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AM- STEP1 > Pharm Need to know > Flashcards

Pharm Need to know Flashcards

1
Q

-afil

A

Phosphodiesterase inhibitor

sildenafil, tadalafil

Erectile dysfunction

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2
Q

-azepam

A

Benzodiazepine

Lorazepam
Diazepam

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3
Q

-azine

A

Phenothiazine

Chlorpromazine
Thioridazine
Promethazine

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4
Q

-azolam

A

Benzodiazepine

Alprazolam
Midazolam
Triazolam

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5
Q

-Barbital

A

Barbiturate

Phenobarbital
SEcobarbital

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6
Q

-bendazole

A

benzimidazole

Mebendazole
Albendazole

Antiparasitic

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7
Q

-caine

A

Local anesthetics

Lidocaine
Tetracaine

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8
Q

-chol

A

muscarinic agonist

Bethanechol carbachol

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9
Q

-cillin

A

Penicillin

Amoxicillin
Methicillin

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10
Q

-conazole

A

Imidazole (antifungal)

Fluconazole
Ketoconzole

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11
Q

-curium

A

Non-depolarizing neuromuscular blocker

Atracurium
Mivacurium

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12
Q

-curonium

A

Non-depolarizing neuromuscular blocker

Vecuronium
Rocuronium

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13
Q

-cycline

A

Protein synthesis inhibitor

Tetracycline
Doxycycline

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14
Q

-dipine

A

Dihydropyridine calcium channel blocker

Fifedipine
Amlodipine

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15
Q

-dronate

A

Biphosphonate

Alendronate
Risedronate

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16
Q

-etine

A

SSRI

FLuoxetine
Paroxetine
Sertraline

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17
Q

-flurane

A

Inhaled anesthetics

Isoflurane
Sevoflurane

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18
Q

-gliptin

A

DPP-IV inhibitor

Sitagliptin
Saxagliptin

Tx Type II diabetes

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19
Q

-glitazone

A

Thiazolidinedione

Pioglitazone
Rosiglitazone

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20
Q

-ipramine

A

TCA

Clomipramine
Imipramine

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21
Q
  • mab
A

Monoclonal Ab

Infliximab
Rituximab

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22
Q

-mustine

A

Nitrosourea (nitrogen mustard)

Lomustine

Cancer drugs brain tumor

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23
Q

-navir

A

Protease inhibitor

Ritonavir
Saquinavir

HIV Tx
CYP450 inhibitor

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24
Q

-olol

A

beta blocker

Atenolol
Metoprolol

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25
Q

-operidol

A

Neuroleptic

Haloperidol
Droperidol

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26
Q

-phylline

A

Methylxanthine

Theophylline
Aminophylline

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27
Q

-pril

A

ACE inhibitor

Enalapril
Lisinopril

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28
Q

-prost

A

Prostaglandin analog

Latanoprost
Travoprost

Tx glaucoma

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29
Q

-sartan

A

Angiotensin receptor blocker

Losartan
Valsartan

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30
Q

-statin

A

HMG-CoA reductase inhibitor

Atorvastatin
Simvastatin

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31
Q

-stigmine

A

Anticholinesterase

Neostigmine
Physostigmine
Rivastigmine (Alz dis)

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32
Q

-terol

A

Beta 2 agonist

Albuterol
Salmeterol

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33
Q

-tidine

A

H2 histamine antagonist

Cimetidine
Ranitidine

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34
Q

-triptan

A

5-HT 1B/1D agonist

Sumatriptan
Rizatriptan

Migranes

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35
Q

-triptyline

A

TCA

Amitriptyline
Nortriptyline

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36
Q

-tropin

A

Pituitary hormone

Somatotropin
Thyrotropin (TSH)

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37
Q

-zosin

A

alpha1-antagonist

Prazosin
Doxazosin

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38
Q

Benzodiazepine

A
  • azepam

- azolam

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39
Q

Benzimidazole

A

-bendazole

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40
Q

Muscarinic agonist

A

-chol

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41
Q

Imidazole (antifungal)

A

-conazole

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42
Q

Non-depolarizing neuromuscular blocker

A
  • curium

- curonium

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43
Q

Dihydropyridine Ca channel blocker

A

-dipine

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44
Q

SSRI

A

-etine

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45
Q

DPP-IV inhibitor

A

-gliptin

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46
Q

TCA

A
  • ipramine

- triptyline

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47
Q

Nitrosourea (nitrogen mustard)

A

-mustine

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48
Q

beta blocker

A

-olol

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49
Q

Methylxanthine

A

-phylline

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50
Q

Prostaglandin analog

A

-prost

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51
Q

HMG-CoA reductase blocker

A

-statin

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52
Q

Anticholinesterase

A

-stigmine

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53
Q

H2 histamine antagonist

A

-tidine

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54
Q

alpha 1 antagonist

A

-zosin

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55
Q

Phosphodiesterase inhibitor

A

-afil

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56
Q

Phenothiazine

A

-azine

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57
Q

Barbiturate

A

-barbital

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58
Q

Local anesthetics

A

-caine

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59
Q

Penicillin

A

-cillin

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60
Q

Protein synthesis inhibitor

A

-cycline

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61
Q

Bisphosphonate

A

-dronate

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62
Q

Inhaled anesthetics

A

-flurane

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63
Q

Thiazolidinedione

A

-glitazone

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64
Q

Monoclonal Ab

A

-mab

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65
Q

Protease inhibitor

A

-navir

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66
Q

Neuroleptic

A

-operidol

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67
Q

ACE inhibitor

A

-pril

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68
Q

Angiotensin receptor blocker

A

-sartan

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69
Q

beta 2 agonist

A

-terol

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70
Q

5-HT IB/ID agonist

A

-triptan

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71
Q

Pituitary hormone

A

-tropin

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72
Q

First line pharmacotherapy for idiopathic intracranial hypertension

A

Acetazolamide

Diuretic

Inhibition of carbonic anhydrase
Decrease aqueous humor

PCT

Acidosis

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73
Q

Tx for Tension headache

A

NSAIDS
- Ibuprofen, naproxen

Acetaminophen

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74
Q

Pharmacotherapy for Migraine HA

A

Triptans

  • Sumatriptan
  • Rizatriptan
  • Zolmitriptan

Serotonin agonist
Causes vasoconstriction
Modulates neurotransmission in trigeminal n.

Contraindications:
CAD
Prinzmetal angina
Pregnancy

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75
Q

What is contraindicated in prinzmetal angina and CAD

A

Triptans

  • Sumatriptan
  • Rizatriptan
  • Zolmitriptan
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76
Q

Tx for Cluster headache

A

100% O2

Triptans NSAID

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77
Q

Drugs for Alz

A

Cholinesterase inhibitors

  • Donepezil
  • Galantamine
  • Rivastigmine

NMDA receptor antagonist (Glutamate receptor type)
- Memantine

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78
Q

Drugs that cause delirum

A

Benzo

Anticholinergics

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79
Q

Tx organophosphate poisoning

A

Increased ACh

Tx: Atropine (block muscarinic receptor
Pralidoxime
reactivate acetylcholinesterase)

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80
Q

Tx Myasthenia gravis

A

Indirect cholinergic agonist

Thymectomy

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81
Q

Alzheimer drugs pneumonic

A

Grandma doesnt remember

Galantamine
Donepezil
Rivastigmine

AChE inhibitors

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82
Q

Cholinergic agonist

  • Direct (4)
  • Indirect ( 6)
A

Direct

1) Bethanechol- Post op ileus, urinary retention
2) Carbachol- glaucoma
3) Pilocarpine- sweat, tears saliva
4) Methacholine- asthma

Indirect

1) Neostigmine- post op ileus, urinary retention, MG
2) Pyridostigmine- MG long term
3) Edrophonium- MG diagnosis
4) Physostigmine- Atropine toxicity
5) Echothiophate- Glaucoma
6) Donepezil- Alz dis

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83
Q

Muscarinic antagonist (8)

A

1) Atropine- bradycardia, organophophate poisoning
2) Homotropine, tropicamide, cyclophentolate - pupil dilation
3) Benztropine- parkinson dis, tx effects of antipsychotics
4) Glycopyrrolate- reduce salivary, tracheobronchial, pharyngeal secretions, decrease gastric acid
5) Hyocyamine, dicyclomine- antispasmodics for IBS
6) Scopolamine- motion sickness
7) Ipratropium, tiotropium- asthma, copd
8) oxybutynin- decrease overreactive bladder

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84
Q

Three drugs for pupil dilation

A

Muscarinic antagonist

Homotropine
Tropicomide
Cyclophentolate

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85
Q

Muscarinic antagonist
Reduces salivary, tracheobronchial, pharyngeal secretions
Decrease gastric acid

A

Glycopyrrolate

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86
Q

Antispasmodics for IBS (2)

A

Hyocyamine

Dicyclomine

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87
Q

Anticholinergics to tx urge incontience

Pneumonic

A

Off the Damn Toilet seat

Oxybutyin
Tolterodine
Darifenacin
Trospium
Solifenacin
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88
Q

Atropine contraindicated (4)

A

BPH
Hyperthermia
Acute angle glaucoma*
Elderly- delirum

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89
Q

Alpha 2 drug that decrease BP

A

Clonidine

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90
Q

Indirect sympahtomimetics

Release catecholamines from presynaptic terminal

Inhibit reuptake catecholamines

A

Amphetamines- release stored
Ephedrine- release stored
Cocaine- inhibit reuptake

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91
Q

Which receptor are stimulated by each

1) Clonidine
2) Dopamine
3) Phenylephrine
4) Albuterol
5) NE
6) Isoproterenol
7) Epinephrine
8) Dobutamine
9) Terbutaline

A 
Clonidine: Alpha 2
Dopamine: All
Phenylephrine: A1>A2
Albuterol: B2>B1
NE: A1, A2 B1
Isoproterenol: B1, B2
Epinephrine: All
Dobutamine: B1>B2
Terbutaline: B2 >B1
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92
Q

Anaphylaxis
Severe croup
Hypotension

Tx

A

Epinephrine

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93
Q

Septic shock tx

A

NE

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94
Q

heart failure stress test

A

Dobutamine

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95
Q

Pupillary dilation

Nasal decongestant

A

Phenylephrine

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96
Q

Asthma

A

Albuterol, levalbuterol, salmeterol

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97
Q

Bronchospasm

Tocolysis tx

A

Terbutaline

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98
Q

SQ Asthma

A

Terbutaline

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99
Q

Selective alpha 1 blockers

A

Prazosin
Doxazosin
Terazosin

Decrease BP, relax bladder sphincter

TX: BPH

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100
Q

Selective Alpha 1 A,D receptor blocker

A

Tamsulosin

Tx: BPH, just in prostate
wont lower BP

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101
Q

Non-selective alpha blockers (2)

  • MOA
  • adverse effect
A

Phenoxybenzamine
- irreversibly bind alpha 1

Phentolamine
- diagnosis and temporary tx phenochromocytoma

Adverse effect

  • orthostatic hypotension
  • reflex tachycardia
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102
Q

Non-selective beta blockers (3)

A

Propranolol
Timolol
Nadolol

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103
Q

Selective beta 1 blockers (3)

A

Metoprolol
Atenolol
Esmolol

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104
Q

Weak Beta 1 adn B2 agonist (2)

A

Acebutolol
Pindolol

HTN
Bradycardia

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105
Q

Selective B1 blocker

Produce endothelium derived NO- dependent vasodilation

A

Nebivolol

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106
Q

Alpha 1/Beta1 blockers (2)

A

Carvedilol

Labetalol

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107
Q

What hides symptoms of hypoglycemia

A

Beta blockers

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108
Q

Tx for malignant HTN

A

Clonidine

Alpha 2 adrenergic agonist

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109
Q

Tx for pregnancy induced HTN

A

Alpha-methyldopa

Alpha 2 adrenergic agonist

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110
Q

Medical tx for pheochromocytoma

A

Alpha-antagonist

Phentolamine
Phenoxybenzoamine

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111
Q

Selective Alpha 1 antagonist used to tx BPH

A

Tamsulosin

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112
Q

Blocks choline/ Na transporter

A

Hemicholinium

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113
Q

Blocks choline acetyltransferase

A

Vesamicol

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114
Q

Blocks Tyrosine hydroxylase

A

Metyrosine

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115
Q

BLocks NE packaging

A

Reserpine

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116
Q

Inhibit NE release

A

Guanethidine

Bretylium

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117
Q

Induce NE release

A

Amphetamine
Ephedrine
Tyramine

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118
Q

Inhibit NE reuptake

A

Cocaine
TCA
SNRI

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119
Q

Low therapeutic index drugs

A

Some Drugs With Low Therapeutic index

Seizure drugs
Digoxin
Warfarin
Lithium
Theophylline
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120
Q

P450 inhibitors

A

Cracked Amigos

Ciprofloxacin
Ritonavir
Amiodarone
Cimetidine
Ketoconazole
Acute alcohol
Macrolides (erythromycin, clarithromycin)
Isonazid
Grape fruit juice
Sulfonamides
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121
Q

P450 Inducers

A

Guinness, Coronas, PBRs Induce Chronic alcoholism

Griseofulvin
Carbamazepine
Barbiturates
Rifampin
St. John's wort
Chronic alcoholism
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122
Q

Inhibit Alcohol dehydrogenase

A

Fomepizole

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123
Q

Inhibite Acetaldehyde dehydrogenase

A

Disulfiram

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124
Q

Three zero order elimination drugs

A

Phenytoin
Ethanol
Aspirin

“PEA”

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125
Q

Drugs that cause flushing

A

Vancomycin (Red man syn)
Niacin
Adenosine
Dihydropyridine Ca channel blockers

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126
Q

Fomepizole

A

Inhibit alcohol dehydrogenase

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127
Q

Drugs that cause coronary vasospasm

A

Cocaine
Amphetamines
Triptans
Ergotamine

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128
Q

Drugs that cause dilated cardiomyopathy

A

Doxorubicin

Daunorubicin

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129
Q

Drugs that cause Torsades de pointes

A 
Potassium channel blockers
Sodium channel blockers
Macrolides
Haloperidol
Chloroquine
Protease inhibitors
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130
Q

Disulfiram

A

Inhibit Acetaldehyde dehydrogenase

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131
Q

Drugs that cause Thrombocytopenia

A

Heparin

Cimetidine

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132
Q

Drugs that cause agranulocytosis

A

Drugs Can Cause Pretty Major Collapse of Granulocytes

Clozapine
Carbamazepine
Colchicine

Propylthiouracil
Methimazole
Ganciclovir

Dapsone

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133
Q

Drugs that cause aplastic anemia

A

Cant Make New Blood Cells Properly

Carbamazepine
Methimazole
NSAIDs
Benzene
Chloramphenicol
Propylthiouracil
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134
Q

Drug that causes gray baby syndrome

A

Chloramphenicol

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135
Q

Drugs that cause hemolysis in G6PD def

A

Hemolysis IS D PAIN

Isoniazid
Sulfonamides
Dapsone
Primaquine
Aspirin
Ibuprofin
Nitrofurantoin
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136
Q

Drugs that cause thrombosis

A

Oral contraceptives

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137
Q

Drugs that cause Pulmonary fibrosis

A

Amiodarone
Bleomycin
Busfulan

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138
Q

Drugs that cause cough

A

ACE inhibitors

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139
Q

Drugs that cause Pseuomemebranous colitis

A

Clindamycin
Amoxicillin
Ampicillin

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140
Q

Drugs that cause hepatic necrosis

A

Halothane
Acetaminophen
Valproic acid

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141
Q

Drug that causes hepatitis

A

Isoniazid

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142
Q

Drugs that cause Gynecomastia

A

STACKED

Spironolactone
THC
Alcohol
Cimetidine
Ketoconazole
Estrogens
Digoxin
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143
Q

Drugs that cause hot flashes

A

Tamoxifen

Clomiphene

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144
Q

Drugs that cause hypothyroidism

A

Amiodarone
LIthium
Sulfonamides

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145
Q

Drugs that cause gingival hyperplasia

A

Phenytoin
Verapamil
(Cyclosporin)

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146
Q

Drugs that cause osteoporosis

A 
Corticosteriods
Heparin
Bisphosphonates
SERM- raloxifene (decrease vertebral factures) 
Teriparatide (recombinat PTH)
Denosumab (RankL inhibitor)
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147
Q

Drugs that cause photosensitivity

A

Sulfonamides
Amiodarone
Tetracycline

SAT

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148
Q

Drugs that cause Steven-Johnson syndrome

A

CLAPPPERS

Carbamazepine
Lamotrigine
Allopurinol
Phenytoin
Phenobarbital
Penicillin
Ethosuximide
RASH
Sulfa drugs
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149
Q

Drugs that induce lupus

A 
SHIPP
Sulfonamides
Hydralazine
Isoniazid
Procainamide
Phenytoin
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150
Q

Drugs that cause intersitital nephritis

A

NSAIDs
Furosemide
Antibiotics

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151
Q

Drugs that cause Diabetes insipidus

A

Lithium

Demeclocycline

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152
Q

Drugs that cause Hemorrhagic cystitis

A

Cyclophosphamide

Ifosfamide

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153
Q

Drugs that cause Parkinson like syn

A

Metoclopramide
Antipsychotics
Reserpine

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154
Q

Drugs that cause Cinchonism

A

Dizziness w/ HA, vision changes, tinnitus

Quinidine
Quinine

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155
Q

Drugs that cause seizures

A 
Bupropion
Imipenem/ cilastatin
Isoniazid
Tramadol
Metoclopramide
Benzodiazepine
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156
Q

Drugs that cause Tardive dyskinesia

A

Antipsychotics

Metoclopramide

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157
Q

Drugs that cause Disulfram like reaction

A

Disulfram like Meds Cause Flush Skin and Green Puke

Metronidazole
Certain cephalosporins
First generation sulfonyureas
- Chlorpropamide, tolbutamide
Griseofulvin 
Procarbazine
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158
Q

Drugs that cause Nephrotoxicity and neurotoxicity

A

Aminoglycosides
Cisplatin
Polymixins

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159
Q

Drugs that cause Nephrotoxicity and ototoxicity

A

Aminoglycosides
Vancomycin
Loop diuretics
Cisplatin

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160
Q

Drugs that cause Anticholinergic effects

A

Absence of sweating, flushing, mydraiasis, lack of salivation, delirum, constipation, urinary retention, tachycardia

Atropine
TCA
-Amitriptyline
H1 blockers
-Diphenhydramine
-Hydroxyzine
Low potency neuroleptics
- Thioridazine
- Chlorpramazine
Amantidine (anti influenza)
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161
Q

Side effect

  • Donorubicin
  • Daunorubicin
A

Dilated cardiomyopathy

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162
Q

Side effect?

a. Haloperidol
b. Chloroquine
c. Macrolides

A

Torsades de pointes

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163
Q

Side effect?
Clozapine
Carbamazepine
Colchicine

A

Agranulocytosis

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164
Q

Side effect?

