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STEP > Pharm Mini Board > Flashcards

Pharm Mini Board Flashcards

1
Q

Tacrolimus

A

Calcineurin inhibition preventing IL-2 transcription; used for transplant rejection prophylaxis

ADRs: Nephrotoxicity

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2
Q

Sirolimus

A

mTOR inhibitor that prevents T-cell response to IL-2; used for kidney transplant prophylaxis

ADRs: Aplastic anemia, insulin resistance, delayed wound healing

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3
Q

Daclizuma, basiliximab

A

Abs that block the IL-2 receptor

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4
Q

Azathioprine

A

Antimetabolite precursor of 6-MP; inhibits lymphocyte proliferation “Azathiopurine”

Uses: Transplant rejection prophylaxis, RA, Crohn’s

ADRs: Aplastic anemia, increased toxicity w/ allopurinol since 6-MP is degraded by xanthine oxidase

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5
Q

Glucocorticoids (immunosuppressive action)

A

Inhibits NFkB; decreases transcription of cytokines

Uses: Transplant rejection prophylaxis. AI disorders, inflammation

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6
Q

Cyclosporine

A

Binds to cyclophilin and inhibits IL-2 transcription; used to prevent transplant rejection as well as for psoriasis

ADRs: Nephrotoxicity, gingival hyperplasia, hirsutism, HTN

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7
Q

Alemtuzumab

A

CD52 antibody

Used for CLL

“lem=lymphocytic”

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8
Q

Bevacizumab

A

VEGF ab

-Used for colorectal and renal cell carcinomas

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9
Q

Rituximab

A

CD20 ab

B-cell non-Hodgkin’s lymphoma, CLL, RA, ITP

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10
Q

Etanercept

A

Decoy TNF-a receptor used for IBD, RA, ankylosing spondylitis

-Adalimumab and infliximab are TNF-a abs

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11
Q

Eculizumab

A

C5 ab

Used for PNH

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12
Q

Natalizumab

A

a4-integrin ab

Used for MS, Crohn’s

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13
Q

Abciximab

A

Glycoprotein IIb/IIIa ab

  • Used for prevention of ischemic complications in pts. undergoing coronary interventions;
  • also for unstable angina ya dingus
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14
Q

Denosumab

A

RANKL ab

-Used for osteoporosis; mimics osteoprotegrin by inhibiting osteoclast maturation

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15
Q

Omalizumab

A

IgE ab

Used for severe allergic asthma

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16
Q

Palivizumab

A

RSV F protein ab

-Used as prophylaxis for high risk infants

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17
Q

Penicillinase Resistant Drugs

A

Methicillin, Oxacillin, Nafcillin (IV), Cloxacillin, Dicloxacillin (PO)

-Also, general ADRs for penicillins include rash, interstitial nephritis, and seizures

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18
Q

DOC for Listeria

A

Ampicillin; aminopenicillins also have more gram neg activity and useful for enterics

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19
Q

Antipseudomonal penicillins

A

Piperacillin, Ticarcillin (taken off market due to INCREASED SODIUM)

  • Also covers anaerobes, Staph/**Enterococcus, Piddly, Fence, SPACE)
  • Make sure to use B-lactamase inhibitor with these
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20
Q

Cefazolin

A

1st gen Cephalosporin that covers Gram +, ^PEK

-Used as a prophylactic prior to surgery to prevent S. aureus infxns

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21
Q

Cefuroxime, Cefoxitin, Cefotetan

A

Covers Gram +, ^PEK

TAN FOX =» Also covers ANAEROBES

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22
Q

Ceftriaxone

A

3rd gen cephalosporins that cover serious Gram - inxns (^SACE)

DOC for N. meningitidis/gonorrheae and Lyme disease

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23
Q

Ceftazidime

A

3rd gen cephalosporin that covers Pseud BUT loses gram +

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24
Q

Cefepime

A

Same as ceftazidime but recovers Gram + orgs

-What does this mean it covers?

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25
Q

Ceftaroline

A

5th gen cephalosporin that covers Gram pos, neg, and MRSA

-Lose pseud tho

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26
Q

Cephalosporin ADRs

A
  • Cross reactivity w/ penicillin allergy
  • Bleeding due to inhibition of Vitamin-K coag factors
  • Disulfarim like reaction
  • Pseudoemembranous colitis
  • Don’t use w/ AGCs (increases nephrotoxicity)
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27
Q

Imipenem

A

DOC for ESBL species; also used for Staph, Strep, Entero, SPACE, anaerobes

  • Is metabolized in the kidneys to a nephrotoxic product; administer w/ cilastatin (to make the kill lastin’)
  • Severe ADRs include: Seizures, anemia/leukopenia/thrombocytopenia
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28
Q

Ertapenem

A

Similar to meropenem and doripenem BUT adds some pseud. coverage and takes away entero

