Pharm - Rami Flashcards
1
Q
penicillin MOA
A
binds PBPs thereby blocking peptidoglycan cross linking
2
Q
what 3 penicillins are more susceptible to beta lactamases?
A
penicillin, ampicillin, piperacillin
3
Q
general side effect of penicillins
A
allergic reaction
4
Q
side effect of penicillin
A
drug induced coombs positive hemolytic anemia
5
Q
drugs that cause drug induced coombs positive hemolytic anemia
A
penicillin, alpha methyldopa, and cephalosporins
6
Q
side effect of ampicillin/amoxicillin
A
non-allergenic skin rash
7
Q
side effect of methicillin
A
interstitial nephritis
8
Q
drugs that cause interstitial nephritis
A
methicillin, NSAIDs, furosemide (“buy meth in dollars instead of euros”)
9
Q
what form is pen V given
A
oral
10
Q
what form is pen G given
A
IV
11
Q
aztreonam structure
A
monocyclic beta lactam ring
blocks peptidoglycan cross-linking as well
12
Q
why give aztreonam
A
renally insufficient patient;
allergic to penicillin
13
Q
side effect of aztreonam
A
elevated LFTs
14
Q
imipenem side effect
A
seizures in renally impaired patients
15
Q
what do you give with imipenem
A
cilastin - inhibits renal dihydropeptidase I (enzyme that inactivates drug in renal tubules)
16
Q
antibiotic you do not want to give to renally insufficient patient that aztreonam might be great for
A
aminoglycosides
17
Q
gen 1 cephalosporins
A
gram positive
CEFAZOLIN, CEPHALEXIN
18
Q
gen 2 cephalosporins
A
gram positive, anaerobes, H flu
CEFACLOR, CEFUROXIME
19
Q
gen 3 cephalosporins
A
gram negative
CEFTRIAXONE
20
Q
gen 4 cephalosporins
A
gram positive and negative
pseudomonas, CEFEPIME
21
Q
gen 5 cephalosporins
A
MRSA,
CEFTAROLINE
22
Q
cephalosporin side effects
A
hypersensitivity reaction (10% of patients with penicillin allergy with be allergic),
disulfiram-like reaction,
nephrotoxicity
23
Q
drugs that cause disulfiram like reactions
A
“Sorry pals, can’t go mingle”
1st gen sulfonylureas, procarbazine, cephalosporins, griseofulvin. metronidazole
24
Q
50S inhibitors
A
"50 cent - I'm a CMLC" chloramphenicol, macrolides, linezolid, clindamycin,
25
30S inhibitors
aminoglycosides,
| tetracyclines
26
chloramphenicol MOA
reversibly binds 50S to inhibit peptidyl transferase
27
clindamycin MOA
inhibits formation of initiation complex
28
aminoglycosides MOA
inhibits formation of initiation complex and causes mRNA misreading
29
tetracyclines MOA
blocks AMINOACYL tRNA from binding to the ribosome
30
chloramphenicol side effects
aplastic anemia,
gray baby syndrome (vomiting, flaccidity, gray skin hue, shock in newborns due to lack of UDP-glucuronyl transferase in liver)
31
drugs that cause aplastic anemia
```
"Cant Make New Blood Cells Properly"
(carbamazepine,
methimazole,
NSAIDs,
benzene,
chloramphenicol,
PTU)
```
32
side effects of macrolides
| erythromycin, clarithromycin, azithromycin
acute cholestatic hepatitis (jaundice)
33
uses of clindamycin
anaerobic infections above the diaphragm
34
side effects of clindamycin
pseudomembranous colitis (c. diff)
35
linezolid treats...
VRE, MRSA
| VRE: vancomycin resistant enterococcus
36
uses of metronidazole
anaerobic infections below the diaphragm
37
side effects of aminoglycosides
nephrotoxicity (especially with cephalosporin),
ototoxicity (especially with loop diuretic),
teratogenicity
38
aminoglycosides are ineffective against...
anaerobes because they require oxygen to be taken up into bacterial cells
39
tetracycline side effects
teeth discoloration, bone deformity in kids, fanconi syndrome (aminoaciduria, phosphaturia, acidosis, glycosuria), photosensitivity
40
how is doxycycline eliminated
fecally -->
so it can be used in renally insufficient patients
41
uses of demeclocycline
treats SIADH (competitive antagonist at V2 receptor)
42
name all of the anti mycobacterial agents
```
rifampin,
isoniazid
pyrazinamide
ethambutol
dapsone
```
43
rifampin MOA
inhibits bacterial DNA-dependent RNA polymerase
44
side effects of rifampin
orange urine, hepatitis
45
isoniazid MOA
inhibits synthesis of mycolic acids
46
side effects of isoniazid
peripheral neuropathy (due to Vitamin B6 depletion),
G6PD-hemolytic anemia,
drug induced lupus,
hepatitis
47
dapsone MOA
PABA antagonist, inhibits folic acid synthesis
48
dapsone side effects
G6PD hemolytic anemia
49
ethambutol MOA
inhibits mycobacterial arabinosyl transferase
50
ethambutol side effects
retrobulbar neuritis (decreased visual acuity and red green color blindness)
51
pyrazinamide side effects
hepatotoxicity,
| hyperuricemia (gout)
52
drugs that are hepatotoxic
"Patron is FIRSt fun, then hepatotoxic"
```
pyrazinamide,
fibrates,
isoniazid,
rifampin,
statins,
```
53
drugs that cause SLE like syndrome
"Having lupus is Mega SHIPP-E"
```
methyldopa,
sulfa,
hydralazine,
isoniazid,
procainamide,
phenytoin,
etanercept
```
54
drugs that cause hyperuricemia/gout
"Painful Tophi in Feet Need Care"
```
pyrazinamide,
thiazide,
furosemide,
niacin,
cyclosporine
```
55
drugs that cause G6PD hemolytic anemia
"Hemolysis IS D PAIN"
```
isoniazid,
sulfonamides,
dapsone,
primaquine,
aspirin,
ibuprofen,
nitrofurantoin
```
56
isoniazid causes peripheral neuropathy because...
