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Kaplan Pharm Flashcards

1
Q

ADR of bosentan?

A

heptotoxic and extremely teratogenic

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2
Q

What does grapefruit juice do to sildenafil, tadalafil, etc?

A

increase levels b/c grapefruit inhibits CYP450

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3
Q

epoprostenol, treprostinil, iloprost are what class of drug?

A

Prostacyclin analogs

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4
Q

ADR of PTU and methimzole:

A

neutropenia, by inhibiting bone marrow. purpuric skin lesions.

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5
Q

effect on CYP450:

Grapefruit Juice

A

INHIBITORS (–)

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6
Q

effect on CYP450:

Macrolides (except for azithromycin)

A

INHIBITORS (–)

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7
Q

what is the MOA of Cromolyn?

A

stabilizes mast cells

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8
Q

MOA of sulfonylureas:

A

release insulin via block of ATP-dep K+ ch. on pancreatic beta-islet cells and allow voltage-gated Ca2+ dependent depolarization of cells and release of stored insulin.

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9
Q

DOC for mild comedonal acne?

A

topical benxoyl-peroxide & a topical ABX like clindamycin.

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10
Q

what pulm drug has the ADRs of termors, seizures, arrhythmias and has a very low therapeutic index

A

Theophilline

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11
Q

what do you use riociguat to Tx?

A

chronic pulm hypertension in those who cannot under go surgery.

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12
Q

What is anagrelide and what is its MOA and when is it the answer?

A

reduces the number of circulating platelets.

  • acts at megakaryocyte to inhibit the maturation of platelets.
  • Tx of thrombocytosis secondary to myeloproliferative disorders; lowers platelet count in CML, PV, etc.
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13
Q

Pt. with abd. bloating, fullness, early satiety, n/v, is best treated with what?

A

pt. has diabetic gastroparesis. use erythromycin (increase release of motilin) and metoclopramide (increase force of gastric contractions)

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14
Q

What are the ADRs of Erythropoiesis-stimulating agents (ESA)?

A

increase risk of hypertension and thromboembolic events.

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15
Q

Penicillamine ADRs?

A

nephrotic syndrome and bone marrow suppressive.

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16
Q

what are the main benefits of inhaled steroids?

A

anti-inflammation, bronchodilation is secondary.

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17
Q

what are linaclotide and lubiprostone used for?

A

Tx. chronic constipation; also used in IBS when the main Sx is constipation.

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18
Q

what are approved uses of octreotide and pegvisomant? (4)

A
  1. variceal bleeding
  2. carcinoid syndrome for Tx of diarrhea and flushing.
  3. acromegaly
  4. VIPoma (S/Sx similar to carcinoid synd.)
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19
Q

for what Q is omalizumab the correct ans?

A

omalizumab for asthmatic pt. with extrinsic allergic triggers that is not controlled by inhaled steroids. (elevated IgE or positive skin test for a specific allergen); look for a pt. how is refactory to inhaled steroids, but should be kept of steroids.

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20
Q

When in varenicline the asnwer?

A

DOC for smoking cessation; nicotinic ACh receptor partial agonist that blocks nicotine binding

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21
Q

what drug is used to decrease the frequency of painful sickle cells crises, but does NOT terminate an acute crisis?

A

Hydroxyurea; also increases level of fetal hemoglobin, and increases amount of water in the red cells.

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22
Q

What is the long-acting version of octreotide?

A

Lanreotide

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23
Q

What is eculizumab and when is it the answer?

A

monoclonal Ab vs. C5. DOC for paroxysmal nocturnal hemoglobinuria. but the only cure for PNH is bone marrown transplantation

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24
Q

effect on CYP450:

Quinidine

A

INHIBITORS (–)

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25
Q

ADRs of Thiazolidinediones (pioflitazone & rosiglitazone)?

A

wt. gain. contraindicated in CHF d/t fluid retention.

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26
Q

What is Ustekinumab and what does it Tx?

A

antagonist of IL-12 and IL-23; used as mono-therapy for severe psoriasis

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27
Q

In what way are Dabigatran, Apiaban, and Rivaroxaban inferior to Warfarin?

A

A-Fib that is d/t to VALVULAR DEFECTS!!!

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28
Q

describe the pt. you would give epoprostenol, treprostinil, or iloprost to?

