Pharm Flashcards
NMS vs serotonin syndrome
- Timeline
NMS - 1-3 days
Serotonin syndrome <12 hours
NMS vs serotonin syndrome
- Neuro
NMS - hyporeflexia, but diffuse lead pipe rigidity
Serotonin syndrome - hyperreflexia, clonus, ocular signs and pupil dilation
NMS vs serotonin syndrome
- Bowels
NMS - hypoactive
Serotonin - hyperactive
NMS vs serotonin syndrome
- Pathophys and Rx
NMS - Da antagonists. Rx with bromocriptine (Da agonist)
Serotonin syndrome. Serotenergic agents. Managed with cyproheptadine
Medication CI with tamoxifen due to CYP2D6 inhibition (reduced conversion)
Paroxetine/fluoxetine`
CYP2C19 - pro-drugs that are converted to active form by this cyp enzyme
Clopidogrel (clopidogrel resistance)
PPI’s
Use pantoprazole as competes least with clopidogrel when concurrently used
Which rate control is substrate of CYP2D6
Metoprolol
Can decrease excretion of Lithium
Thiazide
ACEi
P gylcoprotein inhibitiors
Ketoconazole
Verapamil
Hypertension
Tachycardia
Fever
Pupil dilation
Sympathomimetic toxidrome
Differentiate between MDA and cocaine OD
Cocaine more likely to have conduction abnormalities (due to Na channel blockade)
Biosimilar
When biologic becomes off patent, near identical cheaper version
Phase 1 reaction
- End product
- Processes
- Enzyme
Reactive metabolites
Via oxidation, reduction, hydrolysis
CYP class enzymes
Phase 2 reactions
- End product
- Processes
REactive metabolite –> conjugated drug
Multiple processes - glurodination, sulfation, acetylation etc
Phase 3 reaction
Conjugate drug transport intol bile - P GP
Drug that skip phase I and direct phase II
Isoniazid - acetylation
Medication causing most severe serotonin syndrome
MAO - CNS specific
Long halflife SSRI’s
Fluoextine
Norfluoextine - 2.5 wees (metabolite)
Smoking cessation and concomittant psychiatric disorder
Varenicline (nicotinic receptor agonist)
Smoking cessation, history of seizure disorder - do not use?
Bupropion
Clearance formula with AUC?
Clearance = dose/AUC
ANtipsychotic most associated with photosensitivity
Clozapine
Gentamicin ineffective in which body location?
Lung
Bilateral schqannomas
NF2
2 formulas for renal clearance
1) - fraction unbound x GFR
2) Urine conc/Plasma conc. (proportion) x Urine output (L/hr)
Clearance formula with AUC
Cl =
AUC
Clearance formula with elimination
El = Cl x Css / F
CYP inducers
CRP GPSS
CBZ
Rifampacin
Phenytoin
Griseofulvin
Phenobarbitol
Smoking/SUlfonylureas
St Johns Wort
