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STEP1 2015 > pharm > Flashcards

pharm Flashcards

1
Q

triptans mechanism

A

serotonin agonists
cause vasoconstriction
modulate neurotransmission in trigeminal nerve
should be taken as soon as the headache starts

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2
Q

contraindications to triptans

A

vasoconstricts; do not give in pregnancy or CAD, or prinzmetal angina

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3
Q

DUMBBELSS

A

Diarrhea, urination, miosis, bradycardia, bronchospasm, excitation of skeletal muscle (ACh at NMJ), lacrimation, salivation sweating (ACh despite being a SNS function)

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4
Q

Endogenous stim at mu receptor

A

beta endorphin

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5
Q

endogenous stim at delta receptor

A

enkephalin

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6
Q

endogenous stim at kappa receptor

A

dynorphin

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7
Q

anticholinergic effects: atropine

A

hot as a hare (hyperpyrexia), red as a beet (flushing), blind as a bat (mydriasis), dry as a bone (no salivation), mad as a hatter (delirium), bloated as a toad (constipation), tachycardia

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8
Q

on the darn toilet: drugs that treat urge incontinence

A

oxybutinin, tolterodine, darifenacin and solifenacin, trospium; anticholinergics

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9
Q

physostigmine

A

anticholinesterase (indirect cholinergic agonist)

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10
Q

pilocarpine

A

direct muscarinic agonist

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11
Q

oxybutynin

A

muscarinic antagonist for urge incontinence

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12
Q

donepezil

A

anticholinesterase

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13
Q

pralidoxime

A

regenerator of AChE

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14
Q

bethanecol

A

cholinergic agonist

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15
Q

neostigmine

A

anticholinesterase inhibitor

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16
Q

darifenacin

A

muscarinic antagonist

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17
Q

ipratropium

A

muscarinic antagonist

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18
Q

tropicamide

A

muscarinic antagonist

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19
Q

benztropine

A

muscarinic antagonist

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20
Q

scopolamine

A

muscarinic antagonist for motion sicknesss and decreased salivary secretion in ventilated patients

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21
Q

edrophonium

A

anticholinesterase

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22
Q

tolteridine

A

muscarinic antagonist

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23
Q

trospium

A

muscarinic antagonist

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24
Q

rivastigmine

A

anticholinesterase, used in AD

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25
Q

homatropine

A

muscarinic antagonist

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26
Q

pyridostigmine

A

anticholinesterase

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27
Q

carbachol

A

cholinergic agonist

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28
Q

nonselective beta blockers

A

propanolol, timolol, nadolol

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29
Q

selective beta1 blockers

A

metoprolol, atenolol

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30
Q

partial agonists

A

acebutol (beta-1 only), pindolol (alpha and beta)

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31
Q

alpha and beta blockers

A

carvedilol, labetalol

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32
Q

glaucoma drugs

A

timolol, nadolol

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33
Q

opioid cough suppressant commonly used with the expectorant guaifenesin

A

dextromethorphan (DM)

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34
Q

opioid used in the treatment of diarrhea

A

loperamide, diphenoxylate

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35
Q

opioid receptor antagonist

A

naloxone, naltrexone

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36
Q

non-addictive weak opiod agonist

A

tramadol

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37
Q

partial opioid agonist that causes less respiratory depression

A

butorphanol

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38
Q

hemicholinium

A

inhibits choline - sodium transport into cholinergic axons for ACh synthesis

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39
Q

Vesimacol

A

inhibits ACh packaging into vesicles

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40
Q

Botulinum

A

inhibits presynaptic ACh vesicle release for flaccid paralysis

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41
Q

Black widow spider toxin

A

promotes ACh release from presynaptic terminal for spastic paralysis

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42
Q

Metyrosine

A

tyrozine hydroxylase inhibitor

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43
Q

reserpine

A

inhibits DOPA decarboxylase (conversion of DOPA to DA)

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44
Q

Bretylium, guanethidine

A

inhibit NE release from presynapse

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45
Q

Tyramine, amphetamine, ephedrine

A

promotes NE release from presynapse

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46
Q

Cocaine, TCA, amphetamine

A

inhibits NE reuptake

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47
Q

ATII

A

promotes NE release

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48
Q

alpha2 agonists

A

inhibit NE release from presynapse

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49
Q

Disulfiram- like reaction

A

p. 95, 260

metronidazole, certain cephalosporins, procarbazine, 1st generation sulfonylureas

50
Q

CYP450 inducers

A

Guiness, coronas, PBRs induce chronic alcoholism

griseofulvan, carbamazepine, phenytoin, barbiturates, rifampin, st. john’s wart, chronic alcoholism

51
Q

CYP inhibitors

A

CRACK AMIGOS:
ciprofloxacin, ritonavir, amiodarone, cimetidine, ketoconazole, acute alcohol use, macrolides, isoniazid, grapefruit juice, omeprazole, sulfonamides

