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First Aid > First Aid - Pharm > Flashcards

First Aid - Pharm Flashcards

1
Q

K_m reflects ___

A

substrate affinity for enzyme (inversely)

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2
Q

V_max is a function of ___

A

enzyme concentration

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3
Q

low ___ means high enzyme affinity

A

K_m

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4
Q

inhibitors are studied with graph of ___ vs. ___

this is aka ___ plot (2)

A

1/V
1/[S]
double reciprocal
Lineweaver-Burk

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5
Q

x intercept of double reciprocal plot is ___

A

(-)1/K_m

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6
Q

y intercept of double reciprocal plot is ___

A

1/V_max

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7
Q

K_m is the ___ at which V is ___

A

substrate concentration

V_max/2

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8
Q

competitive/noncompetitive inhibitors do not change V_max

A

competitive

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9
Q

competitive/noncompetitive inhibitors do not change K_m

A

noncompetitive

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10
Q

efficacy change means ___ of dose response curve

A

vertical shift

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11
Q

potency change means ___ of dose response curve

A

horizontal shift

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12
Q

competitive inhibitors change ___

A

potency

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13
Q

non-competitive inhibitors change ___

A

efficacy

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14
Q

V_d in terms of plasma drug concentration

A

V_d = (amount of drug in body)/(plasma concentration)

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15
Q

drugs with low V_d distribute in ___
drugs with medium V_d distribute in ___
drugs with high V_d distribute in ___

A

blood
ECF or TBW
tissues

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16
Q

low V_d means ___ L

A

4–8

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17
Q

clearance (CL) in terms of plasma drug concentration (C_p)

A

CL = (rate of drug elimination)/(C_p)

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18
Q

CL in terms of V_d

A

CL = V_d x K_e

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19
Q

t_1/2 in terms of V_d

A

t_1/2 = (0.7 x V_d)/CL

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20
Q

loading dose in terms of V_d

A

LD = (C_p x V_d)/F

where F is bioavailability

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21
Q

maintenance dose in terms of C_p

A

MD = (C_p x CL)/F

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22
Q

zero order kinetics means

A

constant elimination per unit time

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23
Q

3 drugs with zero order kinetics

A

phenytoin
ethanol
aspirin

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24
Q

first order kinetics means

A

constant fraction of drug eliminated per unit time

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25
Q

5 weak acid drugs

treat overdose of weak acid with ___

A 
phenobarbital
MTX
TCAs
aspirin
bicarbonate
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26
Q

weak base drug
__a__

treat overdose wtih _b__

A

a. amphetamine

b. ammonium chloride

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27
Q

phase I metabolism is done by ___
its products are active/inactive
3 phase I reactions:

A

CYP450

active

reduction
oxidation
hydrolysis

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28
Q

phase II metabolism products are active/inactive,
polar/nonpolar
3 phase II reactions

A

inactive

very polar

glucuronidation
acetylation
sulfation

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29
Q

geriatric patients lose phase ___ metabolism first

A

I

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30
Q

therapeutic index

A

TI = LD_50/ED_50

where LD_50 is median toxic dose,
ED_50 is median effective dose

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31
Q

the first synapse in a parasympathetic pathway is ___

A

nicotinic

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32
Q

the second synapse in a parasympathetic pathway is ___

A

muscarinic

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33
Q

the first synapse in a sympathetic pathway is ___

A

nicotinic

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34
Q

the second synapse in most sympathetic pathways is ___

2 exceptions are ___

A

noradrenergic

sweat gland
renal vascular smooth muscle

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35
Q

2nd synapse in sweat gland pathway is ___

A

muscarinic

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36
Q

2nd synapse in renal vascular smooth muscle pathway is ___

A

D1 dopaminergic

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37
Q

nicotinic receptor is ___tropic

muscarinic receptor is ___tropic

A

iono

metabo

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38
Q

nicotinic receptor is a ___-gated ___ channel

A

ligand

Na+/K+

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39
Q

alpha1 major functions

A

inc. vascular smooth muscle contraction
inc. pupillary dilator muscle contraction (mydriasis)
increase intestinal and bladder sphincter muscle contraction

