pharmacology 1-30 38% 2-10 48% 3-50% Flashcards
treatment for Lyme and other rickettsial infections (Rocky mount spotted fever and typhus)
doxycycline-can also be used to treat acne
pt with Lyme, end-stage renal disease and severe rxn to penicillin and macs should be given doxycycline and not methacycline because
methacycline is excreted by liver (containidicated in renal dz) vs doxycycline (and minocycline) which are eliminated in feces unchanged.
potency
amount of drug needed to reach 50% effect
treatment for UTIs that can cause tendon rupture and arthropathy in children. mech of action
fluroquinolones-inhbiits DNA gyrase (maes negative supercoils during DNA replication)
blood dycraias, avoid in women in 2nd or 3rd trimester due to risk of kernicterus
sulfonamindes
tooth discoloration, bone abnormalities, and hepatic problems in fetus if taken by mother-mechanism
tetracyclines- blocks aminoacyl-tRNA
neprotoxcity and ototoxity, used for severe gram-negative UTIs
aminoglycosides
parathesias and peripheral nephropathy-prevent how?
isoniazid, prevent by giving pyridoxime
action of benzodiazepems on GABA A channel increases frequency and not duration of channel opening because
benzo works on receptor
barbiturates increase duration of GABA A channel opening
name 2 endings of tricyclic anti-depressants. 2 exceptions
all end in “-iptyline and -ipramine except doxepin and amoxapine”
imipramine amitriptyline, nortriptyline and doxepin
inhibit biogenic amine (NE and 5-HT) reuptake at presynaptic neuron
antidepressants (amitriptyline, nortripttyline, and doxepin)
drug that causes orange urine and used for TB inhibits DNA-dependent RNA polymerase and not mycolic acid synthesis because
rifampin inhibits RNA synthesis, it also blocks RNA transcription. isoniazid disrupts cell wall synthsis in TB but doesn’t cause urine color change.
inhibits mycobacterial arabinsoyl transferase, use if isonazid is not working
ethambutol
used as adjunctive therapy in very early TB
streptomycin
two drugs that can cause urine color changes
rifampin-orange
pyridoxine-bright yellow (used to prevent neuropathy effect of isonazid)
side effect of treatment for parkinson’s (trihexyphenidyl and benztropine) is dry mouth and not diarrehea becuase
these dugs are muscarinic antagonists (decrease Ach which is increased in Parkinson’s) effects of anit-muscarinics are- red as a beet, dry as a bone, blind as a bad, mad as a hatter, and hot asa hare
mecanhism of overdose of acetaminophen
overdose overloads liver’s normal metabolies enzymes and rest is shunted over to P-450 which converts acetaminophen to NAPQI (toxic-centrilobular necrosis). glutathinone is conjugated with NAPQI to become nontoxic, give NAC N-acetylcysteine to replenish glutathione levels
copper overload in Wilson’s disease, other metallic poisons, and treatment for severe rheumatoid arthritis
penicillamine-metal chelator
cyanide overdose
sodium thiosulfate
anti-depressant to avoid in pts with eating disorder is bupropion and not fluoxetine because
bupropion can cause seizures in pts with eating disorder, wheras fluoxetine is the only anti-depressant approved for bulimmia bervosa
- well tolerated antianxiety used for co-morbid depression and anxiety
- causes weight gain, dry mouth, and somnolence
- serotonin syndrome, CNS stimulation and sexual dysfunction
- can be used with eating disorders
- causes seizures if used with eating disorders
buspirone mirtazapine sertraline SSRIs fluoxetine buspirone
pt with ulcerative colitis (UC) needs mesalamine and not infliximab because
mesalamine. infliximab is a monoclonal antibody that bind TNF alpha to reduce inflammation- used for Crohn’s disease.
