PHARM Flashcards
3 direct cholinergic agonists
Carbachol
Bethanechol
Pilocarpine
6 Cholinergic Antagonists
Atropine Ipratropium Scopolamine Benztropine Oxybutynin Glucopyrrolate
4 Indrect cholinergic agonists (anti-acetylcholinesterases)
Neostigmine
Echothiophate
Donepezil
Edrophonium
Nicotinic antagonist
Hexamethonium
Cholinesterase regenerator
Pralidoxime
a1 a2 b1 b2 agonist
epinephrine
a1 a2 b1 agonist
norepinephrine
D1=D2 > B1 > a1 agonist
Dopamine
B1=B2 agonist
Isoproterenol
B2>B1 agonist
Dobutamine
a1>a2 agonist
Phenylephrine
HIV Rx that cause pancreattis
Ritonavir
NRTIs: Didanosine, stavudine, zalcitabine
HIV Rx that cause rash
NNRTIs: Nevirapine, Delavirdine, Efavirenz
Abacavir
Which HIV Rx cause lactic acidosis
All NNRTIs except abacavir
Which HIV Rx cause peripheral neuropathy?
NRTIs (Didanosine, Stavudine, Zalcitabine)
What birth defect results from lithium?
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
Which receptors use a Gs protein? There are 5.
B1, B2, V2, H2, D1
Name 3 drugs that regulate the secretion of gastric acid.
PPIs
H2 blockers
Anti-muscarinics (atropine)
Antacid that may cause diarrhea
Magnesium hydroxide
Antacid that may cause constipation
Aluminum hydroxide
Antacid that may cause rebound hypercalcemia
Calcium carbonate
Electrolyte abnormality commonly seen in administration of antacids
Hypokalemia
Main MOA of prokinetic agents
Increased ACh
Increased 5-HT
Decreased D2
MOA of Metoclopramide
Stimulates 5-HT4
Inhibits D2
Prokinetic agent –increases contractility and tone at rest
Indicated in diabetics with gastroparesis
MOA of Domperidone
Inhibits D2
MOA of Cisapride
Stimulates 5-HT4
5 drugs known to cause seizures
Metoclopramide Buproprion Tramadol Enflurane Evening primrose oil
MOA of protease inhibitors
Inhibit viral assembly by blocking protease enzyme
MOA of fusion inhibitors
Bind viral glycoprotein 41, thus inhibiting fusion iwth CD4 cells
How does aspirin cause Reye syndrome?
The metabolites of aspirin inhibit mitochondrial enzymes, thus decreasing beta oxidation.
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.
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.
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.
Drug that inhibits conversion of dopa –> dopamine
Carbidopa (it is inhibiting dopa decarboxylase)
Treatment for cystinuria
Acetazolamide – CAI that alkalinizes urine (prevents cystine stones)
Volume of distribution equation
Vd=amount of drug given (IV) / [drug] in plasma
Clearance equation
Cl=0.7 x Vd / T(1/2)
Loading Dose equation
LD = Css x Vd
Maintenance dose equation
MD = Css x Cl
7 P450 inhibitors
PICK EGS Protease inhibitors Isoniazid Cimetidine Ketoconazole Erythromycin Grapefruit juice Sulfonamides
7 P450 inducers
BCG PQRS Barbiturates Carbamazepine Griseofulvin Phenytoin Quinidine Rifampin St. John's Wort
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+)
Tx for an acidic drug overdose (e.g. salicylates)
NaHCO3
Traps acidic drug in basic urine
Tx for basic drug OD (e.g. amphetamines)
NH4Cl
Traps basic drug in the acidic urine
General byproduct of Phase I metabolism and 3 reactions that take place
Slightly more polar metabolites
Oxidation, reduction, and hydrolysis
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
Which hepatic phase of metabolism is lost first by geriatric patients?
Phase I
Which hepatic phase of metabolism is mediated by CYP450?
Phase I
4 Rx that cause disulfiram like reactions
Metronidazole
Certain cephalosporins
Procarbazine
1st generation sulfonylureas
Rx that inhibits alcohol dehydrogenase
Fomepizole
Rx that inhibits acetaldehyde dehydrogenase
Disulfiram
Ends in -tidine
H2 blockers
Ends in -mustine
Nitrosoureas
Ends in -glitazone
Thiazolinediones
Treatment for heparin-induced thrombocytopenia?
