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HY - pharm Flashcards

1
Q

drug that inhibits alcohol dehydrogenase

A

fomepizole

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2
Q

drug that inhibits acetaldehyde dehydrogenase

A

disulfiram

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3
Q

alcohol dehydrogenase degrades ethanol into _____

A

acetaldehyde

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4
Q

_____ ______ degrades acetaldehyde into acetate

A

acetaldehyde dehydrogenase

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5
Q

Drug used to decrease triglyceride levels

A

Fibrates - activates PPARa and decreases VLDL synthesis

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6
Q

Two drugs that increase HDL

A

Niacin and Fibrates

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7
Q

Cholestyramine MOA

A

blocks bile reabsoprtion in terminal ileum forcing liver to breakdown cholesterol

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8
Q

Ezetimibe MOA

A

blocks gut reabsorption of cholesterol

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9
Q

Flushing, pruritis, hepaptoxicity, hyperuricemia caused by lipid lowering drug

A

Niacin

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10
Q

Lipid lowering drug that can cause nausea, bloating, cramping, and decreased abosrption of other drugs and fat soluble vitamins

A

cholestyramine

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11
Q

If added to statins, can worse hepatotoxic side effect

A

ezetimibe

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12
Q

nephro and ototoxic drugs

A

cisplatin, aminoglycosides, loop diuretics, vancomycin

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13
Q

drugs that can cause hemolytic anemia in G6PD patients

A

isoniazid, sulfonamides, primaquine, aspiring, ibuprofen, nitrofurantoin (hemolysis IS PAIN)

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14
Q

sulfa allergies sx

A

fever, pruritic rash, SJS, hemolytic anemia, thrombocytopenia, agranulocytosis, urticaria

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15
Q

sulfa drugs

A

celecoxib, probenicid, furosemide, thiazides, TMP/SMX, sulfonylureas, sulfasalazine, sumitriptan

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16
Q

give mesna with this drug to avoid hemorrhagic cystitis

A

cyclophosphamide

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17
Q

can cause coronary vasospasm

A

sumatriptan, cocaine

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18
Q

give this to treat vasospasms seen in migraines, prinzmetal angina, raynauds

A

calcium channel blockers

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19
Q

can cause cutaneous flushing

A

vancomycin, adenosine, niacin, ca channel blockers (flushing = VANC)

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20
Q

can cause pulmonary fibrosis

A

amiodarone, belomycine, bisulfran

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21
Q

can cause hepatic necrosis

A

halothane, valproic acid, acetaminophen, and exposure to amanito phalloides (mushroom)

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22
Q

can cause dilated cardiomyopathy

A

doxorubicin, danorubicin

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23
Q

can cause agranulocytosis

A

clozapine, carbamazepine, colchicine, propylthiouracil, methimazole

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24
Q

can cause gynecomastia

A

spironolactone, digitalis, cimetidine, estrogens, ketoconazole

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25
Q

can cause interstitial nephritis

A

methicillin, NSAIDs, furosemide

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26
Q

what can doxorubicin cause?

A

dilated cardiomyopathy

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27
Q

what can amiodarone cause?

A

pulmonary fibrosis

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28
Q

Equation for half-life of drug

A

Half life = (Vd x 0.7) / clearance

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29
Q

Equation for loading dose of drug

A

Loading dose = (target plasma concentration x Vd) / bioavailability

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30
Q

Equation for clearance of drug

A

clearance of drug = rate of elimination of drug / plasma drug concentration

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31
Q

Equation of Vd of drug

A

Vd = amount of drug in body / plasma drug concentration

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32
Q

DM drug that can cause hypoglycemia and weight gain

A

sulfonylureas + meglitinides

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33
Q

Child who took parents Metformin drugs is at risk of what?

A

lactic acidosis

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34
Q

stimulates PPARy which leads to decreased insulin resistance

A

glitazones

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35
Q

glitazones can cause what SE?

A

fluid retention, heart failure, weight gain

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36
Q

pancreatitis is a side effect of which DM drug?

A

GLP1 agonists - exanetide, liraglutide

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37
Q

GLP1 “tide” MOA?

A

increase insulin secretion, decrease glucagon secretion, delays gastric emptying

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38
Q

MOA of “gliptins” DPPA inhibitors?

A

prevents breakdown of GLP1 increasing GLP1 and GIP levels

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39
Q

diarrhea and flatulence are SE of which DM drugs?

A

a-glucosidase inhibitors (acarose and miglitol) which reduce intestinal disaccharide absorption

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40
Q

UTI and hypotension are SE of which DM drugs?

