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pharm incorrects Flashcards

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USMLE® Step 1 flashcards
1
Q

treatment for durg-induced parkinsons e.g. from antispychotics?

A

benztropine (an anticholinergic)

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2
Q

why is erithromycin used to treat diabetes induced gatroparesis?

A

increases activity of motilin receptors

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3
Q

mechanism of increasing blood delivery to brain?

A

inhibiting p-glycoprotein, a cellular efflux transporter

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4
Q

DDP-4 inhibitors effect

A

increase effect of GLP1 which increase glucose dependent insulin release.

(glp1 degreaded by dipeptidyl peptidase 4 )

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5
Q

how do tetracylines eg doxycyclines cause Pili Esophagitis?

A

direct mucosal injury by the drug

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6
Q

which class of drugs is used to treat subarachnoid hemorrhage?

A

Calcium cannel blockers
Nimodpine
prevents cerebral vasospasm - induces cerebral vasodilation

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7
Q

treatment for nausea as a result of GI insult?

treatment for vestibular nausea?

migraine associated nausea?

A
  • 5HT3 receptor antagonists - eg ondansetron

vestibular nausea - antihistamines, anticholinergics

migraine associated = dopamine antagonists

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8
Q

effect of chelation of tetracylines with cations such as iron?

A

decreased absorption of drug in GI tract

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9
Q

signs of digoxin toxicity? most serious side effect?

A

nausea and vomting, change in colour vision, arrythmias (most serious)

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10
Q

treatment for cryptococcal meningitis?
search picture of how cyrptococcus neoformans looks on india ink stain

A

amophotericin B

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11
Q

treatment for shistosomiasis?

A

praziquantel - like most helminths

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12
Q

effect of methadone on the heart?

A

QT prolongation -> torsades de pointes risk -> syncopes. sudden cardiac death

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13
Q

treatment for oral thrush in non-immunocompromised patients?

A

nystatin

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14
Q

side effect of rapid vancomycin infusion?

A

direct mast cell activation i.e without IgE

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15
Q

in the presence of C1 esterase defeciency, what drugs should be avoided?

A

Ace Inhibitors e.g. captopril

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16
Q

treatment for atopic dermatitis? drug mechanism?

A

topical corticosteroids -> inhibit phospholipase A2 -> inhibit leukotrienes and prostaglandins

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17
Q

dextromethorpan use?
side effect?

A

cough

  • serotonin syndrome when used with other serotonergic drugs e.g SSRIs
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18
Q

lipoatrophy (particularly in the face) and central fat deposition is a side effect of which types of drugs?

A

HAART for HIV

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19
Q

treatment for anorexia?

A

CBT
nutrional therapy
olanzapine if this fails

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20
Q

treatment for bulimia nervosa?

A

CBG
nutritional therapy
+ SSRI fluoxetine

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21
Q

how does binge eating disorder differ from bulimia?

binge eating disorder tretament?

A
  • no appropriate compensatory behaviour for food consumed
  • CBT
  • behavioral weight loss therapy
  • SSRI
  • lisdexamphetamine - ADHD stimulant
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22
Q

ADHD drugs?

A

stimulants - amphetamine, methylphenidate

non stimulants - atomoxetine

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23
Q

panic disorder first line?

A

SSRIs

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24
Q

side effect of methylphenidate for ADHD?

A

insomnia and decreased appetite and weight loss

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25
Q

with second generation antiphsycotics such as olanzapine and clozapine, what must you measure when patient is being treated?

A

fasting glucose and lipids

  • risk of hyperglycemia and dyslipidemia
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26
Q

signs of alcohol intoxication? treatment?

A

tremor, agitation, elevated blood pressure

benzodiazepines - e.g chlordiazepoxide

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27
Q

what to monitor when patient is on clozapine (antipsychotic)

A

absolute neutrophil count - agranulocytosis risk

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28
Q

what can be potentiated if patients with eating disorders have their depression treated with buproprion?

A

siezures

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29
Q

what short term anxiolytic also has muscle relaxant and anticonvulsant effects?

A

benzodiazepines

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30
Q

second generation antipsychotics antagonise dopamine receptors and ___ receptors

A

serotonin

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31
Q

A 2 week wash out period between monamine oxidase inhibitor and SSRI prescription allows for?

A

monoamine oxidase regeneration

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32
Q

which opiod can precipitate opioid withdrawal symptoms?

