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PHARM Flashcards

1
Q

3 direct cholinergic agonists

A

Carbachol
Bethanechol
Pilocarpine

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2
Q

6 Cholinergic Antagonists

A 
Atropine
Ipratropium
Scopolamine
Benztropine
Oxybutynin
Glucopyrrolate
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3
Q

4 Indrect cholinergic agonists (anti-acetylcholinesterases)

A

Neostigmine
Echothiophate
Donepezil
Edrophonium

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4
Q

Nicotinic antagonist

A

Hexamethonium

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5
Q

Cholinesterase regenerator

A

Pralidoxime

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6
Q

a1 a2 b1 b2 agonist

A

epinephrine

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7
Q

a1 a2 b1 agonist

A

norepinephrine

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8
Q

D1=D2 > B1 > a1 agonist

A

Dopamine

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9
Q

B1=B2 agonist

A

Isoproterenol

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10
Q

B2>B1 agonist

A

Dobutamine

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11
Q

a1>a2 agonist

A

Phenylephrine

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12
Q

HIV Rx that cause pancreattis

A

Ritonavir

NRTIs: Didanosine, stavudine, zalcitabine

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13
Q

HIV Rx that cause rash

A

NNRTIs: Nevirapine, Delavirdine, Efavirenz

Abacavir

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14
Q

Which HIV Rx cause lactic acidosis

A

All NNRTIs except abacavir

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15
Q

Which HIV Rx cause peripheral neuropathy?

A

NRTIs (Didanosine, Stavudine, Zalcitabine)

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16
Q

What birth defect results from lithium?

A

Ebstein anomaly - displacement of posterior and septal tricuspid valve leaflets towards the apex which leads to atrialization of the right ventricle.
It is associated with Wolff-Parkinson White

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17
Q

Which receptors use a Gs protein? There are 5.

A

B1, B2, V2, H2, D1

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18
Q

Name 3 drugs that regulate the secretion of gastric acid.

A

PPIs
H2 blockers
Anti-muscarinics (atropine)

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19
Q

Antacid that may cause diarrhea

A

Magnesium hydroxide

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20
Q

Antacid that may cause constipation

A

Aluminum hydroxide

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21
Q

Antacid that may cause rebound hypercalcemia

A

Calcium carbonate

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22
Q

Electrolyte abnormality commonly seen in administration of antacids

A

Hypokalemia

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23
Q

Main MOA of prokinetic agents

A

Increased ACh
Increased 5-HT
Decreased D2

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24
Q

MOA of Metoclopramide

A

Stimulates 5-HT4
Inhibits D2
Prokinetic agent –increases contractility and tone at rest
Indicated in diabetics with gastroparesis

