Pharm Flashcards
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
Benzotropine and trihexyphenidyl
long acting insulin
Detmir (Dont), Go (Glargine)
Intermediate Acting Insulin
regular insulin (Rest), NPH (neutral protamine Hagedorn) (Now); peaks 2-3 hours after admin
Short Acting insulin (pe-prandial admin)
Glulisine (Girls) Aspart (And) Lispro (Lads)
Diuretic used to treat acute decompensated HF
Loop diuretics which work at the TaLH; inhibit NaKCl2; Furosemide and Ethacrynic Acid
diuretic primarily used to treat Hypertension
Thiazide diuretics; work at DCT inhibiting the NaCl; Hydrochlorothiazide and Chlorothalidone
Phase I Drug metabolism
Reduction, oxidation, hydrolysis with Cytochrome P450 yields slightly polar water-soluble metabolites
Phase II Drug metabolism
Conjugation (methylation, glucuronidation, acetylation, sulfanation) yields very polar inactive metabolites that can be really excreted
Drugs that can cause drug induced lupus in slow acetylators
Procainamide, isoniazid, hydralazine (increases cGMP leading to smooth muscle dilation; used in HTN emergency)
Hydralazine MOA, Use and SAE
MOA: Increases cGMP –> smooth muscle relaxation; Hypertensive emergency (smooth muscle dilation); reflexive Tachycardia, SLE, fluid retention, headache, angina
Treat for extended spectrum beta lactamase organism
Carbapanems
SAEs of Carbapenems
Diarrhea, lower seizure threshold, rash
SAEs of Amphotericin B
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
Class IV Antiarr
Verapamil, Diltiazem- RATE control (SA and AV node conduction)
Adverse SAEs of Adenosine
Flushing, SOB, Chest pain, Sense of impeding doom, headache, hypotension, bronchospasm; effects are blunted by theophylline and caffeine (A1r Antagonist)
Class V Antiarrythmics
Adenosine, Digoxin, Magnesium, Potassium
MOA of Adenosine
Binds A1 receptors increased K+ efflux from the cell, decreased Ca current (Ica) –> Decreased AV node conduction
Drug that causes selective inhibition of I funny channels prolonging phase 4 of the pacemaker AP; decreases SA node firing; reduces Cardiac O2 requirement
Ivabradine
SAE of ivabradine
Visual brightness, hypertension, bradycardia
This drug causes smooth muscle relaxation by inhibiting Na current mediated action potentials; however it is less efficacious in infected tissues
Lidocaine, bupivacaine; less effective in ischemic and acidotic tissue
Conditions treated with FFP/ prothrombin Complex concentrate
Deficiencies in F II, VII, IX, X C and S; Warfarin too, rodent poisoning, etc; DIC, cirrhosis
Conditions treated with Cyoprecipitate
cry contains fibronectin, VIII, XIII and vWF; so you can treat vWF deficiency, fibrinogen deficiency and Hemophilia A.
Cholinomimetics
bethancol, pilocarpine, carbachol, methacholine
Alzheimer’s Drugs that are AChEi
Rivastigmine, Donepezil, Galantamine; penetrate the CNS
Treatment of Myasthenia Gravis
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)
Treatment for non-depolarizing NMJ blockade with tubocurarine, rocuronium, etc
Neostigmine (does not penetrate CNS)
Treatment for depolarizing NMJ blockade with Succinylcholine
AchEi; must be administered in Phase II of NM blockade otherwise it will potentiate effects of Succinylcholine in phase I
Symptoms of Ach Toxicity associated with AChEi and Organophosphates
DUMBBELSS: Diarrhea, Urination, Miosis, Bradycardia, bronchospasm, Emesis, Lacrimation, salivation, sweating.
