Pharm High Yield Flashcards
Desmopressin stops bleeding in pts with VWD–>release of vWF from Endothelial cell Weibel-Palade Bodies
Can also be useful in Hemophilia A.
Nimodipine is a CCB used to prevent vasospasm in subarachnoid hemorrhage (usually 2-3 days post hemorrhage)
.
Atropine will NOT TX paralysis in organophosphate/Anticholinergic poisoning (no effect on nicotinic R–>Nm receptors)
Atropine + Pralidoxime.
Foscarnet (PP analog vs. CMV and HSV) can chelate Ca and Mg–>Seizures and nephrotoxicity
Does NOT require activation by viral or host enzymes.
Potassium Iodine prevents radiation mediated Thyroid disease (Wolffe-Chaikoff Effect)
Also treats Sporothrix.
Triazolam, Oxazapam, Alprazolam, and Midazloam are SHORT acting benzodiazepines–>less hangover
Flurazepam, diazepam, and chlordiazepoxide are long acting.
Vancomycin should be used for blood infection (valves) with Staph Epidermidis–>Common methicillin resistance
.
Jimson weed (gardening) has the same effects as atropine (block sludge)
.
Protease inhibitors (-navir) in HAART cause hyperglycemia and fat redistribution (Cushing-like rxn) and are strong CYP inhibitors
.
Amiodarone causes pulmonary fibrosis, hypothyroidism, and liver damage –>check Lung, liver, and thyroid function
40% Iodine by weight.
Halothane (anesthesia) and Valproic acid can cause hepatic necrosis (also amanita phalloides mushroom and acetaminophen)
Amantinin blocks RNA Pol II (mRNA synthesis).
C. diff pseudomembranous colitis is especially likely with Clindamycin, ampicillin and cephalosporins
.
Gray Baby Syndrome– Chloramphenicol–hypotension, ashen discoloration, vomiting, flaccidity
.
Red man syndrome–> Vancomycin (histamine mediated)–>slow infusion rate or pretreat w/ antihistamines
.
The hypersensitivity reaction associated with Niacin is prostaglandin mediated; BEST drug to increase HDL
.
Do NOT give vitamin B6 with Levodopa–>increases metabolism; Absorption blocked by Leucine/isoleucine (don’t take w/ meals)
Do give B6 w/ isoniazid.
Fibrates (dec TG) and Statins both cause myopathy–> can cause Acute Tubular Necrosis due to myoglobinurea, especially when used together
.
Tetracyclines and sulfonamides cause photosensitivity; also 5-FU and amiodarone
.
Allopurinol can cause Stevens-Johnson syndrome (also penecillin, sulfas, and anti-epileptics–Lamotrigine)
.
Bupriopion has a high risk of seizures in Bulemia, anorexia, and other eating disorders
Blocks NE and DA reuptake, also used for SAD and smoking.
Lithium causes Nephrogenic Diabetes Insipidus and Ebstein’s Anomaly; Also hypothyroidism (Constipation, hair loss, weight gain, bradycardia)
Demeclocycline can also cause Nephro DI–>blocks ADH receptors (TX for SIADH).
Expired tetracycline use and Tenofovir causes Fanconi Syndrome–>nothing reabsorbed in proximal tubule
Also Wilson’s disease.
Giving Mesna with cyclophosphamide blocks hemorrhagic cystitis (cyclophosphamide is a prodrug–acrolein + mustard)
.
Pulmonary Fibrosis–> Bleomycin, Busulfan, Amiodarone, and Methotrexate
.
Disulfiram RXNS: Metronidazole, some cephalosporins, Griseofulvan (fungal microtubules), procarbazine, 1st gen sulfonylureas
.
Use of Loop Diuretics (Furosemide) will worsen ototoxicity associated with Aminoglycoside Abx
.
Theophylline has a very narrow therapeutic index and is influenced by CYP inhibitors–>Seizures, blocks PDE3 and adenosine
.
Cimetidine is both a potent CYP450 inhibitor and is antiandrogenic
.
Long term use of PPI (omeprazole) is associated with hip fractures and low serum Magnesium
.
Tetracyclines and fluoroquinolones should not be taken with antacids or any Ca containing food/beverages
Tetracyclines bind Ca–> teeth discoloration and deposit in bones.
Aluminum–constipation, Magnesium–diarrhea
.
Docusate salts are stool softeners/surfactants
.
Warfarin causes skin necrosis, especially in patients with Protein C deficiency–>protein C is anticoagulant and has the shortest half life of the liver-produced clotting factors
.
