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USMLE/COMLEX > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

List the Histamine 2 Blockers

A

1) Cimetidine
2) Ranitidine
3) Famotidine
4) Nizatidine

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2
Q

Mechanism of H2 Blockers

A

Reversible block of histamine H2-reeptors –> Decreased H+ secretion via parietal cells

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3
Q

Indications of H2 Blockers

A

1) Peptic Ulcer
2) Gastritis
3) Mild Esophageal Reflex

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4
Q

H2 Blocker Relative Contraindication

A

Pregnancy

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5
Q

Cimetidine is a ___ inhibitor and has ___ effects

A

P-450

Antiandrogenic Effects

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6
Q

List the Antiandrogenic Effects of Cimetidine

A

1) Gynecomastia in Men

2) Galactorrhea in Women

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7
Q

Ranitidine and Cimetidine have effects on kidneys by decreasing the secretion of _____,

A

Creatinine

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8
Q

List the PPIs

A 
Lansoprazole 
Dexlansoprazole 
Omeprazole
Esomeprazole
Pantoprazole 
Rabeprazole
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9
Q

Mechanism of PPIs

A

Covalently binds sulfhydryl groups of H+/K+ ATPase of parietal cells

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10
Q

Indications of PPIs

A

1) Peptic Ulcer
2) Gastritis
3) Zollinger-Ellison Syndrome
4) Component of H. Pylori Therapy
5) Stress Ulcer Prophylaxis

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11
Q

Relative contraindication of PPI

A

Pregnancy

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12
Q

Adverse Effects of PPI’s

A

1) Increased C. Difficle infection risk
2) Pneumonia
3) AKI
4) Vitamin B12 Malabsorption
5) Decreased Ca2+ and Mg2+ Absorption (Osteoporosis)

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13
Q

Omeprazole is a ____ inhibitor and has many drug interactions

A

CYP450

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14
Q

Sucralfate Indications

A

1) Increase Ulcer Healing

2) Duodenal Ulcer

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15
Q

Contraindications of Sucralfate

A

1) Severe Renal Failure (due to aluminum) - pts should also avoid antacids

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16
Q

Mechanism of Sucralfate

A

1) Provides physical protection

2) Allows HCO3- secretion to reestablish pH gradient in mucous layer

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17
Q

Sucralfate should not be given with ___ and ___ because it requires an acidic enviroment.

A

1) PPI

2) H2 Blockers

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18
Q

Adverse Effects of Sucralfate

A

1) Constipation (Aluminum Hydroxide)

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19
Q

Since sucralfate has many drug interactions you’ll want to take this medication as well as Bismuth ___ after other medication.

A

2 hours

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20
Q

Bismuth (Subsalicylate) Indications

A

1) Travelers Diarrhea

2) Combination Therapy for H. Pylori Gastritis

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21
Q

Relative Contraindications of Bismuth

A

1) Antiplatelet and Anticoagulants

2) Severe Renal Failure

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22
Q

Absolute Contraindications of Bismuth

A

1) GI bleeding

2) Salicylate Hypersensitivity

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23
Q

Bismuth Mechanism

A

1) Prevent Microbial attachment to mucosa
2) Inactivation of Enterotoxins
3) Disruption of bacterial cell wall

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24
Q

Adverse Effects of Bismuth

A

1) Constipation

2) Black/Dark (regularly-formed) stools

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25
Q

Misoprostol (PGE analog) Mechanism

A

1) Increase Production and Secretion of Gastric Mucous Barrier
2) Decrease Acid Production (Parietal Cell)

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26
Q

Indications of Misoprostol

A

Prevention of NSAID-induced peptic ulcers

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27
Q

Off-label usage of Misoprostol

A

1) Cervical Ripening
2) Post-partum Hemorrhaging
3) Pregnancy Termination

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28
Q

Contraindications of Misoprostol

A

1) Pregnancy

2) IBD (AVOID)