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29
Q

Aztreonam

A

DOC for penicillin allergy pts. but only covers Gram negs

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30
Q

Ciprofloxacin, moxifloxacin, levofloxacin

A

MOA: DNA gyrase inhibitor (topoisomerase II); exhibits a PAE

***CANNOT TAKE W/ ANTACIDS

ADRs: Damage cartilage (young people usually) => tendonitis and tendon rupture (old people usually)

       QT prolongation 

       Photosensitivity, rashes 

       CI= pregnant women
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31
Q

Ciprofloxacin facts

A

Least tendency to prolong QT interval of FQNs

Highest tendency for photosensitivity

Good pseud. coverage

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32
Q

Levofloxacin

A

Good for enteric GNR inxns, atypical pneumonias

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33
Q

Moxifloxacin

A

Hs anaerobic coverage

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34
Q

Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin,

Mean GNATS caNNOT kill anaerobes

A

AGCs tht bind to the 30s subunit and inhibit the initiation complex

*Bactericidal, concentration dependent killing

DOC for gram negative AEROBES (requires O2 for uptake)

ADRs: Nephrotoxicity, Ototoxicity, Teratogen

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35
Q

Mechanism of tetracycline resistance

A

Efflux of active drug, (classic question)

-Decreased absorption w/ milk and antacids

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36
Q

Doxycycline

A

Only tetracycline not cleared by the kidney or liver (can be used in renal failure); accumulates intracellular (good for rickettsia and chlamydia)

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37
Q

Macrolide general characteristics

A

Bind to 23S rRNA of the 50s subunit (bacteriostatic)

-Good for covering atypical pneumonias (mycoplasma, chlamydia, legionella) and pertussis

ADRs: 
Motility issues (GI) 
Arrhythmia (QT prolongation) 
Cholestatic hepatitis (estolate form; DONT USE IN PREGNANCY) 
Rash
eOsinophilia

CYP450 inhibitors*

*MoR: Methlyation of 23s rRNA-binding site

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38
Q

DOC for legionella

A

Azithromycin (also covers other respiratory pathogens like h. flu, m. cat, s. pneumo, mycoplasma)

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39
Q

Telithromycin

A

Macrolide used against resistant S. pneumo

-Reaches high tissue conc.

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40
Q

Bactrim

A

Sulfonamide: PABA analog that inhibits dihydropteroate synthase
ADRs: Displaces warfarin from albumin
Morbilliform rash, Steven-Johnson
Tubulointerstitial nephritis (administer w/ fluids)
Kernicterus in newborns (given during late pregnancy)

Trimethoprim: Inhibits DHFR
ADRs: Megaloblastic anemia, leukopenia

Uses: Staph (+MRSA), Gram negs (UTIs), salmonella, shigella, chlamydia
*Prophylaxis for Toxoplasma gondii and PCP

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41
Q

Vanc ADRs

A

Nephrotoxicity
Ototoxicity
Thrombophlebitis (Red-Man Syndrome; slow infusion rate)

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42
Q

Daptomycin

A

Disrupts cell membrane of Gram + cocci

**Inactivated by pulmonary surfactant, so don’t use for pneumonia

***ADRs: Rhabdomyolysis (monitor CK)

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43
Q

Linezolid

A

Similar to Macrolides; useful for MRSA and VRE

ADRs: Aplastic anemia
***Serotonin syndrome w/ serotonergics
Peripheral neuropathy

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44
Q

Clindamycin

A

Used for anaerobic infxns above the diaphragm (Bacteroides, C. perfringens); typically in aspiration pneumonia or oral infxns

-But causes what classic GI infxn

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45
Q

Metronidazole

A

Generates free radicals that damage bacterial RNA

DOC for anaerobes and C.diff BELOW the diaphragm

-Also used for Giardia, entamoeba, trichomonas, gardnerella

ADRs: Dilsulfarin w/ alcohol (hypotension, flushing, tachycardia)

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46
Q

Chloramphenicol

A

***Causes aplastic anemia and gray baby syndrome (due to accumulation)

But works great against anaerobes and meningitis and stuff (just FYI)

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47
Q

t^1/2 equation

A

.693/ke

or

Vd x .693/ CL

so what does Ke equal?

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48
Q

Zero-order eliminated drugs

A

Phenytoin
Ethanol
Aspirin

-Same amnt is eliminated no matter what

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49
Q

Works on Gq/ PLC (autonomics)

A

HAVe 1 M&M

H1, a1, V1, M1, M3

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50
Q

Works on Gi (autonomics)

A

MAD 2s

M2, a2, D2

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51
Q

Where are M1 receptors found?

A

Brain

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52
Q

Where are M2 receptors found?

