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Pharma Flashcards

1
Q

Short acting Frenzodiazepams TOM

A

Triazolam Oxazepam Midazolam

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2
Q

1st line for Pseudomonas

A

antipseudomonal PCN + amnoglycoside. Pip Tazo plus Genta. PP Pseudomonas is Pip Tazo.

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3
Q

Antibiotic requiring oxygen for uptake into host cell therefore not effective against anaerobes

A

aminoglycoside

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4
Q

synergistic antibiotics

A

Beta lactam plus aminoglycoside

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5
Q

Drugs that cause coronary vasospasm

A

Cocaine Sumatriptan Ergot alkaloid

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6
Q

Drugs that cause cutaneous flushing VANC

A

Vancomycin Adenosine Niacin Ca channel blocker

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7
Q

Drugs that cause dilated cardiomyopathy

A

Doxorubicin (adriamycin) Daunorubicin

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8
Q

Cause torsade de pointes

A

Class III (sotalol) and class Ia (quinidine) antiarrhythmics

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9
Q

Cause agranulocytosis

A

Clozapine Carbamazepine Colchicine Propylthiouracil Methimazole Dapsone

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10
Q

Cause aplastic anemia

A

Chloramphenicol Benzene NSAIDs PTU Methimazole

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11
Q

Direct Coombs test positive

A

Methodopa Penicillin

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12
Q

SE

Gray baby syndrome

A

Chloramphenicol

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13
Q

SE

Hemolysis in G6PD. IS PAIN

A

Isoniazid Sulfonamide Primaquine ASA Ibuprofen

Nitrofurantoin

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14
Q

SE

MegaloBLASTic anemia

A

Phenytoin Methotrexate Sulfa drugs

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15
Q

SE thrombotic complications

A

OCP

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16
Q

SE pulmonary fibrosis

A

Bleomycin Amiodarone Busulfan

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17
Q

SE

Acute cholestatic hepatitis , jaundice

A

Erythromycin

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18
Q

SE

Focal to massive hepatic necrosis

A

Halothane Amanita phylloides Valproic acid Acetaminophen

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19
Q

Hepatitis

A

Isoniazid

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20
Q

Pseudomembranous colitis cause

A

Ampicillin clindamycin

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21
Q

SE

Adrenocortical suppression

A

Withdrawal of steroids

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22
Q

SE
Gynecomastia
Some Drugs Create Awkward Knockers

A

Spirinolactone digitalis cimetidine alcohol ketoconazole

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23
Q

SE

Hot flashes

A

Tamoxifen clomiphene

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24
Q

SE

Hyperglycemia

A

Niacin , tacrolimus ,protease inhibitors, hctz, steroids

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25
Q

SE

Hypothyroidism

A

Lithium Amiodarone sulfonamide

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26
Q

Most vestibulotoxic aminoglycoside

A

Gentamicin.

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27
Q

SE

Aminoglycosides

A

Nephrotoxicity and ototoxicity.

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28
Q

Extra pyramidal effects of antipsychotics after 4 hours, 4 days, 4 weeks, 4 months?

A

4 hours Acute dystonia - involuntary spasm of facial muscles only
4 days Akinesia - Parkinson like
4 weeks Akathisia - feeling of restlessness
4 months Tardive dyskinesia - involuntary spasm of facial muscles plus trunk, extremities

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29
Q

Slow involuntary writhing movement of hands and feet seen in cerebral palsy or Huntingtons disease

A

Athetosis

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30
Q

Chemo for ESTROGEN + or PROGESTERONE + receptor breast Ca

A

Tamoxifen

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31
Q

Monoclonal antibody against human epidermal growth factor receptor 2

A

Transtuzumab or herceptin used in breast ca with HER2 over expression

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32
Q

Therapeutic antibody against CD 20 of B cell NHL

A

Rituximab

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33
Q

Therapeutic antibody against TNF alpha used in crohn’s ds, rheumatoid arthritis, psoriatic arthritis

A

Infliximab, adalimumab

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34
Q

Asthma drugs. Identify drug class Ipratropium vs Salmetrol vs albuterol

A

Ipratropium anti muscarinic. Competitively bucks muscarinic r
Salmetrol long acting beta 2 agonist works up to 12 hours
Albuterol short acting beta 2 agonist 3 to 6 hours

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35
Q

Therapeutic antibody vs VEGF used in macular degeneration and colon, breast or non small cell lung ca.

A

Bevacizumab or Ranibizumab

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36
Q

What is ABVD used for Hodgkin’s lymphoma ?

A

A adriamycin (doxorubicin). intercalates DNA
B bleomycin - SE pulmonary fibrosis. Induces DNA strand breaks
V vinblastine - inhibit micro tubule assembly (Metaphase)
D dacarbizine - alkylation agent

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37
Q

Blocks t type calcium channels used in absence with SE of SJS

A

Ethosuximide

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38
Q

MOA Valproic acid

A

Inc GABA in brain, inc na channel inactivation

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39
Q

Anti epileptic drugs that Increase Na channel inactivation

A

Phenytoin, carbamazepine

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40
Q

First line generalized tonic clonic seizure

A

Phenytoin, carbamazepine

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41
Q

First line partial simple or complex seizure

A

Carbamazepine

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42
Q

Status epileptics meds

A

Benzodiazepams (diazepam or lorazepam) and phenytoin

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43
Q

Moa phenobarbital

A

Inc GABA action

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44
Q

Irreversibly inhibits GABA

A

Vigabatrin

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45
Q

MOA Gabapentin

A

Inhibit Calcium channels

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46
Q

Topiramate MOA

A

Blocks Na channels and Inc GABA action

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47
Q

Chemo drugs acting on S phase

A

Antimetabolites: 5FU, methotrexate, mercaptopurine

Etoposide

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48
Q

Chemo drugs acting on G2 phase

A

Synthesis of components needed for mitosis
Etoposide
Bleomycin

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49
Q

Inhibit formation of pyrimidines

A

5FU, methotrexate

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50
Q

Inhibit formation of purines

A

Mercaptopurine

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51
Q

SE neural tube defect vs fetal hydantoin syndrome

A

neural tube defect : Valproic acid

fetal hydantoin syndrome: Phenytoin

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52
Q

Inhibits thymidylate synthase vs dihydrofolate reductase

A

thymidylate synthase inhibitor: 5FU

dihydrofolate reductase: methotrexate

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53
Q

Inhibits bacterial transpeptidase

A

Penicillin drug class

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54
Q

Most vestibulotoxic aminoglycoside

A

Gentamicin.

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55
Q

SE

Aminoglycosides

A

Nephrotoxicity and ototoxicity.

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56
Q

Extra pyramidal effects of antipsychotics after 4 hours, 4 days, 4 weeks, 4 months?

A

4 hours Acute dystonia - involuntary spasm of facial muscles only
4 days Akinesia - Parkinson like
4 weeks Akathisia - feeling of restlessness
4 months Tardive dyskinesia - involuntary spasm of facial muscles plus trunk, extremities

How well did you know this?
1
Not at all
2
3
4
5
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57
Q

Slow involuntary writhing movement of hands and feet seen in cerebral palsy or Huntingtons disease

A

Athetosis

How well did you know this?
1
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2
3
4
5
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58
Q

Chemo for ESTROGEN + or PROGESTERONE + receptor breast Ca

A

Tamoxifen

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59
Q

Monoclonal antibody against human epidermal growth factor receptor 2

A

Transtuzumab or herceptin used in breast ca with HER2 over expression

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60
Q

Therapeutic antibody against CD 20 of B cell NHL

A

Rituximab

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61
Q

Therapeutic antibody against TNF alpha used in crohn’s ds, rheumatoid arthritis, psoriatic arthritis

A

Infliximab, adalimumab

How well did you know this?
1
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2
3
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5
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62
Q

Asthma drugs. Identify drug class Ipratropium vs Salmetrol vs albuterol

A

Ipratropium anti muscarinic. Competitively bucks muscarinic r
Salmetrol long acting beta 2 agonist works up to 12 hours
Albuterol short acting beta 2 agonist 3 to 6 hours

How well did you know this?
1
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2
3
4
5
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63
Q

Therapeutic antibody vs VEGF used in macular degeneration and colon, breast or non small cell lung ca.