Crohn’s disease vs ulcerative colitits (UC)
UC-bloody diarrhea, abdominal paon, fecal urgency. inflammation of colonic mucosa
C-transmural inflammation and relapsing and remitting remission
treatment for GERD
lansoprazole, proton pump inhibitor (similar to omeprazole)
pt with BPH and HTN needs a drug that selectively blocks alpha 1 receptors and not a drug that inhibits 5-alpha reductase because
5-alpha reductase inhibitors (finasteride) only treats BPH. whereas alpha-1 receptor blockers (terazosin and doxazosin) treat both HTN and BPH
drug used for child with Wilm’s tumor that can lead to peripheral neuropathy
vincristine-inhibits spindle formation during mitosis.
drugs with Cushinoid syndrome as side effect
prednisone and dexamethasone
tox=hemorrhagic cystitis
cyclophosphamide
tox=pulmonary fibrosis
bleomycin
tox=hyperpigmentation and treatment
busulfan treats chronic myelocytic leukemia
another name for tPA
alteplase
use alteplase and not warfarin for pt with ischemic stroke b/c
tPA is great for breaking down clots that have already formed. Warfarin is good for long time prophylaxis against clot formation but won’t break down clots that have already formed
-alpha adrenergic receptor blocker that lowers systemic vascular resistance and increases HR via baroreceptor reflex
beta1 and beta 2 agonist that lowers TPR and increases HR via beta 2 and baroreceptor reflex
-alpha and beta agonist that increases MAP and lowers HR
-non selective beta blocker that lowers HR
alpha-adrenrgic receptor blocker (phentolamine)
- isoproterenol
- NE (alpha is greater than beta is why HR goes down instead of going up with beta 1 activation)
- non selective beta-adrenergic receptor blocker (propanolol)
in a patient with hepatic encephalopathy a drug that decreases serum ammonia levels is one that acidifies intestinal contents and not a bile acid sequestrant or chelator b/c
chelator used for metal toxicities, cholestryamine lowers LDL by sequestering bile.
mecahism of losartan? effects on arterial pressure, TPR, Na excretion and plasma aldosterone levels?
ANG II inhibitor
-decrease, decrease, increase, decrease
name of mutation seen in CML (chronic myelogenous leukemia)? treatment drug and mechanism
Philadelphia chromosome (bcr-abl transcript), imatinib, protein kinase inhbitor (bcr-abl is a constitutively active tyrosine kinase)
anastrozole
aromatase inhibitor used to treat breast cancer
busulfan
alkylating agent used to treat chronic myeloid leukemia
carmustine
alkylating agent used to treat brain tumors, myeloma, and lymphomas
cisplatin-myeosupression effects
platinum compound binds and crosslinks DNA, anticancer with less severe myelosupression effects
ALS treatment (supportive/symptoms)
riuzole-inhbits gluamate release/blocks Na channel. glutamate can cause excitatory toxicity to neurons
baclofen (GABA-B agonist)-treats spacisity
tizanidine (alpha 2 receptor agonist, increases inhibition of motor neurons)-treats spacisity
why give a monoclonal TNF-alpha antibody toa patient suffering from jarisch Herxheimer reaction?
J-H rxn is when endotoxin released from any spirochete (techinally gram negative bacteria) leads to direct stimulation of macrophages leading to inceased production of mac mediators such as IL-1, IL-6, and TNF-alpha. (micro-immunology)
how does glucose regulate insulin release. what is role of diazoxide
glucose enters beta cell is metabolize to create ATP-causes closure of K+ channel-delpolarizing the cell and promoting exocytosis of insulin. diazoxide opens K+ on smooth muscle and can hyperpolarize and vasodilation (decreasing insulin response to glucose)
which generation of anti-histamines can cause sedation
1st generation H1 blockers- (diphehydramine, chlorpheniramine, hydroxyine), cross BBB
why are 2nd generation antihistamines drug of choice for allergic disorders but not 1st generation
2nd generation can’t cross BBB.
