Pharmacology Flashcards
1
Q
What does the PNS innervate?
A
cardiac and smooth muscle, gland cells, nerve terminals. The nerves come from the medulla and use Ach at pre and postganglionic receptors
2
Q
What receptors does the SNS use to innverate sweat glands?
A
Ach for pregang
Ach for postgangiolinic M receptor
3
Q
What receptors does the SNS use to innervate cardiac and smooth muscle, gland cells, and nerve terminals?
A
ACh for pregang
NE for alpha and beta receptors
4
Q
What receptors does the SNS use to innervate renal vasculature, and smooth muscle
A
Ach for pregang
Dopamine for D1 receptors
5
Q
What receptors does the Somatic system use to innervate skeletal muscle?
A
The voluntary motor nerve uses ACH at N receptors
6
Q
What aspects of SNS are innervated by cholinergic fibers?
A
- adrenal medulla
2. sweat glands
7
Q
What does botulinum toxin do?
A
prevents release of neurotransmitters at all cholinergic terminals
8
Q
How do Nicotinic Ach receptors work?
A
ligand gated NaK channels. Nn found in autonomic ganglia and Nm found in neuromuscular
9
Q
How do Muscarinic Ach receptors work?
A
GPCR that act via 2nd messengers. 5 subtypes M1-M5
10
Q
What does alpha one receptor do?
A
VC - increases vascular SM contraction; increases pupillary dilator muscle contraction (mydriasis); increases intestinal and bladder sphincter muscle contraction
11
Q
What does alpha 2 receptor do?
A
VD - decreases sympathetic outflow, decreases insulin release, decreases lipolysis, and increases platelet aggregation
12
Q
What does beta 1 receptor do
A
increases heart rate, increases contractility, increases renin release, and increases lipolysis
13
Q
What does beta 2 receptor do?
A
VD, BD, and decreases uterine tone
increases heart rate, increases contractility, increases lipolysis, increases insulin release, ciliary muscle relaxation, increases aqueous humor production
14
Q
What does M1 receptor do?
A
CNS and ENS
15
Q
What are the sympathetic receptors?
A
Alpha 1 and 2; Beta 1 and 2. They use NE
16
Q
What are the Parasympathetic receptors?
A
M1-M3 using Ach
17
Q
What does the M2 receptor do?
A
decreases heart rate and contractility or atria at SA node
18
Q
What does M3 receptor do?
A
increase exocrine gland secretions, increases gut peristalsis, increases bladder contraction, bronchoconstriction, increased pupillary sphincter muscle contraction (miosis), ciliary muscle contraction (accommodation)
19
Q
What does the D1 receptor do?
A
relaxes renal vascular SM to improve renal blood flow
20
Q
What does the D2 receptor do?
A
modulates transmitter release especially in the brain
21
Q
What does the H1 receptor do?
A
increases nasal and bronchial mucus production, contraction of bronchioles, pruritus, pain
22
Q
What does the H2 receptor do?
A
increases gastric acid secretion
23
Q
What does V1 receptor do?
A
increases vascular CM contraction
24
Q
What does V2 receptor do?
A
increases H20 permeability and reabsorption in the collecting tubules of kidney
25
What 2nd messengers are used for the autonomic drug receptors?
```
Alpha 1 - q
Alpha 2 - i
Beta 1 - s
Beta 2 - s
M1 - q
M2 - i
M2 - q
D1 - s
D2 - i
H1 - q
H2 - s
V1 - q
V2 - s
```
* HAVe 1M & M for Gq (H1,A1,V1,M1, and M3)
* MAD 2's for Gi (M2, A2, D2)
26
How does the Gq receptor work?
PLC breaks down lipids to PIP2
PIP2 broken down into IP3 and DAG
IP3 increases Ca from Sr, Ca activates CAM kinase
DAG activates PKC
27
How does the G2 receptor work?