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25
MOA of Domperidone
Inhibits D2
26
MOA of Cisapride
Stimulates 5-HT4
27
5 drugs known to cause seizures
``` Metoclopramide Buproprion Tramadol Enflurane Evening primrose oil ```
28
MOA of protease inhibitors
Inhibit viral assembly by blocking protease enzyme
29
MOA of fusion inhibitors
Bind viral glycoprotein 41, thus inhibiting fusion iwth CD4 cells
30
How does aspirin cause Reye syndrome?
The metabolites of aspirin inhibit mitochondrial enzymes, thus decreasing beta oxidation.
31
Medications used in treatment of chronic hep B and hep c?
IFN alpha is used to treat chronic hep B and hep C. | Ribavirin is also used to treat hep C.
32
Cocktail of meds taken by patients suffering from severe cirrhosis (4).
Lactulose to treat encephalopathy. Vitamin K to allow for maximum clotting potential (they are not producing coagulation factors as well --their liver sucks) Diuretics to treat ascites or edema. A beta blocker to prevent bleeding from esophageal varices.
33
MOA of drug of choice in hepatic encephalopathy
LACTULOSE Lactulose is a sugar that is not absorbed by the enterocytes. So the bacteria metabolize lactulose, creating this acidic environment. NH3 passes by the colon and it gets acidified -- > as a cation (NH4+), it can not get back into the body. Thus it is excreted in the stool.
34
Drug that inhibits conversion of dopa --> dopamine
Carbidopa (it is inhibiting dopa decarboxylase)
35
Treatment for cystinuria
Acetazolamide -- CAI that alkalinizes urine (prevents cystine stones)
36
Volume of distribution equation
Vd=amount of drug given (IV) / [drug] in plasma
37
Clearance equation
Cl=0.7 x Vd / T(1/2)
38
Loading Dose equation
LD = Css x Vd
39
Maintenance dose equation
MD = Css x Cl
40
7 P450 inhibitors
``` PICK EGS Protease inhibitors Isoniazid Cimetidine Ketoconazole Erythromycin Grapefruit juice Sulfonamides ```
41
7 P450 inducers
``` BCG PQRS Barbiturates Carbamazepine Griseofulvin Phenytoin Quinidine Rifampin St. John's Wort ```
42
pKa definition
the pH at which the amount of non-protonated form (A- or B) is equal to the amount of protonated form (HA or BH+)
43
Tx for an acidic drug overdose (e.g. salicylates)
NaHCO3 | Traps acidic drug in basic urine
44
Tx for basic drug OD (e.g. amphetamines)
NH4Cl | Traps basic drug in the acidic urine
45
General byproduct of Phase I metabolism and 3 reactions that take place
Slightly more polar metabolites | Oxidation, reduction, and hydrolysis
46
General byproduct of Phase II metabolism and 3 reactions that take place
Very polar metabolites (aka very inactive; thus easily renally excreted) Acetylation, sulfation, glucuronidation
47
Which hepatic phase of metabolism is lost first by geriatric patients?
Phase I
48
Which hepatic phase of metabolism is mediated by CYP450?
Phase I
49
4 Rx that cause disulfiram like reactions
Metronidazole Certain cephalosporins Procarbazine 1st generation sulfonylureas
50
Rx that inhibits alcohol dehydrogenase
Fomepizole
51
Rx that inhibits acetaldehyde dehydrogenase
Disulfiram
52
Ends in -tidine
H2 blockers
53
Ends in -mustine
Nitrosoureas
54
Ends in -glitazone
Thiazolinediones
55
Treatment for heparin-induced thrombocytopenia?
Anti-coagulate! Lepirudin or bivalirudin (direct thrombin inhibitors)
56
Diabetes drug that causes lactic acidosis (rare but serious)
Metformin
57
Diabetes drug thats most common SE is hypoglycemia
Sulfonylureas (gliburide, glipizide)
58
MOA of sulfonylureas
Closes potassium channel on the beta cells causing depolarization. This leads to an influx of calcium, causing insulin release!
59
MOA of acarbose
Inhibits alpha-glucosidase at intestinal brush border
60
MOA of pioglitazone (TZDs)
Agonist at PPAR gamma receptors
61
MOA of heparin
Cofactor for activation of anti-thrombin. Decreasing thrombin and decreasing factor Xa.
62
MOA and advantages of LMWH
Enoxaparin and dalteparin act more on factor Xa. Better bioavailability and longer half life. Can be admin subcutaneously and without lab monitoring.
63
Rx used in pateitns with HIT
Lepirduin and bivalirudin (direct thrombin inhibitors) that are derivatives of hirudin, the anticoagulant used by leeches. These are used as an alternative to heparin for anticoagulating patients with HIT.
64
Drug that increases [Warfarin]
Sulfonamide abx
65
3 drugs that decrease [Warfarin]
Bile acid sequestrants (e.g. cholestyramine) St. John's Wort Vitamin K
66
Lab value not altered by warfarin
Bleeding time
67
Lab values seen in thrombolytic use
Increased PT and PTT | NO CHANGE IN PLATELET COUNT.
68
MOA of thrombolytics
Directly or indirectly aid conversion of plasminogen to plasmin which cleaves thrombin and fibrin clots.
69
Toxicity of thrombolytics is treated with
aminocaproic acid
70
MOA of Hydroxyurea
Inhibits ribonucleotide reductase thus decreasing the production of deoxyribonucleotides. -indicated for use in sickle cell anemia, CML, psoriasis, myeloproliferative d/o, etc.
71
MOA of methotrexate
Inhibits eukaryotic dihydrofolate reductase (unlike TMP which inhibits prokaryotic dihydrofolate reductase)
72
MOA of mycophenolate
A reversible inhibitor of inosine monophosphate dehydrogenase (IMPDH) in purine (guanine) biosynthesis which is necessary for the growth of T cells and B cells
73
MOA of 6-mercaptopurine
Inhibits purine nucleotide synthesis and metabolism by inhibiting an enzyme called Phosphoribosyl pyrophosphate amidotransferase (PRPP Amidotransferase) -- the rate limiting enzyme of purine synthesis. Thus, 6-MP alters the synthesis and function of RNA and DNA. It also interferes with nucleotide interconversion and glycoprotein synthesis.
74
MOA of linezolid
Binds 50S, blocking translocation
75
MOA of Rifampin
Inhibits prokaryotic RNA polymerase
76
HIV rx that causes bone marrow suppression
Zidovudine
77
Tx for lead poisoning - In adults? - In children?
In adults: succimer, EDTA | In kids: dimercaprol, EDTA, succimer
78
An 11 y.o. child presents with a chronic non-healing ulcer and a small calcified spleen. What drug can improve his sx?
Hydroxyurea Hint: this is SCD
79
MOA of streptokinase
Directly or indirectly aid conversion of plasminogen to plasmin which cleaves thrombin and fibrin clots.
80
MOA of clopidogrel/ticlopidine
Inhibits platelet aggregation by irreversibly blocking ADP receptors. Also inhibits fibrinogen binding by preventing glycoprotein IIb/IIIa from binding to fibrinogen.
81
MOA of Abciximab/Eptifibatide/Tirofiban
Bind glycoprotein receptor IIb/IIIa on activated platelets, preventing aggregation. Used in NSTEMIs.
82
6 hormones that use tyrosine kinase receptors
``` Insulin IGF-1 FGF PDGF Prolactin Growth hormone ```
83
3 drugs that stimulate NE release
Amphetamine Ephedrine Tyramine
84
3 drugs that inhibit NE reuptake
Cocaine TCAs Amphetamine
85
CD4<200 begin prophylaxis with?
TMP-SMX Dapsone or aerosolized pentamidine Prophylaxis for PCP
86
CD4<100 begin prophylaxis with
TMP-SMX Dapsone pentamidine + leucovorin Prophylaxis for toxo if there is a + toxo IgG titer
87
CD4 <50 begin prophylaxis with
Single weekly dose of azithromycin to prevent a MAC infection.
88
Drug that interferes with Gp120
Miraviroc (CCR5)
89
Drug that interferes with Gp41
Enfuvirtide
90
Tx for E. coli infections
TMP-SMX | Fluoroquinolones
91
3 drugs that cause photosensitivity reactions
SAT for a photo Sulfonamides Amiodarone Tetracyclines
92
8 drugs to be avoided in patients with an allergy to sulfa
