Final

Question 1

Alteplase

Answer 1

Indications: thrombolytic agent used in acute ischemic stroke and, pulmonary emblolism and acute MI. Also called tPA
Dose: ten percent as bolus with remainder over 60
Adverse effects: bleeding, angioedema, anaphylaxis, fever
Contra: any type of internal bleeding

Question 2

Amiodarone

Answer 2

Tx: life threatening ventricular arrthytmias; off label for SVT, a-fi
MOA: Class III antiarrhythmic - blocks pottassium channel but also blocks beta-adrenergic receptors (beta 1), calcium channels and sodium channels.
Adverse Effects: High rate of adverse effects 15-50 percent for long term use. Most common side effect is corneal microdeposits is 90%

Question 3

Amitriptyline

Answer 3

Tx: major depressive ; Non FDA approved anxiety, PTSD, insomnia, chronic pain, IBS
MOA: tricyclic antidepressent blocks reuptake of serotonin and norepinephrine: it is more sedating than other TCA
Adverse Effects: weight gain, GI symptoms; may cause orthostatic hypotension and anticholinergic effects
Contra: history of QTc or recent cardiac history, no MOA,

Question 4

Amlodipine

Answer 4

Oral dihydropyridine calcium channel blocker
Indications: 1st line for hypertension: chronic stable angina,
May be used in pregnancy

Question 5

Amoxicillin Clavulanate

Answer 5

Tx: aspiration pnuemonia, CAP, acute baterial rhinosinusitis, UTI, otitis media, skin and soft tissue infection off label human bite, group a strep, impetigo, exacerbation of COPD
MOA: Broad spectrum beta lactam - inhibits peptidoglycan layer of cell wall
Adverse Effects: rare but one of the most frequent causes of idiosyncratic drug induced hepatic injury

Question 6

Amoxicillin

Answer 6

An amino penicillin - one of the most common
Tx: mainly gram positive susceptible beta lactamase negative organisms : These are most effective in the time dependent vs concentration dependent manner. they are dosed more frequently
Adverse Effects - Type 1 hypersensitivity reactions is an IgE mediated response triggering histamine release. Type IV not mediated by histamine. A few cases of dramatic liver disease have been reported.

Question 7

Amphetamine

Answer 7

TX: ADHD
Interesting: two isomers L and D. Dextroamphetamine has none of the l isomer
MOA: CNS stimulant increasing amounts of dopamine, norepinephrine and serotonin.
Adverse Effects: CYP2D6 inhibitors including fluoxetine, paroxetine and bupropion can increase serotonin syndrome

Question 8

Amphotericin B

Answer 8

Indications: invasive fungal infections but not first line antifungal now - invasive candidiasis, neonatal candida albicans
MOA: binds to ergosterol in cell membrane of fungi
Admin: must be IV
Adverse Effects - 80% will experience renal toxicity

Question 9

Atomoxetine

Answer 9

Indications: ADHD in adults and children over six
MOA Atomoxetine is a selective, presynaptic, norepinephrine reuptake inhibitor known as a NET inhibitor
Adverse EffectsDrug Interactions: Because of the potential for interaction with CYP2D6 inhibitors (paroxetine,fluoxetine, and quinidine) dose of atomoxetine needs to be adjusted to prevent side effects froma higher concentration of atomoxetine.
[19]

Question 10

Atorvastatin

Answer 10

IndicationsPrimary Prevention
For patients without coronary heart disease but with multiple risk factors, the FDA has approvedatorvastatin to reduce the risk of myocardial infarction, stroke, revascularization procedures, andangina.
For patients diagnosed with type 2 diabetes mellitus without coronary heart disease but with multiplerisk factors, atorvastatin has FDA approval to reduce the risk of myocardial infarction and stroke.
MOA:Atorvastatin competitively inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase.
[2]
Bypreventing the conversion of HMG-CoA to mevalonate, statin medications decrease cholesterolproduction in the liver. Atorvastatin also increases the number of LDL receptors on the surface ofhepatic cells.
Adverse:Common adverse effects for patients taking atorvastatin include arthralgia, dyspepsia, diarrhea,nausea, nasopharyngitis, insomnia, urinary tract infection, and pain in the extremities.
Contraindications:Atorvastatin is contraindicated during pregnancy or in female patients who may become pregnant. Allfemale patients of childbearing age should receive counseling on the potential risks to a fetus shouldthey become pregnant while on atorvastatin. This risk is most pronounced in the first trimester, socurrent guidelines recommend ceasing statin therapy for at least three months prior to becomingpregnant.

