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Pharmacology: 5/4-5/5 > Pharm- FA > Flashcards

Pharm- FA Flashcards

1
Q

Describe how dopamine works as a direct sympathomimetics

A

D1=D2> beta (low dose) > alpha (high dose)

D1: renal vasodilation -> increase RBF

beta: systemic vasodilation, increase CO
alpha: systemic vasoconstriction

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2
Q

Only TWO locations of beta 1 receptor?

A
  • JGA cells

- cardiomyocytes

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3
Q

Non-selective Beta blockers are which ones? contraindications?

A

N to Z (Beta 2, 2nd half of alphabet)

contraindicated in

  • COPD
  • Diabetes (selective beta 1 blocker is preferred as beta 2 is associated with gluconeogenesis)
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4
Q

Scoplamaine

  • MOA
  • indication
A
  • muscarinic antagonist

- motion sickness

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5
Q

What is use of pralidoxime?

A

To reverse organophosphate inhibitor, pralidoxime is given with atropine. Pralidoxime regenerates AchE

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6
Q

Why is clonidine not indicated as a first line for hypertension

A

extensive side effect profile

- CNS depression, depression, fatigue, hypotension, bradycardia, miosis

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7
Q

Vasopressin receptor: which signaling pathway?

  • V1
  • V2
A
  • V1: Gq
  • HAVe 1 M&M
  • V2: Gs
  • Gs is rest (not HAV1 M&M and MAD2)
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8
Q

gestational hypertension: what drug?

A

alpha-methyldopa

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9
Q

alpha-methyldopa

  • MOA
  • indication
  • side effect
A

alpha 2 agonist

hypertension during pregnancy

autoimmune drug induced hemolytic anemia
: warm IgG

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10
Q

Three reactions in phase 1 of drug metabolism

A
  • reduction
  • oxidation
  • hydrolysis
  • all done by P-450
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11
Q

Four reactions in phase 2 of drug metabolism

A
  • acetylation
  • glucuronidation
  • methylation
  • sulfation
  • all are conjugation reactions
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12
Q

8 drugs that induce cytochrome p-450?

remember pneumonic?

A

chronic alhocoholics steal phen-phen never refuses greasy carb

  • chronic alcoholism
  • st. Jones wart
  • phenytoin
  • phenobarbitol
  • nevirapine
  • rifampin
  • griseofulvin
  • carbamazepine
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13
Q

Efficacy vs. potency

A

efficacy: maximal effect drug can poduce
more efficient, more maximal effect it can produce
= Vmax

potency: amount of drug needed for a given effect
more potent, less drug needed for same effect
= Km

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14
Q

Bethanecol

  • MOA
  • indications (2)
A
  • cholinomimetic
  • bladder and bowel activation
    : urinary retention and post-opertavie (or neurogenec) ileus
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15
Q

10 drugs that inhibit cytochrome p-450

remember pneumonic?

A

AAA RACKS IN GQ Magazine

  • Acute Alcohol Abuse (vs. chronic: inducer)
  • Ritonavier
  • Amiadarone
  • Cimentidine
  • Ketoconazole
  • Sulfanamide
  • INH
  • Grapefruit juice (this was UWORLD question)
  • Quinidine
  • Macrolides (except azithromycin)
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16
Q

phenoxybenzamine vs. phentolamine

  • MOA
  • indication
A

phenoxybenzamine

  • irreversible alpha 1 antagonist
  • pheocytochroma (followed by beta blocker to inhibit reflex tachy)

phentolamine

  • reversible alpha 1 antagonist
  • hypertensive crisis after tyramine ingestion (cheese/ wine)
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17
Q

Antidote for salicylate (aspirin) overdose?

A

NaHCO3
also dialysis

salicylate

  • early: respiratory alkalosis
  • late: anion gap metabolic acidosis
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18
Q

What are the two subtypes of nicotinic acetylcholine receptors, and where are they typically found?

A
  • NN is found in autonomic ganglia and adrenal medulla

- NM is found at neuromuscular junctions of skeletal muscle

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19
Q

In renal/ hepatic failure, how do maintenance dose and loading dose are changed?

A
  • no change in loading dose
  • decrease maintenance dose
  • this makes sense: loading dose is dependent of Cp and Vd, which are not affected by metabolism
    However, maintenance dose is dependent of clearance, which is dependent on metabolism rate.
    Thus ONLY MAINTENANCE DOSE is reduced
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20
Q

anti-platelet therapy with clopidogrel and aspirin. What interaction will these drugs have?