Anti-coagulate! Lepirudin or bivalirudin (direct thrombin inhibitors)
Diabetes drug that causes lactic acidosis (rare but serious)
Metformin
Diabetes drug thats most common SE is hypoglycemia
Sulfonylureas (gliburide, glipizide)
MOA of sulfonylureas
Closes potassium channel on the beta cells causing depolarization. This leads to an influx of calcium, causing insulin release!
MOA of acarbose
Inhibits alpha-glucosidase at intestinal brush border
MOA of pioglitazone (TZDs)
Agonist at PPAR gamma receptors
MOA of heparin
Cofactor for activation of anti-thrombin. Decreasing thrombin and decreasing factor Xa.
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.
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.
Drug that increases [Warfarin]
Sulfonamide abx
3 drugs that decrease [Warfarin]
Bile acid sequestrants (e.g. cholestyramine)
St. John’s Wort
Vitamin K
Lab value not altered by warfarin
Bleeding time
Lab values seen in thrombolytic use
Increased PT and PTT
NO CHANGE IN PLATELET COUNT.
MOA of thrombolytics
Directly or indirectly aid conversion of plasminogen to plasmin which cleaves thrombin and fibrin clots.
Toxicity of thrombolytics is treated with
aminocaproic acid
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.
MOA of methotrexate
Inhibits eukaryotic dihydrofolate reductase (unlike TMP which inhibits prokaryotic dihydrofolate reductase)
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
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.
MOA of linezolid
Binds 50S, blocking translocation
MOA of Rifampin
Inhibits prokaryotic RNA polymerase
HIV rx that causes bone marrow suppression
Zidovudine
Tx for lead poisoning
- In adults?
- In children?
In adults: succimer, EDTA
In kids: dimercaprol, EDTA, succimer
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
MOA of streptokinase
Directly or indirectly aid conversion of plasminogen to plasmin which cleaves thrombin and fibrin clots.
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.
MOA of Abciximab/Eptifibatide/Tirofiban
Bind glycoprotein receptor IIb/IIIa on activated platelets, preventing aggregation.
Used in NSTEMIs.
6 hormones that use tyrosine kinase receptors
Insulin IGF-1 FGF PDGF Prolactin Growth hormone
3 drugs that stimulate NE release
Amphetamine
Ephedrine
Tyramine
3 drugs that inhibit NE reuptake
Cocaine
TCAs
Amphetamine
CD4<200 begin prophylaxis with?
TMP-SMX
Dapsone or aerosolized pentamidine
Prophylaxis for PCP
CD4<100 begin prophylaxis with
TMP-SMX
Dapsone pentamidine + leucovorin
Prophylaxis for toxo if there is a + toxo IgG titer
CD4 <50 begin prophylaxis with
Single weekly dose of azithromycin to prevent a MAC infection.
Drug that interferes with Gp120
Miraviroc (CCR5)
Drug that interferes with Gp41
Enfuvirtide
Tx for E. coli infections
TMP-SMX
Fluoroquinolones
3 drugs that cause photosensitivity reactions
SAT for a photo
Sulfonamides
Amiodarone
Tetracyclines
8 drugs to be avoided in patients with an allergy to sulfa
Celecoxib Furosemide Probenecid Thiazides TMP-SMX Sulfasalazine Sulfonylureas Acetazolamide
4 drug (classes) that cause Stevens Johnson syndrome
Penicillins
Sulfa drugs
Seizure drugs
Allopurinol
4 clinical uses of TMP-SMX
UTIs
Shigella/Salmonella
MRSA
AIDS - pneumocystis jiroveci pneumonia CD4<200
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 :)
Indications for fluoroquinolones
Gram - (1st and 2nd generation like cipro)
Pseudomonas
Gram + (3rd and 4th generation like levo and moxi, respectively)
1 time you can use fluoroquinolones in pediatric patients
Cystic fibrosis
6 bugs treated with Metronidazole
GET GAP on the Metro Giardia lamblia Entamoeba histolytica Trichomonas Gardnerella vaginalis Anaerobes H. pylori
Tx for Chaga’s disease
Nifurtimox
4 treatments for resistant malarias
Quinine + doxycycline
Mefloquine
Atovaquone-proguanil
Artemether-lumefantrine
Tx for cutaneous leishmaniasis
Sodium stibogluconate
Tx for visceral leishmaniasis
Liposomal ampho B
How does the body metabolize 6-mercaptopurine?