Question 11

Atropine

Answer 11

anti-sialagogue/anti-vagal effect,organophosphate/muscarinic poisoning, and bradycardiaAtropine is an antimuscarinic that works through competitive inhibition of postganglionic acetylcholine
receptors and direct vagolytic action, which leads to parasympathetic inhibition of the acetylcholine
receptors in smooth muscleAll
Datura
plant species have endogenous atropine and other assorted anticholinergic alkaloids. Theseinclude Jimson weed and angel’s trumpet, typically seen in warm or temperate climate areas. It may beaccidental ingestion or intentionally smoked or ingested for the goal effect of hallucinations. Whiletreatment for ingestions is similar to other toxic overdoses of anticholinergics, whole-bowel irrigation isrecommended after a large quantity of seed ingestion. Clinicians need to avoid using phenothiazines inthese patients. Physostigmine is the basis of reversal.

Question 12

Azithromycin

Answer 12

broad spectrum macrolide - derivitive of erthromycin with greatly enhanced activity against gram-negative and covers gram positive
MOA:As an inhibitor of bacterial protein synthesis (rather than a peptidoglycan cell-wall inhibitor likebeta-lactam agents), azithromycin is effective against many “atypical” bacteria such as chlamydiae(e.g.,
Chlamydia trachomatis
and
Chlamydophila psittaci
), legionella (i.e.,
Legionella pneumophila
),mycoplasma (e.g.,
Mycoplasma pneumoniae
), and mycobacteria (e.g.,
Mycobacterium avium
MOA:Like other macrolides and protein-synthesis inhibitors, azithromycin primarilyacts as a bacteriostatic agent, meaning it inhibits bacterial growth rather than directly killingorganisms.

Question 13

Benztropine

Answer 13

Benztropine belongs to the synthetic class of muscarinic receptor antagonists (anticholinergic drugs).Thus, it has a structure similar to that of diphenhydramine and atropine. However, it is long-acting, sothat its administration can be with less frequency than
Adverse -Thus, clinicians should avoid the usage
of benztropine as a preventative agent for extrapyramidal disorders is avoided in geriatric patients. In
general, the geriatric population should avoid potent anticholinergic agents such as benztropine
because of the higher incidence of side effects among this group of patients

Question 14

Bupropion

Answer 14

The medication is FDA-approved for adult depression, seasonal affective disorder, and smokingcessation.

Off-label, non-FDA-approved uses include anti-depressant-induced sexual dysfunction, attention-deficit/hyperactivity disorder (ADHD), depression associated with bipolar disorder, and obesity.

In the pediatric population, bupropion is used off-label for ADHD.
MOA:Bupropion is an aminoketone antidepressant with a mechanism that is not fully understood.
[10]
Bupropion seems not to affect monoamine uptake but is known to inhibit the reuptake ofnorepinephrine and dopamine weakly.
Adverse Effects: Lowers seizure threshhold
Contraindications: Seizure disorder, MOAThe most serious adverse
effects are lowered seizure threshold and potential worsening of suicidal ideation. Clinicians should
perform a mental health assessment of patients at each visit and educate them on what to do if and
when a seizure develops.

Question 15

Buspirone

Answer 15

Indications: Typically, it is used as a second-line agent behind selectiveserotonin reuptake inhibitors(SSRIs) when a patient does not respond to or cannot tolerate the sideeffects of SSRIs
MOA:Buspirone is classified in the azapirone drug class. It has a strong affinity for serotonin 5HT1areceptors, where it acts as a partial agonist, which some researchers believe produces thepreponderance of clinical effects. It also has a weak affinity for serotonin 5HT2 receptors and acts as aweak antagonist on dopamine D2 autoreceptors.

