HY - pharm Flashcards
drug that inhibits alcohol dehydrogenase
fomepizole
drug that inhibits acetaldehyde dehydrogenase
disulfiram
alcohol dehydrogenase degrades ethanol into _____
acetaldehyde
_____ ______ degrades acetaldehyde into acetate
acetaldehyde dehydrogenase
Drug used to decrease triglyceride levels
Fibrates - activates PPARa and decreases VLDL synthesis
Two drugs that increase HDL
Niacin and Fibrates
Cholestyramine MOA
blocks bile reabsoprtion in terminal ileum forcing liver to breakdown cholesterol
Ezetimibe MOA
blocks gut reabsorption of cholesterol
Flushing, pruritis, hepaptoxicity, hyperuricemia caused by lipid lowering drug
Niacin
Lipid lowering drug that can cause nausea, bloating, cramping, and decreased abosrption of other drugs and fat soluble vitamins
cholestyramine
If added to statins, can worse hepatotoxic side effect
ezetimibe
nephro and ototoxic drugs
cisplatin, aminoglycosides, loop diuretics, vancomycin
drugs that can cause hemolytic anemia in G6PD patients
isoniazid, sulfonamides, primaquine, aspiring, ibuprofen, nitrofurantoin (hemolysis IS PAIN)
sulfa allergies sx
fever, pruritic rash, SJS, hemolytic anemia, thrombocytopenia, agranulocytosis, urticaria
sulfa drugs
celecoxib, probenicid, furosemide, thiazides, TMP/SMX, sulfonylureas, sulfasalazine, sumitriptan
give mesna with this drug to avoid hemorrhagic cystitis
cyclophosphamide
can cause coronary vasospasm
sumatriptan, cocaine
give this to treat vasospasms seen in migraines, prinzmetal angina, raynauds
calcium channel blockers
can cause cutaneous flushing
vancomycin, adenosine, niacin, ca channel blockers (flushing = VANC)
can cause pulmonary fibrosis
amiodarone, belomycine, bisulfran
can cause hepatic necrosis
halothane, valproic acid, acetaminophen, and exposure to amanito phalloides (mushroom)
can cause dilated cardiomyopathy
doxorubicin, danorubicin
can cause agranulocytosis
clozapine, carbamazepine, colchicine, propylthiouracil, methimazole
can cause gynecomastia
spironolactone, digitalis, cimetidine, estrogens, ketoconazole
can cause interstitial nephritis
methicillin, NSAIDs, furosemide
what can doxorubicin cause?
dilated cardiomyopathy
what can amiodarone cause?
pulmonary fibrosis
Equation for half-life of drug
Half life = (Vd x 0.7) / clearance
Equation for loading dose of drug
Loading dose = (target plasma concentration x Vd) / bioavailability
Equation for clearance of drug
clearance of drug = rate of elimination of drug / plasma drug concentration
Equation of Vd of drug
Vd = amount of drug in body / plasma drug concentration
DM drug that can cause hypoglycemia and weight gain
sulfonylureas + meglitinides
Child who took parents Metformin drugs is at risk of what?
lactic acidosis
stimulates PPARy which leads to decreased insulin resistance
glitazones
glitazones can cause what SE?
fluid retention, heart failure, weight gain
pancreatitis is a side effect of which DM drug?
GLP1 agonists - exanetide, liraglutide
GLP1 “tide” MOA?
increase insulin secretion, decrease glucagon secretion, delays gastric emptying
MOA of “gliptins” DPPA inhibitors?
prevents breakdown of GLP1 increasing GLP1 and GIP levels
diarrhea and flatulence are SE of which DM drugs?
a-glucosidase inhibitors (acarose and miglitol) which reduce intestinal disaccharide absorption
UTI and hypotension are SE of which DM drugs?