Xanthine oxidase
Thus toxicity is increased if used with allopurinol (would use 6-thioguanine instead)
Anti-cancer drug used in rheumatoid diseases as well as ectopic pregnancies
Methotrexate
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
5 drugs that inhibit microtubules
Vinca drugs (vincristine/vinblastine) Taxanes (paclitaxel) Anti-helminthics (-bendazoles) Griseofulvin Colchicine
Myelosuppression induced by MTX can be reversed with administration of?
Leucovorin –folinic acid “rescue” agent
5-fluorouracil can be used topically to treat?
Actinic keratosis (prevent it from progressing to malignancy)
MOA of Cytarabine
Pyrimidine analog that inhibits DNA polymerase
Drug that chelates iron to prevent cardiotoxicity induced by doxorubicin
Dexrazoxane
2 cancer drugs associated with pulmonary fibrosis
Bleomycin
Busulfan
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.
The hemorrhagic cystitis associated with cyclophosphamide can be prevented with what Rx?
Mesna
Binds acrolein which is a toxic metabolite
Toxicity of vincristine
Neurotoxicity (areflexia, peripheral neuritis), paralytic ileus
Toxicity of vinblastine
Vinblastine BLASTS bone marrow (suppression)
3 drugs used to treat testicular cancer
Eradicate Ball Cancer
Etoposide
Bleomycin
Cisplatin
Monoclonal ab against CD20
Rituximab – treats NHL and rheumatoid arthritis
2 anti-cancer agents that cause cardiotoxicity
Doxorubicin – DILATED CARDIOMYOPATHY
Trastuzumab
Toxicity of cisplatin/carboplatin
Acoustic nerve damage and nephrotoxicity
3 anti-cancer agents that cause myelosuppression
5-FU
6-MP
Methotrexate
Antibody against philadelphia chromosome
Imatinib
Intercalates DNA and produces oxygen free radicals
Doxorubicin
Daunorubicin
3 drugs that cause free-radical induced DNA strand breakage
Bleomycin
Doxorubicin
Daunorubicin
Tx for AML
Cytarabine
Tx for CML
Busulfan
Imatinib
Tx for Trypanosoma
Suramin or melarsoprol
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
Treatment for methemoglobinemia
Methylene blue, vitamin C
4 treatment options available for pulmonary hypertension
Bosentan, ambrisentan
Prostaglandin analog (these decrease bronchial tone)
Sildenafil
Dihydropyridine CCB such as nifedipine
MOA of Bosentan
Tx for pulmonary hypertension
Antagonist of endothelium-1 receptor, thus decreasing pulmonary vascular resistance
Name 6 conditions treated with hyperbaric oxygen therapy.
Gas gangrene Decompression sickness Arterial gas embolism CO poisoning Osteomyelitis MI
Tx of choice for toxoplasma gondii
Sulfadiazine + pyrimethamine
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
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
Use and MOA of chlorpheniramine
1st gen anti-histamine (H1) used in tx of allergies
Its in several OTC allergy/cold medicines.
Use and MOA of hydroxyzine
1st gen anti-histamine (H1)
Sedative, anti-itch
Use and MOA of meclizine
1st gen Anti-histamine (H1) and anti-emetic
Tx of vertigo
Long-acting prophylactic agents for asthma that may cause tremor and arrythmia
Salmeterol and formoterol (B2 agonists)
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.
Overdose of theophylline is treated with?
Beta blockers
MOA and use of cromolyn sodium
Inhibits the release of mast cell mediators such as histamine.
Prophylaxis in asthma patients.
MOA of ipratropium, tiotropium
Competitively blocks muscarinic receptors, preventing bronchoconstriction. Used in asthma and COPD.
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.
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
MOA of zileuton
5-lipoxygenase pathway inhibitor that blocks the conversion of arachidonic acid to leukotrienes
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
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.