A

Bupenorphine
- it is a partial agonist
- thus can bind and displace other opioids (antagonists)
- withdrawal signs = dilated pupils, diaphoresis, yawning, lacrimation, rhinorrhea

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33
Q

First line long term therapy for alcohol use disorder?

A
  • naltrexone (opioid antagonist)
  • for acute withdrawal = benzodiazepines
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34
Q

Methadone is metabolized by cytochrome P-450. so name one drug which can coause toxicity with co-administration

A

fluconazole

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35
Q

hypertensive crisis with ingestion of tyramine is seen with administration of which class of drugs?

A

monoamine oxidase inhibitors

selegeline, rasagaline, phenelzine, isocarboxazid

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36
Q

which opiod medication also has serotinergic properties and can precipitate serotonin syndrome when used with SSRIs?

A

Tramadol

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37
Q

name the high potency 1st generation antipsychotics. they are more likely to cause extrapyramidal side effects

A

Hal Tries to Fly
- Haloperidol, Trifluperazine, fluphenazine

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38
Q

signs of lithium toxicity

drug interactions that cause this?

A

acute= nausea. diarrhea
chronic = ataxia, tremor, agitation

NSAIDS (e.g ibuprofen)
Thiazides
ACE inhibitors

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39
Q

good reason why buspirone is used to treat GAD?

A

No risk of tolerance

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40
Q

why is there a risk of toxicity when you administer metformin to someone with Heart failure?

A

decreased perfusion of kidneys in HF -> decreased clearance of drug

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41
Q

drugs that cause SIADH? (euovalemic hyponatremia = sign)

A

SSRIs
carbamezapine
cyclophosphamide

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42
Q

treatment for exposure to radioactive iodine?

A

potassium iodide to limit iodine uptake

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43
Q

what type of drug is phenelzine?

A

it is a MAO inhibitor - used to treat treatment resistant depression with atypical features e.g mood reactivity, hypersomnia

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44
Q

ANP, BNP, NO and sildenafil all have what common mechansim?

A

increase CGMP levels

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45
Q

treatment for trigeminal neuralgia?
mechanism?
side effect

A

carbamezapine (antiepileptic)
blocks sodium channels
bone marrow suppression

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46
Q

treatment for pulmonary hypertension?

A

Bosentan (competitive antagonist of endothelin receptors)

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47
Q

when is celecoxib prefferable to other NSAIDS

A

in patients with history of peptic ulcer disease

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48
Q

treatment for dermatomyositis?

A

systemic glucocorticoids

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49
Q

Which HIV drug is contraindicated in patients with HLA-B*57:01 allelle?

A

Abacavir - risk of Type 4 Hypersensitivity reaction

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50
Q

Which HIV drug can damage proximal tubule of kidney and leaves glomerulus and interstitium unaffected?

A

Tenofivir
damage to PCT = AKI = water retention and rising creatinine

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51
Q

for acute pancreatitis and Cystic fibrosis, what medication is used in combination with pancreatic enzyme replacement?

A

proton pump inhibitors

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52
Q

what diuretic is used to treat calcium kidney stones? why?

A

hydrochlorothiazide.
it prevents renal calcium excretion by increasing reabsorption

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53
Q

describe the role of mifeprisTONE and misoprostol in pregnancy termination

A
  • mifepristone = progesterONE antagonist = necrosis of uterine decidua
    -misoprostol = prostaglandin E1 agonist = contraction and expulsion of pregnancy

*use methotrexate for ectopic pregnancy

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54
Q

which TB drug relies on bacterial catalase peroxidase for activation?

A

Isoniazid (INH)

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55
Q

1st line treatment for Migraines? mechanism of action?

A

Triptans
5HT2 agonists at trigeminovascular serotonin receptors

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56
Q

airway inflammation and airway remodelling in asthma is best inhbited by which class of drugs?

A

corticosteroids - fluticasone

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57
Q

key behavioural side effect of dopamine agonists used to treat Parkinsons?

A

impulse control disorders - gambling, compulsive buying, compulsive sexual behaviour,

mechanism - stimulation of central dopamine receptors

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58
Q

Why are amiloride or tiamterene frequently added to hydrocholorthiaziade therapy for HTN?