SGLT2 inhibitors “flozin’s”; increase renal glucose excretion
Direct thrombin inhibitors
Bivalirudin, agaratroban, dabigitraban
What type of drug is dabigitraban?
direct thrombin inhibitor
Tx of DVT in a pregnant woman
LMWH - “parin’s”, ie Enoxaparin
inhibits gamma carboxylation of co-factor
Warfarin
Fondaparinux
a type of heparin
what are the three types of heparin?
LMWH (parin’s) + unfractionated + fondaparinux
reversal of unfractionated heparin
protamine sulfate
What drug causes IgG-PF4 formation with clots
Heparin = heparin induced thrombocytopenia
SE of heparin
HIT, hyperkalemia, osteoporosis, bleeding
risk of warfarin tx
if without a bridge, coagulation risk with skin/tissue necrosis
agaratroban
direct thrombin inhibitor
this drug activates plasminogen to break down fibrin clot
tPA
reverse tPA with this drug
aminocaproic acid + FFP
inhibits ADP receptor for platelet aggregation
prasugrel, ticlodipine, clopidogrel, ticagrelor
irreversible COX1 and COX2 inhibitor
ASA
antibody against Gp2b3a preventing interaction with fibrinogen for platelet cross-linking
abciximab, eptifibatide
MOA of abciximab?
antibody against Gp2b3a
blocks phosphodiesterase preventing cAMP breakdown in platelets
cilostaxol, dypyridamide
rx’s for drug-induced parkinsonism
D2 receptors blocks = anti-psychotics and antiemetics (prochlorperazine, metoclopromide)
tx of drug induced parkinsonism
X drug and treat with anti-cholinergi = tirhexyphenidyl, benzotropine
benzotropine
used to treat drug induced parkinsonism (muscle rigidity and hand shakingin someone recently treated with an anti-psychotic, like haloperido)
what to treat diffuse muscle rigidity, high fever, HTN, tachycardia, and altered sensorium?
thi sis NMS - give dantrole, direct-acting skeletal muscle relaxant
CYP 450 inducers
carbamazepine, barbiturates, phenytoin, rifampin, griseofluvin, st john’s wort, modafinil, cyclophasphamide
How does cyclophosphamide afftect CYP460?
induces
How does St. John Wort affect CYP450?
induces
Who do anti-epileptics affects CYP450?
induce
How does griseofulvin affect CYP450?
Induce
Which drugs inhibit CYP450?
Amiodarone, cimetidine, fluroquinolone, clarithromycin, azole antifunfals, grapefruit guice, isoniazide, ritonavir
How to anti-microbials (anti-biotics, fungals, HIV, and TB) affect CYP450?
inhibit
which anti-microbial induces CYP450
rifampin
how does cimetidine affect CYP 450?
inhibits
how does amiodarone affect CYP 450?
inhibits
rx mood stabilizers for bipolar disorder
lithium, valproate, carbamazepine, lamotrigine
SE of lithium
DI, hypothyroidism, tremor, ebstein anomaly
SE of valproate
hepatotozicity, NT defects
SE of carbamazepine
agranulocytosis, hyponatremia (SIADH), NT defects
SE of lamotriging
benign rash, SJS
which mood stabilizer can cause hepatotoxicity?
valproate
which mood stabilizer can cause agranulocytosis?
carbamazepine
patient has new sx of constipation, fatigue, and dry skin. which mood stabilizer can cause these symptoms?
lithium; hypothroudism
primary effects of B1 stimulation?
increase inotropy and chronotropy, and renin release of JG cells
two locations of B1 receptors
heart and JG of kidney
primary effects of B2 stimulation?
peripheral vasodilation, bronchodilation, glucago release by pancreatic a cells
which two receptors increase cAMP
B1 and B2
primary effects of a-1 stimulation?
peripheral vasoconstriciton, urethral constirciton, pupillary dilation
primary effects of a-2 stimulation
stop sympathetic response of CNS, decrease stointenstine motility and insulin release by pancreatic b cells
which receptors does NE act on?