A

Bevacizumab or Ranibizumab

How well did you know this?
1
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2
3
4
5
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64
Q

What is ABVD used for Hodgkin’s lymphoma ?

A

A adriamycin (doxorubicin). intercalates DNA
B bleomycin - SE pulmonary fibrosis. Induces DNA strand breaks
V vinblastine - inhibit micro tubule assembly
D dacarbizine - alkylation agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Blocks t type calcium channels used in absence with SE of SJS

A

Ethosuximide

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66
Q

MOA Valproic acid

A

Inc GABA in brain, inc na channel inactivation

How well did you know this?
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3
4
5
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67
Q

Anti epileptic drugs that Increase Na channel inactivation

A

Phenytoin, carbamazepine

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68
Q

First line generalized tonic clonic seizure

A

Phenytoin, carbamazepine

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69
Q

First line partial simple or complex seizure

A

Carbamazepine

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70
Q

Status epileptics meds

A

Benzodiazepams (diazepam or lorazepam) and phenytoin

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71
Q

Moa phenobarbital

A

Inc GABA action

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72
Q

Irreversibly inhibits GABA

A

Vigabatrin

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73
Q

MOA Gabapentin

A

Inhibit Calcium channels

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74
Q

Topiramate MOA

A

Blocks Na channels and Inc GABA action

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75
Q

Chemo drugs acting on S phase

A

Antimetabolites: 5FU, methotrexate, mercaptopurine

Etoposide

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76
Q

Chemo drugs acting on G2 phase

A

Synthesis of components needed for mitosis
Etoposide
Bleomycin

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77
Q

Inhibit formation of pyrimidines

A

5FU, methotrexate

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78
Q

Inhibit formation of purines

A

Mercaptopurine

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79
Q

SE neural tube defect vs fetal hydantoin syndrome

A

neural tube defect : Valproic acid

fetal hydantoin syndrome: Phenytoin

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80
Q

Inhibits thymidylate synthase vs dihydrofolate reductase

A

thymidylate synthase inhibitor: 5FU

dihydrofolate reductase: methotrexate

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81
Q

Inhibits bacterial transpeptidase

A

Penicillin drug class

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82
Q

Most vestibulotoxic aminoglycoside

A

Gentamicin.

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83
Q

SE

Aminoglycosides

A

Nephrotoxicity and ototoxicity.

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84
Q

Extra pyramidal effects of antipsychotics after 4 hours, 4 days, 4 weeks, 4 months?

A

4 hours Acute dystonia - involuntary spasm of facial muscles only
4 days Akinesia - Parkinson like
4 weeks Akathisia - feeling of restlessness
4 months Tardive dyskinesia - involuntary spasm of facial muscles plus trunk, extremities

How well did you know this?
1
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2
3
4
5
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85
Q

Slow involuntary writhing movement of hands and feet seen in cerebral palsy or Huntingtons disease

A

Athetosis

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86
Q

Chemo for ESTROGEN + or PROGESTERONE + receptor breast Ca

A

Tamoxifen

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87
Q

Monoclonal antibody against human epidermal growth factor receptor 2

A

Transtuzumab or herceptin used in breast ca with HER2 over expression

How well did you know this?
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88
Q

Therapeutic antibody against CD 20 of B cell NHL

A

Rituximab

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89
Q

Therapeutic antibody against TNF alpha used in crohn’s ds, rheumatoid arthritis, psoriatic arthritis

A

Infliximab, adalimumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Asthma drugs. Identify drug class Ipratropium vs Salmetrol vs albuterol

A

Ipratropium anti muscarinic. Competitively bucks muscarinic r
Salmetrol long acting beta 2 agonist works up to 12 hours
Albuterol short acting beta 2 agonist 3 to 6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Therapeutic antibody vs VEGF used in macular degeneration and colon, breast or non small cell lung ca.

A

Bevacizumab or Ranibizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What is ABVD used for Hodgkin’s lymphoma ?

A

A adriamycin (doxorubicin). intercalates DNA
B bleomycin - SE pulmonary fibrosis. Induces DNA strand breaks
V vinblastine - inhibit micro tubule assembly
D dacarbizine - alkylation agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Blocks t type calcium channels used in absence with SE of SJS

A

Ethosuximide

How well did you know this?
1
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2
3
4
5
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94
Q

MOA Valproic acid

A

Inc GABA in brain, inc na channel inactivation

How well did you know this?
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2
3
4
5
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95
Q

Anti epileptic drugs that Increase Na channel inactivation

A

Phenytoin, carbamazepine

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96
Q

First line generalized tonic clonic seizure

A

Phenytoin, carbamazepine

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97
Q

First line partial simple or complex seizure

A

Carbamazepine

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98
Q

Status epileptics meds

A

Benzodiazepams (diazepam or lorazepam) and phenytoin

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99
Q

Moa phenobarbital

A

Inc GABA action

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100
Q

Irreversibly inhibits GABA

A

Vigabatrin

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101
Q

MOA Gabapentin

A

Inhibit Calcium channels

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102
Q

Topiramate MOA

A

Blocks Na channels and Inc GABA action

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103
Q

Chemo drugs acting on S phase

A

Antimetabolites: 5FU, methotrexate, mercaptopurine

Etoposide

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104
Q

Chemo drugs acting on G2 phase

A

Synthesis of components needed for mitosis
Etoposide
Bleomycin

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105
Q

Inhibit formation of pyrimidines

A

5FU, methotrexate

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106
Q

Inhibit formation of purines

A

Mercaptopurine

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107
Q

SE neural tube defect vs fetal hydantoin syndrome

A

neural tube defect : Valproic acid

fetal hydantoin syndrome: Phenytoin

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108
Q

Inhibits thymidylate synthase vs dihydrofolate reductase

A

thymidylate synthase inhibitor: 5FU

dihydrofolate reductase: methotrexate

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109
Q

Inhibits bacterial transpeptidase

A

Penicillin drug class

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110
Q

Medication for Alzheimer’s that inhibits cholinesterase ie indirect cholinomimetic.

A

Donepezil

Not a cure, slows down disease but does not alter course.

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111
Q

Multinucleated giant cells. After initial infection, travels in retrograde manner to DRG.

Enveloped ds DNA virus.

