NSAIDs, sedative-hypnotics, alcohols, anti-seizure, anes, anti-parkinsons Flashcards
1
Q
nonselective irreversible cox1 and 2 inhibitor, reduces plt production of TXA2, stimulator of plt aggregation; duration of use for arterial thrombosis; associated with ___ in children; prevents uric acid _______so (must/ must not) be used in gout
A
ASA; 8-10 days(plt lifespan); Reye syndrome; excretion; must not
2
Q
ASA dose effective for reducing platelet aggregation; follows ____ order elimination
A
<300mg/day; first order
3
Q
ASA dose effective as anti-inflamm; follows ____ order elimination
A
2400-4000mg/d; zero order
4
Q
ASA intermediate dose for
A
antipyretic and analgesic
5
Q
ASA toxic dose
A
150mg/kg (21 ASA 500mg tabs)
6
Q
ASA lethal dose
A
30g (60 500mg tabs)
7
Q
nonselective reversible cox1 and 2 inhibitor, inhibits prostaglandin synthesis; long-term use reduces risk of ___
A
ibuprofen, diclofenac, mefanamic acid, meloxicam, piroxicam; colon CA
8
Q
prevents NSAID-induced gastritis
A
misoprostol
9
Q
COX 2>COX1
A
meloxicam, peroxicam
10
Q
only IV NSAID, used for post-surgical analgesia; purely analgesic, no anti-inflamm; use for ___ hrs only
A
Ketorolac; 72
11
Q
nonselective reversible COX inhibitor used for gout and closure of PDA; special SE
A
indomethacin; hematologic (aplastic anemia, thrombocytopenia)
12
Q
selective Cox-2 inhibitor; available IV form; risk for MI and stroke
A
celecoxib; parecoxib; rofecoxib and valdecoxib
13
Q
selective Cox-3 inhibitor, weak effect on cox1 and 2; MC SE especially with _____ use; antidote
A
Paracetamol; hepatotoxicity; alcohol; NAC
14
Q
similar drug of paracetamol which can cause renal papillary necrosis and interstitial nephritis
A
phenacetin
15
Q
in Paracetamol toxicity, ____ accumulates due to oxidation by ______; region of liver preferentially involved
A
NAPQ1 (N-acetyl-p-benzoquinoneimime); CYP2E1; centrilobular region (zone III)
16
Q
paracetamol toxic dose; lethal dose
A
150mg/kg; 15g
17
Q
MOA of MTX; first choice DMARD for tx of ____; rescue agent
A
inhibits AICAR transformylase and thymidylate synthetase with secondary effects on PMN chemotaxis; RA; leucovorin (folinic acid)
18
Q
binds to TNF-a; used for Crohn’s disease, TV reactivation, lymphoma; synergistic effect w/ MTX
A
infliximab, etanercept
19
Q
forms 6-thioguianine (purine anti-metabolite) which suppresses inosinic acid synthesis, b and t-cell function, Ig production and IL-2 secretion; similar MOA with ____ (chemotx); don’t give with ____
A
azathioprine; mercaptopurine; allopurinol
20
Q
DMARD also anti-malarial; SE; safe for pregnant?
A
chloroquine; ocular toxicity (retinal reposits); safe
21
Q
forms phosphoramide mustard which cross-links DNA to prevent replication, supresses t-cell and b-cell; metabolite ____ causes_____; rescue agent
A
cyclophosphamide; acrolein; hemorrhagic cystits; mesna
22
Q
inhibits IL-1 and IL-2 receptor production, secondarily inhibits macrophage t-cell interaction and t-cell responsiveness; SE
A
cyclosporine; gingival hyperplasia
23
Q
inhibits inosine monophosphate dehydrogenase (impt in guanine synthesis), inhibits T-cell proliferation; SE
A
mycophenolate mofetil; reversible myelosuppression
24
Q
DMARD which inhibits release of inflamm cytokines; SE
A
sulfasalazine; hemolytic anemia, methemoglobinemia; reversible infertility in men
25
microtubule assembly inhibitor, decreases macrophage migration and phagocytosis; used in gout and familial mediterranean fever; SE
colchicine; agranulocytosis, necrosis, ARF
26
first line for acute gouty attack; MOA
NSAIDS (indomethacin); inhibi`ts urate crsytal phagocytosis
27
competes with uric acid for reabsorption in the proximal tubules thereby increasing uric acid excretion; similar drug; SE; potentiates other weak acids e.g. (____)
probenecid; sulfinpyrazone; nephrotic syndrome (probenecid), aplastic anemia; penicillin, MTX
28
these drugs (3) may precipitate acute gout during early phase of drug action; so coadminister with ___ or ___
probenecid, allopurinol, febuxostat; colchicine or indomethacin
29
irreversible xanthine oxidase inhibitor, lowers production of uric acid; SE; inhibits metab of ___ and ___
allopurinol; peripheral neuritis, aplastic anemia, cataracts (idiosyncratic); mercaptopurine and azathioprine
30
first line for chronic gout, tumor lysis syndrome
allopurinol
31
reversible inhibitor of xanthine oxidase
febuxostat
32
GABA receptor effect of benzodiazepine; barbiturates; which is safer?
