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Rapid Review USMLE Step 1 > Pharm > Flashcards

Pharm Flashcards

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USMLE® Step 1 flashcards
1
Q

Anti-muscarcinic that can be used as a treatment for drug-induced parkinsonian symptoms (cog-wheel rigidity, resting tremor, masked facies, bradykinesia) typically caused by D2 receptor blockade in the nigrostriatal pathway

A

Benzotropine and trihexyphenidyl

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2
Q

long acting insulin

A

Detmir (Dont), Go (Glargine)

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3
Q

Intermediate Acting Insulin

A

regular insulin (Rest), NPH (neutral protamine Hagedorn) (Now); peaks 2-3 hours after admin

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4
Q

Short Acting insulin (pe-prandial admin)

A

Glulisine (Girls) Aspart (And) Lispro (Lads)

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5
Q

Diuretic used to treat acute decompensated HF

A

Loop diuretics which work at the TaLH; inhibit NaKCl2; Furosemide and Ethacrynic Acid

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6
Q

diuretic primarily used to treat Hypertension

A

Thiazide diuretics; work at DCT inhibiting the NaCl; Hydrochlorothiazide and Chlorothalidone

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7
Q

Phase I Drug metabolism

A

Reduction, oxidation, hydrolysis with Cytochrome P450 yields slightly polar water-soluble metabolites

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8
Q

Phase II Drug metabolism

A

Conjugation (methylation, glucuronidation, acetylation, sulfanation) yields very polar inactive metabolites that can be really excreted

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9
Q

Drugs that can cause drug induced lupus in slow acetylators

A

Procainamide, isoniazid, hydralazine (increases cGMP leading to smooth muscle dilation; used in HTN emergency)

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10
Q

Hydralazine MOA, Use and SAE

A

MOA: Increases cGMP –> smooth muscle relaxation; Hypertensive emergency (smooth muscle dilation); reflexive Tachycardia, SLE, fluid retention, headache, angina

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11
Q

Treat for extended spectrum beta lactamase organism

A

Carbapanems

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12
Q

SAEs of Carbapenems

A

Diarrhea, lower seizure threshold, rash

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13
Q

SAEs of Amphotericin B

A

Infusion related: fever, chills, headache, hypotension; Long term complication: Type I renal tubular acidosis (1 cylinder), Anemia second to decreased Epo production, magnesium wasting’ seizures with intrathecal administration

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14
Q

Class IV Antiarr

A

Verapamil, Diltiazem- RATE control (SA and AV node conduction)

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15
Q

Adverse SAEs of Adenosine

A

Flushing, SOB, Chest pain, Sense of impeding doom, headache, hypotension, bronchospasm; effects are blunted by theophylline and caffeine (A1r Antagonist)

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16
Q

Class V Antiarrythmics

A

Adenosine, Digoxin, Magnesium, Potassium

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17
Q

MOA of Adenosine

A

Binds A1 receptors increased K+ efflux from the cell, decreased Ca current (Ica) –> Decreased AV node conduction

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18
Q

Drug that causes selective inhibition of I funny channels prolonging phase 4 of the pacemaker AP; decreases SA node firing; reduces Cardiac O2 requirement

A

Ivabradine

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19
Q

SAE of ivabradine

A

Visual brightness, hypertension, bradycardia

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20
Q

This drug causes smooth muscle relaxation by inhibiting Na current mediated action potentials; however it is less efficacious in infected tissues

A

Lidocaine, bupivacaine; less effective in ischemic and acidotic tissue

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21
Q

Conditions treated with FFP/ prothrombin Complex concentrate

A

Deficiencies in F II, VII, IX, X C and S; Warfarin too, rodent poisoning, etc; DIC, cirrhosis

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22
Q

Conditions treated with Cyoprecipitate

A

cry contains fibronectin, VIII, XIII and vWF; so you can treat vWF deficiency, fibrinogen deficiency and Hemophilia A.

