Pharmaceuticals (41-60)

Question 1

Dimercaptopropane sulfonate (DMPS)

Answer 1

C: chelation

A: chelates Hg, Au, arsenc

I: Mercury, Gold and arsenic poisoning

SE: Steven-johnson syndrome

CI: liver insufficiency

Intx: DEPLETES COPPER, SELENIUM, ZINC, MAGNESIUM

Question 2

EDTA

Answer 2

C: Chelator

A: chelates lead out of bone - also calcium, zinc, Mn, and iron

I: lead poisoning, digoxin arrhythmias

SE: hypocalcemia, kidney damage

Intx: depleted calcium

Question 3

Penicillamine

Answer 3

C: Immunosuppressant and heavy metal chelator

A: chelates copper, Hg, Zn and lead, decreases IgM RF levels

I: wilsons disease, copper toxicosis, mercury and lead poisoning

SE: aplastic anemia, leukopenia, proteinuria

CI: penicillin allergy, kidney dz

Intx: gold, antmalarials, other immunosuppressants

DEPLETES COPPER, IRON, MAGNESIUM PYRIDOXINE, FERRITIN

Question 4

DMSA (succimer, Dimercaptosuccinic acid)

Answer 4

C: Chelator

A: chelates Pb, Hg, Cd, Ar and removes in urine

I: lead, mercury, arsenic, cadmium poisoning

SE: transient elevation in liver enzymes

Intx: DEPLETES ZINC, IRON, CALCIUM, MAGNESIUM

Question 5

Odansetron (Zofran)

Answer 5

C: anti-emetic

SE: prolonged QT intervals

Intx: Many

Question 6

Prochlorperazine

Answer 6

C: anti-emetic and antipsychotic

A: Dopamine antagonist

I: N/V, psychosis (schizo), anxiety

SE: anticholinergic effects and extrapyramidal symptoms

CI: PD, epilepsy

Intx: MAOis, CNS depressants, anticholinergics

Question 7

Metoclopramide (Reglan)

Answer 7

C: Anti-emetic

A: DA antagonist, pro-PNS, and improves gastric motility

I: N/V, GERD

SE: extrapyramidal symptoms, diarrhea

CI: pheochromocytoma, PD, epilepsy

Intx: synergy with DA antagonists/sedatives/CNS depressants

Question 8

Sodium Phosphate

Answer 8

C and A: OSMOTIC laxative

I: colonoscopy, barium enema, surgery prep, atonic constipation

SE: high phosphates

CI: elderly, kidney failure, IBD, hear issues

Intx: ACEi, ARB, diuretics, NSAIDs
***DEPLETES MAGNESIUM AND PHOSPHORUS

Question 9

Bisacodyl

Answer 9

C: Laxative

A: increased colon motility

I: atonic constipation (short term)

SE: low potassium, long term = can induce atonic constipation and pseudomembraneous constipation

CI: 10+ days, obstruction, appendicitis, IBD, tartrazine allergy

Intx: many drugs and herbs by decreasing TT, potentiates hypokalemia inducing agents

Question 10

Docusate

Answer 10

C: stool softener - NOT LAXATIVE

A: increases fat and water mixing to soften stool

I: atonic constipation, hemorrhoids, anal fissures

SE: minimal

CI: long-term, obstruction

Question 11

Bismuth subsalicylate

Answer 11

C: anti-diarrheal

A: modulates inflam and anti-secretory, protects the mucosa

I: PUD with H.pylori, gastroenteritis

SE: black tongue and stool, high calcium, salicylate toxicity

CI: salicylate allergy, younger than 2 yo, viral infx

Intx: tetracycline, NSAIDs

Question 12

Loperamide (Imodium)

Answer 12

C: Anti-diarrhea

A: Cholinergic muscarinic antagonist (anti-cholinergic)

I: acute diarrhea, IBS-diarrhea

SE: anticholinergic effects (dry mouth, cramping)

CI: acute UC, pseudomembraneous coli

Intx: gemfibrozil, SJW and Valerian (increased toxicity)

Question 13

Esomeprazole

Answer 13

C: PPI

A: blocks Hcl formation in stomach

I: erositive esophagitis, PUD, GERD

SE: decreases B12 absorption, C. diff and gastric infx - more serious SE with long-term

CI: severe liver dz, stomach cancer

Intx: depleted calcium, magnesium, folic acid, iron, B12

Question 14

Misoprostol

Answer 14

C: Prostaglandins

A: inhibits gastric acid secretions = increased bicarb and mucus = increased TT and stool

I: gastric ulcers, pregnancy termination, PP hemorrhagic

SE: uterine contractions

CI: PREGNANCY X

Question 15

Sucralfate

Answer 15

C: Protectants

A: creates a gel barrier = protecting mucosa from injury

I: GERD, PUD, ulcers

SE: constipation, hyperglycemia

CI: renal failure, AD

Intx: interferes with drug absorption

Question 16

Sulfasalazine

Answer 16

C: Anti-inflam

A: converted into 5-ASA = inhibits COX = antiinflam

I: UC, mild Crohns

SE: GI irritation, HA - high dose = BM suppression, liver/kidney toxicity, pancreatitis

CI: sulfa/salicylate allergy, obstruction, kids under 2 yo , G6PD def

Intx: iron, digoxin
*depletes folic acid

Question 17

Phentermine

Answer 17

C: anoretic

A: suppresses appetite

I: obesity

SE: palpitations, HTN, heart valve issues, addiction, hyperglycemia

CI: atherosclerosis, CVD, CAD, stroke, CHF, hyperthyroidism

Intx: MAOIs (hypertensive crisis), SSRI, other stimulants

Question 18

Dicyclomine

Answer 18

C: Anticholinergic

A: GI smooth muscle relaxant

I: IBS with spasms

SE: anticholinergic - esp constipation, blurred vision, dizziness

CI: GI/renal obstruction, GERD, MG

Intx: alcohol and other anticholinergics

Question 19

Interferon

Answer 19

C: Biologic response modifier

A: anticancer and anti-hepatitis

I: cancer, chronic hep B and C, multiple sclerosis

SE: neutropenia, thrombocytopenia, fever/flu-like sx, SI

CI: renal insufficiency, major depression, alcohol, AI dz

Intx: NSAIDs help reduce flu-like SE, synergistic BM suppression with zidovudine

Question 20

Mebendazole

Answer 20

C: Anti-helmintics

A: destroys worms

SE: very safe because not systemically absorbed

Intx: metronidazole = necrolysis