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Pharmacology > NSAIDs, sedative-hypnotics, alcohols, anti-seizure, anes, anti-parkinsons > Flashcards

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

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2
Q

ASA dose effective for reducing platelet aggregation; follows ____ order elimination

A

<300mg/day; first order

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3
Q

ASA dose effective as anti-inflamm; follows ____ order elimination

A

2400-4000mg/d; zero order

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4
Q

ASA intermediate dose for

A

antipyretic and analgesic

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5
Q

ASA toxic dose

A

150mg/kg (21 ASA 500mg tabs)

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6
Q

ASA lethal dose

A

30g (60 500mg tabs)

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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

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8
Q

prevents NSAID-induced gastritis

A

misoprostol

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9
Q

COX 2>COX1

A

meloxicam, peroxicam

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10
Q

only IV NSAID, used for post-surgical analgesia; purely analgesic, no anti-inflamm; use for ___ hrs only

A

Ketorolac; 72

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11
Q

nonselective reversible COX inhibitor used for gout and closure of PDA; special SE

A

indomethacin; hematologic (aplastic anemia, thrombocytopenia)

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12
Q

selective Cox-2 inhibitor; available IV form; risk for MI and stroke

A

celecoxib; parecoxib; rofecoxib and valdecoxib

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13
Q

selective Cox-3 inhibitor, weak effect on cox1 and 2; MC SE especially with _____ use; antidote

A

Paracetamol; hepatotoxicity; alcohol; NAC

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14
Q

similar drug of paracetamol which can cause renal papillary necrosis and interstitial nephritis

A

phenacetin

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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)

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16
Q

paracetamol toxic dose; lethal dose

A

150mg/kg; 15g

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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)

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18
Q

binds to TNF-a; used for Crohn’s disease, TV reactivation, lymphoma; synergistic effect w/ MTX

A

infliximab, etanercept

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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

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20
Q

DMARD also anti-malarial; SE; safe for pregnant?

A

chloroquine; ocular toxicity (retinal reposits); safe

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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

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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

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23
Q

inhibits inosine monophosphate dehydrogenase (impt in guanine synthesis), inhibits T-cell proliferation; SE

A

mycophenolate mofetil; reversible myelosuppression

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24
Q

DMARD which inhibits release of inflamm cytokines; SE

A

sulfasalazine; hemolytic anemia, methemoglobinemia; reversible infertility in men

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25
Q

microtubule assembly inhibitor, decreases macrophage migration and phagocytosis; used in gout and familial mediterranean fever; SE

A

colchicine; agranulocytosis, necrosis, ARF

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26
Q

first line for acute gouty attack; MOA

A

NSAIDS (indomethacin); inhibi`ts urate crsytal phagocytosis

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27
Q

competes with uric acid for reabsorption in the proximal tubules thereby increasing uric acid excretion; similar drug; SE; potentiates other weak acids e.g. (____)

A

probenecid; sulfinpyrazone; nephrotic syndrome (probenecid), aplastic anemia; penicillin, MTX

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28
Q

these drugs (3) may precipitate acute gout during early phase of drug action; so coadminister with ___ or ___

A

probenecid, allopurinol, febuxostat; colchicine or indomethacin

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29
Q

irreversible xanthine oxidase inhibitor, lowers production of uric acid; SE; inhibits metab of ___ and ___

A

allopurinol; peripheral neuritis, aplastic anemia, cataracts (idiosyncratic); mercaptopurine and azathioprine

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30
Q

first line for chronic gout, tumor lysis syndrome

A

allopurinol

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31
Q

reversible inhibitor of xanthine oxidase

A

febuxostat

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32
Q

GABA receptor effect of benzodiazepine; barbiturates; which is safer?

