Pharm High Yield

Question 1

Desmopressin stops bleeding in pts with VWD–>release of vWF from Endothelial cell Weibel-Palade Bodies

Answer 1

Can also be useful in Hemophilia A.

Question 2

Nimodipine is a CCB used to prevent vasospasm in subarachnoid hemorrhage (usually 2-3 days post hemorrhage)

Answer 2

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Question 3

Atropine will NOT TX paralysis in organophosphate/Anticholinergic poisoning (no effect on nicotinic R–>Nm receptors)

Answer 3

Atropine + Pralidoxime.

Question 4

Foscarnet (PP analog vs. CMV and HSV) can chelate Ca and Mg–>Seizures and nephrotoxicity

Answer 4

Does NOT require activation by viral or host enzymes.

Question 5

Potassium Iodine prevents radiation mediated Thyroid disease (Wolffe-Chaikoff Effect)

Answer 5

Also treats Sporothrix.

Question 6

Triazolam, Oxazapam, Alprazolam, and Midazloam are SHORT acting benzodiazepines–>less hangover

Answer 6

Flurazepam, diazepam, and chlordiazepoxide are long acting.

Question 7

Vancomycin should be used for blood infection (valves) with Staph Epidermidis–>Common methicillin resistance

Answer 7

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Question 8

Jimson weed (gardening) has the same effects as atropine (block sludge)

Answer 8

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Question 9

Protease inhibitors (-navir) in HAART cause hyperglycemia and fat redistribution (Cushing-like rxn) and are strong CYP inhibitors

Answer 9

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Question 10

Amiodarone causes pulmonary fibrosis, hypothyroidism, and liver damage –>check Lung, liver, and thyroid function

Answer 10

40% Iodine by weight.

Question 11

Halothane (anesthesia) and Valproic acid can cause hepatic necrosis (also amanita phalloides mushroom and acetaminophen)

Answer 11

Amantinin blocks RNA Pol II (mRNA synthesis).

Question 12

C. diff pseudomembranous colitis is especially likely with Clindamycin, ampicillin and cephalosporins

Answer 12

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Question 13

Gray Baby Syndrome– Chloramphenicol–hypotension, ashen discoloration, vomiting, flaccidity

Answer 13

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Question 14

Red man syndrome–> Vancomycin (histamine mediated)–>slow infusion rate or pretreat w/ antihistamines

Answer 14

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Question 15

The hypersensitivity reaction associated with Niacin is prostaglandin mediated; BEST drug to increase HDL

Answer 15

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Question 16

Do NOT give vitamin B6 with Levodopa–>increases metabolism; Absorption blocked by Leucine/isoleucine (don’t take w/ meals)

Answer 16

Do give B6 w/ isoniazid.

Question 17

Fibrates (dec TG) and Statins both cause myopathy–> can cause Acute Tubular Necrosis due to myoglobinurea, especially when used together

Answer 17

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Question 18

Tetracyclines and sulfonamides cause photosensitivity; also 5-FU and amiodarone

Answer 18

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Question 19

Allopurinol can cause Stevens-Johnson syndrome (also penecillin, sulfas, and anti-epileptics–Lamotrigine)

Answer 19

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Question 20

Bupriopion has a high risk of seizures in Bulemia, anorexia, and other eating disorders

Answer 20

Blocks NE and DA reuptake, also used for SAD and smoking.

Question 21

Lithium causes Nephrogenic Diabetes Insipidus and Ebstein’s Anomaly; Also hypothyroidism (Constipation, hair loss, weight gain, bradycardia)

Answer 21

Demeclocycline can also cause Nephro DI–>blocks ADH receptors (TX for SIADH).

Question 22

Expired tetracycline use and Tenofovir causes Fanconi Syndrome–>nothing reabsorbed in proximal tubule

Answer 22

Also Wilson’s disease.

Question 23

Giving Mesna with cyclophosphamide blocks hemorrhagic cystitis (cyclophosphamide is a prodrug–acrolein + mustard)

Answer 23

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Question 24

Pulmonary Fibrosis–> Bleomycin, Busulfan, Amiodarone, and Methotrexate

Answer 24

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Question 25

Disulfiram RXNS: Metronidazole, some cephalosporins, Griseofulvan (fungal microtubules), procarbazine, 1st gen sulfonylureas

Answer 25

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Question 26

Use of Loop Diuretics (Furosemide) will worsen ototoxicity associated with Aminoglycoside Abx

Answer 26

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Question 27

Theophylline has a very narrow therapeutic index and is influenced by CYP inhibitors–>Seizures, blocks PDE3 and adenosine

Answer 27

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Question 28

Cimetidine is both a potent CYP450 inhibitor and is antiandrogenic

Answer 28

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Question 29

Long term use of PPI (omeprazole) is associated with hip fractures and low serum Magnesium

Answer 29

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Question 30

Tetracyclines and fluoroquinolones should not be taken with antacids or any Ca containing food/beverages

Answer 30

Tetracyclines bind Ca–> teeth discoloration and deposit in bones.