``` Celecoxib Furosemide Probenecid Thiazides TMP-SMX Sulfasalazine Sulfonylureas Acetazolamide ```
93
4 drug (classes) that cause Stevens Johnson syndrome
Penicillins Sulfa drugs Seizure drugs Allopurinol
94
4 clinical uses of TMP-SMX
UTIs Shigella/Salmonella MRSA AIDS - pneumocystis jiroveci pneumonia CD4<200
95
MOA and indications for Nitrofurantoin
Bacteriocidal --reduced by bacterial proteins to a reactive intermediate that inactivates bacterial ribosomes. Indicated for UTI cystitis (not pyelonephritis) by E. coli or S. saprophyticus (not Proteus) Safe in pregnancy :)
96
Indications for fluoroquinolones
Gram - (1st and 2nd generation like cipro) Pseudomonas Gram + (3rd and 4th generation like levo and moxi, respectively)
97
1 time you can use fluoroquinolones in pediatric patients
Cystic fibrosis
98
6 bugs treated with Metronidazole
``` GET GAP on the Metro Giardia lamblia Entamoeba histolytica Trichomonas Gardnerella vaginalis Anaerobes H. pylori ```
99
Tx for Chaga's disease
Nifurtimox
100
4 treatments for resistant malarias
Quinine + doxycycline Mefloquine Atovaquone-proguanil Artemether-lumefantrine
101
Tx for cutaneous leishmaniasis
Sodium stibogluconate
102
Tx for visceral leishmaniasis
Liposomal ampho B
103
How does the body metabolize 6-mercaptopurine?
Xanthine oxidase | Thus toxicity is increased if used with allopurinol (would use 6-thioguanine instead)
104
Anti-cancer drug used in rheumatoid diseases as well as ectopic pregnancies
Methotrexate
105
For which cancers is dactinomycin particularly useful and what is its MOA?
Wilm's tumor Ewing's sarcoma Rhabdomyosarcoma Intercalates in DNA therefore DNA cannot replicate
106
5 drugs that inhibit microtubules
``` Vinca drugs (vincristine/vinblastine) Taxanes (paclitaxel) Anti-helminthics (-bendazoles) Griseofulvin Colchicine ```
107
Myelosuppression induced by MTX can be reversed with administration of?
Leucovorin --folinic acid "rescue" agent
108
5-fluorouracil can be used topically to treat?
Actinic keratosis (prevent it from progressing to malignancy)
109
MOA of Cytarabine
Pyrimidine analog that inhibits DNA polymerase
110
Drug that chelates iron to prevent cardiotoxicity induced by doxorubicin
Dexrazoxane
111
2 cancer drugs associated with pulmonary fibrosis
Bleomycin | Busulfan
112
This alkylating agent is associated with CNS toxicity
Nitrosoureas (the -mustines) cross blood brain barrier and can cause CNS toxicity like dizziness and ataxia. They are used to treat brain tumors including GBM.
113
The hemorrhagic cystitis associated with cyclophosphamide can be prevented with what Rx?
Mesna | Binds acrolein which is a toxic metabolite
114
Toxicity of vincristine
Neurotoxicity (areflexia, peripheral neuritis), paralytic ileus
115
Toxicity of vinblastine
Vinblastine BLASTS bone marrow (suppression)
116
3 drugs used to treat testicular cancer
Eradicate Ball Cancer Etoposide Bleomycin Cisplatin
117
Monoclonal ab against CD20
Rituximab -- treats NHL and rheumatoid arthritis
118
2 anti-cancer agents that cause cardiotoxicity
Doxorubicin -- DILATED CARDIOMYOPATHY | Trastuzumab
119
Toxicity of cisplatin/carboplatin
Acoustic nerve damage and nephrotoxicity
120
3 anti-cancer agents that cause myelosuppression
5-FU 6-MP Methotrexate
121
Antibody against philadelphia chromosome
Imatinib
122
Intercalates DNA and produces oxygen free radicals
Doxorubicin | Daunorubicin
123
3 drugs that cause free-radical induced DNA strand breakage
Bleomycin Doxorubicin Daunorubicin
124
Tx for AML
Cytarabine
125
Tx for CML
Busulfan | Imatinib
126
Tx for Trypanosoma
Suramin or melarsoprol
127
When treating a patient long-term with Dapsone (maybe the patient has leprosy or dermatitis herpetiformis from Celiac disease), what would you want to supplement their tx with in order to prevent methemoglobinemia from occurring?
Cimetidine
128
Treatment for methemoglobinemia
Methylene blue, vitamin C
129
4 treatment options available for pulmonary hypertension
Bosentan, ambrisentan Prostaglandin analog (these decrease bronchial tone) Sildenafil Dihydropyridine CCB such as nifedipine
130
MOA of Bosentan
Tx for pulmonary hypertension | Antagonist of endothelium-1 receptor, thus decreasing pulmonary vascular resistance
131
Name 6 conditions treated with hyperbaric oxygen therapy.
``` Gas gangrene Decompression sickness Arterial gas embolism CO poisoning Osteomyelitis MI ```
132
Tx of choice for toxoplasma gondii
Sulfadiazine + pyrimethamine
133
Use and MOA of cyproheptadine
1st gen anti-histamine (H1) | Used as appetite stimulant since it has additional anti-cholinergic, anti-serotinergic, and local anesthetic properties
134
Use and MOA of promethazine
1st gen anti-histamine (H1) with anti-emetic and anti-cholinergic properties Therefore it is used to tx N/V
135
Use and MOA of chlorpheniramine
1st gen anti-histamine (H1) used in tx of allergies | Its in several OTC allergy/cold medicines.
136
Use and MOA of hydroxyzine
1st gen anti-histamine (H1) | Sedative, anti-itch
137
Use and MOA of meclizine
1st gen Anti-histamine (H1) and anti-emetic | Tx of vertigo
138
Long-acting prophylactic agents for asthma that may cause tremor and arrythmia
Salmeterol and formoterol (B2 agonists)
139
MOA of last-resort asthma treatment that blocks the actions of adenosine
Theophylline likely causes bronchodilation by inhibiting phosphodiesterase, thereby decreasing cAMP hydrolysis. Its limited in use due to its narrow therapeutic index, often causing cardiotoxicity and neurotoxicity.
140
Overdose of theophylline is treated with?
Beta blockers
141
MOA and use of cromolyn sodium
Inhibits the release of mast cell mediators such as histamine. Prophylaxis in asthma patients.
142
MOA of ipratropium, tiotropium
Competitively blocks muscarinic receptors, preventing bronchoconstriction. Used in asthma and COPD.
143
1st line inhaled therapy for chronic asthma and MOA
Corticosteroids -- Beclomethasone and fluticasone These inhibit the synthesis of virtually all cytokines. They inactivate NF-kB, the transcription factor that induces the production of TNF alpha among other inflammatory agents.
144
Tx for aspirin-induced asthma and MOA
Montelukast (better in 1 y.o. and up) Zafirlukast (5 y.o. and up) Block leukotriene receptors -- think lu kast = "last" ste in leukotriene synthesis
145
MOA of zileuton
5-lipoxygenase pathway inhibitor that blocks the conversion of arachidonic acid to leukotrienes
146
Drug used for allergic asthma resistant to inhaled steroids and long-acting B2 agonists and its MOA
Omalizumab --monoclonal anti-IgE Ab that binds mostly unbound serum IgE
147
What 3 conditions can be treated with N-acetylcysteine?
CF --cleaves disulfide bonds within mucous glycoproteins, thus loosening mucus plugs. Antidote in acetaminophen OD as it regenerates glutathione (an anti-oxidant). Can be taken orally to protect kidneys against contrast-induced nephropathy, as in diabetics with renal failure who need an emergency contrast CT.
148
3 things you need to check before placing a patient on amiodarone
Liver function tests Pulmonary function tests Thyroid function tests
149
2 major treatments of choice in anaerobic infections
Metronidazole | Clindamycin
150
Clinical uses for ampicillin/amoxicillin
``` H. influenzae E. coli, enterococci Listeria Proteus mirabilis Salmonella, Shigella ``` Hint: HEELPSS
151
3 anti-pseudomonal penicillins
Ticarcillin Carbencillin Piperacillin