A

HSV

Tzank smear

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112
Q

CYP 450 Inhibitors

Quin V inhibited was SICK with RAGE

A 
Quinidine
V inhibited was
Sulfonamides
Isoniazid
Cimetidine
Ketoconazole
Riot avid
Amniodarone
Grapefruit
Erythromycin
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113
Q

CYP 450 Inducers

Momma Ethel Booba Phoned Refusing Smoked or Grilled Carp

A 
Modafinil
Ethanol
Barbidurates
Phenytoin aka phenobarbiedoll
Rifampicin
Smoking or St. John's wort
Griseofulvin
Carbamazepine
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114
Q

Bactericidal antibiotics

Very Finely Proficient At Murder

A 
Vancomycin - binds D ala D ala
Fluroquinolone - inhibits DNA gyrase
PCN - bind transpeptidase
Aminoglycoside - inhibits initiation complex , 30s
Metronidazole -
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115
Q

Bacteriostatic antibiotics

BacteriostaTTECCS

A 
Trimethoprim
Tetracycline
Erythromycin
Clindamycin
Chloramphenicol
Sulfamethoxazole
How well did you know this?
1
Not at all
2
3
4
5
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116
Q

Antifungal: disrupts membrane function

A

Amphotheracin B

Nystatin

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117
Q

Antifungal: disrupts cell wall synthesis

A

Caspofungin

Anidulfungin

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118
Q

Antifungal: disrupts ergosterol synthesis

A

Fluconazole
Itraconazole
Voriconazole

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2
3
4
5
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119
Q

Antifungal: disrupts lanosterol synthesis

A

Terbinafine

Naftifine

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2
3
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5
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120
Q

SE of protease inhibitors “navir”s used in HIV tx

A

Lipodystrophy - fat redistribution
Hyperglycemia
GI intolerance, Nephropathy, Hematuria (indinavir)

Lopinavir, Atazanavir, Ritonavir, Indinavir, etc

How well did you know this?
1
Not at all
2
3
4
5
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121
Q

Nucleoside reverse transcriptase inhibitors NRTI side effect.

A

Bone marrow suppression
Peripheral neuropathy
Anemia - zidovudine

Didanosine, lamivudine, abacavir, tenofovir, zidovudine formerly azt,

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122
Q

Effect of drug on body

A

PharmacoDynamics

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123
Q

Effect of body on the drug

A

Pharmacokinetics

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124
Q

of hours max for pralidoxime to work

A

6 to 8 hrs

Used like atropine for organophosphate poisoning

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2
3
4
5
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125
Q

Used to alkalinize or acidify urine

A

alkalinize urine - make it Basic with Bicarbonate

acidify urine - make it Acidic with Ammonium chloride

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1
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2
3
4
5
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126
Q

Sublingual hypertensive meds pathway

A

Lingual vein -> IJV -> brachiocephalic or innominate vein -> SVC -> RA

How well did you know this?
1
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2
3
4
5
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127
Q

Rectal route of meds partial first pass because

A

Superior rectal vain -> IMV -> portal system FIRST PASS
Middle rectal vein -> IIV -> IVC
Inferior rectal vein -> IPV -> IIV -> IVC

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128
Q

Best topical preparation

A

Ointment > foam > cream

Slowest drug route

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129
Q

Routes of administration

Significant first pass effect ?
Partially bypasses first pass effect ?
Completely bypasses first pass effect ?

A

Significant first pass effect ? Oral

Partially bypasses first pass effect ? Rectal

Completely bypasses first pass effect ? IV, IM, SC, SL, inhalation, topical, transdermal (systemic effect)

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1
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130
Q

Soluble drugs are _____ & ________

A

Non ionized and non polar aka lipid soluble

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131
Q

Drugs that have zero order kinetics ie constant elimination rate over time / Linear

WHAT PET

A 
Warfarin
Heparin
Aspirin
Tolbutamide
Phenytoin
Ethanol
Theophylline

Note. NO Half life in zero order!!!

How well did you know this?
1
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2
3
4
5
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132
Q

Dosage required to have 50% efficacy aka amount needed to produce a given effect.

A

Potency

Efficacy is the height of the curve, potency is concentration in x axis

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133
Q

Concentration required to bind 50% of receptors

A

Kd

High Kd, low affinity etc

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134
Q

Measures of potency

A

ED50 median effective
TD50 median toxic
LD50 median lethal

135
Q

Agonist + competitive antagonist

A

Dec potency but same efficacy.

Lower Kmax, same Vmax

Shift to the right. You need more to obtain same effect in presence of competitive antagonist.

136
Q

Agonist plus concompetitive antagonist

A

DECrease efficacy, with same potency.

Lower Vmax, same Kd

137
Q

Idiosyncratic effect of allopurinol

138
Q

First order kinetics. Drugs metabolized 1, 2, 3 half life

A

1st half life 50%
2nd half life 75 %
3rd half life 87.5%

It takes 4 to 5 half lives to reach 100 %

139
Q

Area under the plasma concentration curve AUC

Aka the amount of drug that reached systemic circulation

A

Bioavailability

140
Q

Phase 1 reactions

To make drug more polar / water soluble for excretion as urine

HOaRD water

A 
Hydrolysis
Oxidation
a
Reduction
Deamination

Phase II reactions are Glucoronidation, acetylation, glutathione conjugation, glycine conjugation, sulfation, methylation

141
Q

Viral DNA polymerase inhibitor used in CMV retinitis when ganciclovir fails.

142
Q

Inhibition of neuraminidase which is necessary to release virions.

Works against influenza A and B

A

Zanamivir

Oseltmivir

143
Q

Nucleoside analogue that inhibits the synthesis of Guanine nucleotides.

Used in RSV and Hep C (+ interferon alpha)

144
Q

Regimen for HIV

A

2 NRTI + 1 NNRTI or 1 protease inhibitor or 1 integrase inhibitor

NRTI: zidovudine, didanosine, lamivudine, abacavir,
stavudine, emricitabine, tenofovir - no activation reqd
Protease inhibitors: “-navir” drugs
NNRTI: nevirapine, efavirenz, delavirdine. DEFeN need activation
Integrase inhibitor: Raltegravir

145
Q

Prevent maturation of new virus

A

Protease inhibitor

146
Q

Inhibit HIV genome integration into host cell

A

Integrase inhibitor - Raltegravir

147
Q

Allergic to TMP SMX, what is the alternative for P jirovenci

A

Pentamidine or dapsone

148
Q

Blocks peptidoglycan synthesis
Vs
Blocks cell wall synthesis by inhibiting peptidoglycan cross linking

A

Blocks peptidoglycan synthesis - vancomycin by binding D Ala D Ala part of cell wall precursors

Blocks cell wall synthesis by inhibiting peptidoglycan cross linking - PCN

149
Q

Hepatitis B medication

A

Lamivudine + interferon alpha

150
Q

Cephalosporin effective against Pseudomonas aeruginosa 3

A

1 cefoPERAzone 3 gen
2 ceftaziDIME 3 gen
3 CEFEpime 4 gen

CE FE ang PERA DIME

151
Q

Anti HIV drug tha decrease mother to fetus transmission of HiV

A

Zidovudine

152
Q

MOA clindamycin

A

Blocks peptide bond formation at the 50sS ribosomal subunit

Clindamycin - prevents bond formation so no new bacteria is produced : BACTERIOSTATIC

Indication: methicillin resistant Staph aureus

153
Q

Inhibits 50s peptidyltransferase

A

Chloramphenicol

Meningitis: H influenza, N meningitidis, S pneumonia

SE
Gray baby syndrome - lack of liver UDP glucuronyl transferase
Anemia/Aplastic anemia

154
Q

Medication for Alzheimer’s that inhibits cholinesterase ie indirect cholinomimetic.

A

Donepezil

Not a cure, slows down disease but does not alter course.

155
Q

Multinucleated giant cells. After initial infection, travels in retrograde manner to DRG.

Enveloped ds DNA virus.