Treatment of Organophosphate toxicity (irreversible AChEi)
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)
Non-selective Alpha and Beta Blockers and indications
Carveidilol (HF, Variceal bleed); Labetalol (HTN emergency)
MOA of Sildenafil, -nafil suffix
PDE5 inhibitor–> increased cGMP –> Increased Smooth muscle relaxation in response to NO –> increased blood flow in the corpus cavernous and decreased pulmonary vascular resistance
SAEs of Sildenafil
Headache, flushing, dyspepsia, cyanopia, risk of life threatening hypotension when administered with nitrates (potentiates its affects)
NNRTis that inhibit Reverse Transcriptase in HIV
Delvirdine, efavirenz, Nevirapine
NRTIs that inhibit Reverse Transcriptase in HIV
Abacivir, didanosine, emtricitabine, lamuvidine, stavudine, tenofivir, zidovudine
Integrase inhibitors for HIV
Dolute(gravir), Elvite(gravir,) Ralte(gravir )
Protease Inhibitors of HIV
Atanzavir, darunavir, fosamprenavir, indinavir, lopinavir, ritonavir, saquin(avir)
Inhibits attachment of HIV to cells by blocking CCR5 and inhibiting interaction with gp120
Maraviroc
Inhibits penetration of HIV into cells
Enfuviritide binds gp41
protease inhibitor SAEs
Metabolic complications (lipodystrophy, insulin resistance, hyperglycemia, etc)
NRTI SAEs
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)
NNRTI Saes
stevens johnsons syndrome (red mask), hepatoxicity (yellow stag with liver spot), neuropsychologist effects (holding head), teratogenic (tarantula), and Nevirapine is a CYP450 inducer
SAEs of integrate inhibitors
myopathy
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?
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
Thyroid peroxidase inhibitors
Propylthiouracil, methimazole
Inhibitors of peripheral conversion of T3 and T4
propranolol, propylthiouracil, Ipodate (IV contrast)
inhibitors of Iodine uptake
potassium iodide; inhibits Iodine uptake and inhibits T3,T4 release
Treatment for urinary urgency
Anti-mAChR (Oxybutanin, Tolteridine)
Treatment for Overflow incontinence 2nd BPH
Alpha-1 Agonists: Prazosin, tamrulosin, terazosin;
Treatment of overflow incontinence due to detrusor under activity
bethanecol
MOA of Spironolactone and Eplerenone
Competitive aldosterone receptor antagonist (blocks aldo causing potassium wasting) at the collecting duct
MOA of Triamterence and Amiloride
Block sodium channels at the collecting duct
Indications for K+ Sparing diuretics
Hyperaldosteronism, K+ depletion, HF, hepatic ascites (spiro), nephrogenic DI (amiloride), antiandrogen
Treatment of Malignant hyperthermia and MOA
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
What causes uncoupling in the ETC
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
Blocks Complex V of ETC
Oligomycin
Blocks Complex IV of ETC
CN, CO, Azide
Blocks complex III of ETC
Antimycin A
Blocks Complex I of ETC
Rotenone
Nonbenzo that is used in the treatment of generalize anxiety disorder and is a partial 51HT agonist
Buspirone
Explain blood gas partition coefficient in the context of Volatile Anesthetics
High b:g partition coefficient–> High solubility–> slow onset of action.
Explain blood:gas partition coefficient in the context of gaseous anesthetics (N2o, NO)
Low b:g partition coefficient–> Low solubility–> Rapid onset of action.
MO of Nitrates
work primarily by increasing venous capacitance and therefore decrease preload; they also function to decrease SVR –> decreased Afterload (decreases myocardial O2 demand)
MOA for sulfonureas in DM and AE
Bind to ATP dependent K+ channel, preventing K+ efflux–> depolarization –> Ca influx–> release of insulin granules; hypoglycemia independent of blood glucose levels
Proteasome inhibitors used in the treatment of MM and mantle cell lymphoma; MOA
bortezomib (moronic acid derivative), and carfilozamib; Induce arrest of cell cycle at G2-M phase
Treatment for pneumocystis jirovecci
TMX
First line treatment for essential tremor
Propranolol/ Beta Antagonists
Indications for bupropion
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)
SAEs of bupropion
causes seizures (shaking slam dunk), contraindicated in anorexia(skinny player) and bulimia (binge size) because it lowers seizure threshold.