A

tx. severe pulm hypertension. pt with progressive shortness of breath that is worst on exertation, loud P2 heart sound, clear lungs, and pulm HTN on Echocardiography.

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29
Q

DOC for overactive bladder, aka “urge” incontinence?

A 
tolterodine
oxybutynin
trospium
darifenacin
solifenacin
fesoterodine

no meds has a benefit over the other all are [M]-receptor antagonists, so look for anticholinergic ADRs

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30
Q

What is metformin?

A

biguanide that decrease hepatic gluconeogenesis and increases peripheral sensitivity to insulin. req. FUNCTIONAL beta-islet cells to work. ADR: lactic acidosis. contraindicated in renal failure pt.

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31
Q

direct thrombin inhibitors MOA?

A

dev. from hirudin, the anti-coagulant in leech saliva that blocks coagulation by directly inhibit thrombin.

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32
Q

effect on CYP450:

Sulfonamides

A

INHIBITORS (–)

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33
Q

How do you Tx acute esophageal bleeding?

A

endoscopic band ligation, then/or transvenous (or transjugular) intrahepatic portosysmtemic shunt (TIPS)

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34
Q

What is used to Tx PBC?

A

ursodeoxycholic acid; poorly understood MOA, thought to decrease plasma and endogenous bile acid concentration; also decrease eosinophils activation and may decrease immune destruction of hepatocytes.

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35
Q

How do you Tx widespread psoriasis?

A

UV light photography. methotrexate is most effective, but also has the most severe ADRs (use etanercept, alefacept, and efalizumab as alternatives)

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36
Q

DOC for organophophate poisoning?

A

Atropine; will quickly dry out excessive mucous secretions and reverse the effects of anticholinesterase.

  • Pralidoxime is the definitive Tx.
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37
Q

DOC for moderate to severe acne?

A

topical benxoyl-peroxide + topical vitamin A (isotretinoin) which increases collagen in skin. oral minocycline can be used too.

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38
Q

what antidepressant can also help with smoking cession?

A

Bupropion; inhibits re-uptake of NE and Da and is a weak antag at N-ACh receptors; ADRs: insomnia, HTN, seizures, appetite suppresion.

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39
Q

effect on CYP450:

Amiodarone

A

INHIBITORS (–)

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40
Q

omalizumab ADRs?

A

very low risk of anaphaylaxis

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41
Q

what is the best pulm drug for a pt. with atopic, allergic disorder, like rhinitis?

A

Montelukast

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42
Q

DOC for acetaminophen OD?

A

N-acetylsysteine (NAC) and activated charcoal/ ***acetaminophen toxicity Sx may not appear for 48-72 hours, but liver damage can occur before then.

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43
Q

What is the best inital Tx for aspirin OD?

A

Bicarbonate; alkalinize the urine resulting in increase asa excretion.

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44
Q

what is the DOC for hepatic encephalopathy?

A

Lactulose; can also use neomycin or rifaximin. Lactulose is a non-absorbed disaccharide that bacteria consume to lower the pH of bowel (more acidic); this changes the NH3 to ammonium, NH4+ which can be excreted.

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45
Q

What drug can be used in acture variceal bleeding to decrease severity of hemorrhage?

A

octreotide (somatostatin analog); decrease portal pressure and splanchnic blood flow.

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46
Q

What is fludrocortisone used to Tx: (4)

A
  1. Addisons; adrenal insufficiency
  2. orthostatic hypotension
  3. septic shock
  4. type IV renal tubular acidosis
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47
Q

DOC for achalasia?

A

esophageal dilation; for those who refuse, use botox injections. Heller myotomy is an option, which involves surgical cutting of the LES.

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48
Q

omalizumab MOA?

A

binds free IgE and attached IgE antigen on B-cells. prevents IgE recognition and avoid type 1 HSR.

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49
Q

What are Dabigatran, Apiaban, and Rivaroxaban?

A

new oral anticoagulants, meant to sub for warfarin in most indications.

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50
Q

best initial drug Tx for Crohns?

A

Mesalamine derivatives [Asacol, Mesaamine, Sulfasalazine]; most effective way for deliver 5-aminosalicyclic acid (5-ASA).

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51
Q

What is Penicillamine?

