Pharma Flashcards
what is the mehanism for anaphylaxis in epinephrine?
counteracts mast cells
2 drugs that can lead to aquierd angioedema
ACEi + Sacubitril
C/I for ACEi+ sacubitril
Heradetiry angioedema (low C1 inhibition)
What the diagnosis?
Vancomycin»_space; few minute after rash & flushing & pruritus
how to manage?
RED MAN SYNDROME
stop drug + antihistamine
if stops»_space; return to low infusion rate
What is the mechanism of Red man syndrome?
Psuedoallergy, Non IgE mediated = direct mast cell activation
Which drugs can cause DIRECT mast cell activation (psuedoallergy)
Vancomycin + opiods
What is the pre and post synaptic mechanism of opiods?
pre synaptic- closing of voltage gated Ca channels»_space; decrease excitatory neurotrasnmitters
Post synaptic- opening of K chaneels»_space; membrane hypopolarization
Which 2 side effects of downregulation by chronic opiod use is not exhibit tolerance?
miosis + constipation
Why opiods cuase
constipation
Respiratory acidosis
and how we treat
constipation- decrease GI motility (mu)»_space; fluid & laxatives
Respiratory acidosis- reduce RR and TV
How do chronic opiod use effect the hypothalmus
primary hypogonadism - low GRH = low LH + FSH
Which Hormones from thr ant. pituatry produce form POMC procursour
ACTH, MSH, beta endrophins
endrophins balance cortisol
Which population have high risk for opiods overdose?
CHF
COPD
CKD
CKD
What is the treatment for acute aortic dissection
beta 1 blocker (Esmolol) essss like tearing
reduce the aortic wall shear stress
What are Statins direct and inderct mechanism
Direct- inhibtion of HMG-Coa reductase
Indirect- Increase LDL receptors»_space; more uptake by hepatocytes
Common side effect of statins?
clue: which 2 organs
Myopathy and hepatotoxicity
How does statins metabolized? (by which molecule)
CYP3A4
What is the diagnosis?
Diffuse muscle pain + elevated CK (rabhdo) in a pt under statins
Statin induce myopathy
Why fibrates increase risk for statin myopathy?
impair hepatic statin clearance
fibrates- lower LDL
What is the sinergistic effect of Statin and Cholestyramine?
low plasma LDL levels
Which drugs can increase statin levels?
Macrolides, Ketoconazole, CCB, Amiodarone
What is the best treamtent for hypertriglyceridemia?
Fibrates (Fenofibrate)
What is Fenofibrate mechanism
(low TG)
activation of PPAR-alpha»_space; low VLDL + incresre LPL activity
How niacin (b3) work?
HLD, LDL, TG
increase HDL + Decrease LDL + TG
What is niacin famous side effect? what can we give to prevent?
Flushing
prevent:
Pre-treatment with Aspirin
how does Gemfibrozil induce gallstone formation?
to treat hyperTG
by reduce cholestraolsolubility and bile acid synthesis
G for Gallstones
how to Fish oil effect LDL metabolism
reduce VLDL + APO B production
what is the mechanism of PCSK9
reduce LDL receptor degradation = more LDL is uptake by the liver
how do Ezetimibe reduce LDL levels in blood
by reducing interstital absorbation»_space; more LDL receptors on the liver
eze ti iem= איזה טעים = קשור לקיבה= ירידה בספיגה של LDL
What is the MOA for Resins?
inhibit enterohepatic circulation of bile acids»_space; increase cholesterol uptake»_space; hyperTG
Which family belongs this two medications
Cilostazol
Sildenafil
PDE inhibitors
What is the MOA of Cilostazol
and in what indication we will give
reduce PLT aggregation + Direct atriel vasodilator
use for Peripheral artery disease (should also get secondary prevention - Aspirin or clopidogrel)
Which second messenger NO/ ANP / BNP elevate and what it the outcome
cGMP»_space; Vasodilation
what is the MOA of Slidenafil
PDE -5 inhibitor (all ends will fil)
reduce cGMP degradation»_space; smooth muscle relaxation
exception- Slidenfail also inhibit PDE-6 Six for Sindanefil=cyanopia, blue tinted vision
Whats the treatment for Mucocutaneous candidasis?
Nystatin»_space; bind ergosterol»_space; pores formation»_space; leakage of fungal content»_space; Swish and swallow
NOT PO. not absorb by the GI
לערבב בפה ואז לבלוע
Whats the trestment for Dermatophytosis
Terbinafine»_space; reduce sqalene poxidase»_space; reduce shyntesis of glucose membrane ergosterol
Which type of food should not be taken with Levothyroxine and why?
Soy products and chelators (Iron, Ca, Antacids)»_space; poor interstitnal reabsorbation»_space; persisitent hypothyroidisim symptoms
Whats the treatment for prolactinemia
Dopamin agonist
Carbegolin, Bromocriptin
Acromegly treatment?
