Pharm Flashcards
1
Q
Pulm HTN Drugs
A
Endothelin-R Antagonist (Bosentan), PDE-5 Inhibitors (Sildenafil), Prostacyclin analog (eproprosentenol, iloprost)
2
Q
Anatgonize endothelin-1 receptors = decreased pulm vascular resistance.
Name drug and toxicity
A
Bosentan
Hepatotoxic (monitor LFT)
3
Q
Inhibit cGMP PDE5 and prolong vasodilatory effect of NO. Used for Pulm HTN and erectile dysfunction
A
Sildenafil
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
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.
6
Q
Treatment for Doxorubicin cardiotaxoicity
A
Dexrazoxane (Fe-chelator)
7
Q
Cisplatin MOA
A
Cross-link DNA (alkylating agent)
8
Q
Cisplatin toxicity
A
Nephrotoxic and ototoxic (acoustic nerve). Also nausea and vomiting (tx w/ondansetron). Note: no bone marrow supp.
9
Q
Tx for cisplatin nephrotoxicity
A
Amifostine
10
Q
Antibiotic metabolized to 5-FU: name and organism
A
Flucytosine. Use for Cryptococcus
11
Q
inhibits dUMP–>dTMP (Thymidylate Synthase) (=decreased DNA synthesis)
A
5-Fluorouracil
12
Q
unique feature that antitumor drug can be taken topically
A
5-FU topically to tx basal cell carcinoma
13
Q
Myelosuppression tx with Leucovorin (folinic acid)
A
Rescues methotrexate bone marrow suppression but NOT 5-FU
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
15
Q
drugs that inhibit microtubules (i.e. drugs that can be used in M phase)
A
Vincas, pacliataxel, colchicine
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)
17
Q
Anticancer drugs that do NOT suppress bone marrow (3)
A
Vincristine (neurotoxic), Cisplatin (nephrotoxic and ototoxic), and Bleomycin (pulm fibrosis)
18
Q
Anticancer drug that causes hematuria
A
Cyclophosphamide –> hemorrhagic cystitis
19
Q
Ototoxic agents
A
Cisplatin, Furesomide (loops), Aminoglycosides, salicylates
20
Q
Name 3 Loop diuretics (sulfonamides)
A
Furosemide, Bumetanide, Torsemide. Also, Ethacrynic acid is a nonsulfonamide with same MOA.
21
Q
Loop toxicity
A
Ototoxicity, Hypokalemia, HYPOcalcemia (loops lose Ca), Hyperuricemia (GOUT)
22
Q
Loop MOA drug that can be used in pt with sulfa allergy
A
Ethacrynic acid
23
Q
Why not use a beta-blocker DURING heart failure?
A
Would further inhibit CO
24
Q
Side effects of Thiazides
A
Hyponatremia, Hypokalemia (metab acidosis). Hyperglycemia, Hyperuricemia (gout), HYPERcalcemia
25
reversibly inhibits cox
acetaminophen. nsaids (ibuprofen, naproxen, indomethacen, ketorolac, diclofenac)
26
acetaminophen depletes ______, which is restored by _______
glutathione depletion restored by n-acetylcysteine
27
drug for child with viral URI
give acetaminophen. avoid aspirin (Reye)
28
is acetaminophen anti-inflammatory?
No...anti-pyretic and analgesic
29
is aspirin anti-inflammatory?
Yes, at high dose. lower doses inhibit platelet aggregation, analgesic, and anti-pyretic
30
aspirin MOA
irreversibly inhibit cox via acetylation
31
aspirin efect hematologically
increase bleeding time. it decreases synth of txas2 and pg. no effect on pt/ptt
32
celecoxib used for:
rheumatoid arthritis, osteoarthritis. cox2 selective. also can be used in pt with hx of peptic ulcer disease because lower risk of gastric ulceration
33
alendronate drug class
bisphosphonates
34
drug class that are pyrophosphate analogs...bind hydroxyapatite in bone
bisphosphonates...inhibit osteoclast activity
35
Parathyroid hormone: f(x)
1. stimulates calcium rel 2. stimulates OSTEOBLASTIC cell 2. stimulate bone resorption via INDIRECT EFFECT ON OSTEOCLAST
36
cause of hypercalcemia in malignancy (hormone not pharm)
PTHrP
37
teriparatide
increases, wait for it, osteoblastic activity. useful in osteoporosis
38
Bisphosphonates are analgous to _________
pyrophosphate
39
leuktotriene synthesis inhibitor-->block 5-lipoxygenase
Zileuton
40
inhibit LTC4, D4, E4 (which increase bronchial tone normally)
-lukast. Montelukast, Zafirlukast.
