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Pharm Flashcards

1
Q

Pulm HTN Drugs

A

Endothelin-R Antagonist (Bosentan), PDE-5 Inhibitors (Sildenafil), Prostacyclin analog (eproprosentenol, iloprost)

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2
Q

Anatgonize endothelin-1 receptors = decreased pulm vascular resistance.

Name drug and toxicity

A

Bosentan

Hepatotoxic (monitor LFT)

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3
Q

Inhibit cGMP PDE5 and prolong vasodilatory effect of NO. Used for Pulm HTN and erectile dysfunction

A

Sildenafil

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4
Q

PGI2 (prostacyclin) with direct vasodilatory effect on pulm and systemic arteries. Decrease pulm HTN and inibi platelet aggregation

A

Protacyclin analogs = Epoprosentenol, Iloprost

toxicity = jaw pain and flushing

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5
Q

Doxorubicin MOA

A

Antitumor Antibiotic.
form free radicals –> can be neutralized in most tissues, except for tumor cells and cardiac cells (cardiotoxicity: DCM) and causes alopecia also.

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6
Q

Treatment for Doxorubicin cardiotaxoicity

A

Dexrazoxane (Fe-chelator)

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7
Q

Cisplatin MOA

A

Cross-link DNA (alkylating agent)

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8
Q

Cisplatin toxicity

A

Nephrotoxic and ototoxic (acoustic nerve). Also nausea and vomiting (tx w/ondansetron). Note: no bone marrow supp.

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9
Q

Tx for cisplatin nephrotoxicity

A

Amifostine

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10
Q

Antibiotic metabolized to 5-FU: name and organism

A

Flucytosine. Use for Cryptococcus

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11
Q

inhibits dUMP–>dTMP (Thymidylate Synthase) (=decreased DNA synthesis)

A

5-Fluorouracil

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12
Q

unique feature that antitumor drug can be taken topically

A

5-FU topically to tx basal cell carcinoma

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13
Q

Myelosuppression tx with Leucovorin (folinic acid)

A

Rescues methotrexate bone marrow suppression but NOT 5-FU

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14
Q

Allopurinol interferes with which anti-tumor drug

A

6-mercaptopurine and Azothiopurine(metab into 6-mp) –> its metabolized by XO, which Allopurinol inhibits

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15
Q

drugs that inhibit microtubules (i.e. drugs that can be used in M phase)

A

Vincas, pacliataxel, colchicine

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16
Q

Toxicity of vinca’s

A

Vinblastine follows the rule of most antitumor: Bone Marrow Suppression (blasts bone marrow)
Vincristine breaks it: Neuro toxicity (periph neuropathy aka tingling)

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17
Q

Anticancer drugs that do NOT suppress bone marrow (3)

A

Vincristine (neurotoxic), Cisplatin (nephrotoxic and ototoxic), and Bleomycin (pulm fibrosis)

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18
Q

Anticancer drug that causes hematuria

A

Cyclophosphamide –> hemorrhagic cystitis

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19
Q

Ototoxic agents

A

Cisplatin, Furesomide (loops), Aminoglycosides, salicylates

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20
Q

Name 3 Loop diuretics (sulfonamides)

A

Furosemide, Bumetanide, Torsemide. Also, Ethacrynic acid is a nonsulfonamide with same MOA.

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21
Q

Loop toxicity

A

Ototoxicity, Hypokalemia, HYPOcalcemia (loops lose Ca), Hyperuricemia (GOUT)

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22
Q

Loop MOA drug that can be used in pt with sulfa allergy

A

Ethacrynic acid

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23
Q

Why not use a beta-blocker DURING heart failure?

A

Would further inhibit CO

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24
Q

Side effects of Thiazides

A

Hyponatremia, Hypokalemia (metab acidosis). Hyperglycemia, Hyperuricemia (gout), HYPERcalcemia

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25
Q

reversibly inhibits cox

A

acetaminophen. nsaids (ibuprofen, naproxen, indomethacen, ketorolac, diclofenac)

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26
Q

acetaminophen depletes ______, which is restored by _______

A

glutathione depletion restored by n-acetylcysteine

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27
Q

drug for child with viral URI

A

give acetaminophen. avoid aspirin (Reye)

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28
Q

is acetaminophen anti-inflammatory?