a1, a2 and b1 agonists
muscarinic signs of cholinergic toxicity
DUMBELS: diarrphea/diaphoresis, urination, miosis, bronchospasm/bradycardia, emesis, lacrimation, salivation
nicotic signs of cholinergic toxicity
muscle weakness and parasthesias
this drug requires activation by virus-encoded thymidine kinase
acycloviry (a nucleoside analog)
treatment for c trachomatis
doxycycline + macrolide
short half-life benzos
triazolam, oxazepam, mdiazolam; high abuse potential
intermediate half-life benzos
alprazolam, lorazepam, temazepam
long half-life benzos
diazepam, chlordiazepoxide, flurazepam
what is the half-life like for lorazepam?
intermediate
half life of diazepam?
long
what’s the role of neprilysin inhibitor drugs?
prevents degradaition of natriuretic peptides, enhancing their role in vasodilation, natriuresis in patients with heart failure
why chloroquine + primaquine?
chloroquine = plasmodia in bloodstream, primaquine = eradicate the hypnozoites, responsible for latenet infection and relapses
How do the effects of dopamine depend on dose?
low dose = b1 adrenergic recpetors; high dose = stimulation of a-1
anti-IgE antidbody rx
Omalizumab
inhibit lipoxygenase and thus leukotriene fomration
zileuton
stabilizes histamine, preventing degranulation
cromoglycates - cromolyn and nedocromil
montelukast
leukotriene receptor antagonist
DM rx that is a SGLT2 inhibitor
canagliflozin
in what patients do you avoid SGLT2 inhibitors (flozins)?
patients with moderate to severe renal impairment, worse SE of symptomatic hypotension, UTI
what test to order to monitor patients on SGLT2 inhibitors?
serum BUN and creatinine
MOA of sulfonylurease (glyburide)?
increase insulin secretion rate of residual pancreatic islet B cells
does metformin increase insulin release by the pancreas?
no, like rosiglitazone, metformin does NOT have a drect effect on insulin secretion, rather they reduce the hepatic glucose production and increase insulin sensitivity
which antifungal inhibits squalene epoxidase?
terbinafine
this anti-fungal works by binding ergosterol leading to holes in membrane
amphotericin B and nystain
what is the MOA of caspofungin?
blocks b-D-glucan synthesis, a main compelent in fungal cell walls
this anti-fungal used for dermantophytosis prevents mitosis by binding tubulin
griseofulvin
moa of flucytosine?
inhibits fungal protein synthesis as antimetabolite that is transformed into 5 fluorouracinl
viral dependent nucleosides
acyclovir, valacyclovir, famciclovir, ganviclovir
anti-viral nucleotides that do not need phosphorylation by viral machinery
cidofovir, tenofovir
watchout for this SE with halothane and sucinylcholine
malignant hyperthermia - fever, muscle rigidity, tachycardia, HTN, hyperkalemia, myoglobinemia
tx of malignant hyperthermia
dantrolene - prevents further release of CA into cytoplasm
these two rx’s significantly reduce mortality in patients with systolic HG
ACEi and ARBs
does dobutamine cause an increase in myocardial oxygen consumption?
YES - as a B1 agonist, dobutamine increases both chronotropy and inotropy of heart thereby leading to an increase in O2 consumption by heart
give a clinical circumstance when dobutamine can be used?
cardiogenic shock
tx for hiker with foul-smelling stools, abdominal cramps, flatulence
hiker has giardia infection; metronidazole
major bugs metronidazole used for
trichomoniasis, amebiasis, H pylori, giardia
on sigmoidoscopy, patient is determined to have white/yellow plaques on colonic mucosa. what rx leads to this?