Chloramphenicol

A

Gray Baby syndrome

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165
Q

Side effect?
Vancomycin
Niacin

A

Flushing

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166
Q

Side effect?
Heparin
Cimetidine

A

Thrombocytopenia

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167
Q

Side effect?
Amiodarone
Bleomycin
Busulfan

A

Pulmonary Fibrosis

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168
Q

Side effect?
Spironolactone
Estrogens
Ketoconazole

A

Gynecomastia

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169
Q

Side effect?
Clindamycin
Amoxicillin
Ampicillin

A

Pseudomembranous colitis

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170
Q

Side effect?
Amiodarone
Lithium
Sulfonamides

A

Hypothyroidism

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171
Q

Side effect?
Halothane
Acetaminophen
Valproic acid

A

Hepatic Necrosis

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172
Q

Side effect?
Sulfonamides
Amiodarone
Tetracycline

A

Photosensitivity

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173
Q

Side effect?
Quinidine
Quinine

A

Cinchonism

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174
Q

Side effect?
Phenytoin
Verapamil

A

Gingival hyperplasia

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175
Q

Side effect?
Hydralazine
Isoniazid
Procainamide

A

Drug-induced lupus

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176
Q

Side effect?

Fluoroquinolones

A

Tendonitis

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177
Q

Side effect?
Allopurinol
Seizure drugs
Antibiotics

A

Steven-Johnson Syn

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178
Q

What medication causes cardiotoxicity and bone marrow suppression

A

Doxorubicin

Daunorubicin

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179
Q

Antidote for Acetaminophen

A

N-acetylcysteine

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180
Q

Antidote for Salicylates

A

Sodium bicarb

Dialysis

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181
Q

Antidote for Amphetamines

A

Ammonium chloride

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182
Q

Antidote for Anticholinesterases, organophosphates

A

Atropine

Pralidoxine

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183
Q

Antidote for antimuscarinic, anticholinergic agents

A

Physostigmine

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184
Q

Antidote for Digoxin

A

Normalize K and Mg
Atropine
Anti-digoxin Ab fragments

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185
Q

Antidote for Iron

A

Deferoxamine

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186
Q

Antidote for Lead

A

EDTA
Succimer
Dimercaprol

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187
Q

Antidote for Arsenic, mercury, gold

A

Dimercaprol

Succimer

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188
Q

Antidote for Copper, arsenic, gold

A

Pencillamine

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189
Q

Antidote for cyanide

A

Nitrates
Hydroxocobalamin
Thiosulfate

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190
Q

Antidote for Methemoglobin

A

Methylene blue,

Vit C

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191
Q

Antidote for Carbon monoxide

A

100% oxygen

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192
Q

Antidote for Methanol, ethylene glycol

A

Fomepizole
Ethanol
Dialysis

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193
Q

Antidote for Opioids

A

Naloxone

Naltrexone

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194
Q

Antidote for Benzodiazepines

A

Flumazenil

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195
Q

Antidote for TCA

A

Sodium bicarb

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196
Q

Antidote for Heparin

A

Protamine

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197
Q

Antidote for Warfarin

A

Vit K

Fresh frozen plasma

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198
Q

Antidote for t-PA, streptokinase

A

Aminocaproic acid

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199
Q

Antidote for theophylline

A

Beta blocker

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200
Q

N-acetylcysteine for tx of

A

Acetaminophen toxin

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201
Q

Physostigmine for tx of

A

Antimuscarinic anticholinergic events

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202
Q

Atropine/ pralidoxime for tx of

A

Anticholinesterases, organophosphates toxin

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203
Q

Deferoxamine for tx of

A

Iron poisoning

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204
Q

EDTA for tx of

A

Lead poisoning

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205
Q

Penicillamine for tx of

A

Copper, arsenic gold

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206
Q

Nitrates
Hydroxocobalamin
Thiosulfate for tx of

A

Cyanide

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207
Q

Naloxoen and Naltrexone for tx of

A

Opioids

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208
Q

Flumazenil for tx of

A

benzodiazepines

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209
Q

Protamine for tx of

A

Heparin

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210
Q

Tx Patent ductus arteriosus

A

Indomethacin

Blocks prostaglandin syn

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211
Q

Harsh holosystolic murmur defect

A

Ventricular septal defect

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212
Q

Loud S1 heart sound and wide fixed splitting of S2 defect

A

Atrail septal defect

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213
Q

Continous machine like murmur - defect

A

Patent ductus arteriosus

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214
Q

Drugs for improved survival in chronic CHF

A 
ACE inhibitors
ARBs
Aldosterone antagonist
Certain beta blockers
(Metoprolol, carvediolol, bisoprolol)
Nitrates w/ hydralazine (African Americans)
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215
Q

Drugs for symptomatic relief in chronic CHF

A

Diuretics
DIgoxin
Vasodilators

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216
Q

Blurry yellow vision

A

Digoxin toxicity

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217
Q

Tx for Acute CHF

A

NO LIP

Nitrate
Oxygen

Loop diuretics
Inotropic
Position

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218
Q

Na channel blockers
1A
1B
1C

A

1A Double Quarter Pounder

  • Disopyramide
  • Quinidine
  • Procainamide

1B Mayo, Lettuce, Tomato

  • Mexiletine
  • Lidocaine
  • Tocainide

1C Fries please
Flecainide
Propafenone

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219
Q

What inhibits the Funny Na channels which are permeable to both Na and K

Adverse effect

A

Ivabradine

Decrease SA node firing

Chronic stable angina in patients who cannot take beta blockers

Luminous phenomena
- Overly bright vision

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220
Q

K channel blockers

A

Sotalol

Amiodarone

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221
Q

Used for Supraventricular tachycardia

A

Adenosine

Increases K efflux
hyperpolarizing the cell and decrease Ca

Prevents depolarization

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222
Q

alpha adrenergic antagonist used in tx of pheochromocytoma

A

Phenoxybenzamine

Phentolamine

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223
Q

Lytic metastasis of bone

Blastic metastasis of bone

Lytic and blastic metastasis of bone

A

Renal cell carcinoma
Thyroid cancer

Blastic= prostate

Both
- Breast and lung

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224
Q

Neostigmine vs Physostigmine vs Pyridostigmine vs Rivastigmine

A

Neostigmine

  • MG
  • Reverse anesthesia
  • Post op urinary retention

Physostigmine
- Anticholinergic poisoning (atropine)

Pyridostigmine

  • Reverse anesthesia
  • MG

Rivastigmine
- Alz disease

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225
Q

Competitive antagonist used to tx benzodiazepine overdose

A

Flumazenil

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226
Q

Tx seronegative spondyloarthorpathies

A

TNF alpha inhibitor

Prevent activation of immune system

Etanercept
Inflixumab
Adalimumab
Golimumab
Certolizumab
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227
Q

Reactive arthritis clinical presentation

A

Conjunctivitis
Urethritis
Arthritis

Cant see
Cant pee
Cant climb a tree

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228
Q

Uses of sympathomimetics

Dopamine
Clonidine
Amphetamine
Terbutaline
Epinephrine
A

Dopamine: Shock

Clonidine: HTN

Amphetamine: ADHD, WL, Obesity, narcolepsy

Terbutaline: Asthma, tocolysis

Epinephrine: anaphylactic shock

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229
Q

ACNE Tx

1) Hyperkeratosis
2) Sebum overproduction
3) Propionibacterium acnes proliferation
4) Inflammation

A

1) Hyperkeratosis
- Vit A analong (retinoic acid)
- Tretinoin
- Isotretinoin

2) Sebum overproduction
- Isotretinoin
- Spironolactone
- OCPs

3) Propionibacterium acnes proliferation
- Erythromycin, Clindamycin
- Tetracycline, Doxycycline, Minocycline
- Benzoyl peroxide

4) Inflammation
- Steroids

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230
Q

Penicillins MOA

A

Interact w/ transpeptidase and inhibit peptidoglycan cell wall synthesis

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231
Q

Inhibit DNA gyrase and topoisomerase (which participate in supercoiling)

A

Fluoroquinolones

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232
Q

Inhibit bacterial ribosome translational proofreeding

A

Aminoglycosides

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233
Q

Inhibits viral assembly

A

Amantadine

Also inhibits viral release through interactions iwth the viral M2 protein

No longer used due to resistance

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234
Q

Inhibits viral protein synthesis

A

Ribavirin inhibits viral RAN polymerase activity adn rRNA fragment initiation adn elongation leadign to viral protein synthesis inhibition

Used in Chronic Hep C infections and respiratory syncytial virus infection

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235
Q

Viral reverse transcriptase inhibitors

A

Lamivudine
emtricitabine

Tx HIV

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236
Q

Ototoxic drugs

A 
Aminoglycosides
Vancomycin
loop diuretics
Cisplatin
Amphotericin B
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237
Q

Etoposide

A

Cancer drug

Inhibits topoisomerse II

Myelosuppression
Alopecia

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238
Q

Drug induced interstital lung disease

A

Amiodarone
Bleomycin
Methotrexate

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239
Q

Misoprostol

A

Prostaglandin E1 analog

Prevent or treat NSAID induced gastritis of peptic ulcer disease

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240
Q

Bacterial resistance to fluoroquinoles (Ciprofloxacin)

A

Efflux pumps

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241
Q

Antibitoics that target protein synthesis 30s subunit

A

Tetracyclines (Doxycycline)

Aminoglycosides (Streptomycin)

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242
Q

Antibiotics that target 50s subunit

A 
Chloramphenicol
Clindamycin
Macrolides (erythromycin) 
LInezolid
Linocmycin
Streptogramins
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243
Q

Anti-TNF alpha

A

Infliximab

Etanercept

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244
Q

Tx for absence seizures

MOA

A

Ethosuximide

Decreases the calcium current in thalamic neurons

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245
Q

Drugs taht inhibit osteoclastic resorption

A

Bisphosphonates

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246
Q

Decreases vertebral fracture in women w/ osteoporosis

A

Raloxifene

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247
Q

recombinant PTH analog stimulates osteoblasts

A

Teriparatide

Dont use more than 2 years

Pulsitale

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248
Q

Rank L inhibitor

A

Denosumab

Inhibits osteoclast activity

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249
Q

Side effects amiodarone

A 
Pulmonary fibrosis
Hepatotoxicity
Hypo/hyper thyroidism
Corneal deposits
Photosensitivity
Neurologic defect
Constipation
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250
Q

Competitive antagonist used to tx benzodiazepine overdose

A

Flumazenil

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251
Q

Acetaminophen toxicity MOA

A

Liver problems and hepatic necrosis

NAPQ1 depletes glutathione
Build up NAPQ1

N-acetylcysteine regenerates glutathione

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252
Q

Aspirin toxicity failure of

A

Acute renal failure

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253
Q

Rheumatoid arthritis acute vs chronic tx

A

Acute

  • NSAIDS
  • Steroids
  • Cox 2 inhibitor (celecoxib)

Chronic
- DMARDS
(Methotrexate, hydroxychloroquine, sulfasalazine, TNF-alpha inhibitors [imab, umab])

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254
Q

NSAID cause of renal disease MOA

A

blocks prostaglandin synthesis
Constricts renal vessels
Decrease renal blood flow

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255
Q

TNF-alpha inhibitors

A 
Etanercept
Inflixumab
Adalimumab
Golimumab
Certolizumab
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256
Q

Clinical uses of following antimuscarinics

1) Ipratropium
2) Atropine, homatropine, tropicamide
3) Benztropine
4) Scopolamine

A

1) COPD, asthma
2) Pupil dilation
3) Parkinson dis
4) Motion sickness

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257
Q

Tx SLE

A

Steroids
NSAIDs
Hydroxychloroquine
Cyclophosphamide

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258
Q

Drug induced Lupus

A 
Sulfonamides
Hydralazine
Isoniazid
Phenytoin
Procainamide
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259
Q

Tx Fibromyalgia

A

FDA approved: pregabalin, milnacipran

Amitriptyline, not FDA approved

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260
Q

Tx polymyalgia rheumatica

A

Prednisone

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261
Q

Uses for following sympathomimetics

1) Dopamine
2) Clonidine
3) Amphetamine
4) Terbutaline
5) Epinephrine

A

1) Dopamine: Shock
2) Clonidine: HTN
3) Amphetamine: ADHD, WL, obesity, narcolepsy
4) Terbutaline: asthma, tocolysis
4) Epinephrine: anaphylactic shock

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262
Q

Tacrolimus

Pimecrolimus

A

Calcineurin inhibitors
- prevents IL-2 Transcription

Atopic dermatitis tx

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263
Q

Tx Actinic keratosis

A

5-Fluorouracil

Cryoablation

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264
Q

Drugs for Tx ED

A

Phosphodiesterase 5 inhibitors

Sildanafil
Tadalafil

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265
Q
  • operidol
  • phylline
  • terol
  • triptyline
  • zosin
  • azine
A
  • operidol: neuroleptic
  • phylline: Methylxanthines
  • terol: beta2 agonist
  • triptyline: TCA
  • zosin: Alpha 1 antagonist
  • phenothiazines
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266
Q

nonsteroidal competitive inhibitor at testosterone receptor

Used to Tx prostate cancer

A

Flutamide

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267
Q

What is used to prevent hirsutism in PCOS

A

Spironolactone

inhibits steroid binding

Can cause gyncomastia and amenorrhea

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268
Q

Prostatitis tx

A

Tx: Fluoroquinolone (levofloxacin), TMP-SMX

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269
Q

BPH tx

A

Nonselective alpha 1 blockers:
doxazosin, prazosin, terazosin

Selective alpha 1 A,D blocker

  • tamsulosin
  • no hypotension side effect

5alpha reductase inhibitors
- finasteride, dutasteride

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270
Q

Side effects sildenafil

A

Phosphodiesterase inhibitor

Flushing 
HA
Dyspepsia
Impaired blue/green color vision
Life threatening hypotension (w/ nitrates)
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271
Q

Induces of cytochrome P450

A 
Griseofulvin
Carbamezpine
Phenytoin
Barbiturates
Rifampin
St. Johns wart
Chronic alcoholism
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272
Q

OCPs have weird association with

A

hepatic adenoma (tumors of liver)

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273
Q

Drugs with low therapeutic index

A

Some Drugs With Low Therapeutic index

Seizure drugs
Digoxin
Warfarin
Lithium
Theophylline
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274
Q

Endometritis tx

A

Broad spectrum Ab
Post partum
- Gentamicin + clindamycin

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275
Q

Pharmacological tx for endometriosis

A

OCPs
Progestins

Leuprolide
- continous GnRH agonist

Danazol

  • synthetic androgen
  • partial agonist at androgen receptor –> inhibits release FSH and LH via negative feedback
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276
Q

Side effects Danazol

A
  • synthetic androgen
  • partial agonist at androgen receptor –> inhibits release FSH and LH via negative feedback
Acne
Hirsutism
Deepening of voice
WG
Decrease HDL
Hepatotoxicity
Hot flashes
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277
Q

Tx to shrink leiomyomas before surgery

A

Leuprolide

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278
Q

Leuprolide

  • what is it
  • what does it do
  • state
  • side effects
  • uses
A

GnRH analog

Downregulation GnRH receptor –> decrease release FSH, LH and estrogen

Hypogonadotrophic state

Amenorrhea
Hot flashes
Decreased libido
Depression
Bone loss**

Endometriosis
Leiomyomas
Advanced prostate cancer
Infertility

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279
Q

PCOS tx

A 
OCPs
Cyclic progestins
Spironolactone (diuretic)
Metformin (Type 2 DM)
Clomiphene (ovulation induction)
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280
Q

Clomiphene

  • tx for
  • type
  • MOA
  • SE
A 
Tx of infertility due to anovulation
SERM 
Agonist/ antagonist depending on tissue
Binds estrogen receptors
Blocks negative feedback
Increase FSH and LH

Hot flashes
Ovarian enlargement
Multiple gestations
Visual disturbances

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281
Q

Chronic HTN meds in pregnancy

A

Methyldopa (central acting Alpha 2 agonist)

Labetalol: alpha beta blocker

Amlodipine: Ca channel blocker

Nifedipine

Hydralazine

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282
Q

Eclampsia tx

A

Rapid acting antihypertensives

Hydralazine
labetalol
Nifedipine
Magnesium sulfate

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283
Q

Terbutaline

  • use
  • AE
A

Selective beta agonist

Asthma and tocolysis

AE: tachycardia, hypotension, pulmonary edema

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284
Q

Induce labor

A

Prostaglandin drugs

Misoprostol
- Prostaglandin E1

Dinoprostone
- Prostaglandin E2

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285
Q

Used for termination of early pregnancy

A

Mifepristone (RU-486)

Competitive antagonist at progesterone receptor

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286
Q

MOA Mifepristone

MOA terbutaline

A

Mifepristone: competitive antagonist at progesterone receptor

Terbutaline: B2 selective agonist, uterine contraction

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287
Q

Cystic fibrosis tx

A

N-acetylcysteine

Antibiotics ( fluoroquinolones)

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288
Q

Breast cancer tx

A

SERMS
Tamoxifen, raloxifene
bind estrogen receptors

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289
Q

Tamoxifen

- effect on location

A

Estrogen antagonist in breast
Estrogen agonist in endometrial tissue
- increase risk endometrial cancer

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290
Q

Raloxifene

- effect on location

A

Estrogen agonist in bone
Estrogen antagonist in breast

Doesnt not increase risk of endometrial cancer

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291
Q

Anastrozole

A

Aromatase inhibitor

Post menopausal women w/ breast cancer

Increase risk of osteoporosis and fracture

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292
Q

Clomiphene

A

Infertility

Estrogen receptor antagonist int he hypothalamus

Limits normal feedback inhbition. Induces FSH secretion adn stimulates follicles

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293
Q

Dopamine analog

A

Bromocriptine

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294
Q

Clostiridium difficle tx

A

Tx

  • Metronidazole
  • Oral vancomycin
  • Fidxomicin (recurrent)
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295
Q

Corynebacterium diphtheriae tx

A

Erythromycin or penicillin
Antitoxin
Vaccinate

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296
Q

Tx N. GOnorrhoeae

A

Ceftriaxone

Azithromycin

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297
Q

Tx N. Meningitides

A

Prophylaxis

  • Rifampin
  • Ciprofloxacin
  • Ceftriaxone

Tx

  • Cefotaxime
  • Ceftriaxone
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298
Q

Legionella pneumophila tx

A

Macrolides

Fluoroquinole

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299
Q

Psudomonas aeruginosa tx

A

Oral: fluoroquinolones
- Ciprofloxacin
Levofloxacin

Ticardillin
Pipercillin
Cefepime
ceftazidime
Carbapenems 
- impenem
- meropenem
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300
Q

