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Pharmacology Flashcards

1
Q

Why did FDA issue a black box warning against the use of SPS for treating hyperkalemia?

A

It can cause serious GI side effects such as colonic necrosis, colonic perforation.
The incidence of colonic perforation with SPS use has been estimated at 0.14%–1.8%, and a large retrospective cohort study showed a 1.9-fold higher risk of hospitalization for GI complications with SPS use compared with non-use.

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2
Q

SPS is contraindicated in patients with ____? (3)

A

Obstructive bowel disease, hypersensitivity to SPS, hypokalemia

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3
Q

SPS should be used in caution with ___? (3)

A

Gut dysmotility, constipation or those who cannot handle a large sodium load

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4
Q

What are causes of diuretic resistance? (7)

A
  1. nonadherence to salt and water restriction
  2. intestinal edema
  3. reduced tubular uptake in advanced CKD
  4. nephron adaptation by upregulation of sodium transporters
  5. RAAS activation
  6. NSAIDs
  7. low intravascular volume
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5
Q

what is the management for a patient who developed a standard infusion to rituximab?

A

Decrease the rate of rituximab at 50% of the initial rate

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6
Q

3 Drugs a/w retroperitoneal fibrosis (bonus: 7)

A
  1. Bromocriptine
  2. Beta blockers
  3. Hydralazine*
  4. Ergot alkaloids
  5. Methyldopa*
  6. Etanercept
  7. Infliximab
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7
Q

what is the antidote for anticholinergic overdose?

A

physostigmine

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8
Q

What is the antidote for warfarin toxicity?

A

Vitamin K or phytonadione

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9
Q

What is the antidote for unfractionated heparin?

A

Protamine sulfate

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10
Q

Antidote to DOAC toxicity

A

Andexanet alfa

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11
Q

Name 5 drugs that require dialysis when toxic levels are detected. (bonus: 12)

A
  1. methanol 2. lithium 3. salicylate 4. ethylene glycol
  2. isopropanol 6. theophylline 7. procainamide 8. phenobarbital 9. methaqualone 10. valproate 11. methotrexate 12. metformin
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12
Q

what is the treatment for BZD overdose?

A

Flumazenil (a BZD antagonist)

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13
Q

what is the treatment for acetaminophen overdose?

A

N-Acetylcysteine

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14
Q

What is the treatment for carbon monoxide poisoning?

A

hyperbaric oxygen

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15
Q

What is the treatment for digoxin toxicity?

A

specific Fab fragment (digibind or digoxin immune Fab)

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16
Q

what is used to reverse opiate overdose?

A

naloxone

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17
Q

What are the nephrotoxic effects of tenofovir? (3)

A

AKI, fanconi’s and nephrogenic DI

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18
Q

Nonoliguric AKI from aminoglycosides usually occur after how many days from exposure?

A

after 7-10 days

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19
Q

what is the pathophysiology of Bartter like syndrome related to aminoglycoside use?

A

Activation of the CaSR
A/w lower aminoglycoside use

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20
Q

What is the pathophysiology of Fanconi syndrome related to aminoglycoside use?

A

reduced expression of NHE expression
A/w higher aminoglycoside use

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21
Q

Ciprofloxacin is associated with AKI from various causes (4):

A
  1. AIN
  2. Necrotizing vasculitis
  3. ATN
  4. Crystalluria (starburst needle crystals)
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22
Q

Name 3 drugs that can cause pRTA or Fanconi syndrome?

A

Tenofovir, ifosfamide, cisplatin

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23
Q

What is the formula for modified maintenance dose in renal failure?

A

[patient GFR/120] x std maintenance dose

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24
Q

What is the formula for modified drug frequency for reduced kidney function?

A

[120/patient eGFR] x frequency (hrs)

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25
Q

Why do tacrolimus levels increase with diarrhea?

A

Tacrolimus is a P-glycoprotein substrate; P-glycoproteins help in drug secretion in the gut; P-glycoprotein activity is reduced during diarrhea, which explains why Tac levels increase during diarrhea

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26
Q

Is lipid amphotericin B used to treat fungal UTI?

A

No.

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27
Q

How does TMP cause hyperkalemia and metabolic acidosis?

A

TMP blocks ENaC.

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28
Q

How does cimetifine, dolutegravir and TMP increase serum creatinine?

A

It inhibits the tubular secretion of creatinine via OCT2

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29
Q

Are ARBS generally dialyzable or non-dialyzable?

A

Non-Dialyzable

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30
Q

Name 2 ACEi that are dialyzable?

A

Lisinopril, captopril

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31
Q

In general, are CCBs dialyzable or non-dialyzable?

A

Non-dialyzable

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32
Q

Name 4 BB that are non-dialyzable?

A

Carvedilol, labetalol, propanolol, timolol

33
Q

Name 4 BB that are dialyzable

A

Metoprolol, atenolol, sotalol, nadolol (MASoN)

34
Q

What is the mechanism of nephrotoxicity of ACEI/ARBS?

A

efferent vasodilation

35
Q

What is the mechanism of nephrotoxicity of NSAIDs?

A

Afferent vasoconstriction, direct tubular toxicity, TIN,

36
Q

What is the mechanism of nephrotoxicity of amphotericin?