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23
Q

Cholinomimetics

A

bethancol, pilocarpine, carbachol, methacholine

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24
Q

Alzheimer’s Drugs that are AChEi

A

Rivastigmine, Donepezil, Galantamine; penetrate the CNS

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25
Q

Treatment of Myasthenia Gravis

A

Pyridostigmine or Neostigmine (AChEi); Edrophonium for Dgx (improvement in weakness= myasthenia crisis + tension test; negative tension test is an exacerbation of sx and suggest AChEi OD)

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26
Q

Treatment for non-depolarizing NMJ blockade with tubocurarine, rocuronium, etc

A

Neostigmine (does not penetrate CNS)

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27
Q

Treatment for depolarizing NMJ blockade with Succinylcholine

A

AchEi; must be administered in Phase II of NM blockade otherwise it will potentiate effects of Succinylcholine in phase I

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28
Q

Symptoms of Ach Toxicity associated with AChEi and Organophosphates

A

DUMBBELSS: Diarrhea, Urination, Miosis, Bradycardia, bronchospasm, Emesis, Lacrimation, salivation, sweating.

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29
Q

Treatment of Organophosphate toxicity (irreversible AChEi)

A

Atropine (CNS reversal) and Pralidoxine (if organophosphate bound hasn’t aged with AchE then Pralidoxine can reverse the interaction and increase AChE reverse peripheral effects including flaccid paralysis)

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30
Q

Non-selective Alpha and Beta Blockers and indications

A

Carveidilol (HF, Variceal bleed); Labetalol (HTN emergency)

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31
Q

MOA of Sildenafil, -nafil suffix

A

PDE5 inhibitor–> increased cGMP –> Increased Smooth muscle relaxation in response to NO –> increased blood flow in the corpus cavernous and decreased pulmonary vascular resistance

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32
Q

SAEs of Sildenafil

A

Headache, flushing, dyspepsia, cyanopia, risk of life threatening hypotension when administered with nitrates (potentiates its affects)

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33
Q

NNRTis that inhibit Reverse Transcriptase in HIV

A

Delvirdine, efavirenz, Nevirapine

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34
Q

NRTIs that inhibit Reverse Transcriptase in HIV

A

Abacivir, didanosine, emtricitabine, lamuvidine, stavudine, tenofivir, zidovudine

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35
Q

Integrase inhibitors for HIV

A

Dolute(gravir), Elvite(gravir,) Ralte(gravir )

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36
Q

Protease Inhibitors of HIV

A

Atanzavir, darunavir, fosamprenavir, indinavir, lopinavir, ritonavir, saquin(avir)

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37
Q

Inhibits attachment of HIV to cells by blocking CCR5 and inhibiting interaction with gp120

A

Maraviroc

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38
Q

Inhibits penetration of HIV into cells

A

Enfuviritide binds gp41

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39
Q

protease inhibitor SAEs

A

Metabolic complications (lipodystrophy, insulin resistance, hyperglycemia, etc)

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40
Q

NRTI SAEs

A

lipodystrophy (horse) , lactic acidosis (spilled milk) , hypersensitivity with Abracavir (red bubbles from pot), pancreatitis with didanosine (sir dan holding sponge) and bone marrow suppression with zidovudine (princess izolde eating from depressed bone marrow plate)

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41
Q

NNRTI Saes

A

stevens johnsons syndrome (red mask), hepatoxicity (yellow stag with liver spot), neuropsychologist effects (holding head), teratogenic (tarantula), and Nevirapine is a CYP450 inducer

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42
Q

SAEs of integrate inhibitors

A

myopathy

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43
Q

Prevents catecholamine crisis in patients who are to have surgical resection of pheochromocytoma; In addition to a non-selective beta blocker like propranolol, what drug do you administer?