A

Heart

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53
Q

Cholinesterase inhibitor poisoning

A 
Diarrhea
Urination
Miosis
Bradycardia
Bronchospasm
Excitation of skeletal muscles and CNS 
Lacrimation
Sweating 
Salivation
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54
Q

Muscarininic antagonist ADRs

A

Hot as a hare (decreased sweating)

Dry as a bone (dry mouth/skin)

Red as a beet (flushed skin)

Blind as a bat (cycloplegia)

Mad as a hatter (disorientation)

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55
Q

Raltegravir

A

HIV integrase inhibitor

-disrupts the ability of HIV dsDNA to integrate into the host cell’s chromosomes thereby preventing transcription of viral mRNA

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56
Q

Beer’s Criteria

A

Anticholinergics: 1st gen antihistamines like diphenhydramine and GI antispasmodics

CV: a-blockers, antiarrhythmics

CNS: TCAs, antipsychotics, barbiturates, benzos

Endocrine: Sulfonylureas

Pain: Indomethacin, Meperidine

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57
Q

Calcipotriol

A

Calcitriol analog that binds to the Vitamin D receptor, a nuclear transcription factor, and inhibits keratinocyte proliferation

-Can also inhibit T-cell proliferation

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58
Q

Dobutamine

A

B-agonist that primarily works on B1 receptors

=»increased inotropy, mild vasodilation, increased HR
-increased myocardial O2 demand is outweighed by heavy increased in CO

-Also has some action on B2 and a1

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59
Q

Ipratropium

A

Competitive muscarinic receptor blocker

=»Prevention of bronchoconstriction

  • enhances effect of B2 agonists (albuterol) but not as good alone
  • Also blocks submucosal gland secretion in the lungs
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60
Q

Ribavirin

A

Inhibits synthesis of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase
=»depletes intracellular GTP and overall inhibition of the duplication of viral genetic material

-Used in HCV and RSV

ADRs: Hemolytic anemia; teratogen

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61
Q

Drug used to decreased likelihood of calicum renal stones

A

HCTZ

-By reabsorbing Ca2+, there will be less in the lumen; also there will be a higher h2o content in the lumen

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62
Q

Sotalol

A

BB and a type III anti arrhythmic

***Excessive B-blockade can cause TORSADES DE POINTES

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63
Q

Lidocaine, Mexilitine

A

Class IB antiarrhythmic that Decreases the AP duration

***Preferentially affects ischemic or depolarized tissue

*DOC for post-MI arrhythmias and digitoxin-induced arrhythmias

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64
Q

Nimodipine

A

CCB useful in prevention of cerebral vasospasms following an SAH

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65
Q

Nitroprusside

A

Directly stimulates NO increasing cGMP

*Used in HTN emergencies

**OD can cause CN- toxicity =» Give thiosulfate

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66
Q

Dopamine doses

A

Low =» vasodilation of renal BF

Medium =» increased cardiac contractility

High =» Generalized vasoconstriction

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67
Q

Metoclopramide

A

D2 receptor antagonist that is used to increase LES tone, motility, and contractility of the GI tract

ADRs: Parkinsonian effects! Tardive dyskinesia

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68
Q

Cilostazol

A

PDE III inhibitor; increases the cAMP in platelets resulting in decreased aggregation

Tx: Intermittent claudication, coronary vasodilation, prevention of stroke/TIAs

ADRs: Flushing, nausea, headache e

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69
Q

5-FU

A

Pyrimidine analog activated to 5F-dUMP which complexes w/ folic acid
=»inhibition of thimidylate synthase

Uses: Solid tumors (colon cancer, pancreatic cancer, basal cell carcinoma)

ADRs: Myelosuppression (can’t be rescued)

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70
Q

Methotrexate

A

Folic acid analog that inhibits DHF

Uses: Leukemia, Lymphoma, choriocarcinoma, sarcomas, abortion, RA, psoriasis, IBD

ADRs: Myelosuppression (rescued), hepatotoxicity, pulmonary fibrosis

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71
Q

Azathioprine, 6-MP

A

Purine analog that must be activated by HGPRT; azathioprine is metabolized to 6-MP

Uses: Rejection prophylaxis, IBD, RA, SLE

ADRs: Myelosuppression; ***Increased toxicity w/ allopurinol

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72
Q

Bleomycin

A

Induces free radical formation =» breaks in dsDNA

Uses: Testicular cancer, Hodgkin’s

ADRs: ***Pulmonary fibrosis, skin hyperpigmentation

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73
Q

Doxorubicin

A

Generates free radicals that intercalate into DNA and produce breaks

Uses: Solid tumors, leukemias, lymphomas

ADRs: Dilated cardiomyopathy, alopecia
**Dexrazoxane will prevent cardiomyopathy

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74
Q

Cyclophosphamide

A

Cross link DNA; requires hepatic activation

Uses: Solid tumors

ADRs: Hemorrhagic cystitis; prevent w mesna

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75
Q

Carmustine, Lomustine, Streptozocin

A

Alkylating agent that can cross the BBB

Uses: ***Glioblastoma multiforme and other brain tumors

ADRs: Convulsions, dizziness, ataxia

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76
Q

Paclitaxel

A

Stabilize polymerized microtubules in the M phase
=»mitotic spindle cannot break down

