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Pharm Flashcards

1
Q

Receptors that work on Gi

A

M2, a2, D2 (MAD2s inhibit)

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2
Q

Receptors that work on Gs

A

B1,b2, D1, H2, V2

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3
Q

Receptors that work on Gq

A

H1, a1,v1, m1, m3 (cutesies HAV 1 M&M)

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4
Q

Alpha 1 effects

A

Increases vascular smooth muscle contraction (increase TPR,increase BP)

pupillary dilation

intestinal and sphincter muscle contraction

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5
Q

Alpha 2 effects

A

Inhibits sympathetic outflow, negative feedback on presynaptic nerves

decreases insulin release (found on pancreatic cells)

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6
Q

Beta 1 effects

A

Found mainly on heart and kidney: increases heart rate, contractility, increase renin release

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7
Q

Beta 2 effects

A

Smooth muscle relaxation (peripheral vasodilation, broncodilation, GI, utuers, bladder), causes decreasedTPR, reflex tachycardia, decrease uterine tone

Increases insulin release, increased glycogenolysis

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8
Q

Dopamine 1 effect

A

Relaxes renal vascular smooth muscle

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9
Q

Dopamine 2 effect

A

Modualtes transmitter release in the brain

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10
Q

Histamine 1 effect

A

Increases nasal and bronchial mucus production, contract bronchioles, pruritis

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11
Q

Histamine 2 effect

A

Increases gastric acid secetion

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12
Q

Vasopressin 1

A

increases vascular smooth muscle contraction

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13
Q

Vasopressin 2

A

Increases H2O permeability and RAB in collecting tubules

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14
Q

Definition of Km

A

[S] at which V = 1/2Vmax

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15
Q

This value is related to affinity of enzyme for substrate

A

Km

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16
Q

Vm is directly proportional to…

A

Enzyme concentration

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17
Q

Line-weaver burke plot:

X axis, Y axis, slope

A

X axis: -1/Km
Y axis: 1/Vm
Slope: Km/Vm

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18
Q

Origins of Parasympathetic NS

A

CN III, VII, IX, X, S2/S3

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19
Q

Which is more selective, PNS or SNS, and why?

A

PNS because longer preganglionic fibers, which allow one nerve-one organ effect. SNS has shorter preganglionic fibers and postganglionic fibers branch and affect multiple targets

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20
Q

Equation for Volume of distribution

A

Vd = amount of drug in body/plasma drug concentration

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21
Q

Half life equation

A

T1/2 = 0.7xVd/CL

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22
Q

Clearance (CL) equation

A

CL = rate of eliminiation of drug/plasma drug concentration = (Vd) * (Ke) = 0.7*Vd/t1/2

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23
Q

Loading Dosage equation

A

Dose = Volume of distribution * target plasma concentration / bioavailability

Vd depdendent, not affected by renail/iver disease

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24
Q

Maintainance Dose equation

A

Dose = target plasma concentration * clearance / bioavailability

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25
Q

which drugs have zero order elimination?

A

PEA

Phenytoin,Ethanol, Aspirin

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26
Q

Phase I of metabolism does what? and done by what system?

A

Done by CytP450 in liver, yields slightly polar molecules, still somewhat active

ROH - Reduction, oxidation, hydrolysis

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27
Q

What phase of metabolism is lost first in elderly patients?

A

Phase I

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28
Q

Phase II of metabolism includes what?

A

Conjugation reactions - methylation, glucordination, aceylation, sulfation

yields polar, inacative metabolites

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29
Q

Therapeutic index =

A

LD50/ED50

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30
Q

Hemicholinum

A

Blocks choline entry into nerves

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31
Q

Vasamicol

A

blocks packaging of Ach into vesicles

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32
Q

Botulinum fxn

A

Decreases ACh release into synapse

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33
Q

Black Widow Spider Toxin

A

Causes release of Ach into synapse, causing paralysis

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34
Q

Metyrsoine fxn

A

blocks conversion of Tyrosine to Dopa by blocking tyrosine hydroxylase

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35
Q

Reserpine

A

Inhibits NE packaging into vesicles

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36
Q

Amphetamine

A

Stimulates release of NE into synapse

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37
Q

Guanethidine, bretylium

A

Blocks NE release into synapse

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38
Q

Ephedrine, Tyramine

A

Stimulates release of NE into synapse

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39
Q

Cocaine, TCA

A

blocks NE reuptake by pre-synaptic neuron

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40
Q

Feedback on pre-synaptic neuron via 3 signals

A

M2: inhibits NE release
A2: inhibits NE release
AII: promotes NE release

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41
Q

MOA, Clinical indications for Bethanechol

A

Direct Cholinergic Agonist
Activates bowel and bladder smooth muscle
Used for post op ileus, neurogenic ileus and urinary retention