H. pylori tx

A 
Tx:
Triple therapy
- PPI
- Clarithromycin
- Amoxicillin or metronidazole

Quadruple therapy

  • PPI
  • Bismuth
  • Metronidazole
  • Tetracycline
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301
Q

Tx Shigella

Tx Salmonella

Tx Campylobacter

Tx Yersinia enterocolitica

Tx Vibero cholerae

A

Shigella (bloody)

  • Fluroquinolones
  • TMP-SMX
  • Azithromycin (macrolide)

Salmonella (bloody)

  • Fluroquinoles
  • ceftriaxone

Camppylobacter jejuni (bloody)

  • Supportive
  • Fluroquinoles
  • Azithromycin

Yersinia enterocolitica (bloody)

  • Supportive
  • Fluroquinoles
  • TMP-SMX

Vibero cholerae
- rehydration

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302
Q

Tx Leptospira interrogens

A

Question mark shaped
Rodent urine

Pencillin
Ceftriaxone
Doxycycline

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303
Q

Tx Borrelia burgdorferi

lyme disease

A

Tx Doxycycline (early stage)
Amoxicilin (children <8)
Doxycycline or Ceftriaxone (late)

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304
Q

Syphilis tx

A

Penicillin G

allergy:doxycycline

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305
Q

Why should beta blockers never be used in cases of suspected cocaine intoxication

A

B blocker can lead to severe hypotension from:

unopposed alpha 1 activation
blockade of beta 2 vasodilaiton

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306
Q

Tx Tb

A

RIPE

2 months
Rifampin
Isoniazid
Pyrazinamide
Ethambutol

4 months
Rifampin
Isoniazid

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307
Q

what antibiotic is used for prevention of mycobacteriuma vium intracellulare (MAI) in AIDs patients? When is it began

A

Azithromycin

Given once weekly

Beginning when CD4 < 50

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308
Q

Rifampin

A

Tb tx

RNA polymerase inhibitor
Revs up cytochrome P450
Red orange body fluids
Rapid Resistance used alone

Hepatotoxicity

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309
Q

Isoniazid (INH)

A

Inhibits synthesis of mycolic acids

Hepatotoxicity
Peripheral neuropathy

Give w/ B6

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310
Q

Ethambutol

A

Inhibits arabinosyl transferase
Imparied cellw all synthesis

Optic neuropathy
Color blindness
Decreased visual acuity

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311
Q

Mycobacterium leprae tx

A

Tuberculoid disease
- Dapsone + rifampin (12 months)

Lepromatous disease
- Dapsone + rifampin + cloflazimine (24 months)

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312
Q

Dapsone uses

A

Leprosy
Penumocystis jirovecii pneumonia

Hemolysis in G6PD deficiency

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313
Q

Hemolysis in G6PD deficiency

A

“Spleen Purges Nasty Inclusions From Damaged Cells”

Sulfonamides
Primaquine
Nitrofurantoin
Isoniazid
Fava beans
Dapsone
Chloroquine
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314
Q

Tx Gardnerella vaginalis

A

Oral metronidazole

Metronidazole cream

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315
Q

Rickettsial disease tx

A

Doxycycline

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316
Q

Tx Chlamydia

A

Azithromycin

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317
Q

Tx Atypical pneuonia

A

Azithromycin

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318
Q

Tx Chlamydophila pneumoniae

A

Doxycyline

or azithromycin for atypical pneumoniae

(Macrolide or Tetracyclines)

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319
Q

Adenosine as antiarrhythmic MOA

A

Increase K efflux

Hyperpolarization of cells

Decrease intracellular Ca

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320
Q

Immunosuppressant mneumonic

A

I’m Supposed to cycle past tacos sir but my appetitie

Immuno
Suppressant
Cyclosporine
Pimecrolimus
Tacrolimus
Sirlimus
Basiliximab
Mycophenolate mofetil
Azathioprine
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321
Q

Cyclosporine

  • binds
  • inhibits
  • prevents

SE (2)

A

Binds cyclophilins
Inhibits calcineurin
Prevents IL-2 production

Nephrotoxicity
HTN

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322
Q

Tacrolimus and Pimecrolimus

  • bind
  • inhibit
  • prevent

SE (3)

A

FK506

Binds FK binding protein
Inhibits calcineurin
Prevents IL-2 production

Nephrotoxicity
HTN
Neurotoxicity 
- HA 
- Paresthesias
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323
Q

Sirolimus

  • aka
  • bind
  • inhibit
  • type inhibitor

SE (1)

A

aka rapamycin

Binds FK protein 12

Inhibits mTOR

Inhibits T cell proliferation and response to IL-2

Not nephrotoxic

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324
Q

Azathioprine

  • is what
  • interferes
  • Se
  • Metabolized
A

Precursor of 6-mercaptopruine (cancer drug)

Interferes w/ nucleic acid synthesis

Bone marrow suppression

Metabolized by xanthine oxidase (toxic effects increased by allopurinol)

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325
Q

Monoclonal Ab that bind to TNF-alpha to take it out of circulation

use for

A

Infliximab
Adalimumab

Seronegative spondolopathy
RA

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326
Q

Mimics TNF alpha receptor

A

Etanercept

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327
Q

Monoclonal Ab taht binds to CD20 of B cells

Causes
Use

A

Rituximab

Induces complement to lyse B cell

Non-hodgkin lymphoma

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328
Q

Ab against IgE

Use

A

Omalizumab

Severe asthma patient

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329
Q

Ab against glycoprotein 2b3A receptor on platelets

Use

A

Abciximab

Used on patients who recently has angioplasty and stenting of cardiac vessels

Unstable angina or MI

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330
Q

Antibody against protein called ERBB2

Use

A

Trastuzumab

Breast cancer taht express HER2

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331
Q

Recombinant IL-2

Does
Use

A

Aldesleukin

Stimulates T cells

Used to tx renal cell carcinoma
Metastatic melanoma

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332
Q

GM-CSF analogs

A

“grastim”

Filgrastim
Sargramostim

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333
Q

IL-11 derivative

Use

A

Oprelvekin

Tx thrombocytopenia

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334
Q

IFN- beta analong used for

IFN- gamma analog used for

A

MS

Chronic granulomatous disease

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335
Q

Mycophenolate (mycophenolate mofetil)

  • inhibits
  • inhibits
  • prevents
A

Inhibits inosine monophosphate (IMP) dehydrogenase

Inhibits guanine synthesis

Prevents lymphocyte proliferation

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336
Q

Thalidomide

  • suppreses
  • increases
  • uses
  • SE
A

Suppresses TNF-alpha production

Increases NK cells and IL-2

Erythema nodosum leprosum ((hansen disease)
Multiple myeloma

Phocomelia

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337
Q

Tx Trigeminal neuralgia

A

Carbamazepine

or anticonvulsant (phenytoin, gabapentin, topiramate)

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338
Q

Drug of choice for absence seizures

A

Ethosuximide

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339
Q

Used to tx status epilepticus

A

Benzodiaepines (diazepam or lorazepam) increase GABA

Concurrently admistered w/ phenytoin (Na channel blocker)

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340
Q

Used to tx eclampsia

A

Magnesium sulfate

fails: benzo

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341
Q

Additional SE of phenytoin pneumonic

A

Phenytoin Has Given MDs Frustration

Peripheral neuropathy
Hirsutism
Gingival hyperplasia
Megaloblastic anemia due to decrease folate absorption
Drug induced lupus
Steven johnson
Fetal hydantoin syndrome
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342
Q

Which antiepileptics are teratogens

A

Phenytoin
Carbamazepine
Valproic acid

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343
Q

Drugs cause Steven Johnsons

A

Steve Jobs made APPLE PCS”

Allopurinol
Pheytoin
Phenobarbital
Lamotrigine
Ethosuximide

Penicillin
Carbamazepine
Sulfonamide

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344
Q

Drugs that cause agranulocytosis

A 
Carbamazepine
Clozapine
Colchicine
Propyltiouracil (PTU)
Methimazole
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345
Q

Hepatoxic epileptics

A

Valproic acid

Carbamazepine

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346
Q 
Port wine stain
Glaucoma
Seizures
Hemiparesis
Intellectual disability
A

Sturge-Weber syndrome

CNV1 or V2
Overabundance of capillaries
Vascular malformation

Mutation of GNAQ gene
Not inheriteid

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347
Q

Tx essential tremor

A

Beta blocker (propranolol)

Primidone (anticonvulsant)
CLonazepam

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348
Q

First line Tx parkinson

SE

A

Levodopa

Not all makes into CNS

  • HTN arrhythmias
  • Hallucinations
  • Tolerance

Given w/ Carbidopa

  • Inhibits DOPA in periphery
  • Inhibits conversion of levodopa in periphery
  • reduce side effects
  • Doesnt effect anxiety and agitation
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349
Q

Parkinson Drugs

A

PBR Always Last Can, Everyone Takes Real Smooth Beer

Pramipexole
Bromocriptine
Ropinirole

Amantadine

Levodopa
Carbidopa

Entacapone
Tolcapone

Rasagiline
Selegine

Benztropine (antimuscarinic)

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350
Q

Dopamine receptor agonist

A

Bromocriptine (ergot)
- vasoconstrictor

Pramipexole
Ropinirole

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351
Q

Amantadine

A

Increase dopamine release and inhibit reuptake

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352
Q

Selective MAO-B inhibitor

A

Selegiline, rasagiline

Inhibit dopamine breakdown

MPTP exposure **

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353
Q

Inhibits COMT

A

Tolcapone
Entacapone

Decreasing peripheral levodopa degradation

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354
Q

Tx Huntingtons

A

Tetrabenazine
- blocks dopamine release

Neuroleptics
- Olanzapine
- Haloperidol
Antagonist to dopamine
Tx chorea and psychosis
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355
Q

Inhibits opening of ryanodine receptor

tx for

A

Dantrolene

Prevents release of Ca from SR

Muscle relaxation

Malignant hyperthermia

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356
Q

Muscle relaxants

A

Baclofen

  • Activates GABA-B at SC
  • Induce relaxation

Cyclobenzaprine

  • Centrally acting
  • Anticholinergic effects

Metaxalone

Carisoprodol

  • Centrally acting
  • addictive
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357
Q

First line tx for psoriasis

A

Topical corticosteriods (diflorasone)

Vit D analogs
(Calcipotriene, calcitriol)

Inhibition of T cell and keratinocyte proliferation

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358
Q

Knee buckling
Diminished patellar reflex
Trouble walking up stairs

  • also seen
A

Femoral neuropathy

Sensory loss over anterior and medial thigh

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359
Q

Enterococci that substitute D-lactate for D-alanine in synthesis of pentapeptide proteoglycan precursors.

Decreases binding of what antibiotic

A

Vancomycin

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360
Q

Bacteria that increase efflux pump is resistant to

A

Tetracycline

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361
Q

Phenylephrine

A

selective alpha 1 adrenegic receptor agonist

Arterial vasoconstriction

362
Q

Isoproterenol

  • type
  • MOA
  • uses
A

Nonselective beta agonist

Decreased peripheral vascular resistance and bp

Increased cardiac rate

Rarely used

363
Q

Clonidine

  • type
  • MOA
  • Adverse effect
A

Alpha 2 adrenergic agonist

Decreases BP by decreasing central sympathetic outflow

CNS depression
Bradycardia hypotension
Respiratory depression
Miosis
Rebound HTN w/ abrupt cessation
364
Q 
Teratogenic drugs (15) 
- effects
A

1) ACE inhbitors and ARBs
- renal failure and oligohydramnios

2) Aminoglycosides
- Ototoxicity

3) FLuoroquinoles
- Cartilage damage

4) Tetracyclines
- discolored teeth

5) Cyclophosphamide
- ear/facail anomalies, limb hypoplasia, absence of digits

6) Methotrexate
- Neural tube defects, abortion

7) Carbamazepine
- neural tube defects

8) valproic acid
- neural tube defects

9) phenytoin
- fetal hydantoin syndrome

10) Lithium
- Ebstein anomaly

11) Statins
- CNS and limb abnromaltiies

12 ) warfarin
- bone/ cartilage defects, nasal hypoplasia

13) Isotretinoin
- spontaneous abortion, birth defects

14) DES
- clear cell vaginal adenocarcinoma

15) Thalidomide
- Phocomelia

365
Q

Drugs acting on microtubules (6)

A

Vincristine: block polymerization, prevent growing

Vinblastine: block polymerization, prevent growing

Taxanes: hypersensitize the microtuble, can grow but breask down

Benzimidazoles

Griseofulvin: antifungal

Colchicine: anti-inflammatory gout

366
Q

Digoxin

  • MOA
  • use
  • adverse effects
A

Cardiac glycoside inhibits Na/K ATPase

  • indirect inhibition of Na/Ca exchanger
  • Increase Ca –> positive inotropy (force of contraction) –> decrease HR

HF (to increase contractility)
Afib (decrease conduction at AV node)

Blurry yellow vision
Hyperkalemia

367
Q

Inhibits 5- lipoxygenase

  • does what
A

Zileuton

Prevents production of Leukotrienes

368
Q

Blocks leukotrienes on receptor

A

Zafirlukast

Montelukast (approved for young)

369
Q

Drugs that act on arachidonic acid product pathway

What enzymes do they affect

A

Glucocorticoids: phospholipase A2

Zileuton: 5- lipoxygenase

Zafirlukast & montelukast: inhibit leukotriene receptors

NSAID, Acetaminophen, ASA, celecoxib: cycloxygenase

370
Q

Tx for granulomas

A

Infliximab

Blocks TNF-alpha

371
Q

Tx that is used to decrease ICP

372
Q

Chronic pheobarbital use causes what organelle to become hypertrophied

373
Q

Drug tx for subarachnoid hemorrhage

A

Nimodipine

dihydropyridine calcium channel blocker

374
Q

Name eight different indirect cholinergic agonists and state their use for each

A

1) Neostigmine
- Neurogenic ileus
- NMJ blockade reversal
- MG

2) Pyridostigmine
- MG

3) Edrophonium
- MG (diagnosis)

4) Physostigmine
- Atropine overdose

5) Echothiophate
- Glaucoma

6) Donepezil
- Alzheimer disease

7) Galantamine
- Alzheimer disease

8) Rivastigmine
- Alzheimer disease

375
Q

Glaucoma tx

A

Lowers intraocular pressure
Eye drops
1) Timolol (beta 2 blocker) (decrease synthesis)
2) Apraclonidine (alpha agonist) (decrease aqueous humor synthesis)

Increase outflow of aqueous humor

1) prostaglandins
2) Acetazolamine (diuretic- proximal tubule)(decrease aqueous humor, inhibit carbonic anhydriase)
3) Mannitol (osmotic diuretic, proximal tubule)
4) Pilocarpine (cholinergic agonist)

First line tx: prostaglandins and beta blockers drops

376
Q

Abnormal blood vessels in eye
Cant see in center of eye

Tx

A

Macular degeneration

Neovascularization in choroid
Fragile new vessels bleed and damage photoreceptors

Smoking cessation
Antioxidants
- Beta carotene
- Vit C
- Lutein
- Selenium
- Zinc
377
Q

Tx acute otitis media

A

S. pneumoniae
Nontypable H. influenzae
Ml. catarrhalis

Antibiotics

  • Amoxicillin
  • Amoxicillin + clavulanic acid
  • Cephalosporins
378
Q

Tx Restless leg syndrome

A 
Check iron stores
Pramipexole (dopamine agonist) 
Ropinirole (dopamine agonist) 
Gabapentin (gaba analog) 
Pregabalin
379
Q

Tx Night Terrors

A

Benzodiazepines

decrease stage N3

380
Q

Nocturnal Enuresis tx

A 
Desmopression (first line)
Imipramine (TCA)
- reduce stage N3
Indomethacin
- decrease renal blood flow
381
Q

Narcolepsy tx

A

Modafinil

Methylphenidate

382
Q

Drugs that shorten stage N3 sleep

A

Benzodiazepines

Imipramine

383
Q

Inhaled anesthetics with low blood solubility and high lipid solubility

A

Sevoflurane
Desflurane

Higher lipid solubility –> more potent

384
Q

Propofol

A

Milk of amnesia
Increases GABA in CNS
rapid onset induce anesthesdia
Rapid off

385
Q

Anesthetic to use for brain surgery

A

Barbiturates
Decrease CSF

Act on GABA receptor
Binds chloride channel, keeps open longer

386
Q

Tx for Crigler-Najjar syndrome type II

A

Phenobarbital

387
Q

Benzodiazepines

A

Diazepam, Lorazepam
Alprazolam, Midazolam

Increases frequency of chloride channel opening on GABA receptor

388
Q

Long acting anesthetic for insomina

A

Temazepam (benzo)

389
Q

Used for conscious sedation and short procedures

A

Midazolam (benzo)

390
Q

Reverse benzo

A

Flumazenil

Trigger withdrawal seizure

391
Q

Succinylcholine

  • type
  • binds
  • MOA
  • seen

Risk

A

Depolarizing NMJ blocking agent

Binds nicotinic receptors

Stimulates receptor, depolarize, remains bound

Fasciculations

Pt w/ RYR1 gene mutation –> malignant hyperthermia
tx dantrolene

392
Q

Non-depolarizing NMJ blocking agents

A

Curare
Curium

Reverse w/ acetylcholinesterase inhibitors

393
Q

Prevents release of calcium fro SR

A

Dantrolene

Causes muscle relaxation

394
Q

Tx of malignant hyperthermia

A

Dantrolene

395
Q

Which anesthetic fits each

1) IV, associated with hallucinations and bad dreams
2) IV, most commonly used benzodiazepine for conscious sedation
3) Inhaled, has side effect of hepatotoxicity
4) IV, rapid, anesthesia induction and short duration of action
5) IV, decreased cerebral blood flow (brain surgery)
6) Opioid that does not induce histamine release
7) High triglyceride content increases risk of pancreatitis with long term use

A

1) Ketamine
2) Midazolam
3) Halothane
4) Propofol
5) Thiopental (Benzo)
6) Fentyl
7) Propofol

396
Q

MOA of local anesthetics

A

Block Na channels

397
Q

Tx for hemorrhage from an ulcer

A

Somatostatin (octreotide)

Decreases splanchnic blood flow

398
Q

Tx for H. pylori

A

Triple therapy
- PPI + clarithromycin + amoxicillin
“-prazole”
- PPI + clarithromycin + metronidazole

Quadruple therapy
- PPI + bismuth + metronidazole + tetracycline

Clarithromycin: macrolide
-50 S subunit

Metronidazole
- forms free toxic radical damages DNA

Amoxicillin

  • AMPed up penicillin
  • D-Ala-D-Ala structural analog
  • Binds penicillin binding proteins (transpeptidases), blocks crosslinking of peptidoglycan in cell wall
399
Q