Question 16

Calcium Carbonate

Answer 16

needed additional calcium Rifampin (antibiotic)
Loop-diuretics
Anti-seizure medications (phenytoin and phenobarbital)
Bisphosphonates (alendronate, ibandronate, zoledronic acid, and risedronate)
Calcitonin
Chloroquine
Corticosteroids
PlicamycinAs a phosphate binder and drug chelator, calcium carbonate works in the small intestines. Inindividuals with hyperphosphatemia or overdose, calcium will bind to form an insoluble compoundblocking dietary phosphate or excess drug absorption and excreting it in feces.
Contraindications:Calcium carbonate use is contraindicated in cases of hypersensitivity, renal calculus, high urine calciumlevels, elevated serum calcium, low serum phosphate, achlorhydria, or suspected digoxin toxicity.

Question 17

Calcium Gluconate

Answer 17

Calcium gluconate is a calcium salt used to directly replete serum calcium levels in cases ofhypocalcemia through IV administration.
Adverse Events:One of the most concerning adverse effects of calcium gluconate is extravasation from intravenoussites. Calcium can induce tissue necrosis through calcium-induced vasoconstriction of capillaries andintracellular fluid retention, leading to deep tissue damage and late-onset calcifications.

Question 18

Carbamazepine

Answer 18

Carbamazepine is FDA indicated for epilepsy, trigeminal neuralgia, and acute manic and mixedepisodes in bipolar I disorder.
Off label: restless leg, schizophrenia
MOACarbamazepine modulates voltage-gated sodium channels (VGSC), causing inhibition of actionpotentials and decreased synaptic transmission. Similar to other anti-convulsions, carbamazepine issuggested to bind to the alpha subunit of VGSC, specifically at a binding pocket formed by the external
pore loop and the pore-lining part of domain
Adverse Effects:The most common side effects of carbamazepine include dizziness, drowsiness, ataxia, nausea, andvomiting. Although rarer in occurrence, this comes with a black box warning for several severedermatologic reactions. In patients of Han Chinese ancestry, studies have indicated a strong associationbetweenCarbamazepine has another black box warning on agranulocytosis and aplastic anemia.
[10]
Otherserious side effects include central nervous system depression, hepatotoxicity, confusion, renal
Contra:Carbamazepine is contraindicated in patients with bone marrow depression and hypersensitivity to thisdrug or tricyclic compounds such as amitriptyline.
[

Question 19

Carbidopa

Answer 19

Carbidopa is indicated for combination use with levodopa (L-dopa) for the treatment of motorsymptoms encountered in Parkinson disease (PD), post-encephalitic parkinsonism, and parkinsonismsymptoms resulting from intoxication by carbon monoxide or manganese.
MOA:Carbidopa, 1-α-methyldopahydrazine, acts by irreversibly binding pyridoxal 5′-phosphate (PLP),inhibiting l-aromatic amino acid decarboxylase (AADC), a PLP-dependent enzyme. AACD acts tometabolize 5-HTP to serotonin and L-dopa to dopamine
ContraindicationsBecause of limited data, carbidopa should not beused in those under 18 years old and should be avoided in pregnancy. It is contraindicated to givecarbidopa/levodopa capsules along with nonselective monoamine oxidase inhibitors due to a risk ofhypertension.

Question 20

Cefepime

Answer 20

Cefepime has a similar mechanism of action to other beta-lactams. Cefepime inhibits bacterial cell wall synthesis by covalentlybinding enzymes responsible for the final step in transpeptidation during peptidoglycan wall synthesis. This binding causes defects inthe cell wall leading to autolysis and subsequent death of the organism
Adverse Effects:Neurotoxicity is a serious, life-threatening adverse effect that deserves special mention. Symptoms can present as altered mentalstatus, encephalopathy, seizures, myoclonus, hallucinations, coma, and

Question 21

Chloroquine

Answer 21

Chloroquine is FDA-approved for the treatment and prophylaxis of uncomplicated malaria in countrieswhere chloroquine-sensitive malaria (certain strains of
P. falciparum
,
P. ovale
,
P. vivax
, and
P. malariae
)is present.
MOAChloroquine exerts its antimalarial effects by preventing the polymerization of heme into hemozoin (afood source for the malarial parasite)
Adverse:Dermatological reactions include pruritus and photosensitivity.
Retinopathy will typically present with the inability to focus between near and far objects.
Neuropathy can include seizures, paranoia, and hallucinations.