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42
Q

MOA, Clinical indications for carbhachol

A

Direct cholinergic agonist, used for glaucoma and relief of IOP

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43
Q

MOA, Clinical indications for Pilocarpine

A

Contracts ciliary muscle of eye, pupillary sphincter, resistant to AChE
Used for stimulatoin of sweat, tears, and saliva
Used for open/closed angle Glaucoma

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44
Q

MOA, Clinical indications for Methacholine

A

Challenge test for asthma dx, direct cholinergic agonist, stimulates muscarinic receptors in airway when inhaled

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45
Q

MOA, Clinical indications for Neostigmine

A

Acetylcholinesterase Inhibitors

Post op and neurogenic ileus, urinary retention, myasthenia gravis, reversal of NMJ blockade

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46
Q

MOA, Clinical indications for pyridostigmine

A

Increases endogeneous ACh bc acetylcholineesterase inhibtor

myasthenia gravis

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47
Q

MOA, Clinical indications for edrophonium

A

Cholinergic that blocks acetylcholinesterase

used for dx of MG

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48
Q

MOA, Clinical indications for physostigmine

A

Blocks acetylcholineesterase fxn, increases ACh

Used for Atropine overdose and anticholingeric toxicity

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49
Q

MOA, Clinical indications for Donepeil,

A

Block acetylcholine function, causing increased ACh, used for Alzhemiers

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50
Q

MOA, Clinical indications for Rivastigmine, Gamantine

A

Block acetylcholine function, causing increased Ach, used for Alzhemiers

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51
Q

Cholinesterase Inhibitor Poisoning Sx

A

DUMBBELSS

Diarrhea, urination, miosis, bradycardia, bronchospasm, exciation of skeletal muscle, lacrimation, sweating, salivation

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52
Q

Cause and tx for cholinesterase inhibitor poisoning

A

Insectasides (Organophosphates)

Tx: atropine, pralidoxime

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53
Q

MOA, Clinical indications for Atropine

A

muscarinic antagonist

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54
Q

MOA, Clinical indications for benztropine

A

muscarininc antagonisns, used for parkinsons

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55
Q

MOA, Clinical indications for scopolamine

A

muscarininc antagonist, used formotion sickness and to decreased oral secretions (eg ICU pt)

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56
Q

MOA, Clinical indications for ipratropium, tiatropium

A

Muscarninc antagonist at level of lungs for COPD and asthma pts, by decreasing bronchoconstriction

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57
Q

MOA, Clinical indications for oxybutynin, tolteridine, trospium

A

Muscarininc antagonist at GU system to reduce urgency and decrease ladder spasms

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58
Q

Sx of atrophine toxicity

A

Caused by excessive anticholnergic sx bc its an antimuscarinic
Hot as a hare, dry as a bone, red as a bat, blind as a bat, mad as a hatter
increased body temp,dry flushed skin, cyclooplegia, constipated, disoriented

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59
Q

MOA, Clinical indications for epinephrine

A

sympathomimetic, beta and alpha agonist

Anaphylaxis, asthma, hypotension

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60
Q

MOA, Clinical indications for norepinephrine

A

sympathomimetic, primarily alpha effects, some B1 effect

hypotension (but decreases renal perfusion), septic shock

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61
Q

MOA, Clinical indications for isoproternol

A

sympathomimetic, Beta effects only

Used for torsade de pointes,bradyarrythmias

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62
Q

MOA, Clinical indications for Dopamine

A

sympathomimetic, low dose: dopamine
Med dose: beta receptors
high dose: alpha receptors