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29
Q

List the Serotonin (5-HT3) Receptor Antagonists

A

1) Dolasetron
2) Granisetron
3) Ondansetron
4) Palonosetron

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30
Q

Mechanism of action of 5-HT3 receptor antagonists

A

Blocks 5-HT3 Receptors at vagal nerve terminals and to CTZ

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31
Q

Ondansetron is most commonly used for ____

A

Mild N/V

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32
Q

Indications for 5-HT3 Blockers

A

1) CINV
2) RINV
3) PONV
4) NVP
5) Mild N/V

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33
Q

____ and ____ are 5-HT3 Blockers that are used for delayed CINV as a single dose

A

1) Palonosetron

2) Sustained-Release Formulation of Granisetron

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34
Q

Adverse Effects of 5-HT3 Blockers

A

1) Serotonin Syndrome

2) Dose-dependent QT Prolongation (Torsade’s)

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35
Q

5-HT3 Blockers Drug interaction

A

Antiarrhythmics/QT-prolonging agents

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36
Q

Which 5-HT3 blocker has the highest risk of death

A

Dolasetron

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37
Q

List the Neurokinin (NKI) Receptor Antagonists

A

1) Aprepitant
2) Fosaprepitant
3) Netupitant
4) Fosnetupitant
5) Rolapitant

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38
Q

MOA of Neurokinin (NK1) Receptor Antagonists

A

Blockade of NK1 (Substances P) receptors in CTZ/VC

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39
Q

Indications of NK1 receptors Blockers

A

CINV (most effective when used in combination)

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40
Q

Which of the NK1 Blockers have the longest half lives

A

1) Netupitant

2) Rolapitant

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41
Q

List the Histamine (H1) Receptor Antagonists

A

1) Diphenhydramine
2) Dimenhydrinate
3) Hydroxyzine
4) Meclizine
5) Cyclizine
6) Doxylamine

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42
Q

MOA of Histamine receptor antagonists

A

Block H1 receptors in VC and Vestibular System

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43
Q

Indications of H1 Blockers

A

1) PONV
2) NVP ( Doxylamine/B6)
3) Motion Sickness/Vertigo (Meclizine and Cyclizine)
4) CINV (Add on therapy)
5) RINV (Add on therapy)
6) Mild N/V

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44
Q

Adverse Effects of H1 Blockers

A

Anticholinergics Effects

  • Drowsiness (CNS Depression)
  • Dry Mouth
  • Constipation
  • Urinary Retention
  • Blurred Vision
  • Decreased BP
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45
Q

What is the initial therapy for NVP?

A

Doxylamine w/ Pyridoxine

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46
Q

List the Dopamine D2 Receptor Antagonists

A

1) Prochlorperazine
2) Olanzapine
3) Metoclopramide
4) Amisulpride

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47
Q

Primary MOA of D2 Receptor Blockers

A

1) D2 receptor blockade in CTZ

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48
Q

Metoclopramide is a ___ receptor blocker. What additional MOA does it have?

A

1) Stimulates ACh actions in GI
- Enhances GI motility (Dysmotility use)
- Increases Lower Esophageal Sphincter Tone

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49
Q

Indication for Amisulpride

A

PONV (IV FORM)

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50
Q

List the indications for D2 Receptor Blockers

A

1) PONV (Amisulpride)
2) NVP
3) Gastroparesis/Dysmotility (Metoclopramide)
4) CINV and RINV

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51
Q

General adverse effects of D2 Blockers

A

1) Drowsiness (All agents)

2) Hypotension (primarily from IV route)

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52
Q

Adverse Effects of Prochlorperazine

A

1) Drowsiness
2) Constipation
3) Urinary Retention
4) Blurred Vision

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53
Q

Amisulpride Adverse Effects

A

1) Hypokalemia
2) Hyperprolactinemia
3) Chills

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54
Q

List the Muscarinic Receptor Antagonists

A

Scopolamine

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55
Q

MOA of Scopolamine

A

Blocks ACh-stimulated muscarinic receptors from vestibular nuclei and reticular formation to VC