describing pseudomembranous colitis by clostridium dificle; brought on by intestinal flora disturbance with abx and exposure to hospital settings
examples of NSAIDS
indomethacin, naproxen
tx for patient with gout with NSAIDs are contra-indicated (PUD, renal impairment)
colchicine, inhibits neutrophil chemotaxis and phagocytosis by inhibiting microtubule formation
anti-depressant that causes sexual dysfuntion
SSRI, like citalopram and sertraline
this rx is a monoclonal antibody used in lymphoma tx and targets CD20 surface immunoglobulin
rituximab
rituximab MOA
CD20 Ab
potent inhibitor of BCR/ABL protein tyrosin kinase
imatinib
used for tx of CML, which has the philadelphia chromosome
imatinib
MOA of imatinib
blocks BCR-ABL tyorsine kinase
MOA of rituximab
bmonoclonal Ab against CD20 on B cells
MOA of infliximab
chimeric IgG1 monoclonal antibody to TNF-alpha
this TNF-a inhibitor is used in treatment of RA and ankylosing spondylitis
inflixmaab
what to do for hospitalized patient with history of drinking who develops agitation and tremor at 4 days?
tx alcohol withdrawal with chloriazepoxide
this boronic acid containing proteasome inhibitor is used in treatment of multiple myeloma
bortezomib
what should you check before prescribing amiodarone?
LFTs, PFTs, and tthyroid hormone - can cause chronic interstitial pneumonitis, elevated transaminases and hepatitis and hypo or hyperthyroidism
what do hydroxyzine, chlorpheniramine, diphehydramine, and promethazine have in common?
all 1st generation antihistamine with loads of CNS side effects, especially in elderly
what is chlorpheniramine?
1st generation anti-histmaine
penicllins, sulfonamides, phenytoin, allopurinol, cephalosporins can all cause a skin drug reaction called _______
cutaneous small vessel vasculitis - violaceous, raised, nonblanchable lesions over bilateral lower extremities - palpable purpura
drug used in gout tx that blocks microtubule assembly
colchicine
side effects of colchicine
N/V/D
this anti-biotic has risk of serotonin syndrome
linezolid
patient has recently been described an rx for her mood and comes in with new symptoms of hyperreflexia and myoclonus. what’s the diagnosis?
serotonin syndrome
a patient is unable to urinate due to a bladder obstruction. can bethanechol be used?
no, only used for urinary retentino due to atonia
a 6 year old comes in with enlarged testes and pubic hair. what tx do you give to slow down this fast puberty development?
leuprolide continuously
what is the efficacy and potency of buprenorophine like?
low efficacy + high potency so it displaces other opioids without stimulating the system as strongly
can buprenophine precipitate withdrawel?
yes, because it pushes opioid out of receptros yet doesn’t work as strongly
what do you give with isoniazide to avoid neuropathic SE?
vitamin B6, normally displaces by isoniazes, thus decreased neurotransmitter synthesis
teratogenic side effects of phenytoin
NT, clefts, microcephaly, naildigit hypoplasia
teratogenic side effects of lithium
ebstein anomaly, nephrogenic DI, hypothyroidism
what mood stabilizer can cause hypothyroidism?
lithium
which drugs can cause QT prolongation with risk of Torsades?
Class IA and III antiarrhytmics (except amiodarone), macrolides, fluroquinolones, methadone, haldol
which anti-emetics are good for tx of chemo induced emesis?
DA-R (metoclopromide), 5HT3 (ondansetron) and NK1R (aprepitant) antagonists
MOA of metoclopromide
DA-R antagonist
MOA of aprepitant
NK1R antagonist
MOA of ondansetron
5HT3 R antagonist
why must you watchout for concurrent use of nitrates and phosphodiesterase inhibitors?
accumulation of cGMP with risk of sever hypotension
this NSAID can be used to close persistent PDA
indomethacin
used for tx of ganciclovir resistance CMV
foscarnet; pyrophosphate analog
SE of foscarnet
hypomagnesia, hypocalcemia, seizures
bacteria become resistant to vancomycin, quinolones, and tetracyclines by _______
increased efflux of abx
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?