A

HSV

Tzank smear

156
Q

CYP 450 Inhibitors

Quin V inhibited was SICK with RAGE

A 
Quinidine
V inhibited was
Sulfonamides
Isoniazid
Cimetidine
Ketoconazole
Riot avid
Amniodarone
Grapefruit
Erythromycin
157
Q

CYP 450 Inducers

Momma Ethel Booba Phoned Refusing Smoked or Grilled Carp

A 
Modafinil
Ethanol
Barbidurates
Phenytoin aka phenobarbiedoll
Rifampicin
Smoking or St. John's wort
Griseofulvin
Carbamazepine
158
Q

Bactericidal antibiotics

Very Finely Proficient At Murder

A 
Vancomycin - binds D ala D ala
Fluroquinolone - inhibits DNA gyrase
PCN - bind transpeptidase
Aminoglycoside - inhibits initiation complex , 30s
Metronidazole -
159
Q

Bacteriostatic antibiotics

BacteriostaTTECCS

A 
Trimethoprim
Tetracycline
Erythromycin
Clindamycin
Chloramphenicol
Sulfamethoxazole
160
Q

Antifungal: disrupts membrane function

A

Amphotheracin B

Nystatin

161
Q

Antifungal: disrupts cell wall synthesis

A

Caspofungin

Anidulfungin

162
Q

Antifungal: disrupts ergosterol synthesis

A

Fluconazole
Itraconazole
Voriconazole

163
Q

Antifungal: disrupts lanosterol synthesis

A

Terbinafine

Naftifine

164
Q

SE of protease inhibitors “navir”s used in HIV tx

A

Lipodystrophy - fat redistribution
Hyperglycemia
GI intolerance, Nephropathy, Hematuria (indinavir)

Lopinavir, Atazanavir, Ritonavir, Indinavir, etc

165
Q

Nucleoside reverse transcriptase inhibitors NRTI side effect.

A

Bone marrow suppression
Peripheral neuropathy
Anemia - zidovudine

Didanosine, lamivudine, abacavir, tenofovir, zidovudine formerly azt,

166
Q

Effect of drug on body

A

PharmacoDynamics

167
Q

Effect of body on the drug

A

Pharmacokinetics

168
Q

of hours max for pralidoxime to work

A

6 to 8 hrs

Used like atropine for organophosphate poisoning

169
Q

Used to alkalinize or acidify urine

A

alkalinize urine - make it Basic with Bicarbonate

acidify urine - make it Acidic with Ammonium chloride

170
Q

Sublingual hypertensive meds pathway

A

Lingual vein -> IJV -> brachiocephalic or innominate vein -> SVC -> RA

171
Q

Rectal route of meds partial first pass because

A

Superior rectal vain -> IMV -> portal system FIRST PASS
Middle rectal vein -> IIV -> IVC
Inferior rectal vein -> IPV -> IIV -> IVC

172
Q

Best topical preparation

A

Ointment > foam > cream

Slowest drug route

173
Q

Routes of administration

Significant first pass effect ?
Partially bypasses first pass effect ?
Completely bypasses first pass effect ?

A

Significant first pass effect ? Oral

Partially bypasses first pass effect ? Rectal

Completely bypasses first pass effect ? IV, IM, SC, SL, inhalation, topical, transdermal (systemic effect)

174
Q

Soluble drugs are _____ & ________

A

Non ionized and non polar aka lipid soluble

175
Q

Drugs that have zero order kinetics ie constant elimination rate over time / Linear

WHAT PET

A 
Warfarin
Heparin
Aspirin
Tolbutamide
Phenytoin
Ethanol
Theophylline

Note. NO Half life in zero order!!!

176
Q

Dosage required to have 50% efficacy aka amount needed to produce a given effect.

A

Potency

Efficacy is the height of the curve, potency is concentration in x axis

177
Q

Concentration required to bind 50% of receptors

A

Kd

High Kd, low affinity etc

178
Q

Measures of potency

A

ED50 median effective
TD50 median toxic
LD50 median lethal

179
Q

Agonist + competitive antagonist

A

Dec potency but same efficacy.

Lower Kmax, same Vmax

Shift to the right. You need more to obtain same effect in presence of competitive antagonist.

180
Q

Agonist plus concompetitive antagonist

A

DECrease efficacy, with same potency.

Lower Vmax, same Kd

181
Q

Idiosyncratic effect of allopurinol

182
Q

First order kinetics. Drugs metabolized 1, 2, 3 half life

A

1st half life 50%
2nd half life 75 %
3rd half life 87.5%

It takes 4 to 5 half lives to reach 100 %

183
Q

Area under the plasma concentration curve AUC

Aka the amount of drug that reached systemic circulation

A

Bioavailability

184
Q

Phase 1 reactions

To make drug more polar / water soluble for excretion as urine

HOaRD water

A 
Hydrolysis
Oxidation
a
Reduction
Deamination

Phase II reactions are Glucoronidation, acetylation, glutathione conjugation, glycine conjugation, sulfation, methylation

185
Q

Viral DNA polymerase inhibitor used in CMV retinitis when ganciclovir fails.

186
Q

Inhibition of neuraminidase which is necessary to release virions.

Works against influenza A and B

A

Zanamivir

Oseltmivir

187
Q

Nucleoside analogue that inhibits the synthesis of Guanine nucleotides.

Used in RSV and Hep C (+ interferon alpha)

188
Q

Regimen for HIV

A

2 NRTI + 1 NNRTI or 1 protease inhibitor or 1 integrase inhibitor

NRTI: zidovudine, didanosine, lamivudine, abacavir,
stavudine, emricitabine, tenofovir - no activation reqd
Protease inhibitors: “-navir” drugs
NNRTI: nevirapine, efavirenz, delavirdine. DEFeN need activation
Integrase inhibitor: Raltegravir

189
Q

Prevent maturation of new virus

A

Protease inhibitor

190
Q

Inhibit HIV genome integration into host cell

A

Integrase inhibitor - Raltegravir

191
Q

Allergic to TMP SMX, what is the alternative for P jirovenci

A

Pentamidine or dapsone

192
Q

Blocks peptidoglycan synthesis
Vs
Blocks cell wall synthesis by inhibiting peptidoglycan cross linking

A

Blocks peptidoglycan synthesis - vancomycin by binding D Ala D Ala part of cell wall precursors

Blocks cell wall synthesis by inhibiting peptidoglycan cross linking - PCN

193
Q

Hepatitis B medication

A

Lamivudine + interferon alpha

194
Q

Cephalosporin effective against Pseudomonas aeruginosa 3

A

1 cefoPERAzone 3 gen
2 ceftaziDIME 3 gen
3 CEFEpime 4 gen

CE FE ang PERA DIME

195
Q

Anti HIV drug tha decrease mother to fetus transmission of HiV

A

Zidovudine

196
Q

MOA clindamycin

A

Blocks peptide bond formation at the 50sS ribosomal subunit

Clindamycin - prevents bond formation so no new bacteria is produced : BACTERIOSTATIC

Indication: methicillin resistant Staph aureus

197
Q

Inhibits 50s peptidyltransferase

A

Chloramphenicol

Meningitis: H influenza, N meningitidis, S pneumonia

SE
Gray baby syndrome - lack of liver UDP glucuronyl transferase
Anemia/Aplastic anemia

198
Q

Medication for Alzheimer’s that inhibits cholinesterase ie indirect cholinomimetic.

A

Donepezil

Not a cure, slows down disease but does not alter course.

199
Q

Multinucleated giant cells. After initial infection, travels in retrograde manner to DRG.

Enveloped ds DNA virus.

