Final Exam Review Flashcards
What are schedule I substances?
Drugs, substances, or chemicals that are defined as drugs with no currently accepted medical use and high potential for abuse
What drugs are schedule I?
-Heroin
-LSD
-Marijuana
-MDMA
What are schedule II drugs?
Drugs, substances, or chemicals that are defined as drugs with high abuse potential with use potentially leading to severe psychological or physical dependence but have an accepted medical use
What drugs are schedule II?
-Methamphetamine
-Oxycodone
-Morphine
-Fetanyl
-Cocaine
What are schedule III drugs?
Moderate or lower abuse potential compared to schedule II drugs
What drugs are schedule III?
-Anabolic steroids
-Testosterone
-Codeine
-Ketamine
What are schedule IV drugs?
Lower abuse potential compared to schedule III drugs
What drugs are schedule IV?
-Diazepam
-Lorazepam
-Tramadol
What are schedule V drugs?
Lowest abuse potential
What drugs are schedule V?
-Low dose opioids in cough medicine
-Lamotil
-Pregabalin
What is the main enzyme in the liver that is responsible for drug metabolism?
Cytochrome P450 (CYP450)
What increases CYP activity and drug metabolism?
-Rifampin
-Carbamazepine
What inhibits CYP and drug metabolism?
-Valproic acid
-Fluoxetine
What drugs are reabsorbed by the kidneys?
Lipid soluble drugs
How many half-lives does it usually take to eliminate a drug from the body?
5-7
What is the median effective dose (ED50)?
Dose at which 50% of the population responds to the drug in a specific manner
What is the median toxic dose (TD50)?
Dose at which 50% of the group exhibits adverse effects
What is the median lethal dose (LD50)?
Dose that causes death in 50% of the group (animal studies)
What is the therapeutic index? What does a higher therapeutic index (TI) indicate?
-TI= TD50/ED50
-The higher the TI, the safer the drug
-A large TI indicates that it takes a much larger dose to evoke a toxic response than it does to produce the desired effect
What are additive effects?
The effect of two chemicals is equal to the sum of the effect of two chemicals taken separately
What are synergistic effects?
The effect of two chemicals taken together is greater than the sum of their separate effects at the same doses
What are antagonistic effects?
The effect of the two chemicals taken together is less than the sum of their separate effects at the same doses
What is the opioid toxicity triad?
-CNS depression (coma)
-Respiratory depression (cyanosis)
-Pupillary miosis
What are the adverse effects of opioids with chronic use?
-Hypogonadism
-Immunosuppression
-Increased feeding
-Increased growth hormone secretion
-Withdrawal effects
-Tolerance and dependence
-Abuse
-Hyperalgesia
-Impairment while driving
What disease should acetaminophen not be used in? What is this condition and who is most at risk?
-Reyes syndrome: a rare but serious condition that causes confusion, swelling in the brain, and liver damage
-Children recovering from a viral infection who have a metabolic condition are most at risk
How does acetaminophen cause liver toxicity?
-Metabolized to a toxic intermediate (NAPQI) in the liver, which is quickly detoxified and eliminated via the urine
-High doses can result in an accumulation of the toxic intermediate with subsequent toxicity to liver proteins
What are the acetaminophen & opioid combination drugs?
-Loratb, lorcet: hydrocodone + acetaminophen
-Darvocet: propoxyphene
-Percocet: oxycodone
What glucocorticoid (SAID) is used for anaphylaxis?
Dexamethasone
How does glucocorticoids breakdown tissue?
-Inhibits the genes responsible for production of collagen and other tissue components by increasing the expression of substances that promote breakdown of bone, muscle, etc.
-Interfere with muscle protein synthesis
What are the symptoms of drug induced Cushing’s syndrome?
-Roundness and puffiness in the face
-Fat deposition and obesity in the trunk
-Muscle wasting in the extremities
-Hypertension
-Osteoporosis
-Increased body hair
-Glucose intolerance
What are the signs and symptoms of adrenal crisis/shock?
-Pain in legs, low back, abdomen
-Low BP, syncope
-Vomiting and diarrhea
-Hyperkalemia
-Hyponatremia
What are the traditional DMARDs for the treatment of RA?
-Hydroxychloroquine
-Methotrexate
-Leflunomide
-Sulfasalazine
What is the MOA of hydroxycholorquine?
Immunomodulation
What is the MOA of methotrexate?
Inhibits DNA synthesis which can lead to the reduction of antibodies
What is the MOA of leflunomide?