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40
Q

alpha_1 adrenergic receptor type

A

G_qPCR

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41
Q

alpha_2 major function

A

decrease sympathetic outflow
decrease insulin release
decrease lipolysis
increase platelet aggregation

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42
Q

alpha_2 adrenergic receptor type

A

G_iPCR

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43
Q

beta 1 adrenergic major functions

A

increase heart rate
increase contractility
increase renin release
increase lipolysis

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44
Q

beta_1 adrenergic receptor type

A

G_sPCR

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45
Q

beta_2 adrenergic major functions

A 
vasodilation
bronchodilation
increase contractility
increase HR
increase insulin release
increase lipolysis
ciliary muscle relaxation
increase aqueous humor production 
decrease uterine tone
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46
Q

beta_2 adrenergic recetor type

A

GsPCR

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47
Q

M1 muscarinic receptor is ___
M2 muscarinic receptor is ___
M3 muscarinic receptor is ___

A

G_qPCR
G_iPCR
G_qPCR

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48
Q

M1 major functions

A

CNS, ENS

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49
Q

M2 major functions

A

decrease HR and contractility of atria

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50
Q

M3 major functions

A

increase exocrine gland secretion
increase gut peristalsis
increase bladder contraction
bronchocontriction
increase pupillary sphincter muscle contraction (miosis)
ciliary muscle contraction (accomodation)

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51
Q

D1Rs: receptor type and

major functions

A

G_sPCR

renal vascular smooth muscle relaxation

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52
Q

D2Rs: receptor type and

major functions

A

G_iPCR

neurotransmitter modulation

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53
Q

H1Rs: receptor type and

major functions

A 
G_qPCR
nasal and bronchial mucus secretion
vascular permeability
bronchoconstriction
itching
pain
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54
Q

H2Rs: receptor type and

major functions

A

G_sPCR

gastric acid secretion

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55
Q

ADH V1Rs: receptor type and major functions

A

G_qPCR

vasoconstriction

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56
Q

ADH V2Rs: receptor type and major functions

A

G_sPCR

H2O reabsorption in collecting duct

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57
Q

Y is converted to ___ by ___.

this is blocked by ___, which works as a ___

A

DOPA
Y hydroxylase
metyrosine
antihypertensive

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58
Q

DOPA is converted to ___ by ___.

cofactor is ___

A

DA
DOPA decarboxylase (AAADC)
B6

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59
Q

DA is imported to vesicles by ___.

this is blocked by ___

A

VMAT (vesicular monoamine transporter)

reserpine

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60
Q

DA is converted to ___ by ___.

cofactor is ___

A

NE
DBH (DA beta hydroxylase)
vitamin C

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61
Q

In ___, NE is converted to ___ by ___, in the ___.

___ is required

A 
adrenal medulla
E
PNMT (phenylethanolamine N-methyl transferase)
cytoplasm
SAM
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62
Q

After MAO-COMT in either order, DA becomes ___

A

HVA (homovanillic acid)

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63
Q

After MAO-COMT in either order, E becomes ___ and NE becomes ___

A

both become MHPG (methoxyhydroxyphenylglycol)

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64
Q

After COMT, E becomes ___ and NE becomes ___.

A

metanephrine

normetanephrine

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65
Q

adrenal pheochromocytomas make more ___ than ___, but other ones do the opposite

A

E

NE

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66
Q

catecholamine exocytosis is potentiated by ___ (2) and inhibited by ___

A

amphetamine
ephedrine
guanethidine

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67
Q

___ (3) blocks catecholamine reuptake

A

cocaine
amphetamine
TCAs

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68
Q

2 presynaptic receptors which inhibit catecholamine release

A

alpha_2

M2

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69
Q

1 presynaptic receptor which facilitates catecholamine release

A

AII (angiotensin)