A

HSV

Tzank smear

200
Q

CYP 450 Inhibitors

Quin V inhibited was SICK with RAGE

A 
Quinidine
V inhibited was
Sulfonamides
Isoniazid
Cimetidine
Ketoconazole
Riot avid
Amniodarone
Grapefruit
Erythromycin
201
Q

CYP 450 Inducers

Momma Ethel Booba Phoned Refusing Smoked or Grilled Carp

A 
Modafinil
Ethanol
Barbidurates
Phenytoin aka phenobarbiedoll
Rifampicin
Smoking or St. John's wort
Griseofulvin
Carbamazepine
202
Q

Bactericidal antibiotics

Very Finely Proficient At Murder

A 
Vancomycin - binds D ala D ala
Fluroquinolone - inhibits DNA gyrase
PCN - bind transpeptidase
Aminoglycoside - inhibits initiation complex , 30s
Metronidazole -
203
Q

Bacteriostatic antibiotics

BacteriostaTTECCS

A 
Trimethoprim
Tetracycline
Erythromycin
Clindamycin
Chloramphenicol
Sulfamethoxazole
204
Q

Antifungal: disrupts membrane function

A

Amphotheracin B

Nystatin

205
Q

Antifungal: disrupts cell wall synthesis

A

Caspofungin

Anidulfungin

206
Q

Antifungal: disrupts ergosterol synthesis

A

Fluconazole
Itraconazole
Voriconazole

207
Q

Antifungal: disrupts lanosterol synthesis

A

Terbinafine

Naftifine

208
Q

SE of protease inhibitors “navir”s used in HIV tx

A

Lipodystrophy - fat redistribution
Hyperglycemia
GI intolerance, Nephropathy, Hematuria (indinavir)

Lopinavir, Atazanavir, Ritonavir, Indinavir, etc

209
Q

Nucleoside reverse transcriptase inhibitors NRTI side effect.

A

Bone marrow suppression
Peripheral neuropathy
Anemia - zidovudine

Didanosine, lamivudine, abacavir, tenofovir, zidovudine formerly azt,

210
Q

Effect of drug on body

A

PharmacoDynamics

211
Q

Effect of body on the drug

A

Pharmacokinetics

212
Q

of hours max for pralidoxime to work

A

6 to 8 hrs

Used like atropine for organophosphate poisoning

213
Q

Used to alkalinize or acidify urine

A

alkalinize urine - make it Basic with Bicarbonate

acidify urine - make it Acidic with Ammonium chloride

214
Q

Sublingual hypertensive meds pathway

A

Lingual vein -> IJV -> brachiocephalic or innominate vein -> SVC -> RA

215
Q

Rectal route of meds partial first pass because

A

Superior rectal vain -> IMV -> portal system FIRST PASS
Middle rectal vein -> IIV -> IVC
Inferior rectal vein -> IPV -> IIV -> IVC

216
Q

Best topical preparation

A

Ointment > foam > cream

Slowest drug route

217
Q

Routes of administration

Significant first pass effect ?
Partially bypasses first pass effect ?
Completely bypasses first pass effect ?

A

Significant first pass effect ? Oral

Partially bypasses first pass effect ? Rectal

Completely bypasses first pass effect ? IV, IM, SC, SL, inhalation, topical, transdermal (systemic effect)

218
Q

Soluble drugs are _____ & ________

A

Non ionized and non polar aka lipid soluble

219
Q

Drugs that have zero order kinetics ie constant elimination rate over time / Linear

WHAT PET

A 
Warfarin
Heparin
Aspirin
Tolbutamide
Phenytoin
Ethanol
Theophylline

Note. NO Half life in zero order!!!

220
Q

Dosage required to have 50% efficacy aka amount needed to produce a given effect.

A

Potency

Efficacy is the height of the curve, potency is concentration in x axis

221
Q

Concentration required to bind 50% of receptors

A

Kd

High Kd, low affinity etc

222
Q

Measures of potency

A

ED50 median effective
TD50 median toxic
LD50 median lethal

223
Q

Agonist + competitive antagonist

A

Dec potency but same efficacy.

Lower Kmax, same Vmax

Shift to the right. You need more to obtain same effect in presence of competitive antagonist.

224
Q

Agonist plus concompetitive antagonist

A

DECrease efficacy, with same potency.

Lower Vmax, same Kd

225
Q

Idiosyncratic effect of allopurinol

226
Q

First order kinetics. Drugs metabolized 1, 2, 3 half life

A

1st half life 50%
2nd half life 75 %
3rd half life 87.5%

It takes 4 to 5 half lives to reach 100 %

227
Q

Area under the plasma concentration curve AUC

Aka the amount of drug that reached systemic circulation

A

Bioavailability

228
Q

Phase 1 reactions

To make drug more polar / water soluble for excretion as urine

HOaRD water

A 
Hydrolysis
Oxidation
a
Reduction
Deamination

Phase II reactions are Glucoronidation, acetylation, glutathione conjugation, glycine conjugation, sulfation, methylation

229
Q

Viral DNA polymerase inhibitor used in CMV retinitis when ganciclovir fails.

230
Q

Inhibition of neuraminidase which is necessary to release virions.

Works against influenza A and B

A

Zanamivir

Oseltmivir

231
Q

Nucleoside analogue that inhibits the synthesis of Guanine nucleotides.

Used in RSV and Hep C (+ interferon alpha)

232
Q

Regimen for HIV

A

2 NRTI + 1 NNRTI or 1 protease inhibitor or 1 integrase inhibitor

NRTI: zidovudine, didanosine, lamivudine, abacavir,
stavudine, emricitabine, tenofovir - no activation reqd
Protease inhibitors: “-navir” drugs
NNRTI: nevirapine, efavirenz, delavirdine. DEFeN need activation
Integrase inhibitor: Raltegravir

233
Q

Prevent maturation of new virus

A

Protease inhibitor

234
Q

Inhibit HIV genome integration into host cell

A

Integrase inhibitor - Raltegravir

235
Q

Allergic to TMP SMX, what is the alternative for P jirovenci

A

Pentamidine or dapsone

236
Q

Blocks peptidoglycan synthesis
Vs
Blocks cell wall synthesis by inhibiting peptidoglycan cross linking

A

Blocks peptidoglycan synthesis - vancomycin by binding D Ala D Ala part of cell wall precursors

Blocks cell wall synthesis by inhibiting peptidoglycan cross linking - PCN

237
Q

Hepatitis B medication

A

Lamivudine + interferon alpha

238
Q

Cephalosporin effective against Pseudomonas aeruginosa 3

A

1 cefoPERAzone 3 gen
2 ceftaziDIME 3 gen
3 CEFEpime 4 gen

CE FE ang PERA DIME

239
Q

Anti HIV drug tha decrease mother to fetus transmission of HiV

A

Zidovudine

240
Q

MOA clindamycin

A

Blocks peptide bond formation at the 50sS ribosomal subunit

Clindamycin - prevents bond formation so no new bacteria is produced : BACTERIOSTATIC

Indication: methicillin resistant Staph aureus

241
Q

Inhibits 50s peptidyltransferase

A

Chloramphenicol

Meningitis: H influenza, N meningitidis, S pneumonia

SE
Gray baby syndrome - lack of liver UDP glucuronyl transferase
Anemia/Aplastic anemia

242
Q

Allergic to TMP SMX, what is the alternative for P jirovenci

A

Pentamidine or dapsone

243
Q

Blocks peptidoglycan synthesis
Vs
Blocks cell wall synthesis by inhibiting peptidoglycan cross linking

A

Blocks peptidoglycan synthesis - vancomycin by binding D Ala D Ala part of cell wall precursors

Blocks cell wall synthesis by inhibiting peptidoglycan cross linking - PCN

244
Q

Hepatitis B medication

A

Lamivudine + interferon alpha

245
Q

Inhibits 50s peptidyltransferase

A

Chloramphenicol

Meningitis: H influenza, N meningitidis, S pneumonia

SE
Gray baby syndrome - lack of liver UDP glucuronyl transferase
Anemia/Aplastic anemia

246
Q

MOA clindamycin

A

Blocks peptide bond formation at the 50sS ribosomal subunit

Clindamycin - prevents bond formation so no new bacteria is produced : BACTERIOSTATIC

Indication: methicillin resistant Staph aureus

247
Q

Anti HIV drug tha decrease mother to fetus transmission of HiV

A

Zidovudine

248
Q

Cephalosporin effective against Pseudomonas aeruginosa 3

A

1 cefoPERAzone 3 gen
2 ceftaziDIME 3 gen
3 CEFEpime 4 gen

CE FE ang PERA DIME

249
Q

Medication for Alzheimer’s that inhibits cholinesterase ie indirect cholinomimetic.