A

inc frequency, duration; benzodiazepine

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33
Q

short acting benzodiazepine; similar drugs; useful for

A

midazolam, brotizolam, trazolam, etizolam, oxazepam; anes induction

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34
Q

intermediate acting benzodiazepine; similar drugs

A

lorazepam, alprazolam, clonazepam, estazolam, nitrazepam, temazepam, lormazepam

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35
Q

causes both anterograde and retrograde amnesia hence banned in Phils

A

lorazepam

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36
Q

site of anterograde amnesia; retrograde

A

hippocampus; thalamus

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37
Q

abnormal sleep pattern from use of benzodiazepines

A

decreased REM sleep

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38
Q

long-acting benzodiazepine; similar drugs; used as a date rape drug

A

diazepam; chlorazepate, chlordiazepoxide, flurazepam, quazepam; flunitrazepam

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39
Q

benzodiazepine with longest half life

A

chlordiazepoxide

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40
Q

date rape drugs

A

alcohol, flunitrazepam (aka Rohypnol), gamma-hydroxybutyrate

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41
Q

toxic dose of benzodiazepine, antidote

A

1000x, flumazenil

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42
Q

ultrashort-acting barbiturate; similar drugs; used for (2)

A

thiopental, methohexital, thiamylal; anes induction, inc ICP

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43
Q

short/intermediate-acting barbiturates

A

pento, seco, amo, buta, aprobarbital, talbutal

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44
Q

long-acting barbiturate; useful in ____ syndrome

A

phenobarbital, mephobarbital, primidone; Gilbert’s syndrome (unconjugated hyperbilirubinemia)

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45
Q

remarkable SE of barbiturates; enzyme deficient

A

acute intermittent porphyria; hmb synthase

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46
Q

most catastrophic sx of sedative-hypnotic withdrawal

A

rebound suicide

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47
Q

newer hypnotic acting like a benzodiazepine used for insomnia; effects reversed with

A

zolpidem, zaleplon, eszopiclone; flumazenil

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48
Q

order of dependence among sedative-hypnotics

A

barbiturates>benzodiazepines>zolpidem

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49
Q

anxiolytic which partially antagonizes 5-HT1a receptors and possibly D2 receptos used for generalized anxiety d/o

A

buspirone

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50
Q

this system is responsible for ethanol metab at blood levels higher than 100mg/dl

A

microsomal ethanol oxidizing system (MEOS)

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51
Q

enzyme inhibited by disulfiram, metronidazole and some cephalosporins

A

aldehyde dehydrogenase

52
Q

blood alcohol concentration (BAC) causing impairment of driving ability

A

60-80mg/dL

53
Q

BAC causing sedation, “high”, slow reaction time

A

50-100 mg/dL

54
Q

BAC causing impaired motor fxn, slurred speech, ataxia

A

100-200mg/dL

55
Q

BAC causing emesis, stupor

A

200-300mg/dL

56
Q

BAC causing coma

A

300-400mg/dL

57
Q

dreaded emergency from alcohol intoxication, presents with ataxia, confusion, paralysis of EOM; hemorrhagic necrosis of ____

A

Wernicke-Korsakoff syndrome; mamillary bodies

58
Q

mental retardation, microcephaly, underdevt of midface region due to consumption during 1st trimester of pregnancy

A

fetal alcohol syndrome

59
Q

alcoholism increases risk of infection associated with; Sx

A

Klebsiella pneumoniae; currant jelly sputum

60
Q

sx of delirium tremens

A

HAD 48 (hallucination, autonomic instability, delirium 48-72 hrs after discontinuation)

61
Q

DOC for alcohol withdrawal syndrome

A

benzodiazepine

62
Q

disulfiram reaction

A

clara took the pre-medical test in the PM (chlorpropramide, cefoperazone, cefomandole, cefotetan, procarbazine, metronidazole)

63
Q

methanol toxicity manifestation; tx (also used in ___)

A

visual dysfunction (retinal damage) due to formaldehyde and formic acid; ethanol/fomepizole(inhibitor of alcohol dehydrogenase); ethylene glycol toxicity

64
Q

only antiseizure drug with effect on K+ receptor

A

oxcarbazepine

65
Q

anticonvulsant drug which blocks voltage gated Na channels, can also be used for arrhythmias (group 1b action); teratogenic effect

A

phenytoin; fetal hydantoin syndrome

66
Q

tricyclic anticonvulsant which blocks Na channels and decreases glutamate release; DOC for ____; SE