inc frequency, duration; benzodiazepine
33
short acting benzodiazepine; similar drugs; useful for
midazolam, brotizolam, trazolam, etizolam, oxazepam; anes induction
34
intermediate acting benzodiazepine; similar drugs
lorazepam, alprazolam, clonazepam, estazolam, nitrazepam, temazepam, lormazepam
35
causes both anterograde and retrograde amnesia hence banned in Phils
lorazepam
36
site of anterograde amnesia; retrograde
hippocampus; thalamus
37
abnormal sleep pattern from use of benzodiazepines
decreased REM sleep
38
long-acting benzodiazepine; similar drugs; used as a date rape drug
diazepam; chlorazepate, chlordiazepoxide, flurazepam, quazepam; flunitrazepam
39
benzodiazepine with longest half life
chlordiazepoxide
40
date rape drugs
alcohol, flunitrazepam (aka Rohypnol), gamma-hydroxybutyrate
41
toxic dose of benzodiazepine, antidote
1000x, flumazenil
42
ultrashort-acting barbiturate; similar drugs; used for (2)
thiopental, methohexital, thiamylal; anes induction, inc ICP
43
short/intermediate-acting barbiturates
pento, seco, amo, buta, aprobarbital, talbutal
44
long-acting barbiturate; useful in ____ syndrome
phenobarbital, mephobarbital, primidone; Gilbert's syndrome (unconjugated hyperbilirubinemia)
45
remarkable SE of barbiturates; enzyme deficient
acute intermittent porphyria; hmb synthase
46
most catastrophic sx of sedative-hypnotic withdrawal
rebound suicide
47
newer hypnotic acting like a benzodiazepine used for insomnia; effects reversed with
zolpidem, zaleplon, eszopiclone; flumazenil
48
order of dependence among sedative-hypnotics
barbiturates>benzodiazepines>zolpidem
49
anxiolytic which partially antagonizes 5-HT1a receptors and possibly D2 receptos used for generalized anxiety d/o
buspirone
50
this system is responsible for ethanol metab at blood levels higher than 100mg/dl
microsomal ethanol oxidizing system (MEOS)
51
enzyme inhibited by disulfiram, metronidazole and some cephalosporins
aldehyde dehydrogenase
52
blood alcohol concentration (BAC) causing impairment of driving ability
60-80mg/dL
53
BAC causing sedation, "high", slow reaction time
50-100 mg/dL
54
BAC causing impaired motor fxn, slurred speech, ataxia
100-200mg/dL
55
BAC causing emesis, stupor
200-300mg/dL
56
BAC causing coma
300-400mg/dL
57
dreaded emergency from alcohol intoxication, presents with ataxia, confusion, paralysis of EOM; hemorrhagic necrosis of ____
Wernicke-Korsakoff syndrome; mamillary bodies
58
mental retardation, microcephaly, underdevt of midface region due to consumption during 1st trimester of pregnancy
fetal alcohol syndrome
59
alcoholism increases risk of infection associated with; Sx
Klebsiella pneumoniae; currant jelly sputum
60
sx of delirium tremens
HAD 48 (hallucination, autonomic instability, delirium 48-72 hrs after discontinuation)
61
DOC for alcohol withdrawal syndrome
benzodiazepine
62
disulfiram reaction
clara took the pre-medical test in the PM (chlorpropramide, cefoperazone, cefomandole, cefotetan, procarbazine, metronidazole)
63
methanol toxicity manifestation; tx (also used in ___)
visual dysfunction (retinal damage) due to formaldehyde and formic acid; ethanol/fomepizole(inhibitor of alcohol dehydrogenase); ethylene glycol toxicity
64
only antiseizure drug with effect on K+ receptor
oxcarbazepine
65
anticonvulsant drug which blocks voltage gated Na channels, can also be used for arrhythmias (group 1b action); teratogenic effect
phenytoin; fetal hydantoin syndrome
66
tricyclic anticonvulsant which blocks Na channels and decreases glutamate release; DOC for ____; SE
carbamezapine; trigeminal neuralgia; SJS
67