Inhibits AA synthesis (pyrimidine)
What is the MOA of sulfasalazine?
Not well understood
What are the side effects of hydroxycholorquine?
-Retinal damage
-Rash
What are the side effects of methotrexate?
-Hepatic fibrosis
-Rash
-Thrombocytopenia
-Leukopenia
What are the side effects of leflunomide?
-Hepatitis
-Alopexia
-HTN
What are the side effects of sulfasalazine?
-Rash
-Photosensitivity
-Alopecia
What are the TNF-⍺ blockers?
-Etanercept
-Infliximab
-Adalimumab
-Certolizumab
-Golimumab
What are the side effects of TNF-⍺ blockers?
-Local injection site reactions
-Infection
-Malignancy
What are the non TNF-⍺ blockers?
-Rituximab
-Abatacept
-Tocilizumab
-Baricitinib
-Anakinra
What are indirect acting cholinergic agonists that are used to treat Alzheimer’s?
-Donepezil
-Rivastigmine
-Galantamine
What are indirect acting cholinergic agonists that are used to treat Myasthenia Gravis?
-Neostigmine
-Pyridostigmine
-Edrophonium
-Ambenonium
What are indirect acting cholinergic agonists that are used to treat Glaucoma?
-Physostigmine
-Echothiopate
What are common anticholinergic drugs?
-Atropine
-Scopolamine
-Ipratropium bromide
-Tiotropium bromide
-Oxybutynin
-Tolterodine
-Benztropine
-Tropicamide
-Dicyclomine
-Hyoscyamine
What are the major side effects of organic nitrates?
-Headache
-Reflex tachycardia
-Orthostatic hypotension
-Facial flushing
-Nitroglycerin specifically has significant interactions with sildenafil (Viagra) and can cause fatal hypotension
What are the major side effects of β-blockers?
-Fatigue
-Bradycardia
-Hypotension
-Bronchoconstriction (only with non-selective β-blockers)
What are the major side effects of calcium-channel blockers?
-Constipation (especially Verapamil)
-Headache
-Dizziness
-Flushing
-Non-dihydropyridines can cause heart failure to worsen due to negative intotropic effects
What are the major side effects of sodium-channel blockers?
-Dizziness
-Headache
-Constipation
-QT interval prolongation
What is the generic name of the sodium channel blocker?
Ranolazine
What are the generic names of the K+ sparing diuretics?
-Spironolactone
-Triamterene
What are the side effects of diuretics?
-Orthostatic hypotension
-Weakness
-Cardiac arrhythmias
-Fatigue
-Hyponatremia
-Hypokalemia
What is the mechanism of action of sprionolactone?
Direct antagonist of aldosterone, which prevents salt retention, myocardial hypertrophy, and hypokalemia
What is the mechanism of action of eplerenone?
Antagonist of aldosterone but with lower incidence of endocrine-related side effects
What are the two aldosterone antagonists?
-Spironolactone
-Eplerenone
What are the common side effects of aldosterone antagonists?
Hyperkalemia
What is a common arterial dilator used for chronic heart failure?
Hydralazine
What are the common side effects of hydralazine and isosorbide dinitrate?
-Headache
-Hypotension
-Tachycardia
What patient population is the combination of hydralazine and isosorbide dinitrate for the treatment of heart failure used in? Why?
-Used in black patients
-Used because ACE inhibitors is not recommended in this group as there are excessive side effects
What are common positive inotropic drugs used for the treatment of heart failure?
-Digoxin
-Dobutamine
-Milrinone
What is a major downside of positive inotropic drugs?
All positive inotropic drugs have been associated with reduced survival in patients with HF, so they are only used for a short period of time with the exception of Digoxin
Which coagulation factors are involved in the extrinsic pathway?
-Factor III
-Factor VII
Which coagulation factors are involved in the intrinsic pathway?
-Factor XII
-Factor XI
-Factor IX
-Factor VIII
Which coagulation factors are involved in the rest of the coagulation pathway?
-Factor X
-Prothrombin (Factor II)
-Prothrombin activator
-Thrombin
-Fibrinogen (Factor I)
-Fibrin
Which coagulation factor is responsible for the conversion from factor X to prothrombin activator?
-Factor III
-Factor V
What is the role of thrombin in the coagulation cascade?
Converts fibrinogen to fibrin
What is the role of factor V in the coagulation cascade?
Converts prothrombin activator to thrombin
What is the role of factor VIII in the coagulation cascade?
Converts fibrin to fibrin polymer
What is the role of vitamin K in the coagulation pathway?