A

they are potassium sparing diuretics. they inhibit sodium channels in collecting duct. cause k+ secretion, relieve hypokalemia and muscle cramps

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59
Q

describe two groups of people to avoid using succinylcholine as a neuromuscular blocker in

A

Myasthenia gravis - not effective at paralysis (lack of receptors)

Acetylcholinesterase deficiency - longer paralysis

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60
Q

which antiepleptic drug is associated with SJS?

A

lamotrigine

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61
Q

Treatment for generalised siezures?

A

Atonic, tonic-clonic, myoclonic = broad spectrum e.g. levitiracetam, valproic acid
absence = ethosuximide

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62
Q

treatment for focal siezures?

A

narrow spectrum - phentoyin, carbamezepine, gabapentin

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63
Q

ethosuximide mechanism of action?

A

decreases Calcium in thalamic neurons
(gabapentin also blocks CA2+)

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64
Q

Why is epinephrine often added to lidocaine?

A

to induce vasoconstriciton = prolonged duration of lidocaine effect

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65
Q

effect of phentoyin, phenoparbital and carbamezapine on C-P450

A

antiepleptics are typically Inducers. therefore lower levels of other drugs

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66
Q

caspsiacin mechanism as a topical analgesic

A

DEPLETION OF SUBSTANCE P
loss of membrane in noiciceptive fibres

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67
Q

what eye structure does timolol target to treat glaucoma?

A

ciliary epithelium -> decreases its secretion of aqueous humour

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68
Q

state 2 key side effects of succynylcholine, a neuromuscular blocking drug

A

hyperkalemia -> arrhythmia risk
malignant hyperthermia

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69
Q

key side effects of carbamazepine?

A
  • diplopia, ataxia (car makes you tumble)
  • siadh, agranulocytosis
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70
Q

treatment for CMV retinitis?

A

gangiclovir

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71
Q

which antiepileptic drug causes gingival hyperplasia?

A

phentoyin

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72
Q

opiates mechanism of action?

A

close presynaptic calcium channels = decreased excitatory neurotransmitter release

OPEN, post-synaptic potassium channels = membrane hyperpolarization

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73
Q

which medication can cause a bluish discolouration of vision and monocular vision loss?

A

PD5-inhibitors, eg sildenafil, tadalafil

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74
Q

effect inhaled anaesthetics on the brain?

A

increase cerebral blood flow -> can result in ICP

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75
Q

why is dypenhydramine often co-administered with metocllopramide for migraines with nausea

A

metoclopramide blocks dopamine receptors and can cause acute dystonic reactions

dypenhydramine helps prevent abnormal motor reaction as it is anticholinergic

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76
Q

treatments for painful diabetic neuropathy?

A

TCAS - amytriptiline
SNRIs - duloxetine, venlafaxine
gapapentoids

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77
Q

why is acetazolamide often added on to loop diuretic therapy?

A

it is a carbonic anhydrase inhibitor, causes metabolic acidosis and there for treats metabolic alkalosis induced by loop diuretics like furosemide

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78
Q

name a drug that can increase cardiac contractility whilst decreasing pepripheral resistance

A

isoproterenol -> both beta 1 and 2 agonist activity

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79
Q

mechanism of phentermine for weight loss?

A

sympathomimetic
other similar drugs -> diethylproprion

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80
Q

which class of antiarrythmics are efficient in inhibiting ischemia induced ventricular arrhythmia

A

Class 1B antiarrythmics like lidocaine

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81
Q

yellow vision is a sign of which cardiac drug?

A

digoxin

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82
Q

niacin can be used to treat which cardiovascular condition? side effects of use?

A

hyperlipidemia
- causes flushing via prostaglandins, avoid by co-administration of NSAIDS

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83
Q

increased risk of cataracts in people with SLE is primarily due to?

A

chronic corticosteroid exposure - e.g. prednison

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84
Q

do water soluble drugs reach higher concentrations in adults or neonates?

A

adults
neonates have a higher body water content

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85
Q

key side effects of amiodarone?

A

pulmonary fibrosis
grey corneal deposits
grey-blue skin discolouration
hypo/hyperthyroidism
CYP450 inhibitor

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86
Q

drug of choice for quick termination of SVTs?

A

adenosine

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87
Q

drug of choice for torsades de pointes termination?

A

magnesium

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88
Q

nitroprusside toxicity manifests as what?