Tums

Rolaids

Maalox, Mylanta

  • Type
  • Action
  • Se
A

Tums

  • Calcium carbonate
  • SE hypercalcemia –> G cells produce gastrin –> rebound excessive acid
Rolaids
- Magnesium hydroxide
- Smooth muscle relaxer
- Diarrhea, hyporeflexia, hypotension, cardiac arrest
(Mg Must Go to bathroom)

Maalox, Mylanta

  • Aluminum hydroxide
  • increases pH
  • constipation, hypophosphatemia, proximal muscle weakness, seizures, osteodystrophy (CHOPS)

All can cause hypokalemia

  • Neutralize acid creates alkalosis
  • React to alkalosis by pumping H ions out of cell in exchange for potassium
400
Q

What binds to tissue at base of an ulcer and forms protective barrier, allowing healing

A

Bismuth

Sulcralfate (requires acidic environment to polymerize)

401
Q

Adverse Effects of prostaglandins

A

-prost

Increase uterine tone
Can cause abortion
Diarrhea

402
Q

Serotonin 5-HT3 receptor antagonist

A

Ondansetron
Granisetron

“-setron”

Chemotherapy
Post-op nausea
Pregnancy

403
Q

Metoclopramide

A

Antagonist at dopamine D2 receptor

Serotonin agonist

Increase contractility in GI tract

404
Q

Antibiotic

Red urine

A

Rifampin

red urine

405
Q

Tx Crohns

A

5-ASA (aminosalicylites)
Mesalamine
Sulfasalazine

406
Q

Tx Vicerticulitis

A

Metronidazole (anaerobic bacteria)

TMP-SMX or fluoroquinolone

407
Q

Tx Chlamydia and chlamydophila species

A

Macrolides

Tetracyclines

408
Q

Tx Glucagonoma

A

Octreotide

resection

409
Q

Liver failure

Tx to lower ammonium levels

A

Lactulose

Antibiotic: rifaximin

410
Q

Tx Ascites

A

Potassium sparing spironolactone w/ furosemide

411
Q

Tx Esophageal varices

A

Octreotide

  • somatostatin analog
  • decreases visceral secretions

Propranolol or nadolol

412
Q

Tx Cirrhosis

A

Diuretic (tx ascites and edema)

  • Spironolactone
  • Fursemide

Beta block (block bleeding from esophageal varices)

  • Propranolol
  • Nadolol

Vit K
(max clotting potential)

Lactulose

  • Trap ammonium to remove from gut
  • Tx hepatic encephalopathy

Rifamacin
- Help tx refractory hepatic encephalopathy

413
Q

Tx wilson disease

A

Penicillamine

Chelates copper adn allows excretion through urine

414
Q

Tx for hemochromatosis

A

Phlebotomy

Deferoxamine (chelating agent)

415
Q

Tx Hepatitis B

A

Tenofovir

Entecavir, telbivudine, lamivudine, adefovir

416
Q

Jaundice
Fever
RUQ abdominal pain

A

Charcot triad for cholangitis

417
Q

Jaundice
Fever RUQ abdominal pain
Hypotension
Altered mental status

A

Reynolds pentad for cholangitis

418
Q

Tx pulmonary HTN

A

Competitive antagonize the endothelium 1 receptor

  • Bosentan
  • Ambrisentan

Prostaglandin analog

  • Iloprost
  • Epoprostenol

Phosphodiesterase inhibitor
(prlong effects of NO)
- Sildenafil

Dihydropyridine Ca channel blocker
-Nifedipine

419
Q

mutation in BMPR2

A

Bone morphogenetic protein receptor type II

Leads to excessive vascular smooth muscle proliferation
- Increased resistance

Primary pulmonary hypertension

420
Q

Bosentan

  • MOA
  • tx for
A

Antagonist at the endothelin 1 receptor

Tx for pulmonary htn

421
Q

Antidepressant overdose

  • signs
  • due to
  • tx
A

Delirium
Seizures
Anticholinergic toxicity

Caused by blockage of cardiac fast sodium channels

Sodium bicarbonate

422
Q

Panic disorder medication

- MOA

A

Benzodiazepine

Allosterically modulate teh binding of GABA, increrasing frequency channel is opening

423
Q

Dobutamine

A

beta adrenergic agonist

Increased cardiac contractility and heart rate

Mild vasodilation

424
Q

Migraine tx

A

Abortive

  • Triptans
  • NSAIDs
  • Antiemetics
  • Ergotamine

Preventive

  • Anticonvulsants (topiramate, valproate)
  • TCA
  • Beta blockers
425
Q

Prolong QT but decreased risk of Torsades

A

Amiodarone

426
Q

Morphine MOA

A

Closure of VG Ca channels
Reduce calcium influx
Decreased excitartory NT release

Increase potassium efflux out of the cells

427
Q

Isopropanol MOA

A

Disrupt cell membranes

428
Q

Phenelzine

Tranylcypromine

A

Monoamine oxidase inhibitors (MAOs)

Antidepressants

INhibit oxidative deamination

Increase serotonin, NE, dopamine

Mood reactivity

429
Q

Leuprolide

A

GnRH analog

Initial increase DHT and testosterone –> decreases

430
Q

First line treatment for major depressive disorder

431
Q

COPD treated with

A

Beta 2 agonists

INcrease cAMP

432
Q

Fibrates MOA

A

activate PPAR-alpha, decreased hepatic VLDL production and increased LPL activity

433
Q

Ezetimibe MOA

A

Blocks intestinal cholesterol absorption

434
Q

Cholestryramine MOA

A

Bile acid binding resins

Increases fecal loss of cholesterol derivatives by binding bile acids in intestine and disrupting enteroheptaic bile acid circulation

435
Q

Resistance of Rifampin

MOA

A

Altered structure of enzyme involved in bacterial RNA synthesis

Inhibition of bacterial DNA-dependent RNA polymerase

436
Q

Isoniazid MOA

Ethamutol MOA

A

Isoniazid:
inhibition of mycolic acid synthesis

Ethambutol: inhibition of arabinosyl transferase

437
Q

Tx sinus bradycardia

Tx SVT

TX VT

A

Atropine

Adenosine
- hyperpolarizes AV node –> AV conduction delay

Amiodarone

438
Q

Choestyramine MOA

A

Bile acid-binding resins

Interferes w/ circulation of bile acids and increase in excretion

Results in hepatic syntheis of new bile acids, which consumes cholesterol stores

Hepatic uptake of LDL from circulation is increased

439
Q

Walking pneumonia tx with

A

Bacterial protein synthesis inhibitor

  • Macrolide
  • Tetracycline
440
Q

Tx Resistant Schizophrenia

441
Q

Valproate used for

A

Bipolar

Anticonvulsant mood stabilizer

442
Q

Schizophrenia first line tx

A

Atypical antipsychotic
Risperidone

  • apine
  • prazole
  • idone
443
Q

Tx for alcoholic wanting to quit

MOA

A

Naltrexone

Blocks Mu opioid receptor
Inhibits reward

Acamprosate
- modulating glutamate neurotransmission at the N-methy-Daspartate receptor

444
Q

Medication lower BP without worsening PR prolongation and sinus bradycardia

A

Nifedipine
Amlodipine
Felodipine
(Dihydropyridines)

Primarily affect smooth muscle

Cause reflex tachycardia due to peripheral vasodilation

445
Q

Beta blocker effect

A

Bradycardia

446
Q

Disopyramide

A

Na channel blocker

447
Q

Prophylactic tx for neisseria meningitidis

A

Rifampin

Tx: current infection
- penicillin, ceftriaxone

448
Q

Enoxaparin

  • type
  • MOA
A

anticoagulants
- LMWH

binds antithrombin III (ATIII), once activated binds factor Xa stops factor Xa from converting prothrombin to thormbin

act on factor Xa

449
Q

Antiemetic therapy

A

5-HT3 receptor antagonist

ondansetron

450
Q

Somatostatin receptor agonist used for

A

octreotide

inhibit bioactive amine relase
diarrhea in carcinoid syndorme or VIPoma

451
Q

Drug binds to cell wall glycoproteins

Drug interferes wit hDNA replication proteins

Drug binds to ribosomal proteins

Drug binds to transpeptidases

A

Vancomycin

Fluoroquinolones, binds DNA gyrase

Macrolides, tetracyclines

Pencillin, cephalosporins

452
Q

Resistance to cephalosporins

A

Change in protein structure

Inhibits binding

453
Q

Bradycardia with QT prolongation. Torsades de pointes, was treated with what previously for palpitations

A

Sotalol
Amiodarone
Dofetilide

K channel blocking properties

454
Q

Canagliflozin

effect depends on

A

SGLT2 inhibitor
- decrease renal reabsorption of glucose

effectiveness depends on glomerular filtration of glucose

455
Q

Reduce nicotine cravings and decrease pleasurable effects of cigarettes

A

Varenicline

456
Q

Anxiety tx with

  • works where
A

SSRI

Blocks reuptake in raphe nuclei

457
Q

Antiretroviral target

A

inhibit HIV protease

Inhibit production of functional viral encoded enzymes

458
Q

Glyburide

  • type
  • MOA
  • adverse effect
A

2nd generation sulfonyureas

Increase insulin secretion by inhibiting beta cell K atp channels

Work even when glucose levels are normal

Hypoglycemia
Weight gain

459
Q

Graves disease and beta blockers MOA

A

Reduce conversion of T4 to T3

460
Q

Drug of choice for altitude sickness

A

Acetazolamide

461
Q

Tx DVT

A

First 10 days:
LMW heparin (enoxaparin, dalteparin)
fondaparinux, unfractionated heparin

Long term anticoagulation

  • warfarin (goal of INR 2-3)
  • LMW heparin
  • fondaparinux
462
Q

Factor Xa inhibitors

  • oral
  • SQ
A

Oral

  • Fibaroxaban
  • Apixaban
  • Edoxaban

SQ
- Fondparinux

463
Q

Direct thrombin inhibitor

A

Dabigatran

464
Q

TX PE

A

First 10 days

  • LMW heparin
  • fondaparinux
  • unfractionated heparin

Long term
- warfarin
Ribaroxaban, apixaban, edoxaban, dabigatran (direct factor Xa inhibitor)

465
Q

Which enzyme is inhibited by proton pump inhibitors (PPI)

Types

A

Inhibit H/K ATPase

Omeprazole
Esomeprazole
Lansoprazole
Pantoprazole

466
Q

Albuterol

A

B2 agonist

Bronchodilation

467
Q

Four antihistamines and their uses

A

1) Cyproheptadine
- Appetite stimulant
- Antidote serotonin syndrome

2) Promethazine
- N/V

3) Hydroxyzine
- Sedation, itching

4) Meclizine
- Vertigo

468
Q

Long acting beta agonist

  • use
  • when used for asthma need
A

Formoterol
Salmeterol

Mainstay of COPD tx

For asthma must be on inhaled corticosteroid

469
Q

Steroids for asthma

  • effects (3)
  • most common (3)
  • use
A

Decreased inflammation
Inhibit cytokine synthesis
Inhibit TNF-alpha production

First line for pts who fail short acting beta agonist

Fluticasone
Budesonide
Beclomethasone

470
Q

Prevents release of histamines from mast cells

A

Cromolyn

Prevents bronchoconstriction and inflammation

471
Q

COPD and severe asthma

A

Muscarinic antagonists

  • Ipratropium (short acting)
  • Tiotropium (long acting)

Decreases overall vagal or parasympathetic tone in lungs

472
Q

5- lipoxygenase inhibitor

A

Zileuton

Blocks conversion of arachidonic acid into leukotrienes

473
Q

Prevents effects of leukotriene D4

Tx for

A

Montelukast
Zafirlukast

Aspirin and allergic induced asthma

474
Q

Theophylline

  • MOA
  • SE
A

Methylxanthines

Can cause bronchodilation by inhibiting phosphodiesterase

Increase cAMP, decrease hydrolysis

SE: tremor and tachycardia, seizures

475
Q

Expectorants

A

Guaifenesin
- thins mucus
- does not suppres cough
+ dextromethorphan to suppress cough

N-acetylcysteine

  • tylenol overdose
  • used for contrast induced nephropathy
  • Mucolytic that breaks disulfide bonds in patients with obstructive lung disease
476
Q

Omalizumab

A

Anti-IgE monoclonal therapy

Severe asthma with an allergic component

Binds to IgE in serum and blocks the receptor

Reduces exacerbation and use of rescue inhaler

477
Q

Diphenhydramine

  • type
  • uses
  • toxicity
A

1st generation H1 blocker
( dimenhydrinate, chlorpheniramine)

Allergies
Motion sickness
Sleep aids

Toxicity: sedation, dry mouth, delirum

478
Q

Loratadine

  • type
  • use
  • toxicity
A

2nd generation H1 blockers

Allergy

Less sedating

479
Q

OTC cough suppressant

A

Dextromethorphan

Derivative of morphine

480
Q

Nasal decongestion

A

Phenylephrine
Pseudoephedrine

Alpha agonist

Constrict dilated arteroles in nasal mucosa

SE: if taken long time rebound nasal congestion

481
Q

Pulmonary HTN 3 tx

A

1) Epoprostenol iloprost
- directly vasodilating the pulmonary vascular beds
- Se: jaw pain, flushing

2) Bosentan
- antagonizing endothelial receptor 1
- Se: hepatotoxicity

3) Sildenafil
- inhibits PDE-5
- do not give w/ nitroglycerin –> unsafe drop in BP

482
Q

Narrow therapeutic index, drug of last resort for asthma med

A

Theophylline

483
Q

Drugs taht may cause restrictive lung disease

A

Bleomycin
- pneumonitis with infiltrates

Busulfan

  • acute lung injury
  • chronic interstitial fibrosis
  • alveolar hemorrhage

Amiodarone
- pulmonary fibrosis

Methotrexate
- hypersensitivity like lung reaction

484
Q

Tx of carcinoid syndrome

A

Octreotide

485
Q

Drugs that reduce triglyceride level

A

Bile acid binding resins

  • Cholestyramine
  • colestipol
  • colesevelam
486
Q

Statin effects of lipid levels

A

Modest reduction in triglycerides levels by decreasing synthesis and increase clearance of VLDL particles

487
Q

Ezetimibe

  • MOA
  • lipid levels
A

Selectively inhibits the intestinal absorption of cholesterol and lowers LDL levels.

Does not affect triglyceride absorption but may lower blood triglyceride levels slightly

488
Q

Gemfibrozil

  • what is it
  • another example
  • MOA
  • Tx for
A

Fibrate
- fenofibrate

Inhibit hepatic production of triglycerides

First line tx for hypertriglyceridemia

489
Q

Niacin

- effect on lipid levels

A

Reduces blood triglyceride levels
Raises HDL levels
Decreases VLDL conversion to LDL, thereby decreasing LDL concentrations as well

Tx w/ aspirin

490
Q

Rabies vaccine

A

Inactivated vaccine

491
Q

Trastuzumab

  • type
  • adverse effect
A

monoclonal ab for tx of breast cancer, bind HER2 and block downstream signaling

Adverse effect
- Cardiotoxicity
Decrease in myocyte contractility

492
Q

Tx acute myocardial infarction

A

Beta blocker

B1 blocker specific
- Metoprolol
Decrease HR, contractility, and O2 consumption, renin

493
Q

Tx Gonorrhea

A

Macrolide

Third generation cephalosporin

494
Q

Tx Lung abscess

A

Clindamycin

- anaerobic oral organisms and aerobes

495
Q

How do alcohol based disinfectants work?

A

Kills veetative bacteria (not spores) fungus and enveloped viruses

Dissolves their lipid bilayer membranes

496
Q

Drug that block surface glycoproteins

A

Neuraminidase blocking

Neuramindase inhibitors

  • Oseltamivir
  • Zanaamivir

Block virion particle release

497
Q

Short acting drugs for anxiety

Intermediate

Long

A

Short benzo <6 hr

  • Triazolam
  • Midazolam

Intermediate 6-50 hr

  • Oxazepam
  • Alprazolam
  • Lorazepam
  • Clonazepam

Long > 50 hr

  • Diazepam
  • chloridiazepoxide
  • flurazepam
498
Q

Drug that is used to target same intracellular target as trimethoprim

A

Methotrexate
Pyrimethamine

Prevent reduction of folic acid to tetrahydrofolate (THF) by inhibiting dihydrofolate reductase (DHFR)

499
Q

Tx for postoperative urinary retention

A

Contraction of detrusor muscle

Muscarinic cholinergic agonist

Bethanechol

500
Q

Finasteride

A

5alpha reductase inhibitor

Bladder outlet obstruction secondary to prostatic hypertrophy

Decreases conversion testosterone to dihydrotestosterone

501
Q

Phenylephrine and bladder

A

Alpha agonist

Encourages trigone and sphincter contaction

Promotes urinary retention

502
Q

Oxybutynin

A

Antimuscarinic

Used for urge incontinence

503
Q

Zolpidem

  • type
  • use
A

GABA receptor agonism
-short acting

Insomnia

504
Q

Dopamine receptor antagonism

A

Haloperidol

Risperidone

505
Q

Melatonin receptor agonism

506
Q

Orexin receptor antagonism

A

Suvorexant

507
Q

Methimazole

  • type
  • MOA
  • tx
A

Thioamide drugs

Tx hyperthyroidism

Inhibit thyroid peroxidase, enzyme responsible for both iodine organification and coupling of iodotyrosines

508
Q

Drugs that blocks

1) Iodide uptake by the thyroid
2) Peripheral thyroxine to triiodothyronine conversion
3) Triiodothyronine/ thyroxine effect on target tisssues
4) Coupling of iodotyrosines

A

1) Perchlorate, pertechnetate
- inhibit Na/iodide symporter

2) Propylthiouracil
- decrase conversion T4–> T3

3) Beta blockers
- propranolol

4) Thioamide drugs
- Methimazole
- propylthiouracil

509
Q

Lipid lower drugs adverse effects

1) Hepatotoxicity
2) Myopathies
3) Decreased absorption of other drugs and fat soluble vitamins
4) Cholesterol gallstones
5) Red, flushed face
6) Hyperglycemia
7) delirium, dementia
8) Myalgias

A

1) Hepatotoxicity
- statins

2) Statins especially w/ fibrates or niacin

3) Decreased absorption
- Bile acid resins
( cholestyramine, colestipol, colesevelam)

4) Fibrates
(Gemibrozil, bezafibrate, fenofibrate)

5) Niacin (vit B3)
6) Niacin (vit B3)

7) PCSK9 inhibitors
- alirocumab
- evolocumab

8) PCSK9 inhibitors

510
Q

Prevent cholesterol absorption at small intestine brush border

LDL
HDL
TG

A

Ezetimibe

Decrease LDL
Increase to no change HDL
Decrease to no change TG

511
Q

Which immunosuppressant matches each of the following statements?

