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first aid pharm Flashcards

1
Q

equatio for volume of distribution

A

Vd = amount of drug in body/ [plasma drug]

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2
Q

Clearance equation

A

CL= rate of elimination / [plasma drug] also = Vd * Ke

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3
Q

half life (t1/2) equation

A

t1/2 = 0.693 * Vd / CL

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4
Q

additive drug interactions means

A

substance A and B together is equal to the sum of their individual effects

(Aspriin, acetaminophen)

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5
Q

presence of substance A is requiredfor the full effect of substance B.

cortisol inc beta receptor expression on cells for catecholamine responsiveness

this is an example of?

A

permissive drug interactions

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6
Q

effect of substance A and B together is greater than the sum of their individual effects?

clpidogrel with aspirin

A

synergistic

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7
Q

acute decrease in response to a drug after initial/repeated administration

(nitrates, niacin, phenylephrine, LSD, MDMA

A

Tachyphylactic

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8
Q

rate of elimination is constant regardless of Cp (target plasma concentration at steady state)

Constant AMOUNT of drug eliminated per unit time.

(Cp dec linearly with time)

Phenytoin, Ethanol, Asprin

A

zero order elimination.

so elimination rate is not proportional to drug concentration!

see linear curve.

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9
Q

rate of elimination is directly proportional to the drug concentration (constant fraction of drug elimnated per unit time.

Cp dec exponentially with time.

A

1st order elimination

the rate of elimination is proportional to teh drug concentration.

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10
Q

aspirin overdose (ASA) what do you give

whats the mechanism how it works?

A

sodium bicarb

H+ + salicylate (Aspirin) is a weak acid and can be reabsorbed into tubular cells. problem its not lost in urine

We give NaHCO3- to still the H+ from the weak acid to make salicylate charged and now bound to H20+ thus it cant be reabsorbed and will be eliminated.

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11
Q

in zero order elimination.

how will drug half life dec as time goes on?

A

time of 1/2 life decreases as concentration decrease

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12
Q

first order elimination.

how does half life chage as concentration decreases?

A

time of 1/2 is CONSTANT as the .concentration decreases.

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13
Q

phenobarbital, methotrexate, aspirin (salicylates).

are all examples of weak acids. thus they get trapped in basic environments.

Tx overdose with? to alkalinize urine.

A

Bicarbonate. to alkalinize urine.

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14
Q

TCA, Amphetamines

are weak bases and get trapped in acidic environments.

tx overdose with? to acidify urine

A

Ammonium chloride.

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15
Q

what dose line A represent?

What does line B represent

What does line C represent.

A

A. Full agonist

B. full agonist in the presence of partial agonist

C. partial agonist

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16
Q

what dose the line blurred out represent

A

agonist plus competitive antagonist.

shift curve right (dec potency)

no chnage in EFFICACY.

can be overcome by inc concentration of agonist to substrate.

example: diazepam (agonist) + Flumazenil (competitive antagonist) on GABA

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17
Q

what does the blurred out line represent

A

agonist plus NONCOMPETITIVE antagonist

shifts curve down (dec efficacy)

cannot by overome by inc agonist subsrate concentraton.

example: nor epi + phenoxybenzamineb (nonceompetitive antagonist) on Alpha receptors.

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18
Q

25 yo man brought into hospital w/ symptoms of confusion and lethargy.

labs reveal elevated liver transaminases and _decreased ceruloplasm_in.

PE reveal kayser-fleischer rings (dark rings that appear to encircle iris)

the drug used to treat the cause of this pts disease is an example of which agent?

A/ chemical antagonist

B. competitive antagonists

C. irreversible antagonist

A

wilsons disease. (autosomal REcessive in copper transporter protein)

to much copper in body so what drug?

copper chelator penecilliamine

chemical antagonist (chelators directly bind to the agonist preventing it from binding to tissue receptors)

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19
Q

what agents can cause coronary vasospasm?