3 things you need to check before placing a patient on amiodarone
Liver function tests
Pulmonary function tests
Thyroid function tests
2 major treatments of choice in anaerobic infections
Metronidazole
Clindamycin
Clinical uses for ampicillin/amoxicillin
H. influenzae E. coli, enterococci Listeria Proteus mirabilis Salmonella, Shigella
Hint: HEELPSS
3 anti-pseudomonal penicillins
Ticarcillin
Carbencillin
Piperacillin
Two different mechanisms of resistance used against penicillin agents
B-lactamase
Alteration of PBPs
2 beta lactamase inhibitors
Sulbactam
Clavulanic acid
Name 4 penicillinase-resistant penicillins and their toxicity.
Oxacillin, nafcillin, dicloxacillin, methicillin
Can cause interstitial nephritis
Drug that increases the half life of Penicillin G via blocking active renal secretion of penicillin
Probenicid
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
2 first gen cephalosporins and their clinical use.
Cefazolin, cephalexin PEcK Gram + cocci Proteus mirabilis E. coli Klebsiella pneumonia
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
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
4th generation cephalosporin and clinical use
Cefepime
Super broad spec. Increased activity against Pseudomonas and gram + organisms.
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)
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.
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.
Against what organisms are imipenem and meropenem effective?
Empiric treatment of life threatening infections due to its serious side effects (like seizures)
Give 4 toxicities of Vancomycin.
Nephrotoxicity
Ototoxicity
Thrombophlebitis
Red Man Syndrome (could have been treated prophylactically with anti histamines and slow infusion rate)
Only agent used as solo prophylaxis in TB
Isoniazid
MOA and side effects of Isoniazid
Decreased synthesis of mycolic acids.
Can cause neurotoxicity, hepatotoxicity, and drug-induced lupus.
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
For which 4 infections if Rifampin used?
M. tuberculosis
Leprosy
Meningococcal prophylaxis
Prophylaxis for H. influenzae type B
DOC in Mycoplasma pneumoniae
Tetracyclines, macrolides, or fluoroquinolones
DOC in early Lyme disease; DOC in late Lyme disease
Early: Doxycycline
Late: Ceftriaxone
3 drug cocktail to treat Leprosy
Dapsone, Rifampin, Clofazimine for 6-24 months
Prophylaxis against bacterial endocarditis
Pen V
Aminopenicillins
Ampicillin
1st generation ceph (cephalexin)
What medications are used to treat CHF?
Digoxin
B blockers
ACE inhibitors
Diuretics
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. :)
Hyperkalemia increases the toxicity of which class of anti-arrhythmics?
Class I.
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.
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.
Which subgroup of class I anti-arrhythmics can lead to Torsades de Pointe?
Class Ia, especially quinidine!
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.
DOC for ventricular arrhythmias (especially post-MI or digitalis-induced).
Lidocaine –also the least cardiotoxic of convential anti-arrhythmics.
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.
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.
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.
Which anti-arrhythmic can cause blue-gray skin deposits that lead to photodermatitis as well as corneal deposits?
Amiodarone.
How does Amiodarone cause pulmonary fibrosis?
It is a hapten which leads to chronic inflammatory states in our lungs –> fibrosis.
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.
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.
Name 2 cardiovascular scenarios that Mg2+ can be used.
Torsades de Pointes
Digoxin toxicity
It decreases K+ efflux.
Name 2 abx that prolong the QT interval.
Macrolides
Chloroquine
Name 2 anti-psychotics that prolong the QT interval.
Haloperidol
Risperidone
Which class of HIV drugs prolong the QT interval?
HIV protease inhibitors (-navirs)
What is the tx for ventricular fibrillation?
CPR, defibrillation
What is the tx for ventricular tachycardia w/o a pulse?
CPR and defibrillation
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.
What category of BP rx is preferred in treatment of aortic dissection?
B blockers as these decrease the slope of the rise in BP.
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.
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.
Which anti-hypertensive can cause dry mouth, sedation, and severe rebound HTN?
Clonidine.
Name 3 classes of anti-hypertensives that can cause reflex tachycardia.
Nitrates
Hydralazine
Dihydropyridine CCBs
Patient presents with HTN + CHF. What are your initial therapeutic options? There are 5.
Diuretics ACE inhib ARB B-blocker Aldo antagonist
Which Rx should be avoided in patients with HTN + CHF?