Vitamin B6 supplementation helps to TX Sideroblastic anemia (cofactor for deficient ALAS)
.
If you TX a child with megaloblastic anemia with folate and B12 and there is no improvement, pt likely has orotic aciduria (UMP Synthase deficiency) and you should TX with Uridine (not uracil b/c pyrimide salvage is at nucleoside level)
If elevated orotic acid and hyperammonemia, pt has Ornithine Transcarbamylase deficiency (Urea Cycle).
Penecillin and Methyldopa are associated with Warm Agglutinins hemolytic anemia
Cold- Mycoplasma and Mono.
Failure to increase PTT with heparin administration implies Antithrombin III deficiency (also lost in nephrotic syndrome)
.
Cladribine is an Adenosine Deaminase inhibitor used to treat Hairy Cell Leukemia (TRAP+)
.
Imatinib is the TX for CML that inhibits the t(9,22) Philadelphia Chr generated bcr-abl tyrosine kinase and c-kit (GIST)
.
Enoxaparin and Dalteparin are LMW Heparins that mainly decrease Factor Xa–>better bioavailability and half life
.
In pts with Heparin-Induced Thrombocytopenia, direct thrombin inhibitors are used–>Bilvalrudin, Dabigatran, Argatroban, Lepiruden
Xa inhibitors: Rivaroxaban, Apixaban, Fondaparinux.
Aspirin prolongs bleeding time (dec thromboxane A2), no effect on PT or PTT
.
PDE3 inhibitors prevent platelet aggregation–>Dipyridimole and cilostazol (also arterial dilation)
.
Methotrexate myelosuppression is reduced with Leucovorin administration (folinic acid “rescue”); 5-FU is not rescued with leucovorin–>treat overdose with uridine
.
Allopurinol cannot be used with 6-MP/Azathioprine b/c both are metabolized the Xanthine Oxidase
.
Dactinomycin is used for childhood tumors–>Wilms, Ewings, Rhabdomyosarcoma
.
Nitrosurea (Carmustine) are chemo drugs that cross the BBB to treat brain tumors but also have CNS toxicity (ataxia)
.
Cisplatin Nephrotoxicity is reduced with Amifostine and chloride diuresis
very potent emetic.
Do not treat a pt with bilateral renal artery stenosis with ACE inhibitors b/c ATII is necessary to maintain GFR ( by constricting the efferent arteriole); will cause renal failure– increased creatinine and K+ by >30%
.
In woman w/ pre-eclampsia, use magnesium sulfate to prevent seizures/eclampsia–>may cause loss of Deep Tendon reflexes
.
Linezolid acts as an MAOI (hypertensive crisis with tyramine)
Look out for case of Depressed pt treated for MRSA skin infection.
Non-sulfa loop diuretic–>Ethacrynic acid
.
Amphotericin B causes Nephrotoxicity (total dose dependent), hypomagnesia, and hypokalemia. Pts feel ill b/c it does bind somewhat to cholesterol in human membrane
.
Fibrates have a high risk of cholesterol gallstones–>block 7alpha hydroxylase-> decreases bile acids–>inc cholesterol in bile
.
Isosorbide Mononitrate is almost 100% orally available, unlike Nitroglycerin and isosorbide dinitrate that have low oral availability
.
Ergonovine is an ergot alkaloid that tests for Prinzmetal Angina–>alpha adrenergic/serotoninergic agonist (also treats migranes)
.
Cidofovir (VZV) and Tenofovir (HIV) are nucleoTIDE analogs that do not require activation by viral kinases
.
PABA in sunscreen protects against UV-B only (most potent); Zinc Oxidase protects against UV-B, A1, and A2
.
Calcipotriene, Calcitriol, and Tacalcitol are Topical anti-psoriasis agents that bind Vitamin D receptor–>effect a nuclear transcription factor
.
Clindmycin treats anaerobes above the diaphragm (aspiration pneuomnia), Metronidazole treats anaerobes below the diaphragm
.
Serotonin Syndrome is treated with Cyproheptadine–>1st gen antihistamine with anti-serotoninergic properties
Basically need to have an MAOi or large overdose to get Serotonin syndrome.
T(1/2)= 0.693xVd/Clearence
.
Loading dose = (Vd x Cs)/Bioavailability; Maintence dose = (Cs x Cl x interval)/Bioavailability
Vd= loading dose/Cs.
Loading dose does NOT change if pt has renal/hepatic disease, but Maintenance dose changes
.
Competitive antagonists decrease affinity w/ no change on efficacy; Noncompetitive and irreversible competitive antagonists decrease efficacy with no effect on affinity
Competitve antagonist “Crosses” the agonist on Lineweaver Burke graphs.