A

cyanide toxicity
nitropruside used for hypertensive emergency

89
Q

effects of beta 2 agonists on potassium

A

hypokalemia
cause intracellular shift
increases activity of Na+ K+ Atpase pump

90
Q

key side effect of manitol

A

pulmonary edema due to rapidly increased intravascular volume -> increased pulmonary capillary hydrostatic pressure

91
Q

Which two classes of diuretics cause hypokalemia and metabolic alkalosis?

how can you distinguish them using lap results?

A

loop diuretics and thiazide diuretics
loop diuretics cause hypocalcemia
thiazide diuretics cause hypercalcemia and hyponatremia

92
Q

treatment for post-operative urinary retention?

A

Bethanechol

93
Q

measurement of which ion is most important in determining the cause of metabolic alkalosis?

A

chloride

94
Q

acetaminophen overdose drug?
mechanism of action?

A

N-acetylcysteine - increases intrahepatic gluthione stores and facilitates NAPQI detoxification

95
Q

Hyperthyoidism drugs? side effects

A

PTU - hepatotoxic
methimazole - teratogenic (ptu preffered in first trimester)

96
Q

class 3 antiarrhythmic drugs side effects

A

Torsade de pointes (ibuletide, dofetilide, soltalol)

bradycardia, hepatotoxicity thyroid dysfunction = amiodarone

97
Q

effect of antibiotics/disruption of intestinal flora on warfarin activity?

A

increases warfarin activity/ prolonged INR

antibiotics distrupt vitamin-K producing intesitnal flora

98
Q

what drug is used to prevent iron related cardiotoxicity/ heart failure in patients recieving chronic blood transfusions?

A

deferoxamine

99
Q

side effect of hydroxyurea

A

inhibits dna synthesis so can cause rbc macrocytosis or pancytopenia

100
Q

what substances has the fastest reversal of warfarin effects?

A

Fresh frozen plasma
(Vitamin K works but is slower)

101
Q

Heparin overdose treatment?

A

Protamine

102
Q

treatment for multiple myeloma?

A

bortezomib

levalidomide -> binds transcription factors -> degraded by proteosomes

103
Q

in addition to INR, what lab values are used to monitor warfarin treatment?

A

PT - warfarin inhibits vitamin K action on clotting factors such as FACTOR 7.

104
Q

What value is used to measure Heparin treatment?

A

PTT

105
Q

how does a BCL-2 inihibitor cause cancer death?

A

cytochrome c is released which activates caspases, causing apoptosis

106
Q

desmopressin mechanism of action for hemophila treatment

A

increases endothelial secretion of vWF (a protein)

107
Q

distinguish TCA overdoses symptoms from Opiate withdrawal and cocaine overdose

A

cocaine and opiate withdrawal both cause hypertension vs hypotension seen with TCA

108
Q

what medications can be used to treat BPH AND HTN at the same time

A

alpha 1 blockers - doxazosin, prazosin etc

109
Q

side effect of erythropeoitin stimulating agents (eg erythropoeitin) used to treat anemia of chronic disease e.g CKD?

A

HTN, thromboembolism

110
Q

in addition to anti-inflammatory effects, why are inhaled corticosteroids helpful in treating asthma?

A

increase beta 2 receptor expression

111
Q

mechanism of anticholinergics in inducing heat stroke

A

impaired diaphoresis = impaired dissipation of heat

112
Q

ezetimibe mechanism of action

A

reduces intestinal absorption of cholesterol

113
Q

first line treatment for arsenic poisoning

A

Dimercarpol

114
Q

which asthma drugs limit the interaction of inflammatory mediators with cell surface receptors

A

leukotriene receptor antagonists
e.g monteleukast

115
Q

what beta blocker is used to treat MI in a patient with a history of asthma or COPD?

A

metoprolol (cardioselective)

116
Q

Hartnups disease which causes ataxia and neutral amino aci

A
117
Q

do hemoglobin molecules release h+ or Cl- as they become saturated?

A

H+

118
Q

what medications can you use to lower BP without affedcting heart rate?

A

nondyhydropine CCBS - Nifedipine, amlodipine

119
Q

beta blocker posioning treatment?

A

glucagon

120
Q

eosophageal varices management?

A

somatostatin and octreotide - ihibit hormones that induce vasodilation

121
Q

treatment for 21 alpha hydroxylase deficiency?

A

corticosteroids to suppress ACTH

122
Q

cause of oropharyngeal ulcers in a patient being treated for Hyperthyrodism?

A

drug induced granulocyte suppression

123
Q

name sulfonyureas (side effect hypoglycemia)

A

glyburide, glymepiride

124
Q

raloxifene when used to treat osteoporosis can result in?

