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USMLE - Pharmacology > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Aspirin: Mechanism

A

Irreversible inhibits cyclooxygenase (1 and 2) by acetylation, decreasing synthesis of thromboxane A2 and prostaglandins.

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2
Q

Aspirin’s effect on PT, PTT and bleeding time

A

Increased BT

No effect of PT and PTT

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3
Q

How much is Aspirin low dose? Usage?

A

Low dose: < 300 mg/day

Platelet aggregation

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4
Q

How much is Aspirin intermediate dose? Usage?

A

300-2400 mg/day

Antipyretic and analgesic

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5
Q

How much is Aspirin high dose? Usage?

A

2400-4000 mg/day

Antiinflammatory

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6
Q

Aspirin: Side effects (6)

A

Gastric ulceration
Tinnitus (CN VIII)

Chronic Use:
Acute renal failure
Interstitial nephritis
Upper GI bleeding
Reye's syndrome after viral
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7
Q

Aspirin: Acid-Base status

A

Respiratory alkalosis by hyperventilation

Anion gap metabolic acidosis

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8
Q

Where is COX 1 and COX 2 found?

A

COX1: platelets and GI
COX2: sites of inflammation

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9
Q 
Ibuprofen
Naproxen
Indomethacin
Keterolac
Diclofenac
A

NSAIDS

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10
Q

NSAIDS: Mechanism

A

Reversibly inhibit COX1 and 2 -> blocks prostaglandin synthesis

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11
Q

NSAIDS: Use (3)

A

Antipyretic
Analgesic
Anti-inflammatory

Indomethacin also closes PDA

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12
Q

NSAIDS: Side effects (3)

A

Interstitial nephritis
Gastric ulcer
Renal ischemia

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13
Q

COX-2 inhibitors: Mechanism

A

Reversibly inhibit COX2

Spares COX-1, which helps maintain gastric mucosa and spares TXA1 production

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14
Q

COX-2 inhibitors: Use (3)

A

RA, osteoarthritis

Patients with gastritis and ulcers

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15
Q

COX-2 inhibitors: Side effects (2)

A

Increased thrombosis risk

Sulfa allergy

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16
Q

Acetaminophen: Mechanism

A

Reversibly inhibits COX, mostly in CNS; inactivated peripherally

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17
Q

Acetaminophen: Use (2)

A

Antipyretic, analgesic
Not anti-inflammatory

Used instead of aspirin to avoid Reye’s syndrome

18
Q

Acetaminophen: Side effects

A

Overdose produces necrosis

Depletes glutathione and forms toxic tissue adducts in liver

19
Q

Treatment for Acetaminophen overdose

A

N-acetylcysteine

Regenerates glutathione

20
Q

Alendronate: Family

A

Bisphosphonate

21
Q

Bisphosphonate: Mechanism

A

Pyrophosphate analog

Binds hydroxyapatite in bone, inhibiting osteoclast activity

22
Q

Bisphosphonate: Use (3)

A

Osteoporosis
Hypercalcemia
Paget’s disease of bone

23
Q

Bisphosphonate: Side effects (2)

A 
Osteonecrosis of the jaw (serious dental work)
Corrosive esophagitis (take while sitting up)

Not for patients with achalasia

24
Q

Allopurinol: Mechnanism

A

Inhibits xanthine oxidase

Decrease conversion of xanthine to uric acid

25
Q

Allopurinol: Use (2)

A

Gout

Lymphoma and leukemia to prevent tumor lysis associated urate nephropathy

26
Q

Allopurinol increases what drug levels?

A

Azathioprine and 6-MP (both metabolized by xanthine oxidase)

27
Q

Rasburicase: Mechanism

A

Urate oxidase to prevent uric acid stones

28
Q

Febuxostat: Mechanism

A

Inhibits xanthine oxidase

29
Q

Febuxostat: Use

A

Gout

30
Q

Probenecid: Mechanism

A

Inhibits reabsorption of uric acid in PCT

Also inhibits secretion of penicillin

31
Q

Colchicine: Mechanism

A

Binds and stabilizes tubulin to inhibit polymerization, impairing leukocyte chemotaxis and degranulation

32
Q

Colchicine: Side effects

A

GI

33
Q

When to use glucocorticoids for gout?

A

First line for renal failure patients

34
Q

When to use colchicine for acute gout attacks?

A

when NSAIDS are contraindicated

35
Q

Etanercept: Mechanism

A 
Fusion protein (receptor for TNFA alpha and IgG1 Fc)
TNF decoy receptor
36
Q

Etanercept: Use (3)

A

RA
Psoriasis
Ankylosing spondylitis

37
Q

Infliximab: Mechanism

A

Anti-TNF-alpha monoclonal antibody

38
Q

Adalimumab: Mechanism

A

Anti-TNF-alpha monoclonal antibody

39
Q

Anti-TNF-alpha MAB: Use (4)

A

Crohn’s disease
RA
Ankylosing spondylitis
Psoriasis

40
Q

Anti-TNF-alpha MAB: Side effect

A

Predispose to reactivation of latent TB

TNF blockage prevents activation of macrophages and destruction of phagocytosed microbes

USMLE - Pharmacology (6 decks)

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