Question 22

Ciprofloxacin

Answer 22

Ciprofloxacin is an antibiotic agent in the fluoroquinolone class usedto treat bacterial infections such as urinary tract infections and pneumoniaCiprofloxacin should not be the first-line empirical treatment for respiratory tract infections ifpenicillin-susceptible
Streptococcus pneumoniae
is the primary pathogen. Ciprofloxacin is anappropriate treatment option in patients with mixed infections or patients with predisposing factors forGram-negative infections.
MOACiprofloxacin is a bactericidal antibiotic of the fluoroquinolone drug class. It inhibits DNA replication byinhibiting bacterial DNA topoisomerase and DNA-gyrase. Of the fluoroquinolone class, ciprofloxacin isthe most potent against gram-negative bacilli bacteria (notably, the
Enterobacteriaceae
such as
Escherichia coli
,
Salmonella
spp.,
Shigella
spp., and
Neisseria
Adverse Effects - Tendon rupture

Question 23

Clonidine

Answer 23

Hypertension, as mentioned above; pediatric use for hypertension is off-label
Treatment of attention deficit hyperactivity disorder (ADHD) in children (FDA approval 2010 forthe extended-release dose form)
[1]
[2]
Management of tics commonly found with Tourette syndrome
Adjunct therapy for severing cancer-related pain
[3]
As an adjunct in neonatal opioid withdrawal syndrome
MOA:As an alpha-adrenergic agonist in the nucleus tractus solitarii (NTS), clonidine excites a pathway thatinhibits excitatory cardiovascular neurons.

Question 24

Clopidogrel

Answer 24

Unstable angina, STEMI, secondary prevention of MI
MOA: Irreversable inhibitor of P2Y12 prevents activation of glycoprotein IIb/IIIa
Adverse Effects: Bleeding

Question 25

Cyclobenzaprine

Answer 25

Fast acting skeletal muscle relaxant related to TCA
MOA (5-HT2) receptor antagonist decreases muscle spasms
Adverse: watch for serotonin syndrome symptoms

Question 26

Cyclophosphamide

Answer 26

Malignant lymphoma stage III and IV including hodgkin and non-hodgkin lymphoma, multiple myeloma
MOA:Cyclophosphamide is a type of nitrogen mustard drug which exerts its effects through the alkylation ofDNA
Adverse Effects:withbladder and gonadal toxicity.

Question 27

Dexamethasone

Answer 27

Indications:acute exacerbations of multiple sclerosis, allergies, cerebral edema,inflammation, and shock
MOA:Dexamethasone is a potent glucocorticoid with very little if any, mineralocorticoid activity.
[5]
Dexamethasone’s effect on the body occurs in a variety of ways. It works by suppressing the migrationof neutrophils and decreasing lymphocyte colony proliferation.
Adverse: osteonecrosis of femoral head; hepatotoxicity when given high doses
Contraindicated: systemic fungal infections

Question 28

Dextromethorphan

Answer 28

Cough suppressent
MOA:Dextromethorphan has multi-faceted pharmacodynamic and pharmacokinetic properties.

Question 29

Digoxin

Answer 29

A-fib and flutter: beneficial in systolic heart failure
Adverse: low index .8 to 2 ng/mlElectrocardiogram changes seen with digoxin demonstrate a downsloping ST-segment depression, alsoknown as a “reverse check” sign. The ST segments may appear “scooped” without abnormal Q wavesor T wave inversions.
[8]
Regular intake of digoxin results in decreased QT interval, prolongation of thePR interval, and T wave inversion or flattening. In the case of overdose, the patient should receivedigoxin immune fab.

Question 30

Dilitiazem

Answer 30

Calcium channel blockerDiltiazem is an oral and parenteral non-dihydropyridine calcium channel blocker. It is useful in manyclinical scenarios as an antihypertensive, anti-arrhythmic, and anti-anginal agent
Primarily, diltiazem inhibits the inflow of calcium ions into the cardiac muscleduring depolarizationDiltiazem possesses negative inotropiceffects and is generally avoided in patients with congestive heart failure, and diltiazem is also on theBeers Criteria.
[41]
These factors highlight the importance of avoiding diltiazem in patients with heartfailure, especially in the elderly, due to drug interactions and exacerbation of heart failure.

