PHARMACOLOGY Flashcards
1
Q
what medications can increase methadone effect
A
fluconazole, voriconazole, ketoconazole
ciprofloxacin
clarithromycin
cimetidine
fluvoxamine
mu-opioid receptor agonist. Metabolised by CYP450 (CYP3A4)
2
Q
what drug used to treat alcohol withdrawal
A
chlordiazepoxide, lorazapam, diazapam (benzodiazapine)
3
Q
what drugs are CI in alcohol withdrawal treatment (due to lowering seizure threshold)
A
antipsychotics (chlorpromazine, haloperidol)
4
Q
methadone has a ________ half life
A
long
supress withdrawal and cravings
5
Q
first line medications to treat alcohol abstinence
A
naltrexone - blocks mu-opioid receptor -> inhibits reward and reduce cravings
acamprosate - moderates glutamate neurotransmission at NMDA receptor
disulfram - aldehyde dehydrogenase inhibitor (second line)
6
Q
rebound tremor, anxiety, insomnia, SNS hyperactivity (diaphoresis, palpitations) is seen in wthdrawal of ….
A
benzodiazapines i.e. lorazapam
can also result in psychosis, seizures, death
increased risk with shorter acting agents - alprazolam
7
Q
hyperphagia, hypersomnia, intense psychomotor retardation, severe depression (crash), vivid dreams - is seen in withdrawal of …..
A
(stimulants) amphetamines, cocaine
manage suicidal ideation
8
Q
phencyclidine is a
A
NMDA receptor antagonist
exact MOA unknown -
predicted NMDA hypofunction causes dopamine dysregulation -> psychosis
9
Q
what to prescribe patients with acute pain and worreid about opioid addiction
A
short course of opioid based pain meds fo rbreakthrough pain only (most will see improvement 3-5 days)
10
Q
IFN is used to treat
A
RNA and DNA viruses
i.e. kaposi sarcoma, HBV
(interferon = ‘interferes’ with replication in host cell)
Downregulates protein synthesis. upregulates MHC.
11
Q
anticholinesterases
A
‘stigmine’
physostigmine
neostigmine
pyridostigmine
donepezil, rivastigmine, galantamine
(indirect agonists of Ach)
prevent (anti) breakdown (ases) of Ach (choline)
12
Q
antidote to anticholinergic toxicity
A
physostigmine
‘phyxes’ atropine overdose
anticholinergic (anti Ach) -> physostigmine (increases Ach) by inhibiting anticholinesterases (prevents Ach breakdown)
13
Q
anticholinesterase poisoning antidote
A
atropine - competitive inhibitor (muscarinic anatgonist)
pralidoxime - regenerates AchE
14
Q
alpha-2 agonists
A
clonidine, guanfacine
a-methyldopa
tizanidine
hypertensive emergency, ADHD
mypertension in pregnancy
spasticity
15
Q
drugs affecting microtubules
A
mebendazole (helminth)
griseofulvin (fungal)
colchicine (gout)
vinca alkaloids (cancer)
taxanes (cancer)
kinesin and dynein transport cellular cargo along icrotubules
16
Q
what effect does vitamin K have on clotting factors
A
y-carboxylation of glutamic residues
post-translational modification
y-carboxylation essential for clotting factor maturation 1972, S, C
epoxide reducase in liver regenerates active vit K for ‘gamma carboxylation’
17
Q
meningitis in elderly is treated with
A
vancomycin (G+)
cephtriazone (G-)
ampicillin (coveres listeria)
18
Q
listeria monocytogenes treated with
A
ampicillin
penicillinase sensitive penacillin
19
Q
Treatment of brucellosis
A
tetracyclines
rifampin
20
Q
treatment AML
A
all-trans retinoic acid (vit A)
21
Q
treatment CML
A
Imatinib
tyrosine kinase inhibitor -> (stops t9;22) translocation
22
Q
treatment ALL
A
cytarabine
pyrimidine analog - nucleoside analog (mimics cytasine) - inhibits DNA s
23
Q
treatment CLL
A
comfort,
rituximab (CD20)
fludarabine, clyclophosphamide, chlorambucil, alemtuzamab
rituximab - monoclonal Ab, associated with an increased risk of PML, a demyelinating disease of the CNS caused by the destruction of oligodendrocytes secondary to reactivation of JC virus.