A

amphetamine.

cocaine - inhibits nor epi reuptake

Ergot alklaoid, sumatriptan

used for head aches - serotonin agonist that activate BV 5HT receptors causing vasoconstriction)

pt comes in with ST elevation. either old lady that has new chest pain or young guy partying all night.

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20
Q

what drug causes red man syndrome. it causes histamine release from mast and basophils.

A

vancomycin.

21
Q

cutaneous flushing drugs?

they are vasodilators –> flushing of skin

A

VANNCE

Vancomycin, Adenosine, Niacin, Nitrates, Ca2+ channel blockers, Echinocandins.

22
Q

Anthracycliens (doxorubicin, daunorubicin) can cause

dilated cardiomyopathy

what can you give to prevent this

A

Dexrazoxane - is a chelator to bind iron in heart.

23
Q

torsades de pointes is polymorphic ventricular tachycardia. occurs in pts w. abnoraml phase 3 repolarization

which drugs causes this?

A

all these drugs compete with potassium channels during phase 3 repolarization. (thus preventing efflux of K can lead to prolongation of QT interval, bc it takes longer for K to leave cell and reach resting potential) always check with ECG before giving.

ABCDE

AntiArrhythmics (class IA, III)

antiBiotics (macrolides)

anti “C”ychotics (haloperidol)

antiDepressants (TCAs)

antiEmetics (ondansetron)

24
Q

what drugs can causes hypothyroidism? and what is the mechanism?

A

lithium: directly inhibit release of T3, T4

amiodarone: inhibits 5’-deiodinase (this inhibits peripheral conversion of T4 –> T3)

Sulfonamides

25
Q

what drugs can causes diabetes insipidus?

A

lithium

demeclocyline.

both inhibit adenylyl cylase thus no cAMP –> no Protein kinase A to phosphorylate AQP2 channels to absorb water.

26
Q

drugs that causes hyperglycemia

“Taking Pills Necessitates Having blood Checked”

A

Tacrolimus

Protease inhibitors

Niacin

HCTZ

Corticosteriods. ( stimulates gluconeogenesis)

27
Q

how does colchicine cause diarrhea?

A

inhibits microtubule polymerization thus limits the high regeneration of the intestinal cells so they die very easy and fall off into the gut lumen.

28
Q

Acarbose works by?

A

inhibiting Alpha-Glucosidase in brush border so carbs arent absorbed

so carbs sit in gut lumen and have an osmotic effect (draw water inito lumen from intestine. giving patient explosive diarrhea.

29
Q

how does metformin cause diarrhea

A

it stimulates enterochromaffin cells in the gut to secrete 5 HT which stimulates parastalsis of gut by activating myenteric nervous system.

30
Q

what drugs can lead to focal to massive hepatic necrosis

“liver HAVAc”

A

Halothane –>CF3 CHCL –> hepatocyte injury

Acetominophen –> NAPQI –> deplete glutathione –> injury

Amanita phalloides (death cap mushroom) (can directly inhibit RNA polyerases)

Valproic acid.

31
Q

a patient has trouble swallowing. thus is at high risk for pill induced esophagitis.

Q: pt has a hx of difficulty swallowing (odyno/dysphagia) and now has GERD-like symp and retrosternal pain.

which drugs can cause this

A

bisphosphonates (old lady with osteoporsis that was started on this)

ferrous sulfate

NSAIDS

potassium chloride

tetracyclines

32
Q

agranulocytosis.

which drugs cause this

Can Cause Pretty Major Collapse of Granulocytes”

A

Clozapine

Carbamazepine

ProrpythiouracilandMethimazole (both structures similiar to pyrimidine)

Colchicine (used for gout, its microtuble polymerization thus granulocytes can mature and are destory)

Gangciclovir

33
Q

aplastic anemia can be caused by what drugs

A

Carbamazepine

Methimazole

Nsaids

Benzene (look out for people who work with engines or industrial worker)

Chloramphenicol (has a benzene ring that can cross BBB used for meningitis. benzene ring inhibit topiosmerase II

Propylthiouracil

34
Q

what drug causes Gray baby syndrome

A

Chloramphenicol

its metabolized by UDPGT. so neonates def in this leading to its accumulation –> inhibits mitochondrial protein synthesis –> end organ hypoxia.