AC increases cAMP
cAMP activates PKA
PKA increases Ca in heart, and inhibits myosin light chain kinase in smooth muscle
28
How does Gi receptor work?
inhibits AC so no increase in cAMP
29
What are all the steps that take place at the cholinergic nerve terminal?
1. Choline enters the axon w/ Na coupled transport
2. Choline + AcetylCoA combine via ChAT to form Ach
3. Ach is packaged into vesicles
4. Ca stimulates release of ACh from vesicles into NMJ
5. Ach has 4 fates: AchE degradation, Diffuse away, bind to postsynaptic receptor, and bind to autorecepto
30
What step does hemicholinium inhibit?
The entry of Choline and Na coupled transport into the axon
31
What step does Vesamicol inhibit?
The packaging of Ach into vesicles
32
What does black widow spider toxin do at the cholinergic nerve terminal?
activates releases of Ach
33
What are the steps that take place at the noradrenergic nerve terminal?
1. Tyr is coupled to Na to enter axon
2. Tyr to NE synthesis pathway
3. NE is packaged into vesicles
4. NE is releases via Ca stimulation
5. NE has 5 fates: binds to the postsynpatic receptor, reuptake, binds to Alpha 2 autoreceptor
34
How do you make NE from Tyr?
1. Tyr to dopa via Try hydroxylase
2. Dopa to dopamine via Dopa decarboxylase
3. Dopamine to NE via Dopamine Beta Hydroxylase
35
What does metyrosine inhibit at the adrenergic terminal?
Tyr hydroxylase
36
How does reserpine inhibit at the adrenergic terminal?
Dopamine Beta hydroxlase
37
What inhibits reuptake of NE at the terminal?
cocaine, TCAs, and amphetamine
38
What do amphetamines do at the adrenergic terminal?
inhibit reuptake of NE and activate release of NE
39
What do guanethidine and bretylium do at the adrenergic terminal?
inhibit release of NE
40
What are the 2 enzymes that metabolize NE?
1. COMT - methylates NE
2. MAO - oxidizes NE
- both make NE unusable and excrete in urine and increases levels of byproduct in serum
41
How is release of NE from a sympathetic nerve ending modulated?
1. By NE itself acting on presynaptic alpha 2 autoreceptor
2. Ach binds to M2 receptors and inhibits release of NE
3. AII binds to its receptor and activates release of NE
42
What are some direct cholinergic agonists?
Bethanechol, carbachol, pilocarpine, methacholine
43
What does bethanechol do?
- activates bowel and bladder SM
- resistant to AchE
used for post op ileus, neurogenic ileus, and urinary retention
44
What does carbachol do?
- think of it as a carbon copy of Ach
| - used in glaucoma, pupillary constriction, and relief of intraocular pressure
45
What does pilocarpine do?
- contracts ciliary muscle of eye (open angled glaucoma), pupillary sphincter
- resistant to AchE
used for potent stimulator of sweat, tears, and saliva. Open and closed angle glaucoma
46
What does methacholine do?
stimulates muscarinic receptors in airway when inhaled
| - used for challenge test for Asthma dx
47
What are some indirect agonists or anticholinesterases?
```
Neostigmine
Pyridostigmine
Edrophonium - Tensilon test
Physostigmine
Donepezil/Galantamine/Rivastigmine
```
48
What is the function of the indirect cholinergic agonists?
they increases endogenous Ach by inhibiting AchE
49
What is neostigmine used for?
Post op and neurogenic ileus, urinary retention, myasthenia gravis, reversal of NMJ blockade via succinycholine
- has NO CNS penetration
50
What is pyridostigmine used for?
- myasthenia gravis (long acting),
| - NO CNS penetration
51
What is edrophonium used for?
for Dx of myasthenia gravis b/c it's short acting
52
What is physostigmine used for?
- Anticholinergic toxicity (crosses BBB)
| - fixes atropine overdose
53
What is donepezil/galantamine/rivastigmine used for?
