Pharmacology 2- systems Flashcards
Overdose:
Acetaminophen(1)
N-acetylcysteine (replenishes gluathione to remove toxic NAPQ1)
(pt: suicide/ chronic pain pt)
(symp: N/V/increase LFTs, ASTs, ALTs, Bilirubin)
Overdose:
AchE inhib/ Organophosphates(2)
Atropine>pralidoxime
DUMBBeLSS- doesn’t correct ‘e’
Overdose:
Amphetamines (basic) (1)
NH4CL (acidify urine)
Overdose:
Antimuscarinic/Anti-cholinergic agents(2)
- Physostigmine
- control Hyperthermia (hot as a hare)
(rhyming symptoms)
Overdose:
Arsenic(2)
- Dimercaprol
- Succimer
* same as Mercury poisoning
Overdose:
Benzodiazepines(1)
bind GABA–> increase freq. of GABA binding
Flumazenil
Overdose:
BBs (3)
- saline
- atropine- antag parasymp to cancel out depressed SNS
- Glucagon–>increase Gs/cAMP
(pt: usually an accident)
Overdose: Carbon Monoxide(2)
- 100% O2
- Hyperbaric O2- increase pressure to increase O2 dissolved
(Combustion/fire, causes change in mental status)
(PulseOx shows 100% sat –> must check carboxyhemoglobin)
Overdose:
Copper(2)
- Penicillamine
- Trientine
(like in wilson’s disease)
Overdose:
Cyanide(2)
- Nitrite + Thisulfate
- Hydroxocobalamine
(cyanide inhib Complex 4 in electron transport chain)
Overdose:
Digitalis (digoxin) (1)
Anti-dig Fab fragments
Overdose:
Gold (3)
- Penicillamine
- dimercaprolol (BAL)
- Succimer
(chelated by anything)
Overdose:
Heparin (1)
- protamine sulfate
Overdose:
Iron (3)
“Defer-“
- Deferoxamine
- Deferasirox
- Deferiprone
Overdose:
Lead (4)
- EDTA
- Dimercaprol
- Succimer
- Penicillamine
(source: paint-old house/batteries-industry worker/moonshine-drunks)
(easily absorbed)
Overdose:
Mercury(2)
- Dimercaprol
2. Succimer
Overdose:
Methanol/ Ethylene glycol(antifreeze) (2)
- Fomepizole > ethanol
- dialysis
(kids drink antifreeze–>oxalic acid precipitates in renal tubules requiring dialysis)
Overdose:
Methemoglobin(2)
- Methylene blue
- Vitamin C
(both act as electron donors to turn back to Fe+2)
(Iron in Hb is at Fe+3–>arterial blood is chocolate colored)
Overdose:
Opioids
Naloxone
symp: RR less than 12, miosis, change mental status, hypotension
Overdose:
Salicylates (2)
- NaHCO3 (alkalinize urine)
2. Dialysis
Overdose:
TCAs (1)
NaHCO3(plasma alkalination)
sump: depression, check for prolonged QRS on EKG
Overdose:
Warfarin (small/lipophilic molecule) (2)
- Vit K (delayed effect)
2. fresh frozen plasma (immediate effect)
Overdose:
tPA(1)
Aminocaproic acid (mimics plasminogen binding site)
Overdoses treated with chelation (6)
- copper
- arsenic
- gold
- lead
- mercury
- iron
Drug induced: Coronary vasospasms (3)
- cocaine
- Sumatriptan
- ergot alkaloids
Drug induced: cutaneous flushing (5)
“Opposite of bob VANCE, VANCE refrigeration”
- Vancomycin
- Adenosine
- Niacin
- Ca+2 channel blockers
- Echinocandins (not really used)
Drug induced: Dilated cardiomyopathy(2)
Prevent w:
Anthracyclines:
- Doxorubicin
- Daunorubicin
prevent w/ dexrazoxan (chelator to bind free Fe+2)
Drug induced:
Torsades de pointes (5)
Precaution to take before drug use
"ABCDE" Anti"a"rrhythmics (class Ia, III) Anti"b"iotics (macrolides) Anti"c"ychotics (haloperidol) Anti"d"epressants (TCAs) Anti"e"metics (ondansetron)
*always do EKG before giving any of these drugs
Drug induced:
Adrenocortical insuff.