Question 31

Aluminum–constipation, Magnesium–diarrhea

Answer 31

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Question 32

Docusate salts are stool softeners/surfactants

Answer 32

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Question 33

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

Answer 33

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Question 34

Vitamin B6 supplementation helps to TX Sideroblastic anemia (cofactor for deficient ALAS)

Answer 34

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Question 35

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)

Answer 35

If elevated orotic acid and hyperammonemia, pt has Ornithine Transcarbamylase deficiency (Urea Cycle).

Question 36

Penecillin and Methyldopa are associated with Warm Agglutinins hemolytic anemia

Answer 36

Cold- Mycoplasma and Mono.

Question 37

Failure to increase PTT with heparin administration implies Antithrombin III deficiency (also lost in nephrotic syndrome)

Answer 37

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Question 38

Cladribine is an Adenosine Deaminase inhibitor used to treat Hairy Cell Leukemia (TRAP+)

Answer 38

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Question 39

Imatinib is the TX for CML that inhibits the t(9,22) Philadelphia Chr generated bcr-abl tyrosine kinase and c-kit (GIST)

Answer 39

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Question 40

Enoxaparin and Dalteparin are LMW Heparins that mainly decrease Factor Xa–>better bioavailability and half life

Answer 40

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Question 41

In pts with Heparin-Induced Thrombocytopenia, direct thrombin inhibitors are used–>Bilvalrudin, Dabigatran, Argatroban, Lepiruden

Answer 41

Xa inhibitors: Rivaroxaban, Apixaban, Fondaparinux.

Question 42

Aspirin prolongs bleeding time (dec thromboxane A2), no effect on PT or PTT

Answer 42

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Question 43

PDE3 inhibitors prevent platelet aggregation–>Dipyridimole and cilostazol (also arterial dilation)

Answer 43

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Question 44

Methotrexate myelosuppression is reduced with Leucovorin administration (folinic acid “rescue”); 5-FU is not rescued with leucovorin–>treat overdose with uridine

Answer 44

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Question 45

Allopurinol cannot be used with 6-MP/Azathioprine b/c both are metabolized the Xanthine Oxidase

Answer 45

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Question 46

Dactinomycin is used for childhood tumors–>Wilms, Ewings, Rhabdomyosarcoma

Answer 46

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Question 47

Nitrosurea (Carmustine) are chemo drugs that cross the BBB to treat brain tumors but also have CNS toxicity (ataxia)

Answer 47

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Question 48

Cisplatin Nephrotoxicity is reduced with Amifostine and chloride diuresis

Answer 48

very potent emetic.

Question 49

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%

Answer 49

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Question 50

In woman w/ pre-eclampsia, use magnesium sulfate to prevent seizures/eclampsia–>may cause loss of Deep Tendon reflexes

Answer 50

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Question 51

Linezolid acts as an MAOI (hypertensive crisis with tyramine)

Answer 51

Look out for case of Depressed pt treated for MRSA skin infection.

Question 52

Non-sulfa loop diuretic–>Ethacrynic acid

Answer 52

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Question 53

Amphotericin B causes Nephrotoxicity (total dose dependent), hypomagnesia, and hypokalemia. Pts feel ill b/c it does bind somewhat to cholesterol in human membrane

Answer 53

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Question 54

Fibrates have a high risk of cholesterol gallstones–>block 7alpha hydroxylase-> decreases bile acids–>inc cholesterol in bile

Answer 54

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Question 55

Isosorbide Mononitrate is almost 100% orally available, unlike Nitroglycerin and isosorbide dinitrate that have low oral availability

Answer 55

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Question 56

Ergonovine is an ergot alkaloid that tests for Prinzmetal Angina–>alpha adrenergic/serotoninergic agonist (also treats migranes)

Answer 56

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Question 57

Cidofovir (VZV) and Tenofovir (HIV) are nucleoTIDE analogs that do not require activation by viral kinases

Answer 57

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Question 58

PABA in sunscreen protects against UV-B only (most potent); Zinc Oxidase protects against UV-B, A1, and A2

Answer 58

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Question 59

Calcipotriene, Calcitriol, and Tacalcitol are Topical anti-psoriasis agents that bind Vitamin D receptor–>effect a nuclear transcription factor

Answer 59

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Question 60

Clindmycin treats anaerobes above the diaphragm (aspiration pneuomnia), Metronidazole treats anaerobes below the diaphragm

Answer 60

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Question 61

Serotonin Syndrome is treated with Cyproheptadine–>1st gen antihistamine with anti-serotoninergic properties

Answer 61

Basically need to have an MAOi or large overdose to get Serotonin syndrome.

Question 62

T(1/2)= 0.693xVd/Clearence

Answer 62

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Question 63

Loading dose = (Vd x Cs)/Bioavailability; Maintence dose = (Cs x Cl x interval)/Bioavailability

Answer 63

Vd= loading dose/Cs.