152
Two different mechanisms of resistance used against penicillin agents
B-lactamase | Alteration of PBPs
153
2 beta lactamase inhibitors
Sulbactam | Clavulanic acid
154
Name 4 penicillinase-resistant penicillins and their toxicity.
Oxacillin, nafcillin, dicloxacillin, methicillin | Can cause interstitial nephritis
155
Drug that increases the half life of Penicillin G via blocking active renal secretion of penicillin
Probenicid
156
Jarish-Herxheimer phenomenon
Acute worsening of sx (fever, HA, muscle pains) soon after Pen G treatment due to released pyrogens from killed organisms, especially with tx of Syphilis
157
2 first gen cephalosporins and their clinical use.
``` Cefazolin, cephalexin PEcK Gram + cocci Proteus mirabilis E. coli Klebsiella pneumonia ```
158
3 second gen cephalosporins and their clinical uses
``` Cefoxitin, cefaclor, cefuroxime Gram + cocci, HEN PEcK** H. influenzae Enterbacter Neisseria Proteus mirabilis E. coli Klebsiella pneumonia Serratia marcescens ```
159
3 third gen cephalosporins and clinical uses.
Ceftriaxone, cefotaxime, ceftazidime Serious gram negative infections resistant to other B lactams. Ceftriaxone: Meningitis, CAP, gonorrhea Ceftazidime: P. aeruginosa
160
4th generation cephalosporin and clinical use
Cefepime | Super broad spec. Increased activity against Pseudomonas and gram + organisms.
161
3 main toxicities associated with cephalosporins
Vitamin K deficiency (thus increased risk of bleeds) INCREASED NEPHROTOXICITY if combined with aminoglycosides Disulfiram like reactions in some (Cefotetan, cefamandole, cefoperazone)
162
MOA and clinical use of aztreonam
Monobactam resistant to beta lactamases. Inhibits cell wall synthesis and binds to penicillin binding proteins. Its used for gram negative rods only in penicillin allergic patients and those with renal insufficiency who thus cannot tolerate aminoglycosides.
163
What drug is always administered with imipenem and how does this agent assist imipenem?
Cilastatin is an inhibitor of renal dehydropeptidase I, thus decreasing the inactivation of imipenem in renal tubules.
164
Against what organisms are imipenem and meropenem effective?
Empiric treatment of life threatening infections due to its serious side effects (like seizures)
165
Give 4 toxicities of Vancomycin.
Nephrotoxicity Ototoxicity Thrombophlebitis Red Man Syndrome (could have been treated prophylactically with anti histamines and slow infusion rate)
166
Only agent used as solo prophylaxis in TB
Isoniazid
167
MOA and side effects of Isoniazid
Decreased synthesis of mycolic acids. | Can cause neurotoxicity, hepatotoxicity, and drug-induced lupus.
168
What are the 4 R's of Rifampin?
RNA polymerase inhibitor Revs up microsomal cytochrome P450 Red/organge body fluids Rapid resistance if used alone
169
For which 4 infections if Rifampin used?
M. tuberculosis Leprosy Meningococcal prophylaxis Prophylaxis for H. influenzae type B
170
DOC in Mycoplasma pneumoniae
Tetracyclines, macrolides, or fluoroquinolones
171
DOC in early Lyme disease; DOC in late Lyme disease
Early: Doxycycline Late: Ceftriaxone
172
3 drug cocktail to treat Leprosy
Dapsone, Rifampin, Clofazimine for 6-24 months
173
Prophylaxis against bacterial endocarditis
Pen V Aminopenicillins Ampicillin 1st generation ceph (cephalexin)
174
What medications are used to treat CHF?
Digoxin B blockers ACE inhibitors Diuretics
175
What medications are used to treat acute heart failure?
LMNOP Lasix/loops Morphine (decreases stress -- > decreases symp system) Nitrates (dilates pulm vasculature) O2 Positioning/pressors --get pt to sit on edge of bed so that the blood pools in their legs, not lungs. :)
176
Hyperkalemia increases the toxicity of which class of anti-arrhythmics?
Class I.
177
Name 3 Class IA anti-arrhythmics, and their MOA.
Double Quarter Pounder = Disopyramide, Quinidine, Procainamide. These block the fast Na+ channels and decrease the slope of phase 0. This increases the overall duration of the AP and the effective refractory period as well as increase the QT intervals.
178
Procainamide is associated with 2 different things --treatment of what? Toxicity of?
Procainamide is used to treat Wolff Parkinson White syndrome. Also, it can cause drug-induced lupus --however, this is reversible.
179
Which subgroup of class I anti-arrhythmics can lead to Torsades de Pointe?
Class Ia, especially quinidine!
180
Name 4 Class Ib anti-arrhythmics and describe their MOA.
Lettuce, Tomato, Mayo, Pickles = Lidocaine, Tocainide, Mexiletine, and Phenytoin. These block fast Na+ channels in the inactivated state, thus decreasing conduction in hypoxic or ischemic cardiac states and decreasing the overall duration of the action potential.
181
DOC for ventricular arrhythmias (especially post-MI or digitalis-induced).
Lidocaine --also the least cardiotoxic of convential anti-arrhythmics.
182
What is the MOA of flecainide and propafenone? What is their clinical use as well as 2 major contraindications.
These are Class IC anti-arrhythmics that have no effect on AP duration. These are only used as a last-resort in refractory tachyarrythmias and are contraindicated in structural heart disease and post-MI since they are pro-arrythmic and significantly prolong the refractory period in the AV node.
183
Describe the MOA of class II anti-arrhythmics. Which Rx exacerbates vasospasm in Prinzmetal's angina and is thus contraindicated?
These beta blockers decrease SA and AV nodal activity by decreasing the cAMP and Ca2+ currents. It takes longer to reach threshold, so abnormal pacemakers are suppressed through the decrease in the Phase 4 slope. An increase in the PR interval is often seen. PROPRANOLOL can exacerbate vasospasm in Prinzmetal's angina.
184
Describe the MOA of Class III anti-arrhythmics and name 4 classic drugs part of this category.
Amiodarone, Ibutilide, Dofetilide, and Sotalol are K+ channel blockers. They slow down phase III of the ventricular action potential, which are mainly dependent on K+ currents. This increases both the AP duration and effective refractory period as well as the QT interval.
185
Which anti-arrhythmic can cause blue-gray skin deposits that lead to photodermatitis as well as corneal deposits?
Amiodarone.
186
How does Amiodarone cause pulmonary fibrosis?
It is a hapten which leads to chronic inflammatory states in our lungs --> fibrosis.
187
What is the MOA of class IV anti-arrhythmics?
Verapamil and diltiazem block L-type (SA, AV) slow channels, decreasing the slope of phase 0. This decreases conduction velocity while increasing the effective refractory period and PR interval.
188
Describe the MOA of adenosine and what clinical scenario it is most often used in.
Adenosine acts on Gi receptors, decreasing cAMP. This decreases the intracellular calcium current and increases the K+ current leaving the cell, thus hyper-polarizing the cell. It is the DOC in diagnosing/abolishing SVT.
189
Name 2 cardiovascular scenarios that Mg2+ can be used.
Torsades de Pointes Digoxin toxicity It decreases K+ efflux.
190
Name 2 abx that prolong the QT interval.
Macrolides | Chloroquine
191
Name 2 anti-psychotics that prolong the QT interval.
Haloperidol | Risperidone
192
Which class of HIV drugs prolong the QT interval?
HIV protease inhibitors (-navirs)
193
What is the tx for ventricular fibrillation?
CPR, defibrillation
194
What is the tx for ventricular tachycardia w/o a pulse?