A

Afferent vasoconstriction, direct tubular toxicity

37
Q

What is the mechanism of nephrotoxicity of CNIs?

A

Afferent vasoconstriction

38
Q

Drugs that can crystallize and cause obstructive uropathy

A
  1. Methotrexate
  2. Acyclovir
  3. Sulfadiazine
  4. Indinavir, nelfinavir
  5. Acetazolamide
  6. Topiramate
  7. Triamterene
  8. Zonisamide
  9. Methoxyflurane
  10. Ciproflaxin
  11. Sodium phosphate bowel prep
39
Q

3 drugs that cause drug-induced ANCA vasculitis

A
  1. Hydralazine
  2. PTU
  3. cocaine
    Others: methimazole, allopurinol, TNF-alpha inhibitors (e.g. infliximab, etanercept, adalimumab)
40
Q

Rhabdomyolysis seen with TAC and statin therapy is seen only with concomitant ____ use?

A

Diltiazem

41
Q

CsA + ____ = high risk for rhabdomyolysis

A

gemfibrozil

42
Q

Most common electrolyte disorder associated with cisplatin?

A

Hypomagnesemia

43
Q

What are the top 4 side effects of cyclophosphamide?

A

hyponatremia, hemorrhagic cystitis, premature ovarian failure, bladder cancer

44
Q

what is the max lifetime cumulative dose of cyclophosphamide to minimize malignancy risk?

A

< 36g

45
Q

What is the max lifetime cumulative dose of cyclophosphamide for those who wish to conceive?

A

< 10g

46
Q

What is given with cyclophosphamide to detoxify acrolein and reduce the risk of hemorrhagic cystitis?

A

MESNA

47
Q

What are the 4 renal side effects of ifosfamide?

A

pRTA, fanconi syndrome, nephrogenic DI, ATN

48
Q

What is the max cumulative lifetime dose of ifosfamide?

A

< 90g

49
Q

High dose of ____ has shown to reduce the nephrotoxicity of Methotrexate

A

folinic acid

50
Q

Cetuximab and panitumumab is associated with what electrolyte disorder?

A

Hypomagnesemia

51
Q

Cranberry can cause ____?

A

Nephrolithiasis, oxaluria

52
Q

Bladder wrack (brown algae) from Japan can cause?

A

chronic interstitial nephritis

53
Q

Cat claw can cause

A

Acute interstitial nephritis

54
Q

Chaparral tea, from a native american shrub, can cause

A

Renal cysts and renal cell carcinoma

55
Q

Djenkol can cause

A

Nephrolithiasis

56
Q

Aristolochic acid/chinese herbal tea can cause

A

Chronic interstitial nephritis, renal cell carcinoma, fanconi syndrome

57
Q

Black licorice can cause

A

hypertension; hypokalemia;

58
Q

Yohimbe can cause

A

Lupus nephritis

59
Q

Star fruit, rhubarb leaves can cause

A

Nephrolithiasis, interstitial nephritis

60
Q

Ma huang (ephedra) can cause

A

HTN, nephrolithiasis

61
Q

Willowbark can cause

A

renal papillary necrosis

62
Q

Wormwood oil can cause

A

Rhabdomyolysis

63
Q

Chronic lead exposure can cause a triad of?

A

CKD, gout, hypertension

64
Q

Accumulation of allopurinol can cause

A

tubulointerstitial nephritis

65
Q

Accumulation of meperidine can cause

A

Seizures

66
Q

Accumulation of morphine can lead to

A

Seizure

67
Q

Accumulation of nitroprusside can lead to

A

Cyanide toxicity

68
Q

Accumulation of tramadol can lead to

A

Seizures, altered mentation

69
Q

Venlafaxine accumulation can lead to

A

Prolonged QT, orthostatic hypotension, accelerated HTN, altered mentation

70
Q

Given to reverse alcohol poisoning

A

Fomepizole
It inhibits alcohol dehydrogenase

71
Q

HD is indicated at what level of alcohol?

A

alcohol > 50 mg/dL in the setting of severe metabolic acidosis or end-organ damage
Note: use large surface area dialyzer (> 1.5m2) and high Qb > 300 ml/min

72
Q

In methanol poisoning, what is given to convert formic acid to CO2 and water?

A

Folinic acid

73
Q

HD is indicated in isopropyl alcohol poisoning at what level of alcohol and what level of osmolal gap?

A

Alcohol > 500 mg/dL and osmolal gap of > 100

74
Q

HD is indicated at what lithium level?

A

Lithium is > 3.5 mmol/L OR
Lithium > 2.5 but with CNS issues, hemodynamically unstable, or AKI

75
Q

What is the acid-base disorder of salicylate overdose?

A

Combined HAGMA + respiratory alkalosis

76
Q

Should we alkalinize or acidify the urine in salicylate (aspirin) poisoning?

A

Alkanize the urine (pH > 7.5) to ionize salicylate and promote excretion

77
Q

What are the indications of HD in salicylate poisoning?

A
  1. Levels > 90 mg/dL
  2. Arterial pH < 7.2
  3. Noncardiogenic pulmonary edema
  4. Neuro (seizures, altered mentation, hyperthermia)
78
Q

Digoxin is not dialyzable but HD is indicated of this is present

A

Hyperkalemia

nephro Boards (9 decks)

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