it depletes the body of vitamin B6
57
trimethoprim- sulfamethoxazole MOA
DNA synthesis disruption
trimeth - blocks dihydrofolate reductase
sulfameth - blocks dihydropteroate synthase
58
bactrim (TMP-SMX) side effects
stevens johnson syndrome,
hemolytic anemia,
kernicterus in newborns,
(BAK)
59
sulfa drugs
"Popular FACTSSS"
```
probenecid,
furosemide,
acetazolamide,
celecoxib,
thiazides,
sulfonamide antibiotics,
sulfasalazine,
sulfonylureas
```
60
fluoroquinolones MOA
inhibits bacterial DNA topoisomerase II -->
| DNA strand breaks --> cell death
61
fluoroquinolones side effects
tendonitis,
tendon rupture,
contraindicated in pregnant women and kids (damages cartilage)
62
fluoroquinolones coverage
gram negative
63
vancomycin MOA
binds D-ala D-ala, inhibits transglycosylase, weakens cell wall and causes cell lysis
64
vancomycin uses
MRSA, C. diff pseudomembranous colitis orally
65
side effects of vancomycin
"NOT" + red man
nephrotoxicity,
ototoxicity,
thrombophlebitis,
and red man syndrome
66
side effects of metronidazole
metallic taste,
| disulfiram-like rxn
67
nucleoside reverse transcriptase inhibitors
zidovudine,
didanosine,
lamivudine,
abacavir
68
non nucleoside reverse transcriptase inhibitors
nevirapine,
efavirenz,
delavirdine
69
NRTI side effects
zidovudine - megaloblastic anemia
| didanosine - pancreatitis
70
NNRTI side effects
efavirenz - CNS disturbances
| nevirapine - stevens johnson syndrome, hepatitis
71
what NRTI is used on pregnant women?
zidovudine
72
what is the suffix of the protease inhibitors
-navir
73
MOA of protease inhibitors
inhibit HIV protease enzyme
74
side effects of protease inhibitors
altered distribution of fat (buffalo hump, increased truncal obesity), insulin resistance = hyperlipidemia, neuropathy
75
what disease causes buffalo hump
cushing syndrome (increased cortisol)
76
what drug besides protease inhibitors leads to fat redistribution
glucocorticoids (fat PIG)
77
acyclovir MOA
phosphorylated by viral thymidine kinase into analog of dGTP (inhibits DNA synthesis)
78
acyclovir side effects
neurotoxicity (tremor, delirium),
| nephrotoxicity
79
ganciclovir MOA
inhibit CMV DNA polymerase,
especially useful for CMV retinitis
"I Gan Ci"
80
amantidine MOA
binds M2 surface protein on influenza A, blocking uncoating of viral RNA,
can also stimulate release of dopamine from neurons of nigra striatum
81
amantidine side effect
CNS symptoms
82
zanamivir MOA
inhibits neuraminidase,
| treats influenza A and B
83
ribavirin MOA
inhibits viral RNA polymerase --> inhibits viral replication
84
ribavirin side effect
teratogenicity
| Contraindicated in pregnancy, and in renally insufficient patients
85
amphotericin MOA
tears holes,
binds ergosterol,
alters permeability of fungal cell membrane,
leads to cell death
86
amphotericin side effects
"Ampho-Terrible"
infusion related reaction,
nephrotoxicity
87
does amphotericin cross the BBB
no
88
flucytosine MOA
inhibits thymidylate synthease - inhibits fungal DNA and RNA synthesis
89
flucytosine side effect
bone marrow suppression
90
caspofungin MOA
inhibits B(1,3)-D-glucan synthase
| β(1,3)-d-glucan is an essential component of the fungal cell wall
91
griseofulvin MOA
interferes with microtubule formation and inhibits fungal cell replication
92
name an allylamine and the enzyme it blocks
terbinafine,
blocks squalene epoxidase,
tx: onychomycosis
93
what enzyme do azoles block
lanosterol 14 alpha demethylase
94
ketoconazole, miconazole, clotrimazole side effect
gynecomastia (because they disrupt gonadal and adrenal steroid synthesis)
can be used to treat cushing syndrome because of this
95
quinine side effects
cinchonism (tinnitus, headache, dizziness, nausea)
coombs positive hemolytic anemia
fetal toxicity
96
mefloquine side effect
mental status change
97
primaquine side effects
G6PD hemolytic anemia,
| fetal toxicity
98
alpha 1 receptor secondary messenger
PLC,
increased IP3 and DAG -->
increased intracellular calcium
99
alpha 2 and D2 secondary messenger
Gi - inhibition of AC leads to decreased cAMP
100
beta 1 and 2 and D1 secondary messenger
Gs - AC activation leading to increased cAMP
101
direct sympathomimetics - uses
emergency shock,
anaphylaxis
(fast decrease in BP)
102
epinephrine - receptors
alpha agonist at high doses,
| beta agonist at low doses
103
uses of epinephrine
anaphylaxis,
| bronchospasm
104
epinephrine SE
hypertension,
| pulmonary edema
105
norepinephrine - receptors
alpha 1, alpha 2, beta 1 (increased contractility)
106
dopamine - receptors
alpha agonist at high doses
beta agonist at low doses
D1 agonist at even lower doses
107
dobutamine - receptors
beta 1 agonist
| selective = B for BRAT
108
uses of dobutamine
cardiac stress test,
| cardiogenic shock
109
side effect of dobutamine
hypotension (via rebound)
110
direct sympathomimetics
"Duplicate sympathetic END point"
dobutamine,
epinephrine,
norepinephrine,
dopamine
111
indirect sympathomimetics - stimulate the release of...
direct sympathomimetics
112
ephedrine stimulates release of...
norepinephrine,
| also stimulates beta 2 receptors and the CNS
113
effect of ephedrine
```
increased contractility (same as NE),
bronchodilation (beta 2)
```
114
uses of ephedrine
nasal decongestant (pseudoephedrine),
athletic enhancement drug
(since it is a CNS stimulant)
115
cocaine MOA
blocks Na/K ATPase pump responsible for reuptake of NE, serotonin, and dopamine
results in euphoria, vasoconstriction
also blocks voltage-gated Na channels
results in anesthesia
116
cocaine side effects
hypertension,
cardiac ischemia,
cardiac arrhythmias
117
indirect sympathomimetics
amphetamines,
cocaine,
ephedrine
118
use of phenylephrine
mydriasis (eye exam)
"would you like me to dilate your Pupils?"
