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Term 5 > Pharm: Final > Flashcards

Pharm: Final Flashcards

1
Q

Antidote: Aspirin poisoning

A

IV NaHCO3

Hemodialysis

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2
Q

Antidote: Acetaminophen toxicitiy

A

N-acetylcysteine (increased glutathione)

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3
Q

Antidote: Amphetamine poisoning

A

Ammounium Cl (acidify the urine)
HTN: phentolamine, nitroprsuside
Tachycardia: Propranolol, Esmolol
Seizures: Benzos

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4
Q

Antidote: Anti-cholinergics

A

Physostigmine (NOT TCA)

Benzo/Anti-psychotic

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5
Q

Antidote: Beta-blocker

A

Glucagon (increased cAMP)

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6
Q

Antidote: CCB

A

Calcium, glucagon, epi

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7
Q

Antidote: TCA

A

Epi, NaHCO3 (not physostigmine)

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8
Q

Antidote: MAOI

A

Phentolamine, labetolol

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9
Q

Neuroleptic malignant syndrome vs. Serotonin syndrome

A

Neuroleptic – OD on anti-psychotic: FEVER (CPK, lead pipe rigidity, unstable vitals)
Serotonin: myoclonus, hyperreflexia

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10
Q

Antidote: Serotonin Syndrome

A

Cyproheptadine, benzo

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11
Q

Antidote: Neuroleptic malignant syndrome

A

Bromocriptine, Dantrolene

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12
Q

Antidote: Opioid

A

Naloxone, Nalmefine

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13
Q

Antidote: CO

A

RA, 100% O2, Hyperbaric O2

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14
Q

Antidote: ETOH acute intoxication

A

Thiamine, dextrose, electrolytes

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15
Q

Antidote: Methanol, ethylene glycol

A

EOTH, Fomepizole

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16
Q

Antidote: OP or Carbamate

A

Atropine, Pralidoxime

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17
Q

Antidote: Rodenticide (Warfarin)

A

Vitamin K, FFP

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18
Q

Antidote: Cyanide

A
  1. Amyl nitrate, Na nitrate

2. Thiosulfate

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19
Q

Antidote: Lead, Arsenic, Mercury

A

EDTA, succimer, dimercaprol

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20
Q

S/S Lead vs. Arsenic vs. Mercury

A

Lead: cognitive/neuro (wrist drop)
Arsenic: Rice water stool/rain drop keratosis
Mercury: Mad as a hatter

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21
Q

Antidote: Fe

A

Deferoxamine

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22
Q

Fatal withdrawal syndromes (3)

A

ETOH, Benzos, Barbs

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23
Q

FDA approved drugs for ETOH addiction “craving”

A
  1. Disulfram: aversion (aldehyde DH) (aversion)
  2. Naltrexone: opiod antagonist (Craving)
  3. Acamprosate: NMDA antagonist (relapse)
    (Not Topiramate)
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24
Q

Treatment for ETOH withdrawal

A
  1. LTM benzos: diazepam, chlordiazepoxide

2. Intermediate: Lorazepam, oxazepam (elderly or liver failure)

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25
Q

Treatment for benzo & barb withdrawal

A

Diazepam

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26
Q

MOA of methylxanthines: caffeine, theophylline, theobromine

A

Block pre-synaptic adenosine receptors

Adenosine inhibits NE release

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27
Q

Treatment of cocaine dependence

A

SSRI

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28
Q

3 approved treatments for nicotine addiction

A
  1. NRT therapy
  2. Bupropion
  3. Varenicline (partial agnoist at nicotine R)
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29
Q

S/S opioid withdrawal

Treatment of opioid intoxication & long term post-detox

A
  • Dysphoria, lacrimation, rhinorhhea, yawning
    1. Long-acting opioid agonist (methadone, bupenorphine)
    2. Adrenergic agonist (Clonidine, lofexidine)
    Post-detox: Naltrexone
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30
Q

Therapeutic effects of dronabinol

A
  • CB-1, brain; CB-2 immune cells
    Anorexia/AIDS
    N+V/Ca CTX
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31
Q

Pinpoint pupils in an agitated patient

A

PCP

* Parenteral Benzo

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32
Q

MDMA releases…

A

Serotonin

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33
Q

LSD “bad trips” treated with

A

Diazepam

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34
Q

Local anesthetics: AE bipivacaine

A

Cardiotoxic

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35
Q

Local anesthetics: AE prilocaine

A

MethHb (metabolite o-toludine)

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36
Q

Among the local anesthetics, who are the PABA derivatives (sulfa): amides or esters?