Question 31

Diphenhydramine

Answer 31

The H1 receptor is located on respiratory smooth muscles, vascular endothelial cells, thegastrointestinal tract (GIT), cardiac tissue, immune cells, the uterus, and the central nervous system(CNS) neurons. When the H1 receptor is stimulated in these tissues, it produces a wide variety ofactions, including increased vascular permeability, promotion of vasodilation causing flushing,decreased atrioventricular (AV) node conduction time, stimulation of sensory nerves of airwaysproducing coughing, smooth muscle contraction of bronchi and GIT, and eosinophilic chemotaxispromoting the allergic immune response.The H1 receptor is similar to muscarinic receptors. Therefore, diphenhydramine also acts as anantimuscarinic; it is a competitive antagonist of muscarinic acetylcholine receptor, resulting in its use asan antiparkinson medication.

Question 32

Dobutamine

Answer 32

Both inotropic and chronotropic effect

Question 33

Docusate

Answer 33

Docusate is an emollient stool softener (surfactant laxatives). By lowering the surface tension of the oil-water interface of the stool, it allows the passage of water and lipids into the stool mass. As a result, thestool softens and passes easily through the intestinal tract.
[6]

Question 34

Donepezil

Answer 34

FDA approved for the treatment of dementia in mild, moderate,and severe Alzheimer disease. There is no evidence that donepezil alters the progression of thedisease. It can, however, lessen some symptoms by improving cognition and/or behaviorLewy body dementia:
Some studies have shown the benefits of donepezil for the treatment ofcognitive and behavioral symptoms in Lewy body dementia.
Traumatic brain injury:
Some research suggests an improvement in memory dysfunction inpatients with traumatic brain injury with donepezil use.
Vascular dementia:
Studies have shown that donepezil may improve cognition in patients withvascular dementia but not overall global functioning.
Dementia associated with Parkinson disease:
Some evidence suggests that donepezil
MOA:Donepezil hydrochloride is a piperidine derivative and a centrally acting, rapid, reversibleacetylcholinesterase inhibitor. Acetylcholinesterase is an enzyme that degrades acetylcholine afterrelease from the presynapse. Donepezil binds reversibly to acetylcholinesterase and inhibits thehydrolysis of acetylcholine, thus increasing the availability of acetylcholine at the synapses, enhancingcholinergic transmission
Adverse Effects: Nausea, diarrhea, vomitting: may trigger seizures, increased GI salivation

Question 35

Epinephrine

Answer 35

Epinephrine is a sympathomimetic catecholamine that exerts its pharmacologic effects on bothalpha and beta-adrenergic receptors using a G protein-linked second messenger system. It has agreater affinity for beta receptors in small doses. However, large doses produce selective action onalpha receptors. Through its action on alpha-1 receptors, epinephrine induces increased vascularsmooth muscle contraction, pupillary dilator muscle contraction, and intestinal sphincter musclecontraction. Other significant effects include increased heart rate, myocardial contractility, and reninrelease via beta-1 receptors. Beta-2 effects produce bronchodilation, which may be useful as an adjuncttreatment of asthma exacerbations and vasodilation, tocolysis, and increased aqueous humorproduction.

Question 36

Escitaprolam

Answer 36

Escitalopram is a selective serotonin reuptake inhibitor (SSRI). It is the S-enantiomer of citalopram andis the most selective of SSRIs. Escitalopram is FDA approved for the acute and maintenance treatmentof major depressive disorder (unipolar) in adults and adolescents (12 to 17 years of age). It is also FDA-approved for treating generalized anxiety disorder in adults.
[1]
Escitalopram is also used off-label forsocial anxiety disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder,premenstrual dysphoric disorder, and vasomotor symptoms of menopause.