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56
Q

Indication of Scopolamine

A

1) Motion Sickness

2) End-of-life care for excessive secretions

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57
Q

Adverse Effects of Scopolamine

A

1) Drowsiness
2) Dry Mouth
3) Constipation
4) Urinary Retention
5) Blurred Vision

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58
Q

Scopolamine can be worn as a transdermal scope patch that lasts ____

A

72 hours

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59
Q

List the Cannabinoid Receptor Agonists

A

1) Dronabinol

2) Nabilone

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60
Q

MOA of cannabinoid Receptor Agonists

A

Stimulates CB1 (central) and CB2 (peripheral) cannabinoid receptors in VC/CTZ

  • Decreases excitability of neurons
  • Minimizes serotonin release from vagal afferent terminals
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61
Q

Indications of Cannabinoid Receptor Agonists

A

1) CINV (reserved for treatment-resistant scenarios) can be used as an add on
2) Appetite Stimulation

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62
Q

Describe H. Pylori Treatment

A

1) Triple therapy (14 days) - all agents 2x day
* ** Only for low Clarithromycin resistance areas and No prior exposure to Clarithromycin
- PPI
- Clarithromycin
- Amoxicillin or Metronidazole

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63
Q

Describe Quadruple Therapy of H. Pylori

A

1) PPI twice/day all other agents four times/day
- PPI
- Metronidazole
- Amoxicillin (Tetracycline; esp for PCN allergy)
- Bismuth Subsalicylate

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64
Q

Describe the substitutions for Quadruple Therapy of H. Pylori

A

1) Clarithromycin for Bismuth

2) Levofloxacin for failed eradication

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65
Q

Treatment for Clostridium Difficle

A

1) ORAL Vancomycin (Fidaxomicin = alternative)

2) I.V. Metronidazole (for severe disease + Oral Vancomycin)

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66
Q

Campylobacter Jejuni Treatment

A

Azithromycin (Ciprofloxacin = alternative)

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67
Q

Salmonella Spp. Treatment

A

Ciprofloxacin/Levofloxacin (Azithromycin (alternative)

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68
Q

Shigella Spp. Treatment

A

Ciprofloxacin/Levofloxacin (Azithromycin = Alternative)

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69
Q

MOA of Benzimidazoles

A

1) Inhibition of Microtubule polymerization via b-tubulin binding
2) Inhibition of mitochondrial fumarate reductase

70
Q

List the GI Anthelmintic

A

1) Benzimidazoles
- Albendazole
- Mebendazole

71
Q

List the GI Anti-Protozoal Agents

A

1) Paromomycin
2) Metronidazole
3) Tinidazole

72
Q

MOA of Paromomycin

A

30S subunit inhibitor

73
Q

Metronidazole and Tinidazole MOA

A

1) Disrupts Electron Transport Chain proteins –> Nitrogen free radicals

74
Q

Treatment of Amebiasis: Entamoeba Histolytica

A

1) Metronidazole followed by paromomycin

75
Q

Treatment for Hookworm: Ancylostoma Spp. and Necator Americanus

A

Albendazole (Mebendazole)

76
Q

Roundworm Treatment: Ascaris Lumbricoides

A

Albendazole (Mebendazole)

77
Q

Giardiasis Treatment: Giardia Spp.

A

Metronidazole (Tinidazole)

78
Q

Tapeworm - Adult Forms: Taenia Spp. (Including T. solium, except cysticercosis)

A

Praziquantel

79
Q

Tapeworm - Larval forms: Echinococcus Spp.

A

Albendazole + Praziquantel

80
Q

Tapeworm - Larval Forms Taenia Solium (Cysticercosis)

A

Albendazole

81
Q

Pinworm Treatment: Enterobius Vermicularis

A

Mebendazole (Albendazole)

82
Q

Schistomiasis Treatment: Schictosoma Spp.

A

Praziquantel (+ steroids for neurological disease)

83
Q

Whipworm Treatment: Trichuris Trichiura

A

Mebendazole (Albendazole)

84
Q

Trichinellosis Treatment: Trichinella Spp.