Question 64

Loading dose does NOT change if pt has renal/hepatic disease, but Maintenance dose changes

Answer 64

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Question 65

Competitive antagonists decrease affinity w/ no change on efficacy; Noncompetitive and irreversible competitive antagonists decrease efficacy with no effect on affinity

Answer 65

Competitve antagonist “Crosses” the agonist on Lineweaver Burke graphs.

Question 66

Oral Vancomycin is not absorbed–>used to tx C difficile

Answer 66

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Question 67

Sulfonamides are contraindicated in neonates because they displace bilirubin from albumin–>kernicterus

Answer 67

Must also be careful giving to 3rd trimester mothers.

Question 68

Fluoroquinolones are contraindicated in children–> tendon rupture; also can prolong QT

Answer 68

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Question 69

Aztreonam is a Beta-Lactam Abx (monobactam) that is Beta-lactamase resistant, treats serious gram -, and does not interact with penecillin allergies

Answer 69

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Question 70

Cilastatin is given with imipenem to decrease inactivation of imipenem by renal dihydropeptidases

Answer 70

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Question 71

Drugs that Cause change in color vision: Digoxin (inotrope,), Ethambutol (red-green, TB tx), Sildenafil/vardenafil (blue/green)

Answer 71

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Question 72

Supplementation with vitamin B6 can prevent isoniazid toxicity (INH decreases mycolic acid synthesis–>branched lipids)

Answer 72

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Question 73

Ketoconazole and Spironolactone have anti-androgen effects

Answer 73

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Question 74

Caspofungin is an anti-fungal that blocks synthesis of B-(1,3)-D-Glucan for the fungal cell wall (candida and aspergillus)

Answer 74

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Question 75

Acyclovir, Valacyclovir, Famciclovir, and penciclovir all require viral thymidine kinase to add first phosphate

Answer 75

Acyclovir+valine=valcyclovir; Famciclovir is converted to Penciclovir.

Question 76

Unlike acyclovir, Ganciclovir is NOT a chain terminator–>both inhibit viral DNA polymerase and need viral activation

Answer 76

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Question 77

Amantadine is an antiviral (influenza A) that Tx Parkinsons; Demeclocycline is a tetracycline that Tx SIADH

Answer 77

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Question 78

All nucleoside reverse transcripatase inhibitors can cause lactic acidosis with hepatic steatosis

Answer 78

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Question 79

Long term high dose Steroids cause atrophy of Type 2B muscle fibers

Answer 79

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Question 80

Efavirenz (non-nucleoside Reverse Transcriptase inhibitor) can cause vivid dreams, CNS symptoms, and false + cannabis tests

Answer 80

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Question 81

Didanosine is a NRTI that can cause pancreatitis

Answer 81

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Question 82

Ritonavir (protease inhibitor) can alter taste and cause numbness around the mouth; CYP 450 inhibitor, teratogen

Answer 82

ACE inhibitors also alter taste.

Question 83

Primaquine is used against Plasmodium ovale and vivax –>kills liver malaria; causes hemolysis is pts with G6PD deficiency

Answer 83

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Question 84

Nifurtimox is the TX for Trypanosoma cruzi (Reduviid bug, dilated cardiomyopathy, megaesophagus, megacolon)

Answer 84

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Question 85

Suramin (blood) and Melarsoprol (CNS) are the TX for Trypanosoma brucei–>African Sleeping Sickness (Tsetse fly-painful bite)

Answer 85

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Question 86

TX for toxoplasma gondii is Pyrimethamine (dihydrofolate reductase inhibitor) and sulfamethoxazole and leucovorin

Answer 86

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Question 87

Cyclophosphamide and Ifosfamide cause hemorrhagic cystitis–>Acrolein causes; mesna prevents (binds acrolein)

Answer 87

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Question 88

Etoposide/Teniposide inhibit DNA topoisomerase II–>double standed breaks; Topotecan/Irinotecan block Topo I–>single breaks

Answer 88

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Question 89

Drug Classes w/ Antimuscarinic Effects: 1. 1st gen Antihistamines 2. TCAs (Amitryptiline) 3. Phenothiazines (low pot. Typical Antipsychotics Chlorpromazine and Thioridazine)

Answer 89

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Question 90

Anticholinergic drugs should be used with extreme caution in pts with narrow angle glaucoma

Answer 90

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Question 91

Ipratropium and Tiotropium are anticholinergics used for COPD

Answer 91

also reverse Beta blocker induced bronchospasm.