Question 37

Ethosuximide

Answer 37

Ethosuximide has level A evidence for childhood absence seizures and has been an effectivemedication in the management of absence seizures

Question 38

Ezetimbe

Answer 38

Ezetimibe is an inhibitor of intestinal cholesterol absorption. It is indicated to reduce totalcholesterol, low-density lipoprotein (LDL), apolipoprotein B (apo B), and non-high-density lipoprotein(HDL) in patients with primary hyperlipidemia, mixed hyperlipidemia, familial hypercholesterolemia(HoFH), and homozygous sitosterolemia (phytosterolemia). Clinicians can use ezetimibe asmonotherapy, in combination with fenofibrate, or with hydroxymethylglutaryl coenzyme A (HMG-CoA)reductase inhibitors
MOA Ezetimibe is asynthetic 2-azetidinone agent. Ezetimibe is different from other cholesterol-lowering agents because itdoes not increase bile acid excretion or inhibit cholesterol synthesis in the liver. Ezetimibe inhibitscholesterol absorption at the brush border of the small intestine mediated by the sterol transporterNiemann-Pick C1-Like-1 (NPC1L1).
[

Question 39

Famotidine

Answer 39

Famotidine is a competitive histamine H-receptor antagonist (H2RA) that binds to the H-receptorslocated on the basolateral membrane of the parietal cell in the stomach, effectively blocking histamineactions. Its pharmacologic activity results in the inhibition of gastric secretion by suppressing acidconcentration and volume of gastric secretion. Famotidine inhibits both basal and nocturnal gastricacid secretion as well as reduces gastric volume, acidity, and secretion stimulated by food, caffeine,insulin, and pentagastrin.

Question 40

Fentanyl

Answer 40

This robust pharmacologic agent is typically 50 to 100 timesmore potent than morphine. A dose of only 100 micrograms can produce equivalent analgesia toapproximately 10 mg of morphine. However, fentanyl exhibits vastly different properties andpharmacokinetics. Clinically, its most frequent use is as a sedative in intubated patients and in severecases of pain in patients with renal failure due to its primarily hepatic elimination.
[1]

Question 41

Fluconazole

Answer 41

Fluconazole is a member of the triazole family, one of the most widely used antifungal agents.
[1]
It isan FDA-approved drug to treat vaginal candidiasis, oropharyngeal and esophageal candidiasis,peritonitis, and systemic
Candida
infections, including candidemia, disseminated candidiasis,pneumonia, and cryptococcal meningitis

Question 42

Fluticasone

Answer 42

Oral fluticasone is FDA-approved to treat asthma and has an off-label use for chronic obstructive lung disease (COPD) and eosinophilic esophagitis
MOAFluticasone directly decreases inflammatory cells such aseosinophils, monocytes, mast cells, macrophages, and dendritic cells. It reduces the number of thesecells and also the number of cytokines they produce.

Question 43

Lasix

Answer 43

The Food and Drug Administration (FDA) has approved furosemide to treat conditions with volumeoverload and edema secondary to congestive heart failure exacerbation, liver failure, or renal failure,including the nephrotic syndrome.
MOAFurosemide inhibits tubular reabsorption of sodium and chloride in the proximal and distal tubulesand the thick ascending loop of Henle by inhibiting the sodium-chloride cotransport system resulting inexcessive excretion of water along with sodium, chloride, magnesium, and calcium

Question 44

Gabapentin

Answer 44

Anticonvulsive - Consider alcohol use disorder
It also has an off-label use for neuropathic pain, fibromyalgia, bipolar disorder, postmenopausal hotflashes, essential tremors, anxiety, resistant depressant and mood disorders, irritable bowel syndrome(IBS), alcohol withdrawal, postoperative analgesia, nausea and vomiting, migraine prophylaxis,headache, interstitial cystitis, painful diabetic neuropathy, social phobia, generalized tonic-clonicseizures, pruritus (itching), insomnia, post-traumatic stress disorder (PTSD), and refractory chroniccough
MOAThe exact mechanism of action with the GABA receptors is unknown; however, researchers know thatgabapentin freely passes the blood-brain barrier and acts on neurotransmitters

Question 45

Gentamicin

Answer 45

Gentamicin, an aminoglycoside antibiotic, is bactericidal. Gentamicin passes through the gram-negativemembrane in an o
xygen-dependent
active transport. As oxygen is required, this is why aminoglycosidesare not effective in anaerobic bacteria.