A

penicillin-derived chealting agent; used for COPPER, MERCURY, ZINC, LEAD, ARSENIC metal toxicity. It also DECREASES T-cell activity and RA factor.

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52
Q

effect on CYP450:

St. John’s Wart

A

inducers (+)

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53
Q

List the direct thrombin inhibitors (4)

A
  • Argatroban
  • Lepirudin
  • Hirudin
  • Bivalirudin
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54
Q

What is the DOC for pt. with acromegaly what cannot undergo surgery?

A

octreotide (somatostatin analog)

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55
Q

What is the MOA of Dabigatran, Apiaban, and Rivaroxaban?

A

Dabigatran: oral DIRECT Thrombin inhibitor (DTI).

Apiaban, and Rivaroxaban: oral Xa inhibitor

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56
Q

interferon beta is used to Tx?

A

MS

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57
Q

What are eltrombopag and rombiplostim and when are they the answer?

A

both are agonist at the thrombopoietin receptor on bone marrow megakaryocytes. works to increase platelet count. expensive$$$, used to Tx chronic idiopathic thrombocytopenic pupura (ITP); may have use in aplastic anemia.

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58
Q

MOA of bosentan?

A

potent inhibitor of endothelin-1 ==> vasodilation.

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59
Q

DOC hepatorenal syndrome

A

midocrine (peripheral alpha agoinst that can be used for orthostatic hypotension). octreotide.
albumin infusion.

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60
Q

MOA of PTU and methimzole:

A

inhibits peroxidase enzyme, blocks oxidation of iodide to iodine, inhibits incorproration of iodotyrosines into mono-, di-, tri- and tetraiodothyronine (T4). PTU also block the peripheral conversion of T4 to T3.

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61
Q

Initial Tx of IBS?

A

dietary modifications, like increase fiber intake (bran, psyllium husk, methylcellulose)

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62
Q

ADRs of direct thrombin inhibitors?

A

bleeding…duh!

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63
Q

effect on CYP450:

Chronic Alcohol use

A

inducers (+)

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64
Q

How do you monitor the following drugs:

  • Argatroban
  • Lepirudin
  • Hirudin
  • Bivalirudin
A

aPTT; these all are direct thrombin inhibitors

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65
Q

DOC for severe cystic acne?

A

oral ABX and ORAL isotretinoin; ADRs: teratogenic and hyperlipidemia.

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66
Q

What is fludrocortisone?

A

steroid with potent mineralcorticoid activity and moderate glucocorticoid activity. used as replacement for Aldo during insufficiency.

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67
Q

What is the use of Calcitonin? (3)

A
  1. acute hypercalcemia
  2. paget disease
  3. osteoporosis
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68
Q

Interferon alpha can be used to Tx what? (4)

A
  1. chronic hep C. in combo with ribavirin & simepervir.
  2. chronic HepB
  3. melanoma
  4. cryoglobulinemia in combo with ribvirin
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69
Q

When is ecallantide the answer?

A

when pt. has asthma, hypotension, local edema and non-pruritic swelling of the face, larynx, respiratory tract. DOC for hereditary angioedema; recombinant plasma kallikrein inhibitor which limits the synthesis of bradykinin.

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70
Q

What anti-proliferative drug can be used to Tx Crohns?

A

Azathrioprine, prodrug, becomes 6-MP and blocks PURINE synthesis.

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71
Q

what is the best intial drug therpy for a pt. with COPD and also provides additional bronchodilation for pt with asthma?

A

iptstropium or tiotropium. inhaled anticholinergics; causes bronchodilation and decrease amount of mucous production.

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72
Q

Sickle cell pt. with a high fever, what do you do?

A

nigga in acute pain crisis from infection, give him ABX like ceftriaxone, levofloxacin. shit can kill dat nigga. ABX lowers mortality in acute pain crisis.

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73
Q

What are GI prokinetic drugs?

A

Bethanechol & metronidsazole are cholinomimetics, and promotes rapid stomach evacuation, used to Tx GERD.

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74
Q

MOA of desmopressin in bleeding disorders?

A

DDAVP is DOC of vWD. causeing the release of subendothelial stores of vWF, which activates/increase amount of Factor VII. ADRs: facial flushing and headache.

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75
Q

DOC for skin atrophy seen in psoriasis?