41
Zileuton vs -lukast
-Lukast inhibit the kast off...LT's produced down the line. Zileuton inhibits the enzyme...lipoxygenase
42
Phospholipids-----PhospholipaseA2--->Arachidonic Acid--->LT (lipoxygenase) and PG, Prostacylin aka PGI2, Thromboxane. what inhibits PLA2?
CorticosteroidsZZX
43
Acute gout drugs
NSAIDS, Glucocorticoids, Colchicine
44
colchicine MOA
stabilizes tublin = inhibit microtubule polymerization --> impaired neutrophil chemotaxis and degranulation = decreased phagocytosis
45
why do we avoid salicylates aka aspirin in gout?
they inhibit uric acid clearance
46
side effects of colchicine
GI side effects (nausea abdominal pain etc)
47
chronic gout drugs (prophylactic)
allopurinol and febuxostat = XO inhibitors
probenecid (inhibit PCT reab of uric acid)
pegloticase (increase uric acid metabolism)
48
which gout drug is going to increase uricosruia (renal excretion and thus uric acid stones/calculi=colic)
Probenicid -> inhibits reabsorption in PCT
49
TNF =which is important granuloma formation and stabilization. TNF-alpha inhibitors increase the risk of:
reactivation of latent TB
| all of them predispose you to infection in general
50
name TNF-alpha inhibitors
Etanercept, Infliximab, Adalimumab
51
Etanercept MOA
TNF decoy reCEPTor.
52
what should you test for before using etanercept?
its a TNF alpha inhibitor, so have to do a TB test
53
clinical uses for tnf alpha inhibitors
rheumatoid arthiris, seronegative spondys
54
Diarrhea opioids
Loperamide, Diphenoxylate (Imodium)
| Can be combined with atropine to decrease abuse
55
Opioid MOA
Open K, Close Ca = decrease transmission.
Inhibit release of ACH, 5-HT, NE, Glutamate, Sub P
56
Opioid (i.e. Heroin) Toxicity
```
Respiratory depression (tolerance)
Miosis, Constipation (NO TOLERANCE)
```
Tx: Naloxone/Naltrexone (receptor antagonist)
(Note: Methadone used in addicts)
57
Butorphanol
K-opioid receptor agonist; u-opioid partial.
| Migraine/labor pain. less resp depression but more withdrawal.
58
Tramadol (take a tram to _____ ______)
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
When are Benzo's used for seizure
Status Epilepticus.
| Follow with phenytoin to prevent recurrence
60
Side effects of Phenytoin
Have you seen Steven Johnsons Phun toy?
Handsom Wolf with Gingival Hyperplasia
```
Hirsutism
Ataxia
Nystagmus
Diplopia
Steven-Johnson
Osteopenia
Megaloblastic Anemia
```
Wolf (Lupus like syndrome) with Gingival Hyperplasia
61
Benzo overdose (Bendragon)
Flumazenil
| avoid benzos in elderly, alcohol, barbiturates, or histamine blockers
62
Dantrolene
- malignant hyperthermia -inhaled anesthetics or succinylcholine;
- MS from d2 blockers
Dan told Ryan to stop drinking my milk!!
Blocks Ca release for RyR (aka SR)
63
Glitazones for diabetes
Bind PPAR gamma to increase insulin sensitivity (decrease resistance)
Toxicity: Fractures, HF, Hepatotoxicity, edema/wt gain
64
Glipizide and Glyburide (are NOT incretins)
Repaglinide, Nateglinide (metaglitinides) same moa
Sulfonylureas: close K = depol = insulin release via Ca influx
useless in T1DM. can cause hypoglycemia
65
what meds should be avoided with Cocaine?