A

venous thromboembolism -> it is an estrogen agonist

125
Q

persistent hypothyroidism when treatment of congenital hypothyroidism with Levothyroxine may be due to?

A

poor intestinal absorption

126
Q

feared side effect of thyrotoxicosis due to too much levothyroxine intake or hyperthyoridism?

A

atrial fibrillation

127
Q

why are burn victims treated with oxandrolone, a testosterone analogue?

A

to decrease protein catabolism

128
Q

how does clonidine, an antihypertensive cause syncope?

A

decreases presynaptic release of norepinephrine

129
Q

in patients with diabetes AND HTN, to reduce risk of CKD, which hypertensive drugs do you use?

A

Ace inhibitors or ARBS

130
Q

feared side effect of fibrinolytic therapy for MI?

A

intracerebral hemorrhage -> neurologic deterioration seen -> comatose

131
Q

rapid infusion of vancomycin can result in?

A

flushing, pruritus, erythema (histamine release)

132
Q

side effect of direct arteriolar casodilators that lower blood pressure? e.g. hydralazine minoxidil

A

sympathetc activity triggers RAAS -> edema.

give with diuretics

133
Q

nitrates are synthesised from? and affect which blood vessels the most?

A

arginine
large veins -> vasodilate -> reduced venous return -> decrease in left ventricular end diastolic volume

134
Q

how to prevent tissue necrosis with norephinephrine iV infection?

A

alpha blockers like phentolamine

135
Q

what drugs should you avoid in patients with HOCM?

A

drugs that decrease left ventricular volume because they worsen left ventricular outflow tract obstruction

e.g. nitrates!! - deceases preload
hydralazine (decreases afterload)
CCBS, Ace inhibitors - decrease both

136
Q

rapid vs long term treatment for rheumatoid arthritis?

A

rapid = NSAIDS, Glucocorticoids (prednisone)

long term = DMARDS (methotrexate, sulfazalazine)

137
Q

how to prevent hemorrhagic cystitis following chemotherapy administration?

A

mesna - binds acrolein

138
Q

which antibiotic can cause serotonin syndrome when combined with SSRIS?

A

linezolid

139
Q

treatment for HPV genital warts?

A

imiquimod

140
Q

which class of diuretics are recommeneded for patients with HTN and osteoporsis?

A

Thiazide -> calcium sparing

141
Q

effect of the selective b1 blocker atenonlol?

A

decreased CAMP in cardiac cells and juxtaglomerular cells.

vascular smooth muscle not affected

142
Q

unllike ace inhibtiors, ARBs and ARBs, digoxin is a symptomatic treatment only and is not associated with improved usrvival in HFreF

A
143
Q

Which diabetic drugs favour weight loss?

A

GLP-1
SGLT 2

144
Q

effect of cinacalcet?
effect of sevalamer?

A

decreases pTH release
decreases absorption of phosphate

145
Q

post-operaitve hypocalcemia can be treated with?

A

calcitriol (vitamin D)

146
Q

addition of carbidopa to levodopa can avoid most side effects of parkinsons treatment except?

A

central/CNS side effects - e.g. anxiety and agitation

147
Q

CEA levels in cancer are used for?

A

monitoring for residual disease or recurrence

148
Q

inhaled anaesthetics may cause fulminant hepatitis

A
149
Q

Cholesterol gallstones treatment?

A

bile acid supplement eg ursodeoxycholic acid

150
Q

rifaximin mechanism for treating hepatic encephalopathy?

A

decreased intraluminal production of ammonium

151
Q

loperamide mechanism of action

A

binds opiate receptor in gut wall. reduces release of prostaglandins. used to treat ibs

152
Q

treatment for wilsons disease? mechanism?

A
  • penicillamine
  • chelating agent - increases copper urinary excretion
153
Q

corticosteroids suppresses total HPA axis by suppressing CRH

A
154
Q

most feared side effect of lamotrigine?

A

rash
SJS

155
Q

constipation is a common side effect of which drugs?

A

non dihidrpine CCBS - dilitiazem, verapamil

Iron tablets
opiods
FHT3 antagonists
anticholinergic agents including TCAs and haloperidol

156
Q

name an opiod drug that can be used to treat constipation without causing withdrawal symptoms

A

methylnatrexone

157
Q

why are magnesium and aluminum hydroxide combined in antacids?