A

Esters

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37
Q

Short vs. Medium vs. LTM local anesthetics

A

Short: procaine, chlorprocaine
Medium: lidocaine, mepivacaine, prilocaine
Long: Tetracaine, Bupivacaine, Etiodocaine, Ropivacaine

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38
Q

Management of local anesthetic induced convulsions

A

O2, IV diazepam, Barbs, Succs

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39
Q

Echinacea

A

Colds

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40
Q

Ephedra

A

Spinal anesthesia

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41
Q

Garlic

A

Anti-cholesterol

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42
Q

Ginko/Ginsing

A

Dementia

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43
Q

Milk thistle

A

Hepatotoxicity

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44
Q

St. John’s Wort

A

Depression

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45
Q

Saw Palmetto

A

BPH

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46
Q

CoQ

A

Parkinson’s; statin-induced myopathy

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47
Q

Glucosamine

A

OA

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48
Q

Black cohosh

A

PMS

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49
Q

Kava

A

Relaxation

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50
Q

Difference between cationic and uncharged portion of a local anesthetic?

A

Cationic: Most active at the receptor
Uncharged: Penetration of membrane

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51
Q

The 3 major constituents of a local anesthetic:

A
  1. Lipophilic (Aromatic group)
  2. Intermediate chain (Ester or Amide)
  3. Ionizable group (Tertiary amine)
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52
Q

Spinal epinepherine alpha-2 receptor inhibits the release of:
AE’s

A

Substance P

AE: delayed wound healing, tissue edema, necrosis

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53
Q

Relationship between liposolubility and potency of a local anesthetic.

A

Proportional

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54
Q

To prevent CNS convulsions when using a local anesthetic…

A

Pre-medicate with benzo

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55
Q

The only local anesthetic that does not cause vasodilation

A

Cocaine

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56
Q

To manage CV AE’s of local anesthetics

A

IVF, pressors

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57
Q

To manage convulsions AE’s of local anesthetics

A

O2, diazepam, barbs, succys

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58
Q

The difference in metabolism of ester and amide local anesthetics

A

Esters: Tissue and plasma pseudocholinesterase
Amides: P450

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59
Q

Major classes of NMJ antagonists and examples of each class

A

Benzylisoquinolones: Mivacurium, Cisatracurium, Atracurium, Tubocurarine
Ammonio-steroids: PAncuronium, Rocuronium, Vocuronium

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60
Q

Major AE’s of the benzylquinolones vs. the ammonio-steroid NMJ blockers

A

Benzyl: hypotension 2/2 histamine release; ganglionic blockade
Ammonio: tachycardia and M2 blocker

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61
Q

The only benzylisoquinolone NMJ blocker that doesn’t cause histamine release

A

Cisatracurium (because it forms less laudunosine metabolite) than does atracurium

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62
Q

The major benzylisoquinolone NMJ blocker that causes ganglionic blockade

A

Tubocurine

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63
Q

The major ammoniosteroid NMJ blocker that causes M2 blockade and tachycardia

A

Pancuronium

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64
Q

The 3 skeletal muscle relaxants whose levels must be modified for patients in renal failure

A
  1. Cisatrcurium
  2. Tubocurine
  3. Pancuronium
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65
Q

How do you overcome the effects of the non-depolarizing blockers?

A

Neostigmine/Edrophonium

Also consider: atopine, glycopyrrolate to prevent bradycardia

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66
Q

What worries would you have with skeletal muscle relaxants for the following patients: Myasthenia gravis, advanced age, burns, UMN disease

A

MG: enhanced blockade
Age: decreased clearance
Burns/UMN: resistant to blockade 2/2 proliferation of extra-junctional receptors

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67
Q

How is atracurium broken down? Any concerns?

A

Broken down by hydrolysis; laudanosine metabolite can cause hypotension and seizures (Cisatracurium is a better alternative)

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68
Q

How is mivacurium broken down?

A

Butylcholinesterase (similar to succys)

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69
Q

Which ammoniosteroid has a rapid onset (similar to succys)

A

Rocuronium

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70
Q

3 important drug interactions that can enhance the effect of NM blockade

A
  1. Inhaled anesthetics
  2. Aminoglycosides
  3. Tetracyclines
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71
Q

The major electrolyte disturbance that must be monitored while using succys is:
* Thus, succys is contraindicated in patients with these conditions:

A

Hyperkalemia

* Malignant hyperthermia, skeletal myopathy, burn, polytrauma, UMN injury

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72
Q

What are some major AE’s of the use of succys?