1) Precursor of 6-mercaptopurine
2) Antibody that binds to CD3 on T cells
3) Antibody that binds IL-2 receptor on activated T cells
4) Inhibits inosine monophosphate dehydrogenase
5) Inhibits calcineurin –> loos of IL-2 production –> blockage of T cell differentiation and activation
6) Metabolized by xanthine oxidase

A

1) Azathiopurine
2) Muromumab
3) Daclizumab
4) Mycophenolate mofetil

5) Cyclosporine
Tacrolimus
Pimecrolimus

6) Azathioprine
6-mercaptopurine

512
Q

Modafinil

  • MOA
  • Use
A

nonamphetamine stimulant

May enhance dopaminergic signaling

Narcolepsy

513
Q

Preventing chemotherapy induced vomiting reflex

A

Serotonin (5-HT) receptor antagonist

Ondansetron
Granisetron
Dolasetron

514
Q

Vestibular nausea and vomiting treatment

A

Histamine blockers

Diphenhydramine
meclizine
Promethazine

515
Q

Alcohol withdrawal treatment

A

Benzo

Lorazepam
Diazepam
Chlordizepoxide

516
Q

Tx severe HTN

A 
IV nitroprusside (risk cyanoide toxicity) 
IV labetalol
517
Q

Aortic dissection tx

A

Beta blockers

518
Q

nisoldipine

  • type
  • MOA
  • Use
A

-dipine
Dihydropyridiens Ca channel blocker

act on vascular smooth muscle to cause vasodilation

(no effect at heart)

HTN, angina, raynaud phenomen (vasospasm), migraine prophylaxis

519
Q

Diltiazem

  • type
  • MOA
  • use
A

Ca channel blockers

Blocks Ca channel at pacemaker cells

HTN, ANGINA, arrhythhmias

520
Q

Difficult to tx hypertension

  • MOA
  • Adverse effects
A

Minoxidil

Opens K channels and hyperpolarizes smooth muscle , resulting in relaxation of vascular smooth m.

Vasodilation

Hypertrichosis (excess hair)

521
Q

Adverse effects ACE inhibitor (5)

A

1) COUGH
- dry hacking
- elevated bradykinin

2) Angioedema
- swelling lips, tongue, oral muscoa

3) Hyperkalemia
4) Renal insufficiency (decrease GFR)
5) Teratogenic

522
Q

Aliskiren

  • MOA
  • Use
  • Side effect (3)
A

Renin inhibitor

HTN

Contraindicated in pregnancy
Hyperkalemia
Renal insufficiency

523
Q

Hydralazine

  • MOA
  • Focuses on
  • Decreases
  • Uses
  • Side effects (3)
A

Increase cGMP
Activates myosin phosphatase –> dephosphorylates myosin –> relaxation and dilation

Dilates arterials (more than veins)

Decrease afterload

HTN urgency and emergency
HTN in pregnancy

Reflex tachycardia
(Prevent w/ beta blocker)
Fluid retention
Drug induced Lupus (SHIPP)

524
Q

HTN in pregnancy

A

Hypertensive Moms Love Nifedipine

Hydralazine
Methyldopa
Labetalol
Nifedipine

525
Q

IV to HTN emergency

A

Nitroprusside

526
Q

Nitrates

  • MOA
  • effect more
  • decreases
  • Uses
  • side effect
A

Release of NO in smooth muscles
Vasodilation
Increase in cGMP

Dilate veins

Decrease preload

Angina
Acute pulmonary edema

SE Nitroprusside –> cyanide toxicity

527
Q

ACE/ARBs decrease what effect on heart

A

Afterload

Preload

528
Q

Initial Antihypertensive therapy

1) CKD patients
2) Black patients w/o CKD
4) Non black w/o CKD

A

1) ACE inhibitor or ARB
2) Thiazide diuretic, Ca channel blocker
3) Thiazide diuretic, Ca channel blocker, ACE inhibitor, ARB

529
Q

Person has bradycardia what to not give them

A

Beta blocker

Diltiazem/ Verapamil

530
Q

BPH with hypertension

A

alpha blocker

531
Q

Migraine with HTN give

A

CCB

Beta blocker

532
Q

Essential tremor give

A

Propranolol

533
Q

Hypertensive medication

Lots of excess hair growth

534
Q

CHF with HTN drugs

A 
ACE inhibitor
ARB
Aldosterone antagonist
Beta blockers
- carbedilol
- metoprolol
- bisoprolol
Diuretics
535
Q

Refractory Angina Tx

  • MOA
  • Adverse effect
A

Ranolazine

Inhibits the late phase of Na current

Reduces diastolic wall tension
Reduces oxygen consumption

No effect HR or BP

Prolongation QT

536
Q

Statins

  • effects
  • adverse effects
A

HMG CoA reductase inhibitors

Prevent production de novo cholesterol
Increase cell surface LDL receptors
Decrease plasma LDL
Increase HDL
Decrease TG

Hepatotoxicity
Myalgias
Myositis**
Rhabdomylolysis

537
Q

Bile acid binding resins

  • examples (3)
  • MOA
  • Adverse effect
A

Cholestyramine
Colestipol
Colesevelam

Prevent intestinal reabsroption of bile acids; liver must use cholesterol to make more

(Cholesterol gallstones?)
GI upset

538
Q

Ezetimibe

  • MOA
  • Use
  • SE
A

Prevents cholesterol reabsorption at teh small intestine brush border

Use if dont tolerate statins
Low lipids

SE
Increase LFTs (rare)
Diarrhea

539
Q

Drug that increases HDL and decreases LDL

  • MOA
  • Side effect
A

Niacin

Inhibits lipolysis in adipose tissue
reduces hepatic VLDL synthesis

Flushing
Rash
Pruritis
Hyperglycemia hyperuricemia

540
Q

Tx for High TG

Adverse effects (4)

Dangerous with

A

Fibrates
Femfibrozil
Fenofibrate

Upregulate LPL –> increase TG clearance
Activates PPAR-alpha to induce HDL synthesis

Myositis**
Myalgias
Hepatotoxicity
Increase cholesterol gallstones**

Statins (increased risk of myositis)

541
Q

Nitrates verse Beta blockers

  • End-diastolic volume (preload)
  • BP
  • Contractility
  • HR
  • Ejection time
  • Myocardial oxygen demand or consumption
A 
Nitrates
End-diastolic volume (preload)
- Decrease (relax venous) 
BP: Decrease
Contractility: increase (due to drop in BP)
HR: Increase
Ejection time: Decrease
Myocardial oxygen demand or consumption: Decrease 
Beta blockers
End-diastolic volume (preload): nothing
BP: decrease
Contractility: decrease
HR: decrease
Ejection time: increase
Myocardial oxygen demand or consumption: Decrease
542
Q

Enoxaparin

A

MI tx if not undergoing stenting

543
Q

Antiplatelet therapy

A

Clopidogrel

Ticagrelor

544
Q

Endocarditis tx

A

Prophylactic Penicillin

Empiric IV vancomycin (covers staph and strep)

545
Q

Fingers go white then blue in cold

Tx

A

Raynaud phenomenon
Arterial vasospasm

Dihydropyridine CCB
- Amlodipine
Nifedipine

546
Q

What antihypertensive drug?

1) First-dose orthostatic hypotension
2) Hypertrichosis
3) Cyanide toxicity
4) Dry mouth, sedation, and severe rebound HTN

A

1) Alpha blockers (-zosin) , clinidine
2) Minoxidil
3) Nitroprusside
4) Clonidine

547
Q

Alpha 1 selective

  • use
  • adverse effects
A

-osin
Urinary symptoms of BPH
PTSD (prazosin)
HTN (except tamsulosin)

First dose orthostatic hypotension

548
Q

Penicillin MOA

A

Bind to penicillin binding proteins

Inhibit formation of corss linkages between peptidoglycan chains

Cell lysis

Upregulate autolysins

549
Q

Penicillin coverage

A 
Gram positive
Spirochetes- syphilis
Gram positive rods
Gram negative cocci
- neisseria
550
Q

Penicillinase resistant penicillins

A

Bulky R group

Methicillin
Nafcillin
Oxacillin
Dixcloxacillin

551
Q

Aminopenicillins

  • examples
  • inhibition
  • Use
A

Ampicillin (IV)
Amoxicillin (greater oral bioavailability)

Pencillinase sensitive

HEELPSS
H. influenzae
E. coli
Enterococci
Listeria
Proteus mirabilis
Salmonella
Shigella
552
Q

Beta lactamase inhibitors

A

Clavulanic acid
Sulbactam
Tazobactam

Add to pencillinase sensitive drugs

553
Q

Resistant otitis media

A

Amoxicillin + clavulanic acid

Cefdinir (3rd generation)

554
Q

Surgical infections

A

Sulbactam + ampicillin

555
Q

Carboxypenicillins

  • examples
  • MOA
  • use
A

Ticarcillin
Carbenicillin
Piperacillin

Attacking cell wall

Pseudomonas
Gram neg rods

Suscpetible to penicillinase

556
Q

Pseudomonas infxn treatment

A 
CAMPFIRE
Carbapenems
Aminoglycosides
Monobactams
Polymyxins
Fluroquinolones (ciprofloxacin, levofloxacin)
thIRd and fourth generation cephalosporins
- ceftazidime
- cefepime
Extended spectrum penicillins
-Ticarcillin
-Carbenicillin
-Piperacillin
557
Q

Cephalosporins

  • MOA
  • Coverage
  • Inhibition
A

Active against cell wall
Bind to penicillin binding proteins

Gram (+)
Gram (-)

Less susceptible to penicillases

558
Q

1st generation cephalosporins

A

Cefazolin
Cephalexin

Gram + cocci

PEcK
Proteus mirabilis
E. coli
Klebsiella

UTIs
URIs

Prophylaxis viridans strep endocarditis

559
Q

1st line prophylaxis against viridans strep endocarditis

A

Amoxicillin

560
Q

2nd generation cephalosporins

A

Cefoxitin
Cefaclor
Cefuroxime
Cefprozil

HENS PEcK
H. influenza
Enterobacter
Neisseria
Serratia marcescens
Proteus mirabilis
Ecoli
Klebsiella

Not used for gonorrhea

561
Q

3rd generation cephalosporins

A

Ceftriaxone
Cefotaxime
Ceftazidime
Cefdinir

Serious gram - infections

HENS PEcK
E.coli
Proteus mirabilis
Klebsiella
Enterobacter
Serratia
Citrobacter
Neisseria
H. influenza
Strep pneumoniae **
562
Q

Tx neisseria gonorrhoeae

  • details (3)
A

Ceftriaxone

Longest 1/2 life
GIve IV
Excreted in bile (good for renal failure)

563
Q

4th generation cephalosporin

  • use
  • coverage
A

cefepime
broad spectrum
Pseudomonas

Gram + coverage

564
Q

5h generation cephalosporin

A

Ceftaroline
Broad spectrum

MRSA

565
Q

Cephalosporin for MRSA

A

Ceftaroline

566
Q

Cephalosporins not effective against

A 
LAME
Listeria
Atypicals (mycoplasma, chlamydia)
MRSA
Enterococci
567
Q

Aztreonam

  • MOA
  • key feature
  • covers
A

Monocyclic beta lactam

Inhibits cell wall synthesis
Binds to penicillin binding protein 3

No sensitivity allergy

E. Coli
Lebsiella
Pseudomonas
Serratia
(Gram neg only)
568
Q

Carbapenems

  • Examples
  • Coverage
  • MOA
A

Imipenem- cilastatin
Meropenem
Ertapenem
Doripenem

Gram + cocci
Gram - rods
Anaerobes
Pseudomonas

Binding penicillin binding proteins

569
Q

Imipenem and cilastatin

A

Cilastatin inhibitor of renal dehydropeptidase 1

Decreased activation of imipenem in renal tubules

570
Q

Ab that decreases seizure risk

571
Q

Vancomycin

  • MOA
  • Coverage
  • Toxic
A

Inhibit cell wall synthesis
Inhibits cell wall mucopeptide formation by binding to the D-ala D-ala moieties of the cell wall precursors

Inhibts cell wall glycopeptide polymerization

Gram positive only
MRSA
Enterococci
Clostridium difficile (oral) 
Coagulase negative staph endocarditis

NOT
Nephrotoxicity
Ototoxicity
Thrombophelbitis

Redman syndrome
- diffuse flushing
- nonspecific mast cell degranulation
pretreat w/ antihistamines

572
Q

Whcih antihypertensive is associated iwth

1) Bradycardia, asthma exacerbation
2) Reflex tachycardia
3) Elevated anti-histone antibodies
4) Hypercalemia

A

1) Beta blockers

2) Any vasodilator
- Nitrates
- Dihydropyridien CCB
- Minoxidil
- Hydralazine

3) Hydralazine
4) Hydrochlorothiazide

573
Q

Protein synthesis inhibitors

mneumonic

A

Buy AT 30, CCELL at 50

30S inhibitors

  • Aminoglycosides
  • Tetracyclines

50S

  • Chloramphenicol
  • Clindamycin
  • Erythromycin, macrolides
  • Lincomycin
  • Linezolid
574
Q

MRSA tx on outpatient basis

Can cause

A

Linezolid

Serotonin syndrome

575
Q

TCA

  • MOA
  • coverage
  • avoid with
  • toxicity
A

Binds 30S
Prevents attachment of aminoacyl tRNA

VACUUM THe BedRoom
Vibrio cholerae
Acne
Chlamydia
Ureapolasma urelyticum
Mycoplasma pneumoniae
Tularemia
Helicobacter pylori
Borrelia burgdorferi
Rickettsia

Avoid with
- milk antiacids
Iron, calcium, magnesium
(inhibit absorption in gut)

Discoloration teeth
Inhibit bone growth kids
Photosensitivity
Blue skin (minocycline)

576
Q

Patient presents with blue skin

antibiotic?

A

Minocycline (TCA)

577
Q

Aminoglycosides

  • MOA
  • Ineffective against
  • Use
  • TOxicity
A

Mean GNATs can NOT kill anaerobes

Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin

Inhibits the formation of the initation complex and causes misreading of mRNA

Ineffective against anaerobes

Use

  • severe gram negative rod infections
  • bowel surgery (neomycin)

“NOT”
Nephrotoxicity
Ototoxicity
Tetatogenic

578
Q

Macrolides

  • Examples
  • MOA
  • Coverage
  • Adverse effects
  • key feature
  • resistance
A

Azithromycin
Clarithromycin
Erythromycin

-romycin

Inhibits protein synthesis by blocking translocation

Binds to the 23S rRNA of the 50S ribosomal subunit

“PUS”
Pneumonia
-Mycoplasma Chlamydophilia, legionella

URI

  • strep pyogenes
  • h. influenza

STD

  • chlamydia
  • gonorrhea

Prolonged QT
Drug interaction w/ warfarin

Safe in pregnancy

Methylation of the 23S rRNA binding site

579
Q

Chloramphenicol

  • MOA
  • Coverage
  • Toxicity
A

Inhibits 50S peptidyltransferase activity

Meningitis

  • H. influenza
  • N. meningitides
  • strep. pneumoniae

Toxicity

  • Anemia
  • Aplastic anemia
  • Gray baby syndrome
580
Q 
Vomiting
Grey color of skin
Poor muscle tone
Cyanosis
CV collapse

Tx

A

Gray baby syndrome

Chloramphenicol

Phenobarbital

581
Q

Streptogramins

  • MOA
  • Use
  • SE
  • Inhibit
A

Quinupristin
Dalfopristin

Bind 23S portion of 50S

MRSA
VRE
Staph and Strep skin infxn

Hepatotoxicity
Pseudomembranous colitis

Inhibit CYP450

582
Q

Clindamycin

  • MOA
  • Use
  • Toxicity
A

Blocks peptide bond formation with the 50S subunit

Anaerobic infections **
MRSA
Protozoal infections
Topically acne
Bacteroides fragilis
Clostridium perfringens
MRSA skin abscess

Toxicity: pseudomembranous colitis

583
Q

Glycylcyclines

  • Example
  • MOA
A

Tigecycline

Binds to 30S

584
Q

atypical pneumonia coverage

A

Macrolides

- romycin

585
Q

Drugs with photosensitivity

A

SAT
Sulfonamides
Amiodarone
Tetracycline

586
Q

Side effects of aminoglycosdies

A

NOT

Nephrotoxicity
Ototoxicity
Teratogenic

587
Q

Gray man syndrome

A

Amiodarone

588
Q

Redman syndrome

A

Vancomycin

too quick infusion

589
Q

Sulfonamides

  • examples
  • MOA
  • side effect
A

Sulfamethoxazole
Sulfadiazine

Folic acid inhibitors
Competitive inhibitors of enzyme dihydropteroate synthetase

Hemolysis in G6PD def
Nephrotoxicity
Kernicterus (infants brain damage due to bilirubin build up) 
Photosensitivity
Steven Johnson syndrome
590
Q

Sulfa drug allergies

A

“Sulfa Pills Frequently Cause Terrible Allergy Symptoms”

Sulfasalazine
Probenecid
Furosemide
Celecoxib
Thaizide (TMP-SMX)
Acetazolamide
Sulfonyureas
591
Q

Steven Johnson syndrome

A 
Steve Jobs made APPLE PCS
Allopurinol
Phenyltoin
Phenobarbital
Lamotrigine
Ethosuximide
Penicillin
Carbamazepine
Sulfonamides
Fever
Bullae formation and necrosis
Sloughing of skin 
\+ Nikolsky
Targetoid lesions
592
Q

Trimethoprim

  • MOA
  • Toxicity
A

Inhibits dihydrofolate reductase

Megaloblastic anemia
Leukopenia
Granulocytopenia

593
Q

TMP-SMX uses

A 
UTIs
Shigella
Salmonella
MRSA skin infections
Pneumocystis jirovecii pneuonia
594
Q

Inhibits dihydrofolate reductase

A

Trimethoprim

Methotrexate

595
Q

Fluoroquinolones

  • Examples
  • MOA
  • Dont take with
  • Use
  • Side effect
  • Resistance
A

Levofloxacin
Nalidixic acid

Inhibits DNA gyrase (topisomerase II)

Dont take w/ antiacids or supplements contains calcium, iron or magnesium

Gram negative infections
Gram negative rods
UTIs
GI tract infections
Pseudomonas
Varying Gram positive coverage

Cartilage damage
Tendonitis and tendon rupture
QT interval prolongation

Chromosome endoced mutation at the DNA gyrase

596
Q

Drug to use in children iwth cystic fibrosis with pseudomonas

A

Fluorquinolones

597
Q

Antibiotic that treats protozoal infections

A

Metronidazole

598
Q

Metronidazole

  • MOA
  • Uses
  • Adverse reaction
A

Forms toxic radicals that damage DNA

"GET GAP on the Metro"
Giardia lamblia
Entamoeba histolytica
Trichomonas
GArdnerella vaginalis
Anaerobic bacteria (clostridium spp, bacteriodes fragillis) 
Pylori