A

synergistic

  • clopidogrel: anti-ADP receptor
  • aspirin: anti TXA2
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21
Q

overdoses on amphetamines. What is antidote? what is MOA?

A

NH4Cl

amphetamine is basic. NH4Cl acidifies urine, enhancing urinary clearance of amphetamine

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22
Q

Two drugs that cause autoimmune hemolytic anemia?

A
  • penicillin

- alpha-methyldopa

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23
Q

two direct agonist cholinomimetic drugs for glaucoma?

A
  • carbachol

- pilocarpine

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24
Q

A person takes multiple doses of LSD and finds that the effects decline rapidly. What type of interaction is this?

A

tachyphylactic

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25
Q

Geriatric patients lose what phase of drug metabolism first?

A

phase 1 by P-450

: oxidation, reduction, hydrolysis

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26
Q

Which gout drug is sulfa drug?

A

probenecid

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27
Q

anticholinergic or antimuscarinic agent toxicity. What is the antidote? Which vital sign is it critical to monitor?

A

physostigmine

body temperature needs to be monitored. It reflects whether drug is working or not

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28
Q

How is Km affected by irreversible competitive inhibitor? Can its effect be overcome by increasing substrate concentration?

A
  • no change in Km
  • can NOT be overcome by increasing substrate concentration

it is irreversible, so once it binds it, that enzyme is no longer useful anyway. enzyme is DEAD once irrversible competitive inhibitor binds to it
Vmax goes down

29
Q

What drug is used for diagnosis of asthma? MOA?

A

methacholine
: muscarinic agonist that induces temporary bronchoconstriction
FEV1/FVC is measured

30
Q

What drug is used for diagnosis of mysathenia gravis? MOA?

A

edrophonium (tensilon)
: short acting AchE inhibitor
=> short symptomatic improvement

  • nowadays edrophonium is not commonly used.
    Anti-AChR antibody detection is more common
31
Q

Anaphylactic reactions after eating Mackerel: what is going on? how to treat it? what other fishes may cause same thing?

A
  • scombroid poisoning:
    bacterial histidine decarboxylase converts histidine to histamine
  • treat with antihistamine
  • other fishes: tuna, mahi-mahi`
  • heavy ion fishes (tuna, mackerel)
    Heavy=Histamine
32
Q

How to treat mercury poisoning?

A

dimercaprol and succimer

  • same as lead
  • both are heavy metal
33
Q

How does AngII receptor on presynaptic terminal modulates NE release?

A

it increases it

  • this makes sense: AngII stimulates vasoconstriction via NE release
34
Q

two nonselective α- and β-antagonists?

A

Carvedilol and labetalol

(which have modified suffixes instead of -olol)

35
Q

A drug inhibits reuptake of norepinephrine from noradrenergic nerve terminals. Name four drugs with this mechanism of action.

A
  • cocaine
  • amphetamine
  • TCA
  • SNRI
  • cocaine and amphetamine are CNS stimulants
36
Q

BOTH methanol intoxication and anti-freeze poisoning can be treated with what medicatino?

A

fomepizole

  • anti-freeze: ethylene glycol
37
Q

How does bretylium work? indication?

A

inhibition of NE release from presynaptic axon

used for ventricular tachy

38
Q

Donepezil

  • indicated for what disease?
  • may exacerbate what two conditions?
A
  • Alzheimer
  • exacerbation
    1. COPD/ asthma
    2. peptic ulcer

Donepezil works for Alzheimer by increasing Ach
More Ach
-> more brochospasm by parasymph: COPD/asthma
-> more HCl release in stomach: peptic ulcer

39
Q

metryosine: MOA?

A

blocks tyrosine hydroxylase (tyrosine -> DOPA)

40
Q

Apart from ADHD, two more indications of amphetamine?

A
  • obesity

- nacrolepsy ( modafinil is more commonly used)

41
Q

Apart from NE reuptake inhibition, what is another MOA of amphetamine that increase NE release from presynaptic axon?

A

Amphetamines displace NE in vesicle as it enters through VMAT

  • > more NE is now available for release (not trapped in vesicle)
  • > increased NE release (through NET, NE Transporter)
42
Q

Fenolodopma

  • MOA
  • indication
A
  • D1 agonist
  • fenoloDOPAM = DOPAMine
  • postoperative hypertensive crisis by inducing natriuresis (D1 stimulation-> renal vasculature relaxation
  • > increased RBF)
43
Q

ADH: V1 receptor vs. V2 receptor

A

V1: vasoconstriction

V2: more AQP in collecting duct -> increased water reabsorption
* V2 in 2 kidneys

44
Q

erythromycin develops jaundice: what is going on?