A

No…anti-pyretic and analgesic

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29
Q

is aspirin anti-inflammatory?

A

Yes, at high dose. lower doses inhibit platelet aggregation, analgesic, and anti-pyretic

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30
Q

aspirin MOA

A

irreversibly inhibit cox via acetylation

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31
Q

aspirin efect hematologically

A

increase bleeding time. it decreases synth of txas2 and pg. no effect on pt/ptt

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32
Q

celecoxib used for:

A

rheumatoid arthritis, osteoarthritis. cox2 selective. also can be used in pt with hx of peptic ulcer disease because lower risk of gastric ulceration

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33
Q

alendronate drug class

A

bisphosphonates

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34
Q

drug class that are pyrophosphate analogs…bind hydroxyapatite in bone

A

bisphosphonates…inhibit osteoclast activity

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35
Q

Parathyroid hormone: f(x)

A
  1. stimulates calcium rel 2. stimulates OSTEOBLASTIC cell 2. stimulate bone resorption via INDIRECT EFFECT ON OSTEOCLAST
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36
Q

cause of hypercalcemia in malignancy (hormone not pharm)

A

PTHrP

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37
Q

teriparatide

A

increases, wait for it, osteoblastic activity. useful in osteoporosis

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38
Q

Bisphosphonates are analgous to _________

A

pyrophosphate

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39
Q

leuktotriene synthesis inhibitor–>block 5-lipoxygenase

A

Zileuton

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40
Q

inhibit LTC4, D4, E4 (which increase bronchial tone normally)

A

-lukast. Montelukast, Zafirlukast.

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41
Q

Zileuton vs -lukast

A

-Lukast inhibit the kast off…LT’s produced down the line. Zileuton inhibits the enzyme…lipoxygenase

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42
Q

Phospholipids—–PhospholipaseA2—>Arachidonic Acid—>LT (lipoxygenase) and PG, Prostacylin aka PGI2, Thromboxane. what inhibits PLA2?

A

CorticosteroidsZZX

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43
Q

Acute gout drugs

A

NSAIDS, Glucocorticoids, Colchicine

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44
Q

colchicine MOA

A

stabilizes tublin = inhibit microtubule polymerization –> impaired neutrophil chemotaxis and degranulation = decreased phagocytosis

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45
Q

why do we avoid salicylates aka aspirin in gout?

A

they inhibit uric acid clearance

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46
Q

side effects of colchicine

A

GI side effects (nausea abdominal pain etc)

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47
Q

chronic gout drugs (prophylactic)

A

allopurinol and febuxostat = XO inhibitors
probenecid (inhibit PCT reab of uric acid)
pegloticase (increase uric acid metabolism)

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48
Q

which gout drug is going to increase uricosruia (renal excretion and thus uric acid stones/calculi=colic)

A

Probenicid -> inhibits reabsorption in PCT

49
Q

TNF =which is important granuloma formation and stabilization. TNF-alpha inhibitors increase the risk of:

A

reactivation of latent TB

all of them predispose you to infection in general

50
Q

name TNF-alpha inhibitors

A

Etanercept, Infliximab, Adalimumab

51
Q

Etanercept MOA

A

TNF decoy reCEPTor.

52
Q

what should you test for before using etanercept?

A

its a TNF alpha inhibitor, so have to do a TB test

53
Q

clinical uses for tnf alpha inhibitors

A

rheumatoid arthiris, seronegative spondys

54
Q

Diarrhea opioids

A

Loperamide, Diphenoxylate (Imodium)

Can be combined with atropine to decrease abuse

55
Q

Opioid MOA

A

Open K, Close Ca = decrease transmission.

Inhibit release of ACH, 5-HT, NE, Glutamate, Sub P

56
Q

Opioid (i.e. Heroin) Toxicity

A 
Respiratory depression (tolerance)
Miosis, Constipation (NO TOLERANCE)

Tx: Naloxone/Naltrexone (receptor antagonist)
(Note: Methadone used in addicts)

57
Q

Butorphanol

A

K-opioid receptor agonist; u-opioid partial.

Migraine/labor pain. less resp depression but more withdrawal.