-Involved in the synthesis of vitamin K dependent clotting factors in the liver
-Factor II (prothrombin)
-Factor VII
-Factor IX
-Factor X
What are the side effects of warfarin (Coumadin)?
-Hemorrhage
-Fetotoxic
-Many drugs interactions
What are the side effects of heparins?
-Hemorrhage
-Thrombocytopenia
-Osteoporosis with long term use
-Hypersensitivity reactions
What is the MOA of aspirin for anticoagulation?
Inhibits COX enzyme which converts arachidonic acid to thromboxane A2, which activates platelets and causes them to clump together
What is the MOA of Clopidogrel for anticoagulation?
Prevents platelets from sticking together by inhibiting a receptor on the platelet called P2Y12
What is the MOA of Ticagrelor and Prasugrel for anticoagulation?
Same mechanism as Clopidogrel but has different pharmacokinetics and dynamics
What is the MOA of Dipyridamole for anticoagulation?
-Used in combination with aspirin
-Inhibits phosphodiesterase enzyme which leads to the increase of cAMP in platelets which inhibits their aggregation
What is a rare but serious side effect of Clopidogrel?
Thrombotic thrombocytopenic purpura (TTP): rare but severe condition where small blood clots form throughout the body
What are the antithrombotic/antiplatelet drugs?
-Aspirin
-Clopidogrel
-Ticagrelor
-Prasugrel
-Dipyridamole
What are the thrombolytic drugs?
-Alteplase (tPA)
-Reteplase
-Tenecteplase
-Streptokinase
-Urokinase
What are the suffixes for thrombolytic drugs?
-“plase”
-“kinase”
What are the suffixes for direct thrombin inhibitors?
-“tran”
-“ban”
-“udin”
What are the suffixes for anti-thrombotics?
-“grel”
-Aspirin
-Dipyridamole
What are the suffixes for factor Xa inhibitors?
“xaban”
What is the MOA of statins?
Inhibits the HMG-CoA reductase enzyme which plays a role in production of cholesterol
What are the major side effects of statins?
-Muscle pain and weakness
-Fatigue
-Rhabdomyolysis
What is the mechanism of action of bile acid sequestrants?
-Bind to bile acid in the intestines, forming a complex that is excreted in the feces
-Bile acids are made in the liver from cholesterol
-By binding these acids and promoting excretion, the liver compensates by converting
What is the only cholesterol absorption inhibitor?
Ezetimibe
What are the rapid acting insulin?
-Lispro
-Aspart
-Glulisine
What are the short acting insulin?
Crystalline
What are the intermediate acting insulin?
-NPH
-Lente
What are the long acting insulin?
-Detemir
-Glargine
What are the suffixes of sulfonylureas?
-First generation: “amide”
-Second generation: “ide”
-Third generation: “piride”
What are the adverse effects of sulfonylureas?
-Hypoglycemia
-Cholestatic jaundice
-Weight gain
-Fetal hypoglycemia
What are the suffixes of meglitinides?
“glinide”
What are the common adverse effects of meglitinides?
Hypoglycemia
What is the only biguanide?
Metformin
What are the adverse effects of metformin?
-GI side effects
-Lactic acidosis
What is the suffix for thiazolidinediones?
“glitazone”
What are the adverse effects of thiazolidinediones?
Edema
What are the alpha-glucosidase inhibitors?
-Acarbose
-Miglitol
What are the adverse effects of alpha-glucosidase inhibitors?
-Flatulence
-Diarrhea
What is the suffix for GLP-1 analogs?
“tide”
What are the adverse effects of GLP-1 analogs?
-GI issues
-Injection site reactions
-Pancreatitis
What is the suffix for DPP-4 inhibitors?
“gliptin”
What are the adverse effects of DPP-4 inhibitors?
-Nasopharyngitis
-Headache
-Pancreatitis
What is the suffix for SGLT-2 inhibitors?
“gliflozin”
What are the adverse effects of SGLT-2 inhibitors?
-Genital yeast infections
-Urinary tract infections
-Bone fracture risk
-Ketoacidosis
What are the short acting β-2 agonists?
-Albuterol
-Levalbuterol
What are the long acting β-2 agonists?
-Salmeterol
-Formoterol
What are the injectable disease modifying drugs for MS?
-Avonex
-Betaseron
-Copaxone
What are the oral disease modifying drugs for MS?
-Gilenya
-Tecfidera
What are the infused disease modifying drugs for MS?
-Novantrone
-Ocrevus
-Tysabri