24
Q
increased risk of PML
JC virus reactivation
A
rituximab
natalizumab
25
treatment of DLBCL
R-CHOP
**Riuximab** (CD20+) -
**Cyclophosphamide**
Hydroxy**daunorubicin **(adriamycin)
Oncovin® (**vincristine**)
**Prednisone**
rituximab added for B cell
| treats non-Hodgkin lymphomas
26
what is a concerning feature of neoplastic process in lymph nodes
lymphocytes with a **single** immunoglobulin variable domain allele - **(monoclonal)**
| single cell dividing uncontrollably, produces identical copies of itself
## Footnote
**polyclonal** - normal response to infection, many B cells mlutify, producing slightly different antibodies
27
purine analog that mimics adenosine
**cladribine**
unable to be processed by ADA
treats hairy cell leukaemia
| inhibits nucleotide metabolism.
inferes with DNA synthesis
## Footnote
cell cycle non-specific*
***'I'm 'clad' you're 'hairy'***
28
what drug is resistant to breakdown by adenosine deaminase
cladribine
| hairy cell leukaemia
29
hydroxyurea is used to treat
sickle cell anaemia
polycythemia vera
30
causes aplastic anaemia
| still used to treat bacterial meningitis in resource-poor countries
chloramphenicol
| H. influenzae
N. meningiditis
S. pneumoniae
## Footnote
*also causes 'grey baby syndrome'*
31
blood in urine, but no RBC in urinalysis
haemoglobinuria
myoglobinuria
| i.e. PNH
## Footnote
true **hematuria** - blood and RBC in urine
32
monobactams used to treat
aerobic gram negative rods
| enterobacter ...
33
NRTI's lack a ? group
3' hydroxyl
| terminates chain
## Footnote
HIV reverse transcriptase normally adds nucleotides to the growing DNA strand via a 3'-5' phosphodiester bond
Since NRTIs resemble natural nucleosides but lack the 3'-OH, they act as chain terminators,
34
name two first line cephalosporins
cefazolin
cefalexin
'azolin' 'lexin'
| 'a stolen lexus'
## Footnote
β-lactam drugs, bactericidal
inhibit cell wall synthesis
less susceptible to penicillinases
Tx gram **(+) PEcK**
*Proteus mirabilis
E coli
Klebsiella pneumoniae*
35
**MOA: **
reversible binding 50S
interrupt peptidyl transferase
**Tx: **
gram (+) and (-)
rocky spotted mountain fever
meningitis
chloramphenicol
| aplastic anaemia
gray baby syndrome
36
treats gram (+) skin infections
can cause myopathy
| can treat MRSA
daptomycin
| dapt-myo-**skin**
## Footnote
**CONTRAINDICATED** in **pneumonia** (deactivated by surfactant)
37
tamoxifen can cause
endometrial polyps
endometrial cancer
| partial agonists: pro-oestrogen effects on endometrium, bone
## Footnote
anti-oestrogen effects on breast
38
DES - diethylsetilbestrol can cause
adenosis
| persistance of columnar epithelium in vaginal canal
## Footnote
can lead to **clear cell adenocarcinoma**
39
what drug decreases vaso-occlusive crises by increasing HbF
hydroxyurea
| sickle cell
40
*adverse* and ***serious adverse*** effects of carbamazepine
| CARBAMAZEPINE
C - CNS - vomiting, D's (dizziness, diplopia, diarrhoea)
A - ***aplastic anaemia, agranulocytosis***
R - rash (face to trunk) - ***SJS, DRESS***
B - blood - pancytopenias
A - ADH - *SIADH*
M - megaloblastic (rare)
A - autoinduction (induces own CYP450)
Z - sedative zzzz
E - enzyme *inducer* - *CYP450*
P - pregnancy (***teratogenic***), periheral neuropathy
I - increased liver enzymes (***hepatotoxicity***)
N - nutrition -*** folate depletion***, nytagmus
E - oedema
41
MOA of flutamide
impairs **androgen-receptor** interaction
| non-steroid agent