Alzheimer's disease
54
What is a caution you should take w/ all the cholinomimetic agents?
watch for exacerbation of COPD, asthma, and peptic ulcers when giving to susceptible patients
55
What is cholinesterase inhibitor poisoning typically do to and how does it present?
- organophosphates such as parathion that irreverisibly inhibit AchE
- causes DUMBBELSS
56
What is the treatment for organophosphate overdose?
1. antidote = atropine
| 2. regenerator of active AchE = pralidoxime
57
What does DUMBBELSS stand for
1. Diarrhea
2. Urination
3. Miosis
4. Bronchospasm
5. Bradycardia
6. Excitation of skeletal muscle and CNS
7. Lacrimation
8. Sweating
9. Salivation
58
What are the muscarinic antagonists?
1. atropine, homatropine, tropicamide
2. benztropine
3. scopolamine
4. ipratropium, tiotropium
5. oxybutynin
6. glycopyrrolate
59
What do atropine, homatropine, and tropicamide do?
produce mydriasis and cycloplegia
60
What does benztropine do?
treatment for parkinson's (park my benz)
61
What does scopolamine do?
motion sickness so acts at the CNS
62
What does ipratropium and tiotropium do?
treats COP and asthma
63
What does oxybutynin do?
reduces urgency in mild cystitis and reduces bladder spasms
64
What other drugs can be used to reduce urgency?
tolterodine, darifenacin, solifenacin, trospium
65
What does glycopyrrolate do?
use parenteral for preop to reduce airway secretions
| orally to stop drooling and peptic ulcers
66
What is atropine really used for?
to treat bradycardia and for ophthalmic applications
67
What effect does atropine have on eyes, airway, stomach, gut, and bladder?
1. eyes - increase pupil dilation, cycloplegia
2. airways- decreases secretions
3. stomach - decrease acid secretion
4. gut - decrease motility
5. bladder- decrease urgency
68
What happens w/ atropine overdose?
it blocks DUMBBELSS
- increases body temp (due to decreased sweating)
- rapid pulse
- dry mouth
- dry, flushed skin
- cycloplegia
- constipation
- disorientation
- Can cause acute angle-closure glaucoma in elderly, urinary retention in men w/ prostatic hyperplasia and hyperthermia in infants
69
What other meds can cause anticholinergic side effects?
1. 1st gen H blockers - diphenhydramine, doxylamine, chlorpheniramine
2. traditional neuroleptics
3. tricyclic antidepressants
4. amantadine
70
What are the direct sympathomimetics?
1. E
2. NE
3. Isoproterenol
4. Dopamine
5. Dobutamine
6. Phenylephrine
7. Albuterol, salmeterol, terbutaline, levalbuterol
8. Ritodrine
71
What are the indirect sympathomimetics?
1. amphetamine
2. ephedrine
3. cocaine (reuptake inhibitor)
- all of these are indirect general agonists
72
MOA of epinephrine?
stimulates all receptors A1/2 and B1/2
- at low doses it has no effect on BP
- at high doses the alpha1 receptors overpower B2 so there is an increase in BP
73
When is epinephrine use?
anaphylaxis, glaucoma, asthma, hypotension
74
MOA of NE?
Alpha receptors >> B1
75
When is NE used?
hypotension but decreases renal perfusion
76
MOA of isoproterenol?
B1 and B2 agonists
77
When is isoproterenol used?
torsade de pointes (tachycardia decreases QT interval), bradyarrhythmias ( but can worsen ischemia)
78
MOA of dopamine?
low dose - D1 receptor to increase renal blood flow
Med Dose - B1/2 receptor agonists
High dose - Alpha1/2 receptor agonists
79
When is dopamine used?
shock (renal perfusion), heart failure, inotropic and chronotropic
80
MOA of dobutamine?