Oral Vancomycin is not absorbed–>used to tx C difficile
.
Sulfonamides are contraindicated in neonates because they displace bilirubin from albumin–>kernicterus
Must also be careful giving to 3rd trimester mothers.
Fluoroquinolones are contraindicated in children–> tendon rupture; also can prolong QT
.
Aztreonam is a Beta-Lactam Abx (monobactam) that is Beta-lactamase resistant, treats serious gram -, and does not interact with penecillin allergies
.
Cilastatin is given with imipenem to decrease inactivation of imipenem by renal dihydropeptidases
.
Drugs that Cause change in color vision: Digoxin (inotrope,), Ethambutol (red-green, TB tx), Sildenafil/vardenafil (blue/green)
.
Supplementation with vitamin B6 can prevent isoniazid toxicity (INH decreases mycolic acid synthesis–>branched lipids)
.
Ketoconazole and Spironolactone have anti-androgen effects
.
Caspofungin is an anti-fungal that blocks synthesis of B-(1,3)-D-Glucan for the fungal cell wall (candida and aspergillus)
.
Acyclovir, Valacyclovir, Famciclovir, and penciclovir all require viral thymidine kinase to add first phosphate
Acyclovir+valine=valcyclovir; Famciclovir is converted to Penciclovir.
Unlike acyclovir, Ganciclovir is NOT a chain terminator–>both inhibit viral DNA polymerase and need viral activation
.
Amantadine is an antiviral (influenza A) that Tx Parkinsons; Demeclocycline is a tetracycline that Tx SIADH
.
All nucleoside reverse transcripatase inhibitors can cause lactic acidosis with hepatic steatosis
.
Long term high dose Steroids cause atrophy of Type 2B muscle fibers
.
Efavirenz (non-nucleoside Reverse Transcriptase inhibitor) can cause vivid dreams, CNS symptoms, and false + cannabis tests
.
Didanosine is a NRTI that can cause pancreatitis
.
Ritonavir (protease inhibitor) can alter taste and cause numbness around the mouth; CYP 450 inhibitor, teratogen
ACE inhibitors also alter taste.
Primaquine is used against Plasmodium ovale and vivax –>kills liver malaria; causes hemolysis is pts with G6PD deficiency
.
Nifurtimox is the TX for Trypanosoma cruzi (Reduviid bug, dilated cardiomyopathy, megaesophagus, megacolon)
.
Suramin (blood) and Melarsoprol (CNS) are the TX for Trypanosoma brucei–>African Sleeping Sickness (Tsetse fly-painful bite)
.
TX for toxoplasma gondii is Pyrimethamine (dihydrofolate reductase inhibitor) and sulfamethoxazole and leucovorin
.
Cyclophosphamide and Ifosfamide cause hemorrhagic cystitis–>Acrolein causes; mesna prevents (binds acrolein)
.
Etoposide/Teniposide inhibit DNA topoisomerase II–>double standed breaks; Topotecan/Irinotecan block Topo I–>single breaks
.
Drug Classes w/ Antimuscarinic Effects: 1. 1st gen Antihistamines 2. TCAs (Amitryptiline) 3. Phenothiazines (low pot. Typical Antipsychotics Chlorpromazine and Thioridazine)
.
Anticholinergic drugs should be used with extreme caution in pts with narrow angle glaucoma
.
Ipratropium and Tiotropium are anticholinergics used for COPD
also reverse Beta blocker induced bronchospasm.
Dantrolene treats Malignant Hyperthermia (succinylcholine, Halothane) and Neuroleptic Malignant Syndrome (Haloperidol) by inhibiting release of Ca2+ from the sarcoplasmic reticulum (ryanodine receptor)
.
Aminoglycosides enhance Neuromuscular blockade by competing with Ca2+ to inhibit Ach release
.
Atracurium is a Non-depolarizing neuromuscular blocker that is safe to use in renal failure->excreted in bile/spontaneous bdown
.
Terazosin/Doxazosin are alpha1 blockers used for BPH and HTN; Tamsulosin is a specific alpha1 blocker for BPH only
.
Yohimbine is an alpha 2 antagonist that treats erectile dysfunction and orthostatic hypotension
.
The Beta Blocker that also blocks K+ channels for use as an AAD is Sotalol–> Class III AAD
.
Acebutolol and Pindolol are beta blockers with partial beta activity/sympathomimetic activity–>Contraindicated in Angina
.