A

carbamezapine; trigeminal neuralgia; SJS

67
Q

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

A

valproic acid; spina bifida, NTD, hepatotoxicity

68
Q

preferred antiseizure drug in children and pregnants

A

phenobarbital

69
Q

decreases ca currents in thalamus; useful for absence seizures

A

ethosuximide

70
Q

DOCs for status epilepticus

A

lorazepam, diazepam, phenytoin, phenobarbital

71
Q

useful for infantile spasms

A

clonazepam

72
Q

used for postherpetic neuralgia, allodynia

A

gabapentin

73
Q

another anticonvulsant which may cause SJS, blocks Na, Ca and gluatamate channel

A

SJS

74
Q

binds synaptic vesicular protein SV2A, modifies synaptic release of glutatmate and
GABA; CI in

A

levetiracetam; schizophrenia

75
Q

anticonvulsant with most extensive MOA and SE: indications (2 syndromes)

A

Topiramate; Lennox-Gastaut syndome; West syndrome

76
Q

best measure of potency of inhaled anesthetics; alveolar concentration required to eliminate response to a painful stimulus in 50% of pts

A

minimum alveolar concentration

77
Q

highest MAC (lowest potency), rapid onset and recovery; useful for ___; SE; good effect

A

nitrous oxide; minor surgery and dental procedures; megaloblastic anemia, euphoria; least cardiotoxic

78
Q

lowest MAC (most potent) but highest partition coefficient (very slow onset and recovery)

A

methoxyflurane

79
Q

blue anes bottle, poor induction agent due to pungent smell, rapid recovery; SE

A

desflurane; bronchospasm

80
Q

yellow anes bottle, unstable in soda-lime, rapid onset and recovery, may cause renal insufficiency

A

sevoflurane

81
Q

purple anes bottle with medium onset and recovery

A

isoflurane

82
Q

orange anes bottle with medium onset and recovery; remarkable SE; use with caution in

A

enflurane; muscle twitching and breath holding; limited cardiac reserve

83
Q

most hepatotoxic inhaled anesthetic, also causes malignant hyperthermia (tx:___)

A

halothane; dantrolene

84
Q

IV anes which blocks excitation by glutamate at NMDA receptors; useful for dissociative anesthesia; notable SE

A

ketamine; hypertension

85
Q

analgesia, amnesia, catatonia with retained consciousness

A

dissociative anesthesia

86
Q

modulates GABAa receptors containing B3 subunits, useful for Pts with limited cardiac or respiratory reserve; notable SE

A

etomidate, adrenocortical suppression

87
Q

opioid analgesic; ______ achieved by combining this with droperidol and nitrous oxide; antidote

A

fentanyl; neuroleptanesthesia; naloxone

88
Q

useful for prolonged sedation, painful to inject, milk of amnesia

A

propofol

89
Q

local anes: esters

A

only 1 i: tetracaine, procaine, benzocaine

90
Q

local anes: amides

A

2 i’s: bupivacaine, ropivacaine, lidocaine

91
Q

local anes with shortest halflife; longest

A

procaine (1-2 mins), ropivacaine (4 hrs)

92
Q

enhances/ antagonizes local anesthetic activity: hypercalcemia, hyperkalemia, acidic envt

A

antagonizes, enhances, antagonizes

93
Q

all local anes are vasodilators EXCEPT; other SE

A

cocaine; abuse, hypertension, cerebral hemorrhage, cardiac arrhythmias, MI

94
Q

toxic dose of lidocaine

A

5mg/kg

95
Q

local anesthetic which causes skin irritation so used cautiously with sunburns or large skin areas

A

benzocaine, butamben

96
Q

notable SE of tetracaine

A

antibody formation

97
Q

MC arrhythmia caused by lidocaine

A

PVC

98
Q

amide local anes which can cause methemoglobinemia; tx

A

prilocaine; methylene blue

99
Q

amide local anesthetics (2) which can cause severe cardiotoxicity (CI as IV regional anes); tx

A

bupivacaine, ropivacaine; intralipid

100
Q

nondepolarizing neuromuscular blocker with most rapid onset time; novel reversal agent

A

rocuronium; sugammadex

101
Q

long-acting nondepolarizing neuromuscular blocker; notable SE; relatively contraindicated in ____