A

Think about it: Pheo– catecholamines–> adrenergic agonists–> sympathetic effects–> if you have already administered a beta blocker then you have to take care of the alpha adrenergic effects of catecholamines Phenoxybenzamine; non-selective alpha antagonist

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44
Q

Thyroid peroxidase inhibitors

A

Propylthiouracil, methimazole

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45
Q

Inhibitors of peripheral conversion of T3 and T4

A

propranolol, propylthiouracil, Ipodate (IV contrast)

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46
Q

inhibitors of Iodine uptake

A

potassium iodide; inhibits Iodine uptake and inhibits T3,T4 release

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47
Q

Treatment for urinary urgency

A

Anti-mAChR (Oxybutanin, Tolteridine)

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48
Q

Treatment for Overflow incontinence 2nd BPH

A

Alpha-1 Agonists: Prazosin, tamrulosin, terazosin;

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49
Q

Treatment of overflow incontinence due to detrusor under activity

A

bethanecol

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50
Q

MOA of Spironolactone and Eplerenone

A

Competitive aldosterone receptor antagonist (blocks aldo causing potassium wasting) at the collecting duct

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51
Q

MOA of Triamterence and Amiloride

A

Block sodium channels at the collecting duct

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52
Q

Indications for K+ Sparing diuretics

A

Hyperaldosteronism, K+ depletion, HF, hepatic ascites (spiro), nephrogenic DI (amiloride), antiandrogen

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53
Q

Treatment of Malignant hyperthermia and MOA

A

MH is caused by inhaled anesthetics/succinylcholine ; due to a mutation of the ryanodine receptor; Dantrolene is a ryandodine receptor blocker and leads to decreased Ca2+ release from the SR decreasing muscle contractions and hyperthermia

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54
Q

What causes uncoupling in the ETC

A

Thermogenin, ASA and dinitrophenol- leads to increased O2 consumption, decreased ATP production and decreased H+ inside (which is why you get less ATP); Produces heat

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55
Q

Blocks Complex V of ETC

A

Oligomycin

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56
Q

Blocks Complex IV of ETC

A

CN, CO, Azide

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57
Q

Blocks complex III of ETC

A

Antimycin A

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58
Q

Blocks Complex I of ETC

A

Rotenone

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59
Q

Nonbenzo that is used in the treatment of generalize anxiety disorder and is a partial 51HT agonist

A

Buspirone

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60
Q

Explain blood gas partition coefficient in the context of Volatile Anesthetics

A

High b:g partition coefficient–> High solubility–> slow onset of action.

61
Q

Explain blood:gas partition coefficient in the context of gaseous anesthetics (N2o, NO)

A

Low b:g partition coefficient–> Low solubility–> Rapid onset of action.

62
Q

MO of Nitrates

A

work primarily by increasing venous capacitance and therefore decrease preload; they also function to decrease SVR –> decreased Afterload (decreases myocardial O2 demand)

63
Q

MOA for sulfonureas in DM and AE

A

Bind to ATP dependent K+ channel, preventing K+ efflux–> depolarization –> Ca influx–> release of insulin granules; hypoglycemia independent of blood glucose levels

64
Q

Proteasome inhibitors used in the treatment of MM and mantle cell lymphoma; MOA

A

bortezomib (moronic acid derivative), and carfilozamib; Induce arrest of cell cycle at G2-M phase

65
Q

Treatment for pneumocystis jirovecci

A

TMX

66
Q

First line treatment for essential tremor

A

Propranolol/ Beta Antagonists

67
Q

Indications for bupropion

A

depression in a smoker (pros dont smoke), depression in someone with excessive fatigue/ sleeping (arousing audience member); Good for patients with a low libido (kissing couple); less likely to cause weight gain (stay fit)

68
Q

SAEs of bupropion

A

causes seizures (shaking slam dunk), contraindicated in anorexia(skinny player) and bulimia (binge size) because it lowers seizure threshold.

69
Q

MOA of bupropion

A

inhibits NE and DA reuptake (NET DAT Ball Pro)

70
Q

Indications for mirtazapine

A

Atypical AD used as first line treatment for depression with insomnia (kid falling asleep)

71
Q

MOA of mirtazapine

A

Alpha-2 antagonist (extinguished candles); H-1 R blockers (swatter–> sedation); 5HT-2 and 5HT-3 R blocker (53 and 52 HT jerseys); Increased NE and See release (Compass and smiley face balloons)

72
Q

SAEs of mirtazapine

A

weight gain (fat kid), sedation (fat kid falling asleep; makes it effective for atypical depression associated with insomnia)