Beta-blockers inhibit all of the effects of thyrotoxicosis/Hypoglycemia except Diaphoresis (Cholinergic receptors)
.
Halothane has a low MAC/high parturition coefficient–>Malignant Hyperthermia, hepatitis, and arrhythmias
low MAC=potent, HIgh parturition coefficient=long time to on/off.
Loperamide and diphenoxylate are opioids used to treat diarrhea
.
Baclofen causes muscle relaxation by activating GABAb receptors–>increases K+ efflux
GABAa receptors are chloride influx channels.
Atypical Depression (mood reactivity, hyperphagia, hypersomnia) is treated with MAOinhibitors
Look out for Tyramine hypertensive crisis questions in Atypical depression pt.
Clomipramine is a TCA used for OCD (SSRI also used)
.
Lithium is reabsorbed in the same manner as sodium, so low sodium can cause lithium toxicity
.
Clozapine (atypical antipsychotic) causes agranulocytosis and seizures
.
Drug Induced Lupus (Anti-histone Ab)= Procainamide, Hydralazine, Isoniazid, Phenytoin, Minocycline
.
Nifedipine(CCB), Phenytoin, and cyclosporine cause gingival hyperplasia
.
Seizures during Pregnancy are treated with Phenobarbital (not eclampsia prevention– magnesium sulfate)
.
Phenytoin and Carbamazepine induce CYP450s–> Decrease oral contraceptive efficacy
.
Sumatriptan can cause vasocontriction of coronary arteries (migrane abortifactant)
.
Terbutaline is a long acting Beta2 agonist used for asthma and as a tocolytic
.
Beta Blocker induced bronchospasm is treated with anticholinergics–>ipratropium and tiotropium
.
Aspirin can cause nasal polyps with prolonged use (nasal polyps also a sign of Cystic Fibrosis in children)
.
Proton Pump Inhibitors increase the risk for hip fracture
.
TX for Helicobacter pylori: PPI + (2 of) metronidazole/amoxicillin/tetracycline/clarithromycin +/- bismuth subsalicylate
PPI + Clarithyromycin + Metronidazole/Ampicillin.
Sulfasalazine’s azo linkage is cleaved by gut bacteria to produce mesalamine and sulfapyridine (sulfonamide Abx)–> UC
.
Cisplatin has very high emesis
.
Diphenoxylate (opioid antidiarrheal) is usually given with atropine to prevent abuse potential; Loperamide has low abuse potential
.
Bisacodyl is an irritant laxative; Lubiprostone stimulates Cl- secretion (used in women with IBS)
.
Key Neutrophil chemotactic factors: LTB4, C5a, IL-8
.
NSAIDs are effective at treating dysmenorrhea because they decrease PGE2 and PGF2–>uterine contraction
.
Epoprostenol is the prostacyclin/PGI2 analog used to treat primary pulmonary hypertension
BMPR2 gene mutation causes smooth muscle hypertrophy in pulmonary vessels.
At very high doses, aspirin can cause hyperthermia by uncoupling oxidative phosphorylation
.
Glucuronidation and Sulfation usually metabolizes acetaminophen, glutathione recues when those fail (N-acteylcysteine)
.
Disopyrimide (Class Ia AAD) has strong anti-cholinergic effects
.
NO/cGMP leads to vasodilation through deactivation of Myosin light chain kinase
.
ACE inhibitors can alter taste (+hyperkalemia, angioedema, and dry cough)
.
Two Contraindications for ACE Inhibitors: 1. Pregnancy (renal teratogen) 2. Bilateral Renal Artery Stenosis (renal failure)
.
Two main adverse effects of Alpha1 antagonists (Prazosin/terazosin) are First Dose Syncope and reflex tachycardia
.
Minoxidil is a K+ channel opening arterial vasodilator that causes hair growth = Rogaine
.
Both Fibrates (dec 7hydroxylase formation of bile acids) and Bile Acid Resins (inc excretion) can cause Cholesterol Gallstones
.
Clopidogrel is used instead of Ticlopidine to block ADP-platelet activation b/c ticlopidine causes neutropenia and TTP
.
Alteplace is a “clot-specific” thrombolytic agent–>It only activates plasminogen that is bound in fibrin clots
tPA is a serine protease.
Streptokinase is a thrombolytic from Beta hemolytic Strep–> binds plasminogen, causing it to activate other plasminogen
Foreign Ag–>anaphlyaxis and rash, ineffective in people with recent strep infections.
Insulin is the TX of choice in diabetic pregnant women (after diet/exercise)
.
Insulin can also be used in hyperkalemia–>increases K+ movement into cells, given with glucose
.