MOA of bupropion
inhibits NE and DA reuptake (NET DAT Ball Pro)
Indications for mirtazapine
Atypical AD used as first line treatment for depression with insomnia (kid falling asleep)
MOA of mirtazapine
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)
SAEs of mirtazapine
weight gain (fat kid), sedation (fat kid falling asleep; makes it effective for atypical depression associated with insomnia)
Indication for Trazadone
Primarily for insomnia, high doses are needed for anti-depressant effects
MOA of Trazadone
Antagonized 5HT receptor and inhibits 5HT reuptake (drummer hitting smiley face drum and wearing a 52-HT jersey)
SAEs of trazadone
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)
First line treatment for GERD with erosions or ulcers
PPI (ompeprazole, -azole)
SAEs of PPI
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)
Antibiotics prolong duration of excretion of what organism when ingested
antibiotics prolong excretion of Salmonella enteritis and salmonella typhi
What effect do Antibiotics have on excretion of Shigella
Shortens duration of excretion
MOA of Carbamazepine
increases Na Channel Inactivation (clipped salty chip bag)
Use of Carbamazepine
Trigeminal neuralgia (3 gems), focal seizures (waitress with shaking hand)
SAEs of carbamazepine
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)
MOA of phenytoin
increase Na channel inactivation (clipped Na peanut bag)
Use of phenytoin
focal seizures, status epilepticus
SAEs of phenytoin
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)
MOA of gabapentin
blocks voltage gated calcium channels
Use of gabapentin
Fibromyalgia (fiber bars), neuropathic pain (frayed wire) DM neuropathic pain (diasweets), post-herpetic neuralgia (zeus)
SAEs of gabapentin
ataxia (sway calcium stack)
MOA of Vigabatrin
Blocks GABA transglutaminase inhibiting break down of GABA (elevated V-cab transmission)
MOA of Tiagabtrin
Inhibited reuptake of GABA (tied up neck tie)
Most effective medication for lowering TGs
Fenofibrate
Most effective medication for lowering LDL
Statins
MOA of cholestyramine
Bile acid resin-> bile acid resin binds bile in the stomach promoting its excretion–> Increased bile acid synthesis which lower cholesterol levels
SAE of cholestyramine
Increased VLDL, increased TGs (VLDL ship escaping)
MOA of Ezetimibe
Decreased intestinal absorption of cholesterol (EZ-eel blocking gold shipment delivery) and decreases LDL (sinking LDL ship)
SAE of ezetimibe
elevated LFTs (waving white flag), diarrhea (eel in muddy water), increased cholesterol (increased crude oil machine activity)
MOA of pioglitazone
bind to PPAR-gamma increasing transcription of adiponectin in the cell which decreases insulin resistance (Turtle neck)
Blocks CCR5 so that GP120 on HIV surface can not bind to host cell
maraviroc
Blocks GP41 from causing viral cell fusion with the host cell
Enfuvirtide
HIV integrase inhibitors
Dolutegravir, elvitegravir, raltegravir
HIV protease Inhibitors (prevent vision release from host cell)
Atanzavir, darunavir, Fosamprenavir, Indinavir, Lopinavir, Ritonavir, Saquinavir
Reverse transcriptase inhibitors that need to be phosphorylated (NRTIs)
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)
NNRTIs
Delaviridine (princess Del), Efavirenz (Queen Elf), and Nevirapine (NEvirapine forest)
Mechanism of resistance associated with Aminoglycosides
Antibiotic modifying enzymes–> acetylation or other groups being added to the drug rendering it inactive
Treatment of Borrelia (adults; pregnant women and children)
Doxycycline or ceftriaxone; cerfuoxime and amoxicillin in women and children.