Question 92

Dantrolene treats Malignant Hyperthermia (succinylcholine, Halothane) and Neuroleptic Malignant Syndrome (Haloperidol) by inhibiting release of Ca2+ from the sarcoplasmic reticulum (ryanodine receptor)

Answer 92

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Question 93

Aminoglycosides enhance Neuromuscular blockade by competing with Ca2+ to inhibit Ach release

Answer 93

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Question 94

Atracurium is a Non-depolarizing neuromuscular blocker that is safe to use in renal failure->excreted in bile/spontaneous bdown

Answer 94

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Question 95

Terazosin/Doxazosin are alpha1 blockers used for BPH and HTN; Tamsulosin is a specific alpha1 blocker for BPH only

Answer 95

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Question 96

Yohimbine is an alpha 2 antagonist that treats erectile dysfunction and orthostatic hypotension

Answer 96

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Question 97

The Beta Blocker that also blocks K+ channels for use as an AAD is Sotalol–> Class III AAD

Answer 97

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Question 98

Acebutolol and Pindolol are beta blockers with partial beta activity/sympathomimetic activity–>Contraindicated in Angina

Answer 98

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Question 99

Beta-blockers inhibit all of the effects of thyrotoxicosis/Hypoglycemia except Diaphoresis (Cholinergic receptors)

Answer 99

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Question 100

Halothane has a low MAC/high parturition coefficient–>Malignant Hyperthermia, hepatitis, and arrhythmias

Answer 100

low MAC=potent, HIgh parturition coefficient=long time to on/off.

Question 101

Loperamide and diphenoxylate are opioids used to treat diarrhea

Answer 101

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Question 102

Baclofen causes muscle relaxation by activating GABAb receptors–>increases K+ efflux

Answer 102

GABAa receptors are chloride influx channels.

Question 103

Atypical Depression (mood reactivity, hyperphagia, hypersomnia) is treated with MAOinhibitors

Answer 103

Look out for Tyramine hypertensive crisis questions in Atypical depression pt.

Question 104

Clomipramine is a TCA used for OCD (SSRI also used)

Answer 104

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Question 105

Lithium is reabsorbed in the same manner as sodium, so low sodium can cause lithium toxicity

Answer 105

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Question 106

Clozapine (atypical antipsychotic) causes agranulocytosis and seizures

Answer 106

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Question 107

Drug Induced Lupus (Anti-histone Ab)= Procainamide, Hydralazine, Isoniazid, Phenytoin, Minocycline

Answer 107

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Question 108

Nifedipine(CCB), Phenytoin, and cyclosporine cause gingival hyperplasia

Answer 108

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Question 109

Seizures during Pregnancy are treated with Phenobarbital (not eclampsia prevention– magnesium sulfate)

Answer 109

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Question 110

Phenytoin and Carbamazepine induce CYP450s–> Decrease oral contraceptive efficacy

Answer 110

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Question 111

Sumatriptan can cause vasocontriction of coronary arteries (migrane abortifactant)

Answer 111

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Question 112

Terbutaline is a long acting Beta2 agonist used for asthma and as a tocolytic

Answer 112

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Question 113

Beta Blocker induced bronchospasm is treated with anticholinergics–>ipratropium and tiotropium

Answer 113

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Question 114

Aspirin can cause nasal polyps with prolonged use (nasal polyps also a sign of Cystic Fibrosis in children)

Answer 114

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Question 115

Proton Pump Inhibitors increase the risk for hip fracture

Answer 115

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Question 116

TX for Helicobacter pylori: PPI + (2 of) metronidazole/amoxicillin/tetracycline/clarithromycin +/- bismuth subsalicylate

Answer 116

PPI + Clarithyromycin + Metronidazole/Ampicillin.

Question 117

Sulfasalazine’s azo linkage is cleaved by gut bacteria to produce mesalamine and sulfapyridine (sulfonamide Abx)–> UC

Answer 117

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Question 118

Cisplatin has very high emesis

Answer 118

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Question 119

Diphenoxylate (opioid antidiarrheal) is usually given with atropine to prevent abuse potential; Loperamide has low abuse potential

Answer 119

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Question 120

Bisacodyl is an irritant laxative; Lubiprostone stimulates Cl- secretion (used in women with IBS)

Answer 120

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Question 121

Key Neutrophil chemotactic factors: LTB4, C5a, IL-8

Answer 121

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Question 122

NSAIDs are effective at treating dysmenorrhea because they decrease PGE2 and PGF2–>uterine contraction

Answer 122

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Question 123

Epoprostenol is the prostacyclin/PGI2 analog used to treat primary pulmonary hypertension

Answer 123

BMPR2 gene mutation causes smooth muscle hypertrophy in pulmonary vessels.