A

Calciptriene; vitamin D analong.

***can also use tazarotene, Vit.A analog.

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76
Q

MOA minocycline?

A

inhibits protein synthesis at 30s ribosomal subunit in bacteria. It has teh broadest spectrum of all the tetracyclines; can causes a bluish discoloration of skin and vertigo d/t vestibular dysfunction.

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77
Q

Thiazolidinediones (pioflitazone & rosiglitazone) increase peripheral insulin sensitivity on muscle, adipose, and liver cells how?

A

activating peroxisome proliferator-active receptors (PPARs)

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78
Q

Which promotility agents has the highest risk of torsade de pointes?

A

Cisapride; never the ans for a Tx of GERD question, unless it ask about what drug to NEVER use.

79
Q

class of drug that is the DOC for restless leg syndrome?

A

Dopamine agonist.

80
Q

eculizumab MOA?

A

removes complement C5 from circulation; PNH is a disease of complement overactivation.

81
Q

effect on CYP450:

Phenytoin

A

inducers (+)

82
Q

What are canagliflozin & dapagliflozin?

A

sodium/glucose transport inhibitors. uses to Tx DM2. blocks SGLT in the PCT (only in kidney) this is the single greatest energy-using step of the kidney is sodium reabsorption of Na+ on the basal (blood) side of the PCT cells. Insulin has NO effects on the SGLT mechanism!

83
Q

effect on CYP450:

Rifampin

A

inducers (+)

84
Q

Where are the serotonin releasing neurons located?

A

Raphe Nuclei

85
Q

When are Dabigatran, Apiaban, and Rivaroxaban indicated?

A

Tx of DVT and PE; as prophylaxis after hip or knee replacement.

-Better that warfarin b/c they do not need to be monitored, work immediately, and are used to prevent clots in A-Fib.

86
Q

what is used to tx osteoporosis and bone loss from prostate cancer treatment?

A

denosumab; monoclonal Ab inhibitinf RANKL, which is the primary signal that promotes bone removal.

87
Q

lubiprostone MOA:

A

chloride ch. activator that enhances secretion of chloride-rich intestinal fluids; it is a derivative of prostaglandin E.

88
Q

When it metformin the answer?

A

Initial Tx for DM2. esp for obese pt. who have peripheral insulin resistance.

89
Q

effect on CYP450:

Nevirapine

A

inducers (+)

90
Q

bicarbonate should be given if the QRS is prolonged above 100milliseconds in what drug OD?

A

TCAs

91
Q

effect on CYP450:

Citmetidine/Ciprofloxacin

A

INHIBITORS (–)

92
Q

What are the other uses of Hydroxyurea, aside from use in sickle cell?

A

lower cell counds in essential thrombocythemia and PV.

93
Q

Best initial Tx for hyperthyroidism?

A

PTU and methimzole. both drugs do NOT interfere with TSH, iodine availability, or target organ action by T3. They only DECREASE thyroid hormone synthesis.

94
Q

Fomepizole inhibits what?

A

alcohol dehydrogenase

95
Q

MoA of interferons?

A

multifocal; stimulate and potentiate immune response by initiating synthesis and release of cytokines. by upregulation/activation of MHC, cytotoxic T cells, macrophages, NK cells.

96
Q

effect on CYP450:

Ritonavir

A

INHIBITORS (–)

97
Q

What is the DOC for Wilsons?

A

Penicillamine; also used to treat RA, and Cystinuria.

98
Q

What are pioflitazone & rosiglitazone?

A

Thiazolidinediones; oral hypoglycemic agents. both activate adipokin & adiponectin, which increases AMP kinase and increase insulin sensitivity.

99
Q

what are “incretin” mimetics?

A

exenatide & liraglutide (glucagon-like peptide-1 agonist (GLP-1). increatine increase insulin synthesis and release by beta cells; and decrease glucagon prod.

100
Q

How do you Tx atopic dermatitis?

A

H1-blocking antihistamines (fexofenadine, cetirizine, loratadine).

101
Q

effect on CYP450:

Ketoconazole

A

INHIBITORS (–)

102
Q

Hydroxyurea ADRs?

A

myelosuppression and leukemia

103
Q

what seizure meds toxicity causes drowsiness, ataxia, and nystagmus.