B-blockers (in acute decompensated CHF or cardiogenic shock)
CCB
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.
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)
Patient presents with A fib and HTN. What are your initial therapeutic options?
Verapamil/Diltiazem (for rate control)
If patient has bradycardia and HTN, what 2 classes of medications do you want to avoid?
Diltiazem/verapamil
B-blocker
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.
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.)
4 classes of drugs that can treat hypertension in a pregnant patient.
Hydralazine
alpha Methyldopa
Labetalol
Dihydropyridine CCB
Patient has essential tremor + HTN. What is your DOC?
Propranolol
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.
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
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.
Which lipid-lowering agent has the best effect on triglycerides/VLDL and what is their MOA?
Fibrates which upregulate lipoprotein lipase, increasing triglyceride clearance.
Which lipid-lowering agent binds C dif toxin?
Cholestyramine
Name 2 lipid lowering agents that can lead to cholesterol gallstonse.
Bile acid resins
Fibrates
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.
DOC in pseudotumor cerebri
Acetazolamide
Name 3 DA agonists used in treatment of PD.
Bromocriptine (ergot)
Pramipexole
Ropinirole
Non-ergots are preferred.
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
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
Name one antimuscarinic that is used to curb the excess cholinergic activity of Parkinson’s.
Benztropine –improves tremor and rigidity.
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.
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.
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.
Name 2 drugs used to slow the progression of MS.
IFN beta
Natalizumab
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).
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.
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.
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.
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.
This antifungal is a cell wall synthesis inhibitor used in invasive aspergillosis.
Caspofungin
These 2 antifungals bind ergosterol and form membrane pores.
Amphotericin B
Nystatin
These 2 antifungals inhibit ergosterol synthesis
-azole
Terbinafine
2 most common tx for onychomycosis
Terbinafine
-azoles
This antifungal can cause arrhythmias and nephrotoxicity.
Amphotericin B
This anti-fungal is important as it deposits in keratin-containing tissues
Griseofulvin
These anti funagls inhibit hormone synthesis and cytochrome P450.
-azoles, particularly Ketoconazole
These 2 antifungals can cause liver dysfunction
-azoles
Griseofulvin
Treatment of cryptococcal meningitis in AIDS
IV Ampho B + flucytosine
This antifungal is converted to fluorouracil, inhibiting DNA synthesis
Flucytosine
This is the DOC for sporotrichosis
Itraconazole
This antifungal can be used intrathecally for fungal meningitis
Amphotericin B
Clinical use for Griseofulvin
Dermatophytes (ringworm, athlete’s foot)
Tinea capitis
Tinea unguium
Tx for dry macular degeneration
Smoking cessation
Supplementation of anti-oxidants
5 drug classes used in treatment of glaucoma
Alpha agonists B blockers Diuretics Cholinomimetics Prostaglandins
Tx of narcolepsy
Modafinil (treats daytime sleepiness – its a stimulant)
SNRI used in tx of ADHD
Atomoxetine
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
What weak opioid agonist is commonly used in chronic pain control prior to prescribing stronger opioids?
Tramadol
4 Rx used to prevent relapse in recovering alcoholics
Disulfiram
Topiramate
Naltrexone
Acamprosate
Drug used for heroin detoxification or long-term maintenance
Methadone
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
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.
MOA of Donepezil, Galantamine, and Rivastigmine
These are Alzheimer’s Rx that are all acetylcholinesterase inhibitors (remember, Alzheimer’s pts have low ACh).
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)
Dopamine receptor antagonist used in the treatment of Huntington’s
Haloperidol
MOA of Sumatriptan and effects
5-HT 1B/1D agonist.
Inhibits trigeminal nerve activation
Prevents vasoactive peptide release
Induces vasoconstriction
3 Contraindications to Sumatriptan use
Pregnancy
CAD
Prinzmetal’s angina
How can you treat a pregnant patient who suffers from migraines?
Opioids
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.
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.
DOC in status epilepticus
Benzos (lorazopam and diazepam)
DOC in alcohol withdrawal to prevent delirium tremens
Benzodiazepines (Chlordiazepoxide)
Potent inhaled anesthetic associated with hepatotoxicity
Halothane
Inhaled anesthetic associated with nephrotoxicity
Methoxyflurane
Inhaled anesthetic associated with seizures
Enflurane
Only inhaled anesthetic not associated with malignant hyperthermia
Nitrous oxide
Inhaled anesthetic used in brain surgery
Isoflurane
Most common anesthetic used for endoscopy
Midazolam
Which anesthetics are associated with amnesia?
