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pharma Flashcards

1
Q

Difference between Pharmacokinetics and Pharmacodynamics

A

Pharmacokinetics - actions of the body on the drug. Pharmacodynamics - actions of the drug on the body.

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2
Q

Heparin is the anticoagulant used for pregnancy due to its large size (unable to cross the placenta). What is it’s MOA?

A

Increases antithrombin III, monitored using PTT, antidote is Protamine Sulfate

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3
Q

Which quadrant of the buttocks is the safest for IM drug administration?

A

Superolateral

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4
Q

What is drug is contraindicated to be given via IM?

A

Anticoagulants - may cause hematomas

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5
Q

Through which BV do drugs administered SL pass before reaching the heart?

A

Lingual vein > IJV > Brachiocephalic/Innominate vein > SVC > RA

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6
Q

Route that has partial avoidance of the first pass effect

A

Rectal or Suppository route

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7
Q

DOC for Parkinsons

A

Levodopa - Dopamine will not cross the BBB

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8
Q

Acidic drugs bind to Albumin, Basic drugs bind to?

A

Orosomucoid

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9
Q

DOC for biolar disorder

A

Lithium

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10
Q

Antiemetic that is contraindicated for patients with seizures

A

Meperidine - active metabolite Normeperidine exacerbates seizures

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11
Q

Cholinergic antagonist used in the treatment of Parkinson’s disease

A

Benztropine - reduces tremors

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12
Q

Colinergic antagonist, applied as a transdermal patch, used for motion sickness

A

Scopolamine - antagonizes histamine and serotonin

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13
Q

Competitively blocks Nn nicotinic Ach receptors. Used for hypertensive emergencies. SE of postural HTN.

A

Hexamethonium

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14
Q

Drugs that are important for producing complete skeletal muscle relaxation in surgery

A

Neuromuscular blockers

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15
Q

Norepinehrine comes from what AA?

A

Tyrosine

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16
Q

Sympathomimetic (non-selective, direct acting). Last resort drug for cardiogenic shock

A

Norepinephrine

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17
Q

Non-selective, direct acting sympathomimetic used for shock and heart failure

A

Dopamine

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18
Q

Beta non selective sympathomimetic used for asthma

A

Isoproterenol

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19
Q

Treatment for rebound hypertension caused by Clonidine

A

Phentolamine

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20
Q

Alpha 2 selective sympathomimetic for the treatment of Pre-eclampsia

A

Methyldopa - decreases central sympathetic outflow

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21
Q

Alpha 2 selective sympathomimetic that decreases secretion of aqueous humor

A

Apraclonidine (Brimonidine) - for glaucoma

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22
Q

Beta 1 selective sympathomimetic used to treat acute heart failure

A

Dobutamine - may also be used in cardiac stress testing

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23
Q

Beta 2 selective sympathomimetic, DOC for acute asthma attacks

A

Albuterol/Salbutamol

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24
Q

Beta 2 selective sympathomimetic that is used for tocolysis of preterm labor

A

Terbutaline and Ritodrine

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25
Q

Drug used for Pheochromocytoma (pre-surgical)

A

Phenoxybenzamine - alpha non selective, irreversible adrenergic antagonist

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26
Q

Alpha 1 selective adrenergic antagonist that is most selective for prostatic smooth muscle

A

Tamsulosin (Prazosin)

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27
Q

SE of Propanolol

A

Masks symptoms of hypglycemia in diabetics

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28
Q

Non selective beta blocker (adrenergic antagonist) with the longest half life

A

Nadolol

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29
Q

Selective B1 blocker (adrenergic antagonist) used for supraventricular tachycardia

A

Esmolol - also has the shortest half life

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30
Q

Muscle that controls accommodation of the eye

A

Ciliary muscle (parasympathetic)

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31
Q

Prostaglandin that increases outflow through Canal of Schlemm

A

Latanoprost

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32
Q

Diuretic that inhibits Na/Cl transporter in distal convoluted tubule

A

Hydrochlorothiazide

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33
Q

Loop diuretic that inhibits Na/K/Cl transporter in the thick ascending limb of the Loop of Henle

A

Furosemide

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34
Q

Obsolete drug for HTN, may cause suicidal ideation

A

Reserpine - nerve terminal blocker

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35
Q

3 drugs used to control HTN in pheochromocyta

A

Phenoxybenzamine, Phentolamine, Labetalol

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36
Q

DOC for heart failure in African patients. May also be used for pre-eclampsia

A

Hydralazine

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37
Q

Marker for drug induced lupus

A

Anti-histone antibodies

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38
Q

Vasodilator for HTN and alopecia

A

Minoxidil - can cause hypertrichosis or excessive hair growth

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39
Q

Block voltage gated L type calcium channels in the heart. For supraventricular tachycardia. Has a side effect of gingival hyperplasia