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70
Q

rate limiting step of cholinergic neurotransmission is ___

this is inhibited by ___

A

Ch uptake

hemicholinium

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71
Q

ACh is synthesized by ___ from ___ and ___

A

choline acetyltransferase (ChAT)
choline
Ac CoA

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72
Q

uptake of ACh into vesicule is inhibited by ___

vesicular exocytosis is inhibited by ___

A

vesamicol

botulinum

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73
Q

direct agonists: cholinomimetics

A

bethanechol, carbachol, pilocarpine, methacholine

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74
Q

direct cholinomimetic for GI motility

A

bethanechol

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75
Q

2 indications for bethanechol

A

ileus (post op, neurogenic)
urinary retention
b/c it activates bladder and bowel

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76
Q

2 direct cholinomimetics for glaucoma

A

pilocarpine

carbachol

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77
Q

pilocarpine causes contraction of ___ (2)

and secretion of ___ (3)

A 
pupillary sphincter
ciliary body
saliva
sweat
tears
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78
Q

contraction of ___ helps open angle glaucoma

contraction of ___ helps closed angle glaucoma

A

ciliary body

sphincter pupillae

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79
Q

direct cholinomimetic for testing asthma

A

methacholine

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80
Q

indirect cholinomimetics are ___s

A

AChEI

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81
Q

Indirect agaonists (cholinomimetics)

A

neostigmine, pyridostigmine, physostigmine, donepezil, rivastigmins, galantamine

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82
Q

indirect cholinomimetic for GI motility

A

neostigmine

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83
Q

neostigmine has high/low CNS penetration

A

low

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84
Q

4 neostigmine indications

A

ileus (post op, neurogenic)
urinary retention
MG
post op NMJ block reversal

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85
Q

cholinomimetic for MG dx

A

edrophonium

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86
Q

cholinomimetic for MG tx

A

pyridostigmine

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87
Q

2 indirect cholinomimetics for glaucoma

A

echothiophate

physiostigmine

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88
Q

CNS penetrations of

a. pyridostigmine
b. physiostigmine
c. echothiophate

A

a. low
b. high
c. low

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89
Q

what indirect agonist do you use for alzheimer’s?

A

donepezil, rivastigmine, galantamine

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90
Q

cholinesterase inhibitor poisoning

A 
DUMBBELSS:
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Excitation of skeletal and CNS
Lacrimation
Sweating
Salivation
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91
Q

2 antidotes for cholinergic intoxication

A

atropine

pralidoxime

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92
Q

pralidoxime functions in cholinergic intoxication by ___

A

regenerating active ChE

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93
Q

antimuscarinic for eye

A

atropine
homatropine
tropicamide

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94
Q

atropine causes ___ (2)

A

mydriasis

cycloplegia

95
Q

cycloplegia means ___

A

inability to accomodate

96
Q

antimuscarinic for Parkinson’s disease

A

benztropine

97
Q

antimuscarinic for motion sickness

A

scopolamine

98
Q

2 antimuscarinic for asthma and COPD

A

ipratropium

tiotropium

99
Q

2 antimuscarinics for bladder spasticity

A

oxybutynin
darifenacin
solifenacin

100
Q

glycopyrrolate used for ___ (3)

A

reduce airway secretions
drooling
peptic ulcers

101
Q

atropine effects

A

eye: pupil dilation, cycloplegia
respiratory: decreased secretions from airway
stomach: decreased acid secretion
gut: decreased motility
bladder: decreased urgency in cystitis

102
Q

atropine toxicity

A 
hot
dry
red
blind (cycloplegia)
mad (disoriented)

may cause acute angle-closure glaucoma, urinary retention (in BPH men or hyperthermic infants)

103
Q

E effects which receptor

A

beta > alpha (with alpha at higher doses)

104
Q

E is indicated for ___ (4)

A

anaphylaxis
open angle glaucoma
asthma
hypoTN

105
Q

NE effects which receptor

A

alpha_1 > alpha_2 > beta_1

106
Q

NE is indicated for ___

A

hypoTN (*decreases renal perfusion)

107
Q

isoproterenol effects which receptor

A

beta_1 = beta_2

108
Q

isoproterenol is indicated for ___

A

evaluation of tachyarrhythmias

109
Q

DA effects which receptor

A

D1 = D2 > beta > alpha

110
Q

DA is indicated for ___ (3)