A

acute cholestatic hepatitis

45
Q

Why steroid should not be abruptly stopped?

A

adrenal insufficiency

  • it should be tapered
46
Q

formula that describes the therapeutic index (TI) of a drug?

A

TD50 (median toxic dose)/ED50 (median effective dose)

47
Q

Two different types of acetylcholine receptor? which one is ionotropic? which one is metatropic?

A

nicotinic: ionotropic, ligand gated ion channel
muscarinic: metatropic, G protein coupled second messenger system
* think like this: nicotinic is everywhere (preganglionic, NMJ), so it needs quick signal transmission. ionotropic

48
Q

Which sympathetic neuron has short pre-ganglionic neuron?

A

sympathetic

Sympathetic, Short

  • note that post-ganglionic is reverse. Sympathetic long, parasympathetic short
49
Q

What is antidote for nephrotoxicity/ototoxicity of cisplatin?

A

amifostine

50
Q

Three antidotes for beta-blocker toxicity?

A
  • saline: excessive B1 block in JGA => dehydration
  • glucagon: beta blockers => masks hypoglycemia
  • atropine: ?? just memorize it..
51
Q

oxybutynin

  • MOA
  • indicatio
A
  • muscarinic antagonist
  • urinary urgency
  • OxyButynin for Overactive Bladder
52
Q

atropine effect on body temperature?

A

increased

atropine -> block sweating

53
Q

A pt has minimal change disease (MCD). Would the apparent Vd of a plasma protein–bound drug increase or decrease?

A

increased

MCD -> loss of protein-> more free drug -> increased Vd

  • protein bound drug is limited to plasma, causing decreased in Vd
54
Q

antidote for BDZ? MOA of this antidote?

A

flumazenil
competitive antagonist to GABA receptor

  • sketchy: muzzle
55
Q

why does epinephrine, a pressor, cause hypotension if a pt is pretreated with an α-blocker?

A

If α-receptors are blocked, the β2-agonist properties of epinephrine predominate and lower the blood pressure

  • In heart, beta1 agonist still works to increase SYSTOLIC pressure

=> However, beta2 agonist action on blood vessel predominates (significant decrease in DIASTOLIC pressure), so NET blood pressure DECREASES

56
Q

effect of ciprofloxacin in P-450 system?

A

p-450 inhibitor

  • this is not in sketchy.
    C in AAA RACKS IN GQ Magazine
57
Q

With given half-life of drug, how long it will take to reach 90% steady state? full steady state?

A

90% steady state: 3.3 half-lives

full steady state: 4-5 half-lives

58
Q

What chemotherpeutic drug causes photosensitivity?

A

5-FU

  • sketchy: photographer on the right bottom corner
59
Q

A pt with bradycardia is given too much atropine. How is skeletal muscle affected?

A

Not at all, as atropine does not affect nicotinic receptors in skeletal muscle

  • this is UWORLD question
  • atropine is muscarinic antagonist, not nicotinic
60
Q

How is nebivolol helpful for treating hypertension

A
  • beta 1 selective blockade in cardiac tissue

- also STIMULATE beta 3 to synthesize NO

61
Q

vesamicol: MOA?

A

inhibits uptake of Ach into presynaptic vesicle, decreasing Ach activity

62
Q

Carbachol is useful for which subtype(s) of glaucoma? What about pilocarpine?

A

Carbachol- only open angle

pilocarpine: BOTH open and closed angle

63
Q

Which drug works on only alpha1 specifically as agonist?

A

midodrine

64
Q

Xerostomia: what drug is indicated?

A

pilocarpine

65
Q

How does beta blockers mask hypoglycemia?

A

hypoglycemic states result in palpitation, tremors, sweating are all mediated by beta adnergic effect

With beta blockers, those signs of hypoglycemia is not presented, thus MASKING hypoglycemia

66
Q

Why glucagon is used for beta blocker toxicity?

A

glucagon independently stimulates cAMP via glucagon receptor. It has positive ionotropic and chronotropic effect despite beta blockade

67
Q

Name three drugs that follow zero-order elmination

A
  • Phenytoin
  • Ethanol
  • Aspirin

PEA is round, shapes like 0, so 0 order

68
Q

Filgrastim

  • MOA
  • indication
A

recombinant cytokine equivalent to G-CSF

recovery after myelosuppression

Pharmacology: 5/4-5/5 (3 decks)

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