A

Verapamil (Diltiazem)

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40
Q

Vasodilator that may cause cyanide toxicity

A

Nitroprusside

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41
Q

Most common cause of bradykinin induced cough. Also delays progression of diabetic nephropathy

A

Captopril - ACE inhibitor

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42
Q

Hyperkalemia and ACE inhibitors/ARBs

A

Drugs reduce aldosterone levels and cause potassium retention

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43
Q

Renin antagonist. Drug for HTN

A

Aliskiren

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44
Q

DOC for Prinzmetal’s angina

A

CCB - Diltiazem

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45
Q

Why are antilipid drugs given to patients with unstable angina?

A

Statins stabilize the plaques

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46
Q

Which portion of the ETC is affected by cyanide poisoning?

A

Complex IV (cytochrome oxidase)

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47
Q

Antidote for cyanide poisoning

A

Inhaled amyl nitrite + IV sodium nitrite + IV sodium thiosulfate

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48
Q

Short acting nitrate that affects veins more

A

Nitroglycerin

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49
Q

Nitrate induced headache

A

Meningeal artery vasodilation

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50
Q

Non-dihydropyridine CCB used to treat angina and Raynaud’s phenemenon

A

Diltiazem

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51
Q

Beta blocker that has erectile dysfunction as a side effect

A

Propanolol

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52
Q

Cardiac glycoside with a narrow therapeutic index

A

Digoxin - inhibits Na/K ATPase, increasing intracellular Ca, drug for heart failure with systolic dysfunction

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53
Q

DOC in antiarrhythmic treatment of digitalis toxicity

A

Lidocaine

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54
Q

Digitalis toxicity is increased by:

A

Hypokalemia, hypomagnesemia, and hypercalcemia

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55
Q

These drugs are of no value in CHF

A

Calcium channel blockers

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56
Q

Diuretic that can be used for immediate reduction of pulmonary congestion and severe edema in HF

A

Furosemide (loop diuretic)

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57
Q

These drugs reduce progression of heart failure

A

Beta blockers - Carvedilol, Labetolol and Metoprolol

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58
Q

Condition induced by antiarrhythmics where there is polymorphic ventricular tachycardia on ECG

A

Torsades de pointes

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59
Q

Class 1 antiarrhythmic with Lupus like syndrome as a side effect

A

Procainamide - used especially after an MI

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60
Q

Class 1 antiarrhythmic that can cause marked antimuscarinic effects

A

Disopyramide

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61
Q

Class 1 antiarrhythmic that can also be used for malaria. SEs of cinchonism and autoimmune reactions (ITP)

A

Quinidine

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62
Q

Drug for class 1A antiarrhythmics to reverse drug induced arehythmias

A

Sodium lactate

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63
Q

Least cardiotoxic anti-arrhythmic. DOC for ventricular arehythmias post MI and digoxin induced arrhythmias.

A

Lidocain - Class 1B antiarrhythmic

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64
Q

Contraindicated for post MI arrhythmias

A

Flecainide - Class 1C antiarrhythmic. Used for refractory arrhythmias.

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65
Q

Post MI prophylaxis against sudden death, can also be used for thyrotoxicosis

A

Propanolol - class 2 anti arrhythmic

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66
Q

Usually given for A-fib, hallmark is prolongation of AP duration and increase in QT interval

A

Class 3 antiarrhythmics

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67
Q

Beta blocker antiarrhythmic that has class 3 properties

A

Sotalol

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68
Q

A super antoarrhythmic with a SE of microcrystalline deposits in cornea and skin

A

Amiodarone - Class 3 anti arrhythmic. Used for refractory arrhythmias

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69
Q

Effective in arrhythmias that must traverse calcium dependent cardiac tissue (AV node)

A

Class 4 antiarrhythmics - PR interval consistently increased

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70
Q

Evoke a compensatory sympathetic discharge which facilitates arrhythmias rather than terminating them

A

Dihydropyridine CCBs

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71
Q

Miscellaneous antiarrhythmic which is the DOC for paroxysmal SVT

A

Adenosine

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72
Q

Site of action of carbonic anhydrase inhibitors (Acetazolamide)

A

Proximal Convoluted Tubule

73
Q

Why is acetazolamide used in treating mountain sickness

A

Acetazolamide causes metabolic acidosis resulting to increased respiration

74
Q

Site of uric acid transport

A

Proximal convoluted tubule

75
Q

Site of action of loop diuretics, site of Ca and Mg reabsorption

A

Thick ascending limb of the loop of henle

76
Q

Site of action of thiazide diuretics, pumps Na and Cl out of the lumen via the Na/Cl carrier