A

Phenytoin. Mild toxicity = horizontal nystagmus; severe toxicity = vertical nystagmus.

104
Q

MOA and ADR of octreotide?

A

somaotostatin is a natural hypothalamic inhibitor of release of hormones like gastrin, insulin, glucagon, and GH.

ADR: biliary sludge, hypothyroidism, hyperglycemia, headache, and long QT.

105
Q

What are acarbose and miglitol? (oral hypoglycemic)

A

alpha glucosidase inhibitors, inhibits the degradation of complex sugars and starches to monosaccs; prevent absorption of glucose and prevents the wt. gaining effects of sulfonylureas.

106
Q

When are finasteride and dutasteride the most likely answer?

A

DOC for BPH. can DECREASE VOLUME of PROSTATE!!! both inhibit 5-a-reductase. finasteride is approved for tx of male pattern hair lost

107
Q

Tx multiple recurrent C. diff diarrhea with what?

A

Fidaxomicin; bactericidal–inhibits bacterial RNA polymerase.

108
Q

What is sofosbuvir?

A

DOC for HepC. inhibits RNA polymerase. often used in combo with RIBVIRIN.

109
Q

effect on CYP450:

INH

A

INHIBITORS (–)

110
Q

DOC for “lone A-Fib?

A

aspirin monotherapy; but when CHADS2 score is 2+ use warfarin.

111
Q

What is ribavirin and MOA and ADR?

A

Ribavirin: purine nucleoside that is used as an anti-viral; inhibits viral mRNA synthesis, fucks with GTP synthesis. It inhibits BOTH RNA and DNA viruses.
-ADR = anemia

112
Q

entecavir, lamivudine, telbivudine, adefovir, interferon are all used to Tx what?

A

HepB, pt. positive for HBeAg. Lactic acidosis is a common ADR.

113
Q

ADRs of sulfonylureas:

A

all sulfonylureas cuases hypoglycemis and wt. gain. they are Teratogenic and can cause SIADH; sulfa allergies

114
Q

what is the indication for use of Bosentan?

A

severe pulmonary hypertension; look for pt. with progressive shortness of breath and high pulmonary artery pressure on echo, or right heart catheterization.

115
Q

how do you Tx localized Z-E or gastrinoma ulcers?

A

surgical resection; for generalized, used PPIs

116
Q

What is parmlintide?

A

amylin-analog that suppresses glucagon release, delays gastric emptying and promotes wt. loss.

117
Q

MOA riociguat?

A

stimulates and increase the sensitivity of the guanylate cyclase receptor to NO, a pulm vasodilator; drug class: guanylate cyclase stimulator.

118
Q

What drug is the best therapy to lower calcium levels after fluids have been initiated?

A

bisphosphonates. also used in osteoporosis is the T-score is 2.5 std.dev below normal.

119
Q

Deferoxamine MOA?

A

binds free iron in plasma and its removed in urine. deferasirox & deferiprone are oral version of drug used in long term management of elevated iron levels.

120
Q

What drug can be used to prevent recurrent variceal bleeding?

A

propranolol,

121
Q

effect on CYP450:

Phenobarbital

A

inducers (+)

122
Q

TCA can be use to treat what GI issue?

A

IBS, used to Tx with neuropathic pain

123
Q

MOA of bisphosphonates?

A

inhibits osteoclast, preventing bone resorption. they bind to calcium hydroxyapatite in bone and prevent dissolution. MAJOR ADR: osteonecrosis of the jaw and esophagitis with oral admin.

124
Q

effect on CYP450:

Griseofulvin

A

inducers (+)

125
Q

glyburide, glipizide, gliclazide, glimepiride are what?

A

sulfonylureas

126
Q

When is ribavirin the answer?

A

chronic hepC in combo with interferon and a protease inhibitor.

Tx of RSV infection.

127
Q

How can antspasmodic medications, like dicyclomine or hyoscyamine be use in the GI?

A

used to Tx IBS

128
Q

If the pt. shows signs of sepsis from bloody diarrhea from food poisoning, what should you treat him with?

A

ABX; use FQ like ciprofloxacin, best coverage vs. invasive pathogens like Campy and Salmonella.

129
Q

What are sitagliptin and saxagliptin?

A

DPP-4 inhibitors. block degradation of incretin; can cause nasopharyngitis & URT infection.