A

Albendazole (Mebendazole) (+steroids for severe disease)

85
Q

Cryptosporidium Spp. Treatment

A

Nitazoxanide

86
Q

Ulcerative Colitis (U.C.) Treatment Classes

A

1) 5-ASA
2) Janus Kinase Inhibitors
3) IL-12/23 Inhibitors
4) TNF-a Inhibitors
5) a-4 Integrin Inhibitors

87
Q

List the 5-ASA’s

A

1) Sulfasalazine
2) Mesalamine
3) Olsalazine
4) Balsalazide

88
Q

List the Janus Kinase (JAK) Inhibitors

A

Tofacitinib

89
Q

List the IL-12/23 inhibitors

A

Ustekinumab

90
Q

List the U.C. TNF-a inhibitors

A

1) Adalimumab
2) Golimumab
3) Infliximab

91
Q

List the U.C. a-4 integrin inhibitors

A

Vedolizumab

92
Q

List the General Classes for Chrons Disease

A

1) IL-12/23 Inhibitors
2) TNF-a Inhibitors
3) a-4 integrin inhibitors

93
Q

List the Chron Disease TNF-a Inhibitors

A

Adalimumab
Certolizumab
Infliximab

94
Q

List the C.D. a-4 Integrin Inhibitors

A

Natalizumab

Vedolizumab

95
Q

MOA of 5-ASA agents

A

1) Inhibition of PG and LT production via arachidonic acid pathway
- COX and LIPOX

2) Reduction in PMN and Macrophage chemotaxis

96
Q

Contraindications of 5-ASA compounds

A

1) ASA-allergic pts

2) Sulfasalazine contraindicated in sulfonamide allergic pts

97
Q

MOA of TNF-a

A

blocks leukocyte migration to site of inflammation

98
Q

Which of the TNF-a inhibitors is supplied via IV

A

Infliximab

99
Q

Side Effects of TNF-a inhibitors

A

1) Infections (TB testing pre-therapy)

100
Q

Indications of Adalimumab

A

Moderate-to-severe U.C. and C.D.

101
Q

Indications for Infliximab

A

1) Moderate-to-Severe C.D.

2) Severe U.C.

102
Q

Indications for Golimumab

A

Moderate-to-Severe U.C. only

103
Q

Indications for Certolizumab

A

Moderate-to-Severe C.D. only

104
Q

Indications for 5-ASA Agents

A

1) Mild-to-Moderate U.C.
- Except Olsalazine (only for maintenance of remission)
- Except Balsalazide (only for active disease)

105
Q

What are the exceptions for 5-ASA Agents

A

All treat Mild-to-Moderate U.C. Except:

1) Olsalazine = maintenance of remission
2) Balsalazide = Active Disease only

106
Q

When should you consider TNF-a inhibitors as a treatment option?

A

After inadequate response to conventional or immunosuppressant therapy

107
Q

MOA of a-4 integrin inhibitors

A

1) Prevents trans-endothelial migration of leukocytes (decrease leukocyte traffic)

108
Q

Indications of a-4 Integrin Inhibitors: Natalizumab

A

Moderate-to-severe C.D.

109
Q

Indications for a-4 Integrin inhibitors: Vedolizumab

A

Moderate-severe C.D. and U.C.

110
Q

Side Effects of a-4 Integrin Inhibitors: Natalizumab ***cases for only Natalizumab at this time

A

Infections:

- PML (Progressive Multifocal Leukoencephalopathy) associated w/ John Cunningham Virus (JCV))

111
Q

3 Risk Factors for PML associated Natalizumab

A

1) Treatment > 2 yrs
2) Prior Immunosuppressant Treatment
3) Anti-JC virus (JCV) antibodies

112
Q

When should you consider a-4 integrin inhibitors

A

** After inadequate response to conventional or TNF-a therapy

113
Q

MOA of Ustekinumab (Interleukin IL-12 and IL-23 Inhibitors)

A

Bind P40-subunit of IL-12 and IL-23

1) Decrease activation and differentiation of naïve T Cells
2) Decrease activation of NK cells

114
Q

Side Effects of IL-12 and IL-23 Inhibitors

A

Infections:

- TB testing pre-therapy recommended

115
Q

Indications for Ustekinumab

A

Moderate-to-Severe UC and CD

116
Q

When should you consider Interleukin inhibitors as a treatment?