Rosiglitazone and Pioglitazone (Thiazolidinediones) are oral hypoglycemics that exacerbated congestive heart failure (bind PPAR-gamma transcription factor increasing adiponectin and GLUT4 in muscle/adipose)
increase adipose/muscle insulin sensitivity.
Estrogens cause a hypercoagulable state by decreasing ATIII and Increasing factors 2,7,9, and 10
.
Aromitase inhibitors: Exemastane, Letrozole, Anastrozole
Breast cancer.
Norethinedrone and Norgestrel are estrogens derived from androgens–> can cause hirsutism and acne
.
Anakinra blocks IL-1
.
Teriparatide is the 34 AA from the N terminal of PTH and increases osteoblast function and calcium absorption
.
Clonidine (alpha2 agonist) is used to counteract the sympathetic effects of opioid withdrawal
Will cause rebound HTN in non-compliant pts.
PCP causes aggressiveness, horizontal and vertical nystagmus, and hyperthermia
Death most commonly from trauma.
Modafinil in a NON-amphetamine stimulant that is 1st line for narcolepsy
.
Dipyridimole and Cilostazol are PDE3 inhibitors that both cause arterial vasodilation and block platelet aggregation (inc cAMP) –> used for intermittant claudication
.
NSAIDS (chronic) cause Chronic Interstitial Nephritis (inc serum creatinine, polyuria, mild proteinuria); Relieved w/ stopping NSAID
.
HCTZ causes: Hyper-GLUC: Glucose, Lipidemia, Uric Acid, and Calcium in blood
.
Isoniazid can cause Sideroblastic Anemia–>decreases vitamin B6, which is necessary for ALA Synthase–> decreased protoporphyrin synthesis—> sideroblastic anemia with ringed sideroblasts (unused iron in mitochondria of erthyrocyte precursors)
Acquired Sideroblastic Anemia can also be caused by Lead poisoning (inhibits ALAD and Ferrochelatase) and Alcoholism (disrupts mitochondria–steps 1,6,7).
Angiosarcoma in the liver is associated with arsenic, vinyl chloride, and thorotrast
Arsenic also causes squamous cell carcinoma of skin.
Beta2 agonists increase insulin release (alpha2 dec), Beta blockers predispose to DM by decreasing insulin release
.
Higher Potency drugs either have higher affinity or are better at getting to the target tissue
.
Physostigmine acts centrally and peripherally (crosses BB); Neostigmine, Pyridostigmine, and edrophonium only act peripherally
.
ALS is treated with Riluzone–>prolongs life a few months
.
Interferon Beta–> Multiple Sclerosis; Interferon Gamma–> Chronic Granulomatous Disease
.
1st Line Tx for Toxoplasma is sulfadiazine and pyramethamine
.
5alpha reductase inhibitor (finasteride) shrinks the size of the prostate in BPH but takes time to tx symptoms; A1 antagonist treat symptoms quickly but do not decrease prostate size
.
TTX (tetrodotoxin) blocks Na+ channels (blocks AP); Curare is a nondepolarizing neuromuscular blocker (blocks Ach Nicotinic Receptors)
.
Hexamethonium/Trimethaphan block Nicotinic receptors in the autonomic ganglia (Nn), no effect at neuromuscular junction
.
Positive dromotropic agents (Beta1 agonists/NE) speed conduction through the AV node–>may compromise ventricular filling
.
Vagal stimulated Gastrin release is mediated by Gastrin-Releasing-Peptide and therefore is not inhibited by Atropine
Direct vagus stimulation on parietal cells is Ach mediated and is atropine inhibited.
TX for Cushings Syndrome–> Pasireotide (somatostatin analog), Off label–> Ketoconazole, Mefepristone
.
HIV Prophylaxis –>TMP/SMX at 200 for Pneumocystis/Toxoplasma; Azithromycin at 50 for Mycobacterium Avium Complex
.
Sodium Stibogluconate is the TX for Leishmania (sandfly, spiking fever, hepatosplenomegaly, pancytopenia)
.
Phentolamine can be given to reverse Norepinephrine Extravasation (NE leaks into surrounding area of venous line causing severe vasoconstriciton and potentially necrosis
.
Leucine and Lysine are only Ketogenic and therefore can be used to TX Pyruvate Dehydrogenase Complex Deficiency because they will not result in lactic acid production
.
Probenicid (inc urate excretion) should not be used in pts with high urine urate–>increased urate stone risk
.
Thymidine can be given in folate deficiency to prevent erythroid precursor apoptosis–>low folate prevents dTMP production De Novo but thymidine can be used by the salvage pathway
.