Benzos
Anesthetic used in kids that block NMDA receptors. What are some SE?
Ketamine – causes disorientation, hallucinations, and bad dreams.
“Special K” :)
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.
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.
Order of nerve blockade in local anesthetics
Small myelinated> small unmyelinated > large myelinated > large unmyelinated
Local anesthetic associated with severe CV toxicity
Bupivacaine
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.
MOA of Tubocurarine
This is a non depolarizing NM blocker. It is a competitive antagonist at the ACh receptor.
Unexpected clinical use of phenobarbital
Can be used to treat Crigler Najjar type II as it increases liver enzymes.
MOA of dantrolene
Inhibits release of calcium from sarcoplasmic reticulum of skeletal muscle thus stopping muscle contraction.
DOC for partial (simple and complex) and tonic clonic seizures
Carbamazepine
Common SE of epilepsy drugs
Diplopia Sedation Ataxia Nystagmus Dizziness
5 AE of phenytoin
Gingival hyperplasia Hirsutism Fetal hydantoin syndrome CYP450 inducer SJS
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.
Name 4 drugs that cause Stevens Johnson syndrome.
Seizure drugs
Sulfonamides
-cillins
Allopurinol
6 drugs that cause agranulocytosis
Carbamazepine Clozapine Colchicine PTU Methimazole Dapsone
Which 3 anti epileptics are teratogens
Phenytoin
Carbamazepine
Valproic aicd
2 anti epileptics associated with hepatotoxicity
Valproic acid
Carbamazepine
5 Anti-epileptics that block Na+ channels
Carbamazepine Phenytoin Lamotrigine Topiramate Valproic acid
Which 5 anti-epileptics work by potentiating the inhibitory effects of GABA?
Valproic acid Phenobarbital Benzos Gabapentin Topiramate
3 high potency neuroleptics
Haloperidol
Fluphenazine
Trifluoperazine
More extrapyrimidal sx than low-potency.
2 low potency neuroleptics
Chlorpromazine
Thioridazine
More anticholinergic, antihistamine, and a1-blockade effects than high-potency.
MOA of all antipsychotics
Block dopamine D2 receptors (increase [cAMP])
Toxic side effect associated with long-term use of antipsychotics
Tardive dyskinesia – stereotypic oral-facial movements. Often irreversible. :(
Name 6 atypical antipsychotics.
Olanzapine Clozapine Quetiapine Risperidone Aripiprazole Ziprasidone
This anti-psychotic is reserved for refractory schizophrenia due to agranulocytosis.
Clozapine
Atypical antipsychotic that may prolong QT interval
Ziprasidone
Atypical antipsychotic associated with weight gain and increased risk of diabetes/metabolic syndrome
Olanzapine
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.
Atypical anti-psychotic that can be used in Parkinson’s pts who are suffering from psychosis as a result of their tx
Quetiapine
Name 4 SSRIs
Fluoxetine
Paroxetine
Sertraline
Citalopram
Flashbacks paralyze senior citizens.
Treatment for serotonin syndrome
Cyproheptadine (5-HT2 receptor antagonist)
Symptoms of serotonin syndrome
Muscle rigidity Hyperthermia CV collapse Flushing Diarrhea Seizures Confusion Myoclonus
Which drug class of anti-depressants are known to cause sexual dysfunction?
SSRIs
SNRI used for fibromyalgia
Milnacipran
SNRI used for weight loss
Sibutramine
2 classic SNRIs
Venlafaxine
Duloxetine
SNRI also indicated for diabetic peripheral neuropathy
Duloxetine
Most common AE of SNRIs
Increased blood pressure
TCA used in obsessive compulsive d/o
Clomipramine
Symptoms of TCA overdose
Convulsions Coma Cardiotoxicity Hyperpyrexia Respiratory depression
MOA of tricyclic antidepressants as well as common suffixes
Block reuptake of NE and serotonin
Include -iptylines and -ipramines; also doxepin and amoxapine
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
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.