73
Q

Indication for Trazadone

A

Primarily for insomnia, high doses are needed for anti-depressant effects

74
Q

MOA of Trazadone

A

Antagonized 5HT receptor and inhibits 5HT reuptake (drummer hitting smiley face drum and wearing a 52-HT jersey)

75
Q

SAEs of trazadone

A

Priapism (erect trombone), sedation (sleeping players on the bench with Swatter- H1 R antagonist), orthostatic hypotension (fainting couch), sexual dysfunction (rejected advances), Smiley face balls spilling everywhere (serotonin syndrome)

76
Q

First line treatment for GERD with erosions or ulcers

A

PPI (ompeprazole, -azole)

77
Q

SAEs of PPI

A

Risk of C diff infection (chocolate fondue), increased risk of pneumonia (dirty lungs), decreased Ca, Fe, and Mg absorption (low medals), osteoporosis (broken bone with porous wagon), and hypomagnesia (low magnets)

78
Q

Antibiotics prolong duration of excretion of what organism when ingested

A

antibiotics prolong excretion of Salmonella enteritis and salmonella typhi

79
Q

What effect do Antibiotics have on excretion of Shigella

A

Shortens duration of excretion

80
Q

MOA of Carbamazepine

A

increases Na Channel Inactivation (clipped salty chip bag)

81
Q

Use of Carbamazepine

A

Trigeminal neuralgia (3 gems), focal seizures (waitress with shaking hand)

82
Q

SAEs of carbamazepine

A

Ataxia (unbalanced stack of pancakes), SIADH (cup on head), Agranulocytosis (sand timer), CYP450 inducer (activated chrome bumper), dress syndrome (polka dot dress), Teratogen (tarantula) causes neural tube defects like spina bifida (exhaust pipe), SJS/ TEN (red mask)

83
Q

MOA of phenytoin

A

increase Na channel inactivation (clipped Na peanut bag)

84
Q

Use of phenytoin

A

focal seizures, status epilepticus

85
Q

SAEs of phenytoin

A

osteoporosis (broken axel), teratogen causes cleft palate (tarantula and bill of hate), hirsutism (beard), gingival hyperplasia (bubblegum), CYP450 inducer (Intact bumper), can cause drug induced lupus (wolf), folate deficiency (tossing salad), diplopia (crossed head lights), ataxia (falling stack of pancakes), Dress syndrome (polka dot dress)

86
Q

MOA of gabapentin

A

blocks voltage gated calcium channels

87
Q

Use of gabapentin

A

Fibromyalgia (fiber bars), neuropathic pain (frayed wire) DM neuropathic pain (diasweets), post-herpetic neuralgia (zeus)

88
Q

SAEs of gabapentin

A

ataxia (sway calcium stack)

89
Q

MOA of Vigabatrin

A

Blocks GABA transglutaminase inhibiting break down of GABA (elevated V-cab transmission)

90
Q

MOA of Tiagabtrin

A

Inhibited reuptake of GABA (tied up neck tie)

91
Q

Most effective medication for lowering TGs

A

Fenofibrate

92
Q

Most effective medication for lowering LDL

A

Statins

93
Q

MOA of cholestyramine

A

Bile acid resin-> bile acid resin binds bile in the stomach promoting its excretion–> Increased bile acid synthesis which lower cholesterol levels

94
Q

SAE of cholestyramine

A

Increased VLDL, increased TGs (VLDL ship escaping)

95
Q

MOA of Ezetimibe

A

Decreased intestinal absorption of cholesterol (EZ-eel blocking gold shipment delivery) and decreases LDL (sinking LDL ship)

96
Q

SAE of ezetimibe

A

elevated LFTs (waving white flag), diarrhea (eel in muddy water), increased cholesterol (increased crude oil machine activity)

97
Q

MOA of pioglitazone

A

bind to PPAR-gamma increasing transcription of adiponectin in the cell which decreases insulin resistance (Turtle neck)

