Pharm Flashcards
How do Thiazides prevent renal Ca stones?
- thiazide inhibit lumenal Na/Cl cotransporter (simporter)
- cell utilizes Na/Ca basal antiporter instead to bring in Na
- cell must then compensate by brining in extra Ca with lumenal transporter, thus lowering urine Ca
Loops _____ Ca.
Lose
Thiazides _____ Ca.
Save
What to ACEi/ARBs do to the glomerular efferent arteriole?
- cause dilation
- this reduces risk of glomerular injury in DM pts by lowering pressure
ACEi drug ending
-pril
ARB drug ending
-sartan
Rifampin
- MOA: inhibition of bacterial DNA dependent RNA polymerase
- side effects: GI, rash, red/orange body fluids, cytopenias
Isoniazid
- MOA: inhibition of mycolic acid synthesis
- resistance: bacterial catalase-peroxidase required to activate
- side effects: neurotoxicity (give with vitamin B6), hepatotoxicity, drug-induced LSE
- side effects worse in slow acetylators
Pyrazinamide
- MOA: unclear
- Side effects: hepatotoxicity, hyperuricemia
Ethambutol
- MOA: inihibition of arabinosyl transferase (needed for cell wall cynthesis)
- side effects: optic toxicity
Streptomycin
- aminoglycoside
- inhibits protein synthesis at 30S ribosomal subunit
ACEi- side effects
- cough (inc. bradykinin)
- angioedema (tongue/lip swelling) (inc. bradykinin), rare, serious side effect
- bradykinin inc. vascular permability
Leukotrienes targeted with asthma treatment
LTC4, LTD4, LTE4
Acid/Base Changes with Aspirin Poisoning
- respiratory alkalosis (real alkalosis)
- anion gap metabolic acidosis
Winter’s Formula
pCO2 = (1.5 x HCO3) + 8 +/- 2
- use to find expected pCO2 value
- if pCO2 measured is lower, then it is a primary resp. alkalosis
- if pCO2 measured is higher, then it is a concurrent resp. acidosis
- if pCO2 is matches expected, it is compensated
Fibrin Specific Fibrinolytics
- tissue plasminogen activator (tPA)
- reteplase
- tenecteplase
- act on fibrin attached to recently formed clot, no systemic activation
- use within 6 hours of acute MI
Tamoxifen
-selective estrogen receptor modulator
“Over the Counter”
-non prescription meds
Most common cause of overdose that leads to death in US?
-opioids
NSIAD Associated Chronic Renal Injury
- chronic interstitial nephritis
- patchy interstitial inflammation with fibrosis, necrotic tubules
Omeprazole/Lansoprazole
- inhibits the H+/K+ ATPase proton pump
- proton pump inhibitor
Fenofibrate
- fibrate- most effective tx for hypertriglyceridemia
- activates PPARa
- dec. VLDL synthesis
- dec. triglycerides
- inc. HDL
- side effects: muscle toxicity, gallstones
Warfarin + Protein C Deficiency
-protein C deficiency at start of warfarin my lead to hypercoagulable state with thrombotic occlusion of microvasculature and skin necrosis
Atropine
- muscarinic receptor blocker
- indiacted for tx of bradycardia
- dec. vagal influence at SA and AV nodes
- contraindicated in glaucoma
Ending of Factor Xa inhibitor drug name?
-xaban
Theophylline
- inhibits phosphodiesterase (which is enzyme responsible for cAMP breakdown)
- indirect adrenergic agent used for tx of acute and chronic asthma
- metabolized by hepatic cytochrome oxidases
- overdose can cause cardiac arrhythmias and seizures
Enoxaparin
- low molecular weight heparin
- safe for use in pregnancy
- does not cross placenta
Meds that cause hyperkalemia?