A

tubocurarine; recurarization; MI

102
Q

reverses effects of nondepolarizing neuromuscular blockers

A

neostigmine

103
Q

short-acting nondepolarizing neuromuscular blocker metabolized by pseudocholinesterase

A

mivacurium

104
Q

intermediate acting nondepolarizing neuromuscular blocker which undergoes Hoffman elimination; similar drug with less adverse effects

A

atracurium, cisatracurium

105
Q

intermediate acting nondepolarizing neuromuscular blocker which undergoes elimination in bile (hence shorter duration of action)

A

vecuronium

106
Q

long-acting nondepolarizing neuromuscular blocker which undergoes elimination in kidneys, used in euthanasia, lethal injection and strychnine poisoning, also causes recurarization

A

pancuronium

107
Q

drugs used for lethal injection

A

thiopental (sedation), pancuronium (apnea and respi arrest), KCl (cardiac arrest)

108
Q

most impt mngt for Pts with hyperkalemia with ECG changes

A

Ca gluconate (cardioprotective)

109
Q

causes fastest dec in K in hyperkalemic pts

A

NaHCO3, causes transcellular shift in K

110
Q

phases of depolarizing blockade

A
  1. depolarization, 2. desensitization
111
Q

depolarizing neuromuscular blocker; notable SE (esp w/ halothane); metabolized via

A

succinylcholine; malignant hyperthermia; pseudocholinesterase

112
Q

early sign of malignant hyperthermia

A

trismus

113
Q

neurodegenerative disease caused by degeneration of dopaminergic neurons in substantia nigra; mnemonic

A

Parkinson’s; PARK (postural instability, akinesia, resting tremor, cogwheel rigidity)

114
Q

drugs which cause reversible parkinsonism

A

methylphenyltetrahydropyridine (MPTP), typical antipsychotics, reserpine

115
Q

primary DOC for parkinsonism; MOA; causes 2 phenomena; ____ occurs when used with MAO inhibitors; CI

A

levodopa-carvidopa; levodopa is a dopamine precursor, carvidopa inhibits peripheral metabolism via dopa decarboxylase; on-off and wearing off phenomena; hypertensive crisis; psychosis

116
Q

alternating periods of improved mobility and akinesia; DOC

A

on-off phenomenon; apomorphine

117
Q

deterioration of drug effect in between medication doses; DOC

A

wearing off phenomenon; entacapone

118
Q

partial agonist at D2 receptors in brain; used in hyper____; notable SE

A

bromocriptine/pergolide; prolactinemia; erythromelalgia, pulmonary fibrosis

119
Q

partial agonist at D3 receptors in brain, used in restless legs syndrome; notable SE; CI

A

pramipexole/ropinirole; compulsive gambling, hypersexuality, overeating, uncontrollable tendency to fall asleep; PUD, pychotic illness, recent MI

120
Q

partial agonist at D3 receptors in brain, also antagonist of 5-HT and alpha adrenoreceptor; also used in ______; notable SE so premedicate with____

A

apomorphine; erectile dysfunction, alzheimer’s, alcoholism, opiate addiction; nausea; trimethobenzamide

121
Q

MAO-B inhibitor leading to decreased degradation of dopa in the brain; combination with ___ causes agitation, delirium and death, ___ occurs with SSRIs

A

selegiline; meperidine; serotonin syndrome

122
Q

COMT inhibitor leading to decreased degradation of dopa in the brain and L-dopa in periphery; similar drug causes hepatotoxicity; other notable SE

A

entacapone; tolcapone; neuroleptic malignant syndrome, rhabdomyolysis

123
Q

antiparkinsonism drug which increases synthesis, release and reuptake of dopamine, antagonizes adenosine; also used to treat this virus; notable SE

A

amantadine; influenza A; livedo reticularis, peripheral edema

124
Q

drugs which cause livedo reticularis

A

Queen Amanda Hydes Many Gems: Quinidine, Amantadine, Hydroxyurea, Minocycline, Gemcitabine

125
Q

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

A

benztropine, biperiden, trihexyphenidyl, orphenadrine

Pharmacology (7 decks)

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