characteristics

Used in an ophthalmic preparation for allergic conjunctivitis

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40
Q

What two receptors can cortisol bind to and activate?

A

Mineralcorticoid

Glucocorticoid

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41
Q

List the major adverse effects seen with elevated cortisol.

A

1) Salt/water retention
2) Hypokalemia
3) HTN

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42
Q

What is Primary Adrenal Insufficiency? What are the symptoms?

A

Autoimmune or tuberculoid destruction of the adrenal cortex leading to:

  • Hypotension
  • Hyponatremia
  • Hypokalemia
  • Hypoglycemia
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43
Q

How do you treat Primary Adrenal Insufficiency?

A

1) Cortisol
2) Increase Na+ intake
3) Fludrocortisone

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44
Q

Aside from iatrogenic Cushing’s Disease, what are the alternate etiologies of Cushing’s?

A

1) Pituitary tumor with increased ACTH
2) Ectopic ACTH tumor
3) Adrenal tumor

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45
Q

What are the three drug therapies for Cushing’s Syndrome?

A

Ketoconazole
Metyrapone
Mifepristone

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46
Q

What is the MOA of Ketoconazole to treat Cushing’s?

A

Antifungal that inhibits 17-a hydroxylase

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47
Q

What toxicity is associated with Ketoconazole?

A

Liver toxicity

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48
Q

What is the MOA of Metyrapone to treat Cushing’s?

A

Inhibits 11-B hydroxylase

Note that this is also used in the diagnosis of ACTH production

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49
Q

What is the MOA of Mifepristone?

A

Glucocorticoid receptor antagonist

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50
Q

What are the specific indications for Mifepristone?

A

1) Inoperable ectopic ACTH production

2) Adrenal carcinoma

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51
Q

What is the MOA of inhaled glucocorticoids in the treatment of asthma?

A
  • Reduced proliferation and hypertrophy of airway smooth muscle
  • Prevents leakage of vascular endothelium
  • Reduces adhesion of molecules to vascular epithelium
  • Increased epithelial integrity
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52
Q

What is a significant adverse effect of inhaled glucocorticoids, especially in kids?

A

Growth retardation

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53
Q

What are the local adverse effects of inhaled glucocorticoids to treat asthma?

A

1) Dysphonia
2) Oropharyngeal candidiasis
3) Cough

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54
Q

List four functions of the thyroid hormones.

A

1) Growth
2) Development
3) Body temperature
4) Energy metabolism

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55
Q

What enzyme converts T4 into T3?

A

5’-deiodinase

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56
Q

What is the effect of low thyroid hormone levels on the SNS?

A

1) Increased Beta-adrenergic receptors

2) Decreased Alpha-adrenergic receptors

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57
Q

List the causes of primary hypothyroidism.

A

1) Congenital i.e. Cretinism
2) Autoimmune Thyroiditis
3) Iodide deficiency
4) Other i.e. surgery, radiation, and meds like Lithium

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58
Q

List the drugs used to treat hypothyroidism.

A

Levothyroxine (T4)
Liothyronine (T3)
Liotrix (Both)

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59
Q

List the adverse effects of thyroid replacement in children,

A

Restlessness
Insomnia
Accelerated bone maturation

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60
Q

List the adverse effects of thyroid replacement in adults.

A 
Nervousness 
Heat intolerance 
Palpitations
Tachycardia 
Weight loss
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61
Q

List the adverse effects of thyroid replacement in the elderly.

A

A-fib

Osteoporosis

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62
Q

List five causes of primary hyperthyroidism.

A

1) Grave’s Disease
2) Thyroid adenoma/ carcinoma
3) Autoimmune thyroiditis
4) Thyroid storm
5) Excess iodide

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63
Q

List the thioamides.

A

Methimazole

Propylthioruacil (PTU)

64
Q

What is the MOA of the thioamides?

A

Inhibition of thyroid hormone synthesis in the thyroid follicle

65
Q

What adverse effects are associated with the thioamides

?

A 
PTU= severe hepatitis 
Methimazole= altered taste and smell
66
Q

List the iodides.

A

Potassium iodide

Lugol’s Solution

67
Q

What are the clinical indications for the iodides?