Antidepressant used in bedwetting for children
Imipramine (TCA)
This antidepressant is known for NOT having any sexual SE.
Buproprion
-Also used in smoking cessation
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).
MOA of Maprotiline
Atypical antidepressant that blocks NE reuptake
MOA and serious AE of Trazodone
Inhibits serotonin reuptake
Can cause PRIAPISM (its called TrazoBONE because of this).
Nobody calls it that.
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.
What kind of drug is Bumetanide?
Loop diuretic
What type of drug is metolazone?
Thiazide
Which diuretic would you use to treat Acute pulmonary edema
Loop
Which type of diuretics (2) would you use to treat mild to moderate CHF with expanded ECV?
Thiazide or loop
Which typeo f diuretic would you use to treat edema associated iwth nephrotic syndrome?
Loop
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.)
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.
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.
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.
MOA of Tetracyclines
Bacteriostatic – bind to 30S and prevent attachment of aminoacyl-tRNA.
Which tetracyclines can be used in patients with renal failure?
Doxycycline
Minocycline
Clinical uses ofr tetracyclines
VACUuM THe BedRoom Vibrio cholera Acne Chlamydia Ureaplasma M. pneumo Tularemia H. pylori B. burgdorferi Rickettsia
What 3 things should you never take with tetracyclines?
Milk
Antacids
Iron-containing preparations
MOA of macrolides
Inhibit protein synthesis by blocking translocation (macroSLIDES!)
Bind to 23S rRNA of 50S ribosomal subunit
Bacteriostatic
Clinical uses for macrolides
Atypical pneumonia
URIs
STDs
What is the clinical use and side effects of Chloramphenicol?
Meningitis
SE:Anemia (dose dependent)
Aplastic anemia
Gray baby syndrome
What are the clinical uses for clindamycin?
Anaerobic infection
Aspiration pneumonia
Lung abscesses
MRSA
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
Uses of Streptogramins and SE
Uses: MRSA, VRE, staph and strep skin infections
SE: hepatotoxicity, pseudomembranous colitis
Macrolide associated with acute cholestatic hepatitis
Erythromycin
AE of Macrolides
MACRO Motility issues Arrhythmia due to prolonged QT acute Cholestatic hepatitis (erythro) Rash eOsinophilia
MOA of Clindamycin
Blocks peptide transfer (transpeptidation) at 50S ribosomal subunit
Bacteriostatic
Prophylaxis for recurrent UTIs
TMP-SMX (or nitrofurantoin)
Prophylaxis for gonorrhea (if a girl got raped and they do not know hx of rapist)
Ceftriaxone
Prophylaxis for postsurgical infection due to S. aureus
Cefazolin
Prophylaxis of strep pharyngitis in child with prior rheumatic fever
Oral penicillin
Tx of VRE
Linezolid and streptogramins (quinupristin/dalfopristin)
Drugs used in H. pylori triple therapy
PPI + amoxicillin + Clarithromycin
If allergic to amox, use metronidazole
Clinical uses and side effects of polymyxins
Resistant gram negative infections
SE: neurotoxicity, nephrotoxicity*
*For this reason, used topically only.
Name 5 classes of abx effective against Pseudomonas
Fluoroquinolones Cefepime Aztreonam Aminoglycosides Extended spectrum penicillins
Abx avoided in pregnancy
Clarithromycin Metronidazole (1st trimester) Griseofulvin Chloramphenicol Sulfonamides Fluoroquinolones Tetracyclines Aminoglycosides Ribavirin
Side effects of Ganciclovir
Leukopenia
Neutropenia (especially if AIDS pt taking ZDV)
Renal toxicity
Thrombocytopenia
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.