Beta 1 agonists
81
When is dobutamine used?
heart failure, cardiac stress testing, inotropic and chronotropic
82
MOA of phenylephrine
Alpha 1 >> Alpha 2 so increases BP
83
When is phenylephrine used?
hypotension, ocular procedures (mydriatic), rhinitis (decongestant)
84
MOA of albuterol, salmeterol, terbutaline, and levalbuterol
B2 >> B1 agonists
85
When is albuterol used?
acute asthma
86
When is salmeterol used?
long term asthma or COPD control
87
when is terbutaline used?
to reduce premature utering contractions
88
MOA of ritodrine?
B2 agonists
89
When is ritodrine used?
reduces premature uterine contractions
90
What is amphetamine used for?
narcoplepsy, obesity, and ADHD
91
What is ephedrine used for?
nasal decongestion, urinary incontinence, hypotenion
92
What can cocaine do?
causes vasoconstriction and local anesthesia.
93
What drug is avoided w/ cocaine overdose?
B-Blockers because it can lead to an unopposed alpha 1 activation and extreme HTN
94
What happens to HR and BP with NE use?
increases BP due to Alpha 1 and there is a reflexive bradycardia (decreased HR)
95
What happens to HR and BP w/ E use?
increase in BP and HR because all four activated
96
What happens to HR and BP w/ isoproterenol use?
little alpha effect but causes B2 mediated VD resulting in decrease BP and increased HR through B1 and reflex activity.
Widened pulse pressure as well
97
What are some sympathoplegic drugs?
clonidine and alpha-methydopa, guanfacine
98
MOA of clonidine and alpha-methyldopa
Alpha 2 agonists - decrease central sympathetic outflow
| - decrease BP due to vasodilation
99
Clonidine use?
low half life, used as a sleep aid for ADHD, used for HTN especially w/ renal disease
100
When is alpha-methyldopa use?
HTN in pregnancy
101
What are nonselective alpha blockers?
Phenoxybenzamine (IR)
| Phentolamine (R)
102
What are some adverse side effects w/ phenoxybenzamine and phentolamine?
orthostatic hypotention and reflexive tachycardia
103
When is phenoxybenzamine used?
pheochromocytoma
104
When is phentolamine used?
givens to pts on MAO inhibitors who eat tyramine-containing foods (aged)
105
What are alpha1 selective blockers?
prazosin, terazosin, doxazosin, tamsulosin
106
When are the alpha 1 selective blockers given?
HTN, urinary retention in BPH
107
What are adverse side effects of alpha 1 selective blockers?
1st dose orthostatic hypotension, dizziness, headache
108
What is tamsulosin a special alpha 1 selective blocker?
it works only at the prostate and has no effect on BP so safe to give to pts who have only BPH symptoms
109
What is an alpha 2 selective blocker?
mirtazapine
110
When is mirtazapine used and what are some side effects?
used - depression
| ADE - sedation, increases serum cholesterol, and increases appetite
111
What are beta blockers used for?
1. Angina - decreased heart rate and contractility, resulting in decreased O2 consumption
2. MI - decreased mortality
3. SVT - decreased AV conduction velocity
4. HTN - decreased CO and decreased renin secretion (due to B1 receptor blockade on JGA cells)
5. CHF - slows progression of chronic failure
6. Glaucoma (timolol) - decreases secretion of aqueous humor
112
What are ADE of beta blockers?
impotence, exacerbation of asthma, CV effects such a bradycardia, AV block, CHF; CNS effects such as seizures, sedation, sleep alterations. Use w/ caution w/ diabetics b/c they can mask symptoms of low glucose
113
What are B1 selective antagonists?
acebutolol, betaxolol, esmolol (short acting), atenolol, metoprolol
- they are advantageous in pts w/ comorbid pulmonary dz
114
What are nonselective B antagonists?
Propranolol, timolol, nadolol, pindolol
115
What are nonselective alpha and beta antagonists?