Used for shock, heart failure

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63
Q

MOA, Clinical indications for dobutamine

A

sympathomimetic, primarily B1 effects

increases Hr and contractility, heart failure, cardiac stess test

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64
Q

MOA, Clinical indications for phenylephrine

A

sympathomimetic, Increases alpha effects

causes vasoconstiction and ocular mydriasis,decongestant for rhinitis

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65
Q

MOA, Clinical indications for albuterol, salmeterol, terbutaline

A

sympathomimetic, Primarily B2,some B1 effect. Acute asthma (metaproternol, albuterol), salmetrol for long term asthma or COPD control

terbutaline helps with uterine relaxation

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66
Q

MOA, Clinical indications for amphetamine

A

indirect sympathetomemimetc, releases stored catecholamines, used for narcolepsy, ADD

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67
Q

MOA, Clinical indications for ephedrine

A

releases stored catecholamines, used for nasal decongestion

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68
Q

MOA, Clinical indications for cocaine

A

blocks reputake of NE at cleft

Used for vasoconstriction and local anesthesia

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69
Q

MOA, Clinical indications for clonidine

A

alpha 2 agonist, used to decrease BP, acts centrally

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70
Q

MOA, Clinical indications for methyldopa

A

central alpha 2 agonist, decreases BP, especially pregnancy induced BP

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71
Q

MOA, Clinical indications for phenoxybenzamine

A

irreversible nonselective alpha blocker, used for phenochromacytoma

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72
Q

MOA, Clinical indications for phentolamine

A

reversible nonselective alpha blocker, used for pts on MAO inhibitors who have eaten tyramine containing foods

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73
Q

MOA, Clinical indications, and toxicity for prazosin, terazosin, doxazosin

A

alpha1 blocker, used for HTN and urinary retension in BPH, can cause 1st dose orthostaiss, reflex tachy, and rebound HTN

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74
Q

MOA, Clinical indications for tamusolosin

A

alpha1 blocker that decreases urinary retention but does not affect BP

75
Q

MOA, Clinical indications for mirtazapine

A

central alpha2 drug, used for depression

76
Q

Cardiac use for B Blockers (6)

A

Angina, MI, SVT, HTN, CHF, aortic dissection

77
Q

Noncardiac use for B blockers (4)

A

glaucoma,anxiety,migraine ppx, hyperthyrooidism

78
Q

Beta blocker toxicity

A

exacerbate asthma (by bronchoconstriction), bradycardia, AV block, CHF, seizures, sedation

79
Q

In which groups must you be careful with B blockers?

A

Asthma/COPD and Diabetics

For diabetics B blockers causes decreased glcogenolysis and glucagon release, which causes hypoglycemia. Also, Bblockers can mask sx of hypoglycemia

80
Q

B1 selective B bockers

A

betaxolol, esmolol, atenolol, metoprolol (BEAM)

81
Q

nonselective B blockers

A

propranolol, timlol, nadolol

82
Q

nonselective alpha and beta blockers

A

carvedilol, labetalol

83
Q

Partial B agonists (fxn essentially as B blockers)

A

pindolol, acebutlol

84
Q

Cant use what drug in cocaine or phenochromocytoma HTN and why

A

B blockers bc unopposed alpha effect causes worsening HTN due to vasoconstriction

85
Q

acetaminphen OD tx and MOA

A

N-acetylglutathione, which replenishes glutathione,which is needed to decrease the toxic NAPQI (metabolite of acetaminophen)

86
Q

Salicylates tx and sx

A

n,V, dizziness, tinnitus

Dialysis, alkanize urine with NaHCO3

87
Q

-bendazole

A

Helminth infections, like mebendazole

88
Q

-azole

A

antifungals

89
Q

-cillin

A

penicillin

90
Q

-cycline

A

abx, protein synthesis inhibitor

91
Q

-navir

A

protease inhibitor

92
Q

-triptan

A

5HT1b/1D agonists - migraines

93
Q

-ane

A

inhaled general anesthetic (halothane)

94
Q

-caine

A

local anesthetic

95
Q

-operidol

A

neuroleptic

96
Q

-azine

A

neuroleptic, antiemetic (chlropromazine)

97
Q

-etine

A

SSRI (fluoxetine)