A

Bradycardia (prevent with atropine), histamine release, muscle pain, hyperkalemia, increased IOP, increased intragastric pressure

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73
Q

Malignant hyperthermia is treated with

A

Dantrolene

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74
Q

Acute spasmolytic agent

A

Cyclobenzaprine (strong anti-muscarinic); can cause sedation/confusion

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75
Q

Chronic skeletal muscle spasmolytics

A
  1. Dantrolene (ryanodine R blocker)

2. Botox: cerebral palsy

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76
Q

Skeletal muscle spasmolytic for cerebral palsy

A

Botox

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77
Q

CNS skeletal muscle spasmolytics

A 
GABA-A: Diazepam
GABA-B: Baclofen [works through Gi]
GABA A+B: Progabide
Increased GABA: Gabapentin
Alpha-2 Ag: Tizanidine
Glycine
Decreased glutamate: Idioclamide, Rilozole
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78
Q

The 4 IV general anesthetics

A
  1. Barbituates (thiopental, methohexital)
  2. Propofol
  3. Ketamine
  4. Etomidate
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79
Q

How does methohexital terminate its action (IV general anesthetic)

A

Redistribution from the brain

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80
Q

Among the IV general anesthetics, which one increased ICP?

A

Ketamine

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81
Q

Which IV general anesthetic provides analgesia: Propofol, Ketamine, Etomidate

A

Ketamine

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82
Q

Which IV general anesthetic is an anti-emetic?

A

Propofol

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83
Q

Which IV general anesthetic blocks NMDA receptors and can cause “emergence” dissociative anesthesia?

A

Ketamine

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84
Q

Which IV general anesthetic is given to patients with increased CV risk? What is the major AE?

A

Etomidate (decreased steroidgenesis)

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85
Q

What are the major AE’s of thipental and methogexital as general anesthetics?

A

Apnea, cough, chest wall spasm, laryngospasm, bronchospasm

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86
Q

Why might you consider using an anti-muscarinic, i.e. Scopalamine as an adjuvant to a general anesthetic?

A

Decreased salivation, decreased bronchial secretions, protect heart from bradycardia

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87
Q

Describe the neuroleptic-opioid combo. What agent is then used for anesthesia?

A

Neuroleptic: droperidol
Opioid: fentanyl
Anesthetic: N2O

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88
Q

AE halothane

A

Hepatitis

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89
Q

AE methoxyflurane

A

Nephrotoxicity

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90
Q

The inheritance pattern of malignant hyperthermia

A

AD

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91
Q

2 drugs that can cause malignant hyperthermia

A

Succys, Halothane

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92
Q

Neuroleptic means

A

Anti-psychotic

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93
Q

How does one test for malignant hyperthermia?

A

Caffeine-halothane test: muscle sample removed, measure contraction, add halothane

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94
Q

Which inhalational anesthetic can cause megaloblastic anemia?

A

N20: can cause a decrease in methionine synthase

* Think poorly ventilated dental suite

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95
Q

Which inhalational anesthetic increases ICP the least?

A

N2O

* Ketamine is the only IV that increases ICP

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96
Q

Which inhalational anesthetics are pungent and can thus induce bronchospasm?

A

Isoflurane, Desflurane

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97
Q

Which inhalational anesthetics decrease cardiac contractility and thus CO? Also, these can increase the sensitivity of myocardium to catecholamines, and thus induce ventricular arrhythmias.

A

Halothane, Enflurane

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98
Q

Which inhalational anesthetics are good to use in patients with impaired cardiac function?

A

Isoflurane, Desflurane, Sevoflurane

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99
Q

Which inhalational anesthetic can cause tonic-clonic seizures?

A

Enflurane

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100
Q

The sequence of events for GETA.

A
  1. IV induction agent
  2. Inhalational anesthetic
  3. Analgesia
  4. NM blocker
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101
Q

MAC is _________

A

Quantal dose response

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102
Q

The more soluble the inhalational anesthetic, the faster/slower onset?

A

Slower onset

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103
Q

MOA of inhalational anesthetics

A

+: GABA-A, glycine

-: Nicotinic

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104
Q

The faster the ventilation rate, the faster/slower dose of the inhaled anesthetic

A

Faster

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105
Q

Inhaled anesthetics increase/decrease brain perfusion and increase/decrease minute ventilation.