Disulfiram like reaction

599
Q

Prophylaxis

1) meningococcal meningitis

2) H. influenza meningitis
Tx

3) Gonorrhea
4) Syphilis
5) Recurrent UTIs
6) Pneumocystisi jirovecii (CD4<200)
7) Endocarditis (dental procedure)
8) Group B strep (pregnant)
9) Gonococcal/ chlamydial conjunctivitis
10) Legionella tx
11) Pseudomonas tx
12) Chlamydia trachomatis
13) Candida albicans
14) Cyroptococus neoformans
15) Toxoplasma gondii

A

1) Ciprofloxacin

2) Rifampin (prophylaxis)
Tx: Ceftriaxone/ penicillin

3) Ceftriaxone (add doxycycline for c. trachomatis)
4) Penicillin G

5) TMP-SMX
Amoxicillin

6) TMP-SMX
7) Penicillin, Amoxicillin, Cephalexin
8) Ampicillin
9) Erythromycin
10) Macrolides (azithromycin)
11) Piperacillin/ tazobactam, aminoglycosides, carbapenems
12) Doxycycline

13) Fluconazole, Caspofungin
Amphotericin B

14) Amphotericin B and flucytosine
Maintenance: fluconazole

15) Sulfadiazine + pyrimethamine

600
Q

Identify antibiotic

1) Inhibit dihydropteroate syntherase
2) Inhibit dihydrofolate reductase
3) Inhibits DNA gyrase (topoisomerase III)
4) Inhibit bacterial ribosomes
5) Forms toxic free radicals that damages DNA
6) Acts like cationic detergent

A

1) Sulfonamides

2) Trimethoprim
Methotrexate

3) Fluoroquinoles
4) Nitrofurantoin
5) Metronidazole
6) Polymyxin B

601
Q

Empiric Tx Meningitis

A

Broad spectrum

Ceftriaxone
Vancomycin
Ampicillin

602
Q

Tx if exposed to bacillus anthracis

A

Ciprofloxacin

Doxycycline

603
Q

Side effects of beta blocker

A 
Exacerbation of asthma
Increase blood glucose
Mask symptoms of hypoglycemia
Bradycardia
AV block
CHF
604
Q

HIV prophylaxis to newborn

A

Zidovudine

605
Q

HSV prophylaxis for newborn

A

Mother: acyclovir starting at 36 weeks

606
Q

Drug for mood swings that causes excess thirst

A

SSRI

  • Fluoxetine
  • Sertraline
  • Escitalopram

Causes SIADH

607
Q

Drug that increases K out of cells and decrease cardiac conduction

608
Q

Megestrol

A

Progestin

Binds progesterone receptor

Use: chemotherapy adverse effects treatment
Tx: loss of appetite
Tx: muscle wasting

609
Q

SVT treatment

A

Antiarrhythmic Na channel blocks

Quinidine, Prcainamdie
Dispyramide

Flecainide
Propafenone

Beta blockers

Ca channel blockers

610
Q

Which antibiotic?

1) Inhibits prokaryotic RNA polymerase
2) Inhibits prokaryotic topoisomerase
3) Inhibits prokaryotic dihydrofolate reductase

A

1) Rifampin
2) Fluroquinoles
3) Trimethoprim

611
Q

Macrolides effective against

A

“PUS”

Pneumonia
(atypical)
- mycoplasma pneu
- Legionella
- Chlamydophilia pneu

URI

  • Strep pyogenes
  • H. influenza

STDS

  • Gonorrhea
  • Chlamydia
612
Q

Topoisomerase inhibited by

A

Fluoroquinoles

Etoposide

613
Q

Tetracyclines effective against

A

VACUuM THe BedRoom

Vibrio cholerae
Ache
Chlamydia
Ureaplasma urelyticum
Mycoplasma pneumoniae
Tularemia
H. pylori
Borrelia burgdorferi 
RIckettsia rickettci
614
Q

Rifampin

A

4 Rs

Inhibits RNA polymerase
Red secretions
RREvs up cytochrome p450

615
Q

Antipsychotics decrease

616
Q

1st generation Antipsychotics

A

Anti cholinergic (sedation, dry mouth, ileus, urinary retention, orthostatic HTN)

  • Chlorpromazine
  • Thioridazine
Higher potency
(Tardive dyskinesia, neuroleptic malignant)
- Haloperidol
- Fluphenazine
(Loxapine)
(Thiothixene)
(Trifluoperazine)

D2 receptor inhibition

Anti HAM

  • Histamine 1
  • Alpha 1
  • Muscarinic i
617
Q

Second generation Antipsychotics (Atypical)

A 
Olanzapine
Quetiapine
Risperidone
Aripiprazole
Clozapine
  • apine
  • asidone

Fewer EPS
Fewer anticholinergic
Weight GAIN

D2 and 5HT2a inhibition

618
Q

Neuroleptic malignant syndrome

Tx

A 
Mental status changes
Hyperthermia
Sympathetic hyperactivity
Diffuse rigidity (lead pipe)
Hyporeflexia

Dantrolene
Dopaminergic drugs
- Bromocriptine (DA agonist)
- Amantadine (Increase DA release)

619
Q

Antipsychotic causes agranulocytosis

620
Q

which antipsychotic is most closely associated with increased risk of diabetes?

A

Olanzapine

621
Q

Bipolar treatment

A

Mood stabilizer
- Lithium

Atypical antipsychotics

  • Risperidone
  • Aripiprazole
  • Olanzapine

Antiepileptics

  • Lamotrigine
  • Valproic acid
  • Carbamazepine
622
Q

Side effects Lithium

A

LITHIUM

Loopy (sedation/ dizziness)
Increased urination
Tremors
Hypothyroidism
Increased thirst
Underactive memory
Myocardial heart lock
623
Q

Antidepressants

  • do what
  • types
  • use
A

Decrease serotonin and decrease NE

SSRI (-xetine, not duloxetine)
SNRIs (-faxine)
TCA (-pramine, triptyline)
MOA Inhibitorss (giline)

Anxiety
OCD
PTSD
Bulemia

624
Q

SSRIs

  • Examples
  • MOA
  • Side effects
A

Fluoxetine
Sertraline
Paroxetine
Citalopram

Inhibit reuptake of serotonin

Sexual dysfunction
Serotonin syndrome

625
Q

Serotonin syndrome

Tx

A 
Increased muscle activity
Hyperthermia
Hyperreflexia
Myoclonus
Autonomic instability
- HTN
- Tachycardia
Flushing
Diarrhea
Mental status changes

Stop drug
Cool patient
Benzodiazepines
Cyproheptadine

626
Q

SNRI

  • Examples
  • MOA
  • Use
  • Side effect
A

Venlafaxine
Desvenlafaxine
Duloxetine
Milnacipran (fibromyalgia)

Serotonin an dNE reuptake inhibitors

Depression
Generalized anxiety
Chronic pain (duloxetine)
Fibromyalgia (milnacipran)

SE

  • Increased BP
  • Sedation
627
Q

TCA

  • Examples
  • MOA
  • Uses
  • Side effects
A 
Amitriptyline
Nortriptyline
Clomipramine
Imipramine
Amoxapine
Doxepin

Blocks reuptake of NE and serotonin

Enuresis (imipramine)
OCD (clomipramine)
Fibromyalgia (amitriptyline)

Anticholinergic effects
Prolong QT

628
Q

Prolong QT

A 
Amiodarone
Dofetilide
Fluoroquinoles
Macrolide (azithromycin)
Ranalazine
Sotalol
629
Q

Torsades

A

ABCDE

antiArrthmic

  • Type IA
  • Type III (amiodarone, sotalol, dofetilide)

antiBiotic

  • Macrolide (azithromycin)
  • Fluroquinolones

antipsyCotic
- Haloperidol

anti-depressant
- TCA

antiEmetic
- ondasetron

630
Q

TCA overdose

Tx

A 
Tachycardia
Hypotension
Arrthymias
Sedation, Coma
Seizure
Dry mouth, urinary retention

Sodium Bicarb

631
Q

MAO inhibitors

  • examples
  • MOA
  • side effect
A

Tranylcypromine
PHenelzine
Selegiline
Rasagiline

Inhibit MAO, which breaks down serotonin and catecholamines (NE an DA)
- Increases NA and DA

Selegiline and Rasagiline

  • selective MAO B inhibitors
  • Break down dopamine

Hypertensive crisis w/ ingestion of tyramine

  • Brown bananas
  • Wine
  • Aged cheeses
  • Soy sauce
632
Q

Antidepressants

Amitriptyline
Bupropion
Citalopram
Clomipramine
Doxepin
Duloxetine
Fluoxetine
Imipramine
Nefazodone
Nortriptyline
Paroxetine
Phenelzine
Sertraline
Tranylcypromine
Trazodone
Venlafaxine
A 
Amitriptyline= TCA
Bupropion= NDRI
Citalopram= SSRI
Clomipramine= TCA
Doxepin= TCA
Duloxetine= SNRI
Fluoxetine= SSRI
Imipramine= TCA
Nefazodone= Sero modulat
Nortriptyline= TCA
Paroxetine= SSRI
Phenelzine= MAOI
Sertraline= SSRI
Tranylcypromine= MAOI
Trazodone= Sero Modulator
Venlafaxine= SNRI
633
Q

Which antidepressant

1) Side effect of priapism
2) Lowers teh seizure threshold
3) Appetite stimulant that is likely to results in WG
4) Can be used for smoking cessation
5) Can be used for bed wetting

A

1) Trazodone, nefazodone
2) Bupropion
3) Mirtazapine
4) Bupropion
5) Imipramine

634
Q

Symptoms of TCA overdose

A

Tri C’s

Cardotoxicity: arrthymias
CNS toxicity: seizure coma
antiCholinergic: confusion, urinary retention, hyperpyrexia

635
Q

Bupropion

  • MOA
  • Uses
  • effect
  • Lowers
A

NE dopamine reuptake inhibitor (NDRI)

Depression
Smoking cessation

Stimulant effect

Lowers seizure threshold (increse risk of seizure)

Does NOT cause sexual dysfunction

636
Q

Mirtazapine

  • type
  • MOA
  • Use
A

Alpha 2 antagonist on presynaptic

Inhibits alpha 2 receptor inhibition on NE and serotonin release

Increases NE and 5-HT release

Weight gain
Sleep

637
Q

Serotonin modulators

  • examples
  • uses
  • side effects
A

Old drugs

  • Trazadone, nefazodone
  • depression, insomnia
  • alpha blocking (hypotension)
  • antihistamine (sedation)
  • PRIAPISM (painful persistent penile erection

New drugs

  • Vilazodone, vortioxetine
  • Depression
  • SE: GI upset, anticholinergic, serotonin syndrome
638
Q

Patient cant get MRI due to claustrophobia what can you give

A

Benzodiazepine

639
Q

Young woman daily anxiety that worsens by her stressful job. Brief episodes of intense fear and palpitations even outside stressful situations still anxious. Tx?

A

GEneralized anxiety disorder
- SSRI

Panic attacks
-Benzo

640
Q

Afraid of giving a speech in public tx

A

SSRI

Beta blocker

641
Q

OCD tx

A

SSRI

Clomipramine (TCA)

642
Q

PTSD tx

643
Q

Buspirone

A

Stimulates serotonin receptor
Generalized anxiety disorder

Not many side effects

644
Q

Tx Anorexia norvosa

A

Supportive therapy

Counseling

645
Q

Tx Bulimia nervosa

A

SSRI (fluoxetine)

646
Q

Electrolyte disorder from bulimia nervosa

A

Hypokalemic hypochloremic metabolic alkalosis

647
Q

Tx Tourette syndrome

A

Tics > 1 year

Behavioral therapy
Alpha 2 agonist (clonidine
Anti dopamine drugs
Fluphenazine, pimozide)

648
Q

Medications to help prevent relapse in recovering alcoholic

A

Naltrexone
- opioid antagonist

Acamprosate

Disulfiram

Topiramate
- Affect glutamate receptors, modulate glutamate transmission

649
Q

Patient presents with agitation, anxiety, delirum and seizures

What is he suffering from?
Tx

A

Barbiturate, benzodiazepines withdrawal

Reversal agent: flumazenil
- can cause seizures

650
Q

Patient presents with Pin point pupils and respiratory depression and confusion

What is he suffering from
Tx

A

Opioid intoxication

Tx Naloxone
Naltrexone

651
Q

Patient comes in agitated, anxious, elevated BP, tachycardia, dilated pupils, paranoid

What is he suffering from
Tx

A

Amphetamine or cocaine intoxication

Benzodiazepines (agitation)
Haloperidol( paranoid idealations)

652
Q

Patient come in sweating, dilated pupils, goose bumps, runny nose

What is he suffering from
Tx

A

Opioid withdrawal

Methadone

653
Q

Tx PCP

A

Benzo

Haloperidol

654
Q

Class I (NA channel blocking) antiarrhythmics

Class IA

  • specific agents
  • effect on phase 0
  • Effect on length of AP

Class IB

  • specific agents
  • effect on phase 0
  • Effect on length of AP

Class IC

  • specific agents
  • effect on phase 0
  • Effect on length of AP
A

Class IA

  • Disopyramide
  • Quinidine
  • Procainamide
  • Intermediate inhibition of phase zero
  • Prolonged AP

Class IB

  • Lidocaine
  • Mexiletine
  • Weak inhibition of phase 0
  • Shortened AP

Class IC

  • Flecainide
  • Propafenone
  • Strong inhibition of phase 0
  • No change on AP
655
Q

Potassium-sparing diuretics (2 types)

A

“SEAT”
Aldosterone antagonists
- Spironolactone
- Eplerenone

Inhibit epithelial Na channel

  • Amiloride
  • Triamterene
656
Q

What diuretic directly affects principal cells

A

Potassium sparing diuretics

657
Q

What class of drug inhibits Na/2Cl/K symporter in thick ascending limb

A

Loop diuretics

Cause isotonic water excretion

658
Q

PCT diuretic

A

Acetazolamide

Mannitol

659
Q

Acetazolamide

  • MOA
  • Effect
  • Use
  • Side effect
A

Carbonic anhydrase inhibitor
Cant reabsorb bicarb
Excreted in urine

Facilitate excretion of bicarb

Altitude sickness (over come resp alkosis more quickly)
Urine alkalinization
Glaucoma

Idiopathic intracranial HTN

  • First line
  • reduces CSF production as well

Metabolic acidosis
Sulfa allergy

660
Q

First line drug for Idiopathic intracranial HTN

A

Acetazolamide

661
Q

Mannitol

  • MOA
  • Effect
  • Use
  • SE
  • Contraindications
A

Osmotic diuretic

  • causes osmolar load to stay in filtrate
  • prevent reabsorption of water
  • cause excretion of water

Increase serum osm
Increase serum Na

Shock
Drug overdose
Glaucoma
Elevated ICP

SE
- dehydration

Contraindications

  • Anuric renal failure
  • CHF
662
Q

Loop diuretics

  • Examples
  • MOA
  • Calcium
  • Uses
A

Bumetanide
Ethacrynic acid
Furosemide
Torsemide

Inhibit Na/K/CL cotransporter
- cant concentrate urine

Loops lose calcium

CHF
Pulmonary edema
Nephrotic syndrome
Cirrhosis

[NOT HTN]

Sulfa allergy 
(all but ethacrynic acid)
Hypokalemia
Dehydration
Gout
Ototoxicity
Nephrotoxicity
663
Q

Patient with pulmonary edema needs diuretic but is allergic to sulfa give what

A

Ethacrynic acid

664
Q

Thiazide diuretic

  • Examples
  • MOA
  • Calcium
  • Uses
  • Side effects
A

Chlorthalidone
Hydrochlorothiazide
Metolazone

Inhibit reabsorption of Na and Cl

Retain calcium
Help with osteoporosis

HTN (first line)
Idiopathic hypercalciuria (not if hypercalcemia)
Nephrogenic diabetes insipidus

Hypokalemia
Hyponatremia
Hyperglycemia
Hyperlipidemia
Hyperuricemia
Hypercalcemia
Sulfa allergy
665
Q

Potassium sparing diuretics

  • Examples
  • MOA
  • Uses
  • SE
A

Aldosterone antagonists

  • Spironolactone
  • Eplerenone

Block Na channel

  • Amiloride
  • Triamterene

Give w/ Loop diuretic to retain potassium
CHF (aldosterone antagonist)

SE
- Hyperkalemia –> arrthymias
- Antagonist androgen receptor –> gynecomastia
Anti-androgen effects
Menstrual irregularities (except eplerenone)

666
Q

Diuretic drugs that are sulfa drugs

A

Acetazolamide

Loop diuretics
- Bumetanide
- Furosemide
- Torsemide
[Not ethacrynic acid)

All thiazides

667
Q

Diuretics that increase NaCl

A

All except acetazolamide

668
Q

Diuretics that causes acidosis

A

Carbonic anhydrase inhibitor (acetazolamide)

K sparing diuretics

669
Q

Diuretics that cause alkalosis

A

[ Lose Na CL in urine, become hypochloremic –> reduced excretion of bicarb]

Loop diuretics
THiazide diuretics

670
Q

Why are aminoglycosides ineffective against gram positive anaerobes

A

Aminoglycosides require oxygen to enter bacterial wall

Use O2 in AminO2glycosides

Use: Metronidazole or clindomycin

671
Q

Tx Central DI

Tx Nephrogenic DI

A

Central: intranasal desmopressin

Nephrogenic DI:
- Hydrochlorothiazide (first line)
(causes dehydration so PCT will concentrate more)

Indomethacin

  • inhibit prostaglandin syn
  • reduce urine output

Amiloride

  • Lithium induced nephrogenic DI
  • Blocks Na channels Lithium uses to enter
672
Q

Tx for Nephrogenic DI caused by Lithium

A

Amiloride

- Blocks Na channels Lithium uses to enter

673
Q

Identify

1) Confusion, seizures, coma
2) abdominal pains, stones, psychosis
3) Tetany, chvostek sign
4) Tetany, Wide QRS, arrthymias
5) Depression of reflexes
6) Prolong QT, flattened T waves, U wave
7) V tach, tall peaked T waves

A

1) Hyponatremia
2) Hypercalcemia
3) Hypocalcemia
4) Hypomagnesemia
5) Hypermagnesemia
6) Hypokalemia
7) Hyperkalemia

674
Q

Drugs that cause Acute interstitial nephritis

A 
NSAIDS
Antibiotics
- pencillin
-cephalosporin
- ciproflxacin
- rifampin
Diuretics
PPI
Cimetidine
Allopurinol
675
Q

Anticholinergic toxicity

A 
Dry as a bone
Hot as a hare
Blind as a bat
Mad as a hatter
Red as beet
Bloated as a toad
676
Q

Vaccines

1) 1st Given
2) Who gets flu shot
3) 2 months
4) 4 months
5) 6 months
6) Vaccines between age 7 and 18

A

1) Hep B- 1st given
2) Yearly from 6 months

2,4,6 (8) who do we appreciate STRIPPERS

“Damn BaBy, ROTate that ass on the POLe”

3) Dtap, HepB, Hib, Rotavirus, Polio (IPV), PCV (pneumococcal)
4) DTaP, Hib, Polio, PCV, Rotavirus
5) DTAP, Hib, PCV, RV
6) Influenza, HPV, Meningococcal, Tdap

677
Q

Tx for neonatal infections

A

Ampicillin + gentimycin

678
Q

Metoclopramide

-MOA

A

Antagonist at dopamine D2 receptor

Serotonin agonist

Increase contractility in GI tract

679
Q

Dantrolene used in

A

Malignant hyperthermia

Neuroleptic malignant syndrome

680
Q

Tx for hyperprolactinemia

A

Dopamine antagonists

  • Bromocriptine
  • Cabergoline

Antipsychotics

  • Haloperidol
  • risperidone

Domperidone

Metoclopramide

681
Q

Somatostatin analog

A

Octreotide
Somatostatin LAR
Lanreotide-P

Tx for: 
Pituitary excesses
Zollinger-Ellison
Carcinoid
VIPoma
Insulinoma

Bleeding varices
Bleeding peptic ulcers

682
Q

Diagnosis Acromegaly

Tx Acromegaly

A

Diagnosis= IGF-1

Tx: Octreotide

683
Q

Treatment Phenochromocytomas

What do you not give?

