Lecture 3

Question 1

NSAID that IRREVERSIBLY acetylates cyclooxegenase activity and affects prostaglandins. respiratory acidoses at suicide doses

Answer 1

Aspirin

Question 2

Roles of Aspirin at High dose

Answer 2

anti inflammatory, protective against MI, decrease risk of stroke and colon cancer

Question 3

Roles of Aspirin at Low dose

Answer 3

anti pyretic, analgesic, diminish risk of MI

Question 4

Side effect caused by NSAIDS but not aspirin

Answer 4

nephritis of kidney

Question 5

Fatal fulminating hepatitis with cerebral edema and death, typically in children, from use of aspirin in children

Answer 5

Reyes syndrome

Question 6

Mild intoxication from aspirin- nausea, vomits

Answer 6

salicylism

Question 7

severe intoxication from aspirin, vasomotor collapse, respiratory acidoses, coma, die from suffocation

Answer 7

salicylate intoxication

Question 8

Drug category with reversible inhibition of cyclooxegenase, so that eicosanoids are not formed

Answer 8

NSAIDs

Question 9

Family of NSAIDS including ibuprofen, naproxen, fenprofen, ketoprofen, flurbiprofen, oxaprozin, widely used in rheumatoid arthritis and aklylosing spodilitis because GI effects less toxic than aspirin

Answer 9

Propionic acid derivatives

Question 10

Acetic acid derivative NSAIDs, this drug is more potent than aspirin, but toxic at high doses, effective analgesic for uveitis and post operative opththalmic procedures, anti pyretic for hodgkins, delay labor contractions

Answer 10

Indometacin

Question 11

Once per day oxicam derviatives for RA and ankylosing spondilytis

Answer 11

Peroxicam and Meloxicam

Question 12

oxicam derivative eliminated through urine only

Answer 12

Peroxicam

Question 13

oxicam derivative eliminated 50/50 urine and feces

Answer 13

Meloxicam

Question 14

Heterodaryl acetic acid that is more potent than indomethacin and naproxin, used in the same way for RA, ankylosing spondylitis, asteoarthritis

Answer 14

Diclofenac

Question 15

Heterodaryl acetic acid used topically for allergic conjunctivitis, prone to abuse so not readily available, cannot be used with analgesics as can cause upper GI bleeding

Answer 15

Keterolac

Question 16

Heterodaryl acetic acid that is as efective as aspirin for RA but has fewer side effects

Answer 16

Nabumetone

Question 17

Heterodaryl acetic acid that is 3-4x as potent than aspirin as analgesic and anti inflammatory, but has NO antipyretic effect- does not cross BBB

Answer 17

Diflunisal

Question 18

COX 2 selective NSAID that is approved for osteoarthritis and is NOT AN ANALGESIC, does not interfere with platelet function. Contraindicated in pts allergic to sulfonamides, lowest incidence of gastro duadenal ulcers compared to other NSAIDS

Answer 18

Celecoxib

Question 19

non narcotic analgesic DOC for fever and pain in children, but no anti inflammatory effect, no interference with platelet function, toxic at high doses, hepatotoxic at suicide doses

Answer 19

Acetominophen

Question 20

What is the antidote for acetaminophen intoxication?

Answer 20

N-Acetyl cysteine

Question 21

DOC for severe rheumatoid or psoriatic arthritis, taken once a week, can cause cytopenia, acute pneumonia-like syndrome (lung fibrosis), also an anti cancer drug

Answer 21

Methrotrexate

Question 22

Immunomodulatory agent that arrests lymphocytes, slows progression of structural damage in RA, lacks analgesic and anti inflammatory properties, reversible inhibition of dihydroorotate dehydrogenase, avoided in potential child bearing mothers

Answer 22

Leflunomide

Question 23

anti malaria drug used in combo with methrotrexate to treat RA unresponsive to NSAIDS

Answer 23

Hydroxychloroquine

Question 24

prevention of progression of RA by suppressing phagocytic function of macrophages and releasing hydrolytic enzymes

Answer 24

Gold Salts

Question 25

Used for RA when Gold Salts fail

Answer 25

Penicillamine

Question 26

Anti cytokine that binds 2 molecules of TNF to prevent coupling with receptors, subcutaneous injection twice a week for RA

Answer 26

Etanercept

Question 27

monoclonal antibody that neutralizes TNF, approved for chrons disease and combo with methrotrexate for RA

Answer 27

Infliximab

Question 28

monoclonal antibody that binds with TNF, treatment for active RA, subcutaneous injection every 2 weeks

Answer 28

Adalimumab

Question 29

Recombinant Fusion Protein that prevents T cell activation in synovial joint tissue

Answer 29

Abatacept

Question 30

monoclonal antibody against CD20 antigen, used with methrotrexate in moderate to severe RA that does not respond to other TNF inhibitors

Answer 30

Rituximab

Question 31

Disease characterized by redness of the great toe joint caused by high serum uric acid formed in the liver, crystallized uric acid in the joint, and other soft tissues including the kidney, genetic, caused by decreased elimination or increased production

Answer 31

Gout

Question 32

Drugs used to treat Acute phase of Gout (2)

Answer 32

Colchicine and Indomethacin

Question 33

Drug contraindicated in Gout patients becuase it competes for acid secretion in the kidney