Question 46

Glipizide

Answer 46

Secosecond-generation sulfonylurea that is FDA-approved for the treatment of adults withdiabetes mellitus type 2. Its use is as an adjunct to diet and exercise. It is usable in combination withmetformin, a biguanide, to reach goal HbA1c in patients with not adequate metabolic control in 3months, despite compliance with diet, exercise, and medicationnd gen
MOAGlipizide is a sulfonylurea. It promotes insulin release from the pancreatic beta cells and reducesglucose output from the liver. It also improves insulin sensitivity at peripheral target sites. Theextrapancreatic effect of sulfonylureas results from an increase in the deficient number of insulinreceptors in the muscle, fat, or liver cells.
[5]

Question 47

Haldol

Answer 47

Haloperidol is a first-generation (typical antipsychotic) which exerts its antipsychotic action by blockingdopamine D2 receptors in the brain. When 72% of dopamine receptors are blocked, this drug achievesits maximal effect.
[11]
Haloperidol is not selective for the D2 receptor. It also has noradrenergic,cholinergic, and histaminergic blocking action. The blocking of these receptors is associated withvarious adverse drug reactions.
[12]
Adverse EffectsExtrapyramidal Symptoms
[16]
Acute Dystonia - (Develops within hours to days of initiation. Maybe presented as muscle spasm,stiffness, oculogyric crisis)
Akathisia - (Develops within days to months of use of haloperidol - characterized by restlessness.)
Neuroleptic malignant syndrome - (NMS; infrequent but severe condition. May present as highfever, muscle rigidity)
Parkinsonism - (Develops after days to month use of haloperidol)
Tardive dyskinesia - (Develops after years, presents as a chore, especially orofacial region)
Common
Anticholinergic effects - (Elevated temperature, dry mouth, drowsiness or sedation, constipation,urinary retention)
Sedation
Weight gain
Erectile dysfunction in male
Oligomenorrhea or amenorrhea in female
Less Common
Orthostatic hypotension - (After IM injection of haloperidol), tachycardia, palpitation
Agitation, generalized anxiety, cerebral edema, new-onset depression, dizziness, euphoric mood,headache, sleeplessness, poikilothermia, restlessness, generalized weakness, confusion
Anorexia, constipation, dyspepsia, ileus, decreased gag reflex.
Lens opacities - (If used for a prolonged time)
Uncommon
ECG changes - (QT prolongation, torsades de pointes)
[17]
Photosensitivity reaction
Generalized pruritus
Diarrhea, gastrointestinal distress
Blood dyscrasia
Ejaculatory problems
Rare
Seizure
[18]
Cholestatic jaundice
Priapism

Question 48

Heparin

Answer 48

Unfractionated heparin is an anticoagulant indicated for both the prevention and treatment ofthrombotic events such as deep vein thrombosis (DVT) and pulmonary embolism (PE) as well as atrialfibrillation (AF). Heparin can also be used to prevent excess coagulation during procedures such ascardiac surgery, extracorporeal circulation, or dialysis, including continuous renal replacement therapy(CRRT).
MonitoringTherapeutic monitoring for heparin includes activated partial thromboplastin time (aPTT) and activatedclotting time (ACT). Both of these are aspects of clotting time, which are prolonged by therapeuticheparin doses.

Question 49

Hydralizine

Answer 49

Hydralazine is primarily used to treat hypertension and hypertensive urgency/emergency.
[1]
It has alsobeen utilized in the treatment of eclampsia along with heart failure with reduced ejection fraction(HFrEF) when in combination with isosorbide dinitrate.
MOA direct arteriole vasodilator

Question 50

Hydrochlorothiazide

Answer 50

Indicated as adjunctive therapy to treat edema associated with congestive heart failure, hepaticcirrhosis, corticosteroid, and estrogen therapy. (FDA-approved)
Indicated to treat edema associated with renal dysfunction. (FDA-approved)
Indicated to treat hypertension as a sole agent or adjunct. (FDA-approved)

Question 51

Interferon

Answer 51

Interferons (IFNs) are proteins that belong to the group of signaling molecules known as cytokinesinvolved in the upregulation of the immune response. Interferons are particularly important in fightingviral infections but also play a vital role in tumor suppression, upregulation of MHC Class 1 and 2,signal transduction, and activation of immune cells, including natural killer cells and macrophages.Interferons can broadly be classified into three main subtypes, interferon-alpha, beta, and gamma, withinterferon-alpha and beta belonging to the Type 1 interferon subclass and interferon-gamma belongingto the Type 2 subclass.
[11]
More recently, there has been the discovery of a third subclass ofinterferons, namely Type 3, which includes interferon lambda.
ContraindicatedContradictions to interferon therapy include kidney dysfunction, cirrhosis, hepatitis, autoimmunedisease, past treatment with immunosuppressive therapy, organ transplantation, uncontrolled thyroiddisease, epilepsy, severe mental and neurological disorders, CNS disorders, organ transplantation, andpsoriasis.
[16]