98
Q

-ipramine

A

TCA

99
Q

-triptyline

A

TCA

100
Q

-olol

A

B antagonist

101
Q

-terol

A

B2 agonist

102
Q

-zosin

A

alpha 1 antagonist

103
Q

-pril

A

ACE inhibitor

104
Q

-afil

A

phosphodiseterase inhibitor for erectyle dysfunction

105
Q

-tropin

A

pituitary hormone (somatotropin)

106
Q

-tidine

A

H2 antagonist (cimetidine)

107
Q

-phylline

A

methylxanthine drug

108
Q

-prost

A

prostaglandin analog

109
Q

-sartan

A

angiotensin II receptor blocker

110
Q

-stigmine

A

anticholinesterase drug

111
Q

-chol

A

muscarinic agonist (carbachol, bethanechl)

112
Q

-curium/curonium

A

non depolarizing NM blocker

113
Q

-dipine

A

DHP CCB

114
Q

-dronate

A

-bisphosphonate

115
Q

-gliptin

A

DPP-IV inhibitors, like sitagliptin

116
Q

-glitazone

A

TZDs like pioglitazone

117
Q

Acetylcholinesterase inhibitors, organophosphates toxicity tx

A

Atropine, pralidoxime

118
Q

Antimuscarinic, anticholinergic agents, atropine OD

A

Physostigmine salicylate, control hyperthermia

119
Q

B blockers, verapimil toxicity

A

Glucagon, atropine, Ca2+

120
Q

Digitalis toxicity tx

A

fragments, Mg2+ (KLAM), Normalize K+, Lidocaine, Anti-dig Fab

121
Q

Iron toxicity tx

A

Deferoxamine, deferasirox

122
Q

Lead toxicity tx

A

CaEDTA, dimercaprol, succimer, penicillamine

123
Q

Mercury, arsenic, gold toxicity tx

A

Dimercaprol ( BAL), succimer

124
Q

Copper, arsenic, gold toxicity tx

A

Penicillamine

125
Q

Cyanide toxicity tx

A

Nitrite + thiosulfate, hydroxocobalamin. Can occur via Na nitroprosude tx in hospitals

126
Q

Methemoglobin toxicity tx

A

Methylene blue, vitamin C

127
Q

Carbon monoxide toxicity

A

10 0 % 02, hyperbaric 02 –think >of CO toxicity with spaceheaters, kerosone gas lamps, ovens, etc.. Can present with “cherry red lips”

128
Q

Methanol, ethylene glycol (antifreeze) toxicity tx

A

Fomepizole >ethanol, dialysis

129
Q

Opioids toxicity tx

A

Naloxone/naltrexone

130
Q

Benzodiazepines toxicity tx

A

Flumazenil

131
Q

TCAs toxicity tx

A

NaHC03 (plasma alkalinization)

132
Q

Heparin toxicity tx

A

Protamine

133
Q

Warfarin toxicity tx

A

Vitamin K, fresh frozen plasma

134
Q

toxicity txt PA, streptokinase, urokinase

A

Aminocaproic acid

135
Q

Theophylline toxicity tx

A

Bblocker

136
Q

Coronary vasospasm

A

Cocaine, sumatriptan, ergot alkaloids

137
Q

Cutaneous flushing

A

Vancomycin, Adenosine, Niacin, Ca2+ channel blockers - VANC

138
Q

Dilated cardiomyopathy

A

Doxorubicin (Adriamycin), daunorubicin

139
Q

Torsades de pointes

A

Class III, class Ia antiarrythmics, macrolides,haloperidol, chloroquine, protease inhibitors

140
Q

Agranulocytosis

A

clozapine,carbamazepine, colchicine, propylthioruacil, methimaziole,dapsone

141
Q

Aplastic anemia

A

Chloramphenicol, benzene, NSAIDs, propylthiouracil, methimazole

142
Q

Direct Coombs + hemolytic anemia

A

Methyldopa, penicillin

143
Q

Grey baby syndrome

A

Chloramphenicol

144
Q

hemolysis in G6PD deficient pts

A

Isoniazid (INH), Sulfonamides, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin

145
Q

megaloblastic anemia caused by drugs?