A

Donepezil

Not a cure, slows down disease but does not alter course.

250
Q

Multinucleated giant cells. After initial infection, travels in retrograde manner to DRG.

Enveloped ds DNA virus.

A

HSV

Tzank smear

251
Q

CYP 450 Inhibitors

Quin V inhibited was SICK with RAGE

A 
Quinidine
V inhibited was
Sulfonamides
Isoniazid
Cimetidine
Ketoconazole
Riot avid
Amniodarone
Grapefruit
Erythromycin
252
Q

Inhibit HIV genome integration into host cell

A

Integrase inhibitor - Raltegravir

253
Q

Prevent maturation of new virus

A

Protease inhibitor

254
Q

Regimen for HIV

A

2 NRTI + 1 NNRTI or 1 protease inhibitor or 1 integrase inhibitor

NRTI: zidovudine, didanosine, lamivudine, abacavir,
stavudine, emricitabine, tenofovir - no activation reqd
Protease inhibitors: “-navir” drugs
NNRTI: nevirapine, efavirenz, delavirdine. DEFeN need activation
Integrase inhibitor: Raltegravir

255
Q

Nucleoside analogue that inhibits the synthesis of Guanine nucleotides.

Used in RSV and Hep C (+ interferon alpha)

256
Q

Inhibition of neuraminidase which is necessary to release virions.

Works against influenza A and B

A

Zanamivir

Oseltmivir

257
Q

Viral DNA polymerase inhibitor used in CMV retinitis when ganciclovir fails.

258
Q

Phase 1 reactions

To make drug more polar / water soluble for excretion as urine

HOaRD water

A 
Hydrolysis
Oxidation
a
Reduction
Deamination

Phase II reactions are Glucoronidation, acetylation, glutathione conjugation, glycine conjugation, sulfation, methylation

259
Q

Area under the plasma concentration curve AUC

Aka the amount of drug that reached systemic circulation

A

Bioavailability

260
Q

First order kinetics. Drugs metabolized 1, 2, 3 half life

A

1st half life 50%
2nd half life 75 %
3rd half life 87.5%

It takes 4 to 5 half lives to reach 100 %

261
Q

Idiosyncratic effect of allopurinol

262
Q

Agonist plus concompetitive antagonist

A

DECrease efficacy, with same potency.

Lower Vmax, same Kd

263
Q

Agonist + competitive antagonist

A

Dec potency but same efficacy.

Lower Kmax, same Vmax

Shift to the right. You need more to obtain same effect in presence of competitive antagonist.

264
Q

Measures of potency

A

ED50 median effective
TD50 median toxic
LD50 median lethal

265
Q

Concentration required to bind 50% of receptors

A

Kd

High Kd, low affinity etc

266
Q

Dosage required to have 50% efficacy aka amount needed to produce a given effect.

A

Potency

Efficacy is the height of the curve, potency is concentration in x axis

267
Q

Drugs that have zero order kinetics ie constant elimination rate over time / Linear

WHAT PET

A 
Warfarin
Heparin
Aspirin
Tolbutamide
Phenytoin
Ethanol
Theophylline

Note. NO Half life in zero order!!!

268
Q

Soluble drugs are _____ & ________

A

Non ionized and non polar aka lipid soluble

269
Q

Routes of administration

Significant first pass effect ?
Partially bypasses first pass effect ?
Completely bypasses first pass effect ?

A

Significant first pass effect ? Oral

Partially bypasses first pass effect ? Rectal

Completely bypasses first pass effect ? IV, IM, SC, SL, inhalation, topical, transdermal (systemic effect)

270
Q

Best topical preparation

A

Ointment > foam > cream

Slowest drug route

271
Q

Rectal route of meds partial first pass because

A

Superior rectal vain -> IMV -> portal system FIRST PASS
Middle rectal vein -> IIV -> IVC
Inferior rectal vein -> IPV -> IIV -> IVC

272
Q

Sublingual hypertensive meds pathway

A

Lingual vein -> IJV -> brachiocephalic or innominate vein -> SVC -> RA

273
Q

Used to alkalinize or acidify urine

A

alkalinize urine - make it Basic with Bicarbonate

acidify urine - make it Acidic with Ammonium chloride

274
Q

of hours max for pralidoxime to work

A

6 to 8 hrs

Used like atropine for organophosphate poisoning

275
Q

CYP 450 Inducers

Momma Ethel Booba Phoned Refusing Smoked or Grilled Carp

A 
Modafinil
Ethanol
Barbidurates
Phenytoin aka phenobarbiedoll
Rifampicin
Smoking or St. John's wort
Griseofulvin
Carbamazepine
276
Q

Effect of body on the drug

A

Pharmacokinetics

277
Q

Effect of drug on body

A

PharmacoDynamics

278
Q

Nucleoside reverse transcriptase inhibitors NRTI side effect.

A

Bone marrow suppression
Peripheral neuropathy
Anemia - zidovudine

Didanosine, lamivudine, abacavir, tenofovir, zidovudine formerly azt,

279
Q

SE of protease inhibitors “navir”s used in HIV tx

A

Lipodystrophy - fat redistribution
Hyperglycemia
GI intolerance, Nephropathy, Hematuria (indinavir)

Lopinavir, Atazanavir, Ritonavir, Indinavir, etc

280
Q

Antifungal: disrupts lanosterol synthesis

A

Terbinafine

Naftifine

281
Q

Antifungal: disrupts ergosterol synthesis

A

Fluconazole
Itraconazole
Voriconazole

282
Q

Bactericidal antibiotics

Very Finely Proficient At Murder

A 
Vancomycin - binds D ala D ala
Fluroquinolone - inhibits DNA gyrase
PCN - bind transpeptidase
Aminoglycoside - inhibits initiation complex , 30s
Metronidazole -
283
Q

Antifungal: disrupts cell wall synthesis

A

Caspofungin

Anidulfungin

284
Q

Antifungal: disrupts membrane function

A

Amphotheracin B

Nystatin

285
Q

Bacteriostatic antibiotics

BacteriostaTTECCS

A 
Trimethoprim
Tetracycline
Erythromycin
Clindamycin
Chloramphenicol
Sulfamethoxazole
286
Q

DOC for PCP ?

If with sulfa allergy?

A

DOC for PCP ? TMP-SMX (tx and prophylaxis)

If with sulfa allergy? Pentamidine

Prophylaxis for CD<200 in HIV

287
Q

Antibiotics versus Pseudomonas aeruginosa

A

Ce Fe Pera Dime

  • CEFEpime
  • CefoPERAzime
  • CeftaziDIME

Extended spectrum PCN + Aminoglycoside
-Aminoglycoside + Ticarcillin/Carbenicillin/Piperacillin

288
Q

Long term medication for chronic atrial fibrillation

A

Warfarin

INT 2-3

289
Q

Prevents further clot formation?

Breaks down existing clots?

Interferes with the binding of fibrinogen to platelets?

Binds glycoprotein receptor IIb/IIIa on activated platelets?

A

Prevents further clot formation? Heparin and ASA

  • does NOT break down existing clots!!!
  • Heparin: catalyzed activation of anti thrombin III
  • ASA side effect: tinnitus

Breaks down existing clots?
Thrombolytics: streptokinase/tissue plasminogen activator tPA
- converts plasminogen to PLASMIN which cleaves thrombin and fibrin clots

Interferes with the binding of fibrinogen to platelets?
Clopidogrel and ticlopidine
- via inhibiting the ADP pathway

Binds glycoprotein receptor IIb/IIIa on activated platelets?
Abciximab: prevents platelet aggregation

290
Q

Blocks leukotriene receptors?