Question 124

At very high doses, aspirin can cause hyperthermia by uncoupling oxidative phosphorylation

Answer 124

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Question 125

Glucuronidation and Sulfation usually metabolizes acetaminophen, glutathione recues when those fail (N-acteylcysteine)

Answer 125

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Question 126

Disopyrimide (Class Ia AAD) has strong anti-cholinergic effects

Answer 126

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Question 127

NO/cGMP leads to vasodilation through deactivation of Myosin light chain kinase

Answer 127

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Question 128

ACE inhibitors can alter taste (+hyperkalemia, angioedema, and dry cough)

Answer 128

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Question 129

Two Contraindications for ACE Inhibitors: 1. Pregnancy (renal teratogen) 2. Bilateral Renal Artery Stenosis (renal failure)

Answer 129

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Question 130

Two main adverse effects of Alpha1 antagonists (Prazosin/terazosin) are First Dose Syncope and reflex tachycardia

Answer 130

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Question 131

Minoxidil is a K+ channel opening arterial vasodilator that causes hair growth = Rogaine

Answer 131

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Question 132

Both Fibrates (dec 7hydroxylase formation of bile acids) and Bile Acid Resins (inc excretion) can cause Cholesterol Gallstones

Answer 132

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Question 133

Clopidogrel is used instead of Ticlopidine to block ADP-platelet activation b/c ticlopidine causes neutropenia and TTP

Answer 133

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Question 134

Alteplace is a “clot-specific” thrombolytic agent–>It only activates plasminogen that is bound in fibrin clots

Answer 134

tPA is a serine protease.

Question 135

Streptokinase is a thrombolytic from Beta hemolytic Strep–> binds plasminogen, causing it to activate other plasminogen

Answer 135

Foreign Ag–>anaphlyaxis and rash, ineffective in people with recent strep infections.

Question 136

Insulin is the TX of choice in diabetic pregnant women (after diet/exercise)

Answer 136

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Question 137

Insulin can also be used in hyperkalemia–>increases K+ movement into cells, given with glucose

Answer 137

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Question 138

Rosiglitazone and Pioglitazone (Thiazolidinediones) are oral hypoglycemics that exacerbated congestive heart failure (bind PPAR-gamma transcription factor increasing adiponectin and GLUT4 in muscle/adipose)

Answer 138

increase adipose/muscle insulin sensitivity.

Question 139

Estrogens cause a hypercoagulable state by decreasing ATIII and Increasing factors 2,7,9, and 10

Answer 139

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Question 140

Aromitase inhibitors: Exemastane, Letrozole, Anastrozole

Answer 140

Breast cancer.

Question 141

Norethinedrone and Norgestrel are estrogens derived from androgens–> can cause hirsutism and acne

Answer 141

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Question 142

Anakinra blocks IL-1

Answer 142

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Question 143

Teriparatide is the 34 AA from the N terminal of PTH and increases osteoblast function and calcium absorption

Answer 143

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Question 144

Clonidine (alpha2 agonist) is used to counteract the sympathetic effects of opioid withdrawal

Answer 144

Will cause rebound HTN in non-compliant pts.

Question 145

PCP causes aggressiveness, horizontal and vertical nystagmus, and hyperthermia

Answer 145

Death most commonly from trauma.

Question 146

Modafinil in a NON-amphetamine stimulant that is 1st line for narcolepsy

Answer 146

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Question 147

Dipyridimole and Cilostazol are PDE3 inhibitors that both cause arterial vasodilation and block platelet aggregation (inc cAMP) –> used for intermittant claudication

Answer 147

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Question 148

NSAIDS (chronic) cause Chronic Interstitial Nephritis (inc serum creatinine, polyuria, mild proteinuria); Relieved w/ stopping NSAID

Answer 148

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Question 149

HCTZ causes: Hyper-GLUC: Glucose, Lipidemia, Uric Acid, and Calcium in blood

Answer 149

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Question 150

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)

Answer 150

Acquired Sideroblastic Anemia can also be caused by Lead poisoning (inhibits ALAD and Ferrochelatase) and Alcoholism (disrupts mitochondria–steps 1,6,7).

Question 151

Angiosarcoma in the liver is associated with arsenic, vinyl chloride, and thorotrast

Answer 151

Arsenic also causes squamous cell carcinoma of skin.

Question 152

Beta2 agonists increase insulin release (alpha2 dec), Beta blockers predispose to DM by decreasing insulin release

Answer 152

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Question 153

Higher Potency drugs either have higher affinity or are better at getting to the target tissue

Answer 153

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Question 154

Physostigmine acts centrally and peripherally (crosses BB); Neostigmine, Pyridostigmine, and edrophonium only act peripherally

Answer 154

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Question 155

ALS is treated with Riluzone–>prolongs life a few months

Answer 155

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Question 156

Interferon Beta–> Multiple Sclerosis; Interferon Gamma–> Chronic Granulomatous Disease

Answer 156

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Question 157

1st Line Tx for Toxoplasma is sulfadiazine and pyramethamine

Answer 157

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Question 158

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

Answer 158

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Question 159

TTX (tetrodotoxin) blocks Na+ channels (blocks AP); Curare is a nondepolarizing neuromuscular blocker (blocks Ach Nicotinic Receptors)

Answer 159

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Question 160

Hexamethonium/Trimethaphan block Nicotinic receptors in the autonomic ganglia (Nn), no effect at neuromuscular junction

Answer 160

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Question 161

Positive dromotropic agents (Beta1 agonists/NE) speed conduction through the AV node–>may compromise ventricular filling

Answer 161

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Question 162

Vagal stimulated Gastrin release is mediated by Gastrin-Releasing-Peptide and therefore is not inhibited by Atropine

Answer 162

Direct vagus stimulation on parietal cells is Ach mediated and is atropine inhibited.