-non-selective beta blockers
-ACE-i
-ARBs
-K-sparing diuretics: spironolactone, amiloride
-cardiac glycosides: digoxin
-NSAIDs
(aldosterone normally inc. Na retention and causes K secretion)
Ethylene Glycol
Antifreeze
MAC Value
- minimal alveolar anesthetic concentration required for 50% of people to respond to stimulus
- low MAC = more potent drug
- additive
- MAC values are lower in elderly
Blood Gas Ratio
- low blood gas ratio = rapid onset and rapid recovery
- the more soluble the anesthetic in the blood, the slower the anesthesia
Thiopental Plasma Decay
Cause of rapid decay (30 min) of thiopental is redistribution into lean body tissue, not metabolism by liver.
Best drug for chemo induced vomiting?
Serotonin 3 receptor blockers such as ondansetron or granisetron.
Block vagus mediated nausea and block central serotonin receptors.
Other drug options include NK1 receptor antagonists like aprepitant, or DA antagonists like prochlorperazine, metochlopramide, H2 antagonists like dephenhydramine, M antagonist like scopolamine, cannabinoids like dronabinol.
What antibiotics inhibit bacterial cell wall synthesis?
- penicillins
- cephalosporins
- carbapenems
- vancomycin
What antibiotics inhibit bacterial protein synthesis?
- aminoglycosides
- chloramphenicol
- macrolides
- tetracyclines
- streptogramins
- linezolid
- clindamycin
What antibiotics inhibit nucleic acid synthesis?
- fluoroquinolones
- rifampin
What antibiotics inhibit folic acid synthesis?
- sulfonamides
- trimethoprim
- pyrimethamine
First Gen Cephalosporins
- Cefazolin
- cephalexin (phirst)
Second Gen Cephalosporins
-Cefaclor
-Cefotetan
-Cefuroxime
It’s a FACt that I have a FOxy, FURry man.
Third Gen Cephalosporins
-cephtriaxone
-cefotaxime
-cefdinir
-cefixime
Use the AX to FIX DINIR
Only beta lactam without cross reaction allergenicity to other beta lactams
-Azotreonam
Antibiotics that inhibit 30S Ribosomal Subunit
- aminoglycosides
- tetracyclines
Antibiotics that inhibit 50S ribosomal subunit
- macrolides
- singles (linezolid, dalfopristin/quinupristin, chloramphenicol, clindamycin)
AmiNOglycoside Name Tricks
- NO
- Need O2
- Oephrotoxicity and ototoxicity
- kill gram Negative Organisms
Drugs that cause ototoxicity?
- aminoglycosides
- loop diuretics
Tetracycline Name Tricks
Tets for ticks!
- borrelia burgdorferi
- rickettsia
Antibiotics to Use During Pregnancy
- penicillins
- cephalosporins
- macrolides
Macrolide Tricks to Remember
Mmm-mm
- Macrolides
- mycoplasma
- mycobactrium avium (MAC)
- motilin receptor activation (diarrhea)
- methylation for resistance
What bugs does Metronidazole work against?
GET BaC on the metro G!
- antiprotozoal: giardia, thrichomonas, entamoeba
- antibacterial: bacteroides, clostridium, gardnerella (BV)
Which drugs are phototoxic?
- FoToS
- fluoroquinolone
- tetracycline
- sulfonamide
What bugs does Metronidazole work against?
GET BaC G!
- antiprotozoal: giardia, thrichomonas, entamoeba
- antibacterial: bacteroides, clostridium, gardnerella (BV)
How is digoxin eliminated?
- digoxin is eliminated unchanged by the kidney
- age related dec in dose may be necessary in elderly pts
SGLT2 Inhibitors
-sodium glucose cotransporter inhibitor
Block SGLT2 in proximal tubule of kidney, inc. glucose excretion. New diabetes drug.
Canagliflozin
Dapagliflozin
Microsidic Sideroblastic Anemia
- lead poisoning
- tx with dimercaprol or succimer in children
CYP450 Inhibitors
Valproate Isoniazid Cimetidine Ketoconazole Sulfonamides Fluconazole/fluoxetine (and all SSRIs) Alcohol..binge drinking (acute) Chloramphenicol Erythromycin (all macrolides except azithromycin) Amiodarone Ciprofloxacin Omeprazole Grapefruit juice/Cranberry Juice Quinidine (Also ritonavir, NSAIDs, Metronidizole, and fibrates)
VICK’S FACE All Over GQ Cover stops the ladies in their tracks.