119
phenylephrine MOA
alpha 1 agonist
120
midodrine MOA
alpha 1 agonist
121
midodrine uses
used in patients with advanced hepatic disease,
orthostatic hypotension
Think: Me go faint & M1dodr1ne
122
side effect of midodrine
supine hypertension
123
clonidine uses
treats hypertension by inhibiting release of sympathetic neurotransmitters
124
clonidine side effect
rebound hypertension if withdrawn quickly
Think: "Clonidine clones itself" - goes from treating HTN to causing it!
125
clonidine MOA
alpha 2 agonist
126
isoproterenol uses
treats torsades de pointes (long QT) - given with magnesium for this,
can also treat cardiac arrest/heart block
127
isoproterenol MOA
beta 1 and 2 agonist
128
fenoldopam use
produces renal vasodilation for severe hypertension
129
albuterol uses
```
produces bronchodilation (treats asthma),
treats hyperkalemia by causing transcellular shift of K into the cell
```
130
beta 2 agonists
"Beta 2 agonist needed for SAT-induced asthma!"
salmeterol,
albuterol,
terbutaline,
131
salmeterol uses
long acting treatment for COPD and asthma;
used with inhaled corticosteroids
analogue of albuterol
132
terbutaline MOA
beta 2 agonist;
relaxes smooth muscle in lungs and uterus
by directly-acting on the receptor
133
terbutaline use
delay preterm labor by reducing uterine contractions
Think: "TERM-butaline"
134
side effects of terbutaline
tachycardia,
| tremor
135
methyldopa MOA
alpha 2 agonist
136
methyldopa uses
treats moderate hypertension
using adrenergic neurotransmitters
137
methyldopa side effects
positive coombs test,
| orthostatic hypotension
138
phenoxybenzamine MOA
irreversible alpha receptor antagonist
139
phenoxybenzamine side effect
inhibition of ejaculation
140
phenoxybenzamine use
treats pheochromocytoma
| both are 16 letters
141
phentolamine MOA
SHORT-ACTING
reversible alpha receptor antagonist
142
phentolamine use
diagnose pheochromocytoma
143
prazosin (-zosin) and tamulosin MOA
selective alpha 1 antagonist
144
prazosin (-zosin) and tamulosin uses
decrease prostatic and bladder neck contraction,
decrease blood pressure,
treatment for hypertension and BPH
145
prazosin (-zosin) and tamulosin side effect
first dose syncope (severe orthostatic hypotension --> syncope)
146
timolol MOA
beta 1 and 2 antagonist
147
timolol uses
ophthalmic solution - decreases aqueous humor secretion;
| used to treat glaucoma
148
pindolol MOA
weak beta receptor agonist,
beta receptor antagonist,
intrinsic sympathomimetic properties
149
pindolol uses
treats: HTN, bradycardia
150
propranolol MOA
beta 1 and 2 antagonist
151
propranolol uses
tachycardia associated with hyperthyroidism and chronic migraines
152
side effects of propranolol
```
bronchoconstriction,
fasting hypoglycemia (decreased glycogenolysis)
```
153
esmolol MOA
short acting beta 1 antagonist
"es small" = short acting
154
esmolol uses
treats critically ill patients with arrhythmias, hypertension, and MI
155
carvedilol MOA
alpha 1 and beta receptor blocker
156
carvedilol uses
decreases HR and contractility;
bronchoconstriction,
treats CHF (given with ACEi and diuretics),
treats hypertension
157
metoprolol MOA
selective beta 1 antagonist
158
metoprolol uses
decreases HR and contractility,
| treats hypertension, tachycardias, CAD, especially in patients with diabetes
159
M1 and M3 receptors
Gq (increased IP3 and DAG --> increased intracellular calcium)
(same mechanism as alpha1 from adrenergics)
160
M2 receptor
Gi (AC is inhibited --> decreased cAMP),
also an increase in K+ conductance
same mechanism as alpha2 from adrenergics
161
Nm and Nn
activation of Na/K channels
162
pilocarpine and carbachol uses
applied topically to eye (ophthalmic solution);
treats glaucoma;
Think: piloCRYpine and CRYbachol
163
pilocarpine/carbachol MOA
M3 muscarinic agonist
164
methacholine uses
bronchial challenge test (inhalation);
| diagnoses asthma
165
methacholine MOA
smooth muscle contraction of bronchi,
| M1, M2, M3 muscarinic agonist (*use targets M3)
166
methacholine side effects
bradycardia, hypotension;
| minimally seen because it is inhaled
167
bethanechol MOA
M2, M3 agonist (use related to M3)
168
bethanechol uses
promotes urination,
| treats neurogenic ileus (urinary retention), especially postpartum or postop
169
bethanechol side effect
diarrhea
170
M3 agonists (3 of them)
pilocarpine,
methacholine,
bethanechol
171
atropine MOA
competitive M1-M3 antagonist
172
atropine use
antidote for cholinesterase inhibitor poisoning (nerve gas, insecticide)
173
treatment for atropine poisoning
physostigmine
| cholinesterase inhibitor
174
atropine side effects
characteristic of muscarinic block:
```
hyperthermia (flushing),
decreased salivation,
cycloplegia (blurred vision),
psychosis,
tachycardia
```
175
tropicamide and homatropine uses
ophthalmic solutions,
retinal examinations,
temporary cycloplegia and mydriasis
176
tropicamide and homatropine MOA
atropine analogs,
| antimuscarinic M1-M3
177
benztropine MOA
```
M1-M3 antagonist,
M1 receptors (brain) in corpus striatum (PD)
```
178
benztropine use
treats parkinson's by improving tremor and rigidity;
| no effect on bradykinesia
179
benztropine contraindication
patients with glaucoma
180
scopolamine MOA
competitive M1-M3 antagonist;
| action at MI for usage
181
scopolamine use
treats motion sickness,
crosses BBB to interact between vestibular ear and vomiting center of brain
think: "scopukeamine"
182
ipratropium MOA
M3 receptor antagonist
183
ipratropium uses
inhaled form causes bronchodilation;
treats COPD and asthma
(especially in those who are unable to take adrenergic agents)
think: "i pray to breathe"
184
oxybutynin MOA
M1-M3 receptor antagonist (action at M3)
185
oxybutynin uses
treats urinary incontinence and hyperhidrosis
186
cholinesterase inhibitors (anticholinesterases) have what effects
parasympathetic/muscarinic,
| increased ACh
187