A

Increase brain perfusion

Decrease minute ventilation

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106
Q

AE Valproate

A

Hepatotoxicity (decreases P450)

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107
Q

AE Phenytoin

A

Diplopia, ataxia, gingival, hirsuitism, Zero-order kinetics

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108
Q

AE Carbamazepine

A

Aplastic anemia, rash

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109
Q

AE Vigabatrin

A

Decreased vision

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110
Q

Valproate in pregnancy can cause

A

NTD (anti-folate)

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111
Q

Anti-epilepsy drugs in pregnancy can cause…

A

Newborn hemorrhagic disease

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112
Q

Treatment: Absence seizure

A

Ethosuximide

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113
Q

Treatment myoclonic seizure

A

Valproate (Topiramiate, Leve)

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114
Q

Treatment for atonic (generally refractory)

A

Valproate, Lamotrigine

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115
Q

Treatment infantile spasm (non-febrile)

A

Corticotropin, GC, Vigabatrin

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116
Q

Treatment febrile convulsion > 15 minutes

A

IV or PR diazepam

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117
Q

Treatment of breakthrough seizure

A

PR diazepam

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118
Q

Treatment of drug-induced seizure

A

Diazepam/Loraezepam, Phenobarbital

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119
Q

Formulary for status epilepticus

A
  1. Lorazepam
  2. Phenytoin
  3. Phenobarbital
  4. GETA
120
Q

Major AE of anti-epileptic drug OD

A

Respiratory depression

121
Q

Anti-epileptic inducers

A

Phenytoin, Phenobarbital, Carbamazepine

122
Q

Tiagabin vs. Vigabatrin

A

Tia: prevents re-uptake of GABA
Viga: Prevents degradation of GABA

123
Q

Epilepsy: Na-channel blocker

A

Phenytoin, Carbamazepine, Lamotrigine, Zonisamide

Phenobarbital, Valproate, Topiramate

124
Q

Epilepsy: Ca-channel blocker (t-type)

A

Ethosuximide, Valproate

125
Q

Synaptic vesicle GP2 anti-epilepsy drug (Ca+)

A

Levetiracetam

126
Q

3 major CI of dopamine precursor therapy for Parkinson’s

A
  1. Anti-psychotics
  2. Arrhythmias
  3. Acute glaucoma
127
Q

Drug used to treat end-of dose akinesia of levodopa

A

Apomorphine

128
Q

AE of apomorphine

A

Emetogenic, QT prolongation

129
Q

AE Bromocriptine

A

Pulmonary infiltrates, fibrosis, megaloblastic, digital vasospasm

130
Q

AE Pramipexole, Ropinirole

A

Somnelesnce (better for younger patients)

131
Q

How is rotigotine applied (anti-Parkinson’s)

A

Transdermal

132
Q

MAOI’s for Parkinson’s

A

Deprenyl: inhibit COMTb

Rasagiline inhibit dopa dc; activation COMT

133
Q

AE Tolcapone

A

Fulminant hepatotoxicity

134
Q

AE Amantadine

A

Livedo reticularis; seizure/CHF = CI

135
Q

Major anti-muscarinic used for Parkinson’s treatment

Major AE?

A

Benztropine (can cause hallucinations, delirum)

136
Q

COMT inhibitors for Parkinson’s (Central & Peripheral)

A

Central: Tolcapone
Peripheral: Entacopone, Tolcapone

137
Q

Used for acute treatment of GAD or as an adjunct with an SSRI being titrated (then tapered)

A

Benzos, i.e. alprazolam

138
Q

Second line therapy for anxiety disorders (After SSRI + benzo)

A

Buspirone

139
Q

Treatment of OCD (aside from SSRI’s)

A

Clomipramine

140
Q

SSRI treatment of choice for PTSD

A

Sertraline, Paroxetine

141
Q

STM, Intermediate and LTM Benzodiazepines

A

STM: Triazolam, Oxazepam
Intermediate: Alprazolam, Lorazepram, Temazepam
LTM: Diazepam, Flurazepam

142
Q

MOA benzodiazepines

A

Bind to GABA-A receptors in CNS (which is a Chloride channel) and hence decreases firing of neurons

143
Q

Benzodiazepine antagonist

A

Flumazenil

* Reveres the CNS effects of benzodiazepines; can hasten recovery following use in anesthesia

144
Q

Benzo: Anticonvulsant

A

Clonazepam

145
Q

Benzo: Muscle relaxant (MS + Cerebral palsy)

A

Diazepam

146
Q

Benzo: #1 drug for status epilepticus

A

Lorazepam

147
Q

Benzo: Drug withdrawal (including ETOH)

A

Diazepam, Oxaxepam

148
Q

T/F Benzodiazepines can cause paradoxical anxiety, irritibility, rage, depression and suicide

A

True

149
Q

Benzodiazepine (BZD) vs. GABA

Which subunits are activated?