Beta blockers
66
when are atypical antipsychotics first line
schizophrenia
67
two major uses of venlafaxine
PTSD
| Panic disorder
68
MOA of methyphenidate
| (and methamphetamine/dextroamphetamine)
CNS stimulant: increase catecholamines (esp NE and Dopamine) in synaptic cleft
-->used for ADHD, narcolepsy
69
Haloperidol + "-azines" (fluphenazine, chlorpromazine, etc)
Antipsychotics: Block D2 receptors (=increase cAMP)
70
High potency antipsychotics (1st gen)
Trifluoperazine, Fluphenazine, Haloperidol: Try Halo Fucking High
Neuro side effects: EPS, delirium, Hungtingtons disease
71
Low potency antipsychotics (1st gen)
Chlorpromazine, Thioridazine: Cheating Thieves are low psycho's
Non-neuro side effects: anticholinergic, antihistamine, alpha blockade
72
specific antipsychotic toxicity (1st gen)
Chlorpromazine: Corneal deposits
Thioridazine: reTinal deposits
(the eyes are lower than the brain)
Haloperidol: Tardive dyskinesia, NMS,
73
Myoglobinuria, diffuse lead pipe muscular rigidity, autonomic instability, extreme fever, altered mental status. name and tx
Neuroleptic Malignant Syndrome (from antipsychotics).
| Tx = Dantrolene, D2 agonists (bromocriptine)
74
Gotta keep Neuroleptic Malignant Syndrome and Serotonin Syndrome straight
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
Alteplase/streptokinase effects and labs
Aid conversion of plasminogen to plasmin.
Increased PT/PTT, no change in platelet count
76
Tx for tPa toxicity
Aminocaproic acid
77
Astrocyte or microglia: removal of excess neurotransmitters
Astrocyte!
78
Tx for CF
N-acetylcysteine (cleaves disulfide bonds in mucus glycoproteins=loosen mucus plugs)
Dornase alfa (DNAse to clear leukocytic debris)
79
2 expectorants
N-acetylcysteine : Mucolytic (also acetaminophin OD antidote)
Guaifesin: expectorant-->thins respiratory secretions (but does not suppress cough)
80
Dextromethorphan
NMDA (glutamate)-R antagonist. Mild opioid acitivity. Can use Naloxone to reverse OD.
Can cause SEROTONIN syndrome!
81
alpha adrenergic agonists used for nasal decongestion
Pseudoephedrine, Phenylephrine (pseudofed used for meth so toxicity = cns stimulation)
82
4 mood stabilizers for Bipolar
Lithium (hypothyroidism)
Valproate (hepatotoxic/neural tube defects)
Carbamazepine (Agranuloc, neural tube, hyponatremia)
Lamotrigine (Steven-Johnsons)
83
Antipsychotics are ________ and thus ______ to leave the body. these drugs can increase QT interval
Lipid soluble so slow to leave body
84
Tx for EPS of antipsychotics
Benztropine or Diphenhydramine
85
Atypical antipsychotics (D2 block and 5-HT, alpha, histamine etc)
Olanzapine, Clozapine, Risperidone (quetiapine, aripiprazole, ziprasidone)
86
Atypical antipsychotic side effects (clozapine, olanzapine, risperidone)
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
LMNOP (lithium toxicity)
Lithium causes Movement (tremor), Nephrogenic diabetes inspidius, hypOthyroidism, Pregnancy problems (ebstain anomaly in newborn)
88
Bipolar pt's also taking _________ will experience lithium toxicity
Thiazide diuretics --> precipitates tremors etc.
| Lithium is excreted by kidneys and reabsorbed at PCT with Na+
89
Buspirone MOA and use (NOT Bupoprion)
Used for generalized Anxiety -->stimulates 5-HT receptors. No interaction with alcohol.