Answer 33

Aspirin

Question 34

drug that binds to tubulin to suprress granulocytic migration and also inhibits synthesis and release of leukotrienes, causes diarrhea, alopecia, myopathy, CI in pregnancy

Answer 34

Colchicine

Question 35

Purine analog which reduces formation of uric acid by competitively inhibiting the last steps ofuric acid synthesis - Xanthine oxidase inhibitor

Answer 35

Allopurinol

Question 36

Category of drugs produced endogenously, local substance produces by same tissue that uses them. similiar to hormones, include prostaglandins, histamines, and serotonin. not hormones because they do not use circulatory system

Answer 36

Autocoids

Question 37

Autocoid that is a derivative of unsaturated fatty acid, arachidonic acid, uses cyclooxigenase pathway, used to terminate pregnancy, erectile dysfunction, peptic ulcer disease

Answer 37

Prostaglandins

Question 38

Autocoid acting as chemical messenger to mediate allergic and inflammatory reactions and HCL production, no clinical use, but agents are employed to interfere with its actions: promote diarrhea, itching, pain, stomach acid production, asthma, smooth muscle contraction, increase BP

Answer 38

Histamine

Question 39

H1 receptor blockers that competitevely block receptor mediated responses to histamines. 1st gen are effective and low cost, cause sleepiness, 2nd gen (loratidine) does not cross BBB so does not cause sleepiness

Answer 39

Antihistamines

Question 40

Most common episodic headache, may be accompanied with premonition, unilateral, pulsating, more in women, auras, treat with triptans and ergotaines or NSAIDS

Answer 40

Migraine

Question 41

headache caused by stress, W>M, bilateral in band, dull and persistent, anorexia, menstrual changes, up to 7 days

Answer 41

Tension

Question 42

headache caused by muscle spasms, during sleep behind or around eye, M>W, sharp pain, uni or bilateral

Answer 42

Cluster

Question 43

DOC, most effective agents for migraines

Answer 43

-Triptans

Question 44

Cheaper second choice for mild to moderate migraine

Answer 44

Ergotamine

Question 45

Drugs used for Prophylactic treatment of migraines (2)

Answer 45

Propranolol and Methysergine

Question 46

Progressive neurologic disorder of muscle movements, causes tremors, muscle rigidity, bradykinesia, postural and gait abnormalities, 4th most common neurologic disorder in pts over 65 y/o, reduction of dopaminergic neurons of substantia negra

Answer 46

Parkinson's Disease

Question 47

Parkinsons DOC that is a precursor of dopamine, adequate to relieve symptoms in early stages but has a wear off effect with time, Peripheral SE: GI, CV, Ocular - mydriasis, blood dyscrasias with Coombs reaction, Central SE: hallucinations, mood changes, depression and anxiety, interacts with MAO A inhibitors - phenelzine and antipsychotic drugs..

Answer 47

Levodopa

Question 48

Selective MAO B inhibitor for Parkinsons that decreases metabolism of dopamine, given in combo with levodopa as it begins to wear off.

Answer 48

Deprenyl

Question 49

Catechol-o--methyl transferase inhibitors (2) used for Parkinsons that decrease plasma concentration of COMT, increasing uptake of dopamine in the brain, reduces wear off phenomenon, SE: continuous fight or flight reaction

Answer 49

Entacapone and Tolacapone

Question 50

Dopamine receptor agonist (ergot type) for Parkinson treatment that produces no effect in pts with do not react to levodopa, similiar action to levodopa but has more psychological SEs like delerium, confusion, hallucination

Answer 50

Bromocriptine

Question 51

(4) Dopamine receptor agonist (non ergot type) for parkinsons that delay the need to use levodopa in early stages of the disease and decrease the dose in advanced disease, SE insomnia, dizziness

Answer 51

Paramipexole, Ropinirole, Apomorphine, Rotigotine

Question 52

Antiviral agent used to enhance synthesis, release or re uptake of dopamine

Answer 52

Amantadine

Question 53

(2) Anti muscarinic Agents used to produce imbalance in dopamine/acetylcholine ratio to increase dopaminergic transmission, SE pupil dilation. constipation, urine retention, Contra in Glaucoma, prostatic hyperplasia-bladder emptying

Answer 53

Benztropin and Biperiden

Question 54

Neurodegenerative disorder manifested by loss of cholinergic cortical neurons, accumulation of senile plaques, formation of neurofibrillary tangles and loss of cortical neurons

Answer 54

Alzheimer's Disease

Question 55

(4) Acetylcholinesterase inhibitors used to treat Alzheimer's, all have the same effect of increasing acetylcholine in the synaptic cleft

Answer 55

Glantamine, Donazepil, Rivastigmine, Tacrine

Question 56

Only NMDA (N-methyl D aspartate) antagonist, neuroprotective by modulation function of ion channels

Answer 56

Memantine

Question 57

Neurodegenerative disease leading to atrophy of muscle fibers, hardening of anterior columns of the spinal cord as the motor neurons degenerate and are replaced by fibrous astrocytes

Answer 57

Amyotropic Lateral Sclerosis - Lou Gherigs Disease

Question 58

Glutamate, sodium, and calcium channel blocker used as supportive therapy for ALS/Lou Gherig's

Answer 58

Riluzole