CPR and defibrillation
195
How do nitrates assist in the treatment of angina?
NO decrease the preload, thus decreasing myocardial oxygen demand. They do NOT act to dilate the coronary arteries and increase blood flow/O2 supply.
196
What category of BP rx is preferred in treatment of aortic dissection?
B blockers as these decrease the slope of the rise in BP.
197
Describe how alpha 2 agonists relax smooth muscle cells.
Alpha 2 agonists cause an increased intracellular calcium, which converts L-arginine to citrulline and NO via cNOS. No then goes to activate guanylyl cyclase, responsible for the conversion of GTP to cGMP. This activates myosin phosphatase, which dephosphorylates myosin-phosphate into myosin, causing relaxation.
198
Patient presents complaining of hypertrichosis due to the BP medication you put them on. What is the MOA of this Rx?
Minoxidil (aka Rogaine) opens potassium channels and hyperpolarizes smooth muscle, resulting in relaxation of vascular smooth muscle. SE include hypertrichosis, hypotension, reflex tach, and fluid retention/edema.
199
Which anti-hypertensive can cause dry mouth, sedation, and severe rebound HTN?
Clonidine.
200
Name 3 classes of anti-hypertensives that can cause reflex tachycardia.
Nitrates Hydralazine Dihydropyridine CCBs
201
Patient presents with HTN + CHF. What are your initial therapeutic options? There are 5.
``` Diuretics ACE inhib ARB B-blocker Aldo antagonist ```
202
Which Rx should be avoided in patients with HTN + CHF?
B-blockers (in acute decompensated CHF or cardiogenic shock) | CCB
203
Patient presents with HTN + DM. What are your 2 initial therapeutic options and which Rx should be avoided?
Could use ACE inhib/ARB or thiazides. | Avoid B-blockers.
204
Patient presents post-MI with HTN. What are your initial therapeutic options?
``` Thiazide B-blocker ACE inhib/ARB CCB (as needed for angina) Nitrates (as needed for angina) ```
205
Patient presents with A fib and HTN. What are your initial therapeutic options?
Verapamil/Diltiazem (for rate control)
206
If patient has bradycardia and HTN, what 2 classes of medications do you want to avoid?
Diltiazem/verapamil | B-blocker
207
If patient has renal insufficiency, what class of drugs may both exacerbate and also be used as treatment?
ACE inhibitors/ARBs prevent proteinuria. However, they may decrease GFR, increasing creatininine. Additionally, K+ sparing diuretics may worsen renal insufficiency.
208
If patient has HTN + hyperparathyroidism, what is your treatment of choice? Which class do you avoid?
``` Use Loops (loops LOSE calcium). Avoid thiazides (lead to hypercalcemia.) ```
209
4 classes of drugs that can treat hypertension in a pregnant patient.
Hydralazine alpha Methyldopa Labetalol Dihydropyridine CCB
210
Patient has essential tremor + HTN. What is your DOC?
Propranolol
211
Patient with a history of poorly controlled HTN presents to the ER with papilledema, retinal hemorrhage, headache, vomiting, and proteinuria. What is your DOC and its MOA?
IV nitroprusside for treatment of malignant HTN. It increases cGMP via direct release of NO. You could also use Fenoldopam, a D1 receptor agonist thus causing dilation of coronary, peripheral, renal, and splanchnic vessels.
212
Which 2 lipid-lowering agents can cause elevated LFTs and myositis?
Statins --can also lead to rhabdomyolysis (especially when combined with fibrates) ==> RENAL FAILURE. Fibrates
213
Which lipid lowering agent has the best effect on HDL and what is its MOA?
Niacin which inhibits lipolysis in adipose tissue and reduces hepatic VLDL secretion into circulation.
214
Which lipid-lowering agent has the best effect on triglycerides/VLDL and what is their MOA?
Fibrates which upregulate lipoprotein lipase, increasing triglyceride clearance.
215
Which lipid-lowering agent binds C dif toxin?
Cholestyramine
216
Name 2 lipid lowering agents that can lead to cholesterol gallstonse.
Bile acid resins | Fibrates
217
CT of a patient demonstrates blood in cisterns of the brain. What drug do you administer?
Nimodipine (CCB) in order to prevent vasospasm that could occur due to blood breakdown and rebleed.
218
DOC in pseudotumor cerebri
Acetazolamide
219
Name 3 DA agonists used in treatment of PD.
Bromocriptine (ergot) Pramipexole Ropinirole Non-ergots are preferred.
220
Name 2 drugs that are used to increase dopamine in Parkinson's Disease.
Amantadine increases DA release (also used as anti-viral against influenza A and rubella) L-dopa/carbidopa
221
Name 3 drugs that prevent dopamine breakdown in the treatment of Parkinson's Disease.
Selegiline -- a selective MAO type B inhibitor | Entacapone, tolcapone - COMT inhibitors that prevent L-dopa degrdation
222
Name one antimuscarinic that is used to curb the excess cholinergic activity of Parkinson's.
Benztropine --improves tremor and rigidity.
223
Describe the MOA of L-dopa/carbidopa. What are 3 toxicities attributed to this tx and 2 scenarios in which you should NOT administer this drug to the patient?
L-dopa can cross BBB unlike dopamine, and is converted by dopa decarboxylase in the CNS to DA. Carbidopa is a peripheral decarboxylase inhibitor that is used to increase the bioavailability of L-dopa in the brain and limit peripheral side effects. It can cause arrhythmias due to the increased peripheral formation of catecholamines. It can also lead to dyskinesia following administration and akinesia between doses. Never administer to a patient on MAOIs or who also has melanoma.
224
Describe the MOA of Selegiline.
Administered adjunctively with L-dopa. Selectively inhibits MAO-B, which preferentially metabolizes DA over NE and 5-HT thereby increasing the availability of dopamine. However, this may enhance the adverse effects of L-dopa.
225
46 y.o. man presents to you complaining of frequent twitching in both of his arms and hands. You note +1 reflexes bilaterally at C7 as well as muscle strength 2/5 in both wrist extension and flexion. Upon further examination, you note pain and temperature sensation as well as eye movements remain intact. He is also oriented X3. What can you give this patient to help improve survival?
This is ALS. Riluzole decreases pysynaptic glutammate release and has been shown to modestly increase survival in these pts.
226
Name 2 drugs used to slow the progression of MS.
IFN beta | Natalizumab
227
A patient presents post-operatively with a fever of 103, HR of 160, RR of 32, muscle rigidity and acidosis. What is the MOA of the drug used to treat this condition?
This is malignant HTN treated with DANTROLENE. Dantrolene prevents the release of calcium from the sarcoplasmic reticulum via blocking the opening of the ryanodine receptor. This is also used in the tx of neuroleptic malignant syndrome (similar scenario with TCAs).
228
A 45 y.o. man presents with pannus, radial deviation, and swan-neck deformity in both hands. He also happens to mention he has recently seen his primary for another disorder, who treated him with Omeprazole. What drug do you choose to give him, and what is its MOA?
This patient has RA and was recently treated for gastric ulcers. Thus, the first line (NSAIDS) would be avoided in this patient because prostaglandins protect the gastric mucosa. Celecoxib reversibly inhibits COX 2, found in inflammatory and vascular endothelium and mediates inflammation and pain. Since it spares COX-1, it helps maintain gastric mucosa in this patient and thus is used in patients with RA and OA and patients that suffer from gastritis or ulcers. It should not be used in those with sulfa allergy.