patient has prolactinoma, most common type of pituitary adenoma. treat with bromocriptine (dopamine agonist that leads to suppression of prolactin)
this anti-depressant has smoking cessation use
varenicline
this tb drugs blocks mycolic acid synthesis and depends on enzyme cat g to be activated
isoniazid
patient was recently put on TB tx and has since developed red/orange urine. what is the MOA of this rx?
rx is rifampin, X bacterial DNA dependent RNA polymerase
MOA of amantadine as anti-viral
impairs uncoating of influenza A virion after host cell endocytosis
rapid on/off meal-time insulins
lispro, aspart, flulisine
what enzyme breaks down azathioprine to inactive metabolites?
xanthine oxidase
concurrent use of allopurinol with azathioprine has what effect?
increases level of active metabolites of azathioprine
these two families of abx X the 30 S ribosome
aminoglycosides + tetracyclines
what labs should you run before starting a stain?
LFTs; is toxic to both liver and muscle
which group of patients are most susceptible to side-effects of isoniazide?
slow-acetylators; increased side effect of nerve and liver toxicity
naltrexone MOA
blocks mu opioid receptor so that there is NO reward of drinking, stops cravings
this GABA-B receptor agonist is good tx for MS
baclofen
what two drugs are mainstay for MS tx?
baclofen + tizanidine
duloxetine MOA
serotonin + NE reuptake inhibitor
this rx can cross the BBB and thus tx for peripheral and CNS effects of belladona toxicity
physostigmine
this rx can be used for both trigeminal neuralgia and seizures and has side effect of bone marrow suppression
carbamazepine
SE of amphotericin B
acute-infusion reaction, nephrotoxicity (decrease GFR), severe elctrolyte abnormalities, anemia, thrombophlebitis
what migraine rx inhibits release of vasoactive peptides, promotes vasoconstriciton, and blocks brainstem pain pathways?
triptans! serotonin agonist
this parkinson drug potentiates the effects of levadopa by preventing its breakdown both in the brain and periphery
tolcopone; COMT inhibitor that can cross the BBB
decoy receptor of TNF
etanercepts
two TNF blocking drugs?
etanercepts + infliximab
selective COX 2 inhibitor
celecoxib
3 rxs good for MRSA tx
daptomycin + vancomycin + linezolid
drinking alcohol while taking this rx can result in a disulfiram like reaction
metronidazole
milirinone MOA?
X PDE3 in smooth muscle and cardiac muscle; leads to positive inotropy and vasodilation
this drug can cause color vision loss and has the fatal SE of cardiac arrhytmia
digoxin
use this rx to treat leukotriene mediated allergies
zileuton
chronic toxicity of lithium
DI + neurologic sx like ataxia, tremor, involuntary movements
AKI + electrolyte disturbances + hyperuricemia + elevated glucose and cholesterol
thiazides
what is MOA of ciprofloxacin
this is a fluorquinolone; blocks DNA gyrase
MOA of bupivicaine
decreased permability to Na+ preventing depolarization
anti-helminth rx’s
pyrantel pamoate + ivermectin + mebendazole + praziquantel + diethylcarbamizne
ivermectin MOA
increase Cl permeability lead to hyperpolarization and death of helmnith
MOA of mebendazole
microtubule inhibitor
praziquantel MOA
increases permeability to calcium causing paralysis and death of hemointh
how does alcohol increase toxicity of acetaminophen
stimulates conversion to toxic metabolite
which part of renal tubule is most susceptible to damage by drugs like aminoglycosides?
proximal tubules
name two cough suppressants
codeine + dextromorphan
why does dextromorphan have less addiction risk than codeine as a a cough suppressant?
codeine synthetic analogue
sx shared by use of hydralazine, procainamide, and isoniazide
myalgia + arthralgias + rash + lyphadenopathy in patient with no history of autoimmune diease; drug-induced lupus
which rx’s could cause positive anti-nuclear anitbody and histone antibody in a patient?
hydralazine, isoniazides, procainamide
filgrastim MOA
human GCSF used to treat low blood neutrophils, usually in setting of chemotherapy
a patient with ringing in ears + fast breathing rate + respiratory and metabolic acidosis likely OD with what rx?