98
Q

Blocks CCR5 so that GP120 on HIV surface can not bind to host cell

A

maraviroc

99
Q

Blocks GP41 from causing viral cell fusion with the host cell

A

Enfuvirtide

100
Q

HIV integrase inhibitors

A

Dolutegravir, elvitegravir, raltegravir

101
Q

HIV protease Inhibitors (prevent vision release from host cell)

A

Atanzavir, darunavir, Fosamprenavir, Indinavir, Lopinavir, Ritonavir, Saquinavir

102
Q

Reverse transcriptase inhibitors that need to be phosphorylated (NRTIs)

A

Abacivir (abracadabra), Didanosine (sir dan), Emtricitabine (excaliber), Lamuvidine (lamb), stavudine (sir steve), Tenofovir (sir tristin sailing the tide, does not need to be phosphorylated), Zidovudine (Princess isolde)

103
Q

NNRTIs

A

Delaviridine (princess Del), Efavirenz (Queen Elf), and Nevirapine (NEvirapine forest)

104
Q

Mechanism of resistance associated with Aminoglycosides

A

Antibiotic modifying enzymes–> acetylation or other groups being added to the drug rendering it inactive

105
Q

Treatment of Borrelia (adults; pregnant women and children)

A

Doxycycline or ceftriaxone; cerfuoxime and amoxicillin in women and children.

106
Q

SAEs of inhaled anesthetics

A

centrilobular hepatic necrosis (liverspot on pinata), malignant hyperthermia (Have a Magnificent birthday RYAN- ryanodine receptor), nephrotoxicity (smacked in the side)

107
Q

Suppresses GnRH –> decreased gonadotropin secretion–> prevention ovulation

A

COC, progestin implant

108
Q

Inhibits peripheral conversion of androgens to estrogens

A

Anastrazole, letrozole (aromatase inhibitor)

109
Q

Indications for leuprolide

A

Uterine fibroids, endometriosis, precocious puberty, prostate cancer, infertility

110
Q

2 mechanisms of Leuprolide

A

GnRH agonist properties when used in a pulsatile fashion ; GnRH antagonist properties when administered continuously

111
Q

SAEs of leuprolide

A

Hypogonadism, decreased libido, erectile dysfunction, nausea, vomiting

112
Q

MOA of Clomiphene

A

Blocks negative feedback of androgens leading to increase GnRH secretion–> Ovulation

113
Q

Termination of pregnancy; emergency conctraception

A

mifepristone with misoprostol; ulipristal

114
Q

Tocolytics- used to decrease contraction frequency in pre-term labor

A

Terbutaline (B2 agonist), Nifedipine (ca2 channel blocker), indomethacin

115
Q

Inhibits steroid synthesis and used in the treatment of PCOS (inhibits 17,20 desmolase/ 17alpha hydroxylase)

A

Ketoconazole

116
Q

Used in the treatment of PCOS Inhibits steroid binding, 17,20 desomolase/ 17alpha hydroxylase

A

Spironolactone

117
Q

Alpha-1 antagonists used in the treatment of BPH to decreased smooth muscle contraction

A

Tamsulosin

118
Q

Diuretic that decreases morbidity and mortality in patients with Congestive HF with reduced EF

A

Spironolactone/ k+ sparing diuretics (falling heart balloon held by the angel kid)

119
Q

CYP450 Inducers (+)

A

Modafinil (MOst), chronic alcohol use (CHRONIC ALCOHOLICS), st. johns wort (STeal), Phenytoin (Phen), Phenobarbital (Phen), Nevirapine (and NEVer), rifampin (Refuse), Griseofulvin (GREASE), carbamezapine (CARBs)

120
Q

Substrates of CYP450

A

Anti-Epileptics (Always), Theophylline (Think), Warfarin (When), OCPs (outdoors)

121
Q

Inhibitors of CYP 450 (-)

A

Sodium Valproate (S), Isoniazid (I), Cimetidine (C), Ketoconazole (K), Fluconazole (F), Acute Alcohol abuse (A), Chloramphenicol (C), Erythromycin/Clarithromycin (E), Sulfonamides (S), Ciprofloxacin (C), Ompeprazole (O), Metronidazole (M), Amiodarone (when i AM) grapefruit juice (drinking grapefruit juice)

