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Pharm SJSM > KISS B2 > Flashcards

KISS B2 Flashcards

1
Q

Prils
Lisinopril & Ramipril (big 2)

Increased Bradykinin
Increased Angiotensin 1
Reduced Angiotensin 2
Reduced Aldosterone
Reduced K+
Reduced Renin

Rx:
HR & HTN

AE:
CATCHH

Cough
Angioedema
Teratogen
Hyperkalemia
Hypotension

A

Prils
Lisinopril & Ramipril (big 2)

Inhibit ACE:
Increased Bradykinin
Increased Angiotensin 1
Reduced Angiotensin 2
Reduced Aldosterone
Reduced K+
Reduced Renin

Rx:
HR & HTN

AE:
CATCHH

Cough
Angioedema
Teratogen
Hyperkalemia
Hypotension

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2
Q

5-lipooxygenase inhibitor

Prevents conversion of arachidonic acid into 5-hydroperoxide (& then leukotrienes)

Rx Severe asthma

AE:
Hepatotoxicity/Hepatitis

A

Zilueton

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3
Q

Rx Myasthenia gravis & Cobra venom use

A

Neostigmine & Pyridostigmine

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4
Q

Blurry yellow vision
Arrythmias
AV block
Diarrhea

Indicate which toxicity? & what is the antidote?

A

Digoxin toxicity treated with digoxin anti-FABS

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5
Q

Activated receptors on precursor RBC’s to stimulate erythropoiesis

Rx Anemia or avoid anemia in transfusions

AE:
Thrombotic events & HTN

A

EPO

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6
Q

B-blocker

MOA:
Blocks norepinephrine’s action at the ciliary epithelium without causing pupil or vision changes

Effects:
1) Reduced aqueous humor production (blocks B2 receptors)

Describes which drug

A

Timolol

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7
Q

Heavy bleeding & skin necrosis

What is the toxicity & the antidote

A

Warfarin toxicity

Rx Vitamin K & Fresh frozen plasma

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8
Q

PDE-5 inhibitor causing more cGMP to generate NO causing vasodilation & pulmonary artery relaxation

A

Sildenafil

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9
Q

B agonist that targets B1 & B2 receptors equally

MOA:
It activates Gs to increase adenylate cyclase & cAMP resulting in more norepinephrine release to bind to B receptors (dilation)

Effects:
1) Increased cardiac output
2) Increased heart rate
3) Reduced BP

Clinical uses:
1) Bradycardia
2) Heart block (AV)
3) Cardiac arrest

Adverse effects:
1) Tachycardia
2) Arrythmia

Describes which drug?

A

Isoprotenolol

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10
Q

Classification: PGE1 analog
Mechanism of Action: relaxes smooth muscle in ductus arteriosus

Clinical Indications: maintains patency of ductus arteriosus, impotence

Adverse Effects: hypotension, N/V/D, vaginal bleeding, uterine cramping, flushing tachycardia

A

Alprostadil

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11
Q

Mechanism of Action: PGE1 analog –– increase production and secretin of gastric mucous barrier and decreased acid production

Clinical Indications: prevention of NSAID-induced peptic ulcers, off label use for labor induction (ripens cervix)

Adverse Effects: N/V/D, hypotension, potential abortifacient (contraindicated of women of childbearing potential), vaginal bleeding, uterine cramping, flushing tachycardia

A

Misoprostol

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12
Q

Mechanism of Action: reversibly inhibits cyclooxygenase – mostly in CNS –– inactivated peripherally –– lacks significant anti-inflammatory effects

Clinical Indications: antipyretics, analgesic (act on cannabinoid receptor)

Adverse Effects: hepatic necrosis (overdose)

A

Acetaminophen

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13
Q

Classification: non-steroidal anti-inflammatory

Mechanism of Action: reversibly inhibit COX-1 and COX-2 –– blocks prostaglandin synthesis

Clinical Indications: antipyretic, analgesics, anti-inflammatory –– close PDA

Adverse Effects: interstitial nephritis, gastric ulcer, renal ischemia, aplastic anemia

A

Indomethacin

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14
Q

Classification: anti-gout

Mechanism of Action: binds and stabilizes tubulin to inhibit microtubule polymerization, impairing neutrophil chemotaxis and degranulation –– decrease LTB4 and decreases leukocyte and granulocyte migration

Clinical Indications: acute and prophylactic (acute gout drug)

Adverse Effects: diarrhea, acute GI pain, hematuria, alopecia, myelosuppression, gastritis, peripheral neuropathy (long-term use)