229
This drug used to treat osteoporosis and Paget's disease of bone can cause corrosive esophagitis and osteonecrosis of the jaw. What is its MOA?
Bisphosphonates are pyrophosphate analogs that bind hydroxyapatite in bone, inhibiting osteoclast activity.
230
A patient with a history of gout presents to you saying his antibiotic for his recent strep throat is causing him severe diarrhea and rash. What drug is he most likely taking for his gout, and why is it causing toxicity?
Probenecid inhibits the reabsorption of uric acid in PCT and is thus sometimes used in tx of chronic gout. However, it also inhibits the secretion of penicillin, thus the patient is experiencing increased serum levels of PCN. Sometimes, this is actually beneficial and physicians do this on purpose to give the patient a lower dose of PCN (so the patient experiences less side effects), coadministering it with probenicid.
231
This drug inhibits xanthine oxidase, thus decreasing the conversion of xanthine to uric acid. What 2 drugs known to have increased concentrations under administration of this drug?
Allopurinol increases the concentrations of azathioprine and 6-MP. It is used in chronic gout as well as lymphoma and leukemia to prevent tumor lysis-associated urate nephropathy. Note: Febuxostat also inhibits xanthine oxidase.
232
This antifungal is a cell wall synthesis inhibitor used in invasive aspergillosis.
Caspofungin
233
These 2 antifungals bind ergosterol and form membrane pores.
Amphotericin B | Nystatin
234
These 2 antifungals inhibit ergosterol synthesis
-azole | Terbinafine
235
2 most common tx for onychomycosis
Terbinafine | -azoles
236
This antifungal can cause arrhythmias and nephrotoxicity.
Amphotericin B
237
This anti-fungal is important as it deposits in keratin-containing tissues
Griseofulvin
238
These anti funagls inhibit hormone synthesis and cytochrome P450.
-azoles, particularly Ketoconazole
239
These 2 antifungals can cause liver dysfunction
-azoles | Griseofulvin
240
Treatment of cryptococcal meningitis in AIDS
IV Ampho B + flucytosine
241
This antifungal is converted to fluorouracil, inhibiting DNA synthesis
Flucytosine
242
This is the DOC for sporotrichosis
Itraconazole
243
This antifungal can be used intrathecally for fungal meningitis
Amphotericin B
244
Clinical use for Griseofulvin
Dermatophytes (ringworm, athlete's foot) Tinea capitis Tinea unguium
245
Tx for dry macular degeneration
Smoking cessation | Supplementation of anti-oxidants
246
5 drug classes used in treatment of glaucoma
``` Alpha agonists B blockers Diuretics Cholinomimetics Prostaglandins ```
247
Tx of narcolepsy
Modafinil (treats daytime sleepiness -- its a stimulant)
248
SNRI used in tx of ADHD
Atomoxetine
249
A patient comes in belligerent, demonstrating nystagmus and homicidal ideations. What drug do you use to treat this?
This is PCP overdose Can use benzos and/or haloperidol to control seizures, agitation
250
What weak opioid agonist is commonly used in chronic pain control prior to prescribing stronger opioids?
Tramadol
251
4 Rx used to prevent relapse in recovering alcoholics
Disulfiram Topiramate Naltrexone Acamprosate
252
Drug used for heroin detoxification or long-term maintenance
Methadone
253
What drug combination is often used in recovering heroin addicts to lower abuse potential?
Naloxone + buprenorphine Naloxone is not active when taken orally so withdrawal symptoms occur only if injected
254
MOA of Memantine and toxicity
This is an Alzheimer's Rx that is an NMDA receptor antagonist, helping to prevent excitotoxicity mediated by Ca2+. It can cause dizziness, confusion, and hallucinations.
255
MOA of Donepezil, Galantamine, and Rivastigmine
These are Alzheimer's Rx that are all acetylcholinesterase inhibitors (remember, Alzheimer's pts have low ACh).
256
MOA and clinical use of Tetrabenazine and reserpine
Inhibit VMAT; limit dopamine vesicle packaging and release. Used in Huntington's (pts have elevated dopamine levels)
257
Dopamine receptor antagonist used in the treatment of Huntington's
Haloperidol
258
MOA of Sumatriptan and effects
5-HT 1B/1D agonist. Inhibits trigeminal nerve activation Prevents vasoactive peptide release Induces vasoconstriction
259
3 Contraindications to Sumatriptan use
Pregnancy CAD Prinzmetal's angina
260
How can you treat a pregnant patient who suffers from migraines?
Opioids
261
MOA of Selegiline
Selectively inhibits MAO-B, which preferentially metabolizes DA over NE and 5-HT, thereby increasing the availability of dopamine. It is an adjunctive agent to L-dopa in treatment of Parkinson's disease.
262
Which receptors do morphine, enkephalin, and dynorphin act at and what is their MOA?
These all act as agonists at opioid receptors (mu=morphine, delta=enkephalin, kappa=dynorphin) to modulate synaptic transmission by opening K+ channels and closing Ca2+ channels. This decreases synaptic transmission and inhibits the release of ACh, NE, 5-HT, glutamate, and substance P.
263
DOC in status epilepticus
Benzos (lorazopam and diazepam)
264
DOC in alcohol withdrawal to prevent delirium tremens
Benzodiazepines (Chlordiazepoxide)
265
Potent inhaled anesthetic associated with hepatotoxicity
Halothane
266
Inhaled anesthetic associated with nephrotoxicity
Methoxyflurane
267
Inhaled anesthetic associated with seizures
Enflurane
268
Only inhaled anesthetic not associated with malignant hyperthermia
Nitrous oxide
269
Inhaled anesthetic used in brain surgery
Isoflurane
270
Most common anesthetic used for endoscopy
Midazolam
271
Which anesthetics are associated with amnesia?
Benzos
272
Anesthetic used in kids that block NMDA receptors. What are some SE?
Ketamine -- causes disorientation, hallucinations, and bad dreams. "Special K" :)
273
This anesthetic potentiates GABA-A and has a high triglyceride content.
Propofol (can lead to acute pancreatitis) | This is why its only used short term.
274
A patient requires spinal anesthesia but tells you they are allergic to tetracaine. What drug can you administer instead?
Any of the amide anesthetics, which all have 2 I's. Lidocaine, bupivacaine, etc.
275
Order of nerve blockade in local anesthetics
Small myelinated> small unmyelinated > large myelinated > large unmyelinated
276
Local anesthetic associated with severe CV toxicity
Bupivacaine
277
Describe the MOA of succinylcholine.
This is the only depolarizing neuromuscular blocker. It is a strong ACh receptor agonist that produces sustained depolarization and prevents muscle contraction.
278
MOA of Tubocurarine
This is a non depolarizing NM blocker. It is a competitive antagonist at the ACh receptor.
279
Unexpected clinical use of phenobarbital
Can be used to treat Crigler Najjar type II as it increases liver enzymes.
280
MOA of dantrolene
Inhibits release of calcium from sarcoplasmic reticulum of skeletal muscle thus stopping muscle contraction.
281
DOC for partial (simple and complex) and tonic clonic seizures
Carbamazepine
282
Common SE of epilepsy drugs
``` Diplopia Sedation Ataxia Nystagmus Dizziness ```
283
5 AE of phenytoin
``` Gingival hyperplasia Hirsutism Fetal hydantoin syndrome CYP450 inducer SJS ```
284
