Pharmacology

Question 1

Atenolol (Tenormin)

Cardio

Answer 1

Beta blocker
* Indications: HTN, angina, post-MI, essential tremor, migraine, cluster headache (prevention), panic disorder
* MOA: ↓ HR, ↓ contractility, and ↓AVN conductivity
* Contraindications: Raynaud, asthma, sinus bradycardia, sinus node disfunction, heart block (other than 1st degree), edema, pregnancy (C)
* AE: Bradycardia, hypotension, glucose/lipid dysmetabolism, dizziness, fatigue, insomnia, constipation, alopecia, sexual dysfunction
* Interaction: Can increase the effect of drugs that slow down AV condition (digoxin, verapamil, diltiazem, alpha blockers), can mask tachycardia from hypoglycemia, decreased effects with aluminum salts/barbituates/NSAIDs/penicillin, depletes COQ10
* Caution: Abrupt withdrawral may cause rebound HTN

Question 2

Carvedilol (Coreg)

Cardio

Answer 2

Beta-adrenergic blocking agent
* MOA: Alpha blocking: Vasodilation > dec. peipheral vascular resistance, dec. preload, dec. afterload, incr. renal blood flow, reduce portal HTN and pressure gradient in hepatic venous. Improve endothelial function and vascular remodeling.
* Indications: Mild to severe heart failure, left ventricular dysfunction.
* Containdications: Bronchial asthma, AV block, sick sinus syndrome, severe bradycardia, cardiogenic shock, severe hepatic impairment, pregnancy (C).
* AE: Hypotension, dizziness, fatigue, hyperglycemia, weight gain, diarrhea, weakness, bradycardia
* Interactions: Inhibited by delavirdine, fluconazole, ketoconazole, NSAIDs, sulfonamides, serum levels increased by chlonidine and cimetidine, depletes COQ10.

Question 3

Metoprolol (Lopressor)

Cardio

Answer 3

Selective B1-receptor blocker
* MOA: ↓ HR, ↓ contractility, and ↓AVN conductivity
* Indications: CAD, compensated HF, arrhythmias (Afib), atrial flutter
* Contraindications: Bradycardia, hypotension, cardiogenic shock, decompensated HF, with CCB (diltiazem, verapamil) can precipitate AV block, sick sinus syndrome, pheochromocytoma (b-blocker before a-blocker → unopposed a-adrenoceptor mediated vasoconstriction → hypertensive crisis), heart block over 1 degrees, pregnancy C
* AE: Bradycardia, bradyarrhythmia
* Interactions: ↑ Effect of drugs that ↓ AV conductivity. ↓ Effects w/ aluminum salts, barbiturates, NSAIDS, penicillin. Can mask tachycardia from hypoglycemia. Depletes CoQ10.
* Caution: Abrupt withdrawral may cause rebound HTN

Question 4

Propranolol (Inderal)

Cardio

Answer 4

Beta blocker
* * MOA: ↓ HR, ↓ contractility, and ↓AVN conductivity
* Indications: HTN, angina pectoris, post-MI, cluster headache prevention, panic disorder, essential tremor, migraine
* Contraindications: Raynaud’s syndrome, asthma, sinus bradycardia, sinus node dysfunction, heart block other than 1st degree, cardiogenic shock, edema, pregnancy C
* AE: Bradycardia, hypotension, glucose and lipid dysmetabolism, sexual dysfunction, dizziness, fatigue, insomnia, constipation, alopecia
* Interactions: Can ↑ effect of drugs that slow AV conditions (digoxin, verapamil, diltiazem, alpha blockers). Can mask tachycardia from hypoglycemia. ↓ Effects w/ aluminum salts, barbiturates, NSAIDS, penicillin. Depletes CoQ10.
* Caution: Abrupt withdrawal may cause rebound HTN

Rarely used today due to it’s non-selectivity with a tendency to cause bronchospasm

Question 5

Lisinopril (Prinivil)

Cardio

Answer 5

ACE Inhibitor
* * MOA: Inhibition of ACE enzyme → ↓ angiotensin II (→ ↓ vasoconstriction → ↓ BP)
* Indications: HTN (esp w/ high renin activity), edema, hypervolemia, CHF, chronic renal failure, diabetic nephropathy
* Contraindications: Bone marrow suppression, renal artery stenosis, hyperkalemia, low renin HTN, pregnancy D
* AE: Dry cough, rash, fever, dizziness, neutropenia (higher risk w/ impaired renal fxn), proteinuria and nephrotic syndromes (in otherwise healthy pt), severe hypotension after first dose in CHF, renal artery stenosis, “scalded mouth” syndrome.
* Interactions: Antacids and NSAIDs interfere, capsaicin exacerbates cough, ↑ digoxin and lithium levels/toxicity, ↑ risk for hyperkalemia w K+sparing diuretics.
* Caution:

Question 6

Amlodipine (Norvasc)

Cardio

Answer 6

CCB
* * MOA: Potent vasodilator (via relaxation of smooth muscle), minimal myocardial depressant activity
* Indications: HTN, angina
* Contraindications: Sick sinus syndrome, heart block, hypotension, acute MI, pulmonary congestion, chronic renal failure, unstable angina, pregnancy C
* AE: Edema, constipation, heartburn, fatigue, dizziness, palpitations, AV block, erectile dysfunction, nausea, headache, gynecomastia
* Interactions: Synergistic toxicity with B-blockers. ↑ Toxicity of carbamazepine, cyclosporine, digoxin, and theophylline. Calcium, vit D, barbiturates, rifampin, and phenytoin ↓ effects. H2-blocker antacids and quinidine ↑ effects/toxicity. Unpredictable interaction w/ lithium.
* Caution: Abrupt withdrawal > cause rebound HTN

Question 7

Clonidine (Carapres)

Cardio

Answer 7

Central alpha agonist
* * MOA: Inhibit alpha-1 receptors (e.g., in smooth muscle): ↓ vasoconstriction → ↓ blood
pressure; relaxation of bladder neck muscles → ↓ bladder outlet obstruction and easier micturition
* Indications: Hypertensive urgency, HTN (alone or in combo w/ diuretics, cardiac glycosides, ACE-I, calcium agonist), BPH sx, symptomatic control of opioid withdrawal
* Contraindications: R/O prostate cancer before prescribing for BPH. Pregnancy C
* AE:
* Interactions: Hypotensive effects ↑ with B-blockers, diuretics, ACE-I, CCB, and other hypertensives. ↓ Effects w NSAIDs. Avoid dong quai, yohimbe, ginseng, garlic. Avoid saw palmetto w/ BPH (depletes COQ10)
* Caution: Syncope may happen within 90 mins of first dose.

Question 8

Valsartan (Diovan)

Cardio

Question 9

Spironolactone (Aldactone)

Cardio

Question 10

Hydrochlorothiazide (HydroDiuril)

Cardio

Question 11

Furosemide (Lasix)

Cardio

Question 12

Nitroglycerin (Nitro-stat)

Cardio

Question 13

Digoxin (Lanoxin)

Cardio

Question 14

Amiodarone (Cordarone)

Cardio

Question 15

Atropine (AtroPen)

Cardio

Question 16

Atorvostatin (Lipitor)

Cardio

Question 17

Gemfibrozil (Lopid)

Cardio

Question 18

Mometasone (Elocon)

Dermatology

Question 19

Isotretinoin (Accutane)

Dermatology

Question 20

Benzoyl Peroxide (Benzac AC Gel)

Dermatology

Question 21

Permethrin Cream

Dermatology

Question 22

Terbinafine (Lamisil)

Dermatology

Question 23

Calcipotriol or Calcipotriene (Daivonex)

Dermatology

Question 24

Selenium Sulfide (Selsun Blue/Head and Shoulders)

Dermatology

Question 25

Mupirocin (Bactroban)

Dermatology

Question 26

Bromocriptine (Parlodel)

Endocrinology

Question 27

Propylthiouracil (PTU)

Endocrinology

Question 28

Lugol Solution

Endocrinology

Question 29

Levothyroixine (Synthroid)

Endocrinology

Question 30

Liothyronine (Cytomel)

Endocrinology

Question 31

Canagliflozin (Invokana)

Endocrinology

Question 32

Dulaglutide (Trulicity)

Endocrinology

Question 33

Exenatide (Byetta, Bydureon)

Endocrinology

Question 34

Glyburide (Diabeta)

Endocrinology

Question 35

Liraglutide (Viktoza)

Endocrinology

Question 36

Metformin (Glucophage)

Endocrinology

Question 37

Pioglitazone (Avandia)

Endocrinology

Question 38

Sitagliptin Phosphate (Januvia)

Endocrinology

Question 39

Insulin (Apida, Humalog, Novalog, Lantus, Levemir)

Endocrinology