Alpha 1 agonist cause reflex Bradycardia and slowed conduction through the AV node
.
Isoniazid should NOT be used as a monotherapy for TB–> resistance develops quickly via gene mutations
.
Cephazolin (1st gen cephalosporin) is used before surgery for prophylaxis against Staph aureus
.
Thiamine supplementation is used to tx Maple Syrup Urine Disease with avoidance of Leucine, Isoleucine, and Valine
deficient alpha-ketoacid dehydrogenase.
Benztropine and Trihexyphenidyl (central acting anticholinergics) are 1st line for Drug-induced Parkinsonism
Especially if due to Antipsychotics, where Levodopa or bromocriptine/Pramipexole/Ropinorole can precipitate psychosis.
Alzheimer’s is treated with Memantine (NMDA blocker-dec excitotoxicity) or Donepezil/Rivastigmine/Galantamine
.
TX for Acute Angle closure glaucoma–> Pilocarpine and Acetazolamide
.
Screening test to detect nicotine in the urine–>Cotinine
Polycyclic Hydrocarbons are the primary carcinogen in smoking.
Screening for alcohol use is GGT (Gamma-glutamyltransferase)
.
Terbinafine inhibits squalene epoxidase–> oral or topical for dermatophyte infections
.
Characteristic non-GI side effects of Methotrexate–> pulmonary fibrosis, apthous ulcers and pancytopenia
.
Oral Contraceptives and Anabolic Steroids are associated with Liver Adenomas (rupture risk) and Cholestasis
if due to OCP, can rupture in pregnancy due to increased hormones.
The Nephrotoxicity caused by Amphotericin is monitored by Potassium and Magnesium levels
.
Chloramphenicol causes Grey baby syndrome and aplastic anemia/pancytopenia in adults; inhibits peptidyltransferase
.
Excess Vitamin E is synergystic with warfarin to inhibit vitamin K mediated gamma carboxylation of clotting factors
.
Vitamin E deficiency can cause hemolytic anemia and Peripheral neuropathy with degeneration of the Posterior Column and Spinocerebellar tract of the SC–> mimics B12/cobalmin deficiency
.
Corn based diets are deficient in Niacin (low niacin and low tryptophan)
Tryptophan deficiency–Dietary, Hartnup disease (cannot reabsorb tryptophan in small bowel or kidney), Carcinoid syndrome.
Na channel binding strength in Class 1 AADs: 1C>1A>1B, therefore class 1C has the greatest use dependent effect because it takes the longest to dissociate
.
TX for severe hypoglycemia (with altered mentation): Parenteral glycogen or IV dextrose (in hospital)
.
Pregnancy HTN TX: Methyldopa, Hydralazine, Labetalol, Atenolol, Nifedipine
.
The control of HTN has its greatest benefit in reducing the incidence of strokes (Goljan)
.
Abciximab (blocks GPIIb/IIIa) is used to prevent platelet thrombus during revascularization procedures of the coronaries
.
Diuretics should be avoided in pts with hypertrophic cardiomyopathy b/c they decrease preload, which leads to increased outflow obstruction (mitral valve draw against the asymmetrically hypertrophied septum)
TX: No exercise, Beta Blocker, implant defibrillator (V fib causes death).
Aminocaproic acid blocks plasminogen activation, alpha2-Antiplasmin inactivates plasmin
.
When using ethambutol to tx TB, you must monitor Visual Acquity–>optic neuropathy (red-green color blindness)
.
Acute Hepatitis: Isoniazid, Halothane, Valproic acid, Acetaminophen, Methyldopa
.
Amiodarone causes liver disease that resembles alcoholic hepatitis, even has Mallory bodies (damaged cytokeratin intermediate filaments)
.
Ursodeoxycholic acid is a synthetic, hydrophilic bile acid used to treat Primary Biliary Cirrhosis
.
Mu Opioid receptors lead to increased K+ conduction and therefore hyperpolarization
.
Thiazide diuretics help prevent osteoporosis when used in older women for HTN –>increase Ca reabsorption
.
If a pt being treated for depression is experiencing sexual side effects, switch them to Bupropion
.
Methicillin, rifampin, NSAIDS, and sulfonamides can cause Acute drug-induced Tubulointerstitial Nephritis–>abrupt onset fever, oliguria, and rash about 2 weeks after starting drug, BUN/SCr
.
Thiazide diuretics are useful for the TX of calium-containing renal stones–>increase Ca reabsorption
TX for stone (once formed)– pain control and fluids +/- tamsulosin (relaxes tract).