35
Q

drugs that cause hemolysis in G6PD def

hemolysis IS D PAIN

A

Isoniazid

sulfonamides

dapsone

Primaquine

Aspirin

Ibuprofen

Nitrofurantoin

36
Q

drugs that cause

Megaloblastic Anemia

“You’re having a mega blastwith PMS”

A

Hydroxyurea

Phenytoin (inhibits intestinal absorption of folic acid)

Methotrexate, Sulfa drugs (both inhibit enzymes that make folate) (DHFR)

folate def –> cant produce thymidilate (TMP) thus nucleous can finish dividing.

37
Q

OCT and Estrogen supplement

have inc risk of thrombosis why?

A

inc estrogen –> dec protein C activity (cleaves Va, VIIIa)

38
Q

pt taking quinidine and presents with tinnitus, hearring loss and vision loss/blurry what is the diagnosis

A

cinchonism

39
Q

what drugs can cause parkinson like syndrome?

“Cogwheel rigidity of ARM”

A

Antipsychotics.

Reserpine

Metoclopramide (this is an antinausea medication, causes these symp bc its a dopamine receptor antagonist)

40
Q

Classic scenario: pt on chronic antipsychotic presents with lip smaking abnormal movment of face and tonque.

what drugs cause this and whats the mechanism

A

antipsychotic

D2>D1 this is preventing the indirect pathway from inhibiting movement.

metoclopramide

41
Q

SEIZURES!!! common drugs that causes this?

“with seizures, I BITE my tongue”

A

Isoniazid (vit B6 deficiency) (isoniazid binds to pyridoxal 5 phosphate instead of B6 . now it cant convert glutamate –> GABA. so now dec GABA so less Cl flowing into neurons to calm thing down, thus inc RMP. now pt more susceptilbe to seizure

Bupropion

Imipenem/cilastatin (inhibit GABA recep)

Tramadol

Enflurane

42
Q

what drugs can cause Fanconi syndrome

A

Tenofovir and ifosfamide ​are taken up by the PCT. this can cause renal epithelial cells to malfunction -> secretion of AA, Glucose, HCO3, PO43- into the urine = faconi

expired tetracyclines

cisplatin

43
Q

pt develops hemorrhagic cystitis from cyclophosphamide or ifosfamide use. whats the mechanism of the tissue injury?

how could this be prevented

A

they are both metabolized to acrolein which depleltes Glutathione –> dec protection –> inc ROS –> hemorrhagic cystitis.

prevents by coadministering with MESNA which binds to acrolein.

44
Q

27 yo male with HTN on lisinopril develops a dry cough. why does he have this cough?

A

lisnopril is a ACE inhibitor thus inhibiting breakdow n of bradykinin.

bradykinin –> bronchoconstriction.

45
Q

what drugs can cause pulmonary fibrosis?

“My Nose Cannot Breathe Bad Air”

A

Methotrexate, carmustine, Bleomycin, Busulfan. are all chemo drugs that cause direct endothelial cell damage triggering intense inflammatory response –> fibrosis

Nitrofurantoin and amiodarone –> Pneumonitis –> fibrosis.

note bleomycin is an antibiotic used for testicular cancer

46
Q

what drugs can cause Disulfiram - like rxn?

inhibiting ACetaldehyde ==> acetate

A

1st gen sulfonylureas

Procarbazine

certain Cephalosporins

Griseofulvin

Metronidazole

47
Q

sulfa drug allergies

Scary Sulfa Pharm FACTS

A

Sulfonamide antibiotics

Sulfasalazine

Probenecid

Furosemide

Acetazolamide

Celecoxib

Thiazides

Sulfonylureas.

48
Q

myelosuppression caused by methotrexate is reversible with?

A

Leucovorin

first aid pharm (2 decks)

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