ASA
patient who is rigid + catatonic + hostile on illicit drug?
PCP
suicide attempt with delayed onset of jaundice + RUQ pain
acetaminophen
pimecrolium + tacrolimus MOA
inhibit cytokine release by T cells
b-blocker SE
bronchospasm + bradycardia + fatigue + sexual dysfunction
a patient OD in amitryptaline is most likely to die from what?
cardiac arrhythmias; in addition to inhibition of NE and serotonin reuptake, TCA also inhibit fast Na channel
why does it take days-weeks for glitazones to take effect?
PPAR-y is a nuclear receptor so transcription is effect
this anti-IgE drug can be used in those with tx resistant asthma
omalizumab
omalizumab MOA
anti-igE antibodies
trastuzumab MOA
monoclonal Ab against HER2/neu for tx of breast cancer
dilated pupils + yawning + lacrimation + piloerection + hyperactive bowels
opioid withdrawel
sever depression crash + hypersomnia + increased appetite
stimulant withdrawal - cocaine or amphetamine
this drug lowers oxygen demant of heart through veno-dilation and resultant decrease in preload
nitrates
isoproterenol MOA
B1 and B2 agonist = increase heart contracitility and promotes vasodialtion thereby decreasng SVR
prevention of recurrent coronary artery events and ischemic stroke
ASA
prevent DVT/PE in high-risk patients
low dose heparine
what effect do volatile anesthetics have on ICP
will increase it because increases blood flow
what do anastrozole, letrozole, and exemestane have in common?
aromatase inhibitors used in tx of estrogen positive tumors
what drugs block conversino of testosterone to estradiol?
aromatase inhibitors = anastrozole, letrozole, and exemestane
MOA of bortezomib?
X 26 S proteasome, preventing degradation of pro-apoptotic proteins; tpromotes apooptosis of cancer cells in multiple myeloma
what biosynthetic pathway does mycophenylate target?
de novo purine synthesis
patient develops gingival hyperplasia after starting a new rx. what was it?
phenytoin
how do opiates affect calcium and potassium?
X calcium influx (decreased release of neurotransmitters) + X potassium (hyperpolarization)
preventative tx of calcium stones
thiazides - less calcium in pee tube
what does desmopressin do?
increase release of vwF, used for treatment of Hemophila A and vwD
what 3 things can synthetic prostacyclin be used as tx for?
pulmonary HTN, peripheral vascular disease + raynaud syndrome
MOA of vincristine + vinblastine?
microtubule inhibitors
this a-2 agonists can be used as tx for PTSD nightmares
prazosin
what drug to avoid in pheochromocytoma?
b-blcoker, because would result in unopposed alpha stimulation with risk of HTN crisis
this irreversible blocker of a-1 and 2 results in a decrease in vmax
phenoxybenzamine
h pylori tx
amoxicillin + clarithromycin + PPI
aminoglycoside MOA?
leads to mRNA misreading through interaction with 30s
how do you prevent acyclovir nephrotoxicity?
adequate hydration
chronic therapy for tx of persistent asthma
inhaled corticosteroids
this tx can reduce the number and severity of acute asthma exacerbations
inhaled corticosteroids
the syndrome caused by second generation anti-psychotics like clozapine and olanzapine
metabolic syndrome, be sure to watch monitor weight and glucose and lipid panel
what is most associated with use of first and second generation anti-psychotic use, respectively?