A

shock
heart failure
unstable bradycardia

111
Q

DA’s effects on the heart

A

+ inotrope
+ chronotrope
at high doses

112
Q

dobutamine effects which receptor

A

beta_1 > beta_2 > alpha

113
Q

dobutamine is indicated for ___ (3)

A

heart failure

cardiac stress testing

114
Q

dobutamine’s effects on the heart

A

inotropic > chronotropic

115
Q

phenylephrine effects which receptor

A

alpha_1 > alpha_2

116
Q

phenylephrine is indicated for ___ (3)

A

pupil dilation
nasal decongestion
hypotension

117
Q

5 beta_2-selective agonists

A 
metaproterenol
albuterol
salmetrol
terbutaline
ritodrine
118
Q

2 beta_2 agonists for acute asthma

A

metaproterenol

albuterol

119
Q

beta_2 agonist for chronic asthma tx

A

salmetrol

120
Q

2 tocolytic beta_2 agonist

A

terbutaline

ritodrine

121
Q

3 indirect sympathomimetics

of these ___ (2) are secretagogues

A

amphetamine
ephedrine
cocaine

amphetamine
ephedrine

122
Q

3 amphetamine indications

A

narcolepsy
obesity
ADD

123
Q

3 ephedrine indications

A

nasal decongestion
urinary incontinence
hypoTN

124
Q

what drug should you avoid prescribing in patients with cocaine intoxication?

A

beta blockers because of the unopposed alpha 1 activation leading to extreme hypertension

125
Q

2 alpha_2 agonists

A

clonidine

alpha-methyldope

126
Q

alpha_2 agonists are indicated for ___ with ___

A

HTN

renal disease

127
Q

clonidine toxicity symptoms

A

CNS depression, bradycardia, hypotension, respiratory depression, small pupil size

128
Q

alpha-methyl dopa toxicity symptoms

A

direct coombs + hemolytic anemia, SLE-like syndrome

129
Q

2 non-selective alpha blockers

___ is reversible blocker

A

phenoxybenzamine
phentolamine

phentolamine

130
Q

phenoxybenzamine use:

A

HTN
prevention in heochromocytoma

131
Q

phenoxybenzamine toxicity:

A

orthostatic hypotension, reflex tachycardia

132
Q

phentolamine use:

A

MAO inhibitor patients who ate too much tyramine

133
Q

alpha_1 selective blockers end in ___

A

zosin

134
Q

alpha_1 blockers are indicated for

A

HTN
urinary retention from BPH
PTSD

135
Q

3 alpha_1 SEs

A

1st dose orthostatic hypoHTN
dizziness
headache

136
Q

alpha_2 selective blocker

A

mirtazapine

137
Q

mirtazapine is indicated for ___

A

depression

138
Q

3 mirtazapine SEs

A

sedation
hyperlipidemia
hyperphagia

139
Q

beta blockers effects

A 
decrease heart rate and contractility
decrease MI mortality
decrease AV conduction velocity in SVT
decrease cardiac output and renin secretion
decrease progression of CHF
decrease aqueous humor
140
Q

2 beta blockers for SVT

A

propranolol

esmolol

141
Q

sexual SE of beta blocker

A

impotence

142
Q

acebutolol is ___-selective beta blocker

A

beta_1

143
Q

atenolol is ___-selective beta blocker

A

beta_1

144
Q

betaxolol is ___-selective beta blocker

A

beta_1

145
Q

esmolol is ___-selective beta blocker

A

beta_1

146
Q

labetalol is ___-selective beta blocker

A

non

147
Q

metoprolol is ___-selective beta blocker

A

beta_1

148
Q

nadolol is ___-selective beta blocker

A

non

149
Q

pindolol is ___-selective beta blocker

A

non

150
Q

propranolol is ___-selective beta blocker

A

non

151
Q

timolol is ___-selective beta blocker

A

non

152
Q

2 non-selectve alpha + beta blockers

A

carvedilol

labetalol

153
Q

2 partial beta agonists

A

pindolol

acebutolol

154
Q

tx for acetaminophen poisoning

A

N-acetyl cysteine

155
Q

tx for salicylate poisoning (2)