neostigmine MOA
reversibly inhibits acetylcholinesterase,
| increased stimulation of nicotinic and muscarinic receptors
188
does neostigmine cross the BBB
no
189
neostigmine uses
treats myasthenia gravis,
| overcomes nondepolarizing neuromuscular blockade (caused by pancuronium or vecuronium)
190
physostigmine MOA
reversibly inhibits Acetylcholinesterase
191
does physostigmine cross BBB
yes - used as antidote for atropine overdose
192
uses of physostigmine
antidote for atropine overdose,
| ophthalmic solution - treats glaucoma
193
edrophonium and pyridostigmine MOA
reversibly inhibit Acetycholinesterase -->
| increased stimulation of both nicotinic and muscarinic receptors
194
edrophonium use
diagnosis of myasthenia gravis (short acting)
think: "a drop lasts a moment, but a stigma lasts forever"
195
pyridostigmine use
treats myasthenia gravis (long acting)
196
tacrine MOA
reversibly inhibits AChE -->
| increased stimulation of both nicotinic and muscarinic receptors
197
tacrine use
treats alzheimers
Think: "Tacrine (taking) care of Alzheimer's patients"
198
tacrine side effect
hepatotoxicity
199
drugs similar to tacrine
Think: "Tacrine RDG"
rivastigmine,
donezepil,
galantamine,
200
echothiophate MOA
inhibits AChE by covalently binding to the enzyme -->
increased stimulation of both nicotinic and muscarinic receptors
201
drugs similar to echothiophate
isoflurophate,
malathion,
parathion
think: "echothiophate - IMP"
202
echothiophate and isoflurophate use
```
ophthalmic ointments,
treat glaucoma (M3)
```
203
side effects of echothiophate
seizures, bradycardia, flaccid paralysis, and muscarinic activation SEs
due to persistent nicotinic activation resulting in NM blockade - depolarizing)
204
echothiophate overdose treatment
atropine,
| pralidozime
205
pralidoxime MOA
cholinesterase reactivator,
reverses cholinesterase inhibitor binding to AChE
(so it opposes acetylcholinesterase inhibitors)
206
pralidoxime effects are similar to what other drug
atropine
207
pralidoxime uses
used with atropine to treat nerve gas or organophosphate poisoning,
treats overdose of neostigmine or pyridostigmine
208
hexamethonium, mecamylamine, trimethphan MOA
competitive inhibition of Nn receptors on postsynaptic neurons of autonomic ganglia,
block outflow to sympathetic and parasympathetic neurons,
anti-nicotinic
209
hexamethonium use
treats hypertensive emergencies
210
hexamethonium side effect
hypotension
211
how long does it take for antidepressants to work
3-4 weeks
212
SSRIs
```
fluoxetine,
fluvoxamine,
paroxetine,
escitalopram,
citalopram,
sertraline
```
Think: "Fun Fabulous PECS"
213
SSRI uses
treat depression and OCD
214
SSRI side effect
sexual dysfunction
215
SSRIs and MAOIs cannot be given together due to
serotonin syndrome - changes in mental status, muscle stiffness, autonomic instability, hyperthermia
216
fluoxetine inhibits what enzyme
cytochrome P450
217
TCAs
Think: "ANTI-Depressant"
```
amitriptyline,
nortriptyline,
trazodone (tetracyclic anti depressant or SARI),
imipramine,
doxepin
```
218
TCA MOA
block norepinephrine and serotonin reuptake,
| also inhibit muscarinic, histamine, and alpha adrenergic receptors (side effects)
219
TCA uses
treats depression, enuresis (bed wetting), chronic pain syndromes
220
given together, TCAs and MAOIs cause
seizures
221
trazodone use
insomnia
think: "trazodone makes you zone out"
222
trazodone side effect
priapism
| prolonged erection
223
amitriptyline use
neuropathic pain
think: "am i tripping?"
224
imipramine use
enuresis
think: "promise me to stop wetting the bed"
225
buproprion use
smoking cessation,
| anti-depressant
226
histamine blockade
sedation
227
adrenergic blockade
postural hypotension, cardiac arrhythmias
228
muscarinic blockade
urinary retention,
blurred vision,
constipation,
dry mouth
229
heterocyclic anti depressants
nefazodone,
venlafaxine,
mitrazapine,
maprotiline
think: "NVM, Man"
230
nefazodone, venlafaxine, maprotiline MOA
block reuptake of norepinephrine and serotonin
231
mirtazapine MOA
inhibits activation at alpha 2 adrenergic receptors and at 5HT2 receptors,
increases release of NE and serotonin
232
mirtazapine side effects
sedation,
increased appetite,
weight gain
233
venlafaxine side effects
elevated BP and HR
234
MAOIs
tranylcypromine,
isocarboxazid,
phenelizine
think: "MAO TIP"
235
MAOa
NE and serotonin
236
MAOb
dopamine
237
MAOI use
atypical depression
238
side effect of MAOI
cheese effect:
MAO metabolizes tyramine- increased tyramine stimulates release of epi and NE
causes hypertensive crisis (HA, HTN, cardiac arrhythmias)
avoid tyramine-containing foods
239
selegiline MOA and use
MAOI for MAOb (dopamine),
treats parkinsons with levodopa,
and major depressive disorder
240
lithium use
bipolar disorder
241
lithium side effects
tremor,
hypothyroidism,
nephrogenic diabetes insipidus (ADH antagonism),
teratogen
242
drugs that cause hypothyroidism
lithium,
amiodarone,
sulfonamide
think: "LASs with hypothyroidism"
243
drugs that cause nephrogenic diabetes insipidus
lithium,
| demeclocycline
244
typical antipsychotics MOA
block dopamine D2 receptors,
| inhibit histamine, cholinergic, and alpha adrenergic receptors
245
typical antipsychotics
fluphenazine,
thioridazine,
chlorpromazine,
haloperidol
think: "antipsychotics For Typical, Crazy, Humans"
246
typical antipsychotics side effects
galactorrhea and amenorrhea (due to hyperprolactinemia),
neuroleptic malignant syndrome,
blockade symptoms,
extrapyramidal side effects
think: typicals treat tourette's syndrome
247
typical antipsychotics are effective against
positive symptoms
248
antidote for neuroleptic malignant syndrome
dantrolene (muscle relaxant)
249
atypical antipsychotics
```
olanzapine,
clozapine,
quetiapine,
risperidone,
aripiprazole,
ziprasidone,
```
think: (its) ATYPICAL (for) OLd CLOSets (to) QUIETly RISPER (from) A (to) Z.