A

GABA: Alpha, beta
Benzo: Alpha, gamma

150
Q

Benzo’s used for difficulty initiating sleep vs. maintaining sleep

A

Initiate: Triazolam, Temazepam
Maintain: Flurazepam

151
Q

Why are barbiturates inferior to benzos? What is the major lethal complication?

A

Because they also block glutamate and Na

- Respiratory depression; decreased activity of central Co2 chemoreceptor

152
Q

These sedative-hypnotics are contraindicated in patients with porphyria

A

Barbituates

153
Q

T/F Barbs are inducers

A

True

154
Q

Which sedative-hypnotic can be used to treat hyperbilirubinemia and/or kernicterus in a child

A

N-phenobarbital

155
Q

Which sedative-hypnotic is a good choice because of its lack of interaction with alcohol?

A

Buspirone (Partial 5-HT1 Ag)

156
Q

Who are the non-benzodiazepine benzodiazepine receptor agonist?

A

Zolpidem, Zaleplon, Eszopiclone

157
Q

Among the “z drugs” which one has the shortest t-1/2 and which one has the longest t-1/2

A

Shortest: Zolpidiem
Longest: Eszopiclone

158
Q

Ambien is which durg?

A

Zolpidiem

159
Q

Which anti-histamine can be used as a sedative/hypnotic?

A

Hydroyzine

160
Q

The MAOI’s for depression include:

A

Tranylcypromine
Isocarboxazid
Phenelzine
Selegiline

161
Q

MAOI’s are reversible/irreversible

A

Irreversible

162
Q

Describe the underlying basis for the cheese reaction.

A

Tyramine is typically inactivated by MAO; hence using OTC cold medicines (i.e. pseudoephedrine) can lead to the cheese reaction

163
Q

Who are the TCA’s? Which ones have better AE profiles? Which one has the worst sexual side effects?

A 
Amitryptiline
*sex Clomipramine
*Desipramine
*Nortryptiline
Imipramine
164
Q

Who are the tetracyclic antidepressants? Do they block net or sert preferentially?

A

Amoxaprine, Maprotiline (net > sert)

165
Q

Aside from blocking SERT & NET, what receptors iare blocked by TCA’s?

A

Alpha-adrenergic, muscarinic, histamine, 5-HT

166
Q

Who are the CYP inhibitors among the SSRI’s?

A

Fluoxetine, Paroxetine, Fluvoxetine (all CYP)

Non-inhibitors: Sertraline, Escitopram, Citalopram

167
Q

Drug of choice for bullemia

A

Fluoxetine

168
Q

Drug of choice for PMDD

A

Fluoxetine, Sertraline

169
Q

Which SSRI causes the most amount of weight gain?

A

Paroxetine

170
Q

OD of SSRI can cause…

A

Seizure

171
Q

Who are the SNRI’s? What is the difference between them?

A

Venlafaxine: SERT > NE
Duloxetine: SERT = NE

172
Q

Which anti-depressant drugs are approved for the treatment of diabetic neuropathy and fibromyalgia?

A

Duloxetine

173
Q

MOA of bupropion

A

NE, Dopamine

* OD = seizure

174
Q

Who are the SARI’s? Major AE’s?

A

Nefazodone: hepatotoxicity
Trazodone: priapism

175
Q

What is the MOA of the SARI’s?

A

Block 5-HT reuptake and also antagonize the 5-HT2 receptor (which is responsible for a lot of AE’s)

176
Q

Why is Trazodone used as a hypnotic?

A

Because it preferentially blocks alpha-1 and H1 receptors

177
Q

Which anti-depressant is used that antagonizes central alpha-2 presynaptic receptors, which also promotes the release of NE and dopamine and antagonizes 5-HT2, 3 receptors?

A

Mirtazapine

178
Q

What is the major AE of Mirtazapine?

A

Weight gain

179
Q

Which atypical anti-psychotics can be used for the treatment of depression?

A

Quetiapine, Ariprazole, Olanzapine

180
Q

What is the MOA of Lithium?