A

Distal convoluted tubule

77
Q

Calcium is reabsorbed in this segment under the control of PTH

A

Distal convoluted tubule

78
Q

Site of action of potassium sparing diuretics

A

Cortical collecting duct

79
Q

Steroid inhibitors of cytoplasmic aldosterone receptor in CCD. Can cause gynecomastia

A

Spironolactone - potassium sparing diuretic

80
Q

Retains water in tubule by reducing reabsorption in proximal tubules, descending limb of the loop of Henle and collecting ducts

A

Mannitol - osmotic diuretic

81
Q

Site of action of ADH agonists and antagonists

A

Medullary collecting duct

82
Q

Condition that occurs with rapid correction of hyponatremia

A

Central pontine myelinolysis

83
Q

Increase number of high affinity LDL receptors which clear LDL and VLDL remnants from the blood

84
Q

Reversible competitive inhibitor of HMG COA reductase

A

Simvastatin - given before bedtime

85
Q

Binds bile acids, preventing their reabsorption and increasing cholesterol utilization for replacement

A

Cholestyramine - bile acid binding resin, modestly lowers LDL levels

86
Q

A transport process in jejunal enterocytes that mediates GI uptake of cholesterol and phytosterols. Inhibited by Ezetimibe

A

NPC1L1 transporter

87
Q

Cholesterol analog. Takes the place of dietary and biliary cholesterol, decreasing intestinal absorption

A

Sitosterol

88
Q

Most effective agent for increasing HDL levels

89
Q

Pre treatment with this drug reduces Niacin associated flushing

90
Q

Activates PPAR alpha and increases expression of lipoprotein lipase and apolipoproteins. DOC for hypertriglyceridemia.

A

Gemfibrozil - lowers triglycerides, increases HDL

91
Q

Disadvantage of Fibrate + Resin

A

Increased risk of cholelithiasis

92
Q

Disadvantage of Statin + Fibrate

A

Increased risk of myopathy and rhabsomyolysis

93
Q

Combinations for familial hypercholesterolemia

A

Niacin + Statin, Statin + Ezetimibe

94
Q

Histamine is formed from what amino acid?

95
Q

How do you detect an excess production of histamine?

A

Measurement of Imidazole acetic acid in the urine

96
Q

Triple response effect of histamine

A

Wheal, flush and flare

97
Q

Histamine receptor in stomach, heart and mast cells

98
Q

Histamine receptor in smooth muscle

99
Q

Histaminergic agent with anti-motion sickness effect

A

Meclizine - H1 receptor antagonist (1st generation)

100
Q

Histaminergic agent that reduces gastric acid secretion

A

Cimetidine - H2 receptor antagonist

101
Q

Serotonin is produced from what amino acid?

A

Tryptophan

102
Q

How is excess production of serotonin detected?

A

5-HIAA in urine

103
Q

Serotonin receptor in the brain

104
Q

Serotonin receptor in the sensory and enteric nerves

105
Q

DOC for acute migraine

A

Sumatriptan - 5-HT 1D agonist, causes vasoconstriction

106
Q

DOC for chemotherapy and post-operative vomiting

A

Ondansetron - 5-HT 3 receptor antagonist

107
Q

Antidote for ergotamine (5 HT2 receptor antagonist)

A

Nitroprusside

108
Q

5 HT2 receptor antagonist that has a SE of retroperitoneal fibrosis

A

Methysergide

109
Q

2nd line treatment for migraine and cluster headache

A

Ergotamine - 5 HT2 receptor antagonist

110
Q

5 HT2 receptor antagonist with uteroselective effects

A

Ergonovine (Methylergonovine) - postpartum bleeding

111
Q

Eicosanoid receptor that acts as a slow reacting substance of anaphylaxis

A

LTC4, LDT4

112
Q

Eicosanoid receptor that maintains PDA

A

PGE1 and PGE2

113
Q

Eicosanoid receptor for platelet aggregation

114
Q

PGE1 analog that maintains PDA. Can also be used for erectile dysfunction

A

Alprostadil - vascular smooth muscle relaxation and vasodilation

115
Q

Prostaglandin I2 analog used for pulmonary HTN

A

Epoprostenol

116
Q

Prostaglandin F2 alpha analog used in the treatment of Glaucoma

A

Latanoprost - can alter color of the eyelid causing permanent eye color change

117
Q

DOC for acute asthma attacks

A

Albuterol/Salbutamol - short acting beta 2 selective agonist with a SE of tachycardia