A

to curb side effects = diarrhea and constipation respectively

158
Q

glucocorticoids used for treatment of SLE for instance can trigger what in adrenals?

A

bilateral cortical atrophy - suppression of HPA axis

159
Q

recap microbiology drugs

A
160
Q

which enzyme activates 6-mercatopurine and which enzyme inactivates it?

A

HGPRT - activates

Xathine oxidase and TPMT - deactivates

161
Q

mechanism of timolol used to treat glaucoma?

A

beta adrenergic blocker

162
Q

treatment for gallstones?

A

1st line = cholescytectomy
2nd line = ursodeoxycholic acid/ ursodiol (a bile acid) which inhibits biliary cholesterol secretion

163
Q

Mutiple sclerosis treatment and mechanism of drugs

A

b interferon -> stop relapses and progression

Baclofen (GABA agonist) -> treat muscle spasms

164
Q
A
164
Q

seconds after an injury, bleeding can stop because of?

A

localised secretion of endothelin

165
Q

ppi mechanism of action

A

block HCL secretion in stomach by blocking gastrin, ACh and histamine action

166
Q

name an opiod that can be used to treat diarrhea without crossing BBB

A

loperamide

167
Q

Senna and Bisacodyl mechanism of action in treating constipation?

A

Stimulate enteric nerve -> peristalsis

168
Q

acicyclovir mechanism of action?

A

inhibits DNA replication

169
Q

succinylcholine can cause a prolonged muscular blockade

A
170
Q

cromolyn and nedrocromil mechanism of action asthma treatment

A

inhibit mast cell degranulation

171
Q

which IV fluids are given in shock?

A

0.9% saline or Lactate Ringer Solution

172
Q

why is ketamine useful as an anesthetic in a patient with asthma and bronchospasm?

A

sympathomimetic activity -> releases catecholamine -> bronchodilation

173
Q

give an example of a benzodiazepine that can be used to treat panic disorder

A

Alprazolam

174
Q

treatment for BV?

A

clindamycin or metronidazole

175
Q

name an antihypertensive that can cause peripheral edema

A

amlodipine

176
Q

milrinone mechanism of action in heart failure

A

PDE-3 enzyme inhibitor
increases ca2+ influx in myocytes = increased contractility

vasodilation -> decrease preload and afterload

177
Q

lactose intolerance causes diarrhea similar to what group of drugs to treat constipation?

A

osmotic laxatives

178
Q

treatment for pinworm infection?

A

abendazole

179
Q

gynaecomastia in patients on androgen deprivation therapy for prostate cancer can be treated with?

A

Tamoxifene

180
Q

side effect of acetylcholinesterase inhibitors like donepezil?

A

bradycardia, AV block -> syncope

181
Q

digoxin mechanism of action?

A

decreased sodium efflux from myocardial cells

182
Q

first generation antihistamines can cause blurring of vision due to?

A

anticholinergic side effects

183
Q

describe a +ve side effect of SGLT-2 inhibitors

A

decrease sodium and water reasbsorption = decrease BP, amelioration of HF

184
Q

patiromer mechanism in treating hyperkalemia?

A

exchanges calcium for potassium in intestine

185
Q

name the drug used to treat ganciclovir resistant CMV that does not require intracellular activation

A

Foscarnet

186
Q

lidocaine mechanism of action

A

blockade of sodium channels

187
Q

patent ductus arteriosus treatment?

A

indomethacin = cox inhibitor -> decrease PGE2 production

188
Q

digoxin is effective at controlling ventricular rate of A fib at rest but not with exercise why?

A

shift from dominant parasympathetic activity to sympathetic activity during exercise

189
Q

name some drugs that cause drug induced lupus

A

procainamide, hydralazine, Isoniazid

190
Q

Emicizumab can be used to treat hemophila A. given that it mimics factor 8, what is its mechanism?

A

links factors IXa and X to give Xa

191
Q

ototoxicity can occur with which group of diuretics?

A

loop diuretics eg furosemide

192
Q

describe what happens in acetaminophen overdose

A
  • depletion of glutathione which normally conjugates N-acetyl-p-benzoquinone imime (NAPQI) .
  • buildup of toxic NAPQI
  • acute ingestion of ethanol can help prevent overdose as it competitively inhibits cytochrome P450
  • chronic ethanol ingestion however causes upregulation of p450 and increases risk of toxicity in acetaminophen overdose
193
Q

Etoposide/teniposide mechanism of action as chemotherapy agent?