A

Surgical removal

Alpha blocker
- phenoxybenzamine
(nonselective irreversible)

Never give beta blocker by itself

  • Make HTN worse
  • Epinephrine stimulates both beta and alpha receptors
  • Just block beta –> still stimulating alpha receptors –> alpha 1 vasoconstriction –> raise BP
684
Q

Tx Hypothyroidism

A

Levothyroxine

  • Synthetic analog of T4
  • No side effects if dosed correctly

Over dose

  • Tachycardia
  • Heat intolerance
  • Tremors
  • Arrhythmias

Triiodothyronine
- synthetic analog of T3

685
Q

Tx Hyperthyroidism

A

Methimazole (preferred)
Propylthiouracil (PTU)
Beta blockers (tachycardia and anxiety)

686
Q

Methimazole

  • MOA
  • side effect
A

Inhibits peroxidase enzyme in thyroid, part of thyroid hormone production

Agranulocytosis
(bone marrow stops making WBCs)

Pharyngitis, pharyngeal abscess, fever and sore throat

1st trimester

  • Fetal goiter and hypothyroidism
  • Fetal aplasia cutis (fetal scalp defect)
687
Q

What thyroid medication to use pregnancy for hyperthyroidism

A

1st trimester: Propylthiouracil (PTU)

2nd and 3rd trimester: Methimazole

688
Q

Propylthiouracil (PTU)

  • MOA
  • Side effects
A

Inhibits peroxidase in thyroid and conversion T4 –> T3 in periphery

Agranulocytosis
Liver dysfunction
Fetal goiter and hypothyroidism

689
Q

Thyroid storm

  • is what
  • symptoms
  • Tx
A

thyrotoxic crisis

Big surge of thyroid hormone and catecholamines

Increased body temp
Altered mental status
Tachycardia
Arrhythmias
Vomiting, diarrhea, dehydration
Coma
Death

Beta blocker
(for increased catecholamines)
Methimazole or PTU

690
Q

Which class of antibiotics inhibits prokaryotic DNA topisomerase

A

Fluoroquinoles

691
Q

Which type of antipsychotic is often the first line of treatment for psychosis?

Which antipsychotic should be reserved for severe refractory psychosis because of the risk of agranulocytosis?

A

Atypical antipsychotics

  • Risperidone
  • Aripiprazole
  • Olanzapine

Clozapine

692
Q

Quick insulin drugs

A

Aspart
Glulisine
Lispro

Used with meals

693
Q

Intermediate insulin drugs

A

NPH

Insulin

694
Q

Long duration insulin drugs

A

Glargine

Detemir

695
Q

First line choice for Type II DM drug

696
Q

Metformin

  • Type
  • MOA
  • Adverse effects
A

Biguanide

Decreases hepatic gluconeogenesis

Improve insulin sensitivity

Increased risk of lactic acidosis when used in renal failure

Limited to patients with good renal function

697
Q

Sulfonylureas

  • Drug names
  • MOA
  • Side effects
  • Down side to medication
A

Glimepiride
Glipizide
Glyburide

Closed K channels in beta cells –> depolarization –> increase Ca influx –>

Stimulates continuous insulin release from the beta cells

hypoglycemia
Weight gain

Requires pancreatic function

  • Not effective in Type I
  • not effective in Type II wiht long duration
698
Q

-glitazone

MOA
Side effect

A

Thiazolidinediones

Binds to peroxisome proliferator-activated receptor gamma (PPARy) receptors

Improves insulin sensitivity
Decreases hepatic gluconeogenesis

Weight gain
Fluid retention
Increased risk of CHF
Possible hepatotoxicity

699
Q

Incretin

what is it
most important one
3 fxn

Inhibited by

A

Gut derived hormone that augment pancreatic release of insulin in a glucose dependent way

Most important incretin= Glucagon Like Peptide (GLP-1)

  1. Increase glucose dependent insulin release from pancreas
  2. Decrease glucagon release
  3. Decrease gastric emptying

DDp-4 inactivates GLP-1

700
Q

What inactivates GLP-1

701
Q

Drugs that increase GLP-1 function

A

DDP-4 inhibitors
- endogenous GLP-1 has longer active time

GLP-1 agonist
- mimic effect of endogenous GLP-1

702
Q

-gliptin

A

DDP-4 inhibitors

Gliptin keep GLP in

703
Q

-glutide

side effects

A

GLP-1 agonist

Also Exenatide

Weight loss
Gi side effect nausea

704
Q

Liraglutide

A

Weight loss medication

705
Q

-flozin

MOA
Side effect

A

SGLT-2 inhibitors

-gliflozin

Inhibits Na glucose linked transporter in the kidney (more glucose loss in the urine)

Risk with kidney dysfunction
Glucose in urine –> UTIs, mycotic infections
Dehydration, polyurea
Possible DKA

706
Q

alpha-glucosidase inhibitors

A

Acarbose

  • Inhibit enzyme in brush border of enzyme
  • Loss of ingested carbs through stool

Miglitol

707
Q

Acarbose

A

alpha-glucosidase inhibitors

  • Inhibit enzyme in brush border of enzyme
  • Loss of ingested carbs through stool
708
Q

Lepirudin

A

Direct Thrombin inhibitors

-rudin
Lepirudin, Bivalirudin, Desirudin

Derivatives of hirudin

Directly inhibits thrombin

709
Q

Direct Thrombin inhibitors

A

-rudin
(Lepirudin, Bivalirudin, Desirudin)

Argatroban
Dabigatran

710
Q

Enoxaparin

A

Low Molecular weight heparin

-parin
Enoxaparin
Dalteparin

Stimulate antithrombin to inactivate factor Xa

SQ injections

Weight based dosing

711
Q

Fondaparinux

A

Activates antithrombin

Inhibits factor Xa

712
Q

Rivaroxaban

  • type
  • uses
A

Direct Factor Xa inhibitors

-xaban
Rivaroxaban
Apixaban

Oral anticoagulants

Afib
Prevent post-op DVT

713
Q

Inhibits epoxide reductase

  • drug
  • does what
  • decrease
  • increase
  • uses
  • contraindicated
A

Warfarin (Oral)

Responsible for recycling Vit K

Decrease Factor II, VII, IX, X
Protein C and S

Increase PT

Chronic anticoagulation

  • A fib
  • DVT prophylaxis
  • DVT treatment
  • PE treatment
714
Q

Warfarin use in pregnancy causes

A

Bone and cartilage problems in epiphyses

Nasal hypoplasia

715
Q

Heparin

  • administered
  • reverse
A

IV or subQ

Protamine sulfate

716
Q

Thombolytics

  • what are they
  • examples
  • does what
  • contraindications
  • reversal
A

Clot busting drugs

Streptokinse
Urokinse
tPA (alteplase)

Activates plasmin –> degrades fibrin

Active bleeding
hx intracranial bleeding
Recent surgery
Known bleeding disorder
Severe HTN

Aminocaproic acid

717
Q

Reversal drug for thrombolytics

A

Aminocaproic acid

718
Q

What medication inhibits alcohol dehydrogenase

A

Fomepizole

719
Q

ADP receptor inhibitors

A

-grel

Clopidogrel
Ticlopidine
Ticagrelor
Prasugrel

Block binding of ADP to receptor and expression of glycoprotein IIB/IIIA

MI
After coronary angioplasty
Prevent recurrent strokes
Aspirin allergy

720
Q

Glycoprotein IIb/IIIa inhibitors

A

Abciximab
Tirofiban
eptifibatide

Acute coronary syndrome
-NSTEMI
Angioplasty

721
Q

NSAIDS inhibit the production of which substance important for platelet aggregation

A

Thromboxane A2

722
Q

Which oral agent used in control of Type II diabetes

  1. Lactic acidosis is a rare but worrisome side effect
  2. Most common side effect is hypoglycemia
  3. MOA: closes K channel on beta cells –> depolarization –> Ca influx –> insulin release
  4. MOA: agonist at PPARy receptor
A
  1. Metformin
  2. Sulfonylureas
  3. Sulfonyureas
  4. Thiazolidinediones (TZDs)
723
Q

Tx Actinic keratosis

A

5-fluorouracil (5-fu)

724
Q

Blocks dihydrofolate reductase

side effect

A

Methotrexate

Myelosuppression
- reversible w/ leucovorin

Hepatotoxicity

Mucositis (mouth ulcers)

Fibrotic lung disease

Teratogenicity
- folate deficiency

Nephrotoxicity

725
Q

How to reverse myelosuppresion of methotrexate

A

Leucovorin

726
Q

Inhibits thymidylate synthase

side effect

A

dUMP–> dTMP

5-fluorouracil

pyrimidine analog

Myelosuppression
- uridine rescue agent

Photosensitivity

727
Q

Myelosuppression due to 5-FU reversed by

728
Q

Blocks Glutamine PRPP amidotransferase

Key feature
Side effect

A

6-Mercaptopurine

S-phase antimetabolite

Purine analog

Metabolized by xanthine oxidase

Hepatotoxicity

729
Q

6-thioguanine

A

Same as 6-MP but not metabolized by xanthine oxidase

Can be given w/ allopurinol

730
Q

Inhibits DNA polymerase
Purine analog

  • Does what
  • tx for
  • side effects
A

Cladribine

Purine analog
Induces DNA breaks

Uses
- Hairy cell leukemia

Neurotoxicity
Nephrotoxicity

731
Q

Inhibits DNA polymerase
Pyrimidine analog

  • use
  • side effect
A

Cytarabine

AML

Megaloblastic anemia

732
Q

Cancer alkylating agents

A

Cyclophosphamide
Ifosfamide
Nitrosoureas
Busulfan

733
Q

Cancer anthrocyclines

  • MOA

Toxicity

A

Doxorubicin and daunorubicin

  1. Generate free radicals
  2. Intercalate DNA
    - wedge into DNA between base pairs and form tight bonds
    - DNA can not unwind

Cardiotoxicity
- dilated cardiomyopathy

734
Q

Tx for cardiotoxicity w/ doxorubicin and daunorubicin

A

Dexrazoxane

Iron chelating drug

735
Q

Can cause pulmonary fibrosis cancer drug

A

Busulfan (alkylating agent)

Bleomycin ( free radicals)

736
Q

-mustine

A

Nitrosoureas

alkylating agent

Cross BBB
- brain tumors

CNS toxicity

737
Q

Cancer drug that can cause hemorrhagic cystitis

  • prevent with
A

Ifosfamide
Cyclophosphamide

Prevent w/ Mesna

738
Q

Alkylates guanine residues

  • use
  • specific feature
A

Cyclophosphamide

Immunosuppressant

  • Lupus nephritis
  • POlyarteritis nodosa

Requires bioactivation in liver

739
Q

Used to tx brain tumors

A

Nitrosoureas

- mustine

740
Q

What cancer drug requires bioactivation in liver

A

Cyclophosphamide

741
Q

Dactinomycin

  • MOA
  • Uses
A

Intercalates DNA

Wilms tumor
Ewing sarcoma
Rhabdomyosarcoma

742
Q

List what drug you give this with and what for

  1. Dexrazoxane
  2. Leucovorin
  3. Mesna
  4. Uridine
A
  1. Dexrazoxane
    - Doxorubicin, Daunorubicin
    - Cardiotoxicity
  2. Leucovorin
    - Methotrexate
    - Myelosuppression
  3. Mesna
    - Cyclophosphamide
    - Hemorrhagic cystitis
  4. Uridine
    - 5-FU
    - Myelosuppression
743
Q

Bleomycin

  • MOA
  • Side effect
  • use
A

Binds to DNA and causes ssDNA and dsDNA breaks

Generates free radicals

Pulmonary fibrosis

Testicular cancer

744
Q

Tx for testicular cancer

A

Bleomycin
Etoposide
Cisplatin

745
Q

Which anticancer drug fits

  1. Alkylates DNA, toxicity –> pulmonary fibrosis
  2. Fragments DNA, toxicity –> pulmonary fibrosis
  3. Blocks purine synthesis, metabolized by xanthine oxidase
  4. Nitrogen mustard, alkylates DNA (electrophile that binds DNA)
  5. Folic acid analog that inhibits dihydrofolate reductase
  6. Intercalates DNA produces oxygen free radicals, cardiotoxic
  7. DNA alkylating agents used in brain cancer
  8. Applied topically for actinic keratoses and basal cell cancers
  9. Treatment for childhood tumors (Ewing sarcoma, Wilms tumor, rhabdomyosarcoma)
  10. Side effect of hemorrhagic cystitis
A
  1. Busulfan
  2. Bleomycin
  3. 6-mercaptopurine
  4. Nitrosoureas
  5. Methotrexate
  6. Doxorubicin, Daunorubicin
  7. Nitrosureas
  8. 5-fluorouracil
  9. Dactinomycin
  10. Cyclophosphamide, Ifosfamide
746
Q

Cross links DNA

  • uses
  • side effects
A

Cisplatin, carboplatin, oxaliplatin

Testicular cancer
Ovarian cancer
Bladder cancer

Nephrotoxicity
Ototoxicity

747
Q

Causes nephrotoxicity and ototoxicity

A

Vancomycin
Aminoglycosides
Loop diuretics
Cisplatin and carboplatin

748
Q

Inhibits Topoisomerase II

Cancer drugs

A

Etoposide

Teniposide

749
Q

Treating testicular cancer

A

“Eradicate Ball Cancer”

Etoposide + Bleomycin + Cisplatin

Etoposide + ifosfamide + cisplatin

750
Q

Inhibit topoisomerase I

A

Irinotecan

Topotecan

751
Q

Blocks polymerization of microtubules

A

Vincristine

Vinblastine

752
Q

Vincristine

  • uses
  • toxicity
A

Hodgkin lymphoma
Wilms tumor
Ewing sarcoma
Choriocarcinoma

Neurotoxicity
Peripheral neuritis

753
Q

Vinblastine- side effect

A

Myelosuppression

754
Q

Tx choriocarcinoma

A

Vincristine

Methotrexate

755
Q

Hyperstabilizes the microtubules

Side effect

A

Paclitaxel

Myelosuppresion

Hypersensitivity Rxn

756
Q

Interferes with microtubules

A 
Vincristine
Vinblastine
Paclitaxel
Mebendazole
Albendazole
Griseofulvin
Cochicine
757
Q

Inhibits ribonucleotide reductase

-uses

A

Hydroxyurea

Inhibits DNA synthesis

CML
Myeloproliferative disorders

758
Q

Tamoxifen

A

-xifen
Selective estrogen receptor modulators (SERMs)

ER antagonist= Breast
ER agonist= bone
ER partial agonist= endometrium

Risk of endometrial carcinoma

759
Q

Raloxifene

A

-xifen
Selective estrogen receptor modulators (SERMs)

ER antagonist

  • Breast
  • Endometrium

ER agonist
- Bone

No risk endometrial cancer

760
Q

Monoclonal ab against HER-2

  • use
  • side effect
A

Trastuzumab

Tx breast cancer expressing HER-2

Cardiotoxic

761
Q

Cancer drug that causes

  1. Cardiotoxicity
  2. Hypersensitivity rxn
  3. Increased risk of endometrial cancer
  4. Nephrotoxicity and ototoxicity
  5. Peripheral neuropathy
A

1 Trastuzumab

  1. Paclitaxel
  2. Tamoxifen
  3. Cisplatin
  4. Vincristine
762
Q

Rituximab

A

Monoclonal Ab against CD20

763
Q

Imantinib

A

Enzyme inhibitor

Targets mutant BCR-ABL tyrosine kinase produced by philidelpha chromosome t(9;22)

CML
ALL
AML

764
Q

Protease inhibitors

  • tx
  • side effects
A

Borteozomib
Carfilzomib

Tx
Multiple myeloma
Mnatle cell lymphoma

Peripheral neuropathy
Risk of shingles

765
Q

Tx Tumor lysis syndrome

A

Hyperkalemia
Hyperphosphatemia
Hypercalcemia

IV hydration
ALlopurinol
Rasburicase

766
Q

Rasburicase

A

Recombiant form of urate oxidase (uricase)

Breaks down uric acid –> allantoin

Converted to ammonia and excreted in urine

767
Q

Bevacizumab

  • type
  • use
  • side effect
A

Monoclonal Ab against VEGF

Uses
- Metastic cancer

Impaired wound healing
Hemorrhage
- Hemoptysis
- Epistaxis
- GI bleeding
768
Q

Tx KRAS-positive metastic colon cancer

A

Cetuximab

Antibody against EGFR

Tyrosine kinase receptor

769
Q

Erlotinib

A

EGFR inhibitor

Used for non-small cell lung cancer

Rashes

770
Q

Vemurafenib

A

INhibitor of BRAF oncogene

Serine/ threonine kinase

Metastatic melanoma

771
Q

Treatmetn of choice for atrial fibrillation due to hyperthyroidism

A

Beta blocker (propranolol)

Methinazole

772
Q

Acyclovir

  • key feature
  • MOA
  • uses
A

Guanosine analog

First phosphorylated by viral thymidine kinase

Inhibits DNA plymerase

HSV-1
HSV-2
VZV
EBV

Valacyclovir hydrolyzed to acyclovir

773
Q

Famciclovir

A

Prodrug of penciclovir
- Acyclic guanosine nucleoside analog

Relies on viral thymidine kinase

HSV-1
HSV-2
VZV

Preferred over acyclovir for VZV

774
Q

Tx VZV

A

Famiclovir

775
Q

Tx HSV-1, HSV-2

A

Acyclovir

Famciclovir

776
Q

Ganciclovir

  • activated by
  • MOA
  • side effects
A

Activated by CMV viral kinase

Inhibits viral DNA polymerase

Bone marrow suppression
Renal toxicity

777
Q

Tx CMV

A

Ganciclovir

Foscarnet (retinitis)

