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Pharm Flashcards

1
Q

Characteristics of drugs eliminated by the liver

A

High lipophilicity and a high volume of distribution

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2
Q

How are highly lipophilic anesthetic drugs distributed in the body?

A

Rapidly distributed to organs with high blood flow (brain, liver, kidneys, lungs) then rapidly redistributed to tissues with relatively lower blood flow (skeletal muscle, fat, bone)

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3
Q

What is the formula for half life?

A

T1/2 = (0.7 x Vd) / CL

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4
Q

Which antihistamines should be avoided in elderly patients?

A

Avoid 1st generation antihistamines - hydroxyzine, promethazine, chlorpheniramine, diphenhydramine

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5
Q

Which antihistamines can be given to elderly patients?

A

Newer generation antihistamines - loratadine, cetirizine

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6
Q

Mechanism of action of Rifampin

A

Inhibition of bacterial DNA-dependent RNA polymerase

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7
Q

Side effects of Rifampin

A

Red-orange body fluids

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8
Q

What is the mechanism of action of Digoxin?

A

Positive inotropic agent.
Directly inhibits the Na-K-ATPase pump in myocardial cells, leading to decreased sodium efflux and increase in intracellular sodium. This reduces the forward activity of the sodium-calcium exchanger, causing increased intracellular calcium and improved myocyte contractility.

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9
Q

How is tissue necrosis prevented with NE extravasation?

A

Local injection of alpha 1 blocking drug, such as phentolamine

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10
Q

Which drug can cause a disulfiram-like reaction when combined with alcohol?

A

Metronidazole

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11
Q

How do ACE inhibitors effect GFR?

A

Promote efferent arteriolar dilation, causing GFR reduction

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12
Q

Drug used to treat neuroleptic malignant syndrome

A

Dantrolene, a direct acting skeletal muscle relaxant

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13
Q

Phenylephrine

A

Selective alpha-1 adrenergic receptor agonist that increases peripheral vascular resistance and systolic BP and decreases pulse pressure and HR

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14
Q

Timolol

A

Nonselective beta blocker. Diminishes the secretion of aqueous humor by the ciliary epithelium for treatment of open-angle glaucoma

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15
Q

Acetazolamide treatment of open angle glaucoma

A

Carbonic anhydrase inhibitor. Decreases aqueous humor secretion by the ciliary epithelium

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16
Q

Which drugs work to treat open angle glaucoma by increasing the outflow of aqueous humor?

A

Prostaglandin F2alpha (latanoprost, travoprost) and cholinomimetics (pilocarpine, carbachol)

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17
Q

Atenolol

A

Selective beta-1 adrenergic antagonist. B1 adrenergic receptors are found in cardiac tissue and renal juxtaglomerular cells, but not in vascular smooth muscle.

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18
Q

Fidaxomicin

A

Macrocyclic antibiotic that inhibits the sigma subunit of RNA polymerase, leading to protein synthesis impairment and cell death. Administered orally. Used to treat C. diff

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19
Q

Bosentan

A

Endothelin-receptor antagonist that block effects of endothelin. Used for treatment of idiopathic pulmonary arterial hypertension

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20
Q

Drugs associated with drug-induced lupus erythematosus (DILE)

A

Hydralazine, Procainamide, Isoniazid, Minocycline, Quinidine

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21
Q

The 3 current Alzheimer’s Disease specific therapies

A

Cholinesterase Inhibitor (Donepezil), antioxidants (Vit E), and NMDA receptor antagonists (Memantine)

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22
Q

How does aspirin toxicity present?

A

Fever, tinnitus, tachypnea. Initially develop a primary respiratory alkalosis followed by a mixed respiratory anion gap metabolic acidosis

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23
Q

Rare complication of metformin therapy

A

Lactic acidosis. Risk increased in pts with underlying renal insufficiency

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24
Q

Use caution when prescribing fibrates to?