58
Q

Tramadol (take a tram to _____ ______)

A

Weak opioid agonist that also inhibits 5-HT and NE reuptake –> think Serotonin syndrome and Seizures though!! (lowers threshold)

Take a TRAM to Seize Serotonin

59
Q

When are Benzo’s used for seizure

A

Status Epilepticus.

Follow with phenytoin to prevent recurrence

60
Q

Side effects of Phenytoin

Have you seen Steven Johnsons Phun toy?
Handsom Wolf with Gingival Hyperplasia

A 
Hirsutism
Ataxia
Nystagmus
Diplopia
Steven-Johnson
Osteopenia
Megaloblastic Anemia

Wolf (Lupus like syndrome) with Gingival Hyperplasia

61
Q

Benzo overdose (Bendragon)

A

Flumazenil

avoid benzos in elderly, alcohol, barbiturates, or histamine blockers

62
Q

Dantrolene

  • malignant hyperthermia -inhaled anesthetics or succinylcholine;
  • MS from d2 blockers
A

Dan told Ryan to stop drinking my milk!!

Blocks Ca release for RyR (aka SR)

63
Q

Glitazones for diabetes

A

Bind PPAR gamma to increase insulin sensitivity (decrease resistance)

Toxicity: Fractures, HF, Hepatotoxicity, edema/wt gain

64
Q

Glipizide and Glyburide (are NOT incretins)

Repaglinide, Nateglinide (metaglitinides) same moa

A

Sulfonylureas: close K = depol = insulin release via Ca influx

useless in T1DM. can cause hypoglycemia

65
Q

what meds should be avoided with Cocaine?

A

Beta blockers

66
Q

when are atypical antipsychotics first line

A

schizophrenia

67
Q

two major uses of venlafaxine

A

PTSD

Panic disorder

68
Q

MOA of methyphenidate

(and methamphetamine/dextroamphetamine)

A

CNS stimulant: increase catecholamines (esp NE and Dopamine) in synaptic cleft

–>used for ADHD, narcolepsy

69
Q

Haloperidol + “-azines” (fluphenazine, chlorpromazine, etc)

A

Antipsychotics: Block D2 receptors (=increase cAMP)

70
Q

High potency antipsychotics (1st gen)

A

Trifluoperazine, Fluphenazine, Haloperidol: Try Halo Fucking High

Neuro side effects: EPS, delirium, Hungtingtons disease

71
Q

Low potency antipsychotics (1st gen)

A

Chlorpromazine, Thioridazine: Cheating Thieves are low psycho’s

Non-neuro side effects: anticholinergic, antihistamine, alpha blockade

72
Q

specific antipsychotic toxicity (1st gen)

A

Chlorpromazine: Corneal deposits
Thioridazine: reTinal deposits
(the eyes are lower than the brain)
Haloperidol: Tardive dyskinesia, NMS,

73
Q

Myoglobinuria, diffuse lead pipe muscular rigidity, autonomic instability, extreme fever, altered mental status. name and tx

A

Neuroleptic Malignant Syndrome (from antipsychotics).

Tx = Dantrolene, D2 agonists (bromocriptine)

74
Q

Gotta keep Neuroleptic Malignant Syndrome and Serotonin Syndrome straight

A

Both can present with mental status changes, hyperthermia, and autonomic instability.

NMS: diffuse rigidity/bradyreflexia
SS: neuromuscular hyperactivity (shivering, clonus, hyperreflexia). Nausea/vomiting more common in SS.

75
Q

Alteplase/streptokinase effects and labs

A

Aid conversion of plasminogen to plasmin.

Increased PT/PTT, no change in platelet count

76
Q

Tx for tPa toxicity

A

Aminocaproic acid

77
Q

Astrocyte or microglia: removal of excess neurotransmitters

A

Astrocyte!

78
Q

Tx for CF

A

N-acetylcysteine (cleaves disulfide bonds in mucus glycoproteins=loosen mucus plugs)

Dornase alfa (DNAse to clear leukocytic debris)

79
Q

2 expectorants

A

N-acetylcysteine : Mucolytic (also acetaminophin OD antidote)
Guaifesin: expectorant–>thins respiratory secretions (but does not suppress cough)

80
Q

Dextromethorphan

A

NMDA (glutamate)-R antagonist. Mild opioid acitivity. Can use Naloxone to reverse OD.
Can cause SEROTONIN syndrome!