130
Q

What do peripheral alpha blockers do in the Tx of BPH?

A

relax internal urinary sphincter, opening the bladder neck.

131
Q

What contains dopaminergic neurons?

A

substantia nigra

132
Q

ADR of canagliflozin & dapagliflozin?

A

increase UTI d/t excess sugar in the urine.

133
Q

linaclotide MOA:

A

peptide agonist of guanylate cyclase C, stimulated intestine fluid secretion and transit

134
Q

For which questions are direct thrombin inhibitors the correct answer?

A

for Pt. with clots who have developed heparin-induced thrombocytopenia; Pt. will have decreased platelet count, clots, positive tetst for plastelet factor IV.

135
Q

effect on CYP450:

Acute alcohol use

A

INHIBITORS (–)

136
Q

What diz will the use of FQ like Cipro, exacerbate?

A

myasthenia gravis, other ARDs: tendinopathy, tendon rupture.

137
Q

what are the actions of Prostacyclin analogs?

A

potent pulmonary artery vasodilation, inhibit platelet aggregation, inhibits proliferation of blood vessels via Gs activation, increasing cAMP.

138
Q

effect on CYP450:

Carbamazepine

A

inducers (+)

139
Q

What does diphenoxylate and loperamide do?

A

inhibits GI motility

140
Q

How is Methotrexate used?

A

Used to Tx RA. Answer Methotrexate when the Q asks: “which of the following is most likely to slow the progression of rheumatoid arthritis?”.

Also used for severe psorasis; leukemia, lymphoma, and some solid tumors.

141
Q

Methotrexate MOA?

A

type of anti-proliferative. blocks dihydrofolate reductase (DHRF); tetrahydrofolate is req. for dTMP synthesis via thymidylate synthase. Lack of thymine = DNA damage and failure of replication.

142
Q

ADRs of Methotrexate?

A
  • liver toxicity
  • pulm fibrosis
  • bone marrow suppression; myelosuppression
  • kidney damage d/t precip of methotrexate crystals
143
Q

What are DMARDs and when do you use them?

A

Disease Modifying Drugs. Use for RA if Pt. is intolerant or refractory to methotrexate, or if the disease is mild and you are trying to avoid the ADRs of Methotrexate.

144
Q

What is the MOA and ADR of the following DMARDs:

Hydroxycholoroquine

A

anti-inflammatory via multifocal mechanisms; rentinal damage and hemolysis.

145
Q

What is the MOA and ADR of the following DMARDs:

Sulfasalazine

A

inhibits folate synthesis; rash, hepatitis, agranulocytosis

146
Q

What is the MOA and ADR of the following DMARDs:

Anakinra

A

blocks IL-1 receptor; neutropenia

147
Q

What is the MOA and ADR of the following DMARDs:

Abatacept

A

blocks T-cell activiation by binding to APCs; infections

148
Q

What is the MOA and ADR of the following DMARDs:

Leflunomide

A

blocks de-novo synthesis of rUMP that is needed for DNA synthesis; rash, alopecia, myelosuppression, liver dysfunc.

149
Q

What is the MOA and ADR of the following DMARDs:

Rituximab

A

blocks CN20 on B-cells; infusion reactions, cardiac arrest, tumor lysis syndrome

150
Q

NSAIDs and COX-2 inhibitors are analgesics that can be used in what conditions? (7)`

A 
gout
psuedogout
RA
ankylosing spondylitis
CF
Fever
Still Disease
151
Q

Both NSAIDs and COX-2 inhibitors block prostaglanding synthesis, what are the ADRs?

A

peptic ulcers disease

  • renal insufficiency like intersititial nephritis and nephrotic syndrome.
  • **COX-2 has less adverse effects on gastric mucosa, but greater cardiac toxicity.
152
Q

what is Etanercept?

A

immunosuppressives that target and bind TNF-alpha. etanercept forms a complex that than binds to TNF-alpha.

153
Q

TNF-inhibitors (etanercept, infliximab, adalimumab, golimumab) tx what conditions? (4)

A
  • IBD, particularly Crohns with fistulas
  • RA
  • Psoriatic arthritis
  • Ankylosing spondylitis
154
Q

What are the ADRs of TNF-inhibitors (etanercept, infliximab, adalimumab, golimumab)?