NSAIDS are the most useful drug (other than OCP) for dysmenorrhea –>PGF2 mediated uterine contraction
.
50% of women who receive cyclosporin for kidney transplant develop breast fibroadenomas
.
Vitamin A deficiency can caues Immune suppression
.
Carbamezepine is the 1st line drug to TX Tic Douleroux aka Trigeminal Neuralgia
.
Nitroglycerin, Isosorbide dinitrate and Isosorbide mononitrate all cause flushing and Headaches
.
Total Parenteral Nutrition is associated with Gallstones due to biliary stasis via lack of CCK (give exogenous CCK)
.
Serum K+ is used as an indicator of Digoxin Concentration–>Higher K+, Higher Digoxin; Toxicities include AV block (stimulates Vagus), V tachycardia/arrhythmias, blurry vision, change in color vision, fatigue, diarrhea, confusion, delirium
.
Vitamin A is used to treat measles and AML type 3
.
Disulfiram-like reactions: Metronidazole, Chlorpropamine (typical antipsychotic), 1st gen sulfonylureas, Griseofulvin, some cephalosporins
.
Erythromycin ointment is used to prevent gonococcal or Chlamydia conjunctivitis in newborns
.
Praziquantel is used for Schistosomiasis, Clonorchis, Diphyllobothrium latum and Taenia solium
.
Acyclovir can precipitate in the urine causing obstructive, crystaline nephropathy–>prevent w/ aggressive hydration
.
All NRTI’s causes Bone Marrow Suppression and lactic acidosis and hepatic steatosis
.
Digoxin is cleared by the kidneys w/ a T1/2 of 1.5 days–> decreased renal clearence in older people as GFR decreases
.
Appetite suppressors (fenfluramine) can cause Secondary Pulmonary Hypertension
.
Increased Blood/Gas Partition coefficient=Increased solubility=longer equilibrate in brain=Longer time to onset for inhaled anesthetics=longer time for effect to wear off
.
Angioedema caused by ACE inhibitors is mediated by increased Bradykinin (as is the cough)
ACE Inhibitors are Contraindicated in C1 Esterase Deficiency (also angioedema).
Infertility TX: Menotropin=FSH (isolated from menopausal women) and hCG functions like LH
.
Methimazole (tx for hyperthyroidism) causes agranulocytosis–> presents as fever and sore throat
.
Ace inhibitors are contraindicated in C1 Esterase Inhibitor Deficiency–> both lead to angioedema via increased kallikrein/bradykinin
.
Statin+Fibrate=myopathy; FIbrate+Bile Acide Resin (cholestyramine/cholestipol) = cholesterol gallstones
.
Varenicline is a nicotinic partial agonist–>decreases cravings and prevent full agonist effect if pt smokes
.
Pts on Clozapine must have WBC/CBC monitoring due to agranulocytosis
.
TCA overdoes is treated w/ sodium bicarbonates (TCA’s can have quinidine like effects on the heart–> prolong QRS and QT leading to dysrhythmias
.
Carmustine is a Nitrosourea alkylating agent that crosses BBB and enters the CNS–> Glioblastoma Multiforme
Lomustin, Semustin, Streptozocin.
Vemurafenib–inhibits B-Raf w/ V600E mutation–>malignant melanoma
.
Bisphosphonates are associated w/ corrosive esophagitis (take w/ water, upright) and Osteonecrosis of the jaw
.
If a Myasthenia Gravis pt presents w/ persistant symptoms despite TX, an edrophonium test is done
-if symptoms improve, the pt is undertreat, increase neostigmine/pyridostigmine dosage
-If symptoms do not improve, Pt is Over-treated and is in Cholinergic crisis (muscles Ach resistant), discontinue AchE inhibitor
.
Pt w/ sore throat treated w/ amoxicillin/ampicillin develops a rash 7-10 days post meds, true infection was EBV mononucleosis
.
Leuprolide (GnRH analog) and Flutamide (androgen antagonist) are given to treat advanced prostate cancer
Flutamide blocks initial testosterone increase due to FSH/LH surge from leuprolide.
Pentazocine is a opioid partial agonist that, like buprenorphine, can cause withdrawal symptoms
.
Alpha 1 agonists used for Rhinnitis have tachyphylaxis (rapid tolerance)–> only effective for a few days and if used for more will cause worsened rhinnitis
.
Fibrates increase lipoprotein lipase, decrease VLDL secretion, and increase HDL; myopathy and gallstones
.
Cholestyramine also decreases absorption of digoxin and warfarin
.