A

1) Thyroid storm

2) Preoperative prep for surgery

68
Q

What adverse effect is associated with the iodides?

69
Q

List the anion inhibitors that block the NIS transporter.

A

Percholrate
Pertechnetate
Thiocyanate

70
Q

What is the clinical indication for the anion inhibitors?

A

Iodide induced hyperthyroidism

71
Q

List four antithyroid adjuncts.

A

1) Propanolol
2) Diltiazem
3) Barbiturates
4) Bile acid sequestrates

72
Q

What is the utility of Diltiazem in the treatment of hyperthyroid?

A

Good alternative to propanolol in patients with asthma

73
Q

What does FSH induce the synthesis of in the Sertoli cells?

A

Androgen Binding Protein

74
Q

List the metabolic effects of the androgens.

A

1) Increased muscle growth
2) Liver production of serum proteins
3) Kidney synthesis of EPO
4) Bone growth and bone marrow stem cell production

75
Q

List the three theraputic androgen preparations.

A

Methyltestosterone (17-alkylated)
Testosterone enanthate (ester)
Testosterone

76
Q

List the adverse effects of androgen therapy.

A

1) Reduction in spermatogenesis/testis size
2) Acne
3) Polycythemia
4) Prostatic enlargement
5) Na+ and H20 retention leading to HTN
6) Increased LDL and decreased HDL leading to atherosclerosis
7) Mood swings, depression, and aggression

77
Q

What are the indications of antiandrogen therapy in makes?

A

1) Percocious puberty
2) BPH
3) Prostate cancer
4) Alopecia

78
Q

List the androgen receptor antagonists.

A

Flutamide

Biclatumide

79
Q

What adverse effects are associated with the androgen receptor antagonists?

A

Gynecomastia

Mild liver toxicity

80
Q

What is the MOA of Enzalutamide?

A

Androgen receptor antagonist that also:

1) Inhibits nuclear translocation of the androgen receptor
2) Blocks DNA binding
3) Blocks transcriptional coactivator recruitment

81
Q

List the GnRH agonists.

A

Leuprolide

Goserelin

82
Q

What are the outcomes of constantly elevated GnRH as seen with the GnRH agonsits?

A

1) Desenzitization of GnRH receptors on pituitary
2) Decreased LH production and secretion
3) Decreased Testosterone

83
Q

What is the hallmark GnRH antagonist?

84
Q

What is MOA of Abiraterone?

A

Androgen synthesis inhibitor that inhibits 17-alpha hydroxylase

Indicated for metastatic prostate cancer

85
Q

What are the two 5-a reductase inhibitors?

A

Finasteride

Dutasteride

86
Q

What are the clinical indications for the 5-a reductase inhibitors?

A

BPH

Alopecia

87
Q

What are the key adverse effects associated with the 5-a reductase inhibitors?

A

Impotence
Gynecomastia
Low PSA–>false negative

88
Q

List the PDE-5 inhibitors.

A

Sidenafil
Vardenafil
Tadalafil

89
Q

What drugs are contraindicated with PDE-5 inhibitors?

A

HIV protease inhibitors

Nitrates

90
Q

What adverse effects are associated with PDE-5 inhibitors?

A

1) Priapism
2) Sudden vision loss
3) Cardiac events

91
Q

Outline the two-cell hypothesis of steroidogenesis in the ovary.

A

LH= increased androstenedione synthesis in Theca cells, which is converted into testosterone

FSH= Converts testosterone into estradiol in the granulosa cells

92
Q

What effect does progesterone have on uterine contractions?

A

Decreased contraction

93
Q

What is the MOA of progesterone to decrease uterine contraction?

A

1) Decreased prostaglandin production

2) Maintenance of relaxin

94
Q

What is the primary synthetic estrogen?

A

Ethinyl estradiol

95
Q

What are conjugated equine estrogens? How are these used clinically?

A

Natural water-soluble estrogen sulfates

  • Higher dose vs. synthetics
  • Used for hormone replacement therapy
96
Q

List four indications for estrogen replacement therapy.

A

1) Hypogonadism
2) Hormone replacement therapy
3) Contraception
4) Acne

97
Q

What are the three goals of estrogen used in hormone replacement therapy?