A

reactive or worsen bacterial infections by inhibiting the immune system. TB reactivation is most common. Pt. can also develop lymphoma.

155
Q

What is allopurinol and febuxostat?

A

drugs that lower urate synthesis and decrease serum and urine uric acid levels.

  • both are xanthine oxidase inhibitors.
  • febuxostat is the answer then Pt. has kidney injury.
156
Q

When is allopurinol the answer?

A

when the Q describes a Pt. with recurrent gouty attaches, tophi, and uric acid stones and who has failed with probenecid or sulfinpyrazone.
allopurinol only works in between attacks, does nothing for acute gouty attacks b/c it is NOT anti-inflammatory

157
Q

ADRs of allopurinol?

A

highly allergenic; rash, eosinophila, interstitial nephritis

158
Q

What is DOC for acute gouty attacks when NSAIDs and steroids are contraindicated?

A

Colchicine; binds to cellular tubulin and blocks mitosis in metaphase, also anti-inflammatory, and inhibits leukocytes mobility and decreases WBCs ability to phagocytose w/on joint spaces.

Also used to PREVENT inflammatory recurrences during gouty attacks.

159
Q

ADRs of colchicine?

A

diarrhea, GI upset, neutropenia, aplastic anemia and hair loss.

160
Q

DOC for acute dystonic reactions d/t antipsychotic meds like fluphenazine (as well as an ADR of metoclopramide)?

A

benztropine and diphenhydramine.

161
Q

What is risperidone and how does it work?

A

2nd-gen (atypical) antipsychotic used to Tx chronic schizophrenia; antags 5-HT2a receptors and secondary actions of D2 receptor antage.

162
Q

ADRs of risperidone?

A

weakness (asthenia, sedation, difficulty concentrating, hypotension.

elevated prolactin levels, wt. gain. and TARDIVE DYSKINESIA.

163
Q

What is the MOA of Lithium?

A

alkaki metal taht has no effect on a normal pt. but can Tx mood disorders, precise MOA is unknown.

Used in bipolar disorder and acute mania.

PROPHYLACTIC vs. migraine and cluster headaches.

164
Q

What is the ADRs of Lithium?

A

tremor, ataxia, seizures.

  • Nephrogenic DI via inhibition of ADH receptors (Tx w/ hydrocholorothiazide or desmopressin)
  • Hypothyroidism; inhibits thyroglobulin iodination and coupling
  • Teratogenic (Ebstein anomaly)
165
Q

The precise mechanism of 2-gen, “atypical” anti-psychotics involves binding to which receptors?

A

preferential binding to serotonin receptors. also binds central alpha-2, peripheral alpha-1, and histamine receptors.

166
Q

Which one of 2-gen, “atypical” anti-psychotics suppresses bone marrow?

A

Clozapine; need to monitor blood count

167
Q

Which one of 2-gen, “atypical” anti-psychotics has the hish risk of tardive dyskinesia?

A

Risperidone

168
Q

Which one of 2-gen, “atypical” anti-psychotics can prolong the OT-interval?

A

ziprasidone

169
Q

What is the DOC for “dry” macular degeneration?

A

no proven effective Tx, but antioxidant vitamins like A, C, E and Zinc seem to help.

170
Q

What is the DOC for “wet” (proliferative/exudative) macular degeneration?

A

VEGF-inhibitors (ranibizumab, bevacizumab, pegaptanib, aflibercept)

***these drugs may actually restore vision!

171
Q

What is the goal in the therapy of acute closed-angle glaucoma?

A

increase drainage of aqueous humor (via trabecular meshwork) and DECREASE production of aqueous humor at the ciliary body

172
Q

What are the DOC for initial Tx of acute closed-angle glaucoma?

A

Timolol (beta-blocker); decrease prod. of Aq. humor.

Pilocarpine (cholinergic AGONIST); constricts pupil, which moves iris towars the center and unblocks drainage meshwork over the Canal of Schlemm, increasing drainage.

173
Q

What is the MOA of CA-inhibitors in the Tx of acute closed-angle glaucoma?

A

acetazolamide, dorzolamide; decrease production of Aq. humor

174
Q

What is the MOA of prostaglandin analogs in the Tx of acute closed-angle glaucoma?