**competitive testosterone receptor inhibitor**
## Footnote
used in combo with **GnRH** **agonists** to treat **prostate cancer**
42
first line pharmacotherapy for primary hyperaldosteronism
spironolactone
eplerenone
| mineralocorticoid receptor antagonist
## Footnote
eplerenone (**less** gynacomastica, decreased libido)
43
BPH (leading to bladder outlet obstruction) can cause increased pressure presenting as
| histology
hydronephrosis
renal parenchymal atrophy
scarring
| can progress to CKD
44
(RCC)
what are the risk factors
**smoking**, obesity, HTN
| round polygonal clear cells
## Footnote
toxin exposure - heavy metals
45
seen in
## Footnote
hematuria
renal mass
LBP weight loss
lytic bone lesion vertebrae
smokes drinks
renal cell carcinoma
(rounded polygonal clear cells)
46
bilateral pitting oedema
no abdomen distension
tortuous veins lower abdomen
left flank mass
smoker
renal cell carcinoma
invasion of IVC
| RCC tends to invade renal vein -> by extension will invade IVC
## Footnote
key features :
**bilateral oedema LL
abdominal walls collaterals**
47
Drug reaction with eosinophilia and
systemic symptoms
DRESS
48
what can occur if chronic glucocorticoid use is stopped abruptly
adrenal insufficiency
49
ivermectin
Tx parasites
disrupt microtubles and cellular motility
50
what is used to prevent vasospasm in subarachnoid haemorrhage
nimodepine
| short acting CCB t1/2 <2hrs
51
adverse effects of bisphosphonates
oesophagitis
osteonecrosis jaw
atypical femoral stress fractures
52
Use of leucovorin (with methotrexate)
rescues normal cells from methotrexate toxicity **bypasses** dihydrofolate reductase (methotrexate acts on)
replenishes reduced **folate** levels
| works like folate to reduce myelosuppression
## Footnote
essential if pt has **renal dysfunction **ie.e high creatinine - toxicity, reduced clearace
giving folate wont suffice - methotrexate will complete with it
must give to pts taking **5FU** - increases binding of 5FU wth its target - thymidylate synthase
53
**proteasome** inhibitors treat
| anticancer
****multiple myeloma
mantle cells lymphoma
accumulation of proteins -
**apoptosi
| arrest cell cyle at G2-M phase via
## Footnote
*degrade unfolded and misfoded proteins*
bortezomib
ixazomib
carfilzomib
'**zom**'
**proteasome** needed to clear misfolded/unfolded proteins
not cleared i.e. **multiple myeloma** (plasma cells produce alot of proteins - Igs)
if proteasome inhibitor **inhibits** this clearance of proteins
-> **apoptosis** results
(from response of unfolded protein)
54
treatment of multiple myeloma
**bortezomib**
(proteasome inhibitor)
| arrests G2-M
protein accumulation
apoptosis
## Footnote
**proteasome** needed to clear misfolded/unfolded proteins
not cleared i.e. **multiple myeloma** (plasma cells produce alot of proteins - Igs)
if proteasome inhibitor **inhibits** this clearance of proteins
-> **apoptosis** results
(from response of unfolded protein)
55
treatment of babesiosis (borrelia microti)
atovaquone +
azithromycin
| ring forms or tetrad on giemsa stain
## Footnote
atovaquone - inhibits mitochondrial electron transport
azithromycin - binds 50S, inhibits protein synthesis
56
drug treating muscle cramps
stimulates
**Y-aminobutyric acid B receptor**
**Baclofen**
(stimulates _GABA _ receptor)
| agonist at GABA-B receptor
Tx **muscle spasticity** i.e. paraplegic
## Footnote
also cause **sedation**
increase K+ efflux
hyperpolarise sk ms
decrease action potential frequency
57
hypertonic saline must be given slowly and carefully due to risk of