A

After:

1) Conventional
2) Immune Modulators
3) Steroids or TNF-a therapy

117
Q

MOA of JAK Kinase Inhibitors

A

Bind JAK1 and JAK3 –> inhibition of gene transcription and cytokine release

118
Q

Tofacitinib (oral) is used for U.C., __, ___

A

Psoriatic

RA

119
Q

Indications for JAK’s Inhibitors

A

Moderate to Severe U.C.

120
Q

______: concomitant use of Biologic Therapies or immunosuppressant’s not recommended

A

JAK’s Inhibitors

121
Q

Indications for Glucocorticosteroids

A

Acute and/or Severe U.C. and C.D. uncontrolled by other conventional medications
*** Not for maintenance of remission unless absolutely required

122
Q

List the general classes for Diarrhea

A

1) Prostaglandin Inhibitors
2) Opioid Agonists
3) Serotonin Antagonists
4) Chloride Channel Inhibitors

123
Q

Loperamide is an ___ used for diarrhea

A

Opioid agonist

124
Q

Loperamide causes ___ toxicities leading to death

125
Q

Side efecft of loperamide

A

Anticholinergic

126
Q

Diphenoxylate is an ___ and is used for diarrhea

A

Opioid agonist

127
Q

List the Nucleoside Analogue Reverse Transcriptase Inhibitors that Treat HBV

A

1) Entecavir
2) Lamivudine
3) Telbivudine

128
Q

Entecavir Indication

A

Chronic Hep B Infection

129
Q

Lamivudine Indication

A

Chronic Hep B w/ HIV-1 Infection

130
Q

Contraindication of Lamivudine

A

Hypersensitivity Reaction to Lamivudine

131
Q

Telbivudine Indication

A

Chronic Hepatitis B in Adult Population

132
Q

Contraindication of Telbivudine

A

Can’t use w/ PEGylated Interferon alfa-2a

133
Q

If Telbivudine is used with PEGylated interferon alfa-2a it increases risk of….

A

Peripheral neuropathy

134
Q

BB warning for Entecavir

A

1) Severe Acute Exacerbations of Hep B
2) Pts co-infected w/ HIV and HBV
3) Lactic Acidosis
4) Hepatomegaly

135
Q

BB Warning of Lamivudine

A

1) Lactic Acidosis
2) Severe Hepatomegaly
3) Exacerbations of Hep B

136
Q

BB Warning of Telbivudine

A

1) Lactic Acidosis
2) Severe Hepatomegaly w/ Steatosis
3) Severe Acute Exacerbations of Hepatitis B

137
Q

List the Nucleotide Analogues that Treat Chronic HBV

A

1) Tenofovir disoproxil

2) Adefovir Pipivoxil

138
Q

Indications of Tenofovir

A

1) HIV-1 Treatment in Adults and Peds Pts

2) Chronic HBV (12yrs or older)

139
Q

Adverse Effects of Tenofovir

A

1) Nephrotoxicity:
- Acute Renal Failure
- Fanconi Syndrome

2) Nausea (most Common)

140
Q

BB Warning of Tenofovir

A

1) Lactic Acidosis
2) Severe Hepatomegaly w. Steatosis
3) Post Treatment exacerbation of Hepatitis

141
Q

Indications of Adefovir

A

1) Chronic Hep B (12yrs and older)

142
Q

Contraindications of Adefovir

A

Hypersensitivity to any components

143
Q

Adverse Effects of Adefovir

A

Nephrotoxicity
Asthenia
Increased Creatinine

144
Q

Adefovir should not be used with other drugs that ____ or ___ because it increases risk of increased serum Adefovir