A

Colchicine

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15
Q

Classification: uricosuric –– anti-gout

Mechanism of Action: inhibition of renal reabsorption or uric acid

Clinical Indications: chronic gout

Adverse Effects: precipitate uric acid calculi, nephrotic syndrome, aplastic anemia, allergy

Contraindicated in acute gout

A

Sulfinpyrazone

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16
Q

Classification: anti-gout

Mechanism of Action: inhibits reabsorption of uric acid in PCT –– also inhibits the secretion of penicillin

Clinical Indication: prophylactic (chronic gout drug)

Adverse Effects: precipitate uric acid calculi, nephrotic syndrome, aplastic anemia, allergy

Contraindicated in acute gout

A

Probenecid

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17
Q

Classification: ergot alkaloid

Mechanism of Action: acts as partial agonist at both and 5HT2 receptors in the vasculature and possibly CNS –– vasoconstrictive actions to decrease pulsation in cerebral vessels

Clinical Indications: acute migraine attacks

Adverse Effects: GI distress, prolonged vasoconstriction can lead to ischemia and gangrene – abortion near term

A

Ergotamine

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18
Q

Classification: triptan

Mechanism of Action: 5-HT1B/1D agonists –– inhibit trigeminal nerve activation, prevent vasoactive peptide release, induce vasoconstriction

Clinical Indications: acute migraine, cluster headache attacks

Adverse Effects: coronary vasospasm (contraindicated with CAD and vasospastic angina), mild paresthesia, serotonin syndrome

A

Sumatriptan

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19
Q

Presentation: bleeding, skin necrosis (if low protein C)

A

Warfarin Toxicity

Antidote: fresh frozen plasma (acute), vitamin K (non-acute)

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20
Q

Presentation: bleeding

A

Heparin Toxicity

Antidote: protamine sulfate (positively charged molecule that binds negatively charged heparin)

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21
Q

Predisposing Factors: renal failure (decreased excretion), hypokalemia, drugs that displace digoxin from tissue-binding sites, and decreased clearance
Worsening Factors: hypokalemia, hypomagnesemia, hypercalcaemic

A

DIGOXIN POISONING

Antidote: slowly normalize K+, antiarrhythmics (lidocaine, phenytoin), cardiac pacer (severe), anti-digoxin Fab fragments, Mg2- –– propranolol and atropine (block vagus)

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22
Q

Pathogenesis: toxic doses cause respiratory alkalosis early, but transitions to mixed metabolic acidosis-respiratory alkalosis
Presentation: confusion, lethargy, ataxia, nystagmus, stupor, coma, hypothermia, respiratory failure

A

Aspirin/ Salicylates Poisoning

Sodium bicarbonate

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23
Q

Pathogenesis: acetaminophen metabolite (NAPQI) depletes glutathione and forms toxic tissue by-products in liver –– hepatic necrosis
Presentation: mild anorexia, N/V, delayed jaundice, hepatic and renal failure

A

Acetaminophen toxicity

Antidote: N-acetylcysteine (replenishes glutathione)

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24
Q

Precipitating Factors: consumption of deadly nightshade berries

Presentation: tachycardia, hypertension, hyperthermia (hot, dry skin), delirium, hallucinations, mydriasis

A

Atropine OD rx physostigmine

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25
Q

Presentation: severe GI distress leading to necrotizing gastroenteritis with hematemesis and blood diarrhea, dyspnea, shock and coma –– typically seen in children who have ingested iron tablets

A

Iron poisoning

Antidote: deferoxamine, deferasirox, deferiprone (Iron chelators) as well as gastric aspiration and carbonate lavage

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26
Q

Classification: low-molecular weight heparin

Mechanism of Action: bind ATIII –– have same inhibitory effect on factor Xa as the unfractioned heparin-ATIII complex –– longer half-life than standard heparin

Clinical Indications: anticoagulation –– does not need laboratory monitoring (more predictable mechanism of action)

Adverse Effects: same as heparin, but less likely to experience thrombocytopenia and thrombosis
Contraindicated in renal failure

A

Enopaparin (LWMH)

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27
Q

Predisposing Factors: commonly used as insecticides (poisoning usually seen in farmers)
Pathogenesis: OP irreversibly inhibit AChE

A

Organophosphate Poisoning

Antidote: atropine (antagonizes the actions at muscarinic receptor sites) and pralidoxime (regenerates AChE via dephosphorylation if given early)