A

Inositol depletion; hence decreased central adrenergic activity; no synthesis of PIP2

181
Q

Can Lithium be used in pregnancy?

A

No

182
Q

What drugs can be used for treatment of bipolar instead of Lithium?

A

Anti-epileptics: Valproate, Carbamazepine, Lamotrigine

Atypical antipsychotics: Olanzapine, Ariprazole, Quetipaine, Risperidone, Ziprasidone

183
Q

MOA of classical anti-psychotics.

A

D2 blockers in the mesolimbic pathway

184
Q

High potency classical anti-psychotics vs. low potency.

A

High potency: Haloperidol, Fluphenazine

Low: Thioridazine, Chlorpromazine

185
Q

Who are the atypical antipsychotics?

A

Clozapine, Risperidone, Olanzapine, Quetiapine, Paliperidone, Ariprazole, Ziprasidone

186
Q

Which atypical antipsychotic can cause agranulocytosis?

A

Clozapine

187
Q

Which atypical antipsychotic has the least EPR AE’s?

A

Clozapine

188
Q

Which atypical antipsychotic can be used to treat Autism?

A

Risperidone

189
Q

Which drugs can be used to treat neuroleptic malignant syndrome?

A

Dantrolene, bromocriptine

190
Q

What is the way to treat tardive dyskinesia 2/2 atypical anti-psychotic use?

A

Discontinue drug, eliminate anti-cholinergics, add diazepam and swithch to clozapine

191
Q

Which 2 anti-psychotics can cause seizures?

A

Chlorpromazine,

Clozapine

192
Q

Are anti-muscarinics beneficial to deal with the AE’s of anti-psychotics?

A

Yes

193
Q

Can anti-psychotics cause hyperprolactinemia?

A

Yes

194
Q

The atypical anti-psychotics are dual antagonists at:

A

5-HT2A, D2

195
Q

Neuroleptic anesthesia is achieved with…

A

Droperidol, fentantl

196
Q

Can clozapine be used in pregnancy

A

Yes (can cause hyperglycemia/weight gain)

197
Q

3 drugs and 1 surgical option used for the treatment of hypercalcemia

A
  1. Furosemide (with saline)
  2. Bisphosphonates (-dronate)
  3. Calcitonin
    (4. ) Parathyroidectomy
198
Q

Patients with ESRD often have hyperphosphatemia. Which drug can be used as a phosphate binder in the guy?

A

Sevelamer

199
Q

Drugs which can cause osteoporosis

A
  1. CS
  2. Lithium
  3. ETOH
  4. Heparin
  5. Anastrazole
200
Q

Drugs which can cause osteomalacia

A
  1. Phenytoin

2. Etidronate

201
Q

Drugs which decrease PO4 excretion

A

Thiazides

202
Q

Drugs which can cause hypomagnesiemia

A

PPI, AG, Chronic diarrhea, diuretics, ETOH

203
Q

Treatment of malignant hypercalcemia

A

-dronate

204
Q

AE of bisphosphonates (-dronates)

A

Erosive esophagitis

Osteomalacia, osteonecrosis, jaw fracture

205
Q

Treatment of Paget’s disease

A

Etidronate

206
Q

RANKL inhibitor

A

Denosumab

207
Q

AE of Denosumab

A

Reactivation of latent TB

208
Q

Continuous administration vs. Pulsatile administration of Teriparatide

A

Pulsatile: new bone formation
Continuous: bone resorption

209
Q

Drug which increases Calcium sensing receptors (particularly useful in secondary hyperparathyroidism)

A

Cincalcet

210
Q

Fluoride can be used to promote new bone synthesis. What is the way that this bone is described.

A

Dense, but brittle

211
Q

Gallium nitrate MOA

A

Decreases bone resorption

212
Q

Plicamycin, which is a cytotoxic anti-cancer agent can be used… AE’s?

A

Cancer-related hypercalciuria

AE: TBO-penia, renal/hepatotoxicity

213
Q

To counteract the effect of MgSO4 overdose, one can use…

A

Calcium gluconate

214
Q

A topical treatment for psoriasis

A

Calcipotriene

215
Q

D2/D3

Ergo or Chole

A

Ergo: D2
Chole: D3

216
Q

Sulfonurea drugs (first generation); describe half-lives

A
  1. Tolbutamide (short half life)

2. Chlorpropamide (long half life)

217
Q

Sulfonurea drugs (second generation)

A
  1. Glyburide (high incidence of hypoglycemia)
  2. Glipizide
  3. Glimepiride (can be dosed once daily)
218
Q

Meglitinides

A

Repaglinide

Nateglinide: lower risk of hypoglycemia

219
Q

AE’s chlorpropamide

A

Hyperemic flush with ETOH, SIADH

220
Q

What is the major benefit of the Meglitinides over the Sulfonurea drugs

A

Can be used for patients with sulfa allergy

221
Q

What is the only biguanide? What is its MOA? What is the life threatening AE?