Carvediolol and labetaolol
116
What are partial Beta agonists
Pindolol and acebutolol
117
What are the Beta blockers of choice for MI
carvedilol and metoprolol
118
What is the Beta blocker of choice for thryoid toxicosis?
propranolol
119
What Beta blocker is given for esopheal varicies?
nadolol
120
What do beta blockers do when treating aortic dissection?
1. decrease BP
| 2. decrease slope of rise of BP
121
For Michaelis-Menten kinetics, what is Vmax?
- Vmax is directly related to enzyme concentration
122
For Michaelis-Menten kinetics, what is km?
- concentration of substrate at 1/2Vmax
| - inversely related to affinity of enzyme for its substrate
123
What is the y and x intercept for Lineweaver Burk plot?
1. X-intercept: -1/km
| 2. Y-intercept: 1/vmax
124
What is the slope of the LIneweaver Burk plot?
km/Vmax
125
What happens when the y-intercept increases on the Lineweaver Burk plot?
- Vmax decreases
126
What happens when you go further right on the Lineweaver Burk plot?
- the greater the Km and lower the affinity
127
What effect do competitive inhibitors have on Michaelis Menten kinetics?
1. Vmax is unchanged
2. Km is increased
- can be overcome by increasing substrate concentration
- binds to the active site of the enzyme
- decreases potency
128
What effect do noncompetitive inhibitors have on Michaelis Menten kinetics?
1. Vmax is decreased
2. Km is unchanged
3. Efficacy is decreased
4. doesn't resemble substrate, doesn't bind to active site, and can't be overcome by increasing substrate concentration
129
What is bioavailability?
- fraction of administered drug that reaches systemic circulation unchanged
- for an IV dose = 100%
- Orally: F typically 100% to incomplete absorption and first pass metabolism
130
What is the volume of distribution of a drug?
- theoretical fluid volume required to maintain the total absorbed drug amount at plasma concentration
131
What is the Vd equation?
= amount of drug in the body/plasma drug concentration
132
What can alter the Vd of plasma protein bound drugs
- liver and kidney disease (decreased protein binding, increased Vd)
133
What part of the body has a low Vd?
- blood: usually contains large/charged molecules; plasma protein bound
134
What part of the body has a medium Vd?
ECF: contains small hydrophilic molecules
135
What part of the body has high Vd?
All tissue: contains small lipophilic molecules especially if bound to tissue protein
136
What is the definition of half life?
- time required to change the amount of drug in the body by 1/2 during elimination (or constant infusion)
137
How many half lives does it take for a drug to reach steady state?
- 4-5: 94% of drug at 4 half lives
1. after 1 half life: 50% of drug is remaining
2. after 2 half lives: 25% remaining
3. after 3 half lives: 12.5% remaining
4. after 4 half lives: 6.25% remaining
138
what is the equation for half life?
= 0.7 *Vd/CL
139
What is the definition of clearance?
- relates the rate of elimination to the plasma concentration
- may be impaired w/ defects in cardiac, hepatic, or renal function
140
What is the loading dose equation
LD= VD*Css
141
What is the maintenance dose equation?
MD = CL * Css
142
What happens to maintenance and loading dose in liver and kidney disease?
maintenance dose is decreased but loading dose is unchanged
143
T or F. Time to steady state depends on dosing frequency or size.
False. Depends only on half life
144
What is zero order elimination?
rate of elimination is constant regardless of amount of drug eliminated per unit time
- capacity limited elimination
- Plasma concentration of drug decreases linearly w/ time
145
What are examples of drugs that undergo zero order elimination?
PEA
Phenytoin
EtOH
ASA
146
What is first order elimination?
aka Flow-dependent elimination
- rate of elimination is directly proportional to the drug concentration -- constant fraction of drug eliminated per unit time
- plasma concentration of drug decrease exponentially w/ time
147
What types of drugs are trapped in urine and cleared quickly?
- ionized species
| - neutral forms can be reabsorbed
148
What are examples of weak acid drugs?