Uses: Women cancers

ADRs: alopecia, myelosuppression

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77
Q

Vincristine, Vinblastine

A

Bind to B-tubulin and inhibit microtubule polymerization
=»prevents microtubule formation

Uses: Solid tumors

ADRs: Neurotoxicity

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78
Q

Kinase inhibitor suffix

A

-nib

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79
Q

Aldrenoate

A

Pyrophosphate analogs that bind hydroxyapetite in bones and inhibit osteoclast activity

ADRs: Corrosive esophagitis =» pts. should remain upright for 30 mins

Osteonecrosis of jaw

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80
Q

Pilocarpine

A

Cholinomimmetic that increases the outflow of aqueous humor via contraction of the ciliary muscle (produces miosis)

-Physostigmine will indirectly do this as well

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81
Q

DOC for acute angle closure glaucoma

A

Pilocarpine

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82
Q

Latanoprost

A

PGF2a that increases outflow of aqueous humor

-Darkens the Iris (browning)

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83
Q

Timolol, betaxolol

A

BBs used to decrease aqueous humor synthesis

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84
Q

Drugs to not use in closed-angle glaucoma

A

Epinephrine (produces mydriasis)

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85
Q

Second line tx for absence seizures

A

VA

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86
Q

Olanzapine

A

Atypical antipsychotic that is assoc. w weight gain

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87
Q

Clozapine

A

Atypical antipsychotic that is assoc. w/ agranulocytosis

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88
Q

Risperidone

A

Atypical antipsychotic that is assoc. w/ increased prolactin
=»gynecomastia and lactation

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89
Q

Neuroleptic malignant syndrome

A

Caused by the typical antipsychotics (haloperidol + -azines)

Fever
Encephalopathy
Vitals (unstable)
Enzymes (increased) 
Rigidity of muscles (myoglobinuria too)

Tx: Dantrolene

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90
Q

Tardive dyskinesia

A

Odd, stereotypical facial movements after LONG-TERM typical antipsychotic (chlorpromazine, thioridazine, haloperidol) use

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91
Q

Amitryptiline, imipramine, amoxapine

A

TCAs that block reuptake of NER and 5-HT3

Uses: Major depression, OCD, peripheral neuropathy, migraines

ADRs: Sedation, a1 blocking effects (postural hypotension), anticholinergic effects (dry mouth, tachycardia)

*Amitryptiline can also prolong QT interval (just cause its stronger)

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92
Q

3 Cs of TCAs

A

Convulsions

Coma

Cardiotoxicity

-Also see respiratory depression

Tx: NaHCO3

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93
Q

Phenelzine

A

MAOI used for atypical depression or anxiety

ADRs: HTN crises w/ ingestion of tyramine foods

-Do not use w/ SSRIs, TCAs, detromethorphan

**Irreversibly inhibits the enzyme SO

94
Q

Bupropion

A

Dopamine and NER reuptake inhibitor that has decreased sexual side effects

95
Q

Ethacrynic acid

A

Loop diuretic used in pts w/ a sulfa allergy

96
Q

Amphetamine OD tx

A

NH4Cl =» acidifies urine

97
Q

Digitalis OD tx

A

Anti-dig Fab fragments

98
Q

Mercury OD tx

A

Dimercaprol

MERC

99
Q

tPA, streptokinase reversal tx

A

Aminocaproic acid

100
Q

Rapid glucocorticoid withdrawal

A

Will get a adrenocortical insufficiency due to chronic HPA suppression

101
Q

-azole

A

Ergosterol synthesis inhibitor

-Ketoconazole

102
Q

-ivir

A

Neuraminidase inhibitor

Oseltamivir

103
Q

-navir

A

Protease inhibitor

-Ritonavir

104
Q

-ovir

A

DNA polymerase inhibitor

-Acyclovir

105
Q

-azine

A

Typical antipsychotic

-Thioridazine, dont forget about haloperidol tho

106
Q

-ipramine

A

TCA

-imipramine

107
Q

-triptyline

A

TCA

-Amitriptyline

108
Q

-zolam

A

Benzo

-Alprazolam

109
Q

-chol

A

Cholinergic agonist

-Bethanechol, carbachol

110
Q

-curium

A

Nondepolarizing paralytic

-Atracurium

111
Q

-curonium

A

Nondepolarizing paralytic

-Vecuronium

112
Q

-terol

A

B2-agonist

-Albuterol

113
Q

-zosin

A

a1-antagonist

-Prazosin

114
Q

-dipine

A

Dihydropyridine CCB

-Amlodipine

115
Q

-glitazone

A

PPAR-y acivator

-Rosiglitazone

116
Q

-prost

A

Prostaglandin analog

-Latanoprost

117
Q

Bethanechol

A

Cholinomimetic that is used to activate the bowel and bladder after a postoperative ileus can occur