52
Q

Flushing

A

vancomycin, niacin, adenosine, dihydropyridine CCBs

53
Q

Coronary vasospasm

A

cocaine, amphetamines, triptans (sumatriptan), ergotamine

54
Q

dilated cardiomyopathy

A

doxorubicin, daunorubicin

55
Q

Torsades de pointes

A

potassium channel blockers (class III), sodium channel blockers (class IA), macrolides, haloperidol, chloroquine, protease inhibitors

56
Q

thrombocytopenia after heparin

A

HIT. cimetidine can also cause thrombocytopenia

57
Q

Agranulocytosis

A

clozapine, carbamazepine, colchicine, PTU, Methimazole, dapsone

58
Q

Aplastic anemia

A

chloramphenicol, benzene, NSAIDs, PTU, methimazole

59
Q

Gray baby

A

chloramphenicol 2/2 insufficient UDP- glucaronyl transferase

60
Q

Hemolysis in G6PD deficient patients

A

isoniazid, sulfonamides, primaquine, high dose asa, ibuprofen, nitrofurantoin, dapsone, fava beans, naphthalene

61
Q

thrombosis

A

oral contraceptives

62
Q

pulmonary fibrosis

A

amiodarone, busulfan, bleomycin

63
Q

cough

A

ACEI 2/2 bradykinins

64
Q

pseudomembranous colitis

A

clindamycin, amoxacillin, ampicillin

65
Q

hepatic necrosis

A

halothane, acetaminophen, valproic acid, amanita phalloides

66
Q

hepatitis

A

INH

67
Q

tertiary adrenal insufficiency

A

corticosteroid withdrawal

68
Q

gynecomastia

A

spironolactone, digozin, estrogens, cimetidine, chronic alcohol use, ketoconazole, marijuana (some drugs cause awesome knockers, or stacked where THC)

69
Q

hot flashes

A

tamoxifen, clomiphene SERMs

70
Q

hypothyroidism

A

amiodarone, lithium, sulfonamides

71
Q

gout

A

diuretics (loop and thiazide), niacin, cyclosporine, pyrazinamide

72
Q

gingival hyperplasia

A

phenytoin, verapamil

73
Q

osteoporosis

A

corticosteroids, heparin

74
Q

photosensitivity

A

sulfonamides, amiodarone, tetracycline (SAT for photo)

75
Q

SJS

A 
seizure drugs and penicillin
ethosuximide, carbamazepine, lamotragine, phenytoin, phenobarbital, sulfonamides, penicillins, allopurinol
CLAPPPERS
carbamazepine
lamotragine
allopurinol
phenytoin
phenobarbitol
pcn
ethosuximide
RASH
sulfa drugs
76
Q

drug- induced lupus

A

SHIPP

sulfonamides, hydralazine, INH, phenytoin, procainamide

77
Q

tendinitis, cartilage damage

A

fluoroquinolones

78
Q

interstitial nephritis

A

NSAIDs, furosemide, antibiotics

79
Q

DI

A

lithium, demeclocycline

treat with HCTZ, amiloride

80
Q

Fanconi

A

expired tetracycline, heavy metal exposure, wilson

81
Q

hemorrhagic cystitis

A

cyclophosphamide, ifosfamide

82
Q

Parkinson- like syndrome

A

metaclopramide, antipsychotics, reserpine

83
Q

cinchonism

A

dizziness, HA, vision changes, tinnitus

quinidine, quinine

84
Q

seizures

A

buproprion, imipenem, cilastatin, INH, tramadol, metaclopramide, benzodiasepines, EtOH w/drawal

85
Q

tardive dyskinesia

A

antipsychotics, metoclopramide

86
Q

disulfiram- like reaction

A

metronidazole, cephalosporins, procarbazine, first- generation sulfonylureas, disulfiram

87
Q

nephrotoxic and neurotoxic

A

aminoglycosides, cisplatin, polymyxins

88
Q

nephrotoxic and ototoxic

A

aminoglycosides, vancomycin, loop diuretics, cisplatin

89
Q

anticholinergic side effects

A

atropine, TCAs, H1 blockers (diphenhydramine), low- potency neuroleptics (thioridizine, chlorpromazine)

90
Q

eliminated at a constant rate (zero order)

A

PEA:phenytoin, ethanol, aspirin

91
Q

low therapeutic index

A

warfarin, digoxin, lithium, phenobarbital

92
Q

how does sildenafil lead to erection?