Inhibits the 5 lipoxygenase pathway preventing conversion of arachidonic acid to leukotrienes?

A

Blocks leukotriene receptors? Zafirlukast

Inhibits the 5 lipoxygenase pathway? Zileuton

291
Q

Epinephrine vs Phentolamine

A

Epinephrine : nonselective agonist of Alpha and Beta receptors

Phentolamine : nonselective Alpha antagonist

if you give Epi alone, net inc in BP

  • B1 HR,inc contractility
  • A1 inc TPR (B mediated vasodilation negligible compared to A1 effects)

If you give Phentolamine alone, net inc BP

  • B1 HR,inc contractility
  • Normal Beta mediated vasodilation, no alpha action

If you give Epi then Phentolamine, net effect: Dec BP

  • No Alpha actions, Increased Beta action from Epi
  • arterioles: only Beta acting so massive vasodilation = Dec BP
  • Inc HR and Contractility
292
Q

Epi vs NorE vs Isoproterenol vs Dopa vs DoBu vs Phenylephrine vs Ritodrine vs Salmetrol/Terbutaline/Albuterol

A

A1 A2 B1 B2 D1
Epi +++ +++ ++++ ++++ 0

NorE ++++ ++++ ++ 0 0

Isoproterenol 0 0 ++++ ++++ 0

Dopa +++ H +++H +++M ++M +++L

DoBu + + ++++ + 0

Phenylephrine +++ ++ 0 0 0

Ritodrine 0 0 0 ++++ 0

Salmetrol/ 0 0 ++ ++++ 0
Terbutaline/
Albuterol

293
Q

Un intended effect of Norepinephrine

A

Decrease HR

  • NorE inc venous return to heart, via vasoconstriction and inc HR causing Inc SV. Since heart no longer needs to beat fast to maintain sufficient CO (SV x HR), there is REFLEX Bradycardia
294
Q

Oncology drugs

Induces formation of free radicals during the G2 phase?

Cross links chloride group during active and resting phase?

Inhibits topoisomerase II during the late S and early G2 phase?

A

Induces formation of free radicals at G2 phase causing DNA strand breaks?
- Bleomycin: pulmonary fibrosis: testicular Ca : lymphoma

Cross links chloride group during active and resting phase?
- Cisplatin: alkylating agent: cell cycle non specific : ototoxicity

Inhibits topoisomerase II ( unwinds DNA) during the late S and early G2 phase?
- Etoposide: increases DNA degradation
SE leukopenia/neutropenia/alopecia

295
Q

Antifungals

Disrupts microtubule function?

Forms pores in the cell membrane?

Inhibit DNA synthesis?

Inhibits conversion of lanosterol to ergosterol?

Inhibits conversion of squalene to lanosterol?

A

Disrupts microtubule function? Griseofulvin

Forms pores in the cell membrane? AmPOREthericin
- binds to ergosterol in cell membrane and creates pores

Inhibit DNA synthesis? Flucystosine

  • Pyrimidine anti metabolite like 5FU
  • competes with uracil

Inhibits conversion of lanosterol to ergosterol? Azoles

  • inhibit 14 alpha due methylation of lanosterol
  • ketoconazole, fluconazole

Inhibits conversion of squalene to lanosterol? Terbinafine
- inhibits squalene epoxidase

296
Q

Indication for Cox 2 inhibitors

A

Patients with known inflammation who are at high risk for GI ulceration and are at LOW RISK for CARDIOvascular ds

COX 1 gastric cytoprotection
COX 2 inflammatory state

  • in general , non specific COX inhibitors block conversion of AA to endoperoxides precursor of Prostaglandin, Prostacyclin, Thromboxane.
  • Prostacyclin is a powerful vasodilator and inhibitor of platelet aggregation. Thromboxane is a powerful vasoconstrictor and promoter of platelet aggreation.
  • COX 2 inhibitor increases CVS risk because it decreases Prostacyclin without corresponding decrease in Thromboxane
297
Q

Pulmonary fibrosis causing drugs

A

Bleomycin
Busulfan
Methotrexate
Nitrofurantoin

298
Q

P450 inducers

A

Momma Bar Steals Phen phen and Refuses Greasy Carbs Chronically

Modanifil
Barbidurates
St Johns wort
Phenytoin 
Griseofulvin
Carbamazepine 
Chronic alcohol use
299
Q

Drugs that precipitate hemolysis in G6PD

A 
Sulfonamides
Isoniazid
Aspirin
Ibuprofen
Primaquine
Nitrofurantoin
300
Q

Monoamine oxidase inhibitors

“MAO Takes Pride In Shanghai”

A 
MAO inhibitors inc NE, Serotonin, Dopamine
Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline

Toxicity: serotonin syndrome on exposure to certain food
Toxicity of TCA: excess acetylcholine symptoms

301
Q

MOA of Doxorubicin and Daunorubicin

A

DNA intercalators that act by binding to DNA and disrupting nucleic acid synthesis.

Via “ no covalent intercalation with DNA”

SE dilated cardiomyopathy

302
Q

MOA of 6 Mercaptopurine

A

Acts as a false metabolite and blocks purine synthesis

SE myelosupression, gastrointestinal effects, liver toxicity

303
Q

SE

Cinchonism

Cutaneous flushing

Hemolytic anemia

Photosensitivity

Thrombocytopenia

A

Cinchonism (blurred vision,tinnitus,HA,disorientation) : Quinidine

Cutaneous flushing : vancomycin, adenosine, niacin, Ca blockers

Hemolytic anemia: ribavirin

Photosensitivity: sulfonamide s, Amiodarone, tetracycline

Thrombocytopenia/neutropenia/leukopenia/nephrotoxicity: Ganciclovir

304
Q

Causes of folic acid deficiency

A

1 diet

2 phenytoin

305
Q

Site of action

Bleomycin
Etoposide
5 Fluorouracil
Methotrexate
Paclitaxel
Vincristine
A

Bleomycin : G2 phase : causes DNA strand breaks
Etoposide : late S and G2 phase : inhibits topoisomerase II
5 Fluorouracil : S phase : inhibit thymidylate synthase
Methotrexate : S phase : inhibit dihydrofolate reductase
Paclitaxel : Metaphase
Vincristine : Metaphase

306
Q

Chemo drugs

Causes covalent interstrand cross links in DNS?

Generates free radicals that intercalated DNA?

A

Causes covalent interstrand cross links in DNS?
- cyclophosphamide

Generates free radicals that intercalated DNA?
- Doxorubicin/Adriamycin

307
Q

Used in post renal transplant to inhibit Interleukin 2 secretion

A

Tacrolimus

308
Q

Chemo drugs

Cross links DNS?

Intercalates DNA?

A

Cross links DNS? Cisplatin

Intercalates DNA? Doxorubicin, et al

309
Q

SE. Ganciclovir vs Ribavirin

A

Ganciclovir : leukopenia, neutropenia, thrombocytopenia

Ribavirin : hemolytic anemia (Coombs negative)

310
Q

DOC for PCP ?

If with sulfa allergy?

A

DOC for PCP ? TMP-SMX (tx and prophylaxis)

If with sulfa allergy? Pentamidine

Prophylaxis for CD<200 in HIV

311
Q

Antibiotics versus Pseudomonas aeruginosa

A

Ce Fe Pera Dime

  • CEFEpime
  • CefoPERAzime
  • CeftaziDIME

Extended spectrum PCN + Aminoglycoside
-Aminoglycoside + Ticarcillin/Carbenicillin/Piperacillin

312
Q

Long term medication for chronic atrial fibrillation

A

Warfarin

INT 2-3

313
Q

Prevents further clot formation?

Breaks down existing clots?