A

SGLT2 inhibitors “flozin’s”; increase renal glucose excretion

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41
Q

Direct thrombin inhibitors

A

Bivalirudin, agaratroban, dabigitraban

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42
Q

What type of drug is dabigitraban?

A

direct thrombin inhibitor

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43
Q

Tx of DVT in a pregnant woman

A

LMWH - “parin’s”, ie Enoxaparin

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44
Q

inhibits gamma carboxylation of co-factor

A

Warfarin

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45
Q

Fondaparinux

A

a type of heparin

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46
Q

what are the three types of heparin?

A

LMWH (parin’s) + unfractionated + fondaparinux

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47
Q

reversal of unfractionated heparin

A

protamine sulfate

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48
Q

What drug causes IgG-PF4 formation with clots

A

Heparin = heparin induced thrombocytopenia

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49
Q

SE of heparin

A

HIT, hyperkalemia, osteoporosis, bleeding

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50
Q

risk of warfarin tx

A

if without a bridge, coagulation risk with skin/tissue necrosis

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51
Q

agaratroban

A

direct thrombin inhibitor

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52
Q

this drug activates plasminogen to break down fibrin clot

A

tPA

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53
Q

reverse tPA with this drug

A

aminocaproic acid + FFP

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54
Q

inhibits ADP receptor for platelet aggregation

A

prasugrel, ticlodipine, clopidogrel, ticagrelor

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55
Q

irreversible COX1 and COX2 inhibitor

A

ASA

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56
Q

antibody against Gp2b3a preventing interaction with fibrinogen for platelet cross-linking

A

abciximab, eptifibatide

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57
Q

MOA of abciximab?

A

antibody against Gp2b3a

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58
Q

blocks phosphodiesterase preventing cAMP breakdown in platelets

A

cilostaxol, dypyridamide

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59
Q

rx’s for drug-induced parkinsonism

A

D2 receptors blocks = anti-psychotics and antiemetics (prochlorperazine, metoclopromide)

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60
Q

tx of drug induced parkinsonism

A

X drug and treat with anti-cholinergi = tirhexyphenidyl, benzotropine

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61
Q

benzotropine

A

used to treat drug induced parkinsonism (muscle rigidity and hand shakingin someone recently treated with an anti-psychotic, like haloperido)

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62
Q

what to treat diffuse muscle rigidity, high fever, HTN, tachycardia, and altered sensorium?

A

thi sis NMS - give dantrole, direct-acting skeletal muscle relaxant

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63
Q

CYP 450 inducers

A

carbamazepine, barbiturates, phenytoin, rifampin, griseofluvin, st john’s wort, modafinil, cyclophasphamide

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64
Q

How does cyclophosphamide afftect CYP460?

A

induces

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65
Q

How does St. John Wort affect CYP450?

A

induces

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66
Q

Who do anti-epileptics affects CYP450?

A

induce

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67
Q

How does griseofulvin affect CYP450?

A

Induce

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68
Q

Which drugs inhibit CYP450?

A

Amiodarone, cimetidine, fluroquinolone, clarithromycin, azole antifunfals, grapefruit guice, isoniazide, ritonavir

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69
Q

How to anti-microbials (anti-biotics, fungals, HIV, and TB) affect CYP450?

A

inhibit

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70
Q

which anti-microbial induces CYP450

A

rifampin

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71
Q

how does cimetidine affect CYP 450?

A

inhibits

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72
Q

how does amiodarone affect CYP 450?

A

inhibits

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73
Q

rx mood stabilizers for bipolar disorder

A

lithium, valproate, carbamazepine, lamotrigine

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74
Q

SE of lithium

A

DI, hypothyroidism, tremor, ebstein anomaly

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75
Q

SE of valproate

A

hepatotozicity, NT defects

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76
Q

SE of carbamazepine

A

agranulocytosis, hyponatremia (SIADH), NT defects

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77
Q

SE of lamotriging

A

benign rash, SJS

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78
Q

which mood stabilizer can cause hepatotoxicity?

A

valproate

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79
Q

which mood stabilizer can cause agranulocytosis?

A

carbamazepine

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80
Q

patient has new sx of constipation, fatigue, and dry skin. which mood stabilizer can cause these symptoms?

A

lithium; hypothroudism

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81
Q

primary effects of B1 stimulation?

A

increase inotropy and chronotropy, and renin release of JG cells

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82
Q

two locations of B1 receptors

A

heart and JG of kidney

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83
Q

primary effects of B2 stimulation?

A

peripheral vasodilation, bronchodilation, glucago release by pancreatic a cells

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84
Q

which two receptors increase cAMP

A

B1 and B2

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85
Q

primary effects of a-1 stimulation?