Question 163

TX for Cushings Syndrome–> Pasireotide (somatostatin analog), Off label–> Ketoconazole, Mefepristone

Answer 163

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Question 164

HIV Prophylaxis –>TMP/SMX at 200 for Pneumocystis/Toxoplasma; Azithromycin at 50 for Mycobacterium Avium Complex

Answer 164

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Question 165

Sodium Stibogluconate is the TX for Leishmania (sandfly, spiking fever, hepatosplenomegaly, pancytopenia)

Answer 165

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Question 166

Phentolamine can be given to reverse Norepinephrine Extravasation (NE leaks into surrounding area of venous line causing severe vasoconstriciton and potentially necrosis

Answer 166

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Question 167

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

Answer 167

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Question 168

Probenicid (inc urate excretion) should not be used in pts with high urine urate–>increased urate stone risk

Answer 168

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Question 169

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

Answer 169

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Question 170

Alpha 1 agonist cause reflex Bradycardia and slowed conduction through the AV node

Answer 170

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Question 171

Isoniazid should NOT be used as a monotherapy for TB–> resistance develops quickly via gene mutations

Answer 171

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Question 172

Cephazolin (1st gen cephalosporin) is used before surgery for prophylaxis against Staph aureus

Answer 172

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Question 173

Thiamine supplementation is used to tx Maple Syrup Urine Disease with avoidance of Leucine, Isoleucine, and Valine

Answer 173

deficient alpha-ketoacid dehydrogenase.

Question 174

Benztropine and Trihexyphenidyl (central acting anticholinergics) are 1st line for Drug-induced Parkinsonism

Answer 174

Especially if due to Antipsychotics, where Levodopa or bromocriptine/Pramipexole/Ropinorole can precipitate psychosis.

Question 175

Alzheimer’s is treated with Memantine (NMDA blocker-dec excitotoxicity) or Donepezil/Rivastigmine/Galantamine

Answer 175

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Question 176

TX for Acute Angle closure glaucoma–> Pilocarpine and Acetazolamide

Answer 176

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Question 177

Screening test to detect nicotine in the urine–>Cotinine

Answer 177

Polycyclic Hydrocarbons are the primary carcinogen in smoking.

Question 178

Screening for alcohol use is GGT (Gamma-glutamyltransferase)

Answer 178

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Question 179

Terbinafine inhibits squalene epoxidase–> oral or topical for dermatophyte infections

Answer 179

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Question 180

Characteristic non-GI side effects of Methotrexate–> pulmonary fibrosis, apthous ulcers and pancytopenia

Answer 180

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Question 181

Oral Contraceptives and Anabolic Steroids are associated with Liver Adenomas (rupture risk) and Cholestasis

Answer 181

if due to OCP, can rupture in pregnancy due to increased hormones.

Question 182

The Nephrotoxicity caused by Amphotericin is monitored by Potassium and Magnesium levels

Answer 182

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Question 183

Chloramphenicol causes Grey baby syndrome and aplastic anemia/pancytopenia in adults; inhibits peptidyltransferase

Answer 183

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Question 184

Excess Vitamin E is synergystic with warfarin to inhibit vitamin K mediated gamma carboxylation of clotting factors

Answer 184

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Question 185

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

Answer 185

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Question 186

Corn based diets are deficient in Niacin (low niacin and low tryptophan)

Answer 186

Tryptophan deficiency–Dietary, Hartnup disease (cannot reabsorb tryptophan in small bowel or kidney), Carcinoid syndrome.

Question 187

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

Answer 187

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Question 188

TX for severe hypoglycemia (with altered mentation): Parenteral glycogen or IV dextrose (in hospital)

Answer 188

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Question 189

Pregnancy HTN TX: Methyldopa, Hydralazine, Labetalol, Atenolol, Nifedipine

Answer 189

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Question 190

The control of HTN has its greatest benefit in reducing the incidence of strokes (Goljan)

Answer 190

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Question 191

Abciximab (blocks GPIIb/IIIa) is used to prevent platelet thrombus during revascularization procedures of the coronaries

Answer 191

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Question 192

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)

Answer 192

TX: No exercise, Beta Blocker, implant defibrillator (V fib causes death).