Octrerotide (long acting somatostatin analoug»_space; inhibit GH secretion»_space; less IGF-1 realese from liver
not first line. first line resection
Which type of medication
X-trozole or X- estane
Aromatase inhibitors = reduce synthsis of of estrogen from androgens»_space; less cancer formation in HER2
Which family is Tamoxifen and what is a risk while using it?
SERM (selective estrogen receptor modulator)»_space; inhibit estrogen effect on breast tissue»_space; reduce breast tissue»_space; less cancer
also for prostate cancer pt»_space; reduce gnycomastia
risk factor: hyperplasia of uterus»_space; endometrium hyperplasia / cancer
What can we gave to males with symptomatic hypogonadism
Testosterone replacment thrapy
What is Raloxifene MOA
SERM
Agonist on the bone = less bone reabsorption
R in raloxifene like R in reabsorbtion , X = prevent
What is the MOA of Leuprolide
GnRH agonist: reduce LH relase»_space; resuce testosterone release»_space; osteoporsis
In which cancer Leuprolide is given
prostate cancer
long affect of making the hypophysis less responsive
leu de caprio have prostate
What improve exopthalmos in hyperthyroidism
Cortisol
Which Teratogenic medication cause NTD, Microcephaly, orofical cleft, dysmorophic facial feature, distal digit/ nail hypoplasia?
Phenytoin
Which Teratogenic medication cause Ebtain anomaly, Nephrogenic DI, hypothyrodisim?
Lithium
Which Teratogenic medications cause NTD
Valporate - only NDT
Phyntoin
MTX
Which Teratogenic medication cause Microcephaly + thymic hypoplasia, small ears, hydrocephalus?
Isotretinoin
Which Teratogenic medication cause Limb & craniofacial abnormalies, NTD, abortion
MTX
Which Teratogenic medication cause renal dysgenesis, oligohydramnius
ACEi
Which Teratogenic medication cause nasal hypoplasia, stippled epiphysis
Warfarin
Which medication can be given to CMV colitis
Foscarnet (not require intracellular activation like Gan/Acyclovir)
What are the 3 main side effect of Histamines
- Cholinergic/ Muscarinic- blurry vision, urine retention, consipation
- alpha-adrenergic- postural diziness, falls
- Seratonergic- appietite stimulaiton, weight gain
What is the main adverse effect of Nitrates?
Headaches, Cutaneous flashing, hypotension
Which class is Milirinone and What is the MOA
class- PDE-3 inhibitor
MOA:
vasodilaiton in smooth muscle (increase Ca uptake by the SR)
positive ionotropy in cardiac muscle (Ca cahnnel activation)
What is the option of treatment for Drug- indcue parkinsonism?
Anti-cholinergic : Benztropine, Trihexyphenydil
What is the MOA of Doxycycline?
inhibit protein synthesis by binding to 30S bacterial subunit
What is the MOA of Digoxin?
Slow conduction through the AV node by increase parasymphathetic (vagal) tone = control HR
What is the MOA of Loop diuretics?
inhibit Na-K-2CI transportert in Ascending loop of henle»_space; potent excretion of Na and water
Which medication treat COPD by blocking Ach at muscarinic receptors
(inhibit parasymphatetic)
Ipratropium- anticholinergic ( der. of atropine)
Which Acid-base disturbace happend in loop diuretics?
Metabolic alkelosis:
1. by renal excretion of H and K
2. Kidney retain more HCO3- (due to loss of CI)
Which Diuretics elevate Uric acid?
loop, Thiazide
Which Diuretics can cuause Hyperkalemia?
Pottasium sparing (aldosterone antagonist)
Which medication can be added if theres metabolic alkelosis due to loop diuretics?
Carbonic anhydrase inhibitor (acetazolamide)
What is the muscarinic effect of Cholinergic toxicity?
DUMBLES
Diarrhea/diaporhesis
Urination
Miosis
Bronchospasm, Bradycardia
Emesis
Lacrimination
Salivation
What is the nicotinic effect of Cholinergic toxicity?
Muscle weakness
paralysis & fasciculations
Which medicaiton is giving in organophosphate toxicity to inhibit both nictonic effects and muscarinic effects
Pralidoxime- cholineeaterase reactivating agent
MOA of Organophosphate
Cholinesterase inhibitor = cholinergic toxicity
Atropine MOA
Block connection of Ach connection to M2 receptors (inhibit para-sympathetic stimulation)
Which site is predominantly affeced by Nitrates? and how it effect the heart?
Large veins»_space; smooth muscle relaxation lead to venodilation»_space; pre-load reduce = less O2 needed by myocard
Which medication cuased smooth muscle vasodilation in small arteries and arterioles?
CCB.
What is the MOA of urgency incontinence (overactive bladder) and what is the Tx?
unhibited bladder contractions = detrosur instability
Tx- Beta-3 Adrenergic agonist (Mirabegron) promote detrosur relaxation = more pee is stored
or
Oxybutrin (M3 antagonist)
Omeprazole is a ————- medication which can decrease absorbation of ———- leading to————-
PPI agent, Decrease Ca absorpation»_space; lead to osteoporotic fructures