A

peripheral vasoconstriciton, urethral constirciton, pupillary dilation

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86
Q

primary effects of a-2 stimulation

A

stop sympathetic response of CNS, decrease stointenstine motility and insulin release by pancreatic b cells

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87
Q

which receptors does NE act on?

A

a1, a2 and b1 agonists

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88
Q

muscarinic signs of cholinergic toxicity

A

DUMBELS: diarrphea/diaphoresis, urination, miosis, bronchospasm/bradycardia, emesis, lacrimation, salivation

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89
Q

nicotic signs of cholinergic toxicity

A

muscle weakness and parasthesias

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90
Q

this drug requires activation by virus-encoded thymidine kinase

A

acycloviry (a nucleoside analog)

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91
Q

treatment for c trachomatis

A

doxycycline + macrolide

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92
Q

short half-life benzos

A

triazolam, oxazepam, mdiazolam; high abuse potential

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93
Q

intermediate half-life benzos

A

alprazolam, lorazepam, temazepam

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94
Q

long half-life benzos

A

diazepam, chlordiazepoxide, flurazepam

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95
Q

what is the half-life like for lorazepam?

A

intermediate

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96
Q

half life of diazepam?

A

long

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97
Q

what’s the role of neprilysin inhibitor drugs?

A

prevents degradaition of natriuretic peptides, enhancing their role in vasodilation, natriuresis in patients with heart failure

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98
Q

why chloroquine + primaquine?

A

chloroquine = plasmodia in bloodstream, primaquine = eradicate the hypnozoites, responsible for latenet infection and relapses

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99
Q

How do the effects of dopamine depend on dose?

A

low dose = b1 adrenergic recpetors; high dose = stimulation of a-1

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100
Q

anti-IgE antidbody rx

A

Omalizumab

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101
Q

inhibit lipoxygenase and thus leukotriene fomration

A

zileuton

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102
Q

stabilizes histamine, preventing degranulation

A

cromoglycates - cromolyn and nedocromil

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103
Q

montelukast

A

leukotriene receptor antagonist

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104
Q

DM rx that is a SGLT2 inhibitor

A

canagliflozin

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105
Q

in what patients do you avoid SGLT2 inhibitors (flozins)?

A

patients with moderate to severe renal impairment, worse SE of symptomatic hypotension, UTI

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106
Q

what test to order to monitor patients on SGLT2 inhibitors?

A

serum BUN and creatinine

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107
Q

MOA of sulfonylurease (glyburide)?

A

increase insulin secretion rate of residual pancreatic islet B cells

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108
Q

does metformin increase insulin release by the pancreas?

A

no, like rosiglitazone, metformin does NOT have a drect effect on insulin secretion, rather they reduce the hepatic glucose production and increase insulin sensitivity

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109
Q

which antifungal inhibits squalene epoxidase?

A

terbinafine

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110
Q

this anti-fungal works by binding ergosterol leading to holes in membrane

A

amphotericin B and nystain

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111
Q

what is the MOA of caspofungin?

A

blocks b-D-glucan synthesis, a main compelent in fungal cell walls

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112
Q

this anti-fungal used for dermantophytosis prevents mitosis by binding tubulin

A

griseofulvin

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113
Q

moa of flucytosine?

A

inhibits fungal protein synthesis as antimetabolite that is transformed into 5 fluorouracinl

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114
Q

viral dependent nucleosides

A

acyclovir, valacyclovir, famciclovir, ganviclovir

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115
Q

anti-viral nucleotides that do not need phosphorylation by viral machinery

A

cidofovir, tenofovir

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116
Q

watchout for this SE with halothane and sucinylcholine

A

malignant hyperthermia - fever, muscle rigidity, tachycardia, HTN, hyperkalemia, myoglobinemia

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117
Q

tx of malignant hyperthermia

A

dantrolene - prevents further release of CA into cytoplasm

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118
Q

these two rx’s significantly reduce mortality in patients with systolic HG

A

ACEi and ARBs

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119
Q

does dobutamine cause an increase in myocardial oxygen consumption?

A

YES - as a B1 agonist, dobutamine increases both chronotropy and inotropy of heart thereby leading to an increase in O2 consumption by heart

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120
Q

give a clinical circumstance when dobutamine can be used?

A

cardiogenic shock

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121
Q

tx for hiker with foul-smelling stools, abdominal cramps, flatulence

A

hiker has giardia infection; metronidazole

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122
Q

major bugs metronidazole used for

A

trichomoniasis, amebiasis, H pylori, giardia

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123
Q

on sigmoidoscopy, patient is determined to have white/yellow plaques on colonic mucosa. what rx leads to this?