A

Phenytoin, Methotrexate, Sulfa drugs

146
Q

Thrombotic complications

A

OCPs (e.g., estrogens)

147
Q

Thrombocytopenia

A

Heparin, cimetidine

148
Q

Cough

A

ACE inhibitors

149
Q

Pulmonary fibrosis

A

BLeomycin, Amiodarone, Busulfan

150
Q

Acute cholestatic hepatitis

A

Erythromycin

151
Q

Focal to massive hepatic necrosis

A

Halothane, Amanita phalloides, Valproic acid, Acetaminophen

152
Q

hepatitis

A

INH

153
Q

pseudomembranous colitis

A

Clindamycin, ampicillin, amoxicillin

154
Q

Adrenal insufficinecny

A

Glucocorticoid withdrawal (HPA suppression)

155
Q

gynecomastia

A

Spironolactone, Digitalis, Cimetidine, chronic Alcohol use, estrogens, Ketoconazole

156
Q

Hot flashes

A

Tamoxifen, clomiphene

157
Q

hyperglycemia

A

Niacin, tacrolimus, protease inhibitors, HCTZ, corticosteroids

158
Q

hypothyroidism

A

Lithium, amiodarone, sulfonamides

159
Q

fat redistribution

A

Glucocorticoids, protease inhibitors

160
Q

gingival hyperplasia

A

Phenytoin, verapamil

161
Q

gout

A

Furosemide, thiazides, niacin, cyclosporine

162
Q

myopathies

A

fibrates, niachine,colchicine,hydrocychloroquine, IFNa, statins,glucocorticoids,penicillamine

163
Q

osteporosis

A

corticosteroids,heparin (if on steroids for more than 3 mos, consider giving bisphosphanates)

164
Q

photosensitivity

A

Sulfonamides, Amiodarone, tetracycline (SAT for photo)

165
Q

Rash/SJS

A

Penicillin, ethosuxiide, carbamazepine, Sulfa drugs, lamotrigine, allopurinol, phenytin, phenobarbital

166
Q

SLE like syndrome

A

Hydralazine, INH,procainamide,sulfonadmies,phenytoine (SHIPP)

167
Q

teeth problems in kids

A

tetracyclines

168
Q

tendonitis rupture

A

flouroquinolones

169
Q

Diabes inspidus

A

lithium, demeclocycline

170
Q

fancoinus syndrome

A

expired tetracycline, wilsons disease, heavy metal toxicity

171
Q

hemorrhagic cystitis

A

cyclophosphamide, ifosfamide (prevent with coadmistering mesna)

172
Q

intersitinal nephritis

A

Methicillin, NSAIDs, furosemide

173
Q

SiADH

A

Carbamazepine, cyclophosphamide

174
Q

Cinchonism

A

Quinidine, quinine

175
Q

Parkinson-like symptoms

A

Antipsychotics, reserpine, metoclopramicle

176
Q

Seizures

A

Isoniazid, Bupropion, lmipenem/cilastatin, Tramadol, EnAurane, Metoclopramide (with SEIZURES, I BITE My tongue)

177
Q

Tardive dyskinesia

A

Antipsychotics

178
Q

Antimuscarinic

A

Atropine, TCAs, H1-blockers, neuroleptics

179
Q

Disulfiram-like rxn

A

Metronidazole, certain cephalosporins, procarbazine, 1st-generation sulfonylureas

180
Q

Nephrotoxicity/ototoxicity

A

Aminoglycosides, vancomycin, loop diuretics, cisplatin

181
Q

nephrotoxic/neurotoxic

A

aminoglycosides, cisplatin,polymxin

182
Q

P450 inducing drugs?

A

Modafinil, barbiturates,St Johns wort, phenytoin, rifampin, griseofulvin, carbamazepine, CHRONIC alchol use (Guinness, Coronas,and PBRS induce chronic alcoholism)

183
Q

P450 inhibitng drugs?

A

Macrolides, amiodarone, grapefruit juice, isoniazid, cimetidine, ritonavir/protease inhibitors, acute alcohol abuse

184
Q

Sulfa Drugs

A

Probenecid, Furosmde, Azetazolamide, celocoxib,thiazides, sulfonamide abx, sulfasalazine, sulfonylureas – Popular FACTSSS

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