A

lantanoprost, travoprost; increase secondary uveoscleral drainage.

175
Q

What is the MOA of alpha-2-adrenergic agonist in the Tx of acute closed-angle glaucoma?

A

apraclonidine, brimonidine; decrease production of aq. humor and increase secondary uveoscleral drainage.

176
Q

What drugs can exacerbate acute glaucoma?

A

Atropine and other anti-[M] that produce mydriasis (dilation of pupil) which blocks the outflow of Aq. humor.

think drugs like: alpha-1-agonist, amphetamines, anti-depressants like MAOi, SSRIs, TCAs, cocaine

177
Q

Oprelvekin: ?

A

Oprelvekin is an interleukin-11 (IL-11) analog that stimulates thrombopoiesis by inducing megakaryocyte maturation

178
Q

Aldesleukin:?

A

Aldesleukin is an interleukin-2 (IL-2) analog. Aldesleukin stimulates the proliferation and differentiation of T-cells, B-cells, and cytotoxic cells. This proliferation of cytotoxic cells can produce an anti-tumoral effect used to treat malignant renal cell carcinoma and metastatic melanoma.

179
Q

Filgrastim

A

Filgrastim is a granulocyte colony-stimulating factor (G-CSF) analog that stimulates proliferation and differentiation of granulocytes (basophils, eosinophils, mast cells, neutrophils). Filgrastim is used to treat granulocytopenia and is especially effective for neutropenia caused by chemotherapy or bone marrow transplant.

180
Q

What proteins are DECREASED in the ACUTE phase of inflammation? (3)

A

Albumin, transferrin, transthyretin

181
Q

What are the positive ACUTE phase reactants (APRs)? (4)

A

Fibrinogen (promotes endothelial repair ~w/ ESR), hepcidin, IL-6, Ferritin , C-Reactive Protein, Serum Amyloid A.

182
Q

sirolimus-FKBP12 complex does what?

A

inhibits mTOR; (mammalian tartet of rapamycin; prevents stimulation action of IL-2 on T and B cells

183
Q

What organ transplant is sirolimus commonly used in?

A

Kidney; b/c it does NOT have nephrotoxicity

184
Q

____1____ prevents IL-2 from activating T and B cells, whereas ____2____ prevents IL-2 transcription (calcineurin inhibitor).

A

sirolimus prevents IL-2 from activating T and B cells, whereas tacrolimus prevents IL-2 transcription (calcineurin inhibitor).

185
Q

What drug is used to stimulate the production of neutrophils?

A

Filgrastim

186
Q

Thrombocytopenia is treated with: (4)

A 
Thrombocytopenia is treated with:
Thrombopoietin
Romiplostim
Eltrombopag
Oprelvekin
187
Q

C-reactive protein: ?

A

C-reactive protein is an opsonin that fixes complement and facilitates phagocytosis. It is also used as a clinical measurement of ongoing inflammation.

188
Q

β2 microglobulin is not expressed on what cells?

A

RBCs; b/c RBCs do NOT express MHC-1

189
Q

IL-2 (aldesleukin) is used to treat what two diseases?

A

renal cell carcinoma and metastatic melanoma

190
Q

In contrast to MHC I proteins, what do MHC II proteins present?

A

exogenous antigens from extracellular organisms that have been phagocytosed and digested by the APCs. (Within acidified endosomes)

191
Q

adverse effects of cyclosporine include: ? (6)

A 
Gingival hyperplasia
Hirsutism
Hypertension
Hyperlipidemia
Hyperuricemia (gout)
Neurotoxicity (tremor)
192
Q

________ preferentially binds to cyclophilin to form a complex that inhibits calcineurin

A

Cyclosporin

193
Q

Since bicarbonate is necessary to buffer protons in the bloodstream, the reversal of the Cl-/HCO3- exchanger leads to a net increase of hydrogen and chloride ions in the bloodstream.

A

OK

194
Q

What drug reverses the carbonic anhydrase catalyzed reaction, combining H+ and HCO3- to yield CO2 and H2O. The decrease in intracellular bicarbonate reverses the Cl-/HCO3- exchanger, driving Cl- into the bloodstream and HCO3- into the cell?

A

PPIs; one ADRs is HYPO-Mg+

BT_Step1_NTK (28 decks)

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