Patient presents to you with her 2 year old saying that he is not progressing as well as other kids his age. You note a heart murmur as well as cleft lip. What drug did the mother most likely take during her pregnancy?
This is fetal hydantoin syndrome caused by phenytoin use during pregnancy. Causes MR, cleft lip, and cardiac defects.
285
Name 4 drugs that cause Stevens Johnson syndrome.
Seizure drugs Sulfonamides -cillins Allopurinol
286
6 drugs that cause agranulocytosis
``` Carbamazepine Clozapine Colchicine PTU Methimazole Dapsone ```
287
Which 3 anti epileptics are teratogens
Phenytoin Carbamazepine Valproic aicd
288
2 anti epileptics associated with hepatotoxicity
Valproic acid | Carbamazepine
289
5 Anti-epileptics that block Na+ channels
``` Carbamazepine Phenytoin Lamotrigine Topiramate Valproic acid ```
290
Which 5 anti-epileptics work by potentiating the inhibitory effects of GABA?
``` Valproic acid Phenobarbital Benzos Gabapentin Topiramate ```
291
3 high potency neuroleptics
Haloperidol Fluphenazine Trifluoperazine More extrapyrimidal sx than low-potency.
292
2 low potency neuroleptics
Chlorpromazine Thioridazine More anticholinergic, antihistamine, and a1-blockade effects than high-potency.
293
MOA of all antipsychotics
Block dopamine D2 receptors (increase [cAMP])
294
Toxic side effect associated with long-term use of antipsychotics
Tardive dyskinesia -- stereotypic oral-facial movements. Often irreversible. :(
295
Name 6 atypical antipsychotics.
``` Olanzapine Clozapine Quetiapine Risperidone Aripiprazole Ziprasidone ```
296
This anti-psychotic is reserved for refractory schizophrenia due to agranulocytosis.
Clozapine
297
Atypical antipsychotic that may prolong QT interval
Ziprasidone
298
Atypical antipsychotic associated with weight gain and increased risk of diabetes/metabolic syndrome
Olanzapine
299
Benefits of atypical vs typical antipsychotics
Antipsychotics have little to no effect on negative sx of schizophrenia, whereas atypicals are can treat both positive and negative sx of schizophrenia.
300
Atypical anti-psychotic that can be used in Parkinson's pts who are suffering from psychosis as a result of their tx
Quetiapine
301
Name 4 SSRIs
Fluoxetine Paroxetine Sertraline Citalopram Flashbacks paralyze senior citizens.
302
Treatment for serotonin syndrome
Cyproheptadine (5-HT2 receptor antagonist)
303
Symptoms of serotonin syndrome
``` Muscle rigidity Hyperthermia CV collapse Flushing Diarrhea Seizures Confusion Myoclonus ```
304
Which drug class of anti-depressants are known to cause sexual dysfunction?
SSRIs
305
SNRI used for fibromyalgia
Milnacipran
306
SNRI used for weight loss
Sibutramine
307
2 classic SNRIs
Venlafaxine | Duloxetine
308
SNRI also indicated for diabetic peripheral neuropathy
Duloxetine
309
Most common AE of SNRIs
Increased blood pressure
310
TCA used in obsessive compulsive d/o
Clomipramine
311
Symptoms of TCA overdose
``` Convulsions Coma Cardiotoxicity Hyperpyrexia Respiratory depression ```
312
MOA of tricyclic antidepressants as well as common suffixes
Block reuptake of NE and serotonin | Include -iptylines and -ipramines; also doxepin and amoxapine
313
4 MAOIs including 1 selective MAO-B inhibitor
Tranylcypromine Phenelzine Isocarboxazid Selegiline (selective MAO-B inhibitor also used in Parkinson's) MAO Takes Pride in Shangai
314
Class of anti-depressants that can cause hypertensive crisis with ingestion of tyramine
MAOIs (wine and cheese). Could also cause cardiac arrythmias and even hemorrhagic stroke.
315
Antidepressant used in bedwetting for children
Imipramine (TCA)
316
This antidepressant is known for NOT having any sexual SE.
Buproprion | -Also used in smoking cessation
317
MOA and clinical use of Mirtazapine
``` Alpha2 antagonist (increases release of NE, serotonin) and potent 5-HT2 and 5-HT3 antagonist. Can be used in anorexic or elderly patients to stimulate their appetite as well as depressed patients who are not sleeping well (induces sedation). ```
318
MOA of Maprotiline
Atypical antidepressant that blocks NE reuptake
319
MOA and serious AE of Trazodone
Inhibits serotonin reuptake Can cause PRIAPISM (its called TrazoBONE because of this). Nobody calls it that.
320
Whats the difference in the MOA of Benzos vs Barbiturates?
Benzos increase GABA by increasing the frequency* of chloride channel opening. Barbiturates increase GABA by increasing the duration* of chloride channel opening.
321
What kind of drug is Bumetanide?
Loop diuretic
322
What type of drug is metolazone?
Thiazide
323
Which diuretic would you use to treat Acute pulmonary edema
Loop
324
Which type of diuretics (2) would you use to treat mild to moderate CHF with expanded ECV?
Thiazide or loop
325
Which typeo f diuretic would you use to treat edema associated iwth nephrotic syndrome?
Loop
326
2 diuretics that cause acidemia
CAI (Decreases HCO3- reabsorption) K+ sparing (aldosterone blockade prevents K+ secretion and H+ secretion. Additionally, hyperkalemia leads to K+ entering al lcells via H/K exchanger, in exchange for H+ exiting cells.)
327
Which 2 diuretics cause alkalemia?
Loops and thiazides Volume contraction causes increased AT II --> Increased Na/H exchange in proximal tubule --> Increased HCO3- reabsorption. K+ loss leads to K+ exiting all cells via H/K exchanger in exchange for H entering cells. In low K+ state, H (rather than K+) is exchanged for Na+ in cortical collecting tubule, leading to alkalosis and paradoxical aciduria.
328
MOA and clinical use of aminoglycosides
Bactericidal -- inhibit formation of initiation complex and cause misreading of mRNA. Also block translocation. Used in severe gram negative rod infections.
329
With what type of abx are aminoglycosides synergistic? Why are they ineffective against anaerobes?
Work synergistically with beta lactams. | Ineffective because they require O2 for uptake.
330
MOA of Tetracyclines
Bacteriostatic -- bind to 30S and prevent attachment of aminoacyl-tRNA.
331
Which tetracyclines can be used in patients with renal failure?
Doxycycline | Minocycline
332
Clinical uses ofr tetracyclines
``` VACUuM THe BedRoom Vibrio cholera Acne Chlamydia Ureaplasma M. pneumo Tularemia H. pylori B. burgdorferi Rickettsia ```
333
What 3 things should you never take with tetracyclines?
Milk Antacids Iron-containing preparations
334
MOA of macrolides
Inhibit protein synthesis by blocking translocation (macroSLIDES!) Bind to 23S rRNA of 50S ribosomal subunit Bacteriostatic
335
Clinical uses for macrolides
Atypical pneumonia URIs STDs
336
What is the clinical use and side effects of Chloramphenicol?
Meningitis SE:Anemia (dose dependent) Aplastic anemia Gray baby syndrome
337
What are the clinical uses for clindamycin?
Anaerobic infection Aspiration pneumonia Lung abscesses MRSA
338
Examples of and MOA of Streptogramins
Quinupristin/Dalfopristin Synthesized by Streptomyces virginiae Streptogramin A bnds peptiyl transferase of 50S ribosomal subunit Streptogramin B: prevents protein chain extension
339
Uses of Streptogramins and SE
Uses: MRSA, VRE, staph and strep skin infections SE: hepatotoxicity, pseudomembranous colitis
340
Macrolide associated with acute cholestatic hepatitis
Erythromycin
341
AE of Macrolides
``` MACRO Motility issues Arrhythmia due to prolonged QT acute Cholestatic hepatitis (erythro) Rash eOsinophilia ```
342
MOA of Clindamycin
Blocks peptide transfer (transpeptidation) at 50S ribosomal subunit Bacteriostatic
343
Prophylaxis for recurrent UTIs
TMP-SMX (or nitrofurantoin)
344