SAEs of inhaled anesthetics
centrilobular hepatic necrosis (liverspot on pinata), malignant hyperthermia (Have a Magnificent birthday RYAN- ryanodine receptor), nephrotoxicity (smacked in the side)
Suppresses GnRH –> decreased gonadotropin secretion–> prevention ovulation
COC, progestin implant
Inhibits peripheral conversion of androgens to estrogens
Anastrazole, letrozole (aromatase inhibitor)
Indications for leuprolide
Uterine fibroids, endometriosis, precocious puberty, prostate cancer, infertility
2 mechanisms of Leuprolide
GnRH agonist properties when used in a pulsatile fashion ; GnRH antagonist properties when administered continuously
SAEs of leuprolide
Hypogonadism, decreased libido, erectile dysfunction, nausea, vomiting
MOA of Clomiphene
Blocks negative feedback of androgens leading to increase GnRH secretion–> Ovulation
Termination of pregnancy; emergency conctraception
mifepristone with misoprostol; ulipristal
Tocolytics- used to decrease contraction frequency in pre-term labor
Terbutaline (B2 agonist), Nifedipine (ca2 channel blocker), indomethacin
Inhibits steroid synthesis and used in the treatment of PCOS (inhibits 17,20 desmolase/ 17alpha hydroxylase)
Ketoconazole
Used in the treatment of PCOS Inhibits steroid binding, 17,20 desomolase/ 17alpha hydroxylase
Spironolactone
Alpha-1 antagonists used in the treatment of BPH to decreased smooth muscle contraction
Tamsulosin
Diuretic that decreases morbidity and mortality in patients with Congestive HF with reduced EF
Spironolactone/ k+ sparing diuretics (falling heart balloon held by the angel kid)
CYP450 Inducers (+)
Modafinil (MOst), chronic alcohol use (CHRONIC ALCOHOLICS), st. johns wort (STeal), Phenytoin (Phen), Phenobarbital (Phen), Nevirapine (and NEVer), rifampin (Refuse), Griseofulvin (GREASE), carbamezapine (CARBs)
Substrates of CYP450
Anti-Epileptics (Always), Theophylline (Think), Warfarin (When), OCPs (outdoors)
Inhibitors of CYP 450 (-)
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)
Isoniazid MOA
Inhibits synthesis of mycolic acids (cowboy falling off wall)
SAEs of Isoniazid (INH)
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),
MOA of isoniazid resistance
bacterial down regulation of catalase peroxidase (silenced G cat)
MOA of ethambutol
inhibits arabinosyl transferase in bacteria inhibiting carbohydrate formation of cell wall (arabian horse preventing fence from being built)
SAEs of ethambutol
caused red/ green color blindness, decrease visual acuity (Blinders on horse)
MOA of Rifampin
inhibits DNA dependent RNA polymerase
SAEs of Rifampin
Orange bodily fluids (orange pit up in wagon), CYP450 inducer (intact CYP450 license plate)
Contraindication for Abacavir
HLA-B*5701 Mutation-> increases risk of hypersensitivity
Cladaribine MOA
Purine analog that inhibits DNAP arresting the cell in S phase (Purine analog hammer; cracked replication fork; Stone age)
Indications for Cladarabine and SAE
Hairy Cell leukemia (hairy caveman); bone marrow suppression (broken bone)
MOA of Cytarabine
Pyrimidine analog (cheetah with pyrimidine pattern); inhibits DNAP arresting the cell in S phase; Treats hematological malignancies (Ab Archers and T cell swordsman)
MOA of gemcitabine
pyrimidine analog (gems in the shape of pyrimidines) that inhibit DNAP; treats most cancers (crab fossil)
MOA of metformin
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)
Mycophenylate Mofetil
IMP dehydrogenase inhibitor preventing purine synthesis; tx for RA
Alemtuzumab
CD52 monoclonal Ab used in the treatment of CLL and MS, and ALL
Bevacizumab
VEGF targeting; Colorectal cancer, NSCLC, RCC
Cetuximab
EGFR targeting; Stage IV colorectal cancer, Head and neck cancer
Trastuzumab
HER2 target; breast and gastric cancer
Adalimumab, certolizumab, golimumab, infliximab
soluble TNF-Alpha; IBD, RA, ankylosing spondylitis, psoriasis
Daclizumab
CD25 (part of IL-2); tx of relapsing MS
Eculizumab
Complement protein C5 antibody; PNH
Natalizumab
alpha-4 integrin antibody; MS and Crohns; Risk of PML in pts with JC virus
Ustekinumab
IL-12/IL-23; Psoriasis, psoriatic arthritis
Abciximab
Antibody to GPIIB/IIIA; antiplatelet for prevention of ischemic complications in patients undergoing percutaneous coronary intervention
Denosumab
RANKL antibody; tx for osteoporosis; inhibits osteoclast maturation
Digoxin immune Fan
Digoxin antibody- antidote
Omalizumab
IgE Antibody; asthma- prevents binding to FcEpsilon RI
Palivizumb
RSV F protein; RSV prophylaxis for high risk infants