A

bicarbonate

dialysis

156
Q

purpose of bicarbonate in salicylate poisoning

A

alkalinize urine

157
Q

tx for amphetamine poisoning

A

ammonium chloride

158
Q

purpose of ammonium chloride in amphetamine poisoning

A

acidify urine

159
Q

tx for anticholinesterase poisoning (2)

A

atropine

pralidoxime

160
Q

tx for antimuscarinic toxicity

A

physiostigmine salicylate

161
Q

tx for beta blocker toxicity

A

glucagon

162
Q

tx for digitalis toxicity (5)

A 
stop digitalis
normalize K+
lidocaine
anti-dig Fab
Mg2+
163
Q

tx for Fe toxicity

A

desferoxamine

164
Q

tx for Pb toxicity (4)

A

CaEDTA
dimercaprol
succimer
penicillamine

165
Q

tx for As/Au/Pb toxicity (4)

A

dimercaprol
succimer
penicillamine
CaEDTA

166
Q

tx for Cu toxicity

A

penicillamine

167
Q

tx for CN- toxicity (3)

A

nitrite
hydroxocobalamin
thiosulfate

168
Q

tx for methemoglobinemia (2)

A

methylene blue

vitamin C

169
Q

tx for CO toxicity (2)

A

100% O2

hyperbaric O2

170
Q

tx for MeOH/ethylene glycol toxicity (3)

A

ethanol
dialysis
fomepizole

171
Q

tx for opioid toxicity

A

naloxone

172
Q

tx for benzo toxicity

A

flumazenil

173
Q

tx for TCA toxcity

A

bicarbonate

174
Q

purpose of bicarbonate in TCA toxicity

A

alkalinize serum

175
Q

tx for heparin toxicity

A

protamine

176
Q

tx for warfarin toxicity (2)

A

vitamin K

FFP

177
Q

tx for tPA/streptokinase toxicity

A

aminocaproic acid

178
Q

tx for theophylline toxicity

A

beta blocker

179
Q

Fe poisoning is particularly common with ___

A

kids

180
Q

Fe is cytotoxic because of ___

A

membrane lipid peroxidation

181
Q

acute Fe poisoning presents with ___

A

gastric bleeding

182
Q

chronic Fe poisoning presents wtih ___ (2)