"Always anxious if the bus will be on time"
90
Name 3 SSRIS
Fluoxetine, Paroxetine, Sertraline (and citalopram)
91
1st line for pt with depression that wants to avoid sexual side effects or wt gain
Bupropion-->inhibits reuptake of NE and Dopamine (=increases)
92
Bupoprion (also used for smoking cessation) toxicity
```
Seizures in anorexic/bulimics,
stimulant effects (tachycardia, insomnia)
```
93
Atropine-like (anticholinergic) side effects for Depression and OCD drug
TCA's: Amitriptyline, Imipramine, Clomipramine, Doxepin
94
SSRI vs Benzo for Panic Disorder
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
Name a drug that both increases nt release and inhibits its uptake
Amantadine: Dopamine (Parkinsons)
96
Don't confuse Amantadine and Memantine
Amantadine: Increases dopamine availability (PD)
Memantine: Inhibits NMDA-R (Alzheimers)
97
5-HT agonist
Inhibits Trigeminal nerve activation
Preven VIP; induce vasoconstriction
Sumatriptan
-->can cause coronary vasospasm so CI in CAD/Prinzmetal angina pt
98
Tx for bradycardia
Atropine jignesh bhai. Decreases Vagal input to SA and AV node.
-->increased intraocular P --> Glaucoma (acute closed angle) is common side effect
99
Displaces drugs/substrates from Albumin
Sulfonamides (bactrim)
- ->displaces warfarin
- ->displaces bilirubin = KERNICTERUS in infants
* so dont use Bactrim in pregnant
100
Increases theophylline concentration; used for Atypical pneumonia (myco, chlam, legionella), G+ cocci, Pertussis
Macrolides (azithro, clarithro, erythro)
101
Can treat MRSA and VRE and also cause Serotonin Syndrome
Linezolid
102
inhibits topoisomerase (including gyrase)
Fluoroquinolines (i.e. ciprofloxacin)
103
Can you use ACE-I and ARB in pregnancy?
Naw theyre CI -->can impair renal f(x) = oligohydramnios (Potter)
104
Why is Bactrim CI in pregnant?
Trimethoprim is folate synth blocker so increase risk neural tube defects in 1st trimester
Sulfonamide displaces shit from albumin including bilirubin = Kernicterus
105
Fomepizole inhibits alcohol dehydrogenase
(ethanol--->acetylaldehyde) = antidote for :
Disulfiram inhibits:
Ethylene glycol (antifreeze) or Methanol toxicity
Acetylaldehyde DHase (Acetylaldehyde-->Acetate)
106
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)
Metronidazole w/alcohol
Cephalosporin
Griseofulvin
Sulfonylurea
107
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)
Tx = Cyproheptadine
Flushing, diarrhea, seizures, hyperthermia, confusion, myoclonus, CV instability
108
Triple Therapy
PPI + Clarithromycin + Metronidazole
109
Anaerobe tx (relative to diaphragm)
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
Daptomycin disrupts cell membrane of G+ cocci. Use to treat _____ and _____ ; monitor _____
Tx MRSA and VRE
| Monitor Creatinine Phosphokinase because toxicity = Myopathy and Rhabdomyolysis
111
Cimetidine MOA and Toxicity
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
when you see "-azole", does it necessarily mean antifungal?
NO, can also be PPI
Omeprazole, Lansoprazole, Esmoprazole, Pantoprazole, Dexlansoprazole
-->Irreversibly inhibit Na/K ATPase in parietal cell
113
Prevention of NSAID-induced ulcers
Misoprostol (PGE1 analog)
-->NSAIDS block PG's
this drug also used for maintenance of PDA, abortion, induction of labor
114
Side effects of antacids
All: Hypokalemia
Aluminum Hydroxide:
Constipation (minimum feces), Low phosphate, seizures, mm weakness, osteodystrophy
Magnesium Hydroxide:
Diarrhea (Must Go), hyporeflexia, hypotension, cardiac arrest
115
Sucralfate vs Sulfasalazine (GI)
Sucralfate (and Bismuth) bind ulcer base
Sulfasalazine: used for UC and Crohns. Has antibiotic (sulfapyridine) and antiinflam (5-ASA). Activated by colonic bacteria
116
Drug that inhibits gastric/pancreatic lipase and promotes weight loss
Orlistat (fat soluble vit def = toxicity)
117
Prevents assembly and maturation of HIV virus
Protease Inhibitors "-navir"
| needs Protease to chop up products of of HIV mRNA into functional parts...stems from pol gene
118
Structurally unrelated to nucleosides, not phosphorylated intracellularly, and inhibits synthesis of viral DNA from the RNA template
so you know its inhibiting RTase but not a NRTI (they need to be P. all except Tenofovir)
-->NNRTI: DelaVIRdine, efaVIRenz, neVIRapine