Phenobarbital
MTX
ASA
149
What type of environments are weak acids trapped in?
basic = makes weak acids ionized
150
How can you treat weak acid overdose?
- bicarbonate - traps weak acids in urine
151
What are examples of weak base drugs?
Amphetamines
152
How are weak bases trapped in urine?
acidic environment
153
How can you treat weak base overdose?
Ammonium chloride
154
What type of rxns take place in phase 1 drug metabolism?
Reduction, oxidation, hydrolysis w/ CYP450
155
What kind of metabolites form after first phase metabolism?
- slightly polar, water soluble metabolites
| often still active
156
Who often loses phase 1 metabolism abilities?
Geriatric pts
157
What types of rxns take place in phase 2 drug metabolism?
Conjugation - glucuronidation, acetylation, sulfation
158
What kind of metabolites form after phase 2 metabolism?
- very polar, inactive metabolites
| - renally excreted
159
What is efficacy?
maximal effect a drug can produce = Vmax
160
What are some highly efficacious drugs?
- analgesic (pain) meds, antibiotics, antihistamines, decongestants
- partial agonists have less efficacy than full agonists
161
What is potency?
- amount of drug needed for a given effect
| - increased potency leads to increased affinity for receptor
162
What are some highly potent drugs?
- chemotherapeutic, antihypertensive, and antilipid drugs
163
What effect do competitive antagonsts have on potency or efficacy?
- shift curve to right which decrease potency
| - there is no change w/ efficacy
164
What effect do noncompetitive antagonists have on potency or efficacy?
- shift curve down which decreases efficacy
| -
165
What effect do partial agonists have on potency or efficacy?
- acts at same site as full agonist but w/ reduced maximal effect = decreases efficacy
- potency is a different variable and can be increased or decreased
166
What is therapeutic index?
- measurement of drug safety
| = LD50/ED50 (median lethal dose/median effective dose)
167
What types of drugs have a higher therapeutic index?
- safer drugs
168
What are examples of drugs w/ lower therapeutic index?
digoxin, lithium, theorphylline, and warfarin
169
What is therapeutic window?
- measure of clinical drug safety. range of minimum effective dose to minimum toxic dose
170
What is the antidote/treatment for the following toxicities?
1. Acetaminophen
2. Salicylates
3. Amphetamines
4. ACE inhibitors, organophosphates
5. Antimuscarinic, anticholinergic agents
1. N-acetylcystein (replenishes GSH)
2. NaHCO3 (alkalinizes urine), dialysis
3. NH4Cl (acidify urine)
4. atropine, pralidoxime
5. Physostimgine salicylate, control hyperthermia
171
What is the antidote/treament for the following toxicities?
1. Beta blocerks
2. Digitalis
3. Iron
4. Lead
5. Mercury, arsenic, gold
1. glucagon
2. normalize K, Lidocaine, anti-dig Fab graments, Mg
3. Deferoxamine, defersairox
4. CaEDTA, dimercaprol, succimer, penicillamine
5. dimercaprol, succimer
172
What is the antidote/treament for the following toxicities?
1. copper, arsenic, gold
2. cyanide
3. Methmeoglobin
4. CO
5. Methanol, ethylene glycol (antifreeze)
1. penicillamine
2. nitrite + thiosulfate, hydoxocobalamin
3. methylene blue, Vitamin C
4. 100% O2, hyperbaric O2
5. Fomepizole > ethanol, dialysis
173
What is the antidote/treament for the following toxicities?
1. Opiods
2. Benzodiazepines
3. TCAs
4. Heparin
5. Warfarin
1. naloxone/naltrexone
2. Flumazenil
3. NaHCO3 (plasma alkalinization)
4. Protamine
5. Vit K, Fresh frozen plasma
174
What is the antidote/treament for the following toxicities?
1. tPA, streptokinase, urkokinase
2. theophylline
1. aminocaproic acid
| 2. beta blocker
175
What category of drugs are the following endings?