A

1) Maintain bone density
2) Suppress hot flashes
3) Suppress urogenital atrophy

98
Q

What are four risks specifically associated with estrogen in hormone replacement therapy?

A

CAD
CVA
PE
Invasive breast cancer

99
Q

What is the MOA of estrogen as a treatment for acne?

A

1) Suppression of steroidogensis

2) Increased SHBG to decrease free testosterone

100
Q

What are the adverse effects of non-HRT estrogen therapy?

A

1) Breast tenderness
2) Endometrial hyperplasia
3) Increased blood coagulation

101
Q

What cancer risk is increased by combined HRT?

A

Invasive breast cancer

102
Q

What cancer risk is increased with estrogen monotherapy?

A

Endometrial

103
Q

List the progesterones.

A

Medroxyprogesterone (MPA)
Norethindrone
Norgestrel

104
Q

What are the adverse effects associated with progestins?

A

1) Breakthrough bleeding
2) Impaired glucose tolerance
3) Changes in lipid metabolism: increased LDL and decreased HDL

105
Q

List the “mild” adverse effects of birth control.

A

1) Estrogen-mediated breakthrough bleeding
2) Nausea
3) Mastalgia
4) Edema
5) Headache
6) Withdrawal bleed failure
7) Serum protein changes

106
Q

List the “moderate” adverse effects of birth control.

A

1) Progestin mediated breakthrough bleeding
2) Weight gain
3) Increased skin pigmentation
4) Acne
5) Hirsutism
6) Vaginal infection
7) Amenorrhea

107
Q

List the “severe” adverse effects of birth control.

A

1) Thromboembolic disease
2) MI
3) CVA
4) GI disorders e.g cholestasis
5) Depression
6) Cancer

108
Q

List the benefits of oral contraception, aside from contraception.

A

1) Reduced risk of ovarian and endometrial cancer
2) Reduction in dysmenorrhea/ endometriosis
3) Decreased incidence of ectopic pregnancy
4) Decreased benign breast disease
5) Increased Hb concentrations
6) Suppression of acne and hirsutism

109
Q

List the contraindications to estrogen containing birth control.

A

1) Known or suspect breast cancer
2) Thromboembolic disorder
3) Liver disease
4) Cardiovascular disease
5) Smoker over 35 y/o

110
Q

List three classes of drugs that will induce hormone metabolsim.

A

1) St. John’s Wort
2) Anticonvulsants
3) HIV antiretrovirals

111
Q

What is the clinical indication for Clomiphene?

A

Fertility drug

112
Q

What is the MOA of Clomiphene?

A

Partial agonist that blocks negative feedback on LH and FSH

*Thus, it increases the likelihood of ovulation

113
Q

What two adverse effects are associated with Clomiphene?

A

1) Hot flashes

2) Multiple births

114
Q

What is the effect of SERMS on the endometrium?

A

Partial agonists that increase proliferation of the endometrium

115
Q

What are the adverse effects associated with Tamoxifen?

A

1) Hot flashes
2) Endometrial cancer
3) Nausea and vomiting

Note that vs. Raloxifene, which is hot flashes only

116
Q

What are the indications for Dananzol?

A

1) Fibrocystic breast disease

2) Endometriosis

117
Q

What is the MOA of Dananzol?

A
  • Decreases estrogen concentrations in blood

- Displaces estrogen from serum proteins, which increases excretion

118
Q

List the adverse effects assocaited with Dananzol.

A

1) Hot flashes
2) Weight gain
3) Oily skin
4) Acne
5) Hirsutism

119
Q

What is the MOA of anaztrozole and letrozole?

A
  • Aromatase inhibitors

- Prevent the conversion of testosterone to estrogen

120
Q

What adverse effects are associated with anaztrozole adn letrozole?

A

1) GI disturbances
2) Hot flashes
3) Lethargy

121
Q

List the anti-progesterone drugs.

A

Mifepristone
Ulipristal

*Note that Mifepristone (progesterone antagonist) is followed by MISOPROSTOL–likely test question

122
Q

What is the MOA of Ulipristal?

A

Partial progesterone agonist

123
Q

List the factors that will increase insulin secretion.