122
Q

Isoniazid MOA

A

Inhibits synthesis of mycolic acids (cowboy falling off wall)

123
Q

SAEs of Isoniazid (INH)

A

Promotes excretion of vitamin B6 causing peripheral neuropathy (holding dice), can cause seizure (shaking lines) metabolized in the liver by acetyltransferase, slow acetylators have increased risk of SAEs (slow gun slinger), can lead to drug induced lupus- anti-histone Ab (wolf),

124
Q

MOA of isoniazid resistance

A

bacterial down regulation of catalase peroxidase (silenced G cat)

125
Q

MOA of ethambutol

A

inhibits arabinosyl transferase in bacteria inhibiting carbohydrate formation of cell wall (arabian horse preventing fence from being built)

126
Q

SAEs of ethambutol

A

caused red/ green color blindness, decrease visual acuity (Blinders on horse)

127
Q

MOA of Rifampin

A

inhibits DNA dependent RNA polymerase

128
Q

SAEs of Rifampin

A

Orange bodily fluids (orange pit up in wagon), CYP450 inducer (intact CYP450 license plate)

129
Q

Contraindication for Abacavir

A

HLA-B*5701 Mutation-> increases risk of hypersensitivity

130
Q

Cladaribine MOA

A

Purine analog that inhibits DNAP arresting the cell in S phase (Purine analog hammer; cracked replication fork; Stone age)

131
Q

Indications for Cladarabine and SAE

A

Hairy Cell leukemia (hairy caveman); bone marrow suppression (broken bone)

132
Q

MOA of Cytarabine

A

Pyrimidine analog (cheetah with pyrimidine pattern); inhibits DNAP arresting the cell in S phase; Treats hematological malignancies (Ab Archers and T cell swordsman)

133
Q

MOA of gemcitabine

A

pyrimidine analog (gems in the shape of pyrimidines) that inhibit DNAP; treats most cancers (crab fossil)

134
Q

MOA of metformin

A

Inhibits gluconeogenesis (Blocking candy release from the bag) by inhibiting mitochondrial glycerophosphate dehydrogenase (eating mitochondrial candy); Blocks AMP Kinase, which inhibits gluconeogenesis and increases insulin sensitivity (AMP kinase Candy Bag)

135
Q

Mycophenylate Mofetil

A

IMP dehydrogenase inhibitor preventing purine synthesis; tx for RA

136
Q

Alemtuzumab

A

CD52 monoclonal Ab used in the treatment of CLL and MS, and ALL

137
Q

Bevacizumab

A

VEGF targeting; Colorectal cancer, NSCLC, RCC

138
Q

Cetuximab

A

EGFR targeting; Stage IV colorectal cancer, Head and neck cancer

139
Q

Trastuzumab

A

HER2 target; breast and gastric cancer

140
Q

Adalimumab, certolizumab, golimumab, infliximab

A

soluble TNF-Alpha; IBD, RA, ankylosing spondylitis, psoriasis

141
Q

Daclizumab

A

CD25 (part of IL-2); tx of relapsing MS

142
Q

Eculizumab

A

Complement protein C5 antibody; PNH

143
Q

Natalizumab

A

alpha-4 integrin antibody; MS and Crohns; Risk of PML in pts with JC virus

144
Q

Ustekinumab

A

IL-12/IL-23; Psoriasis, psoriatic arthritis

145
Q

Abciximab

A

Antibody to GPIIB/IIIA; antiplatelet for prevention of ischemic complications in patients undergoing percutaneous coronary intervention

146
Q

Denosumab

A

RANKL antibody; tx for osteoporosis; inhibits osteoclast maturation

147
Q

Digoxin immune Fan

A

Digoxin antibody- antidote

148
Q

Omalizumab

A

IgE Antibody; asthma- prevents binding to FcEpsilon RI

149
Q

Palivizumb

A

RSV F protein; RSV prophylaxis for high risk infants

Rapid Review USMLE Step 1 (8 decks)

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