Highlighted content wk 1

Question 1

1) What is the primary site of metabolism?
2) Via what?
3) What phase of metabolism is this?

Answer 1

1) Liver
2) CYP P450 isoenzymes
3) Phase I

Question 2

1) What is the mnemonic to remember the strongest inducers?
2) What is the mnemonic to remember the strongest inhibitors?
3) Is this an element of pharmacokinetics or dynamics?

*(this is on EVERY EXAM)

Answer 2

1) PS PORCS
2) G PACMAN
3) Pharmacokinetics

Question 3

What are the strongest inducers?

*(this is on EVERY EXAM)

Answer 3

Phenytoin
Smoking
Phenobarbital
Oxcarbazepine
Rifampin (and rifabutin / rifapentine)
Carbamazepine
St. John’s Wort

PS PORCS

Question 4

What are the strongest inhibitors?

*(this is on EVERY EXAM)

Answer 4

Grapefruit
PIs (protease inhibitors)
Azoles
C–cyclosporin & cimetidine
Macrolides –not azithromycin
Amiodarone (and dronedarone)
Non-DHP CCBs (diltiazem and verapamil)

G PACMAN

Question 5

List the 4 drugs that increase AQ humor outflow

Answer 5

1) Prostaglandin analogs
2) Pilocarpine (Isopto Carpine)
3) Brimonidine (Alphagan P)
4) Netarsudil (Rhopressa)

Question 6

1) What is the max adult dose of APAP per day?
2) What abt ibuprofen per day?

Answer 6

1) 4000mg
2) 200-400mg every 4-6 hours as needed (1200mg)

Question 7

Why do children start taking adult doses at age 12?

Answer 7

Your liver fully matures

Question 8

FDA requires manufacturers to include a boxed warning on acetaminophen products that addresses its potential to cause ___________________

Answer 8

hepatotoxicity

Question 9

1) Acetaminophen is metabolized by the cytochrome P450 enzyme system to a hepatotoxic intermediate metabolite that is detoxified by ____________________
2) May be treated with activated charcoal or __________________ to supplement it.

Answer 9

1) glutathione (Phase II conjugation)
2) acetylcysteine

Question 10

Core body temperature is controlled by the _________________ and regulated by a feedback system involving information transmitted between the thermoregulatory center in the anterior hypothalamus and the thermosensitive neurons in the skin and central nervous system (CNS)

Answer 10

hypothalamus

Question 11

______________ , either exogenous or endogenous, are fever-producing substances that activate the body’s host defenses, resulting in an increase in the set point

Answer 11

Pyrogens

Question 12

Fever is treated w what?

Answer 12

APAP or ibuprofen (or alternate both)

Question 13

Adverse effects associated with cholinergic blockage include what 5 things?

Answer 13

1) Dryness of the eyes and mucous membranes (mouth, nose, vagina)
2) Blurred vision
3) Urinary hesitancy and retention
4) Constipation
5) Reflex tachycardia

Question 14

1) What medications inhibit cytochrome P450 (CYP) enzymes in the cell membrane of the infecting pathogen?
2) What does this do to the cell?

Answer 14

1) Azoles
2) Decreases synthesis of the fungal sterol ergosterol

Question 15

1) What do “cold” viruses bind to?
2) Their inflammatory mediators and parasympathetic nervous system reflex mechanisms cause what?

Answer 15

1) Intercellular adhesion molecule-1 receptors
2) Hypersecretion of watery nasal fluid

Question 16

IgE production is associated with what phase of allergic rhinitis?

Answer 16

Sensitization phase

Question 17

Mast cell mediators are released in what stage of allergic rhinitis?

Answer 17

Early phase

Question 18

When are eosinophils recruited with allergic rhinitis?

Answer 18

Cellular recruitment (3rd phase)

Question 19

Mucus hypersecretion occurs in what phase of allergic rhinitis?