A

describing pseudomembranous colitis by clostridium dificle; brought on by intestinal flora disturbance with abx and exposure to hospital settings

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124
Q

examples of NSAIDS

A

indomethacin, naproxen

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125
Q

tx for patient with gout with NSAIDs are contra-indicated (PUD, renal impairment)

A

colchicine, inhibits neutrophil chemotaxis and phagocytosis by inhibiting microtubule formation

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126
Q

anti-depressant that causes sexual dysfuntion

A

SSRI, like citalopram and sertraline

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127
Q

this rx is a monoclonal antibody used in lymphoma tx and targets CD20 surface immunoglobulin

A

rituximab

128
Q

rituximab MOA

A

CD20 Ab

129
Q

potent inhibitor of BCR/ABL protein tyrosin kinase

A

imatinib

130
Q

used for tx of CML, which has the philadelphia chromosome

A

imatinib

131
Q

MOA of imatinib

A

blocks BCR-ABL tyorsine kinase

132
Q

MOA of rituximab

A

bmonoclonal Ab against CD20 on B cells

133
Q

MOA of infliximab

A

chimeric IgG1 monoclonal antibody to TNF-alpha

134
Q

this TNF-a inhibitor is used in treatment of RA and ankylosing spondylitis

A

inflixmaab

135
Q

what to do for hospitalized patient with history of drinking who develops agitation and tremor at 4 days?

A

tx alcohol withdrawal with chloriazepoxide

136
Q

this boronic acid containing proteasome inhibitor is used in treatment of multiple myeloma

A

bortezomib

137
Q

what should you check before prescribing amiodarone?

A

LFTs, PFTs, and tthyroid hormone - can cause chronic interstitial pneumonitis, elevated transaminases and hepatitis and hypo or hyperthyroidism

138
Q

what do hydroxyzine, chlorpheniramine, diphehydramine, and promethazine have in common?

A

all 1st generation antihistamine with loads of CNS side effects, especially in elderly

139
Q

what is chlorpheniramine?

A

1st generation anti-histmaine

140
Q

penicllins, sulfonamides, phenytoin, allopurinol, cephalosporins can all cause a skin drug reaction called _______

A

cutaneous small vessel vasculitis - violaceous, raised, nonblanchable lesions over bilateral lower extremities - palpable purpura

141
Q

drug used in gout tx that blocks microtubule assembly

A

colchicine

142
Q

side effects of colchicine

A

N/V/D

143
Q

this anti-biotic has risk of serotonin syndrome

A

linezolid

144
Q

patient has recently been described an rx for her mood and comes in with new symptoms of hyperreflexia and myoclonus. what’s the diagnosis?

A

serotonin syndrome

145
Q

a patient is unable to urinate due to a bladder obstruction. can bethanechol be used?

A

no, only used for urinary retentino due to atonia

146
Q

a 6 year old comes in with enlarged testes and pubic hair. what tx do you give to slow down this fast puberty development?

A

leuprolide continuously

147
Q

what is the efficacy and potency of buprenorophine like?

A

low efficacy + high potency so it displaces other opioids without stimulating the system as strongly

148
Q

can buprenophine precipitate withdrawel?

A

yes, because it pushes opioid out of receptros yet doesn’t work as strongly

149
Q

what do you give with isoniazide to avoid neuropathic SE?

A

vitamin B6, normally displaces by isoniazes, thus decreased neurotransmitter synthesis

150
Q

teratogenic side effects of phenytoin

A

NT, clefts, microcephaly, naildigit hypoplasia

151
Q

teratogenic side effects of lithium

A

ebstein anomaly, nephrogenic DI, hypothyroidism

152
Q

what mood stabilizer can cause hypothyroidism?

A

lithium

153
Q

which drugs can cause QT prolongation with risk of Torsades?

A

Class IA and III antiarrhytmics (except amiodarone), macrolides, fluroquinolones, methadone, haldol

154
Q

which anti-emetics are good for tx of chemo induced emesis?

A

DA-R (metoclopromide), 5HT3 (ondansetron) and NK1R (aprepitant) antagonists

155
Q

MOA of metoclopromide

A

DA-R antagonist

156
Q

MOA of aprepitant

A

NK1R antagonist

157
Q

MOA of ondansetron

A

5HT3 R antagonist

158
Q

why must you watchout for concurrent use of nitrates and phosphodiesterase inhibitors?

A

accumulation of cGMP with risk of sever hypotension

159
Q

this NSAID can be used to close persistent PDA

A

indomethacin

160
Q

used for tx of ganciclovir resistance CMV

A

foscarnet; pyrophosphate analog

161
Q

SE of foscarnet

A

hypomagnesia, hypocalcemia, seizures

162
Q

bacteria become resistant to vancomycin, quinolones, and tetracyclines by _______

A

increased efflux of abx

163
Q

woman has not had her period in months, has discharge from her nipples, and complains of vision changes which was determined to be bitemporal hemianopsia. how should you treat this woman?