250
atypical antipsychotic MOA
blocks serotonin and dopamine receptors
251
side effects of atypical antipsychotics
mild weight gain,
| parkinsonism
252
atypical antipsychotics treat what symptoms
positive and negative
253
clozapine side effects
leukopenia,
| agranulocytosis
254
drugs that cause agranulocytosis
```
ganciclovir,
clozapine,
carbamazepine,
colchicine,
methimazole,
PTU
```
think: "Gangs CCCrush Myeloblasts and Promyelocytes"
255
benzodiazepines (-lam, -pam, chlordiazepoxide) MOA
enhances GABAa activity, increased chloride ion influx, hyperpolarization, decreased CNS neuronal activity
256
benzo uses
anxiety, seizures, status epilepticus, alcohol withdrawal,
midazolam and diazepam are anesthetics
257
treatment for benzo overdose
flumazenil
| competitive antagonist of benzodiazepines
258
barbiturates uses
thiopental - induction of anesthesia,
| phenobarbital - management of seizures, treats neonatal hyperbilirubinemia
259
CC: crigler najjar syndrome
congenital syndrome where babies have difficulty conjugating bilirubin;
jaundice, encephalopathy
260
zolpidem use
short term tx for insomnia
think: "Zolpidem for Zzz"
261
zolpidem MOA
binds GABAa like benzos
262
zolpidem side effects
mild anterograde amnesia,
| hallucinations
263
phenytoin MOA
decrease flow of Na and Ca ions
264
phenytoin uses
anti-epileptic,
partial seizures,
status epilepticus,
265
phenytoin side effects
nystagmus,
gingival hyperplasia,
drug-induced lupus,
teratogen (fetal hydantoin syndrome)
266
drugs that cause drug induced lupus (SHIPP-E)
```
sulfa,
hydralazine,
isoniazid,
procainamide,
phenytoin,
etanercept
```
267
lamotrigine MOA
blocks fast voltage activated Na channels;
| anti-epileptic
268
lamotrigine side effect
stevens johnson syndrome
269
drugs that cause stevens johnson syndrome
sulfa,
penicillin,
allopurinol,
lamotrigine
270
valproic acid uses
mania,
| seizures
271
valproic acid side effects
hepatotoxic,
| teratogen (neural tube defects)
272
ethosuximide use
treats absence seizures
think: "it sux to be absent"
MOA: is not well-understood
273
carbamazepine MOA
inhibits flow of Na ions
274
carbamazepine uses
first line for simple seizures, complex partial seizures, generalized tonic-clonic seizures (grand mal),
treats trigeminal neuralgia
275
topiramate uses
migraines, seizures
think: "top of head hurts"
276
topiramate MOA
inhibits Na ion flow
277
tiagabine MOA
inhibits reuptake of GABA
278
tiagabine use
partial seizures as adjunct tx
279
vigabatrin MOA
irreversibly inhibts GABA transaminase
280
vigabatrin uses
infantile spasm in kids,
refractory complex partial seizures
think: "Vi-GABA-trin - "Visual" - "GABA transaminase"
281
side effects of vigabatrin
visual field constriction, visual loss in 30% of patients
282
levetiracetam uses
anti-epileptic, treats neuropathic pain
283
side effects of levetiracetam
drowsiness, depression
284
succinylcholine MOA
depolarizing neuromuscular blocker, competes with ACh to reversibly bind to nicotinic receptors
continuous depolarization at NMJ leads to fasciculations and eventual desensitization (NM blockade)
285
succinylcholine antidote
physostigmine
| cholinesterase inhibitor
286
succinylcholine use
muscle paralysis for endotracheal intubation
287
succinylcholine contraindicated with halothane because
malignant hyperthermia (antidote = dantrolene)
288
pancuronium MOA
non-depolarizing neuromuscular blocker,
does not activate nicotinic receptor but just blocks ACh binding to it,
no skeletal muscle contraction can occur
289
pancuronium antidote
neostigmine
| cholinesterase inhibitors
290
pancuronium use
adjunct to general anesthesia induction
291
ester local anesthetics duration of action
shorter than amides
292
side effects of local anesthetics
seizures
293
general inhaled anesthetics (-fluranes and halothane) uses
GA induction and maintenance
294
inhaled general anesthetic side effects
myocardial/respiratory depression,
halothane - fulminant hepatic necrosis,
methoxyflurane/enflurane - nephrotoxic
295
drugs that cause fulminant hepatic necrosis (HAVAc)
halothane,
amanita phalloides (death cap mushroom),
valproic acid,
acetaminophen
think: "Liver HAVAc"
296
bupivacaine side effects
myocardial depression,
| hypotension
297
IV general anesthetics
```
propofol,
etomidate,
ketamine,
benzos,
barbiturates
```
298
propofol uses and side effect
induction and maintenance of GA
conscious sedation;
hypotension
299
etomidate MOA and use
prolongs GABA activity;
induction of anesthesia and conscious sedation
300
ketamine MOA and side effects
NMDA receptor antagonist; decrease neuronal conduction
hallucinations, cardiac and resp depression
301
uses of codeine and dextromethorphan
cough suppressant
302
butorphanol
opioid agonist and antagonist (mixed)
| treats pain, manages migraines via intranasal formulation
303
tramadol
opioid agonist,
moderate to severe pain,
side effect is seizures
304
dantrolene MOA
inhibits calcium release from SR of myocytes to relax muscle -->
muscle relaxants
305
dantrolene uses
malignant hyperthermia;
| neuroleptic malignant syndrome
306
dantrolene side effect
hepatotoxic
307
levodopa crosses the BBB and then becomes
dopamine
308
levodopa use
first line tx for parkinsonism
309
levodopa side effects
dyskinesia, cardiac arrhythmias
310
levodopa is given with
carbidopa,
carbidopa inhibits dopa-decarboxylase peripherally so levodopa can act on the brain
311
sumatriptan MOA
stimulates presynaptic serotonin receptors --> inhibits vasodilation and inflammation of dura
312
sumatriptan uses
treats migraines and cluster headaches
313
sumatriptan side effect
coronary vasospasm (CI in CAD patients)
314
memantine MOA
NMDA antagonist
315
memantine use
moderate to severe alzheimers
316
buproprion MOA
inhibits reuptake of NE and dopamine,
| nicotinic antagonist
317
buproprion side effects
psychosis, seizures, dry mouth
318
varenicline MOA
partial agonist and antagonist (mixed) at a4B2 nicotinic ACh receptors in the brain
319
varenicline use and side effect
smoking cessation,
| suicidal ideation
320
pregabalin (lyrica) uses
treats neuropathic pain and fibromyalgia
321
gabapentin (neurontin) MOA
GABA analog
322
gabapentin uses
treats postherpetic neuralgia, neuropathic pain, partial seizures
323
gabapentin side effect
peripheral edema
324
buspirone MOA
acts on 5-HT1a as partial agonist
325
buspirone use
treats anxiety when used with SSRIs
326
goals of treating systolic heart failure
increase contractility - inotropes (dobutamine, milrinone), digoxin,
optimize HR - beta blockers,
optimize preload - diuretics, venodilators,
reduce afterload - arteriolar vasodilators, mixed vasodilators
327
which phases of the cardiac myocyte action potential are missing from the SA node action potential?