81
Q

alpha adrenergic agonists used for nasal decongestion

A

Pseudoephedrine, Phenylephrine (pseudofed used for meth so toxicity = cns stimulation)

82
Q

4 mood stabilizers for Bipolar

A

Lithium (hypothyroidism)
Valproate (hepatotoxic/neural tube defects)
Carbamazepine (Agranuloc, neural tube, hyponatremia)
Lamotrigine (Steven-Johnsons)

83
Q

Antipsychotics are ________ and thus ______ to leave the body. these drugs can increase QT interval

A

Lipid soluble so slow to leave body

84
Q

Tx for EPS of antipsychotics

A

Benztropine or Diphenhydramine

85
Q

Atypical antipsychotics (D2 block and 5-HT, alpha, histamine etc)

A

Olanzapine, Clozapine, Risperidone (quetiapine, aripiprazole, ziprasidone)

86
Q

Atypical antipsychotic side effects (clozapine, olanzapine, risperidone)

A

Olanz/Cloz: weight gain

Cloz: Agranulocytosis (WEEKLY WBC ct) and Seizures

Risperidone: increase prolactin = lactation, gynecomastia, irregular menstruation (dec GnRH)

All can increase QT interval

87
Q

LMNOP (lithium toxicity)

A

Lithium causes Movement (tremor), Nephrogenic diabetes inspidius, hypOthyroidism, Pregnancy problems (ebstain anomaly in newborn)

88
Q

Bipolar pt’s also taking _________ will experience lithium toxicity

A

Thiazide diuretics –> precipitates tremors etc.

Lithium is excreted by kidneys and reabsorbed at PCT with Na+

89
Q

Buspirone MOA and use (NOT Bupoprion)

A

Used for generalized Anxiety –>stimulates 5-HT receptors. No interaction with alcohol.

“Always anxious if the bus will be on time”

90
Q

Name 3 SSRIS

A

Fluoxetine, Paroxetine, Sertraline (and citalopram)

91
Q

1st line for pt with depression that wants to avoid sexual side effects or wt gain

A

Bupropion–>inhibits reuptake of NE and Dopamine (=increases)

92
Q

Bupoprion (also used for smoking cessation) toxicity

A 
Seizures in anorexic/bulimics, 
stimulant effects (tachycardia, insomnia)
93
Q

Atropine-like (anticholinergic) side effects for Depression and OCD drug

A

TCA’s: Amitriptyline, Imipramine, Clomipramine, Doxepin

94
Q

SSRI vs Benzo for Panic Disorder

A

If the nigga has any substance abuse cannot give him Benzos because these bitches are dank af.

In general: immediate = benzos; long term = SSRI

95
Q

Name a drug that both increases nt release and inhibits its uptake

A

Amantadine: Dopamine (Parkinsons)

96
Q

Don’t confuse Amantadine and Memantine

A

Amantadine: Increases dopamine availability (PD)
Memantine: Inhibits NMDA-R (Alzheimers)

97
Q

5-HT agonist
Inhibits Trigeminal nerve activation
Preven VIP; induce vasoconstriction

A

Sumatriptan

–>can cause coronary vasospasm so CI in CAD/Prinzmetal angina pt

98
Q

Tx for bradycardia

A

Atropine jignesh bhai. Decreases Vagal input to SA and AV node.

–>increased intraocular P –> Glaucoma (acute closed angle) is common side effect

99
Q

Displaces drugs/substrates from Albumin

A

Sulfonamides (bactrim)

  • ->displaces warfarin
  • ->displaces bilirubin = KERNICTERUS in infants
  • so dont use Bactrim in pregnant
100
Q

Increases theophylline concentration; used for Atypical pneumonia (myco, chlam, legionella), G+ cocci, Pertussis

A

Macrolides (azithro, clarithro, erythro)

101
Q

Can treat MRSA and VRE and also cause Serotonin Syndrome

A

Linezolid

102
Q

inhibits topoisomerase (including gyrase)

A

Fluoroquinolines (i.e. ciprofloxacin)

103
Q

Can you use ACE-I and ARB in pregnancy?