A

1) Glucose
2) Amino acids
3) Incretins
4) Epinephrine/ B2 stimulation
5) Vagal stimulation

124
Q

What is the major metabolic response to insulin (at the cellular level)?

A

Translocation of GLUT-4 transporters from the cytoplasmic compartment to the plasma membrane

125
Q

List the rapid acting insulins.

A

Insulin lispro
Insulin aspart
Insulin glulisine

126
Q

What is an intermediate acting insulin?

A

NPH

Forms protamine insulin complexes

127
Q

What are the two long-acting insulins?

A

Glargine

Detemir

128
Q

What is the MOA of metformin?

A

1) Decreased hepatic glucose output

2) Increased peripheral glucose utilization

129
Q

List the Sulfonylureas.

A

Glimepiride
Glipizide
Glyburide

130
Q

List the meglitinides.

A

Repaglinide

Nateglinide

131
Q

What is the MOA of the sulfonylureas and the meglitinides?

A

Inhibition of the ATP-sensitive K+ channel in beta-cells

132
Q

What adverse effects are associated with the sulfonylureas and meglitinides?

A

Weight gain

Hypoglycemia

133
Q

List the glucosidase inhibitors.

A

Acrabose

Miglitol

134
Q

List the Thiazolindinediones.

A

Pioglitazone

Rosiglitazone

135
Q

What is the MOA of the Thiazolindinediones?

A

Increased expression of GLUT-4

136
Q

What is the MOA of Pramlintide?

A

Synthetic amylin that

  • Inhibit glucagon release
  • Inhibits gastric emptying
  • Has an anorexic effect
137
Q

What adverse effects are associated with Pramlintide?

A

1) Anorexia
2) Hypoglycemia
3) Delayed drug absorption

138
Q

List the incretin mimics.

A

Exenatide

Liraglutide

139
Q

List the DPP inhibitors.

A

Sitagliptin
Saxagliptin
Linagliptin

140
Q

List four cardiovascular changes in the elderly that can result in altered pharmacokinetics.

A

1) Decreased sensitivity to B-adrenergic stimulation
2) Decreased baroreceptor activity
3) Decreased CO
4) Increased TPR

141
Q

How is hepatic metabolism altered in the elderly?

A

1) Decreased hepatic blood flow

2) Reduced activity of phase I enzymes

142
Q

What does ALD stand for?

A

Average Lethal Dose

143
Q

What is the mnemonic to remember the anticholinergic toxidrome?

A
  • Hot as a hare: increased body temperature
  • Blind as a bat: mydriasis (dilated pupils)
  • Dry as a bone: dry mouth, dry eyes, decreased sweat
  • Red as a beet: flushed face
  • Mad as a hatter: delirium
144
Q

What are the three C’s of TCA overdose?

A

Convulsions
Coma
Cardiac conduction

145
Q

What is the mnemonic to remember the aspirin OD Toxidrome?

A

DAFT HID

Deafness 
Appear flushed 
Fever 
Tinnitus 
Hyperventilation 
Increased sweating 
Dizziness
146
Q

What is a copy number variation?

A

Duplication or deletion of an entire gene

147
Q

What drugs will have altered metabolism because of CYP2D6 polymorphisms?

A

Tamoxifen
Codiene
Paroxetine

148
Q

What drugs will have altered metabolism because of CYP2C19 polymorphisms?

A

Clopidogrel

Omperazole

149
Q

What is the role of CYP2C9 in Warfarin therapy?

A

CYP2C9 metabolizes warfarin

- Nonfucntional enzyme= increased warfarin concentration and adverse effects

150
Q

What is the MOA of 5-dUMP?

A

Inhibition of thymidylate synthetase

151
Q

What enzyme inactivates 5-FU?

152
Q

What gene codes for thymidylate synthetase?

153
Q

Do polymorphisms in TYMS result in pharmcokinetic or pharmacodynamic changes?

A

Pharmacodynamic

154
Q

What inactivates 6-MP?

155
Q

What do ERa genes code for? What drugs will be effected by ERa polymorphisms?

A

Estrogen receptors

  • Estrogen
  • Progesterone
156
Q

What have ERa polymorphisms been associated with in estrogen HRT?

A

Increased HDL

Pharmacology (64 decks)

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