118
Q

Long acting beta 2 selective agonist used for asthma prophylaxis

A

Salmeterol

119
Q

Muscarinic receptor antagonist used for asthma and COPD

A

Ipratropium - SE of dry mouth

120
Q

Methylxanthine used as a prophylaxis for asthma nocturnal attacks

A

Theophylline - SE of seizures, beta blockers can be used as an antidote in overdosage

121
Q

Mast cell stabilizer used as an asthma prophylaxis and for allergies. No bronchodilator action

122
Q

DOC for asthma prophylaxis

A

Fluticasone - corticosteroid that inhibits phospholipase A2

123
Q

SE of Fluticasone

A

Oropharyngeal candidiasis (oral thrush) - gargle after inhaling

124
Q

Treatment of severe refractory asthma (status asthmaticus)

A

IV hydrocortisone

125
Q

Blocks cysteinyl leukotriene 1 receptor for leukotrienes CD4, D4 and E4. Used as asthma prophylaxis

A

Montelukast - no bronchodilator action

126
Q

Prophylaxis of severe, refractory asthma not responsive to all other drugs

A

Omalizumab - anti IgE antibody

127
Q

Anemia caused by a deficiency of Vit B12 or Folic Acid

A

Megaloblastic anemia - pernicious anemia most common type

128
Q

Intrinsic factor is made from?

A

Parietal cells

129
Q

Side effect of ferrous sulfate

A

Black stools - may obscure acute GI loss

130
Q

Heavy metal chelator used in the treatment of acute iron poisoning and hemachromatosis not adequately treated by phlebotomy

A

Deferoxamine - chelates excess iron

131
Q

State of chronic iron overload. Triad?

A

Hemochromatosis / “Bronze Diabetes” - cirrhosis, DM, skin pigmentation

132
Q

Neurologic defects in Vit B12 deficiency

A

Ataxic gait, impaired position and vibratory sense, spasticity

133
Q

Plasma transport of Vit B12 is accomplished by binding to?

A

Transcobalamin II

134
Q

What are the 2 available forms of Vit B12?

A

Cyanocobalamin and Hydroxocobalamin

135
Q

Large amounts of Vit B12 is stored in the?

A

Liver - 5 year supply

136
Q

Where is folic acid readily absorbed?

A

Proximal jejunum - modest amounts stored in the body

137
Q

Performance enhancing drugs in athletes. Production is stimulated by hypoxia

A

Epoetin Alfa - hematopoietic growth factor . Used for anemia associated with chronic renal failure

138
Q

Used for neutropenia associated with chemotherapy

A

G CSF - myeloid growth factor, accelerates neutrophil recovery

139
Q

For secondary prevention o thrombocytopenia in patients undergoing cytotoxic chemotherapy

A

Oprelvekin - megakaryocyte growth factor that activates IL 11 receptors

140
Q

Nonselective, irreversible COX 1 and 2 inhibitor. Reduces platelet production of Thromboxane A2

A

Aspirin - toxic dose of 150mg/kg, lethal dose of 500mg/kg

141
Q

What is the triad of aspirin hypersensitivity?

A

Samter triad - asthma, aspirin sensitivity, nasal polyps

142
Q

Mechanism of aspirin intoxication that leads to HAGMA

A

Uncoupling of oxidative phosphorylation

143
Q

What is the presentation of aspirin intoxication in adults? Children?

A

Adults - respiratory alkalosis with HAGMA, Children - HAGMA only

144
Q

Drug that is next in line if the patient has an aspirin allergy

A

Clopidogrel - irreversibly inhibits binding of ADP to platelet receptors

145
Q

Antiplatelet drug that interferes with GPIIb/IIIa binding to fibrinogen

A

Abciximab - used during PCI to prevent thrombosis

146
Q

Antiplatelet drug that inhibits phosphodiesterase III and increases cAMP, can also cause vasodilation

A

Dipyridamole - by itself has little or no benefit, contraindicated in heart failure

147
Q

Drugs use mainly for the prevention and treatment of venous thrombosis

A

Anticoagulants - inhibit formation of fibrin clots

148
Q

Heparin vs Warfarin: onset?