EPS in 1st, metabolic syndrome in 2nd
can beta-blockers mask sx of hypoglycemia?
yes
first line for lowering triglycerides
fibrates
drugs with negative chronotropy
b blockets, cerapamil, diltiazem, cardiac glycosides (digoxin)
NRTI SE
lactic acidosis + lipodystrophy
protease inhibitor SE
metabolic compliecations (lipodystrophy, dyslipidemia, insulin resistance)
NRTI with SE of bone marrow toxicity and anemia
zidovudine
tx of restless leg syndrome
pramipexole , dopamine agonist
this group of drugs can cause SM contraction of sphincter of Oddi leading to spasm and biliary colic
opioid anelgeics
what do trimethoprim, methotrexate, and pyrimethamine have in common?
X DHFR in bacteria, humans, and parasites, respectively
patient regularly takes a statin and develops muscle aches upon tx of bacterial infection with erythromycin. why?
erythromycin inhibits cytochrome p450 leading to rise of statin and thus worsening of side effects
someone has sx of adrenal crisis (hypotension, abdominal pain, weakness, fever), what should you treat them with?
hydrocortizone or dexamethasone
which depolarizing muscle blocker has two phases of response?
succinylcholine
chemodrug that can lead to hemorrhagic cystitis + bladder CA
cyclophosphamide
give mesna with this drug to prevent hemorrhagic cystitis
cyclophosphamide
patient recently prescribed linezolid and develops hyperreflexia, tachycardia, and AMS. how should you treat them?
signs of serotonin syndrome, give cyproheptadine
what is cyproheptadine used for?
tx of serotonin syndroe
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?
halogenated inhaled anesthetics - halothane, enflurance, isoflurance
two drugs used for prevention of cardiovascular events
clopidorel (X ADP activation of platelet aggregation) + ASA (irreversible COX1 and COX2 inhibitor)
what type of drugs are enoxaparin + dalteparin
LMWH
eptifibatide moa?
2b/3a inhibtiro
patient recently had mitral valve replacement and now presents with malaise and dyspnea. what rx will likely be used for tx?
vancomycin as this ithe new valve is likely infected with staph epidermidis which is commonly resistant to many drugs
what rx is used in respiratory stress tests?
methacholine
ranitidine MOA
H2R antagonist that inhibits gastric acid secretion
this anti-histamine can be used to calm gastric secretions
ranitidine
how does celecoxib have no effect of gastric tissues?
COX2 specific and this enzyme is unrepgrulated in inflamed tissues due to IL1 and TNFa
patients with HLAb*57:01 mutation will develop a hypersensitivity reaction with a delayed rash after taking what rx?
abacavir, one of the NRTI nucleosides
these drugs used in tx of hyperthryoidism can cause agranulocytosis
thionamides = methimazole, propylthiouracil
a patient who is treated for hyperthyroidism presents with fever, sore throat and oral ulcerations. what should the doc be concerned about?
agranulocytosis SE of methimaxole and propylthioruacil; order WBC cound with differnetial
what is the MOA of thionamides methimaxole and propylthiouracil?
X thyroid peroxidase
tx of DVT in pregnant women
LMWH like enoxaparin
why are heparins safe for the fetus while warfarin is not?
heparins do not cross the placenta
SE of prolonged glucocorticoid therapy?
Cushing syndrome! altered fat distribution, atrophy of adrenal cortex, osteoporosis of bone, atrophy of skeletal muscle, thinning striae and imparied wound healing of skin
theophyline SE
N/VD + diarrhea + cardiac arrhythmias + seizures
new anxiety/agitation in a hospitalized patient with a notable history of drinking
alcohol withdrawal, tx with chlordiazepoxide
methylprednisone MOA
binds to cytoplasmic recptor then translocates to the nucles where it activates transcription of target genes
an organism is resistant to ampicillin but sensitive to ceftriaxone - what is the most likely mechanism of resistance?
b-lactamase production; both antibiotics functino by binding penicilling-binding proteins and so alteration of these would confer resistance to both
do you get a metabolic alkalosis or acidosis with thiazides and loop diuretics?