A

patient has prolactinoma, most common type of pituitary adenoma. treat with bromocriptine (dopamine agonist that leads to suppression of prolactin)

164
Q

this anti-depressant has smoking cessation use

A

varenicline

165
Q

this tb drugs blocks mycolic acid synthesis and depends on enzyme cat g to be activated

A

isoniazid

166
Q

patient was recently put on TB tx and has since developed red/orange urine. what is the MOA of this rx?

A

rx is rifampin, X bacterial DNA dependent RNA polymerase

167
Q

MOA of amantadine as anti-viral

A

impairs uncoating of influenza A virion after host cell endocytosis

168
Q

rapid on/off meal-time insulins

A

lispro, aspart, flulisine

169
Q

what enzyme breaks down azathioprine to inactive metabolites?

A

xanthine oxidase

170
Q

concurrent use of allopurinol with azathioprine has what effect?

A

increases level of active metabolites of azathioprine

171
Q

these two families of abx X the 30 S ribosome

A

aminoglycosides + tetracyclines

172
Q

what labs should you run before starting a stain?

A

LFTs; is toxic to both liver and muscle

173
Q

which group of patients are most susceptible to side-effects of isoniazide?

A

slow-acetylators; increased side effect of nerve and liver toxicity

174
Q

naltrexone MOA

A

blocks mu opioid receptor so that there is NO reward of drinking, stops cravings

175
Q

this GABA-B receptor agonist is good tx for MS

A

baclofen

176
Q

what two drugs are mainstay for MS tx?

A

baclofen + tizanidine

177
Q

duloxetine MOA

A

serotonin + NE reuptake inhibitor

178
Q

this rx can cross the BBB and thus tx for peripheral and CNS effects of belladona toxicity

A

physostigmine

179
Q

this rx can be used for both trigeminal neuralgia and seizures and has side effect of bone marrow suppression

A

carbamazepine

180
Q

SE of amphotericin B

A

acute-infusion reaction, nephrotoxicity (decrease GFR), severe elctrolyte abnormalities, anemia, thrombophlebitis

181
Q

what migraine rx inhibits release of vasoactive peptides, promotes vasoconstriciton, and blocks brainstem pain pathways?

A

triptans! serotonin agonist

182
Q

this parkinson drug potentiates the effects of levadopa by preventing its breakdown both in the brain and periphery

A

tolcopone; COMT inhibitor that can cross the BBB

183
Q

decoy receptor of TNF

A

etanercepts

184
Q

two TNF blocking drugs?

A

etanercepts + infliximab

185
Q

selective COX 2 inhibitor

A

celecoxib

186
Q

3 rxs good for MRSA tx

A

daptomycin + vancomycin + linezolid

187
Q

drinking alcohol while taking this rx can result in a disulfiram like reaction

A

metronidazole

188
Q

milirinone MOA?

A

X PDE3 in smooth muscle and cardiac muscle; leads to positive inotropy and vasodilation

189
Q

this drug can cause color vision loss and has the fatal SE of cardiac arrhytmia

A

digoxin

190
Q

use this rx to treat leukotriene mediated allergies

A

zileuton

191
Q

chronic toxicity of lithium

A

DI + neurologic sx like ataxia, tremor, involuntary movements

192
Q

AKI + electrolyte disturbances + hyperuricemia + elevated glucose and cholesterol

A

thiazides

193
Q

what is MOA of ciprofloxacin

A

this is a fluorquinolone; blocks DNA gyrase

194
Q

MOA of bupivicaine

A

decreased permability to Na+ preventing depolarization

195
Q

anti-helminth rx’s

A

pyrantel pamoate + ivermectin + mebendazole + praziquantel + diethylcarbamizne

196
Q

ivermectin MOA

A

increase Cl permeability lead to hyperpolarization and death of helmnith

197
Q

MOA of mebendazole

A

microtubule inhibitor

198
Q

praziquantel MOA

A

increases permeability to calcium causing paralysis and death of hemointh

199
Q

how does alcohol increase toxicity of acetaminophen

A

stimulates conversion to toxic metabolite

200
Q

which part of renal tubule is most susceptible to damage by drugs like aminoglycosides?

A

proximal tubules

201
Q

name two cough suppressants

A

codeine + dextromorphan

202
Q

why does dextromorphan have less addiction risk than codeine as a a cough suppressant?