A

Patients with underlying gallbladder disease - can promote gallstone formation

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25
Initial empiric treatment of coagulase-negative staphylococcal infection?
Vancomycin
26
Phenoxybenzamine
Irreversible alpha 1 and alpha 2 adrenergic antagonist. Primarily used to treat pheochromocytoma
27
Calcium channel blockers that primarily affect peripheral arteries and cause vasodilation
Dihydropyridines (nifedipine, amlodipine)
28
Calcium channel blockers that affect the myocardium and can cause bradycardia and slowed atrioventricular conduction
Nondihydropyridines (verapamil, diltiazem)
29
Dobutamine mechanism
Beta-adrenergic agonist with predominant activity on B1 receptors and weak activity on B2 and A1 receptors. Stimulation of B1 receptros leads to increased production of cAMP and increased cytosolic Ca concentration. Results in increased myocardial contractility
30
What occurs when nitrates and phosphodiesterase inhibitors are used together?
Profound systemic hypotension because they both increase intracellular cGMP which causes vascular smooth muscle relaxation
31
Hypoglycemic but only symptoms are sweating and hunger. Which medication is causing this?
Non-selective beta-blockers (propanolol, timolol, nadolol) exacerbate hypoglycemia and mask its adrenergic symptoms mediated by norepinephrine and epinephrine
32
Which medications have negative chronotropic effects?
beta-adrenergic blockers (eg, metoprolol, atenolol), non-dihydropyridine calcium channel blockers (eg, verapamil, diltiazem), cardiac glycosides (eg, digoxin), amiodarone and sotalol, cholinergic agonists (eg, pilocarpine, rivastigmine)
33
What substance accumulates in embryonic tissues as a result of methotrexate used to treat ectopic pregnancy?
Dihydrofolate. Methotrexate completely inhibits dihydrofolate reductase, which catalyzes synthesis of tetrahydrofolate
34
Niacin uses
Hyperlipidemia - effective in raising HDL cholesterol and lowering triglycerides and LDL levels
35
Niacin side effects
Flushing, warmth, itching; primarily mediated by the release of prostaglandins
36
Reduce the rate of spontaneous depolarization in cardiac pacemaker cells by prolonging phase 4
Acetylcholine and adenosine
37
Binding strength in subclasses of class I antiarrhythmics
IC (Flecainide, propafenone) > IA (Quinidine, procainamide, disopyramide) > IB (Lidocaine, mexiletine) weaker binding = faster dissociation
38
Mechanism of beta-adrenergic agonists
Stimulate the beta-2 adrenergic receptor, a Gs protein-coupled receptor that activates adenylyl cyclase and increases intracellular cAMP concentrations
39
Cromolyn sodium mechanism
Inhibits mast cell degranulation and release of histamine and leukotrienes
40
Class III antiarrhythmics
Amiodarone, sotalol, dofetilide. Predominantly block potassium channels and inhibit the outward potassium currents during phase 3 of the cardiac action potential, thereby prolonging repolarization and total action potential duration
41
Neprilysin inhibition
A metalloprotease that cleaves endogenous peptides. Inhibition of Neprilysin leads to increased levels of endogenous natriuretic peptides, which improves outcomes in patients with chronic systolic HF
42
Most common adverse effect of thrombolysis
hemorrhage
43
Where do potassium sparing diuretics act?
On the late distal tubule and cortical collecting duct to antagonize the effects of aldosterone
44
Fenoldopam
Short acting, selective, peripheral dopamine-1 receptor agonist. Activates adenylyl cyclase and raises intracellular cAMP, resulting in vasodilation of most arterial beds with corresponding decrease in systemic BP. Renal vasodilation is prominent and leads to increased renal perfusion, diuresis, and natriuresis. Used in HTN emergency in patients with acute kidney injury
45
Isoproteranol
Nonselective beta-adrenergic agonist. Increases cardiac contractility by acting on myocardial B1 adrenergic receptors. Also binds B2 receptors and causes vasodilation by relaxation of vascular smooth muscle, leading to decreased vascular resistance and mean arterial BP