Answer 19

Late phase (last phase)

Question 20

List the 4 stages of allergic rhinitis in order and what’s characteristic of each

Answer 20

1) Sensitization phase: IgE
2) Early phase: Mast cell mediators
3) Cellular recruitment: eosinophils
4) Late phase: Mucus hypersecretion

Question 21

List some drugs that can cause non-allergic rhinitis

Answer 21

Cocaine, beta blockers, ACEIs, chlorpromazine, hydralazine, oral contraceptives, aspirin or other NSAIDs, overuse of topical decongestants

Question 22

What are the 3 classifications of cough duration?

Answer 22

Acute, subacute, chronic

Question 23

Oxymetazoline is also called what?

Answer 23

Afrin

Question 24

Productive coughs:
1) What usually causes a clear productive cough?
2) What usually causes a purulent productive cough?
3) What usually causes a productive cough with a putrid malodor?
4) How would you describe a smoker’s cough? What usually causes it?

Answer 24

1) Acute bronchitis
2) Bacteria
3) Anerobic bacteria
4) Purulent; chronic bronchitis (from smoking)

Question 25

Dryness of the eyes and mucous membranes (mouth, nose, vagina), blurred vision, urinary hesitancy and retention, constipation, and reflex tachycardia are all side effects of what?

Answer 25

Cholinergic blocking (by 1st gen antihistamines)

Question 26

1st gen antihistamines:
1) Sedating antihistamines are contraindicated in what groups?
2) What drug do they interact with to increase risk of ulcers?

Answer 26

1) Newborns or premature infants, lactating women, and patients with narrow-angle glaucoma
2) Potassium chloride

Question 27

Give some examples of second generation histamines (inhibit mast cells). Specify which is most sedating.

Answer 27

1) Loratadine (Claritin)
2) Cetirizine (Zyrtec) – most sedating second generation antihistamine
3) Levocetirizine (Xyzal)
4) Fexofenadine (Allegra)

Question 28

Is antihistamine nasal spray new? What is it called?

Answer 28

New to OTC market (2022); azelastine 0.15 % (Astepro)

Question 29

Anticholinergic is a term interchangeable with what?

Answer 29

Antimuscarinic

Question 30

What medication should be taken 1-2 weeks before exposure to allergens?

Answer 30

Cromolyn sodium

Question 31

Name 2 things that interact with CYP2D6 inhibitors bupropion, fluoxetine & paroxetine

Answer 31

The antitussives:
1) Dextromethorphan (Robitussin or Delsym)
2) Codeine (Cheratussin AC [codeine 10mg / guaifenesin 100 mg / 5 mL])

Question 32

True or false: Codeine is a prodrug, Dextromethorphan (Robitussin or Delsym) is not

Answer 32

True

Question 33

1) What is the first line of defense when treating colds, allergic rhinitis and cough during pregnancy?
2) What is the preferred first line nasal decongestant if there is severe congestion in pregnancy?

Answer 33

1) Intranasal cromolyn
2) Oxymetazoline

Question 34

Differentiate between heartburn and dyspepsia

Answer 34

1) Hearburn: Acidic stomach contents regurgitate through lower esophageal sphincter and stimulates mucosal chemoreceptors
2) Dyspepsia: orginiating from stomach / duodenal area

Question 35

Increasing the pH of the stomach (eating) will cause lots of drug interactions between heartburn/ dyspepsia meds and what?

Answer 35

Azoles, protease inhibitors, fluoroquinolones, thyroxine, digoxin and others

Question 36

0.5 – 2% salicylic acid can be used to treat what?

Answer 36

Acne

Question 37

Silicon sheets or gels are the preferred Tx method for what?

Answer 37

Minimizing scarring

Question 38

What two dermatologic conditions likely need an Rx?

Answer 38

Tinea unguium & Tinea capitis

Question 39

Which drug formulation would you recommend for tinea pedis? Cream or spray?

Answer 39

Spray

Question 40

Permethrin 1% (Nix) and Ivermectin 0.5% (Sklice) both kill lice, but which acts on sodium channels? Which acts on chloride channels?

Answer 40

1) Sodium: Permethrin 1% (Nix)
2) Chloride: Ivermectin 0.5% (Sklice)

Question 41

Can cranberry juice treat or prevent a urinary tract infection?

Answer 41

Possibly, has antibiotic properties