*wouldn’t let you leave after your hernia but these fuckers coulda given you this

118
Q

Carbachol

A

Cholinomimetic that constricts the pupil; can relieve the intraocular pressure in glaucoma

119
Q

Methacholine

A

Cholinomimmetic most commonly used to diagnose asthma; excess reaction to it will cause bronchospasm

120
Q

Neostigmine

A

Anticholinesterase often used to tx MG or reverse neuromuscular blockades

121
Q

Physostigmine

A

AchE-inhibitor that crosses the BBB; used during atropine OD

122
Q

Tropicamide

A

Muscarinic antagonist used for opthalmic examination of the retina; produces short-term mydriasis and cycloplegia

123
Q

Benztropine

A

the muscarinic antagonist used to tx Parkinsons

124
Q

Atropine

A

Muscarinic antagonist used to tx bradycardia

-Has systemic efffects: Dilates pupil and produces cycloplegia

Decreases secretions

Decreases gut motility

Decreases urinary urgency

OD: Hot as hare, dry as a bone, red as a beet, blind as a bat, and mad as a hatter

125
Q

Pufferfish poison

A

Toxin that binds to Na+-gated channels in the cardiac and nerve tissue; prevents depolarization

=»Diarrhea, parasthesias, weakness, dizziness

Tx: Supportive

126
Q

Snapper/Eel toxin

A

Opens Na+ channels causing excess depolarization

⭐️Classically assoc. With temperature dysethesia

DUMBBELSS

Tx: Supportive

127
Q

Mahi-mahi/tuna poisoning

A

Scombroid; endogenous histidine is converted to histamine

Anaphylaxis-like presentation (urticaria, pruritus, flushing, headache)
**BURNING SENSATION OFF MOUTH

Tx: Antihistamines

128
Q

Vinyl chloride (chronic)

A

Angiosarcomas (most likely liver)

129
Q

Ionizing radiation chronic

A

Papillary thyroid carcinoma

130
Q

Radon exposure

A

Lung cancer

Found in the soil

131
Q

CCl4 exposure

A

Centrilobular hepatic necrosis

132
Q

Verapamil

A

Nondihydropyridine CCB that works primarily on the Ventricles; also considered a class IV anti arrhythmic

ADRs: AV block, hyperprolactinemia,

(shared by dihydropyridines)- gingival hyperplasia, edema, flushing, dizziness (due to vascular relaxation dawg)

133
Q

Hydralazine

A

Increases cGMP (arterioles)

-used during HTN emergencies during pregnancy; coadminister w/ BB to prevent reflex tachycardia

ADR: Lupus-like rxn, reflex tachycardia

134
Q

Fenoldopam

A

D1 agonist that causes coronary, renal, and peripheral vasodilation (general)

-Increases natiuresis; is short-acting

135
Q

Monday Disease

A

Development of tolerance for nitrates during work week and loss of tolerance over weekend

-Dizziness and headache on rexposure

136
Q

Class III antiarrhythmics

A

Amiodarone (torsades, hepatotoxic, corneal deposits, p. fibrosis)
Ibutilide
Dofetilide
Sotalol (BB as well)

137
Q

Adenosine

A

Antiarrhythmic that increases K+ efflux out of cells; DOC in abolishing supraventricular tachycardia?

ADRs: Flushing, hypotension (vasodilation)

Chest pain, bronchospasm

138
Q

Sumatriptan

A

5-HT agonist; inhibits CN V activation and inhibits vasoactive peptide release

*Used for migraines and cluster headaches

ADRs: *Coronary vasospasm (do not give to pts. w/ prinzmetal angina)

139
Q

Diphenoxylate

A

Mu-opioid agonist; mostly used to tx. diarrhea

  • Sometimes combined w/ atropine to produce adverse symptoms at high levels (dry mouth, blurry vision) to avoid people taking too much and developing dependence
  • Loperamide is a similar drug
140
Q

Akathisia

A

Antipsychotic ADR that is marked by restlessness and inability to sit still

-These drugs can also induce Parkinsonian like sx., dystonia (painful muscle contractions), tardive dyskinesia, and NMS

141
Q

Metformin

A

Increases glycogen synthesis, increases insulin sensitivity, decreases gluconeogenesis

ADRs: Diarrhea, lactic acidosis

=»CI’D IN RENAL FAILURE PTS. YOU MORON

142
Q

Pioglitazone, Rosiglitazone

A

PPAR nuclear transcription regulator activators; increases the sensitivity of peripheral tissues to insulin