A

Metformin; activation AMP kinase; inhibits GNG
Major AE: lactic acidosis, decreased B12 absorption
CI: renal/hepatic/hypoxia/ETOH

222
Q

What is the 3rd class of oral hypoglycemics?

A

TZD’s: Pio & Ros-glitazone

* Decrease insulin resistance; agonist of PPAR-gamma; promotes insulin uptake

223
Q

AE of TZD’s

A

Fluid retention, weight gain, exacerbate CHF, liver function monitored

224
Q

What is the 4th class of oral hypoglycemics? Major AE?

A

Alpha glucosidase inhibitors: Acarbose, Miglitolo

AE: LFT’s monitor

225
Q

What are the non-oral hypoglycemic agents?

A
  1. Incretin analogue: Exenatide
  2. Inihibtor of DPP-IV: Sitagliptin
  3. Amylin analogue: Pramlintide
  4. Bile acid sequestrant: Colesevelam
226
Q

Major CI for Exenatide

A

Gastroparesis

227
Q

Major AE Sitagliptin

A

Pancreatitis, hypersensitivity

228
Q

T4/T3

Levo vs. Liothyroxine

A

T4 = Levo
* Treatment of Cretinism
AE: hyperthyroidism, CYP induction

229
Q

AE’s propythiouracil and methimazole

A

PTU: Rash, anemia, liver toxicity, vasculitis
Methimazole: teratogenic

230
Q

Drugs that can be used to treat thyroid storm

A

Beta blocker, PTU, IV NaI, GC, amiodarone, radiocontrast

231
Q

Drugs which prevent Na-I symport

A

Perchlorate, thiocyanate, pertechnetate

232
Q

Drugs that can provoke HYPOthyroidism

A

Amiodarone, IFN, IL-2, Lithium, Goitrogens (cabbage, thiocyanate, cassava)

233
Q

Drug used for intraoperative thyroid storm

A

Esmolol

234
Q

AE Iodine & Iodine salts

A

Anaphylaxis, parotid/maxillary enlargement, brassy teeth

235
Q

STM CS

A

All but triamcinolone & Dexamethosone

236
Q

Intermediate CS

A

Triamcinolone

237
Q

LTM CS

A

Dexamethosone

238
Q

Topical CS

A

All but prednisone

239
Q

Aerosolized CS

A

Triamcinolone, Beclomethasone

240
Q

IM or IM/IV CS

A

IM: Triamcinolone

IM/IV: All but beclomethasone

241
Q

PO CS

A

All

242
Q

SST Analogue

A

Octreatide

243
Q

GH Analogues (2)

A

Somatropin, Somatrem

244
Q

Anti GH

A

Pegvisomant

245
Q

ACTH Analogues (2)

A

Corticotropin, Cosyntropin

246
Q

FSH/LH Analogues (4)

A

Menotropins, (Uro)Follitropin, Choriogonadotropin

247
Q

GnRH Analogues (4)

A

Gonadorelin, Goserelin, Leuprolide, Nafarelin

248
Q

Anti GnRH (2)

A

Cetrorelix, Ganirelix

249
Q

Anti ADH

A

Conivaptan

250
Q

Anti Oxytocin

A

Atosiban

251
Q

Positive and Negative aldosterone analogues

A

+: Fludrocortisone

-: Spironolactone

252
Q

Major adrenal hormone synthesis inhibitors (3)

A

Ketoconazole: Adrenal and gonadal synthesis inhibitors
Aminoglutethamide: cholesterol –> pregnenolone
Metyrapone: 11-hydroxylation inhibitor (Cushings/preg)

253
Q

Negative GC & progesterone analogue

A

Mifepristone (GC + progesterone)

254
Q

Cortisol’s effect on PMN’s vs Lymphocytes

A

Increased PMN, Decreased lymphocytes

255
Q

Cortisol increases/decreased ICP

A

Increases

256
Q

AE spironolactone

A

Hyperkalemia, arrhythmias, gynecomastia, GIT/derm

257
Q

Indications for spironolactone

A

Hyperaldosteronism, hirsuitism (Female = androgen antag)

258
Q

Indications for mifepristone

A

Inoperable ectopic ACTH production tumor; adrenal cancer, RU486

259
Q

Which CS can be used for cerebral edema?