branched chain f.a. which acts as an anticonvulsant blocking high-frequency firing of neurons, modifies a.a. metab, used in acute mania; teratogenic effect
valproic acid; spina bifida, NTD, hepatotoxicity
68
preferred antiseizure drug in children and pregnants
phenobarbital
69
decreases ca currents in thalamus; useful for absence seizures
ethosuximide
70
DOCs for status epilepticus
lorazepam, diazepam, phenytoin, phenobarbital
71
useful for infantile spasms
clonazepam
72
used for postherpetic neuralgia, allodynia
gabapentin
73
another anticonvulsant which may cause SJS, blocks Na, Ca and gluatamate channel
SJS
74
binds synaptic vesicular protein SV2A, modifies synaptic release of glutatmate and
GABA; CI in
levetiracetam; schizophrenia
75
anticonvulsant with most extensive MOA and SE: indications (2 syndromes)
Topiramate; Lennox-Gastaut syndome; West syndrome
76
best measure of potency of inhaled anesthetics; alveolar concentration required to eliminate response to a painful stimulus in 50% of pts
minimum alveolar concentration
77
highest MAC (lowest potency), rapid onset and recovery; useful for ___; SE; good effect
nitrous oxide; minor surgery and dental procedures; megaloblastic anemia, euphoria; least cardiotoxic
78
lowest MAC (most potent) but highest partition coefficient (very slow onset and recovery)
methoxyflurane
79
blue anes bottle, poor induction agent due to pungent smell, rapid recovery; SE
desflurane; bronchospasm
80
yellow anes bottle, unstable in soda-lime, rapid onset and recovery, may cause renal insufficiency
sevoflurane
81
purple anes bottle with medium onset and recovery
isoflurane
82
orange anes bottle with medium onset and recovery; remarkable SE; use with caution in
enflurane; muscle twitching and breath holding; limited cardiac reserve
83
most hepatotoxic inhaled anesthetic, also causes malignant hyperthermia (tx:___)
halothane; dantrolene
84
IV anes which blocks excitation by glutamate at NMDA receptors; useful for dissociative anesthesia; notable SE
ketamine; hypertension
85
analgesia, amnesia, catatonia with retained consciousness
dissociative anesthesia
86
modulates GABAa receptors containing B3 subunits, useful for Pts with limited cardiac or respiratory reserve; notable SE
etomidate, adrenocortical suppression
87
opioid analgesic; ______ achieved by combining this with droperidol and nitrous oxide; antidote
fentanyl; neuroleptanesthesia; naloxone
88
useful for prolonged sedation, painful to inject, milk of amnesia
propofol
89
local anes: esters
only 1 i: tetracaine, procaine, benzocaine
90
local anes: amides
2 i's: bupivacaine, ropivacaine, lidocaine
91
local anes with shortest halflife; longest
procaine (1-2 mins), ropivacaine (4 hrs)
92
enhances/ antagonizes local anesthetic activity: hypercalcemia, hyperkalemia, acidic envt
antagonizes, enhances, antagonizes
93
all local anes are vasodilators EXCEPT; other SE
cocaine; abuse, hypertension, cerebral hemorrhage, cardiac arrhythmias, MI
94
toxic dose of lidocaine
5mg/kg
95
local anesthetic which causes skin irritation so used cautiously with sunburns or large skin areas
benzocaine, butamben
96
notable SE of tetracaine
antibody formation
97
MC arrhythmia caused by lidocaine
PVC
98
amide local anes which can cause methemoglobinemia; tx
prilocaine; methylene blue
99
amide local anesthetics (2) which can cause severe cardiotoxicity (CI as IV regional anes); tx
bupivacaine, ropivacaine; intralipid
100
nondepolarizing neuromuscular blocker with most rapid onset time; novel reversal agent
rocuronium; sugammadex
101
long-acting nondepolarizing neuromuscular blocker; notable SE; relatively contraindicated in ____
tubocurarine; recurarization; MI
102
reverses effects of nondepolarizing neuromuscular blockers