ADRs: Weight gain, edema, HF, hepatotoxicity, increased risk of fractures

143
Q

Canagliflozin

A

Inhibits glucose reabsorption in the PCT; causes glucosuria, UTIs, vaginal yeast infxns

144
Q

Acarbose, Miglitol

A

Inhibits brush border a-glucosidases; decreases absorption of glucose

-Sometimes used as monotherapy in type II; can cause diarrhea

145
Q

Demclocycline

A

ADH antagonist used to tx SIADH

146
Q

Cinacalcet

A

Sensitizes the Ca2+-receptor on the parathyroid

=»decreased PTH secretion

147
Q

Misoprostol

A

PGE1 analog

-Increases production and secretion of gastric mucosal barrier; also used off-label to induce labor

ADRs: Diarrhea

148
Q

Sulfasalazine

A

Drug that is activated by colonic bacteria and used to tx. the two IBDs

Guess what allergy it can flare up

149
Q

Orlistat

A

Inhibits pancreatic lipase

-used for weight loss but you get bad poops

150
Q

Cisplatin

A

Cross-links DNA on the same strand; used for testicular, bladder, ovary, and lung cancer

ADRs: NEPHROTOXICITY, ototoxicity
-Can prevent w/ amifostine co-administration

151
Q

Etoposide

A

Inhibit toposiomerase II; used for solid tumors, leukemia, lymphoma

ADRs: Myelosuppression, alopecia

152
Q

Raloxifene

A

Works like tamoxifen BUT it is also an estrogen antagonist in the endometrial tissue and not just the breast tissue

-Good for preventing osteoporosis as well

153
Q

Trastuzumab

A

Ab against HER-2; used against breast cancer and gastric cancer if possible

ADRs: Cardiotoxicity (chemo-tox man)

154
Q

Teriparatide

A

Recombinant PTH given to increase osteoblastic activity

Can cause transient hypercalcemia

155
Q

Febuxostat

A

Xanthine oxidase inhibitor; works the same as allopurinol

-These fellas can also be used in lymphoma and leukemia to prevent tumor lysis syndrome

156
Q

Hexamethonium, Mecamylamine

A

Nicotinic blocking agents; will only appear on questions and have no clinical use

-Will prevent reflex tachycardia in response to hypotension

157
Q

Argatroban, Dabigatran

A

Direct thrombin inhibitors; alternative for pts. w/ HIT

158
Q

Enoxaparin, Fondaparinux

A

LMWH that acts more on factor Xa and has a longer half-life

-Possible HIT (antibodies to heparin-bound platelet factor 4 producing thrombosis w/ thrombocytopenia)

159
Q

Apixaban, rivaroxaban

A

Factor Xa inhibitors

Prophylaxis for DVT and PE, especially in A-fib pts.

160
Q

Brimonidine

A

a2 agonist that decreases aqueous humor synthesis

161
Q

Drug used during acute angle closure glaucoma (emergency)

A

Pilocarpine

162
Q

Butorphanol

A

k-opioid agonist and partial u-opioid agonist; cause less respiratory depression than full agonists like morphine, fentanyl, meperidine

-Can cause withdrawal sx tho

163
Q

Ethosuximide

A

Treats absence seizures by binding to thalamic T-type Ca2+ channels

ADRs: GI distress, Headaches, Itching, Stevens-Johnson

164
Q

1st line prophylactic for status epilepticus seizures

A

Phenytoin; works by inactivating Na+ channels and is really the go-to for all seizures except absence

-Classically causes gingival hyperplasia, peripheral neuropathy, teratogenesis, SJ syndrome, ataxia

165
Q

Gabapentin

A

Inhibits voltage-gated Ca2+ channels and is a neuroleptic drug also used for postherpetic neuralgia and peripheral neuropathy

166
Q

Valproic Acid

A

Increases Na+ channel inactivation and increases GABA conc.

  • Can cause neural tube defects, hepatotoxicity, weight gain
  • Also used for bipolar disorder, myoclonic seizure, and second line for absence
167
Q

Phenobarbital

A

1st line tx of seizure in neonates; works by increases GABA-A action

-Produces respiratory depression, sedation, tolerance, and induces cytochromes

168
Q

Proconvulsant inhaled anesthetic

A

Enflurane

169
Q

Thiopental

A

IV anesthetic potent (which means what about this anesthetic?) and enters brain rapidly

-Effect is diminished via rapid redistribution to tissue and fat

170
Q

Propofol

A

Used for rapid, short-term sedation in the ICU and causes less postoperative nausea than thiopental

171
Q

Tubocurarine, other -curiumss

A

Competitive nicotinic receptor antagonists

-Reverse blockades w/ neostigmine + atropine (to prevent muscarinic effects)

172
Q

Baclofen

A

GABA-B inhibitors at the spinal cord =» muscle relaxation

-Used to tx. lower back pain/spasms

173
Q

Memantine

A

Alzheimer’s drug that acts as a NMDA receptor antagonist

174
Q

Donepezil

A

AchE inhibitor used in Parkinson’s (can also use others like rivastigmine)