778
Q

Herpes drug that doesnt require viral kinase activation

MOA
Uses
SIde effects

A

Foscarnet

Inhibits DNA polymerase

Resistant HSV
CMV retinitis

Renal toxicity
Anemia

779
Q

Anti-influenza antivirals

A

Neuroaminidase inhibitors

Zanamivir
Oseltamivir

Block release of virions from host cell

780
Q

Treatment of Chronic Hepatits C

A

Ribavirin

IFN-alpha

781
Q

Ribavirin

uses

side effects

A

Guanosine analog

RSV
Hep C

Teratogenicity
Hemolytic anemai

782
Q

Tx croup

A

One dose of dexamethasone

supportive

783
Q

RSV immunization

A

Passive w/ palivizumab

784
Q

HIV prophylaxis CD4 < 200

A

PCP prophylaxis

TMP-SMX
Dapsone (in sulfa allergy)

785
Q

HIV prophylaxis CD4 < 100

A

Toxoplasmosis prophylaxis (if positive IgG before)

TMP-SMX
Dapsone + pentamidine + leucovorin

786
Q

HIV prophylaxis CD4 < 50

A

MAC prophylaxis

Azithromycin

787
Q

saquinavir

A

-navir

Protease inhibitors

GI intolerance
Inhibit cytochrome p450
Hyperlipidemia hyperglycemia
Lipodystrophy

788
Q

Protease inhibitor that can cause pancreatitis

789
Q

Protease inhibitor that can cause Nephrolithiasis

A

Kidney stone

indinavir
Atazanavir

790
Q

Protease inhibitor that can increase bilirubin

A

Atazanavir

791
Q

HAART

A

Combination of at least 3 different HIV medications

2 nucleoside reverse transcriptase inhibitors and a different class medication

792
Q

Lamivudine

A

-vudine

Nucleoside Reverse Transcriptase inhibitors (NRTIs)

Didanosine
Abacavir
Emtricitabine
Tenofovir (NtRTI)

793
Q

Nucleotide reverse transcrptase inhibitor

794
Q

Nucleoside Reverse Transcriptase inhibitors (NRTIs)

  • examples
  • MOA
  • feature
  • Adverse txn
A 
Lamivudine
Zidovudine
Didanosine
Abacavir
Emtricitabine
Tenofovir (NtRTI)

Competitive inhibitors

Have to be phosphorylated by thymidine kinase to work

Abacavir

  • Hypersensitivity assoc w/ HLA B57
  • Type IV delayed hypersensitivity
  • Delayed rash
795
Q

Tx Newborns born to HIV mothers

A

Zidovudine (AZT)

796
Q

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

A

-vir, -virine

Nevirapine
Delavirdine
Efavirenz
Etravirine
Rilpivirine

non-competitively inhibit reverse transcriptase

Do NOT require phosphorylation

797
Q

Which NNRTI must be taken with food and not w/ meds that decrease gastric acid

A

Rilpivirine

798
Q

Fusion inhibitor

A

Enfuvirtide

En envelop
Fu fusion

Binds Gp41 and blocks HIV fusion

Given by injection

799
Q

Raltegravir

A

-tegravir

Integrase inhibitors

Blocks integration into host DNA

800
Q

CCR-5 antagonist

A

Maraviroc

CCR-5 on macrophages and CD4 T cells

Inhibits gp120 conformational change

Only in patients with all R5 virus

801
Q

HIV drug causes

  1. Bone marrow suppression
  2. Pancreatitis
  3. Hepatic steatosis
  4. Hypersensitivity rxn
  5. Rash
  6. Nightmares, vivid dreams, depression
  7. False-positive to drug test for cannabinoids
  8. Teratogenic
  9. Nephrolithiasis
  10. Increases bilirubin
  11. peripheral neuropathy
A
  1. Zidovudine (NRTI)
  2. Didanosine (NRTI)
    Ritonavir (PI)
  3. Didanosine (NRTI)
  4. Abacovir (NRTI)
  5. NNRTIs
  6. Efavirenz (NNRTI)
  7. Efavirenz (NNRTI)
  8. Efavirenz (NNRTI)
  9. Indinavir, Atazanavir (protease inhibitor)
  10. Atazanavir (protease inhibitor)
  11. Didanosine
802
Q

What are the two HIV envelope proteins and what drugs interfere with them

A

gp 41: Enfuvirtide

Gp120: maraviroc (not directly CCR-5

803
Q

Tx Candida albicans

A

Superficial

  • Nystatin
  • Clotrimazole (topical)
  • Fluconazole (oral) oral thrush

Systemic

  • Fluconazole
  • Amphotericin B
  • Echinocandin
804
Q

Tx Cryptococcal neoformans

A

Amphotericin B + flucytosine

Followed by fluconazole

805
Q

Tx Pneumocystis jirovecii (PCP)

A

TMP-SMX

Sulfa allergy
- Pentamidine
Clindamycin + primaquine

806
Q

Tx Aspergillus fumigatus

A

Voriconazole

Lipid formation of amphotericin B

807
Q

Tx Mucor

A

Surgical debridment

AMphotericin B

808
Q

Tx Dermatophytes

A

Topical terbinafine or azole

Extensive skin infection or scalp/hair
- Oral terbinafine or azole

809
Q

Tx Tinea versicolor

A

Malassezia furfur

Topical azole
Topical selenium sulfide
Oral azole

810
Q

Side effect orlistat

A

Steatorrhea
GI discomfort
Decreased absorption of fat-soluble vitamins

811
Q

Antifungal that

  1. Disrupts membrane
  2. Disrupts microtubules
  3. Blocks precursors to pyrimidines
  4. Blocks Squalene to lanosterol
  5. Blocks lanosterol to ergosterol
A
  1. Nystatin, Amphotericin B
  2. Griseofulvin
  3. Flucytosine
  4. Terbinafine
  5. -azoles
812
Q

Amphotericin B

  • uses
  • Side effects
A 
Cryptococcosis
Blastomycosis
Coccidioidomycosis
Aspergillosis
Histoplasmosis
Mucormycosis
Fever and chills
Anemia
Arrhythmias
Hypokalemia
Nephrotoxicity**
813
Q

Tx cutaneous candidiasis
Diaper rash
Vulvogainitis

814
Q

Converted into 5-fluorouracil

A

Flucytosine

815
Q

Inhibits cell wall synthesis by inhibiting synthesis of beta-(1,3)-D-glucan

  • uses
  • toxicites
A

Caspofungin

Invasive aspergillosis

GI upset
Flushing

816
Q

First line tx for dimorphic fungi

A

Itraconazole

Blstomyces
Coccidioides
Paracoccidioides
Histoplasma
Sporothirx
817
Q

Azole for aspergillus

A

Voriconazole

818
Q

Azole for refractory fungi

A

Posaconazole

819
Q

Azole for topical fungal infections

A

Clotrimazole

Micronazole

820
Q

-azole side effects

A

Decreased production of cortisol and testosterone

Gynecomastia

Impotence

Drug-drug interactions

Increase hepatic enzymes

821
Q

Terbinafine

  • use
  • side effects
A

Inhibits enzyme squalene epoxidase

uses superficial fungal infections

Hepatotoxicity
GI symptoms

822
Q

Griseofulvin

  • mOA
  • deposits in
  • uses
  • side effects
A

Targets microtubule function –> inhibits mitosis

Deposits in keratin containng tissues

Tinea corporis
Tinea capitis
Onychomycosis

Tertatogenicity
HA
GI symptoms
Confusion
Cytochrome p450
823
Q

What antifungal would you use

  1. Cell wall synthesis inhibitor used in invasive aspergillosis
  2. “Swish and swallow” for oral candidiasis or thrush
  3. Most common treatments for onychomycosis
  4. Deposits in keratin-containing tissues to to treat tinea capitis adn onychomycosis
  5. Used for cryptococcal meningitis in AIDs
  6. Drug of choice for sporotrichosis
A
  1. Caspofungin
  2. Nystatin
  3. Terbinafine, itraconazole, fluconazole
  4. Griseofulvin
  5. IV amphotericin B + flucytosine
  6. Itraconazole
824
Q

Which antifungal can be used intrathecally for fungal meningitis

A

Amphotericin B

825
Q

Tx Giardia lamblia

A

Metronidazole

Tinidazole

826
Q

Tx Entamoeba histolytica

A

Treatment

  • trophozoites= metronidazole or tinidazole
  • cysts= iodoquinol or paromomycin
827
Q

Tx Trichomonas vaginalis

A

Metronidazole

828
Q

Gardnerella vaginalis tx

A

Metronidazole

829
Q

Tx Toxoplasma gondii

A

Sulfadiazine + pyrimethamine + folinic acid

830
Q

Tx Naegleria fowleri

A

Amphotericin B

831
Q

Tx Trypanosoma brucei

African sleeping sickness

A

Early: Suramin

CNS involved: Melarsoprol

832
Q

Tx Trypanosoma cruzi

A

Benznidazole

Nifurtimox

833
Q

Tx Leishmania donovani

- Visceral leishmaniasis

A

Liposomal amphotericin B

834
Q

Tx Leishmania donovani

- cutaneous leishmaniasis

A

Sodium stibogluconate

835
Q

Tx Malaria

A

P. vivax, P. ovale
- primaquine

P. falciparum
- chloroquine

836
Q

Tx Babesia microti

A

Quinine + clindamycin

837
Q

-romycin

838
Q

Tx Enterobius vermicularis

A

Benzimidazoles
- Albendazole
- mebendazole
Pyrantel pamoate

839
Q

Tx Ascaris lumbricoides

A

Benzimidazoles
- Albendazole
- mebendazole
Pyrantel pamoate

840
Q

Tx trichinella spiralis

A

Benzimidazoles

  • Albendazole
  • mebendazole
841
Q

Tx strongyloides stercoralis

A

Ivermectin

Albendazole

842
Q

Tx Ancylostoma and Necator

A

Benzimidazoles
- Albendazole
- mebendazole
Pyrantel pamoate

843
Q

Tx Diphyllobothrium latum

A

Praziquantel

844
Q

Tx Echinococcus granulosus

A

Surgical removal of cysts

845
Q

Tx Taenia solium

A

Albendazole
Praziquentel
Dexamethaone: keep CNS symptoms from getting worse

846
Q

Tx schistosoma

A

Praziquantel

847
Q

Tx Paragonimus westermani

A

Praizquantel

848
Q

Tx Clonorchis sinensis

A

Praziquantel

Albendazole

849
Q

Tx Wuchereria bancrofti

A

Diethylcarbamazine

850
Q

Tx Lice

A

Permethrin Pyrethrin

Malathion

851
Q

Tx Scabies

A

Permethrin

Ivermectin

852
Q

-Azole MOA

A

Inhibition of the cytochrome P450-dependent demethylation reaction

853
Q

Statins increase risk for

A

Hepatotoxicity

Myopathy

854
Q

Acetazolamide

A

Diuretic

Decrease CSF production by the choroid plexus

855
Q

Drug that decreases heart rate and systemic vascular resistance

A

Alpha 1= vasoconstriction
Beta 1= increase heart rate

Labetalol
alpha 1/beta 1 blocker

856
Q

HIV tx and MOA

A

NRTIs main line
- competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain

Abacavir
Didanosine
Lamivudine
Tenofovir

857
Q

Clopidogrel

A

ADP receptor inhibitors

-grel
ticlopidine

858
Q

Increses cAMP in platelets, resulting in inhibition of paltelet aggregation

A

Antiplatelet phosphodiesterase inhibitors

Cilostazol
Dipyridamole

859
Q

Cyclophosphamide depletion of what cell

A

Granulocytes

860
Q

What drugs interferes with DNA synthsis by cross linking?

A

Lomustine

Cyclophosphamide

861
Q

Parkinson like symtpoms from high dose antipsychotic

Tx

A

Amantidine (dopamine agonist)

Benzotropine (anticholinergic)

862
Q

-zomib

A

Proteasome inhibitor

Blocks presentation of antigens to CD8 T lymphocytes

863
Q

Stimulant MOA

A

Increase availability of NE and dopamine

864
Q

Two small cysts in deep brain

Previous Stroke

Died of MI

A

Lipohyalinosis with small vessel occlusion

Lacunes are small cavitary infarcts in basal ganglia, result of occusion to small penetrating arteries

865
Q

Crohns disease and gallstones

A

Dont reabsorb bile acids in terminal ileum –> less bile acids in bile so ratio of cholesterol/bile acids increases. Supersaturation of bile with cholesterol leads to formation of gallstones

866
Q

Tx for gallstones

A

Bile acid suplement

867
Q

Mood stabilizer that causes constipation, dry skin and hair loss

868
Q

Drug which provides both dilation of arteries and inhibition of paltelet aggregation

Abciximab
Argatroban
Aspirin
Cilostazol
Heparin
Tissue plasminogen activator
Warfain
A

Cilostazol

Inhibits platelet phosphodiesterase which is the enzyme responsible for break down of cAMP

also vasodilator

869
Q

Antiemetic drugs for chemotherapy

A

Dopamine receptor antagonists

  • Phochlorperazine
  • Metocloprammide

Serotonin (5-HT) receptor antagonist

  • Ondansetron
  • Granisetron

Neurokinin 1 (NK1) receptor antagonists

  • Aprepitant
  • Fosaprepitant
870
Q

Antiemetic drugs for motion sickness and pregnancy

A

Antimuscarinics (anticholinergics)
- scopolamine

Antihistamines

  • diphehydramine
  • Meclizine
  • Promethazine
871
Q

Drug to not use for elevated TG due to risk of gall stones

A

Fibrates

- fibrozil

872
Q

Colchicine does what beside tx for gout

A

Blocks Leukotriene B4

873
Q

Glyburide MOA

A

Sulfonurea

Increases insulin secretion by inhibiting beta cell K ATP channel

874
Q

Organophosphate poisoning does what

A

Irreversibly inhibit acetylcholinesterase

Increase ACh

Tx Atropine

875
Q

Beta blocker fxn

A

Decrease heart rate and contractility

Decrease O2 consumption

876
Q

Non-selective alpha and beta antagonists

A

Carvedilol

Labetalol

877
Q

What to not prescribe to elderly

A 
Anticholinergics (risk of delirium, sedation, falls, constipati)
Anti histamines
Antidepressants
Benzodiazepines
opioids

alpha blocks (hypotension)

PPIs (risk c. diff)

NSAIDS (Gi bleed)

878
Q

Drugs that cause Hyperglycemia

A

Taking Pills Necessitates Having blood Checked

Tacrolimus
Protease inhibitors
Niacin
HCTZ
Corticosteroids
879
Q

Drugs that cause megaloblastic anemia

A

You’re having a Mega Blast with PMS

Hydroxyurea
Phenytoin
Methotrexate
Sulfa drugs

880
Q

Ptosis and diplopia that worsens throughout the day

  • tx
A

Myasthenia gravis
- ab to acetylcholine recpetor

Tx Indirect cholinergic agonist

  • Neostigmine
  • Edrophonium (diagnosis)
881
Q

Glycopyrrolate

A

Muscarinic antagonist

Reduces salivary, tracheobronchial and pharyngeal secretions

882
Q

Hyocyamine

Dicyclomine

A

Muscarinic antagonist

Antispasmodics for IBS

883
Q

Cyclophentolate

A

Muscarinic antagonist

pupil dilation

884
Q

Muscarinic antagonist Pupil dilation

A

Cyclophentolate
Homotropine
Tropicamide

885
Q

Anticholinergics used to tx urge urinary incontinence

A

“Off The Darn Toilet Seat”

Oxybutynin
Tolterodine
Darifenacin
Trospium
Solifenacin
886
Q

Tx septal defect

A

Indomethacin

  • blocks prostaglandin synthesis
  • closes PDA
887
Q

QT prolongation

A

Macrolides

  • erythromycin
  • azithromycin

Fluroquinoles

  • ciprofloxacin
  • mixifloxacin

Antipsychotics

  • haloperidol
  • risperidone

Antiemetics

  • ondansetron
  • metoclopramide
888
Q

Chlorthalidone monotherapy. See an increase in what?

A. Cholesterol
B. Creatinine
C. Magnesium
D. Potassium
E. Sodium
A

A. Cholesterol

Thiazides inhibit Na/Cl cotransporter

  • Decrease Na and Cl
  • Compensatory rise in renin and aldosterone (hypokalemia)
  • Decrease insulin secretion and reduce glucose uptake into peripheral tissues ( hyperglycemia)
  • Also increase LDL cholesterol and TG levels
889
Q

Diphenoxylate

A

Opiod anti-diarrhea agent

Binds Mu opiate receptor in GI and SLOWS MOTILITY

Relieve diarrhea

890
Q

Giant cell temporal arteritis. Mediator that causes condition

A. Ab to myeloperoxidase
B. Ab to proteinase 3
C. B cell activating factor
D. IL-6
E. matrix metalloproteinase

Tx

A

D. IL-6

Predominantly CD4 T cells and macrophages

Production of cytokines IL-6)

Tocilizumab
- Monoclonal Ab against IL-6

891
Q

Conditions and Drugs that can affect lithium sodium/ lithium reabsorption leads to lithium toxicity

A

CHF
Cirrhosis

Thiazide diuretic
ACE inhibitors
NSAIDS

892
Q

Lipoatrophy or lipodystrophy common adverse effect of

A

Highly active anti-retroviral therapy (HAART)

893
Q

5 classes of medications used to tx glaucoma

A 
alpha agonist
Beta blocker
Diuretic (acetazolamide, mannitol)
Cholinergic agonist
Prostaglandins (PGF2alpha)
894
Q

Tx pulmonary arterial HTN

A

Bosentan

  • Endothelin- receptor antagonist
  • blocks effects of endothelin (vasoconstrictor that also stimulates endothelial proliferation)

Decreases pulmonary arterial pressure and lessens the progression of vascular remodeling and right ventricular hypertrophy

895
Q

Tx HIV associated lipodystrophy

A

Tesamorelin

GHRH analog

896
Q

What medications have anticholinergic side effects

A

Typical neuroleptics

  • Thioridazine
  • Chlorpromazine

1st generation antihistamines

  • diphenhydramine
  • hydroxyzine

TCA
- Amitriptyline

Amantidine
- Anti influenza

897
Q

Cyproheptadine

A

Antihistamine
Use: Appetite stimulant
Antidote serotonin syndrome

898
Q

Promethazine

A

Antihistamine

USe: Nausea and vomiitng

899
Q

Hydroxyzine

A

Antihistamine

Use: Sedation, itching

900
Q

Meclizine

A

AntihistamineUse: vertigo

AM- STEP1 (20 decks)

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