46
Cilostazol
Reduces platelet activation by inhibiting platelet phosphodiesterase, the enzyme responsible for breakdown of cAMP. It is also a direct vasodilator. Net effect is decrease in claudication symptoms and increase in pain free walking distances in patients with peripheral arterial disease
47
Fibrates
Fenofibrate, gemfibrozil. Activate PPAR-alpha, which increases the synthesis of lipoprotein lipase. Most effective agents for the treatment of hypertriglyceridemia
48
What medication improves Graves ophthalmopathy?
Glucocorticoids
49
Best basal long-acting insulins
Glargine and detemir insulin
50
Best short acting insulins
Lispro, aspart, glulisine. Very rapid onset of action with peak effects coinciding with peak postprandial hyperglycemia
51
What medication can reduce the risk of gynecomastia?
Tamoxifen, a selective estrogen receptor modulator that acts as an estrogen antagonist
52
Which medications cause medication induced body fat redistribution (lipoatrophy/lipodystrophy)
Common adverse effect of highly-active antiretroviral therapy (HAART)
53
Beta blockers affect on renin release
Inhibit release of renin from renal juxtaglomerular cells through antagonism of beta-1 receptors on these cells. Prevents activation of the renin-angiotensin-aldosterone pathway
54
What is required for patients taking a long acting nitrate?
A nitrate free interval to prevent development of tolerance
55
Abciximab
GP IIb/IIIa receptor antagonist. Inhibits binding of the receptor to fibrinogen. Used to treat unstable angina and acute coronary syndrome
56
What are the most effective lipid lowering drugs for primary and secondary prevention of cardiovascular events?
HMG-CoA reductase inhibitors (statins)
57
How is post thyroidectomy hypocalcemia treated?
Supplementation with oral calcium and vitamin D
58
Finasteride
5-alpha reductase inhibitor that suppresses peripheral conversion of testosterone to DHT. Used to treat BPH and androgenetic alopecia
59
How does mycobacteria become resistant to INH?
Non-expression of the catalase-peroxidase enzyme or through genetic modification of the INH binding site on the mycolic acid synthesis enzyme
60
Thiazide diuretics and calcium
Increase calcium absorption in the distal convoluted tubules. Recommended for treating HTN in pts at risk for osteoporosis
61
Amlodipine
Dihydropyridine calcium channel blocker used to treat HTN. Side effects - headache, flushing, dizziness, peripheral edema
62
Physostigmine
Cholinesterase inhibitor. Can reverse anticholinergic toxicity
63
Sildenafil
Phosphodiesterase inhibitor. Decreased the degradation of cGMP. Elevated intracellular cGMP levels lead to relaxation of vascular smooth muscle and vasodilation
64
Where is Digoxin cleared?
Cleared by the kidneys. Elderly patients may require dose reduction due to age related renal insufficiency
65
Dobutamine
Beta adrenergic agonist with predominant activity on beta-1 receptors. Causes an increased in HR and cardiac contractility, leading to an increase in myocardial oxygen consumption
66
Lidocaine
Class IB antiarrhythmic. Tends to bind to inactivated sodium channels and rapidly dissociates. Effective in suppressing ventricular tachyarrthymias induced by rapidly depolarizing and ischemix myocardium
67
Oseltamivir
Neuraminidase inhibitor used in the treatment and prevention of influenza A and B. Impairs release of newly formed virions from infected host cells and impairs viral penetration of mucous secretions that overlie the respiratory epithelium
68
Mealtime insulin analogs
Lispro, Aspart, Glulisine
69
Class IV antiarrhythmics
Verapamil, Diltiazem. Calcium channel blockers in slow-response cardiac tissues, slowing phase 4 and phase 0
70
Canagliflozin
Sodium-glucose cotransporter 2 (SGLT2) inhibitors. Decrease proximal tubular reabsoprtion of glucose, thereby promoting urinary glucose loss. Monitor serum creatinine
71
Doxazosin
Alpha-1 blocker. Useful for treatment of BPH and HTN
72
Disapyramide