neostigmine
103
short-acting nondepolarizing neuromuscular blocker metabolized by pseudocholinesterase
mivacurium
104
intermediate acting nondepolarizing neuromuscular blocker which undergoes Hoffman elimination; similar drug with less adverse effects
atracurium, cisatracurium
105
intermediate acting nondepolarizing neuromuscular blocker which undergoes elimination in bile (hence shorter duration of action)
vecuronium
106
long-acting nondepolarizing neuromuscular blocker which undergoes elimination in kidneys, used in euthanasia, lethal injection and strychnine poisoning, also causes recurarization
pancuronium
107
drugs used for lethal injection
thiopental (sedation), pancuronium (apnea and respi arrest), KCl (cardiac arrest)
108
most impt mngt for Pts with hyperkalemia with ECG changes
Ca gluconate (cardioprotective)
109
causes fastest dec in K in hyperkalemic pts
NaHCO3, causes transcellular shift in K
110
phases of depolarizing blockade
1. depolarization, 2. desensitization
111
depolarizing neuromuscular blocker; notable SE (esp w/ halothane); metabolized via
succinylcholine; malignant hyperthermia; pseudocholinesterase
112
early sign of malignant hyperthermia
trismus
113
neurodegenerative disease caused by degeneration of dopaminergic neurons in substantia nigra; mnemonic
Parkinson's; PARK (postural instability, akinesia, resting tremor, cogwheel rigidity)
114
drugs which cause reversible parkinsonism
methylphenyltetrahydropyridine (MPTP), typical antipsychotics, reserpine
115
primary DOC for parkinsonism; MOA; causes 2 phenomena; ____ occurs when used with MAO inhibitors; CI
levodopa-carvidopa; levodopa is a dopamine precursor, carvidopa inhibits peripheral metabolism via dopa decarboxylase; on-off and wearing off phenomena; hypertensive crisis; psychosis
116
alternating periods of improved mobility and akinesia; DOC
on-off phenomenon; apomorphine
117
deterioration of drug effect in between medication doses; DOC
wearing off phenomenon; entacapone
118
partial agonist at D2 receptors in brain; used in hyper____; notable SE
bromocriptine/pergolide; prolactinemia; erythromelalgia, pulmonary fibrosis
119
partial agonist at D3 receptors in brain, used in restless legs syndrome; notable SE; CI
pramipexole/ropinirole; compulsive gambling, hypersexuality, overeating, uncontrollable tendency to fall asleep; PUD, pychotic illness, recent MI
120
partial agonist at D3 receptors in brain, also antagonist of 5-HT and alpha adrenoreceptor; also used in ______; notable SE so premedicate with____
apomorphine; erectile dysfunction, alzheimer's, alcoholism, opiate addiction; nausea; trimethobenzamide
121
MAO-B inhibitor leading to decreased degradation of dopa in the brain; combination with ___ causes agitation, delirium and death, ___ occurs with SSRIs
selegiline; meperidine; serotonin syndrome
122
COMT inhibitor leading to decreased degradation of dopa in the brain and L-dopa in periphery; similar drug causes hepatotoxicity; other notable SE
entacapone; tolcapone; neuroleptic malignant syndrome, rhabdomyolysis
123
antiparkinsonism drug which increases synthesis, release and reuptake of dopamine, antagonizes adenosine; also used to treat this virus; notable SE
amantadine; influenza A; livedo reticularis, peripheral edema
124
drugs which cause livedo reticularis
Queen Amanda Hydes Many Gems: Quinidine, Amantadine, Hydroxyurea, Minocycline, Gemcitabine
125
anti-parkinsonism drug which blocks muscarinic receptors; also used for EPS, causes atropine-like effects but may exacerbate tardive dyskinesias in prolonged use of antipsychotics
benztropine, biperiden, trihexyphenidyl, orphenadrine