Question 193

Aminocaproic acid blocks plasminogen activation, alpha2-Antiplasmin inactivates plasmin

Answer 193

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Question 194

When using ethambutol to tx TB, you must monitor Visual Acquity–>optic neuropathy (red-green color blindness)

Answer 194

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Question 195

Acute Hepatitis: Isoniazid, Halothane, Valproic acid, Acetaminophen, Methyldopa

Answer 195

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Question 196

Amiodarone causes liver disease that resembles alcoholic hepatitis, even has Mallory bodies (damaged cytokeratin intermediate filaments)

Answer 196

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Question 197

Ursodeoxycholic acid is a synthetic, hydrophilic bile acid used to treat Primary Biliary Cirrhosis

Answer 197

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Question 198

Mu Opioid receptors lead to increased K+ conduction and therefore hyperpolarization

Answer 198

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Question 199

Thiazide diuretics help prevent osteoporosis when used in older women for HTN –>increase Ca reabsorption

Answer 199

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Question 200

If a pt being treated for depression is experiencing sexual side effects, switch them to Bupropion

Answer 200

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Question 201

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

Answer 201

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Question 202

Thiazide diuretics are useful for the TX of calium-containing renal stones–>increase Ca reabsorption

Answer 202

TX for stone (once formed)– pain control and fluids +/- tamsulosin (relaxes tract).

Question 203

NSAIDS are the most useful drug (other than OCP) for dysmenorrhea –>PGF2 mediated uterine contraction

Answer 203

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Question 204

50% of women who receive cyclosporin for kidney transplant develop breast fibroadenomas

Answer 204

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Question 205

Vitamin A deficiency can caues Immune suppression

Answer 205

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Question 206

Carbamezepine is the 1st line drug to TX Tic Douleroux aka Trigeminal Neuralgia

Answer 206

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Question 207

Nitroglycerin, Isosorbide dinitrate and Isosorbide mononitrate all cause flushing and Headaches

Answer 207

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Question 208

Total Parenteral Nutrition is associated with Gallstones due to biliary stasis via lack of CCK (give exogenous CCK)

Answer 208

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Question 209

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

Answer 209

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Question 210

Vitamin A is used to treat measles and AML type 3

Answer 210

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Question 211

Disulfiram-like reactions: Metronidazole, Chlorpropamine (typical antipsychotic), 1st gen sulfonylureas, Griseofulvin, some cephalosporins

Answer 211

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Question 212

Erythromycin ointment is used to prevent gonococcal or Chlamydia conjunctivitis in newborns

Answer 212

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Question 213

Praziquantel is used for Schistosomiasis, Clonorchis, Diphyllobothrium latum and Taenia solium

Answer 213

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Question 214

Acyclovir can precipitate in the urine causing obstructive, crystaline nephropathy–>prevent w/ aggressive hydration

Answer 214

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Question 215

All NRTI’s causes Bone Marrow Suppression and lactic acidosis and hepatic steatosis

Answer 215

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Question 216

Digoxin is cleared by the kidneys w/ a T1/2 of 1.5 days–> decreased renal clearence in older people as GFR decreases

Answer 216

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Question 217

Appetite suppressors (fenfluramine) can cause Secondary Pulmonary Hypertension

Answer 217

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Question 218

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

Answer 218

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Question 219

Angioedema caused by ACE inhibitors is mediated by increased Bradykinin (as is the cough)

Answer 219

ACE Inhibitors are Contraindicated in C1 Esterase Deficiency (also angioedema).

Question 220

Infertility TX: Menotropin=FSH (isolated from menopausal women) and hCG functions like LH

Answer 220

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Question 221

Methimazole (tx for hyperthyroidism) causes agranulocytosis–> presents as fever and sore throat

Answer 221

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Question 222

Ace inhibitors are contraindicated in C1 Esterase Inhibitor Deficiency–> both lead to angioedema via increased kallikrein/bradykinin

Answer 222

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Question 223

Statin+Fibrate=myopathy; FIbrate+Bile Acide Resin (cholestyramine/cholestipol) = cholesterol gallstones

Answer 223

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Question 224

Varenicline is a nicotinic partial agonist–>decreases cravings and prevent full agonist effect if pt smokes

Answer 224

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Question 225

Pts on Clozapine must have WBC/CBC monitoring due to agranulocytosis

Answer 225

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Question 226

TCA overdoes is treated w/ sodium bicarbonates (TCA’s can have quinidine like effects on the heart–> prolong QRS and QT leading to dysrhythmias

Answer 226

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Question 227

Carmustine is a Nitrosourea alkylating agent that crosses BBB and enters the CNS–> Glioblastoma Multiforme

Answer 227

Lomustin, Semustin, Streptozocin.

Question 228

Vemurafenib–inhibits B-Raf w/ V600E mutation–>malignant melanoma

Answer 228

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Question 229

Bisphosphonates are associated w/ corrosive esophagitis (take w/ water, upright) and Osteonecrosis of the jaw

Answer 229

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Question 230

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

Answer 230

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Question 231

Pt w/ sore throat treated w/ amoxicillin/ampicillin develops a rash 7-10 days post meds, true infection was EBV mononucleosis

Answer 231

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Question 232

Leuprolide (GnRH analog) and Flutamide (androgen antagonist) are given to treat advanced prostate cancer

Answer 232

Flutamide blocks initial testosterone increase due to FSH/LH surge from leuprolide.