A

1) Reduce renal function

2) Compete for active tubular secretion

145
Q

List the Drugs that Treat HCV

A

1) PEG-Interferon Alfa-2a
2) Elbasvir/Grazoprevir
3) Ledipasvir/Sofosbuvir
4) Velpatasvir/Sofosbuvir
5) Ribavirin
6) Boceprevir

146
Q

MOA of PEG-Interferon Alfa-2a

A

Anti-viral and Immunomodulatory Effects

147
Q

Indications of PEG-Interferon Alfa-2a

A

1) Chronic Hep C (18yr or older)

148
Q

Contraindications of PEG-Interferon Alfa-2a

A

1) Hypersenstivity to INF-a
2) Autoimmune Hepatitis
3) Decompensated Liver Disease

149
Q

Adverse Effects of PEG-Interferon Alfa-2a

A

Flu-Like Sx

150
Q

BB Warning for PEG-Interferon Alfa-2a

A

1) Aggravate Fatal or Life-Threatening Neuropsychatric, Autoimmune, Ischemic and Infectious Disorders

151
Q

-Asvir MOA

A

NS5A Polymerase Inhibitor

152
Q
  • Previr MOA
A

NS3/4A Protease Inhibitor

153
Q
  • Buvir MOA
A

NS5B Polymerase Inhibitor

154
Q

indication for Elbasvir/Grazoprevir

A

Chronic Hep C

155
Q

Elbasvir/Grazoprevir shouldn’t be Co-administered with a ___.

A

CYP3A Inducer (will Decrease its concentration)

156
Q

Ledipasvir/Sofosbuvir Indication

A

Chronic Hep. C

157
Q

Drugs interactions of Ledipasvir/Sofosbuvir

A

1) Poly glycoprotein Inducers
- Rifampin
- St. John’s Wort

158
Q

Velpatasvir/Sofosbuvir Indication

A

1) Chronic Hep C.

- W/o Cirrhosis or w/ Compensated Cirrhosis

159
Q

If a Pt has Decompensated Cirrhosis what should be used in combination with Velpatasvir/Sofosbuvir.

160
Q

Indication for Ribavirin

A

1) Chronic Hep C in combination w/ Interferon alfa-2a

2) CHC pts co-infected with HIV

161
Q

Contraindications of Velpatasvir/Sofosbuvir

A

1) Pregnant Women and Men whose female partners are pregnant
2) Hemoglobinopathies

162
Q

BB Warning for Velpatasvir

A

1) Potentiates Bradycardia w/ amiodarone co-administration

2) Caution w/ Beta Blockers, Cardiac Comorbidities and/or advanced liver disease

163
Q

Indications of Ribavirin

A

1) Chronic Hep C infection in combination w/ interferon alfa-2a
2) CHC pts co-infected with HIV

164
Q

BB Warning of Ribavirin

A

1) Birth Defects and Fetal Death

2) Don’t use in pregnancy and for 6mo after treatment

165
Q

Contraindications of Ribavirin

A

1) Pregnant Women and Men whose female partners are pregnant
2) Hemoglobinopathies

166
Q

Boceprevir MOA

A

NS3/4A Protease Inhibitor

167
Q

Indication of Boceprevir

A

Chronic Hep. C Infection in combination with peginterferon alfa and ribavirin

168
Q

Contraindication of Boceprevir

A

1) Contraindications of Peginterferon
- Hypersensitivity to INF-a
- Autoimmune Hepatitis
- Decompensated Liver Disease

2) Contraindications of Ribavirin
- Pregnant women and men whose female partners are pregnant
- Hemoglobinopathies

169
Q

Pt who has decompensated cirrhosis needs treatment. How would you treat this pt.

A

1) Velpastasvir/Sofosbuvir + Ribavirin

170
Q

Pt has Autoimmune Hepatitis what Drug that treats Hep C would you not want to use?

A

PEG-Interferon Alfa-2a

USMLE/COMLEX (2 decks)

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