CYP450 Inducers
Barbiturates
St. John’s Wort
Carbemazepines
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbital
Sulphonylureas
(And nevirapine, oral contraeptives, ginseng, green vegetables)
Bull Shit CRAP GPS induces my rage.
Amatoxin
Toxin present in mushrooms. Inhibits mRNA. a Amantin in urine confirms poisoning.
Daptomycin
Antibiotic with activity against gram positive organisms. Causes transmembrane channels that result in depolarization of the membrane potential. Inactivated by pulmonary surfactant.
Side effects: inc. creatine phosphate level, and myopathy.
Modafinil
Tx for narcolepsy. Nonamphetamine stimulant. Thought to enhance dopaminergic signaling.
Drugs that cause drug-induced lupus?
HIP H-hydralazine I-isoniazid (slow acetylators) P-procainimide (also minocycline and quinidine)
Entacapone
COMT inhibitor that prevents peripheral degradation/methylation of levodopa in pts with Parkinson’s.
Tolcapone
COMT inhibitor that works to prevent central (in the brain) degradation of levodopa in Parkinson’s pts. Associated with hepatotoxicity.
Eculizumab
- attacks C5
- give N. meningitis vaccine first
- tx: for paroxysmal nocturnal hemoglobinuria
Rituximab
- check first for Hep B and C
- attacks B cells
Activated Protein C
- antithrombic agent
- inactivates factors Va and VIIIa
- pts with factor V leyden deficiency will not respond to activated protein C
Caplan Syndrome
-any pneumoconiosis with rheumatoid arthritis
CYP450
-major enzymes involved in drug metabolism
Ivabradine
- slows heart rate with no effect on chrontractility or relaxation
- inhibits funny Na current channels during phase 4
What category of drug is fluoxetine?
SSRI
Ramelteon
Melatonin agonist that is a safe sleep aid in elderly.
Antidote for beta blocker overdose?
Glucagon: works on cardiac myocytes to inc. cAMP, resulting in inc. Ca release and inc. SA node firing.
How do beta blockers inhibit the RAAS pathway?
They block B1 receptors and therefore block renin.
Drug of choice to treat trigeminal neuralgia?
Carbamazepine
Nitroglycerin acts on what type of vessels? And what is it’s MOA?
- dilates veins»_space;> arteries
- activates guanulate cyclase > inc. cGMP > dec. activity of myosin light chian kinase > dephosphorylation of of myosin light chain > relaxation of vascular smooth muscle
- has the effect of dec. left end-diastolic volume and wall stress, resulting in dec. myocardial oxygen demand and relief of angina sx
Cyclosporin/Tacrolimus
-inhibits calcineurin activation in T cells to prevent immune response to organ transplant
Varenicline
- partial agonist of nicotinic acetylcholine receptors
- helps with tobacco cessation by reducing withdrawal cravings and dec. rewarding effects of nicotine
MOA of Ethosuximide and What it Treats
- blocks T-type Ca channels in thalamic neurons
- tx for absence seizures
MOA of Carbamazapine (also what it tx and major side effect)
- blocks voltage gated Na channels in neuronal membranes
- used for simple partial, complex partial, and generalized tonic clonic seizures
- can cause bone marrow suppression
Flutaminde
-nonsteroid agents that acts as competitive testosterone receptor inhibitor during initiation of long-acting GnRH agonists for prostate cancer tx to prevent initial inc. in T
What receptors does DA effect?
- low dose: D1 (vasodilation and inc. BF)
- higher doses: B1 (inc. cardiac contractility)
- very high doses: A1 (vasoconstriction)
How many half lives does it take to reach steady state?
-4-5
Bosentan
-endothelin receptor antagonist used to dec. pulmonary hypertension
Calcipotriene
- tx for psoriasis
- topical vitamin D analog binds to vit D receptor and inhibits keratinocyte proliferation and stimulates keratinocyte differentiation
- activates a nuclear transcription factor
D-Penicillamine
-chelation therapy for Wilson disease to bind excess copper
Treatment for lead poisoning.