1. azole
2. cillin
3. cycline
4. navir
5. triptan
1. antifungal
2. penicillin
3. antiobiotic, protein synthesis inhibitor - tetracycline
4. protease inhibitor
5. 5HT agonists (migraine) : sumatriptan
176
What category of drugs are the following endings?
1. ane
2. caine
3. operidol
4. azine
5. barbital
1. inhalational general anesthetic - halothane
2. local anesthetic - lidocaine
3. butyrophenone (neuroleptic) - haloperidol
4. Typical antipsychotic - phenothiazine (neuroleptic, antiemetic) - chlorpromazine, thioridazine
5. barbiturate - phenobabital
177
```
What category of drugs are the following endings?
1. zolam
2 azepam
3. etine
4. ipramine
5. triptyline
```
1. benzodiazepine
2. benzodiazepine
3. SSRI - fluoxetine
4. TCA
5. TCA
178
What category of drugs are the following endings?
1. olol
2. terol
3. zosin
4. oxin
5. pril
1. beta blocker
2. beta agonist
3. alpha 1 antagonists
4. cardiac glycosides (inotropic agent)
4. ACE inhibitor
179
What category of drugs are the following endings?
1. afil
2. tropin
3. tidine
4. ivir
5. navir
1. erectile dysfunction
2. pituitary hormone
3. H2 antagonists
4. Neuraminidase inhibitor
5. protease inhibitor
180
What category of drugs are the following endings?
1. thromycin
2. chol
3. curium or curonium
4. stigmine
5. dipine
1. Macrolide abx
2. cholinergic agonist
3. non depolarizing paralytic
4. AChE inhibitor
5. dihydropyridine CCB
181
What category of drugs are the following endings?
1. dronate
2. glitazone
3. prazole
4. prost
5. ximab
6. zumab
1. bisphosphonate
2. PPAR- gamma activator
3. proton pump inhibitor
4. PG analog
5. chiimeric monoclonal ab
6. humanized monoclonal ab
182
What drugs cause coronary vasospasm?
cocaine, sumatriptan, ergot alkaloids
183
what drugs cause cutaneous flushing?
vancomycin, adenosine, niacin, CCB (VANC)
184
what drugs cause dilated cardiomyopathy?
doxorubicine and daunorubicin
185
What drugs cause torsades de pointes?
Class III (sotalol) and Class IA (DQP), macrolides, antipsychotics, and TCAs
186
What can cause adrenocortical insufficiency?
HPA suppression secondary to glucocorticoid withdrawal
187
What drugs can cause hot flashes?
tamoxifen
| clomiphene
188
What drugs can cause hyperglycemia?
Tacrolimus, protease inhibitors, niacin, HCTZ, Beta blockers, corticosteroids.
- taking pills necessitates having blood checked
189
What drugs can cause hypothyroidism?
lithium, amiodarone, sulfonamide
190
What drug causes acute cholestatic hepatitis and jaudice?
erythromycin
191
What drugs can cause diarrhea?
Metformin, erthryomycin, colchicine, orlistat, acarbose
192
What drugs can cause focal to massive hepatic necrosis?
Halothane, amanita phalloides (death cap mushroom), valproic acid, acetaminophen
- liver HAVAc
193
What drug causes hepatitis?
- INH
194
What drugs cause pancreatitis?
didanosine, corticosteroids, alcohol, valproic acid, azathioprine, diuretics
- Drugs Causing A Violent Abdominal Distress
195
What drugs cause pseudomembranous colitis?
Clindamycin, ampicillin, cephalosporins
| - predispose to superinfxn by resistant C difficile
196
What drugs cause agranulocytosis?
Dapson, clozapine, carbamazepine, colchicine, methimazole, PTU
- Drugs CCCrush Myeloblasts and Promyelocytes
197
What drugs cause aplastic anemia?