phase 1 and 2
328
cardiac myocyte depolarizaton occurs with what ion
Na
329
SA node depolarization occurs with what ion
Ca
330
class IA anti arrhythmics
disopyramide,
quinidine,
procainamide
think: "Double Quarter Pounder"
331
class IA anti arrhythmic MOA
block activated Na channels (phase 0 depol prolonged, phase 3 repol prolonged)
prolonged QT interval
332
class IB anti arrhythmics
lidocaine,
tocainide,
mexiletine
think: "lettuce tomato mayo"
333
class IB anti arrhythmic MOA
block activated and inactivated Na channels (phase 3 repol shortened along with AP)
shortened QT interval
334
class IC anti arrhythmics
encainide,
flecainide,
propafenone
think: "extra fries please!"
335
class IC anti arrhythmic MOA
block flow of Na inside;
| phase 0 depol prolonged
336
class III anti arrhythmics
```
bretylium
--
amiodarone,
ibutilide,
dofetilide,
sotalol
```
think: "Band-AIDS"
337
class III anti arrhythmic MOA
block flow of K channels out;
phase 3 repol prolonged (and AP)
prolonged QT interval
338
class IV anti arrhythmics
verapamil,
| diltiazem
339
class IV anti arrhythmic MOA
block voltage gates Ca channels in SA and AV nodes;
| slow phase 4 spontaneous depolarization
340
class I, 3, 4 - assoc. ions
```
class I - Na,
class III - K,
class IV - Ca
```
341
class IA anti arrhythmic uses
WPW syndrome,
a fib,
v tach
342
class IB anti arrhythmic uses
v tach,
| v fib
343
class IC anti arrhythmic uses
supraventricular arrythmias (a fib)
344
class III anti arrhythmic uses
-tilides --> atrial arrhythmias,
| sotalol and amiodarone --> atrial and ventricular arrhythmias
345
class IV anti arrhythmic uses
```
supraventricular tachycardia (a fib),
also treat hypertension and angina
```
346
quinidine side effect
cinchonism (vertigo, headache, tinnitus, psychosis)
class IA anti-arrhythmic
347
procainamide side effect
drug induced lupus
class IA anti-arrhythmic
348
disopyramide side effects
urinary retention,
double vision,
constipation
class IA anti-arrhythmic
349
amiodarone side effects
```
pulmonary fibrosis,
hepatotoxicity,
thyroid dysfunction,
cardiac arrhythmias,
ataxia,
photosensitivity
```
class III anti-arrhythmic; but has class I-IV actions
350
class IA and class III common side effect
torsades de pointes (prolonged QT interval, type of v tach)
351
how to treat torsades de pointes
isoproterenol and magnesium
352
adenosine use
anti arrhythmic used for cardiac stress testing
353
potassium uses
anti arrhythmic,
suppresses ectopic pacemakers,
treats digoxin toxicity
354
magnesium uses
anti arrhythmic,
| treats torsades de pointes and digoxin toxicity
355
nitroglycerin use
treats angina
356
nitroglycerin MOA
--> becomes nitric oxide -->
smooth muscle relaxation of veins,
decreases preload (venous return)
357
nitroglycerin side effect
hypotension
358
nitroprusside MOA
mixed vasodilator,
smooth muscle relaxation of peripheral veins and arteries,
decreased preload (venous return) and afterload (blood pressure)
359
use of nitroprusside
treats hypertensive crisis
360
side effect of nitroprusside
cyanide toxicity (adminster nitroprusside IV)
361
uses of ACEi and ARBs
treat hypertension and CHF,
| treat and prevent diabetic nephropathy
362
side effects of ACEi
cough,
angioedema
due to increased active bradykinin levels, while ARBs do not, since they simply block the angiotensin II receptor without inhibiting ACE
363
hydralazine MOA
direct relaxation of arteriolar smooth muscle;
| arteriolar vasodilators
364
uses of hydralazine
hypertension,
heart failure,
decreases afterload,
first line treatment of hypertension in pregnancy
365
side effect of hydralazine
drug induced lupus
366
minoxidil MOA and use
arteriolar vasodilators,
anti hypertensive agent,
opens K channels in smooth muscle,
also used for hair growth
367
CCB use
treats hypertension,
| verapamil and diltiazem treat supraventricular tachycardia
368
CCBs
```
nifedipine,
diltiazem,
verapamil,
amlodipine,
nicardipine
```
think: "ND VAN"
May need CCBs after eating at the ND VAN
369
side effect of amlodipine
peripheral edema
370
side effects of CCBs
hypotension,
| heart block
371
carbonic anhydrase inhibitor
acetazolamide
372
osmotic diuretics
glycerin,
mannitol,
urea,
isosorbide
think: "GUMI"
373
loop diuretics
furosemide,
bumetanide,
ethacrynic acid
torsemide
think: "F BEaTs"
374
thiazide diuretics
metolazone,
indapamide,
thiazide,
thalidone
think: "MITT"
375
K sparing diuretics
aldosterone receptor antagonists- spironolactone, eplerenone,
Na channel blockers - triamterene, amiloride
376
carbonic anhydrase inhibitors act at which part of the nephron
PCT
think: "PaCeTazolamide"
377
osmotic diuretics act at which part of the nephron
thin descending loop of henle
think: "osmosis jones is a tall, thin man (mannitol)"
378
carbonic anhydrase inhibitors MOA
inhibit carbonic anhydrase,
less bicarbonate reabsorbed,
more Na lost in tubular lumen,
carbonic anhydrase also in the eye - involved in production of aqueous humor
379
carbonic anhydrase inhibitors uses
treats glaucoma,
alkalinize the urine,
prophylaxis for high altitude sickness
380
uses of osmotic diuretics
decrease intracranial or intraocular pressure
381
uses of loop diuretics
for volume overload states,
hypertension,
hypercalcemia (excretes calcium)
382
uses of thiazide diuretics
first line for hypertension,
nephrogenic diabetes insipidus,
recurrent kidney calcium stones (spares calcium) - decreased excretion of calcium
383
MOA of K sparing diuretics
Na channel blockers - spare K by specifically blocking Na channels;
aldosterone receptor antagonists - competitive
384
carbonic anhydrase inhibitor side effects
hyperchloremic metabolic acidosis,
hypokalemia,
neuropathy,
sulfa allergy
385
osmotic diuretics side effects
pulmonary edema,
| contraindicated in CHF patients
386
loop diuretic side effects
ototoxicity,
hyperuricemia,
sulfa allergy (give ethacrynic acid instead),
hypokalemia
387
thiazide diuretics side effects
```
hyperuricemia,
hypokalemia,
hyperglycemia,