Question 52

Ipratropium

Answer 52

Ipratropium is an acetylcholine antagonist via blockade of muscarinic cholinergic receptors. Blockingcholinergic receptors decreases the production of cyclic guanosine monophosphate (cGMP). Thisdecrease in the lung airways will lead to decreased contraction of the smooth muscles

Question 53

Isoniazid

Answer 53

Isoniazid has been the most important drug used in TB treatment regimens since 1952. It is a prodrugactivated by the catalase-peroxidase KatG, creating a variety of radicals and adducts that inhibit themycobacterium’s production of the mycolic acids that make up its cell wall.The mild liver injury will occur in up to 20% of patients taking isoniazid. Clinical manifestations ofhepatotoxicity include fever, fatigue, nausea, and vomiting. However, most patients experiencingisoniazid-induced liver injury are asymptomatic.

Question 54

Ketamine

Answer 54

Ketamine (ketamine hydrochloride) has been approved for general anesthesia either alone or incombination with other medications. It is a superb drug for use in short-term medical procedures thatdo not require skeletal muscle relaxation.

Question 55

Linezolid

Answer 55

It is indicated for gram-positive infections andapproved for the treatment of bacterial pneumonia, skin and skin structure infections, and VREinfections, including infections complicated by bacteremiaLinezolid is a recommended empirical therapy option for MRSA in hospitalized adult patients withcomplicated skin and soft tissue infection, for community-associated MRSA skin and soft tissueinfection, and MRSA-associated purulent and nonpurulent cellulitis. Linezolid is also an alternativeoption for MRSA in hospitalized pediatric patients.
MOALinezolid is the first available oxazolidinone to inhibit bacterial protein synthesis by interfering withtranslation. Linezolid binds to a site on the bacterial 23S ribosomal RNA of the 50S subunit, whichprevents the formation of a functional 70S initiation complex.
[4]
This activity essentially inhibitsprotein production and prevents bacteria from multiplying.Linezolid is also a reversible, nonselective monoamine oxidase (MAO) inhibitor.
[5]
Monoamine oxidase
inhibition leads to an increased concentration of the neurotransmitters epinephrine, norepinephrine,
dopamine, and serotonin in the central and sympathetic nervous system.

Question 56

Quetipine

Answer 56

approved for schizophrenia, acute manic episodes, and adjunctive treatment formajor depressive disorder. There is FDA indication through three 6-week trials and one 6-week trial forschizophrenia in adults and adolescents ages 13 to 17.

Question 57

Sacubitril-Valsartan

Answer 57

Sacubitril/valsartan is the first agent to be approved in a new class of drugs called angiotensin receptorneprilysin inhibitor (ARNI). The medication is FDA-approved to treat patients with chronic heart failurewith reduced ejection fraction (HFrEF) with NYHA class II, III, or IV.
Contra - pregnancy and known fetal death

Question 58

Sulfasalazine

Answer 58

Sulfasalazine is indicated for the treatment of chronic inflammatory diseases such as rheumatoidarthritis in children and adults and ulcerative colitis. It also has off-label uses in treating patients withankylosing spondylitis, mild to moderately active Crohn’s disease, psoriasis, and psoriatic arthritis.

Question 59

Venlafaxine

Answer 59

Depression and anxiety disorders
Venlafaxine works by increasing serotonin levels, norepinephrine, and dopamine in the brain by
blocking transport proteins and stopping their reuptake at the presynaptic terminal.

Not to be used in children under 18

Question 60

Ondansetron

Answer 60

Ondansetron is a selective 5-HT3 serotonin-receptor antagonist used for its antiemetic properties. It isone of the four FDA-approved 5-HT3 serotonin-receptor antagonists used to combat nausea andvomiting, including granisetron, dolasetron, and the second-generation drug, palonosetron.
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