A

Inhibits sealing activity of Topoisomerase 2 = double stranded breaks in cancer cells

194
Q

Side effect of Gancyclovir for CMV retinitis or colitis?

A

Neutropenia

195
Q

Along with a benzodiazepine, which antiepileptic is given to prevent seizure recurrence in status epilepticus?

A

Phentoyin

196
Q

Which class of diuretics results in improved survival in patients with HF?

When is it contraindicated?

A

Aldosterone receptor antagonist - spirinolactone, eplerenone

Contraindicated in hyperkalemia and renal failure

197
Q

Treatment for wet, age-related macular degeneration?

A

Anti-VEGF

198
Q

Fludrocortisone mechanism of action in treating primary adrenal insufficiency?

A

Improves hypovolemia and orthostatic hypotension by decreasing urinary sodium excretion and increasing vascular adrenergic sensitivity

199
Q

Lenalidomide and bortezomib can be used to treat multiple myeloma. Mechanism of action for bortezomib?

A

Proteasome inhibitor
Blocks degradation of ubiquinated proteins -> accumulation of abnormally folded proteins/immunoglobulins -> APOPTOSIS

200
Q

Enoxaparin binds to what in the blood?

A

It is a low molecular weight heparin
It binds and activates anti thrombin 3

201
Q

Excess levodopa when treating a patient with Parkinson’s can result in?

A

Dyskinesia

202
Q

Why is entacapone often co-administered with levodopa for Parkinson’s?

A

It inhibits COMT and therefore peripheral degradation of Levodopa. More to brain

203
Q

Treatment for Peripheral artery disease? Mechanism?

A

Cilostazol - phosphodiesterase inhibitor- inhibits platelet aggregation, causes arterial vasodilation.

This should be given alongside exercise programe for symptomatic treatment.

To prevent MI or stroke in future, give antiplatelets - aspirin or clopidogrel

204
Q

Chronic use of glucocorticoids is the highest RF for osteoporosis, why is this a greater risk than menopause?

A

In menopause, fracture is uncommon until about 10-15 years after cessation of menses

205
Q

Which heart failure medications confer a mortality benefit?

A

Ace inhibitor
ARB
Beta blocker
Mineralocorticoid receptor antagonist
SGLT-2 inhibitor

Those that do NOT
Digoxin
Furosemide, metolazone

206
Q

Treatment for DVT in a pregnant woman

A

Low molecular weight heparin - enoxaparin
Not teratogenic like warfarin

207
Q

Mirabegron, which is used to treat urge incontinence, activates which receptors?

A

Beta 3 adrenergic

208
Q

What risk is faced when using non-selective beta blockers eg propranolol in patients with T1DM?

A

Hypoglycaemia.
Propranolol will exacerbate and mask the symptoms of hypoglycemia (except hunger)

This is mediated by norepinephrine/epinephrine

209
Q

Effect of alpha 1 agonist on the heart?

A

They cause vasoconstriction of peripheral blood vessels
This stimulates baroreceptors in carotid sinus and aortic arch
This results in reflex increase in vagal tone
As a result = decreased atrioventricular node condition velocity

210
Q

Why is it recommended to discontinue aspirin 5 days before surgery?

A

Irreversibly inhibits COX1 = decrease in platelet thromboxane A2 production

211
Q

What medication is used to treat dermatophytosis eg tinea corporis?

Mechanism?

A

Terbinafine
Inhibits synthesis of ergosterol by inhibiting enzyme squalene epoxidase

212
Q

name some drugs that can cause G6PD deficiency

A

antimalarials - primaquine
dapsone
fluoroquinolones - eg ciprofloxacin
Sulfa drugs

213
Q

side effects of vincristine (a chemotherapy drug)

A

it inhibits axonal microtuble formation = impaired axonal transport =

peripheral neuropathy (numbness, tingling)

214
Q

treatment for restless leg syndrome

A

gabapentin, pramipexole

215
Q

treatment for Graves opthalmothapy?

A

glucocorticoids e.g. prednisone

216
Q

zolpidem mechanism of action as sleep drug

A

nobendiazopine gaba receptor agonism

217
Q

medication causes of aplastic anemia?

A

chemotherapy, immunosuppresants,
reactions to antisiezure meds, sulfonamides, nifedipine

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