A

Heparin - rapid (minutes), Warfarin - slow (days)

149
Q

Heparin vs Warfarin: site of action

A

Heparin - blood, Warfarin - liver

150
Q

Heparin vs Warfarin: MOA

A

Heparin - activates antithrombin III, Warfarin - impairs post translational modification of factors X IX VII II (1972)

151
Q

Heparin vs Warfarin: antidote

A

Heparin - protamine, Warfarin - vit K or FFP

152
Q

Heparin vs Warfarin: monitoring

A

Heparin - PTT, Warfarin - PT

153
Q

DOC for anticoagulation during pregnancy

A

Heparin - activates antithrombin III which inactivates thrombin or factor IIa, IXa, Xa by forming stable complexes with them

154
Q

Anticoagulant that binds and potentiates effect of abtithrombin III on factor Xa (more selective)

A

Enoxaparin - less risk of thrombocytopenia (vs heparin), does not require monitoring with PTT

155
Q

Anticoagulation in patients with heparin induced thrombocytopenia

A

Lepirudin - binds to thrombin’s active site and inhibits its enzymatic action

156
Q

Anticoagulant that inhibits vit K epoxide reductase, used for chronic anticoagulation

A

Warfarin - SE of warfarin induced skin necrosis, has a narrow therapeutic window

157
Q

Thrombolytic drug that has a SE of cerebral hemorrhage

A

Alteplase (streptokinase) - converts plasminogen to plasmin, degrades the fibrin and fibrinogen

158
Q

Antidote to Alteplase

A

Aminocaproic acid (Tranexamic acid) - competitively inhibits plasminogen activation

159
Q

Causes a severe infusion reaction when administered too fast (dyspnea, chest and back pain)

A

Vit K - antidote to warfarin, can also prevent hemorrhagic diatheses in newborns

160
Q

Drug that increases the factor VIII activity of patients with mild Hemophilia A or von Willebrand disease

A

Desmopressin - vasopressin V2 receptor agonist (ADH agonist)

161
Q

NSAID and antiplatelet drug that is contraindicated in gout

A

Aspirin - prevents uric acid excretion

162
Q

At what doses do aspirin produce anti-inflammatory effects?

A

High doses (2400-4000 mg/d)

163
Q

Drug used for post surgical analgesic control. The only IV NSAID, use restricted to 72hrs only

A

Ketorolac - nonselective reversible COX 1 and 2 inhibitor, inhibits prostaglandin synthesis

164
Q

NSAID used to close PDA

A

Indomethacin - nonselective reversible COX 1 and 2 inhibitor, inhibits prostaglandin synthesis

165
Q

N-acetylcysteine is the antidote for?

A

Paracetamol - selectively inhibits COX 3, mild analgesic and antipyretic

166
Q

Cytotoxic intermediate in paracetamol overdose

A

NAPQI - centrilobar region (zone III) preferentially involved

167
Q

DMARD of first choice to treat rheumatoid arthritis

A

Methotrexate - inhibits AICAR transformylase and thymidylate synthetase, may cause a pseudolymphomatous reaction

168
Q

Drug for Crohn’s disease but may cause reactivation of latent TB

A

Infliximab - DMARD that binds to TNF alpha

169
Q

DMARD used to treat RA and IBD but may cause bone marrow suppression, increased risk of infections. Never give with Allopurinol.

A

Axathioprine - forms 6 Thioguanine, suppressing B and T cell function and immunoglobulin production

170
Q

DMARD and cancer chemotherapeutic drug that may cause hemorrhagic cystitis. Rescue agent is MESNA

A

Cyclophosphamide - forms phosphoramide mustard, which cross links DNA to prevent cell replication. Also suppresses T and B cell function

171
Q

DMARD used during tissue transplantation

A

Cyclosporine - inhibits IL 1 and 2 receptor and T cell responsiveness

172
Q

DMARD that may cause reversible myelosuppression

A

Mycophenolate mofetil - inhibits inosine monophosphate dehydrogenase and T cell lymphocyte proliferation

173
Q

DMARD that may cause hemolytic anemia, methemoglobinia and reversible infertility in men

A

Sulfasalazine - sulfapyridine inhibits the release of inflammatory cytokines

174
Q

MOA of Colchicine

A

Inhibits microtubule assembly - may cause agranulocytosis, hepatic necrosis

175
Q

NSAID that is commonly used in the initial treatment of gout as the replacement for Colchicine

A

Indomethacin - inhibit urate crystal phagocytosis

176
Q

Uricosuric agent that competes with uric acid for reabsorption in the proximal tubules

A

Probenecid - may precipitate acute gout during early phase of drug administration (co administer with colchicine)

177
Q

First line treatment for chronic gout

A

Allopurinol - alloxanthine irreversibly inhibits xanthine oxidase and lowers production of uric acid

178
Q

Side effect of Allopurinol

179
Q

Xanthine oxidase inhibitor used if the patient has an Allopurinol intolerance

A

Febuxostat

Patho flash cards (33 decks)

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