-CaNa2EDTA forms non-ionizing salts to inc. urinary lead excretion
Treatment for Iron Overload
-chelating agent binds circulating iron and facilitates its urinary excretion
Treatment for Cyanide Poisoning
-Hydroxycobalamin binds intracellular CN and forms cyanobalamin, which can be excreted in urine
Treatment for Methemoglobinemia
-methylene blue acts as artificial electron transporter for reduction of methemoglobin through NADPH pathway
Treatment for Arsenic Poisoning
-dimercaprol (british anti-lewisite) inc. urinary excretion of heavy metals
Cholystyramine
- bile acid binding resin that inhibits recycling of bile acid
- decreases cholesterol and LDL
- actually inc. triglycerides and can cause hypertriglyceridemia (inc. VLDL?)
Major side effect of SSRIs?
-sexual dysfunction
3 Drugs to Tx C. Diff
- metronidazole
- vancomycin
- fidaxomicin
What med should you give to prevent erythroid precursor cell apoptosis during folate deficiency?
-thymidine
Cardioselective Beta Blockers
- action against beta 1 receptors
- metoprolol
- atenolol
- bisoprolol
- nebivolol
Lamotrigine
- antiseizure medication
- fxnal against simple/complex partial and tonic clonic and absence seizures
- blocks voltage gated Na channels
- causes Steven Johnson syndrome (toxic epidermal necrolysis)
Antibiotic Resistance to Penicillin
- B-lactamase
- mutated PBP
- mutated porin protein
Antibiotic Resistance to Vancomycin
- mutated peptidoglycan cell wall matrix
- impaired influx/inc efflux
Antibiotic Resistance to Quinolones
- mutated DNA gyrase
- impaired influx/inc. efflux
Antibiotic Restance to Aminoglycosides
- amnioglycoside modifying enzymes
- mutated ribosomal subunit
- mutated porin protein
Antibiotic Resistance to Tetracyclines
- impaired influx/inc. efflux
- inactivated enzymes
Antibiotic Resistance to Rifamycins
-mutated RNA polymerase
What medication treats Beta Blocker Overdose?
-glucagon
Tachyphylaxis
- rapid decline in effect of nasal decongestants such as pheylephrine, xylometazoline, and oxygetazoline
- due to negative feedback on norepinephrine production
- may lead to rebound rhinnorrhea
- also associated with nitroglycerine (use drug free intervals)
How do fibrates contribute to gall stone formation?
- inhibit cholesterol 7a hyroxylase, which catalyzes the rate limiting step in synthesis of bile acids
- dec. bile acid results in dec. cholesterol solubility and leads to cholesterol gall stones
Chlorpheniramine
- first gen antihistamine (for allergic rxn and motion sickness) (-phen-)
- can cause sedation
- should not be given with other sedating drugs
Topical Capsaicin
-causes dysfunction of afferent pain fibers and depletion of substance P
Abciximab
- GP 2b/3a receptor antagonist
- inhibits binding of this receptor to fibrinogen
- GP2b3a normally promotes platelet binding to fibrinogen
What kind of drugs are metabolized by the liver?
Lipophlic ones.
Phencyclidine
PCP
NMDA receptor antagonist
May cause vertical and horizontal nystagmus as well as delirium
Tricyclic Antidepressant Overdose
- delerium, seizures, cardiac abnormalities, hypotension, anticholinergic toxicity
- caused by block of cardiac fast Na channels, inhibition of Ach, histamine, and A1 rec.