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28
Q

3 Drugs that block ADP receptor to reduce GpIIB/IIIa EXPRESSION

Anti-inflammatory & antiplatelet

AE: Neutropenia & TTP

A

Clopidogrel, Prasugrel, Ticlopidine

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29
Q

Mechanism of Action: activates antithrombin III, which decreases action of IIa (thrombin) and factor Xa –– also IXa, Xia, XIIa and kallikrein(intrinsic and common pathways) –– short half-life –– conformational change in antithrombin that makes reactive site more accessible to proteases

Clinical Indications: immediate anticoagulation for PE, acute coronary syndrome, MI, DVT –– used during pregnancy (does not cross the placenta) –– follow PTT

Adverse Effects: bleeding, thrombocytopenia (non-immune and immune), osteoporosis, drug-drug interaction (warfarin), hyperkalemia

Contraindicated in patients with: hypersensitivity, active bleeding, active TB, threatened abortion, hemophilia, advanced hepatic/ renal disease, GIT ulcers, significant thrombocytopenia, purpura, severe hypertension, intracranial hemorrhage, infective endocarditis

A

Heparin

30
Q

Classification: erythropoiesis-stimulating agent

Mechanism of Action: agonist of erythropoietin receptors expressed by red cell progenitors

Clinical Indications: anemias especially in chronic renal failure, HIV infection, cancer, prematurity –– prevention of need for transfusions

Adverse Effects: hypertension, thrombotic complications, pure red cell aplasia

A

Epoetin alfa (Erythropoietin)

31
Q

Classification: Vitamin B12

Mechanism of Action: cofactor required for essential enzymatic reactions that form tetrahydrofolate, convert homocysteine to methionine, and metabolize L-methyl malonyl-CoA

Clinical Indications: vitamin B12 deficiency (megaloblastic anemia), basis of pernicious anemia

A

Cyanocobalamin

32
Q

Mechanism of Action: precursor of an essential donor of methyl groups used for synthesis of amnio acids, purines and deoxynucleotides

Clinical Indications: folic acid deficiency (megaloblastic anemia), prevention of congenital neural tube defects

Adverse Effects: can mask vitamin B12 deficiency in large amounts

A

Folic Acid

33
Q

Classification: megakaryocyte growth factor

Mechanism of Action: recombinant form of an endogenous cytokine –– activates IL-11 receptors –– stimulates the growth of primitive megakaryocytic progenitors and increases the number of peripheral platelets

Clinical Indications: secondary prevention of thrombocytopenia in patients undergoing cytotoxic chemotherapy for non-myeloid cancer

Adverse Effects: fatigue, headache, dizziness, anemia, fluid accumulation in the lungs, transient atrial arrythmias

A

Oprelvekin (IL-11)

34
Q

Anti HTN safe in pregnancy?

A

Hydralazine
Labetolol
Methyldopa
Nifedipine

35
Q

Amlodipine, Clevidipine, nicardipine, nimodipine

A

Ca channel blockers (class4 antiarrhythmics)

All treat raynauds
Nicar/clev rx HTN urgency
Nimo rx subarachnoid hemorrhage

36
Q

Veramipil & dialtizem

A

Ca channel blockers that rx angina HTN, & Afib

37
Q

Classification: sympathomimetics – direct –– selective 1 agonist

Mechanism of Action: stimulates β1- adrenergic receptors with minor effect on HR or peripheral blood vessels –– increases CO without significantly increasing HR

Clinical Indications: heart failure, cardiogenic shock (inotropic), cardiac stress testing

Adverse Effects: hypertension, tachycardia, PVCs, arrhythmias

A

Dobutamine β1 >β 2, 𝛂

38
Q

Classification: PDE-5 inhibitor

Mechanism of Action: inhibits PDE-5 leading to increased cGMP resulting in prolonged vasodilatory effect of NO –– pulmonary artery relaxation

Clinical Indications: pulmonary hypertension, erectile dysfunction

Adverse Effects: headache, flushing, insomnia, transient blue-green tinting of vision (related to inhibition of retinal PDE6 that is involved in transduction)

A

Sildenafil

39
Q

Classification: antiarrhythmics – sodium channel blocker (class IA)

Mechanism of Action: moderate Na+ channel blockade – increases AP duration, increases effective refractory period in ventricular action potential, increases QT interval, some potassium channel blocking effects –– metabolized via N-acetyltransferase

Clinical Indications: both atrial and ventricular arrhythmias, especially re-entrant and ectopic SVT and VT (WPW, Afib, V Tach)

Adverse Effects: reversible SLE-like syndrome, thrombocytopenia, torsades de pointes due to increased QT interval

A

Procainamide

40
Q

Very low LDL
high HDL
Low TG

Inhibit HMG-CoA

Avoid with fibrates

A

Statins

41
Q

Very low LDL
Very high HDL
Low TG

Inhibit lipolysis (vitamin btw)