Carbamazepine, methimazole, NSAIDS, benzene, chloramphenicol, PTU
- Can't Make New Blood Cells Properly
198
What drugs can direct coombs positive hemolytic anemia
Methyldopa and penicillin
199
What drugs cause gray baby syndrome?
chloramphenicol
200
What drugs cause hemolysis in G6PD deficiency?
INH, sulfonamides, dapsone, primaquine, aspirin, ibuprofen, nitrofurantoin
201
What causes megaloblastic anemia?
Phenytoin, MTX, Sulfa drugs
202
What causes thrombocytopenia?
heparin, cimetidine
203
What causes thrombotic complications
OCPs
204
What causes fat redistribution?
protease inhibitors and glucocorticoids
205
What causes gingival hyperplasia?
Phenytoin, verapamil, cyclosporine, nifedipine
206
What causes hyperuricemia (gout)?
Pyrazinamide, thiazides, furosemide, niazin, cyclosporine
207
What causes myopathy?
Fibrates, niacin, colchicine, hydroxychloroquine, IFN alpha, penicillamine, statins, glucocorticoids
208
What causes osteoporosis
corticosteroids and heparin
209
What causes photosensivity
Sulfonamides, amiodarone, tetracyclines, and 5FU
210
What causes Rash (SJS)?
anti-epileptic drugs (ethosiximide, carbamazepine, lamotrigine, phenytoin, phenobarbital)
- allopurinol, sulfa drugs, penicillin
211
What causes SLE like symptoms?
sulfa drugs, hydralazine, INH, procainamide, phenytoin, etanercept
212
What causes teeth discoloration?
tetracyclines
213
What causes tendonitis, tendon rupture, and cartilage damage
fluroquinolones
214
What causes cinchonism?
quinidine and quinine
215
What causes parkinson like syndrome?
Antipsychotics, Reserpine, Metoclopramie
216
What causes seizures?
INH (vit B6 deficiency), Bupropion, Imipenem/cilastatin, Tramadol, Enflurane, Metoclopramide
- I BITE My tongue
217
What causes tardive dyskinesia
antipsychotics and metoclopramide
218
What causes diabetes insipidues?
lithium and demeclocycline
219
What causes fanconi syndrome?
expired tetracycline
220
What causes hemorrhagic cystits?
cyclophosphamide and ifosfamide
221
What causes interstitial nephritis?
Methicillin, NSAIDS, furosemide
222
What causes SIADH?
Carbamazepine, cyclophosphamide, SSRIs
223
What causes pulmonary fibrosis?
Bleomycin, Amiodarone, Busulfan, MTX
224
What causes antimuscarinic reactions?
Atropines, TCAs, H1 blockers, Antipsychotics
225
What causes disulfiram like reaction?
Metronidazole, certain cephalosporins, griseofulvin, procarbazine, 1st gen sulfonylureas
226
What causes nephrotoxicity/ototoxicity?
Aminoglycosides, vanocmyin, loops diuretics, cisplatin
227
What are you CYP inducers?
1. Chronic alcohol use
2. Modafinil
3. St John's wort
4. Phenytoin
5. Phenobarbital
6. Nevirapine
7. Rifampin
8. Griseofulvin
9. Carbamazepine
228
What are CYP substrates?
```
Anti-epileptics
Anti-depressants
Anti - psychotics
Anethetics
Theophylline
Warfarin
Statins
OCPs
```
229
What are CYP inhibitors?
1. Acute alcohol abuse
2. Gemfibrozil
3. Ciprofloxacin
4. INH
5. Grapefruit juice
6. Quinindine
7. Amiodarone
8. Ketoconazole
9. Macrolides
10. Sulfonamides
11. Cimetidine
12. Ritonavir
230
What are you sulfa drugs?
Probenecid, furosemide, acetazolamide, celecoxib, thiazides, sulfonamide abx, sulfasalazine, sulfonylureas