cetirizine, loratadine, delosratadine
intranasal antihistamine
azelastine
in ventricular vol vs pressure curve:
- height=
- widght
- slope from (0,0) to top of end systolic volume
- MAP
- SV
- Contractility
question 4 this is from exam 2. the questions below are from exam 3
answer
name 6 drugs known to increase QT interval
quinidine, procainamide, sotalol, amiodarone, dofetilide, pheothiazines, and TCAs
How does zileuton treat asthma?
it inhibits 5-lopoxygenase, prevents leukotriene synthesis from arachidonic acid. also inhibits binding of LTD4 to target tissues. LTD4 can cause asthma symptoms.
inhibits phosphlipase A inhibits cyclooxygenase stimulates PGI2 stimulates prostaglandins leukotriene agonists
glucocorticoids
NSAIDS (specific for COX-2)=celecoxib and glucocorticoids
epoprostenol (treats pulmonary HTN)
misoprostol PGE1, alprostadil PGE1, dinoprostone PGE2, carboprost PGF2alpha, lantoprost PGF2 alpha
zafrilukast and montelukast
salmeterol (mech, use, side effects)
long acting beta-2 receptor agonist-treats asthma and COPD. side effects-insomnia, tremor, and anxiety
a drug with 1st order kinetics will kill what number of cancer cells?
zero order kinetics?
does it depend on 1/2 life?
- constant portion
- constant number
- no. the number of cells eliminated per unit time is independent of the actual number of cancer cells
log kill hypothesis
magnitude of killing a by ac cytotoxic agent is a log function. i.e. a drug producint a 3-log kill will reduce 10^12 cells to 10^9 to 10^6 etc…
mechanism of drugs used to treat PID?
treat chlamydia with doxy (bind 30S and prevent amnioaclyl-transferase from entering A site) or azithromycin (macrolide that prevents protein synthesis by blocking translocation-binds to 50S)
treat nesseria gonnorrhea with 3rd gen cef-ceftriaxone (inhibits peptidoglycan synthesis through blockage of transpeptidation enzymes).
binds to microtubules and causes mitotic arrest in metaphase
podophyllum resin in tincture of benzoin- treats condylomata acuminatum (genital warts)
methimazole is used to treat? side effect?
hyperthyroidism, inhbits formation of thyyroid hormone by inhbiting thryoid peroxidase. can cause agranulocytosis. if pt has fever or sore throat give a human granulocyte stimulating factor (fligrastm)
treatment for congenital toxoplasmosis gondii
pyrimethamine and sulfadiazine
can give leucovorin to replenish folate that doesn’t need dihydrofolate reductase-to improve pt outcome and still kill bacteria
sirolimus (mech, uses, toxicity)
inhibits T-cell activation and proliferation by binding mTOR, has minimal nephrotoxicity and neurotoxicity vs other immunosupressants. mc tox are hypercholestermia and hypertriglyceridemia
cytokine release syndrome is associated with?
muromonab-CD3 therapy
overdose of anticholingerics vs stimulants
skin- dry with anticholingerics and sweaty with stimulants
diphenhydramine
over the counter anti-histamine that can cause profound anticholingeric effects in high doses
antacids that cause diarrhea vs constipation
D-MG2+
C-aluminium and Ca2+
famotidine (mechanism)
suppress acid secretion
metoclopramide effect on GI tract. contraindications?
prokinetic agent that stimulates intestinal tract. contraindicated in pt in bowl obstruction
treatment of choice for legionella pneuomonia?
erythromycin
treatment of choice for PCP or pneumocystis jiroveci?
pentamidine
end systolic volume depends on
aortic blood pressure. if MAP is high then end systolic is high and vs versa
end diastolic vol=
end systolic vol +filling vol per beat
filing vol=
venous return/heart rate
glucocorticoids do what to glucose levels?
how do they lead to osteoporosis?