metabolic alkalosis = increased Na hitting collecting duct stimulates excretion of K+ and H+
tx of the normally self limited salmonella enterica infection with abx is likely to do what?
prolong the fecal excretion of the organism
what do PPI, glucocorticoids + aromatase inhibitors have in common?
all can predispose to osteoporosis
what 3 groups of drugs can be used for tx of BPH?
a-adrenergic antagonists (terazosin, tamsulosin) + 5-a-reductase inhibitors (finasteride and dutasteride) + antimuscarinics (tolterodine)
MOA of terazosin?
relax smooth muscle in bladder neck and prostatic urethra
SE of terazosin?
orthostatic hypotension and dizziness
How long does it take to see benefit of finasteride?
6-12 months; blocks conversion of testosterone resulting in decreased prostate gland size
SE of finasteride?
decreased libido and erectile dysfunction
risedronate is what type of drug?
bisphosphonate; inhibits osteoclast activity + induce osteoclast apoptosis + decrease development of osteoclast precursor cells
useful for the simultaneous tx of BPH and HTN
prazosin - a-1 blockers
how to prevent first dose hypotension when starting an ACE inhibitor?
start at low dose and titrate up as needed
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?
patient has NMS due to too much dopamine bloackagge of brain. give dantrole to stop sx - it blocks calcium ion release from SR
amphotericin effects of the kidney and electrolytes?
lahuge renal toxcitiy + decrease GFR, + ATN + RTA + hypomagneis and hypokalemia t
this anti-viral inhibits both RT in HIV and DNA polymerase in herpes virus
foscarnet; does not require intraceullular activation
which drugs interact with lithium and can precipitate toxicity?
thiazides, NSAIDs, ACE inhibitor, tetracyclines, metronidazole
two dopamine agonists used in tx of parkinsons
bromocriptine + pramipexole
tx for iron overdoser
deferoxamine
tx for lead poisoning
edetate calcium disodium
tx for wilson disease (copper overload)
D-penicillamine
two rx used in tx of conditions of hyperammonemia
rifaximin + lactulose
rifaximin MOA
knocks out flora to decrease production of intraluminal ammonia products
lactulose MOA
lowers colonic pH to increase conversion of ammonia to ammonium which is excreted from the body
patient has OD’d on unknown drug but presents with flushing, nonreactive mydriasis, delirium + urinary retention. what is the likely rx?
amitryptaline - has strong anti-cholinergic properties
phenytoin + carbamazepine moa
blocks Na+ channels
valproic acid moa
blocks Na+ channels & + GABA levels
benzodiazepine + phenobarbital moa
increase GABA action; increased chloride current through the ion channel hyperpolarizing the cell
levetiracetam moa
modulates GABA and glutamate release
ethosuximide moa
blocks thalamic T type calcium channels
reduce risk of gynecomastia in men with high estrogen to androgen ratio
tamoxifen
life threatening arrhythmias + color vision changes
digoxin toxicity, can be increased with impaired renal clearance
this rx used for bipolar tx is teratogenic and can results in ebstein’s anomaly (atrialization of R ventrical)
lithium
increase peripheral vascular resistance + increases systolic blood pressure + decrease heart rate
phenylephrine - selectively a-1 receptor agonist= increases vascular resistance which triggers increase of vagal tone with decrease in HR
phenylephrine moa
a-1 agonist with SVR increase, + BP and decrease HR due to increased vagal tone
dobutamine moa
beta-adrenergic receptor agonism = increase HR with little effect of vascular resistance
is there an effect on vascular resistance with dobutamine?
no, just increases HR
of the class I anti-arrhytmics, 1___ has strongest binding
flecainide, propafenone of 1C
Class 1 ___ has the weakest binding (fastest dissociation) of all the Class 1 anti-arrhytmics
Class 1 B lidocaine and mexiletine