Interferes with the binding of fibrinogen to platelets?

Binds glycoprotein receptor IIb/IIIa on activated platelets?

A

Prevents further clot formation? Heparin and ASA

  • does NOT break down existing clots!!!
  • Heparin: catalyzed activation of anti thrombin III
  • ASA side effect: tinnitus

Breaks down existing clots?
Thrombolytics: streptokinase/tissue plasminogen activator tPA
- converts plasminogen to PLASMIN which cleaves thrombin and fibrin clots

Interferes with the binding of fibrinogen to platelets?
Clopidogrel and ticlopidine
- via inhibiting the ADP pathway

Binds glycoprotein receptor IIb/IIIa on activated platelets?
Abciximab: prevents platelet aggregation

314
Q

Blocks leukotriene receptors?

Inhibits the 5 lipoxygenase pathway preventing conversion of arachidonic acid to leukotrienes?

A

Blocks leukotriene receptors? Zafirlukast

Inhibits the 5 lipoxygenase pathway? Zileuton

315
Q

Epinephrine vs Phentolamine

A

Epinephrine : nonselective agonist of Alpha and Beta receptors

Phentolamine : nonselective Alpha antagonist

if you give Epi alone, net inc in BP

  • B1 HR,inc contractility
  • A1 inc TPR (B mediated vasodilation negligible compared to A1 effects)

If you give Phentolamine alone, net inc BP

  • B1 HR,inc contractility
  • Normal Beta mediated vasodilation, no alpha action

If you give Epi then Phentolamine, net effect: Dec BP

  • No Alpha actions, Increased Beta action from Epi
  • arterioles: only Beta acting so massive vasodilation = Dec BP
  • Inc HR and Contractility
316
Q

Epi vs NorE vs Isoproterenol vs Dopa vs DoBu vs Phenylephrine vs Ritodrine vs Salmetrol/Terbutaline/Albuterol

A

A1 A2 B1 B2 D1
Epi +++ +++ ++++ ++++ 0

NorE ++++ ++++ ++ 0 0

Isoproterenol 0 0 ++++ ++++ 0

Dopa +++ H +++H +++M ++M +++L

DoBu + + ++++ + 0

Phenylephrine +++ ++ 0 0 0

Ritodrine 0 0 0 ++++ 0

Salmetrol/ 0 0 ++ ++++ 0
Terbutaline/
Albuterol

317
Q

Un intended effect of Norepinephrine

A

Decrease HR

  • NorE inc venous return to heart, via vasoconstriction and inc HR causing Inc SV. Since heart no longer needs to beat fast to maintain sufficient CO (SV x HR), there is REFLEX Bradycardia
318
Q

Oncology drugs

Induces formation of free radicals during the G2 phase?

Cross links chloride group during active and resting phase?

Inhibits topoisomerase II during the late S and early G2 phase?

A

Induces formation of free radicals at G2 phase causing DNA strand breaks?
- Bleomycin: pulmonary fibrosis: testicular Ca : lymphoma

Cross links chloride group during active and resting phase?
- Cisplatin: alkylating agent: cell cycle non specific : ototoxicity

Inhibits topoisomerase II ( unwinds DNA) during the late S and early G2 phase?
- Etoposide: increases DNA degradation
SE leukopenia/neutropenia/alopecia

319
Q

Antifungals

Disrupts microtubule function?

Forms pores in the cell membrane?

Inhibit DNA synthesis?

Inhibits conversion of lanosterol to ergosterol?

Inhibits conversion of squalene to lanosterol?

A

Disrupts microtubule function? Griseofulvin

Forms pores in the cell membrane? AmPOREthericin
- binds to ergosterol in cell membrane and creates pores

Inhibit DNA synthesis? Flucystosine

  • Pyrimidine anti metabolite like 5FU
  • competes with uracil

Inhibits conversion of lanosterol to ergosterol? Azoles

  • inhibit 14 alpha due methylation of lanosterol
  • ketoconazole, fluconazole

Inhibits conversion of squalene to lanosterol? Terbinafine
- inhibits squalene epoxidase

320
Q

Indication for Cox 2 inhibitors

A

Patients with known inflammation who are at high risk for GI ulceration and are at LOW RISK for CARDIOvascular ds

COX 1 gastric cytoprotection
COX 2 inflammatory state

  • in general , non specific COX inhibitors block conversion of AA to endoperoxides precursor of Prostaglandin, Prostacyclin, Thromboxane.
  • Prostacyclin is a powerful vasodilator and inhibitor of platelet aggregation. Thromboxane is a powerful vasoconstrictor and promoter of platelet aggreation.
  • COX 2 inhibitor increases CVS risk because it decreases Prostacyclin without corresponding decrease in Thromboxane
321
Q

Pulmonary fibrosis causing drugs

A

Bleomycin
Busulfan
Methotrexate
Nitrofurantoin

322
Q

P450 inducers

A

Momma Bar Steals Phen phen and Refuses Greasy Carbs Chronically

Modanifil
Barbidurates
St Johns wort
Phenytoin 
Griseofulvin
Carbamazepine 
Chronic alcohol use
323
Q

Drugs that precipitate hemolysis in G6PD

A 
Sulfonamides
Isoniazid
Aspirin
Ibuprofen
Primaquine
Nitrofurantoin
324
Q

Monoamine oxidase inhibitors

“MAO Takes Pride In Shanghai”

A 
MAO inhibitors inc NE, Serotonin, Dopamine
Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline

Toxicity: serotonin syndrome on exposure to certain food
Toxicity of TCA: excess acetylcholine symptoms

325
Q

MOA of Doxorubicin and Daunorubicin

A

DNA intercalators that act by binding to DNA and disrupting nucleic acid synthesis.

Via “ no covalent intercalation with DNA”

SE dilated cardiomyopathy

326
Q

MOA of 6 Mercaptopurine

A

Acts as a false metabolite and blocks purine synthesis

SE myelosupression, gastrointestinal effects, liver toxicity

327
Q

SE

Cinchonism

Cutaneous flushing

Hemolytic anemia

Photosensitivity

Thrombocytopenia

A

Cinchonism (blurred vision,tinnitus,HA,disorientation) : Quinidine

Cutaneous flushing : vancomycin, adenosine, niacin, Ca blockers

Hemolytic anemia: ribavirin

Photosensitivity: sulfonamide s, Amiodarone, tetracycline

Thrombocytopenia/neutropenia/leukopenia/nephrotoxicity: Ganciclovir

328
Q

Causes of folic acid deficiency

A

1 diet

2 phenytoin

329
Q

Site of action

Bleomycin
Etoposide
5 Fluorouracil
Methotrexate
Paclitaxel
Vincristine
A

Bleomycin : G2 phase : causes DNA strand breaks
Etoposide : late S and G2 phase : inhibits topoisomerase II
5 Fluorouracil : S phase : inhibit thymidylate synthase
Methotrexate : S phase : inhibit dihydrofolate reductase
Paclitaxel : Metaphase
Vincristine : Metaphase

330
Q

Chemo drugs

Causes covalent interstrand cross links in DNS?

Generates free radicals that intercalated DNA?

A

Causes covalent interstrand cross links in DNS?
- cyclophosphamide

Generates free radicals that intercalated DNA?
- Doxorubicin/Adriamycin

331
Q

Used in post renal transplant to inhibit Interleukin 2 secretion

A

Tacrolimus

332
Q

Chemo drugs

Cross links DNS?

Intercalates DNA?

A

Cross links DNS? Cisplatin

Intercalates DNA? Doxorubicin, et al

333
Q

SE. Ganciclovir vs Ribavirin

A

Ganciclovir : leukopenia, neutropenia, thrombocytopenia

Ribavirin : hemolytic anemia (Coombs negative)

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