A

Niacin

42
Q

Low LDL
High HDL
Very very low TG

+ve PARR alpha
avoid with statins

A

Fibrates

43
Q

Classification: β2 agonist (short acting)

Mechanism of Action: relaxes bronchial smooth muscle –– bronchodilation

Clinical Indications: acute exacerbations and prophylaxis of exercise-induced

Adverse Effects: tremor, arrythmia, tolerance, tachyphylaxis

A

Albuterol

44
Q

Classification: β2 agonist (short acting)

Mechanism of Action: relaxes bronchial smooth muscle –– bronchodilation
Clinical Indications: asthma prophylaxis

Adverse Effects: tremor, arrythmia, tolerance, tachyphylaxis

A

Salbutamol

45
Q

Rx hyperkalemia

A

Insulin + glucose, calcium gluconate, β2 agonists

46
Q

Classification: antileukotriene
Mechanism of Action: 5-lipoxygenase pathway inhibitor – blocks conversion of arachidonic acid to leukotrienes –– LTB4 (chemotactic) LTC4/ LTD4 (bronchoconstriction) –– short acting

Clinical Indications: asthma prophylaxis

Adverse Effects: hepatotoxic

A

Zileuton

47
Q

Classification: antileukotriene

Mechanism of Action: antagonists at LTD4 receptors –– block leukotriene receptors (CysLT1): competitive antagonist –– reduce bronchoconstriction in asthma –– additive action with 2-adrenoreceptor agonist

Clinical Indications: prophylaxis –– especially good for aspirin-induced and exercise-induced asthma –– mainly used as add-on therapy to inhaled corticosteroids and long-acting 2 agonist –– safe during pregnancy

Adverse Effects: hepatotoxic

A

Montelukast

48
Q

HTN only

AE
Orthostatic hypotension

A

Prazosin

49
Q

BPH & HTN

AE: Ortho hypo

A

Doxazosin & Terazosin

50
Q

Just BPH

AE: Floppy iris

A

Tamsulosin

51
Q

Rx pheochromocytoma

A

Phenoxybenzamine (irr a antagonist to avoid HTN crisis)

52
Q

Classification: selective 1a/d blockers
Mechanism of Action: inhibit 1 receptor leading to relaxation of smooth muscle (bladder neck, prostate) resulting in decreased urinary obstruction
Adverse Effects: ‘first dose’ hypotension and syncope, headache

A

Treatment for BPH
Tamsulosin

53
Q

Classification: sympathomimetics – indirect
Mechanism of Action: blocks NE reuptake and dopamine reuptake –– also blocks Na+/K-ATPase
Clinical Indications: causes vasoconstriction and local anesthesia – caution when giving beta-blockers if cocaine intoxication is suspected – can lead to unopposed ɑ1 activation)
Adverse Effects: highly addictive, hypertension, arrythmias, seizures

A

Cocain

54
Q

Classification: cholinomimetic agents – direct agonist
Mechanism of Action: muscarinic agonist activated M3 receptor (increases IP3 and DAG) leading to contraction of detrusor smooth muscle resulting in increased bladder emptying– resistant to AChE, no nicotinic activity
Clinical Indications: urinary retention, ileus (postop/neurogenic)
Adverse Effects: parasympathomimetic effects, cyclospasm, diarrhea, urinary urgency, vasodilation, reflex tachycardia, sweating

A

Bethanechol: Bladder

55
Q

Classification: direct-acting muscarinic agonist (M1 and M3)

Mechanism of Action: bind and activate muscarinic receptors – M1 receptors are common in secretory glands and their activation results in increased secretion from the secretory glands –– M3 receptors are found in smooth muscles and glands and their activation results in smooth muscle contraction and increased glandular secretion

Clinical Indications: xerostomia (Sjörgen Syndrome)

Adverse Effects: sweating, nausea, rhinitis, sinusitis, URIs

A

Cevimeline

56
Q

Mechanism of Action: chemical antagonist of organophosphates –– regenerates AChE via dephosphorylation if given early – reactivate cholinesterase inactivated by phosphating due to OP (mainly outside CNS)

Clinical Indications: organophosphate poisoning –– works on nicotinic effects

Adverse Effects: muscle weakness

A

Pralidoxime (quaternary amine) (-oxime)