A

Naw theyre CI –>can impair renal f(x) = oligohydramnios (Potter)

104
Q

Why is Bactrim CI in pregnant?

A

Trimethoprim is folate synth blocker so increase risk neural tube defects in 1st trimester

Sulfonamide displaces shit from albumin including bilirubin = Kernicterus

105
Q

Fomepizole inhibits alcohol dehydrogenase
(ethanol—>acetylaldehyde) = antidote for :

Disulfiram inhibits:

A

Ethylene glycol (antifreeze) or Methanol toxicity

Acetylaldehyde DHase (Acetylaldehyde–>Acetate)

106
Q

Disulfiram-like rxn (Flushing, Hypotension, Tachycardia)
dont confuse with:

Serotonin syndrome (flushing/diarrhea/confusion and 5-HT meds)

Carcinoid (flushing/diarrhea/R side valvular disease/pellagra/asthmatic wheeeeezing)

A

Metronidazole w/alcohol
Cephalosporin

Griseofulvin
Sulfonylurea

107
Q

Serotonin syndrome. Drugs to not forget:

  • Linezolid: block protein synth @50S
  • Tramadol: weak opioid agonist, also block 5-HT/NE reuptake (and dec seizure threshold)
  • Dextromethorphan (Antitussive - blocks NMDA-R; mild opioid)
A

Tx = Cyproheptadine

Flushing, diarrhea, seizures, hyperthermia, confusion, myoclonus, CV instability

108
Q

Triple Therapy

A

PPI + Clarithromycin + Metronidazole

109
Q

Anaerobe tx (relative to diaphragm)

A

Above: Clindamycin (Aspiration pneumonia/abscess. toxicity = c dif pseudo colitis)

Below: Metronidazole (Bacterioides, C dif. Toxic free radical metabolites damage DNA)

So Clinda can cause C dif; Metro treats C dif

110
Q

Daptomycin disrupts cell membrane of G+ cocci. Use to treat _____ and _____ ; monitor _____

A

Tx MRSA and VRE

Monitor Creatinine Phosphokinase because toxicity = Myopathy and Rhabdomyolysis

111
Q

Cimetidine MOA and Toxicity

A

Reversible H2 blocker (Peptic ulcer disease/ reflux)

  1. Cyt p450 inhibitor
  2. Anti-androgen effects: Increases Prolactin, Gynecomastia, Impotence, Decreased Libido
  3. Crosses BBB (confusion/headaches)
  4. Decreases renal excretion of creatinine (also Ranitidine does)
112
Q

when you see “-azole”, does it necessarily mean antifungal?

A

NO, can also be PPI
Omeprazole, Lansoprazole, Esmoprazole, Pantoprazole, Dexlansoprazole

–>Irreversibly inhibit Na/K ATPase in parietal cell

113
Q

Prevention of NSAID-induced ulcers

A

Misoprostol (PGE1 analog)
–>NSAIDS block PG’s

this drug also used for maintenance of PDA, abortion, induction of labor

114
Q

Side effects of antacids

A

All: Hypokalemia

Aluminum Hydroxide:
Constipation (minimum feces), Low phosphate, seizures, mm weakness, osteodystrophy

Magnesium Hydroxide:
Diarrhea (Must Go), hyporeflexia, hypotension, cardiac arrest

115
Q

Sucralfate vs Sulfasalazine (GI)

A

Sucralfate (and Bismuth) bind ulcer base

Sulfasalazine: used for UC and Crohns. Has antibiotic (sulfapyridine) and antiinflam (5-ASA). Activated by colonic bacteria

116
Q

Drug that inhibits gastric/pancreatic lipase and promotes weight loss

A

Orlistat (fat soluble vit def = toxicity)

117
Q

Prevents assembly and maturation of HIV virus

A

Protease Inhibitors “-navir”

needs Protease to chop up products of of HIV mRNA into functional parts…stems from pol gene

118
Q

Structurally unrelated to nucleosides, not phosphorylated intracellularly, and inhibits synthesis of viral DNA from the RNA template

A

so you know its inhibiting RTase but not a NRTI (they need to be P. all except Tenofovir)

–>NNRTI: DelaVIRdine, efaVIRenz, neVIRapine

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