hyperlipidemia,
hypercalcemia,
metabolic alkalosis,
hypersensitivity reactions
```
388
Na channel blocker K sparing diuretic side effect
hyperkalemia
389
aldosterone receptor antagonist K sparing diuretic side effects
hyperkalemia,
| gynecomastia (anti- androgen effect with spironolactone)
390
phosphodiesterase inhibitors
sildenafil (viagra),
| milrinone
391
sildenafil MOA
selectively inhibits cGMP-specific PDE type 5 found in corpus cavernosum of the penis and smooth muscle of pulmonary vasculature
think: "sildenafive for type 5"
392
sildenafil uses
treats erectile dysfunction and pulmonary arterial hypertension
393
milrinone MOA
inhibits PDE type 3 (increased cAMP, open calcium channels, increased contractility)
394
milrinone use
treats acute decompensated heart failure
395
side effects of milrinone
nausea, thrombocytopenia
396
nesiritide MOA
synthetic human B type natriuretic peptide (hBNP),
| binds guanylate cyclase - increased cGMP, smooth muscle relaxation, reduced preload and afterload
397
nesiritide use
treats acute decompensated heart failure
398
nesiritide side effect
hypotension
399
digoxin (cardiac glycoside - others are digitoxin and ouabain) MOA
inhibits Na/K pump - increased intracellular Na, decreased activity of Na/Ca exchanger, increased intracellular Ca, increased contractility
400
digoxin use
treats heart failure
401
digoxin side effects
GI upset,
blurry, yellow vision,
ECG changes (prolonged PR, decreased QT, ST segment scooping, T wave inversion),
increase in parasympathetic flow
402
digoxin side effects are made worse by:
hypokalemia (digoxin and K compete for binding site to ATPase),
quinidine (displaces digoxin from binding sites on albumin and increases serum levels of digoxin)
403
heparin MOA
activates antithrombin III,
short half life,
rapid onset
404
LMWHs (low molecular weight heparin)
| (enoxaparin, dalteparin) duration of action
longer than heparin,
| need less frequent dosing
405
warfarin MOA
inhibits vitamin K dependent g-carboxylation of factors 2, 7, 9, 10, protein C and protein S;
long half life,
slow onset
406
direct thrombin inhibitors (argatroban) MOA
directly inhibit thrombin
-rudin, -gatroban, & -gatran
407
fondaparinux MOA
accelerate selective action of antithrombin III by inhibiting factor Xa
408
does fondaparinux have HIT has a side effect?
Heparin Induced Thrombocytopenia (HIT)
no
because Fondaparinux is selective --> doesn't have HIT as a side-effect
409
rivaroxaban MOA
direct inhibition of factor Xa
410
what do you give to a patient that is allergic to heparin?
fondaparinux or rivaroxaban
411
heparin uses
acute DVT,
| pulmonary embolism
412
warfarin use
chronic anticoagulation
413
direct thrombin inhibitors (argatroban) uses
acute and chronic anticoagulation
414
argatroban use
treats HIT
415
bivalirudin use
treats acute coronary syndromes during cardiac catheterization
can be used by patients allergic to heparin
416
fondaparinux uses
acute DVT,
| pulmonary embolism
417
rivaroxaban uses
DVT prophylaxis,
prevent thromboembolism in patients with A Fib
can be used by patients allergic to heparin
418
heparin side effects
bleeding (give protamine sulfate),
| HIT
419
warfarin side effects
bleeding,
| teratogen
420
aspirin MOA
irreversibly inhibits COX 1 and 2 to decrease prostaglandin synthesis -->
TXA2 inhibition provides decreased platelet aggregation
421
clopidogrel/prasurgel MOA
irreversibly inhibits binding of ADP to platelet P2Y receptor, blocking ADP mediated platelet aggregation;
no fibrinogen interaction with platelets so no platelet plug
422
cilostazol MOA
inhibits cAMP phosphodiesterase III;
inhibits TXA2 which decreases platelet aggregation
prasugrel is the same
423
dipyridamole MOA
inhibits uptake of adenosine into platelets,
inhibits platelet aggregation and thrombus formation
promotes vasodilation,
inhibits cGMP PDE
424
abciximab MOA
binds GP IIb/IIIa receptor complex,
inhibits binding of fibrinogen and vWF to the receptor
no platelet aggregation
think: "ABC it's easy as GP-2,3"
425
aspirin overdose can lead to
respiratory or metabolic acidosis (must alkalinize urine to promote excretion - give sodium bicarbonate)
426
ticagrelor MOA
reversible allosteric inhibitor of P2Y12 receptor,
| no platelet plug
427
aspirin indications
```
many uses,
pain,
fever,
antiplatelet,
antiinflammatory
```
428
clopidrogel uses
acute coronary syndrome (with aspirin),
patients undergoing placement of a coronary stent
prasugrel is the same
429
cilostazol use
claudication
430
dipyridamole uses
cardiac stress test,
| used with aspirin for stroke prevention
431
abciximab use
acute coronary syndrome
432
aspirin side effects
bleeding in GI tract,
gastric ulcers/gastritis,
reye's syndrome (fatal liver failure in kids with viral infections),
tinnitus
433
ticlopidine side effects
bleeding,
neutropenia,
thrombocytopenic purpura
434
prasugrel side effect
thrombocytopenic purpura
435
cilostazol side effects
headache,
| palpitations
436
dipyridamole side effects
hypotension,
| hepatotoxicity
437
abciximab side effects
bleeding,
thrombocytopenia,
diffuse alveolar hemorrhage
438
fibrinolytic agents
streptokinase,
urokinase,
alteplase,
reteplase
439
fibrinolytic agents MOA
promote conversion of plasminogen to plasmin
440
fibrinolytic agents indications
massive pulmonary embolism,
stroke,
acute MI,
most effective when given early on
441
fibrinolytic agents side effect
bleeding
442
aminocaproic acid (tranexamic acid) MOA
inhibits plasminogen activation,
inhibition of fibrinolysis,
promotes clotting
443
aminocaproic acid use
treats bleeding
444
aminocaproic acid side effect
thrombosis
445
synthetic erythropoietin (epoetin, darbepoetin) MOA
stimulates bone marrow to enhance erythroid proliferation and differentiation,
increases hematocrit
446
epoetin use
treats anemia
447
epoetin side effects
CV events and thrombotic complications,
| teratogen
448
epoetin contraindications
renal patients
449
how is insulin secreted?