A

metabolic acidosis

GI obstruction 2’ to scarring

183
Q

drugs causing atropine-like SEs

A

TCA

184
Q

2 drugs causing coronary vasospasm

A

cocaine

sumatriptan

185
Q

4 drugs causing flushing

A

vancomycin
adenosine
niacin
CCBs

186
Q

3 drugs which cause torsades

A 
class Ia antiarrhythmics
class III antiarrhythmics
cisapride
187
Q

6 drugs which cause agranulocytosis

A 
clozapine
carbamazepine
colchicine
dapsone
PTU
methimazole
188
Q

5 drugs which cause aplastic anemia

A 
chloramphenicol
benzene
NSAIDs
PTU
methimazole
189
Q

drug causing direct coombs positive hemolytic anemia

A

alpha methyldopa

190
Q

drug causing gray baby syndrome

A

chloramphenicol

191
Q

drugs causing hemolysis in context of G6PD deficiency

A 
INH
sulfonamides
primaquine
aspirin
ibuprofen
nitrofurantoin
192
Q

drugs causing megaloblastic anemia

A

pheyntoin
MTX
sulfa

193
Q

drug causing cough

A

ACEI

194
Q

3 drugs causing pulmonary fibrosis

A

bleomycin
amiodarone
busulfan

195
Q

drug causing acute cholestatic hepatitis

A

macrolide

196
Q

4 drugs causing hepatic necrosis

A

halothane
VPA
acetaminophen
amanita phalloides

197
Q

drug causing hepatitis

A

INH

198
Q

2 drugs causing pseudomembranous colitis

A

clindamycin

ampicillin

199
Q

6 drugs causing gynecomastia

A 
spironolactone
digitalis
cimetidine
alcohol
ketoconazole
estrogens
200
Q

2 drugs causing hot flashes

A

tamoxifen

clomiphene

201
Q

2 drugs causing hypothyroidism

A

Li

amiodarone

202
Q

2 drugs causing gout

A

furosemide

thiazides

203
Q

3 drugs causing photosensitivity

A

sulfonamides
amiodarone
tetracycline

204
Q

8 drugs causing Stevens-Johnson syndrome

A 
carbamazepine
ethosuximide
lamotrigine
phenobarbital
phenytoin
sulfa
penicillin
allopurinol
205
Q

4 drugs causing SLE-like syndrome

A

hydralazine
INH
procainamide
phenytoin

206
Q

fluoroquinolones cause ___ (3) in kids

A

tendonitis
tendon rupture
cartilage damage

207
Q

___ causes Fanconi’s syndrome

A

expired tetracycline

208
Q

Fanconi’s syndrome is ___ wasting of ___ (4)

A 
tubular
bicarbonate
AAs
glucose
uric acid
209
Q

3 drugs causing interstitial nephritis

A

methicillin
NSAIDs
furosemide

210
Q

2 drugs causing hemorrhagic cystitis

prevent this by giving ___

A

CTX
ifosfamide
mesna

211
Q

2 drugs which cause cinchonism

A

quinidine

quinine

212
Q

cardiovascular aspects of cinchonism

A

flushing

arrhythmia

213
Q

4 neurological sx of cinchonism

A

tinnitus/hearing loss
blurry vision
somnolence
confusion

214
Q

2 cutaneous sx of cinchonism

A

flushing

rash

215
Q

2 drugs causing DI

A

Li

demeclocycline

216
Q

4 drugs causing PD-like syndrome

A

haloperidol
chlorpromazine
metoclopramide
reserpine

217
Q

3 drugs causing seizures

A

buproprion
imipinem/cilastatin
INH

218
Q

drugs causing tardive dyskinesia

A

antipsychotics

219
Q

4 drugs causing disulfiram-like reaction

A

metronidazole
cephalosporins (some)
procarbazine
1st generation sulfonylureas

220
Q

disulfiram-like reaction means

mechanism is ___

A

feeling bad after EtOH

acetaldehyde dehydrogenase inhibition

221
Q

drug causing nephrotoxicity + neurotoxicity

A

polymixins

222
Q

4 drugs causing nephrotoxicity + ototoxicity

A

aminoglycosides
vancomycin
loop diuretics
cisplatin

223
Q

9 CYP450 inducers

A 
quinidine
barbiturates
st. john's wort
phenytoin
rifampin
griseofulvin
carbamazepine
chronic alcholism
224
Q

CYP450 inhibitors

A 
INH
sulfonamides
cimetidine
erythromycin
grapefruit
225
Q

3 drugs metabolized by alcohol dehydrogenase

A

ethylene glycol
MeOH
EtOH

226
Q

ethylene glycol is metabolized by alcohol dehydrogenase to ___
effects are ___ (2)

A

oxalic acid
acidosis
nephrotoxicity

227
Q

MeOH is metabolized by alcohol dehydrogenase to ___ (2)

effects are ___ (2)

A

formaldehyde
formic acid
acidosis
retinal damage

228
Q

EtOH is metabolized by alcohol dehydrogenase to ___

effects are ___ (3)

A

acetaldehyde
nausea
vomiting
hypoTN

229
Q

___ inhibits alcohol dehydrogenase

A

fomepizole

230
Q

5 non-obvious sulfa drugs

A 
celecoxib
probenecid
thiazides
sulfonylurea
sumatriptan
231
Q

systemic part of sulfa allergic rxn

A

fever

232
Q

cutaneous part of sulfa allergic rxn (3)

A

rash
urticaria (hives)
Stevens-Johnson

233
Q

hematologic part of sulfa allergic rxn (3)

A

HA
thrombocytopenia
agranulocytosis

First Aid (23 decks)

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