SE of Foscarnet
Nephrotoxicity
7 drugs or drug classes that cause anticholinergic SE
Atropine TCAs H1 blockers Low potency neuroleptics Digoxin Amantadine Promethazine
5 drugs that cause coronary vasospasm
Cocaine Amphetamines Methamphetamines Triptans Ergotamines
4 drugs that cause cutaneous flushing
Vanco
Niacin
Adenosine
Dihydropyridine CCBs
6 drugs that cause torsades de pointes
Class III antiarrhythmics Class Ia anti-arrhythmics Macrolides Haloperidol Chloroquine Protease inhibitors
5 drugs that can cause aplastic anemia
Chloramphenicol Benzene NSAIDS PTU Methimazole
2 drugs associated with thrombocytopenia
Heparin
H2 blockers
9 things that can cause hemolysis in G6PD deficient patients
INH Sulfonamides Primaquine High dose ASA Ibuprofen Nitrofurantin Dapsone Fava beans Naphthalene
3 drugs that cause pulmonary fibrosis
Busulfan
Bleomycin
Amiodarone
4 drugs that cause focal to massive hepatic necrosis
Halothane
Acetaminophen
Valproic acid
Amanita phalloides
Drug that can cause acute cholestatic hepatitis, jaundice
Erythromycin estylate
7 things associated with gynecomastia
Spironolactone Digitalis Cimetidine Estrogens Ketoconazole Marijuana Chronic alcohol use
2 drugs associated with hot flashes
Tamoxifen
Clomiphene
3 drugs associated with hypothyroidism
Lithium
Amiodarone
Sulfonamides
2 Rx that cause fat redistribution
Glucocorticoids
Protease inhibitors
2 drugs responsible for gingival hyperplasia
Phenytoin
Verapamil
4 drugs responsible for gout
Furosemide
Thiazides
Niacin
Cyclosporine
8 drugs known for causing myopathies
Fibrates Niacin Colchicine Hydroxychloroquine IFN-alpha Penicillamine Statins Glucocorticoids
8 drugs associated with Stevens Johnson syndrome
Penicillin Ethosuximide Carbamazepine Sulfa drugs Lamotrigine Allopurinol Phenytoin Phenobarbital
2 drugs that can cause nephrogenic DI and how to treat this
Lithium and demeclocycline
TX: hydrochlorothiazine, indomethacin, amiloride if Lithium induced
3 things that can cause proximal renal tubular acidosis
Fanconi syndrome
Expired tetracycline
Heavy metal exposure
Wilson disease
3 drugs associated with interstitial nephritis
Methicillin
NSAIDs
Furosemide
2 drugs associated with SIADH
Carbamazepine
Cyclophosphamide
3 drugs associated with Parkinson like syndrome
Antipsychotics
Reserpine
Metoclopramide
3 drugs that can cause increased lithium toxicity
Thiazides
ACE inhibitors
NSAIDs
Antidote for copper, arsenic, and gold poisoning
Penicillamine
TCA overdose antidote
Sodium bicarb
Theophylline OD antidote
Beta blocker
Methanol or ethylene glycol poisoning can be treated with?
Fomepizole
If unavailable use ethanol, dialysis
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.
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.
What is a good choice of contraception for patients with MR?
Depo provera – associated with bone mineral density loss
What is a contraindication to IUD use?
if patient has a high risk of STD
Why does HRT work in treatment of osteoporosis?
Decreased osteoclastic activity (decreases bone breakdown)
Best option for BC in mentally retarded patient
Depo
Why is progesterone used in combination with estrogen during estrogen replacement?
Unopposed estrogen increases the risk of endometrial cancer.
Pros of OCP use
Low failure rate
Decreases risk of endometrial and ovarian cancers
Decreases risk of ectopic pregnancy
MOA of drug that is used to treat endometriosis and hereditary angioedema
Danazol - synthetic androgen that acts as partial agonist at androgen receptors
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).
MOA of terbutaline
Beta 2 agonist that relaxes the uterus; reduces premature uterine contractions
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.
MOA of mifepristone
Competitive inhibitor of progestins at progesterone receptors –causes termination of pregnancy
3 commonly used tocolytics
Magnesium sulfate
Ritodrine
Terbutaline
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.
Describe the MOA of anastrozole/exemestane.
Aromatase inhibitors used in post-menopausal women with breast cancer.
3 short acting benzodiaepines
Triazolam
Oxazepam
Midazolam
Because they are short-acting, they have higher addictive potential.
Vitamin that should never be administered with levodopa
B6. It increases the peripheral metabolism of levodopa, thus decreasing its effects (less enters CNS.)
3 drugs used in treatment of acute manic episode
Mood stabilizers
Lithium
Valproic acid
Carbamazepine
Often administered with an atypical antipsychotic like olanzapine.
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.