A

codeine synthetic analogue

203
Q

sx shared by use of hydralazine, procainamide, and isoniazide

A

myalgia + arthralgias + rash + lyphadenopathy in patient with no history of autoimmune diease; drug-induced lupus

204
Q

which rx’s could cause positive anti-nuclear anitbody and histone antibody in a patient?

A

hydralazine, isoniazides, procainamide

205
Q

filgrastim MOA

A

human GCSF used to treat low blood neutrophils, usually in setting of chemotherapy

206
Q

a patient with ringing in ears + fast breathing rate + respiratory and metabolic acidosis likely OD with what rx?

A

ASA

207
Q

patient who is rigid + catatonic + hostile on illicit drug?

A

PCP

208
Q

suicide attempt with delayed onset of jaundice + RUQ pain

A

acetaminophen

209
Q

pimecrolium + tacrolimus MOA

A

inhibit cytokine release by T cells

210
Q

b-blocker SE

A

bronchospasm + bradycardia + fatigue + sexual dysfunction

211
Q

a patient OD in amitryptaline is most likely to die from what?

A

cardiac arrhythmias; in addition to inhibition of NE and serotonin reuptake, TCA also inhibit fast Na channel

212
Q

why does it take days-weeks for glitazones to take effect?

A

PPAR-y is a nuclear receptor so transcription is effect

213
Q

this anti-IgE drug can be used in those with tx resistant asthma

A

omalizumab

214
Q

omalizumab MOA

A

anti-igE antibodies

215
Q

trastuzumab MOA

A

monoclonal Ab against HER2/neu for tx of breast cancer

216
Q

dilated pupils + yawning + lacrimation + piloerection + hyperactive bowels

A

opioid withdrawel

217
Q

sever depression crash + hypersomnia + increased appetite

A

stimulant withdrawal - cocaine or amphetamine

218
Q

this drug lowers oxygen demant of heart through veno-dilation and resultant decrease in preload

A

nitrates

219
Q

isoproterenol MOA

A

B1 and B2 agonist = increase heart contracitility and promotes vasodialtion thereby decreasng SVR

220
Q

prevention of recurrent coronary artery events and ischemic stroke

A

ASA

221
Q

prevent DVT/PE in high-risk patients

A

low dose heparine

222
Q

what effect do volatile anesthetics have on ICP

A

will increase it because increases blood flow

223
Q

what do anastrozole, letrozole, and exemestane have in common?

A

aromatase inhibitors used in tx of estrogen positive tumors

224
Q

what drugs block conversino of testosterone to estradiol?

A

aromatase inhibitors = anastrozole, letrozole, and exemestane

225
Q

MOA of bortezomib?

A

X 26 S proteasome, preventing degradation of pro-apoptotic proteins; tpromotes apooptosis of cancer cells in multiple myeloma

226
Q

what biosynthetic pathway does mycophenylate target?

A

de novo purine synthesis

227
Q

patient develops gingival hyperplasia after starting a new rx. what was it?

A

phenytoin

228
Q

how do opiates affect calcium and potassium?

A

X calcium influx (decreased release of neurotransmitters) + X potassium (hyperpolarization)

229
Q

preventative tx of calcium stones

A

thiazides - less calcium in pee tube

230
Q

what does desmopressin do?

A

increase release of vwF, used for treatment of Hemophila A and vwD

231
Q

what 3 things can synthetic prostacyclin be used as tx for?

A

pulmonary HTN, peripheral vascular disease + raynaud syndrome

232
Q

MOA of vincristine + vinblastine?

A

microtubule inhibitors

233
Q

this a-2 agonists can be used as tx for PTSD nightmares

A

prazosin

234
Q

what drug to avoid in pheochromocytoma?

A

b-blcoker, because would result in unopposed alpha stimulation with risk of HTN crisis

235
Q

this irreversible blocker of a-1 and 2 results in a decrease in vmax

A

phenoxybenzamine

236
Q

h pylori tx

A

amoxicillin + clarithromycin + PPI

237
Q

aminoglycoside MOA?

A

leads to mRNA misreading through interaction with 30s

238
Q

how do you prevent acyclovir nephrotoxicity?

A

adequate hydration

239
Q

chronic therapy for tx of persistent asthma

A

inhaled corticosteroids

240
Q

this tx can reduce the number and severity of acute asthma exacerbations

A

inhaled corticosteroids

241
Q

the syndrome caused by second generation anti-psychotics like clozapine and olanzapine

A

metabolic syndrome, be sure to watch monitor weight and glucose and lipid panel

242
Q

what is most associated with use of first and second generation anti-psychotic use, respectively?

A

EPS in 1st, metabolic syndrome in 2nd

243
Q

can beta-blockers mask sx of hypoglycemia?