What patient population?
HPA suppression 2ary to glucocorticoid withdrawal (like prednisone)
- long term prednison: lupus, RA, vasculitis
Drug induced: Hot Flashes (2)
- Tamoxifen
- Clomiphene
(antagonize E-R, used for breast cancer)
Drug induced:
Hyperglycemia (5)
“Taking Pills Necessitates Having blood Checked”
- Tacrolimus
- Protease Inhibitors
- Niacin
- HCTZ
- Corticosteroids
Drug induced:
Hypothyroidism (3)
- Lithium (inhib T3/T4)
- Amiodarone (class III antiarrhythmia, inhib 5’ deiodinase in periphery)
- Sulfonamides (binds thyroid peroxidase)
Drug induced:
Acute cholestatic hepatitis/jaundice(1)
Erythromycin (metabolite in bile)
Drug induced:
Diarrhea (12)
Issue
- Acamprosate
- Acarbose (a-glucosidase inhib)
- Cholinesterase inhib (increase Ach)
- Colchicine (decrease microtubule polymerization= sloughing off for GOUT tx)
- Erythromycin (binds Motilin-R to increase sm. muscle contractions)
- Ezetimibe
- metformin (increase 5-HT)
- misoprostol
- orlistat(lipase inhib similar to acarbose)
- pramlintide (amylin-like to slow gastric emptying)
- Quinidine
- SSRI (increase 5-HT)
* high non-compliance rate
Drug induced:
Focal to massive hepatic necrosis(4)
‘Liver HAVAc’
- Halothane
- Amanita phalloides (death cap- inhib RNA pol II(mRNA))
- Valproic Acid
- Acetaminophen
Drug induced:
Hepatitis(5)
- Rifampin
- isoniazid
- Pyrazinamide
- Statins
- Fibrates
(1-3 tx TB, 4-5 tx dylipidemia)
Drug induced:
Pancreatitis (6)
“Drugs Causing A Violent Abdominal Distress”
- Didanosine
- Corticosteroids
- Alcohol
- Valproic Acid (tx: epilepsy, bipolar)
- Azathioprine
- Diuretics (furosemide, HCTZ)
Drug induced:
Esophagitis (3)
- Tetracyclines (esp. Doxy)
- Bisphosphonates (in osteoporosis pt.)
- Potassium Chloride (not used)
*Caustic effect minimized with upright posture and adequate water ingestion
Drug induced: Pseudomemb Colitis (3)
- Clindamycin
- Ampicillin
- Cephalosporins
*all abx predispose to superinfection by resistant C.diff
Describe C.Diff Gram stain Does it form spores? anaerobic/aerobic toxin treatment(2)
- Gram +
- spore forming anaerobic bacteria (hangs around in hospitals)
- Produces Toxin A to disrupt tight junctions and H2O leaks out
- Treat: Metronitazole or Vancomycin (PO)
Drug induced:
Agranulocytosis (6)
What is defined as agranulocytosis?