A

inhibits cGMP phosphodiesterase> increase in cGMP> relaxation of smooth muscle in corpus cavernosum> increased bloodflow> erection

93
Q

pseudomonas aeruginosa

A 
fluoroquinolones (ciprofloxacin, levofloxacin
ticarcillin
piperacillin
cefepime
ceftazidime
carbapenems (imipenem, meropenem)
94
Q

Triple therapy H. Pylori

A

PPI
Clarithromycin
Amoxicillin or metronidazole (if allergic to PCN)

95
Q

Quadruple therapy H Pylori

A

PPI
Bismuth
Metronidazole
Tetracycline

96
Q

adenosine

A

increases outward potassium current, hyperpolarization of cells, decreases intracellular calcium (stops the heart transiently)

97
Q

precursor of 6MP

A

azathioprine

98
Q

ab that binds CD3 on T cells

A

muromonab

99
Q

ab that binds IL2 receptor on activated T cells

A

daclizumab

100
Q

inhibits inosine monophosphate dehydrogenase

A

mycophenolate mofetil

101
Q

inhibits calcineurin leading to loss of IL2 production and blockage of T cell differentiation and activation

A

cyclosporing, tacrolimus, pimecrolimus

102
Q

metabolized by xanthine oxidase, thereby increasing allopurinol toxicity

A

azathioprine, and 6MP

103
Q

ACEI

A

inhibits angiotensin vasoconstrictor production thereby preventing vasoconstriction.

Dropping angiotensin keeps bradykinin around longer leading to more vasodilation

Used in HTN, CHF to prevent LV remodeling

Post MI
Diabetic kidney disease- reduced proteinuris, reduced progression of nephropathy

overall, well tolerated.
SE:
dry hacking cough
(due to bradykining)
angioedemia (complicated possibly by airway compromise)
cough
angioedema
kyperkalemia, especially if also on a potassium- sparing diuretic.
decreased GFR: renal insufficiency
BL renal artery stenosis is a contraindication
teratogenesis- pregnancy is a contraindication

104
Q

ARB

A

candesartan, losartan
side effects: teratogenesis, hyperkalemia, renal insufficiency
NO cough (no bradykinin)
but can cause angioedema sometimes

if pt on ACEI gets angioedema then, you can’t just sweitch

105
Q

Aliskerin

A

renin inhibitor

hyperkalemia, renal insufficiency, contraindicated in pregnancy

NOT indicated in CHF or MI.
ONLY FOR HTN

106
Q

Calcium channel blockers- dihydropyridines

A

amlodipine, felodipine, nicardipine, nifedipine, nisoldipine

act on vascular smooth muscle to cause vasodilation.

indicated to treat HTN, angina, vasospasm (Prinzmetal’s angina, Raynaud), esophageal spasm, migraine prophylaxis, cluster HA

adverse effects: peripheral edema, flushing, dizziness, constipation, deflex tachycardia

107
Q

CCB- non-dihydropyridine

A

acts on heart
diltiazem, verapamil

verapamil acts at calcium channels of pacemaker cells in the heart. no effect on systemic vasodilation

Diltiazem is less specific, acting at calcium channels of heart and vessels. commonly used in patients with angina to slow the heart and decrease o2 demand
also used to control HR in patients with ventricular fibrillation and other tachycardias

adverse effects: cardiac depression, AV block, flushing, dizziness, constipation

108
Q

Hydralazine

A

increases cGMP inside of smooth muscle cells, dilating arterioles> veins, thereby decreasing afterload.
uses include hypertensive urgency and emergency. HTN in pregnancy

side effects: reflex tachycardia (don’t give if coronary disease), may need to give with beta blocker
fluid retention
nausea headache
drug- induced lupus

109
Q

Hypertensive Moms Love Nifedipine (know these HTN drugs that are safe during pregnancy

A

Hydralazine
Methyldopa
Labetalol
Nifedipine

110
Q

Minoxidil

A

another arterial vasodilator. Opens potassium channels and hyperpolarizes smooth muscle, resulting in relaxation of vascular smooth muscle
therapeutic for severe HTN
or, apply topically to induce hypertrichosis (hair growth)

adverse effects: hypertrichosis, hypotension, reflex tachycardia, fluid retention/edema

111
Q

Nitrates

A

nitroglycerin
isosorbide dinitrate
nitroprusside

dilate veins, reducing preload

treats angina, acute pulmonary edema

side effects: reflex tachycardia, flushing, HA, nitroprusside, CN toxicity

112
Q

decreases afterload only

A

hydralazine

113
Q

decreases preload and afterload

A

ACEI/ARB

114
Q

decreases nitrates

A

nitrates

115
Q

lipid- lowering agent with side effect of facial flushing

A

niacin

116
Q

lipid- lowering agent with SE of elevated LFTs, myositis

A

statins, fibrates

117
Q

lipid lowering agent with SE of GI discomfort, bad taste

A

bile acid binding resins

118
Q

Best effect on HDL

A

niacin

119
Q

Best effect on TGs/ VLDL

A

fibrates, omega 3 fatty acids

120
Q

best effect on LDL/cholesterol

A

statins

121
Q

lipid- lowering agent that bind c. diff toxin

A

cholestyramine

122
Q

lipid- lowering agent that causes rash, vasodilation, diarrhea

A

niacin

prevent at bedtime, pretreat with ASA or NSAID 30 min in advance, avoid alcohol

STEP1 2015 (30 decks)

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