A

yes

244
Q

first line for lowering triglycerides

A

fibrates

245
Q

drugs with negative chronotropy

A

b blockets, cerapamil, diltiazem, cardiac glycosides (digoxin)

246
Q

NRTI SE

A

lactic acidosis + lipodystrophy

247
Q

protease inhibitor SE

A

metabolic compliecations (lipodystrophy, dyslipidemia, insulin resistance)

248
Q

NRTI with SE of bone marrow toxicity and anemia

A

zidovudine

249
Q

tx of restless leg syndrome

A

pramipexole , dopamine agonist

250
Q

this group of drugs can cause SM contraction of sphincter of Oddi leading to spasm and biliary colic

A

opioid anelgeics

251
Q

what do trimethoprim, methotrexate, and pyrimethamine have in common?

A

X DHFR in bacteria, humans, and parasites, respectively

252
Q

patient regularly takes a statin and develops muscle aches upon tx of bacterial infection with erythromycin. why?

A

erythromycin inhibits cytochrome p450 leading to rise of statin and thus worsening of side effects

253
Q

someone has sx of adrenal crisis (hypotension, abdominal pain, weakness, fever), what should you treat them with?

A

hydrocortizone or dexamethasone

254
Q

which depolarizing muscle blocker has two phases of response?

A

succinylcholine

255
Q

chemodrug that can lead to hemorrhagic cystitis + bladder CA

A

cyclophosphamide

256
Q

give mesna with this drug to prevent hemorrhagic cystitis

A

cyclophosphamide

257
Q

patient recently prescribed linezolid and develops hyperreflexia, tachycardia, and AMS. how should you treat them?

A

signs of serotonin syndrome, give cyproheptadine

258
Q

what is cyproheptadine used for?

A

tx of serotonin syndroe

259
Q

patient recently had a surgery in mexico and presents with abdominal pain. she is determine to have centrilobar hepatic necrosis and elevated LFTs. what is the responsible drug?

A

halogenated inhaled anesthetics - halothane, enflurance, isoflurance

260
Q

two drugs used for prevention of cardiovascular events

A

clopidorel (X ADP activation of platelet aggregation) + ASA (irreversible COX1 and COX2 inhibitor)

261
Q

what type of drugs are enoxaparin + dalteparin

A

LMWH

262
Q

eptifibatide moa?

A

2b/3a inhibtiro

263
Q

patient recently had mitral valve replacement and now presents with malaise and dyspnea. what rx will likely be used for tx?

A

vancomycin as this ithe new valve is likely infected with staph epidermidis which is commonly resistant to many drugs

264
Q

what rx is used in respiratory stress tests?

A

methacholine

265
Q

ranitidine MOA

A

H2R antagonist that inhibits gastric acid secretion

266
Q

this anti-histamine can be used to calm gastric secretions

A

ranitidine

267
Q

how does celecoxib have no effect of gastric tissues?

A

COX2 specific and this enzyme is unrepgrulated in inflamed tissues due to IL1 and TNFa

268
Q

patients with HLAb*57:01 mutation will develop a hypersensitivity reaction with a delayed rash after taking what rx?

A

abacavir, one of the NRTI nucleosides

269
Q

these drugs used in tx of hyperthryoidism can cause agranulocytosis

A

thionamides = methimazole, propylthiouracil

270
Q

a patient who is treated for hyperthyroidism presents with fever, sore throat and oral ulcerations. what should the doc be concerned about?

A

agranulocytosis SE of methimaxole and propylthioruacil; order WBC cound with differnetial

271
Q

what is the MOA of thionamides methimaxole and propylthiouracil?

A

X thyroid peroxidase

272
Q

tx of DVT in pregnant women

A

LMWH like enoxaparin

273
Q

why are heparins safe for the fetus while warfarin is not?

A

heparins do not cross the placenta

274
Q

SE of prolonged glucocorticoid therapy?

A

Cushing syndrome! altered fat distribution, atrophy of adrenal cortex, osteoporosis of bone, atrophy of skeletal muscle, thinning striae and imparied wound healing of skin

275
Q

theophyline SE

A

N/VD + diarrhea + cardiac arrhythmias + seizures

276
Q

new anxiety/agitation in a hospitalized patient with a notable history of drinking

A

alcohol withdrawal, tx with chlordiazepoxide

277
Q

methylprednisone MOA

A

binds to cytoplasmic recptor then translocates to the nucles where it activates transcription of target genes

278
Q

an organism is resistant to ampicillin but sensitive to ceftriaxone - what is the most likely mechanism of resistance?

A

b-lactamase production; both antibiotics functino by binding penicilling-binding proteins and so alteration of these would confer resistance to both

279
Q

do you get a metabolic alkalosis or acidosis with thiazides and loop diuretics?