A

Dexamethosone

260
Q

Which CS can be used to stimulate fetal lungs

A

Dexamethosone

261
Q

Acute adrenal insufficiency is treated with…

A

IV hydrocortisone and electrolyte repletion

262
Q

Treatment of idiopathic orthostatic hypotension

A

Fludrocortisone

263
Q

AE: Somatotropin and Somatrem in adults and children

A

Adults: Connective tissue, edema, myalgia
Children: Scoliosis, hypothyroid, IC htn, Otitis Media (Turner’s syndrome), DM, pancreatitis, gynecomastia

264
Q

AE Pegvisomant

A

GH-R antagonist

* Gallstones, bradycardia, decreased B12

265
Q

Who has a longer half life: bromocriptine or cabergoline

A

Cabergoline

266
Q

HBA1C target

A

< 7%

267
Q

FPG target

A

< 130

268
Q

Post-prandial glucose target

A

< 180

269
Q

Major AE of alpha-glucosidase inhibitors

A

Flatulence, diarrhea

270
Q

Rapid, Short, Intermediate, Long acting insulin

A

Rapid: Lispro, Aspart, Glusine
Short: Regular
Intermediate: NPH
Long: Glargine, Detemir

271
Q

Which insulin preps are given just before a meal

A

Rapid-acting

272
Q

Differentiate between continuous and pulsatile GnRH

A

Pulsitile: stimulate FSH, LH
Continuous: hypogonadism (with a flare at 7 days)

273
Q

AE of high dose cabergoline

A

Peripheral vasospasm, pulmonary infiltrates

274
Q

Continuous administration of Goserelin, Leuprolide, Nafarelin can be used to treat: (M & F)

A

F: endometriosis, fibroids (with Fe)
M: PRCA, precocious puberty, BRCA, PCOD

275
Q

AE Goserelin, Leuprolide, Nafarelin

A

F: Menapause, Depression, Ovarian cysts, Osteoporosis
M: Hot flush, edema, gynecomastia

276
Q

Why might you use cetrorelix or ganirelix?

A

To prevent LH surge associated with ovarian hyperstimulation

277
Q

V1R vs V2R

A

V1: vasoconstriction, IP3
V2: renal, cAMP

278
Q

Treatment of infantile spasm

A

Cosyntropin (West syndrome)

279
Q

AE oxytocin

A

Excessive contraction, ADH activation, hypotension

280
Q

Which drug is used (not in the US) to prevent pre-term labor?

A

Atosiban

281
Q

Desmopressin acts primarily at which receptors?

A

V2

282
Q

Indications vasopressin

A

Esophageal varices, colonic diverticulitis

283
Q

Indications desmopressin

A

Coagulopathy associated with hemophilia A, VW disease

284
Q

OD of desmopressin can cause

A

Hyponatremia and seizure

285
Q

Conivaptan is used to treat

A

Hyponatremia

286
Q

The + progesterone agent with anti-androgen properties

A

Drospirinone (acne treatment), Norgestimate

287
Q

Anti-progesterone drug that inhibits P450 and can be used to treat endometriosis and FCC breast

A

Danazol

288
Q

AE Danazol

A

Abnormal LFT’s and masculinizing effects

289
Q

Full estrogen receptor antagonist

A

Fulvestrant

290
Q

What is special about clomiphene when used to treat infertility?

A

It is an estrogen antagonist which prevents negative feedback inhibition

291
Q

Aromatase inhibitors (steroidal and non-steroidal)

A

S: Exemestane
NS: Rev: anastrazole, Letrozole

292
Q

Which progesterone Ag can be used to treat acne?

A

Drospirinone

293
Q

Which are the positive androgen agents?

A

Oxandrolone, Stanozol, Fluoxymestrone, Oxymetholone, Nandrolone

294
Q

The androgen receptor antagonists

A

Flutamide, nulutamide, bicalutamide (can be use with leuprolide to prevent a PRCA flare)

295
Q

5-alpha reductase inhibitor

A

Finasteride

296
Q

What hormonal agent can be used for MTF transition (transgender)?

A

Cyproterone (androgen synthesis inhibitor)

Term 5 (9 decks)

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