Prophylaxis for gonorrhea (if a girl got raped and they do not know hx of rapist)
Ceftriaxone
345
Prophylaxis for postsurgical infection due to S. aureus
Cefazolin
346
Prophylaxis of strep pharyngitis in child with prior rheumatic fever
Oral penicillin
347
Tx of VRE
Linezolid and streptogramins (quinupristin/dalfopristin)
348
Drugs used in H. pylori triple therapy
PPI + amoxicillin + Clarithromycin If allergic to amox, use metronidazole
349
Clinical uses and side effects of polymyxins
Resistant gram negative infections SE: neurotoxicity, nephrotoxicity* *For this reason, used topically only.
350
Name 5 classes of abx effective against Pseudomonas
``` Fluoroquinolones Cefepime Aztreonam Aminoglycosides Extended spectrum penicillins ```
351
Abx avoided in pregnancy
``` Clarithromycin Metronidazole (1st trimester) Griseofulvin Chloramphenicol Sulfonamides Fluoroquinolones Tetracyclines Aminoglycosides Ribavirin ```
352
Side effects of Ganciclovir
Leukopenia Neutropenia (especially if AIDS pt taking ZDV) Renal toxicity Thrombocytopenia
353
MOA of Foscarnet
Viral DNA polymerase inhibitor that binds to the pyrophosphate-binding site of the enzyme (inhibits viral DNA polymerase). Does NOT require activation by viral kinase.
354
SE of Foscarnet
Nephrotoxicity
355
7 drugs or drug classes that cause anticholinergic SE
``` Atropine TCAs H1 blockers Low potency neuroleptics Digoxin Amantadine Promethazine ```
356
5 drugs that cause coronary vasospasm
``` Cocaine Amphetamines Methamphetamines Triptans Ergotamines ```
357
4 drugs that cause cutaneous flushing
Vanco Niacin Adenosine Dihydropyridine CCBs
358
6 drugs that cause torsades de pointes
``` Class III antiarrhythmics Class Ia anti-arrhythmics Macrolides Haloperidol Chloroquine Protease inhibitors ```
359
5 drugs that can cause aplastic anemia
``` Chloramphenicol Benzene NSAIDS PTU Methimazole ```
360
2 drugs associated with thrombocytopenia
Heparin | H2 blockers
361
9 things that can cause hemolysis in G6PD deficient patients
``` INH Sulfonamides Primaquine High dose ASA Ibuprofen Nitrofurantin Dapsone Fava beans Naphthalene ```
362
3 drugs that cause pulmonary fibrosis
Busulfan Bleomycin Amiodarone
363
4 drugs that cause focal to massive hepatic necrosis
Halothane Acetaminophen Valproic acid Amanita phalloides
364
Drug that can cause acute cholestatic hepatitis, jaundice
Erythromycin estylate
365
7 things associated with gynecomastia
``` Spironolactone Digitalis Cimetidine Estrogens Ketoconazole Marijuana Chronic alcohol use ```
366
2 drugs associated with hot flashes
Tamoxifen | Clomiphene
367
3 drugs associated with hypothyroidism
Lithium Amiodarone Sulfonamides
368
2 Rx that cause fat redistribution
Glucocorticoids | Protease inhibitors
369
2 drugs responsible for gingival hyperplasia
Phenytoin | Verapamil
370
4 drugs responsible for gout
Furosemide Thiazides Niacin Cyclosporine
371
8 drugs known for causing myopathies
``` Fibrates Niacin Colchicine Hydroxychloroquine IFN-alpha Penicillamine Statins Glucocorticoids ```
372
8 drugs associated with Stevens Johnson syndrome
``` Penicillin Ethosuximide Carbamazepine Sulfa drugs Lamotrigine Allopurinol Phenytoin Phenobarbital ```
373
2 drugs that can cause nephrogenic DI and how to treat this
Lithium and demeclocycline | TX: hydrochlorothiazine, indomethacin, amiloride if Lithium induced
374
3 things that can cause proximal renal tubular acidosis
Fanconi syndrome Expired tetracycline Heavy metal exposure Wilson disease
375
3 drugs associated with interstitial nephritis
Methicillin NSAIDs Furosemide
376
2 drugs associated with SIADH
Carbamazepine | Cyclophosphamide
377
3 drugs associated with Parkinson like syndrome
Antipsychotics Reserpine Metoclopramide
378
3 drugs that can cause increased lithium toxicity
Thiazides ACE inhibitors NSAIDs
379
Antidote for copper, arsenic, and gold poisoning
Penicillamine
380
TCA overdose antidote
Sodium bicarb
381
Theophylline OD antidote
Beta blocker
382
Methanol or ethylene glycol poisoning can be treated with?
Fomepizole | If unavailable use ethanol, dialysis
383
2 drugs used to treat PCOS
Ketoconazole (inhibits steroid synthesis via inhibition of 17,20-desmolase) and Spironolactone, which prevents steroid binding. Both cause gynecomastia and amenorrhea.
384
How does flutamide differ from finasteride in relation to MOA and clinical use?
Flutamide is an inhibitor of androgens at the testosterone receptor and is used for prostatic adenocarcinoma. Finasteride is a 5 alpha reducase inhibitor that prevents conversion of testosterone to DHT and is used for BPH and male pattern baldness.
385
What is a good choice of contraception for patients with MR?
Depo provera -- associated with bone mineral density loss
386
What is a contraindication to IUD use?
if patient has a high risk of STD
387
Why does HRT work in treatment of osteoporosis?
Decreased osteoclastic activity (decreases bone breakdown)
388
Best option for BC in mentally retarded patient
Depo
389
Why is progesterone used in combination with estrogen during estrogen replacement?
Unopposed estrogen increases the risk of endometrial cancer.
390
Pros of OCP use
Low failure rate Decreases risk of endometrial and ovarian cancers Decreases risk of ectopic pregnancy
391
MOA of drug that is used to treat endometriosis and hereditary angioedema
Danazol - synthetic androgen that acts as partial agonist at androgen receptors
392
How does the dosing of leuprolide affect its physiologic impact?
Puts women in synthetic menopause because it is a GnRH analog with agonist properties when used in pulsatile fashion. Antagonist properties when used in continuous fashion (downregulates GnRH receptor in pituitary --> decreased FSH/LH).
393
MOA of terbutaline
Beta 2 agonist that relaxes the uterus; reduces premature uterine contractions
394
MOA of drug used to treat infertility and PCOS
Clomiphene -- partial agonist at estrogen receptors in hypothalamus. Prevents normal feedback inhibition and increased release of LH and FSH from pituitary which stimulates ovulation.
395
MOA of mifepristone
Competitive inhibitor of progestins at progesterone receptors --causes termination of pregnancy
396
3 commonly used tocolytics
Magnesium sulfate Ritodrine Terbutaline
397
A 58 y.o. post-menopausal woman is on Tamoxifen. What is she at increased risk of acquiring and what is this drugs MOA?
Endometrial cancer Tamoxifen is an antagonist on breast tissue and used to treat and prevent recurrence of ER positive breast cancer.
398
Describe the MOA of anastrozole/exemestane.
Aromatase inhibitors used in post-menopausal women with breast cancer.
399
3 short acting benzodiaepines
Triazolam Oxazepam Midazolam Because they are short-acting, they have higher addictive potential.
400
Vitamin that should never be administered with levodopa
B6. It increases the peripheral metabolism of levodopa, thus decreasing its effects (less enters CNS.)
401
3 drugs used in treatment of acute manic episode
Mood stabilizers Lithium Valproic acid Carbamazepine Often administered with an atypical antipsychotic like olanzapine.
402
3 drugs used to treat oculogyric crisis
Oculogyric crisis is an acute dystonic reaction to anti-psychoticcs such as haloperidol and fluphenazine. Other sx include restlessness, agitation, or a fixed stare. It can be treated with diphenhydramine, benztropine, or amantadine.

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