central pontine myelinosis
58
MOA of **neomycin** in *hepatic encephalopathy*
kills bacteria in the **gut** tht generate **ammonia**
| treats hepatic encephalopathy
**NO LONGER USED - AKI, ototoxicity**
## Footnote
aminoglycoside AB (inhibits 30S) - prevent translation
killing **gram negative flora** reduces ammonia
cannot kill anaerobes (as require O2 for uptake)
**Rifaximin now drug of choice
59
what antibiotic is used to treat hyperammonia
rifamixin
| neomycin no longer used
60
**atherosclerosis**
abdominal pain **after** eating
weight loss
PAD
CAD
diminished pedal pulses
celiac or mesentierc ischaemia
| reduced blood flow to small intestine
acute or chronic
## Footnote
acute = embolic or thrombotic arterial obstruction
chronic = atherosclerotic stenosis (SMA common)
common asssoc findings:
atherosclerotic sequalae - PAD, CAD, pedal pulses
61
Samters triad caused by aspirin
aspirin sensitivity
nasal polypopsis
asthma
| urticara (hives)
## Footnote
NSAIDS --> inhibit co1 --> decrease PGE2 --> promote 5-lipoxygenase --> increase leukotriene 4 --> increased inflammation
in asthma **leukotrienes** key mediator of inflammation
62
**protease** inhibitors function
block formation of mature viral core
| in HIV replication
**prevents maturation**
63
treatment of Kawasaki disease
high dose aspirin
IV immunoglobulins
| normally aspirin CI in children - Reyes syndrome
64
_acute_ treatment of gout (3)
NSAIDS (indomethacin)
glucocortoids
colchicine
65
MOA of colchicine
inhibit **microtubule polymerisation **-->
decrease **leukocyte motility **and **infiltration** into joint
| tx **gout**
## Footnote
**stabilises tubulin** - inhibits microtuble polymerisation
66
treatment of _chronic_ gout (2)
allopurinol
febuxostat
| **xanthine oxidase inhibitors**
67
type of crystals in gout
**needle** shaped
**negative** bifringent
yellow under parallel
blue under perpendicular
| polarised light:
## Footnote
**_calcium pyrphosphate deposition disease_** (pseudogout)
pseudogout
**rhomboid** crystals
weakly **positive** bifringent
blue under parallel light
68
**rhomboid** crystals
weakly **positive** bifringent
seen in
calcium pyrphosphate deposition disease
(pseudogout)
## Footnote
blue under parallel light
69
MOA of probenecid
**inhibits** PCT reabsorbing uric acid
| gout Tx
70
MOA of pegloticase
increased uric acid solubility in serum/synovial fluid
## Footnote
recombinant form of urate-oxidase enzyme --> converts uric acid to water soluble metabolite (allantoin)
71
inhibits **alcohol** dehydrogenase
fomepizole
| Tx of methanol poisoning
## Footnote
**first step **of metabolism
prevents conversion methanol to toxic metabolites
72
inhibits **aldehyde** dehydrogenase
disulfiram
| **not used acute** management methanol toxicity
73
name anti-folate medications (4)
phenytoin
methotrexate
trimethoprim
dapsone
74
**mifepristone** MOA & use
competitive inhibitor progesterone
dilation of cervix
| **elective abortion**
## Footnote
primes for misoprostol
75
76
**misoprostol** MOA & use
synthetic prostaglandin
uterine contractions
| follows mifepristone
77
main resistance of E coli to B-lactam AB
(i.e. ampicillin)
B-lactamase production
| penicillinases
## Footnote
main resistance to B-lactam ABs:
**gram negative **= B-lactamase production
**gram positive **= altered structure transpeptidases PBPs
(B-lactam AB can'd bind)
78
main resistance of S pneumoniae to B-lactamase AB
(i.e. ampicillin)