Question 233

Pentazocine is a opioid partial agonist that, like buprenorphine, can cause withdrawal symptoms

Answer 233

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Question 234

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

Answer 234

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Question 235

Fibrates increase lipoprotein lipase, decrease VLDL secretion, and increase HDL; myopathy and gallstones

Answer 235

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Question 236

Cholestyramine also decreases absorption of digoxin and warfarin

Answer 236

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Question 237

Resistance to aminoglycosides is via conjugation of the drug at the bacteria surface (acetylation, adenylation, phosphorylation)

Answer 237

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Question 238

Ketoconazole absorption is increased in acidic conditions–>drink Coke/Pepsi when taking to increase acid

Answer 238

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Question 239

Griseofulvin is contraindicated in pts w/ Acute Intermittant Porphyria– CYP450 inducer that increases heme synthesis

Answer 239

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Question 240

Pts w/ cocaine intoxication should NOT be given Beta blockers–> extreme HTN w/ unopposed alpha1

Answer 240

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Question 241

Atropine overdose is treated w/ Physostigmine (enters CNS)

Answer 241

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Question 242

Bromocriptine and cabergoline are dopamine agonists used to treat prolactin excess; Pramipexole and Ropinirole are dopamine agonists used for parkinsons

Answer 242

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Question 243

The two treatments for Acromegaly are Octreotide and Pegvisomant (GH receptor antagonist)

Answer 243

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Question 244

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)

Answer 244

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Question 245

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)

Answer 245

Can also be used in pts w/ insulinomas.

Question 246

Sulfasalazine can cause reversible oligospermia

Answer 246

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Question 247

Meperidine is an opioid that also blocks serotonin reuptake–> can cause Serotonin syndrome if given w/ a MAOi

Answer 247

Tramadol also blocks serotonin reuptake and can cause serotonin syndrome.

Question 248

Local anesthetics effect smaller myelinated fibers first (size is most important)

Answer 248

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Question 249

Meperidine should be used for pain w/ chololithiasis/cholecystitis–>morphine constricts the sphincter of Oddi

Answer 249

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Question 250

ACE inhibitors are used to TX Autosomal Dominant Polycystic Kidney Disease–Renin dependent HTN

Answer 250

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Question 251

Exenatide–GLP-1 analog; Exemestane–Aromatase inhibitor; Ezetimibe–Blocks lipid absorption in gut

Answer 251

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Question 252

Normal drugs that block alpha 1–> Typical antipsychotics and TCAs

Answer 252

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Question 253

Tranylcypromine, Phenelzine and Isocarboxazid are the non-selective MAOIs

Answer 253

Selegiline is selective for MAO-B.

Question 254

What two opioids can cause serotonin syndrome when used w/ MAOI–> Meperidine and Dextromethorphan

Answer 254

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Question 255

TCAs block what receptors causing SE: Muscarinic, Alpha 1 adrenergic, Histaminergic, Sodium channels (Class IAAD-like)

Answer 255

Sedation, Xerostomia, blurred vision, uinary retention, constipation, Acute Glaucoma, Orthostatic Hypotension.

Question 256

Amytriptiline- Neuropathic pain and migrane prevention; Clomipramine- OCD; Imipramine- Nocturnal enuresis

Answer 256

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Question 257

Buprioprion is associated w/ seizures (lowers threshold)–> especially in bulemia, contraindicated in epilepsy

Answer 257

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Question 258

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

Answer 258

Lithium causes hypothyroidism by inhibiting 5’ Deionidase.

Question 259

The main SE of Amantidine (Parkinsons/influenza) is Livedo Reticularis–>Discoloration of skin due to dilation of venules/capill

Answer 259

Can also be caused by atheroemboli after coronary angioplasty.

Question 260

Azathioprine and 6-Mercaptopurine would not be effective in a Lesch-Nyhan pt b/c they require HGPRT to be active

Answer 260

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Question 261

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

Answer 261

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Question 262

Sotalol and Propafenone are class III and IC AAD’s respectively that also act as Beta blockers

Answer 262

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Question 263

Clonidine is usually given w/ diuretics b/c it causes sodium and water retention

Answer 263

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Question 264

N-acetylcysteine acts as a mucolytic via its sulfhydryl group breaking disulfide bonds in mucoproteins–> lower viscosity

Answer 264

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Question 265

Ulcerative colitis patients TX w/ sulfasalazine should receive folate supplementation

Answer 265

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Question 266

Denosumab is a monoclonal Ab that blocks RANKL and mimics osteoprotegrin

Answer 266

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Question 267

Cholinergic agents (bethanechol or neostigmine) used for post-op ileus or non-obstructive urinary retention can exacerbate COPD, asthma, and peptic ulcers

Answer 267

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Question 268

Urge Incontinence is TX w/ antimuscarinics–> Oxybutynin, darifenacin, solifenacin

Answer 268

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Question 269

Atropine should not be used in pts w/ BPH, Acute angle closure glaucoma, or infants (hyperthermia)

Answer 269

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