increases them. glucocorticoid-induced diabetes
lowers intestinal calcium absorption, no need to measure 1,25 vit D levels
symptoms of and ways to diagnose multiple myeloma
bone pain, renal impairment, fatigue, and anemia. use serum protein electrophoresis
drugs that can decrease cardiac remodeling and increase lifespan of CHF pts
ACE inhbitors, ARBS, aldosterone antagonists, and beta blockers
hypertrophic cardiomyopathy is treated with
beta blockers and calcium channel blockers (verapamil)
drugs used to treat metabolic syndrome: effect on triglycerides, HDL, C-reactive protein, glucose, and BP
- ACE inhibitors
- ARBS
- Niacin
- Statins
- Thiazolidinediones
- none,none,+/-, kidney benefits no effect on glucose levels, decrease
- same as ACE Inhibitors
- decrease, increase, none, increase, none
- decrease, increases, decrease, none, none
- decrease, increase, decrease, decrease, +/- (acts via PPAR-gamma-found in adipose and endothelium)
CRP
important marker of inflammation. increased in metabolic syndrome
signs of high potassium
no P waves and tall peaked T waves. don’t give spironolactone
NSAIDS effect on kidney?
decrease prostaglandin production which results in decreased blood flow to the kidneys, this exacerbating renal failure
what effect does corticosteroids have on fluid and electrolyte imbalances?
associated with water retention, hypernatremia, hypokalemia, and hypocalcemia
sucralfate (aka, mech, uses)
aluminum sucrose sulfate- works as a protective coat. stress ulcers, duodenal ulcers, and GERD
severe pain along dermatone followed by grouped vesicular lesions
VZV shingles, treat with famciclovir, acyclovir or valacyclovir
mechanisms of ACE inhibitors and ARF. NSAIDS and ARF?
catopril can prevent efferent renal arteriolar constriction to a great extent than of the afferent arteriole, decreasing GFR. also NSAIDS can do this too (renal vasoconstrictors- block PG production and prevent dilation of afferent arteriole)
mechanism of methamphetamine and amphetamines
increased dopamine-cause of addiction
increased NE-cause of increased BP
effect of hydrochlorothiazide on calcium levels
increases ca2+ levels
risk of corticosteroids and postmenopausal women
can cause various musculoskeletal alteration including bone matrix atrophy (osteoporosis) and bone fractures (vertebral compression fractures or fractures of long bone and avascular necrosis of femoral or humeral heads or both)
age to switch over from aspirin to warfarin
75, also look for anyone with past history of embolic or cardiac disease.
large binucleated cells with prominent nucleoli with an eosinophilic cytoplasm
Reed-Sternberg cells, Hodgkin lymphoma
how to treat Hodgkin’s? mech of drug? toxicities? treatment?
cyclophasphamide, alkylating agent, can lead to hemorrhagic cystitis (treat with mensa), bone marrow suppression, and hepatotoxicity. can also be used to treat non-hodgkin, breast and ovarian cancer
mech of succinylcholine and K+ levels. pt pop at risk for this effect? how to screen for this effect?
depolarizes skeletal muscle and opens nicotinic cholinergeric receptor caused K+ efflux.
succinylcholine-induced hyperkalemia is more commonly seen in burn pts b/c tissue damage causes K+ leak out of cells. measure K+ levels or see no P waves and spiked T waves on ECG
serum-sickness
immune complexes are formed by binding of specific antigens to circulating antibodies (type III)
mc symptoms are fever, pruritiusm and arthropathy
treat with antihistamines (itching) and corticosteroids (immune)
class of histamine drugs that are not sedating?
second generation-choise of treatment for allergic disorders (fexofenadine)
ring shaped lesions with an advancing scaly border and central clearin or scaly patches with a distinct border on the exposed skin surfaces or the trunk
tinea corporis
treatment for tinea corporis. how long?
topical antfungals- clotrimazole, use 1-2 weeks after clinical clearing of the lesions
digitoxin effect on K+ levels. effect of loop diuretics on K+ and digitoxin toxicity.
hypokalemia, leading to cardiac arrhythimias. loop diuretics make this worse.