Resistance to aminoglycosides is via conjugation of the drug at the bacteria surface (acetylation, adenylation, phosphorylation)
.
Ketoconazole absorption is increased in acidic conditions–>drink Coke/Pepsi when taking to increase acid
.
Griseofulvin is contraindicated in pts w/ Acute Intermittant Porphyria– CYP450 inducer that increases heme synthesis
.
Pts w/ cocaine intoxication should NOT be given Beta blockers–> extreme HTN w/ unopposed alpha1
.
Atropine overdose is treated w/ Physostigmine (enters CNS)
.
Bromocriptine and cabergoline are dopamine agonists used to treat prolactin excess; Pramipexole and Ropinirole are dopamine agonists used for parkinsons
.
The two treatments for Acromegaly are Octreotide and Pegvisomant (GH receptor antagonist)
.
Pts w/ secondary hyperparathyroidism due to chronic renal failure can be treated w/: Vitamin D, Sevelamer (phosphate binder) and Cinacalcet (calimimetic that increases sensitivity of CaSR, decreasing PTH)
.
Diazoxide opens K+ channels, causing two effects–>Vasodilation (hyperpolarization) and Decreased Insulin release (closing of K+ channels due to inc glucose causes Ca channel opening causing insulin release)
Can also be used in pts w/ insulinomas.
Sulfasalazine can cause reversible oligospermia
.
Meperidine is an opioid that also blocks serotonin reuptake–> can cause Serotonin syndrome if given w/ a MAOi
Tramadol also blocks serotonin reuptake and can cause serotonin syndrome.
Local anesthetics effect smaller myelinated fibers first (size is most important)
.
Meperidine should be used for pain w/ chololithiasis/cholecystitis–>morphine constricts the sphincter of Oddi
.
ACE inhibitors are used to TX Autosomal Dominant Polycystic Kidney Disease–Renin dependent HTN
.
Exenatide–GLP-1 analog; Exemestane–Aromatase inhibitor; Ezetimibe–Blocks lipid absorption in gut
.
Normal drugs that block alpha 1–> Typical antipsychotics and TCAs
.
Tranylcypromine, Phenelzine and Isocarboxazid are the non-selective MAOIs
Selegiline is selective for MAO-B.
What two opioids can cause serotonin syndrome when used w/ MAOI–> Meperidine and Dextromethorphan
.
TCAs block what receptors causing SE: Muscarinic, Alpha 1 adrenergic, Histaminergic, Sodium channels (Class IAAD-like)
Sedation, Xerostomia, blurred vision, uinary retention, constipation, Acute Glaucoma, Orthostatic Hypotension.
Amytriptiline- Neuropathic pain and migrane prevention; Clomipramine- OCD; Imipramine- Nocturnal enuresis
.
Buprioprion is associated w/ seizures (lowers threshold)–> especially in bulemia, contraindicated in epilepsy
.
Thiazide Diuretics are used to TX Nephrogenic diabetes insipidus unless its caused by Litihium, then amiloride is used b/c thiazides would increase Lithium reabsorption
Lithium causes hypothyroidism by inhibiting 5’ Deionidase.
The main SE of Amantidine (Parkinsons/influenza) is Livedo Reticularis–>Discoloration of skin due to dilation of venules/capill
Can also be caused by atheroemboli after coronary angioplasty.
Azathioprine and 6-Mercaptopurine would not be effective in a Lesch-Nyhan pt b/c they require HGPRT to be active
.
Doxorubicin is a chemotherapy drug that is a Anthracyline antibiotic–>Anthracycline Abx chemo drugs block Topoisomerase II, form free radicals, intercalate in DNA and inhibit DNA/RNA synthesis
.
Sotalol and Propafenone are class III and IC AAD’s respectively that also act as Beta blockers
.
Clonidine is usually given w/ diuretics b/c it causes sodium and water retention
.
N-acetylcysteine acts as a mucolytic via its sulfhydryl group breaking disulfide bonds in mucoproteins–> lower viscosity
.
Ulcerative colitis patients TX w/ sulfasalazine should receive folate supplementation
.
Denosumab is a monoclonal Ab that blocks RANKL and mimics osteoprotegrin
.
Cholinergic agents (bethanechol or neostigmine) used for post-op ileus or non-obstructive urinary retention can exacerbate COPD, asthma, and peptic ulcers
.
Urge Incontinence is TX w/ antimuscarinics–> Oxybutynin, darifenacin, solifenacin
.
Atropine should not be used in pts w/ BPH, Acute angle closure glaucoma, or infants (hyperthermia)
.