Class IA antiarrhythmic. Sodium channel-blocking agent that depresses phase 0 depolarization. Also prolong repolarization due to moderate potassium channel blocking activity
73
Terbinafine
Used for treatment of dermatophytosis. Inhibits synthesis of fungal membrane ergosterol by suppressing the enzyme squalene epoxidase
74
Chlorthalidone
Thiazide diuretic. Raises serum calcium, uric acid, glucose, cholesterol, and triglyceride levels. Lower serum sodium, potassium, and magnesium levels
75
Drugs that inhibit dihydrofolate reductase
Trimethoprim, methotrexate, and pyrimethamine
76
Medications associated with an increased risk of osteoporosis
Proton pump inhibitors, glucocorticoids, aromatase inhibitors, and anticonvulsants that induce cytochrome P450
77
Mechanism of colchicine
Inhibits polymerization and microtubule formation in leukocytes, reducing neutrophil chemotaxis and emigration to sites inflamed by tissue deposition of monosodium urate crystals
78
Valproate
Broad-spectrum antiepileptic that is effective for absence and tonic clonic seizures
79
What drugs are used for hypertensive emergency?
Nitroprusside and Fenoldopam
80
HMG-CoA reductase inhibitors
Statins. Hepatotoxicity, myopathy
81
Bile acid resins
Cholestyramine, colestipol, colesevelam. Prevent intestinal reabsorption of bile acids.
82
Ezetimibe
Prevents cholesterol absorption at small intestine brush border
83
Fibrates
Large decrease in TGs. Upregulate LPL leading to increased TG clearance. Myopathy, cholesterol gallstones due in inhibition of 7-alpha hydroxylase
84
Niacin
Inhibits lipolysis in adipose tissue. Red flushed face, hyperglycemia, hyperuricemia
85
PCSK9 Inhibitors
Inactivation of LDL receptor degradation. Neurocognitive effects
86
Which classes of antiarrhytmics can cause torsades?
Class 1A, Class III
87
Treatment for urgency incontinence
Antimuscarinics (oxybutynin)
88
Osmotic diuretic. Increases tubular fluid osmolarity and increases urine flow. Clinical use in drug overdose and elevated ICP
Mannitol
89
Acetazolamide
Carbonic anhydrase inhibitor. Used for glaucoma, metabolic alkalosis, altitude sickness, pseudotumor cerebri
90
Loop diuretics
Furosemide, bumetanide, torsemide. Inhibit Na/K/2Cl system of thick ascending limb. Stimulate PGE release. Increase calcium excretion. Clinical use = edematous states, HTN, hypercalcemia
91
Adverse effects of loop diuretics
Ototoxicity, hypokalemia, hypomagnesemia, dehydration, sulfa allergy, metabolic alkalosis, interstitial nephritis, gout
92
Thiaze diuretics
Inhibit NaCl reabsorption in early DCT. Decreased calcium excretion. Clinical use = HTN, HF, idiopathic hypercalciuria, nephrogenic DI, osteoporosis.
93
Potassium sparing diuretics
Spironolactone, Epleronone, Amiloride, Triameterene. Act on cortical collecting tubule.
94
ACE Inhibitors
End in -pril. Can cause cough and angioedema due to increased bradykinin
95
ARBs
End in -sartan.
96
Aliskiren
Direct renin inhibitor. Used for HTN. Contraindicated in pts already taking ACE inhibitor or ARB and in pregnancy.
97
Amlodipine
Dihydropyridine calcium channel blocker commonly used for HTN.
98
Side effects of Amlodipine
Headache, flushing, dizziness, peripheral edema
99
Fibrates mechanism
Lower triglyceride levels by activating PPAR-alpha, which leads to decreased hepatic VLDL prod and increased LPL activity
100
Extended-spectrum beta-lactamase producing E. coli
Genes encoding these enzymes are often on plasmids
101
Adverse side effects of Ethambutol
Optic neuropathy that results in color blindness, central scotoma, and decreased visual acuity
102
How does Desmopressin work to treat hemophilia A?
By increasing the circulating level of factor VIII
103
Varenicline
Partial agonist of nicotinic acetylcholine receptors
104
What drug binds to the immunophilin FK-506 binding protein, forming a complex that binds and inhibits mTOR? This blocks IL-2 signal transduction and prevents cell cycle progression and lymphocyte proliferation
Sirolimus

Step 1 (Steffanie) (21 decks)

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