A

metabolic alkalosis = increased Na hitting collecting duct stimulates excretion of K+ and H+

280
Q

tx of the normally self limited salmonella enterica infection with abx is likely to do what?

A

prolong the fecal excretion of the organism

281
Q

what do PPI, glucocorticoids + aromatase inhibitors have in common?

A

all can predispose to osteoporosis

282
Q

what 3 groups of drugs can be used for tx of BPH?

A

a-adrenergic antagonists (terazosin, tamsulosin) + 5-a-reductase inhibitors (finasteride and dutasteride) + antimuscarinics (tolterodine)

283
Q

MOA of terazosin?

A

relax smooth muscle in bladder neck and prostatic urethra

284
Q

SE of terazosin?

A

orthostatic hypotension and dizziness

285
Q

How long does it take to see benefit of finasteride?

A

6-12 months; blocks conversion of testosterone resulting in decreased prostate gland size

286
Q

SE of finasteride?

A

decreased libido and erectile dysfunction

287
Q

risedronate is what type of drug?

A

bisphosphonate; inhibits osteoclast activity + induce osteoclast apoptosis + decrease development of osteoclast precursor cells

288
Q

useful for the simultaneous tx of BPH and HTN

A

prazosin - a-1 blockers

289
Q

how to prevent first dose hypotension when starting an ACE inhibitor?

A

start at low dose and titrate up as needed

290
Q

patient has diffuse muscle rigitiy, HTN, tachycardia, and altered state of mind. family members believe the patient OD on his risperidone medication. how shall you treat this patient?

A

patient has NMS due to too much dopamine bloackagge of brain. give dantrole to stop sx - it blocks calcium ion release from SR

291
Q

amphotericin effects of the kidney and electrolytes?

A

lahuge renal toxcitiy + decrease GFR, + ATN + RTA + hypomagneis and hypokalemia t

292
Q

this anti-viral inhibits both RT in HIV and DNA polymerase in herpes virus

A

foscarnet; does not require intraceullular activation

293
Q

which drugs interact with lithium and can precipitate toxicity?

A

thiazides, NSAIDs, ACE inhibitor, tetracyclines, metronidazole

294
Q

two dopamine agonists used in tx of parkinsons

A

bromocriptine + pramipexole

295
Q

tx for iron overdoser

A

deferoxamine

296
Q

tx for lead poisoning

A

edetate calcium disodium

297
Q

tx for wilson disease (copper overload)

A

D-penicillamine

298
Q

two rx used in tx of conditions of hyperammonemia

A

rifaximin + lactulose

299
Q

rifaximin MOA

A

knocks out flora to decrease production of intraluminal ammonia products

300
Q

lactulose MOA

A

lowers colonic pH to increase conversion of ammonia to ammonium which is excreted from the body

301
Q

patient has OD’d on unknown drug but presents with flushing, nonreactive mydriasis, delirium + urinary retention. what is the likely rx?

A

amitryptaline - has strong anti-cholinergic properties

302
Q

phenytoin + carbamazepine moa

A

blocks Na+ channels

303
Q

valproic acid moa

A

blocks Na+ channels & + GABA levels

304
Q

benzodiazepine + phenobarbital moa

A

increase GABA action; increased chloride current through the ion channel hyperpolarizing the cell

305
Q

levetiracetam moa

A

modulates GABA and glutamate release

306
Q

ethosuximide moa

A

blocks thalamic T type calcium channels

307
Q

reduce risk of gynecomastia in men with high estrogen to androgen ratio

A

tamoxifen

308
Q

life threatening arrhythmias + color vision changes

A

digoxin toxicity, can be increased with impaired renal clearance

309
Q

this rx used for bipolar tx is teratogenic and can results in ebstein’s anomaly (atrialization of R ventrical)

A

lithium

310
Q

increase peripheral vascular resistance + increases systolic blood pressure + decrease heart rate

A

phenylephrine - selectively a-1 receptor agonist= increases vascular resistance which triggers increase of vagal tone with decrease in HR

311
Q

phenylephrine moa

A

a-1 agonist with SVR increase, + BP and decrease HR due to increased vagal tone

312
Q

dobutamine moa

A

beta-adrenergic receptor agonism = increase HR with little effect of vascular resistance

313
Q

is there an effect on vascular resistance with dobutamine?

A

no, just increases HR

314
Q

of the class I anti-arrhytmics, 1___ has strongest binding

A

flecainide, propafenone of 1C

315
Q

Class 1 ___ has the weakest binding (fastest dissociation) of all the Class 1 anti-arrhytmics

A

Class 1 B lidocaine and mexiletine

neuro (34 decks)

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