175
Q

Delirium tremens

A

Life-threatening alcohol withdrawal syndrome assoc. w/ autonomic hyperactivity (tachycardia, tremors, anxiety) up to 4 days after last drink

Classically occurs in hospital settings***

Tx: Benzos

-Hallucinosis is distinct and occurs within 2 days of last drink

176
Q

Fluphenazine

A

Typical antipsychotic commonly used during the treatment of Tourette’s

Evolution of extrapyramidal side effects:
4 hours- dystonia
4 days- akathisia 
4 weeks- Parkinsonian sx 
4 months- tardive dyskinesia
177
Q

Duloxetine

A

SNRI that nonselectively inhibits the reuptake of 5-HT and NER; commonly used to tx. diabetic peripheral neuropathy (treats pain assoc. w/ depression)

Venlafaxine is also in this class

178
Q

Bupropion

A

Atypical antidepressent that is Used for smoking cessation

-Has stimulant effects and seizures in anorexics

179
Q

Mirtazapine

A

a2-antagonist and 5-HT2 and 3 antagonist

-Used for sedation, weight gain in elderly

180
Q

Trazadone

A

a1 and 5-HT antagonist; used for insomnia

-Boners tho

181
Q

Hydralazine

A

Increases cGMP causing arteriodilation&raquo_space;»> venodilation

-Used for severe HTN or HF during pregnancy

***Administer w/ BB to prevent reflex tachycardia

ADRs: FLUID AND SODIUM RETENTION
Lupus-like syndrome
Headache
Tachycardia if no BB

-Excluding LLS, ADRs are due to sympathetic reflex limiting this drug’s chronic utility

182
Q

Pediatric Febrile Seizure

A

Tx w/ acetaminophen/ibuprofen

-Caused by increased circulating cytokines due to current infxn; hypothalamus sets a high temperature point that is reduced by decreased PGE2

183
Q

Pediatric Febrile Seizure

A

Tx w/ acetaminophen/ibuprofen

-Caused by increased circulating cytokines due to current infxn; hypothalamus sets a high temperature point that is reduced by decreased PGE2

184
Q

Nevirapine

A

Works the same as efavirenz….

NNRTI !!!!

Binds to and inhibits RT; does NOT need to be phosphorylated intracellularly to become activated like NRTIs (lamivudine, tenofovir, emtricitabine)

ADRs: Rash, hepatotoxicity, ***VIVID DREAMS W/ EFAVIRENZ

185
Q

Pramipexole

A

Dopamine agonist used in parkinsons

replaces B in BALSAC

186
Q

Drug-induced Lupus

A

Caused by procainamid, isoniazid, hydralazine

*These pts. are slow histone acetylators and it is why they have this rxn

187
Q

Acyclovir, famciclovir

A

Guanosine analog phosphorylated by HSV thimydine kinase and terminate DNA chain polymers

TOXICITY: CRYSTALLINE NEPHROPATHY
=»HYDRATE PTS. TO AVOID

188
Q

Fluconazole

A

Inhibits fungal ergosterol synthesis by blocking lanosterol conversion

Itra for area-assoc. infxns (coccidiodes and such)

189
Q

Amphotericin B

A

Binds to ergosterol forming membrane pores

ADR: ***Renal toxicity due to renal vasoconstriction =»hypokalemia and hypomagnesemia

-Also fever, anemia, hypotension, arrhythmia

190
Q

ADRs of corticosteroids

A

Skin: Central obesity, muscle weakness, buffalo hump, striae

GI: Bleed, PUD

Endocrine: Hyperglycemia, hypogonadism, osteoporosis

Immune: NEUTROPHILIA (demargination), suppression

Nervos: Psychosis

191
Q

Aliskrein

A

Direct renin inhibitor (decreased angiotensinogen activation)

ADRs: Hyperkalemia, decreased renal fnxn

192
Q

Demeclocycline

A

ADH antagonist used to tx. SIADH

193
Q

Clomiphene

A

Estrogen receptor antagonist at the hypothalamus

=» decreased negative feedback at the hypothalamus and overall increase in FSH and LH release
=»ovulation

-Tx for pregnancy due to PCOS

194
Q

Progestins

A

Increase the vascularization and decrease the growth of the endometrium

-Used in OCPs and tx of endometrial carcinoma

195
Q

Mifepristone

A

Competitive inhibitor off progestins at progesterone receptors

-Used to terminate pregnancies alongside PGE1

196
Q

CIs to OCPs

A

Smokers

Pts. w/ history of stroke/ coagulation disorders

Hx of estrogen-dependent tumors

197
Q

Terbutaline

A

B2-agonist that relaxes the uterus and decreases contraction frequency in women during labor

198
Q

Danazol

A

Androgen agonist; used for endometriosis and hereditary angioedema

ADRs: Weight gain, acne, hirsutism, virilization

199
Q

Flutamide

A

Competitive androgen receptor inhibitor sometimes used in prostate carcinoma

200
Q

Minoxidil

A

Was supposed to be a vasodilator but now used as ROGAINE

201
Q

Diphenhydramine

A

H1 inhibitors used for allergies, motion sickness, and as sleep aids

ADRs: Sedation, antimuscarine (5 classes), and anti-a1 adrenergic
   -Can you think of another class of drug that causes these?