```
glucose enters cell,
metabolizes to ATP,
ATP binds K channel and closes it so K cannot flow out of the cell,
depolarization,
calcium release intracellularly,
promotes exocytosis of insulin
```
450
thiazolidinediones (-glitazone) MOA
bind to PPAR-g which upregulates genes that lead to decrease in insulin resistance
451
rosiglitazone side effect
heart attacks
452
troglitazone side effect
liver damage
453
pioglitazone side effect
bladder cancer
454
thiazolidinediones (-glitazone) general side effects
edema, hypoglycemia
455
sulfonylureas MOA
inhibit K channel on beta cells
456
chlorpropamide side effect
disulfiram like reaction with alcohol
457
sulfonylurea general side effect
hypoglycemia
458
contraindication for sulfonylureas
pregnancy
459
1st generation sulfonylureas
chlorpropamide,
tolbutamide,
tolazamide
460
2nd generation sulfonylureas
glyburide,
| glipizide
461
3rd generation sulfonylureas
glimepiride
think: M3
462
alpha glucosidase inhibitors (acarbose and miglitol) MOA
inhibt alpha glucosidase which breaks down carbs into monosaccharides for absorption (no more absorption of glucose)
463
acarbose and miglitol side effects
GI upset (flatulence, diarrhea)
464
metformin uses
diabetes,
| treats polycystic ovarian syndrome (PCOS)
465
does metformin cause hypoglycemia?
no
466
metformin side effects
GI upset,
| lactic acidosis
467
metformin contraindication
renal patients (this is how it is excreted)
468
metformin MOA
inhibits hepatic gluconeogenesis and helps make beta cells work better
(improves insulin sensitivity)
469
meglitinides (-glinide) - ex. repaglinide MOA
bind K channel (different channel from sulfonylureas but same effect essentially)
470
meglitinides side effects
weight gain,
| hypoglycemia
471
DPP-4 inhibitors (sitagliptin, saxagliptin) MOA
DPP-4 degrades GLP-1,
GLP-1 increases insulin and decreases glucagon secretion,
inhibition of DPP-4 allows for more GLP-1 action
472
DPP-4 inhibitors side effect
nausea/vomiting
473
GLP-1 analogs (exenatide, liraglutide) MOA
mimic GLP-1 --> increase insulin and decrease glucagon secretion
474
GLP-1 analog side effects
pancreatitis,
hypoglycemia,
weight loss
475
bile acid resins
cholestyramine,
colestipol,
colesevelam
476
bile acid resins MOA
inhibit reabsorption of bile acids in jejunum and ileum,
| decreases LDL levels
477
bile acid resins side effects
GI upset,
| decreased fat soluble vitamin absorption (ADEK) and folic acid
478
statins MOA
HMG-coA reductase inhibitors,
| decrease total cholesterol and LDL levels
479
statins side effects
myopathy,
| abnormal LFTs
480
niacin MOA
increases HDL levels
481
niacin side effects
flushing (give aspirin to decrease),
| hyperuricemia
482
fibrates (gemfibrozil, -fibrates) MOA
stimulates lipoprotein lipase (breaks down TG into VLDL and chylomicrons which are then removed from circulation),
decreases TG levels
483
fibrates side effect
gallstone formation
484
ezetimibe MOA
decreases absorption of cholesterol in small intestine,
| decreases serum LDL
485
ezetimibe use
adjunct for hypercholesterolemia
486
ezetimibe side effects
steatorrhea (diarrhea),
myalgia,
elevated LFT
487
levothyroxine MOA
synthetic T4
think: "LeFOURthyroxine"
488
levothyroxine uses
hypothyroidism,
| goiters (thyroid cancer) by suppressing TSH secretion
489
PTU and methamizole MOA
inhibit thyroid peroxidase,
| inhibition of thyroid hormone synthesis and peripheral conversion of T4 to T3
490
PTU and methamizole use
hyperthyroidism
491
PTU and methamizole side effects
hepatotoxicity,
rash,
methamizole also is teratogen
492
symptoms of hyperthyroidism
tachycardia,
weight loss,
diarrhea
493
symptoms of hypothyroidism
bradycardia,
weight gain,
constipation
494
where is T4 secreted from?
follicular cells of the thyroid gland
495
prednisone (synthetic corticosteroid) MOA
synthetic glucocorticoids that mimic the action of endogenous glucocorticoids
496
prednisone uses
```
adrenocortical insufficiency,
IBD,
allergic reactions,
SLE, RA,
diagnosis of cushing's syndrome,
immunosuppression in organ transplants
```
497
prednisone side effects
symptoms of cushing syndrome (osteoporosis, hyperglycemia, fat redistribution - buffalo hump and moon facies),
impaired wound healing
498
how do we diagnose cushing's syndrome?
dexamethasone suppression test
499
beclomethasone use
inhaled corticosteroid used to treat chronic asthma
think: "B for Bronchial asthma and Beclomethasone"
500
bisphosphonates (-onate) - ex. alendronate MOA
decrease osteoclastic bone reabsorption