altered structure transpeptidases PBPs
## Footnote
main resistance to B-lactam ABs:
**gram negative **= B-lactamase production
**gram positive **= altered structure transpeptidases PBPs
(B-lactam AB can'd bind)
79
klebsiella, pseudomonas, serratia demonstrate B-lactam resistance by mutations in
genes coding for **porins**
80
_\_\_ are used by bacteria to decrease intracellular concentrations of AB
| (i.e. tetracycline - intracellular working AB)
Efflux pumps
| used by **E coli**
81
cyanide inhibits enzyme
cytochrome C oxidase
| leads to lacrtic acidosis
Inhibits ETC)
82
tachypnoea
hypotension
confusion, lethagy
bradycardia
metabolic acidosis
| toxin
cyanide poisoning
## Footnote
metabolic acidosis from lactic acidosis caused by cytochrom c inhibition - uncoupling electron tranport chain (ETC)
83
byproduct of sodium pitroprusside
cyanide
| tx of malignant HTN
84
drugs causing radiation pneumonitis
doxorubicin
bleomycin
85
treatment for anorexia nervosa
olanzapine
86
treatment for bulimia nervosa
fluoxetine
| bupeopion CI - increased seizure risk
87
treatment of angina
nitroglycerin
| vaso**dilation** **veins** > arteries
decrease **Preload**
## Footnote
**CCB** in **prinzmetal** angina - decrease coronary vasospasm
88
treatments of myocardial infarction
aspirin / heparin
nitrates
BB
ACEi
supplemental O2
| fibrinolysis / angioplasty (opens blocked vessel)
89
2 adverse risks of fibrinolysis or angioplasty in MI
contraction band necrosis
reperfusion injury
## Footnote
CBN: calcium influx --> hypercontraction myofibrils
RI: oxygen --> free radicals --> myocyte damage
90
cabergoline and bromocriptine are
dopamine agonists
| Tx prolactinomas (reduce tumour size)
91
omeprazole MOA
**direct** & **_irreversible_** inhibition of luminal *H+/K+ ATPase* on gastric parietal cells
| = proton pump inhibitors 'prazole' drugs
treatment GERD
## Footnote
increased risk C diff infection
92
**cimetidine** is a potent inhibitor of
CYP450
*also has:*
*antiandrogenic effects
cross BBB, placenta*
| H2 blocker -> decresed recretion parietal cells
93
what family impairs DNA synthesis by direct inhibition of DNA gyrase
fluroquinolones
(topioisomerase II in prokaryotes)
## Footnote
Tx legionella pneumophillia - atypical pneumonia
94
long acting opioid known for
prolonging QT interval
**methadone**
95
aripiprazole MOA
**partial agonist **D2
| **atypical** antipsychotic (second gen)
## Footnote
less attenuation dopamine in BG
less likely to lead to drug induced parkinsonian symptoms
(locking limbic system - decreases psychotic symptoms)
96
what is the function of cilostazol
tx **claudication**
(peripheral arterial disease)
| PDE3 inhibitor (phosphodiesterase III)
## Footnote
**decreases CAMP degradation** -in platelets / vascular smooth muscle --> increased intracellular CAMP --> increased PKA --> **inhibition platelet aggregation**
vascular sm - **increased vasodiltion **(inhibition MLCK)
97
AE of albuterol
| how is the ae treated
tremor
| Albuterol - B2 agonist
Tx with **propranolol** (NS beta blocker)
## Footnote
*others:
increased NA/K ATPase pump, hypokalaemia, glycogenolysis, hyperglycaemia, tachycardia, HTN, headache*
98
what effect does nitroglycerin have on cGMP
increases
## Footnote
acts within vascular sm cells
releases NO
activates gyanyl cyclase
increases cGMP
sm ms relaxation + vasodilation
99
anticholinergics, antihistamines, benzos, sedative hypnotics and opiods can cause medication induced _\_\_
delirium
| psychoactive drugs