- tx widened QRS or ventricular arrhythmias with NaHCO3
Drugs to Avoid During Pregnancy
- Warfarin- depressed nasal bridge, stippling of epiphyses, nail hypoplasia, fetal bleeding
- Lithium- hypothyroidism, ebstein anomaly (atrialization of R ventricle)
- Phenytoin- fetal hydantoin syndrome with orofacial clefts, microcephaly, nail/digit hypoplasia, cardiac defects, dysmorphic facial feature
- ACE/ARB- renal dysgenesis
- Alcohol- fetal EtOH syndrome
- Valproate- neural tube defects
- Isotretinoin- microcephaly, thymic hypoplasia, small ears, hydrocephalus
- Methotrexate- limb and craniofacial abnormalities, neural tube defects, abortion
Doxorubicin
- anthracycline
- chemo agent associated w/ severe cardiotoxicity
- generates free radicals
- causes dose-related dilated cardiomyopathy
- prevent with dexrazoxane (Fe chelating agent that dec. formation of O2 radicals)
Flumazenil
-benzodiazepine receptor antagonist to reverse CNS depression
Alendronate
- stabalizes bone structure and induces osteoblasts to secrete inhibitors of osteoclasts
- dec. bone resporption
- tx: Pagets, osteoprosis
- side effect: GI distress and esophageal ulcers
Baclofen
- muscle relaxant
- agonist at the GABA-B receptor
- effective monotherapy for tx of spasticity secondary to brain and spinal cord dz
- tizanidine may also be used for this purpose
Azathioprine
- immunosuppressive drug used in organ transplant and autoimmune disease
- purine analog
- prodrug of mercaptopurine (6MP) that inc. active metabolites that inhibit purine synthesis and thus prevent DNA replication
- effect is enhanced by allopurinol, which inhibits xanthine oxidase, an enzyme that favor the formation of inactive metabolites
MOA of Benzos
- bind allosterically to GABA receptor, upregulating effect pf GABA
- GABA receptor is a Cl channel
- inc. influx of Cl causes hyperpolarization
- EtOH and barbs bind to other allosteric sites in GABA rec.
Reyes Syndrome
- salicylates + virus in children
- hepatic dysfunction: vomiting and hepatomegaly, inc. ALT/AST, inc. PT/PTT
- light micro shows microvesicular steatosis (fat vacuoles in the cytoplasm)
- e mico shows swelling and dec. mitochondria and glycogen dec.
- ecephalopathy: hyperammonemia in CNS leads to cerebral edema
MOA of Bisphosphonates
- stabilize hydroxyapatite structure
- induce osteoblasts to secrete inhibitors of osteoclasts
- dec. bone resorption
Filgrastim
- granulocyte colony stimulating factor
- inc. white blood count in pts with leukopenia
Treatment of Oral and Vaginal Candidiasis
- oral: nystatin
- vaginal: azole
Bleomycin
- may cause pulmonary fibrosis
- causes DNA strand breakage
- cancer drug
Cyclophosphamide
- may cause bladder cancer
- cancer drug
- cross links DNA
Nitric Oxide
- pulmonary vasodilator
- could be used in neonatal HTN
- not same as nitrous oxide (laughing gas)
- inc. cGMP and causes reuptake of Ca, causing smooth muscle relaxation
Sumatriptan MOA
- 5HT receptor agonist
- reduces vascular inflammation ass. w/ migraines
Macrolide MOA
- 50S ribosomal inhibitor
- bacteriostatic
- interferes with aminoacyl translocation, preventing transfer of the tRNA bound at the A site to the P site
MOA of Cisplatin
- cross links DNA, blocking DNA replication and causing cell death
- alkylating agent
Pindolol
- non selective beta blocker with partial agonist activity
- avoid it pts with heart failure or hx of MI
Dextromethorphan
- cough suppressant
- does not cause constipation and low potential for substance abuse
Cocaine MOA
- inhibits reuptake of serotonin, NE, and DA (enhances sympathetic activity at low doses)
- blocks Na channels in cardiac tissue leading to sudden cardiac death
- acts like a class 1 antiarrhythmic agent (blocking Na and K channels) (local anesthetic action at higher doses)
- also stimulates release of endothelin-1 (potent vasoconstrictor)
Docusate
-stool softener
Bidacodyl
- laxative
- stimulats enteric nerves to cause colonic contractions
- inc. fluid and salt secretion
Sucrasulfate
- treats active duodenal ulcers and GERD
- binds ulcer and creates physical barrier that protects from acid erosion
Clomiphene
- selective estrogen receptor modulator
- widely used drug for ovulation induction in women with difficulty conceiving