CI’d in geriatric pts.; use a second generation

202
Q

Bosentan

A

Competitively antagonizes the endothelin-1 receptor

=»Decreased pulmonary vascular resistance

203
Q

Salmeterol, formoterol

A

Long acting B2 agonists used for prophylaxis

ADRs: Tremor, arrhythmia

204
Q

Theophylline

A

PDE inhibitor =» increased cAMP =» bronchodilation

*Narrow TI (cardiotoxic, neurotoxic)

CYP-metabolized

205
Q

Glucose transporters

A

GLUT 1- RBCs, Brain

GLUT 2- Liver, kidney, SI, B-cells (pancreas)

GLUT 3- Brain

***GLUT 4- Adipose, striated muscle

GLUT 5- FRUCTOSE (sperm, SI)

206
Q

Ephedrine

A

Increases release of stored catecholamines; used for nasal decongestion

207
Q

Clonidine

A

a2-agonist used in a hypertensive urgency (sometimes)

208
Q

a-methyldopa

A

a2 agonist used in HTN in pregnancy; can cause DAT (+) hemolysis and SLE-like syndrome

209
Q

Mirtazapine

A

a2-antagonist used to tx depression

-Cases sedation and increased appetite

210
Q

Glycopyrrolate

A

Muscarinic antagonist used to reduce airway secretions preoperatively

211
Q

Oxybutynin, Tolterodine

A

Muscarinic antagonist that targets genitourinary receptors and reduces urinary incontinence

“Toilet-odine”
“Oxy-BUTT-IN”

212
Q

Nonselective a and b agonists

A

Carvedilol, labetalol

213
Q

Nebivolol

A

B1-blockade WITH B2 activation

214
Q

Lamotrigine

A

Anticonvulsant that blocks voltage-gated Na+ channels

Watch out for SJS**

215
Q

PCSK9 inhibitors

A

Injections for diabetics that act as monoclonal abs that reduce LDL receptor degradation in the liver

-Cause great decrease in cholesterol levels

216
Q

Fibrates

A

PPAR-y activators that decrease hepatic VLDL prod. and increase LPL activity

-Greatest reduction in TGLS

ADRs: Myopathy; cholesterol gallstones (esp. w/ fenofibrate

217
Q

Blood/gas partition coefficient

A

Basically means solubility

A drug with a high blood/gas partition coefficients has…

LARGE amount needed to saturate the blood

SLOW rise in partial pressure in the blood

SLOW equilibration within the brain

SLOW onset of action

218
Q

First line tx for acute status epilepticus

A

IV BENZOs; also for eclampsia seizures if there is no MgSO4

219
Q

Colcichine

A

Binds and stabilizes tubulin to inhibit microtubule polymerization

**Disrupts PMN chemotaxis and degranulation

220
Q

Anastrazole

A

Aromatase inhibitor!

  • Used in ER (+) breast cancer
  • Exemestane also does this
221
Q

Chlorthalidone

A

Thiazide diuretic lol

ADRs: Hyperglcyemia, hyperlipidemia, hyperuricemia, hypercalcemia

222
Q

Niacin

A

Inhibits lipolysis (LPL) in adipose; reduces hepatic VLDL synthesis

ADRs: Flushing, hyperglycemia, hyperuricemia

223
Q

Class I antiarrhythmics

A

IA: Only ones that prolong the QT interval

IB: Preferred after MIs, lidocaine can possibly cause seizures;

IC: Highest potential to create dependence; bind strongest to the Na+ channel, CI’d in IHD

224
Q

Possible Tx for torsades du pointes

A

Mg2+

-Also used for digoxin toxicity

225
Q

Alprostadil

A

PGE1 analog used to tx sexual dysnfnxn and maintain the PDA

226
Q

Carboprost

A

PGF2 analog used to increase uterine tone and shoot out stubborn babies

227
Q

Methemeglobin Tx

A

Methylene blue

228
Q

Risk of expired tetracyclines

A

Fanconi syndrome: generalized REABSORPTION defect in the PCT

-Can lead to a metabolic acidosis

229
Q

Amifostine

A

Given alongside Cisplatin to prevent Ototoxicity

230
Q

Miravoc

A

CCR5 inhibitor blocking the binding of HIV molecules to T-cells

STEP (11 decks)

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