57
Q

Classification: sympatholytic – ɑ2 agonist presynaptic
Mechanism of Action: stimulate prejunctional receptors in the CNS to decrease sympathetic outflow, decrease TPR and HR
Clinical Indications: hypertensive urgency, ADHD, Tourette syndrome, symptom control in opioid withdrawal
Adverse Effects: CNS depression, bradycardia, hypotension, respiratory depression, miosis, rebound hypertension with abrupt cessation

A

Clonidine

58
Q

Classification: muscarinic antagonist (competitive at all M receptors)
Mechanism of Action: produce mydriasis and cycloplegia –– bronchodilation and decrease airway secretions –– decrease stomach acid secretion –– decrease GI motility –– decrease bladder urgency in cystitis
Clinical Indications: bradycardia and for ophthalmic applications (long action), antispasmodic, antisecretory, management of AChE inhibitor overdose, antidiarrheal
Adverse Effects: increased body temperature (decrease sweating), tachycardia, dry mouth, dry, flushed skin, cycloplegia, constipation, disorientation –– can cause acute-angle glaucoma in elderly, urinary retention in men with prostatic hyperplasia and hyperthermia in infants

A

Atropine

59
Q

Classification: cholinomimetic agent – indirect agonist (anticholinesterase)
Mechanism of Action: inhibits cholinesterase and amplifies endogenously released Ach –– increase Ach – freely crosses blood brain barrier into CNS
Clinical Indications: glaucoma, antidote for anticholinergic toxicity (atropine)
Adverse Effects: increased parasympathetic effects (especially N/V/D, urinary urgency), seizures

A

Physostigmine (tertiary amine)

60
Q

Classification: cholinomimetic agent – indirect agonist (anticholinesterase)
Mechanism of Action: increase ACh
Clinical Indications: first line for Alzheimer disease
Adverse Effects: nausea and vomiting

A

Donepezil (also Rivastigmine, galantamine

61
Q

Classification: antiarrhythmics –– beta-blocker (class II) –– β1 selective
Mechanism of Action: decrease SA and AV nodal activity by decreasing cAMP, decreasing Ca2+ currents –– suppress abnormal pacemakers by decreasing slope of phase 4 –– AV node particularly sensitive (increase PR interval)
Clinical Indications: SVT, ventricular rate control for atrial fibrillation/ atrial flutter
Adverse Effects: impotence, exacerbation of COPD and asthma, cardiovascular effects (bradycardia, AV block, HF), CNS effects (sedation, sleep alterations) – may mask hypoglycemia

A

Atenolol

62
Q

Classification: beta-blocker
Mechanism of Action: blocks action of NE at ciliary epithelium –– decrease aqueous humor synthesis via Beta 2
Adverse Effects: no pupillary or vision changes

A

Timolol

63
Q

Classification: prostaglandin (PGF2) analog (-toprost)
Mechanism of Action: increase outflow of aqueous humor via decrease resistance of flow through uveoscleral pathway
Adverse Effects: darkens color of iris (browning), eyelash growth, macular edema in aphasics (have no eye lens), reactivation of uveitis

A

Latanoprost

64
Q

Classification: cholinomimetic agent: direct agonist
MOA: act like Ach
Indications:
contracts ciliary muscle of the eye: open angle glaucoma
pupillary sphincter: closed angle glaucoma
xerostomia: SJS (increases tear, sweat, saliva production)
A/E: exacerbation of COPD, asthma, peptic ulcer

A

Pilocarpine

65
Q

Glaucoma B-blockers & their effects?

A

Timolol, Betaxolol & Carteolol

Reduce aqueous humor synthesis no pupil or vision changes

66
Q

Glaucoma Alpha agonists & their effects?

A

apraclonidine & Brimonidine

Reduces aqueous humor synthesis & increase uveoscleral out flow

Causes mydriases so avoid in closed angle glaucoma

67
Q

Glaucoma Diuretic & effects?

A

Acetazolamide (carbonic anhydrase inhibitor PCT)

Reduced aqueous humor production no pupil or vision changes

68
Q

Glaucoma Prostaglandins & effects?

A

Latanoprost & Bimatoprost

Increase uveoscleral outflow

Darken iris & eyelash growth

69
Q

Glaucoma M3 agonists & effects?

A

Pilocarpine & carbachol (direct) miosis & cyclopsams Increases outflow through trabecular meshwork used in acute angle/closed glaucoma

Physostigmine- (indirect

70
Q

Diphenhydramine, dimenhydrinate. chlorpheniramine & doxylamine

A

H1 antihistamines for allergies & motion sickness

AE: Sedation

71
Q

Loratidine, Fexofenadine, desloratadine, & cetirizine

A

H2 Antihistamines just for allergies no AE cause they don’t breach CNS

Pharm SJSM (23 decks)

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