“Can Cause Pretty Major Collapse of Granulocytes”
- Clozapine
- Carbamazepine
- Propylthiouracil (similar to pyrimidine)
- Methimazole (similar to pyrimidine)
- Colchicine
- Ganciclivir (similar to purine)
*Agranulocytosis= Neutrophils
Drug induced: Aplastic Anemia(6)
” Can’t Make New Blood Cells Properly”
- Carbamazepine
- Methimazole
- NSAIDs
- Benzene (Gas exposure)
- Chloramphenicol (smilar Benzene rink and cross BBB)
- Propylthiouracil
Drug induced:
Direct Coombs-positive Hemolytic anemia (2)
- Methyldopa
2. Penicillin
Drug induced:
Gray Baby syndrome
Chloramphenicol
Drug induced:
Hemolysis in G6PD deficiency(7)
“Hemolysis IS D PAIN’
- Isoniazid
- Sulfonamides
- Dapsone
- Primaquine
- Aspirin
- Ibuprofen
- Nitrofurantoin
Drug induced: Megaloblastic Anemia (3)
“having a BLAST with PMS”
- Phenytoin
- Methotrexate
- Sulfa drugs/TMP
*all cause decreased folate
Drug induced:
Thrombocytopenia(1)
Heparin (HIT)
Drug induced: Thrombotic complications (2)
- OCPs
2. Hormone Replacement Therapy
Classic G6PD vignettes to be cautious of:
- UTI
- Chronic pain
- TB
- avoid Bacrim and Nitrofurantoin
- avoid aspirin/ibuprofen
- avoid Isoniazid
How does Heparin cause HIT?
Treatment?
platelet-factor 4 bind Heparin trigger Abs to bind causing:
- platelets destroyed in spleen–>thrombocytopenia
- platelets activated (decrease platelets but increase risk of thrombosis)
Tx: stop heparin, admin argotroban
Drug induced: Fat redistribution (2)
“FAT PiG”
- Protease Inhibitor
- Glucocorticoids
Drug induced: Gingival Hyperplasia (3)
- Phenytoin (50%)
- Ca+2 channel blocker (rare)
- Cyclosporine (30%)
Drug induced:
Hyperuricemia (gout) (5)
“Painful Tophi & Feet Need Care”
- Pyrazinamide
- Thiazides
- Furosemide
- Niacin
- Cyclosporine
Drug induced:
Myopathy (8)
- Fibrates (combo w/ statins is worse)
- Niacin
- colchicine
- hydroxychloroquine (treats lupus)
- IFN-a
- penicillamine
- statins (combo w/ fibrates is worse)
- glucocorticoids
Drug induced:
Osteoporosis (2)
- Coricosteroids (increase osteoblast apoptosis)
- Heparin (stim osteoclast after longtime)
- pt. on glucocorticoids should be taking a Bisphosphonate
Drug induced:
Photosensitivity(4)
“SAT For PHOTO”
- Sulfonamides
- Amiodarone
- Tetracyclines
- 5-FU (cream)
Drug induced:
Rash (Steven-Johnson) (9)
“CLAPPPERS”
- CARBAMAZEPINE
- LAMOTRIGINE
- ALLOPURINOL
- PHENYTOIN
- PHENOBARBITAL
- PENICILLIN
- ETHOSUXIMIDE
- RASH
- SULFA DRUGS
Drug induced:
SLE-like syndrome
“Having Lupus is SHIPP-E”
- Sulfa drugs
- Hydralazine
- Isoniazid
- Procainamide
- Phenytoin
- Etanercept
Drug induced: Teeth discoloration(1)
Tetracycline
Drug induced:
Tendonitis, Tendon Rupture, Cartilage damage(1)
Fluroquinolones (inhib fibroblasts)
*esp. in elderly,
Drug induced:
Cinchonism(2)
What is the cinchonism triad?
- Deaf 2. Tinnitus 3. Blurred Vision
- Quinidine
- Quinine (less potent)
* derived from the cinchona tree
Drug induced:
Parkinson-like syndrome(3)
“Cogwheel rigidity of ARM”
- Antipsychotics
- Reserpine
- Metoclopramide
symp=’ TRAP’
Drug induced:
Seizures (5)
“with seizures, I BITE My tongue”
- Isoniazid (B6 def)
- Bupropion, Benzo&Alcohol withdrawal
- Imipenem/cilastatin (direct GABA inhib)
- Tramadol
- Enflurane (decrease neuro responsiveness to GABA)
- Metoclopramide
Drug induced: Tardive Dyskinesia(facial/oral movements)
- Antipsych
- Metoclopramide
*classic vignette of schizophrenic pt with abnormal facial movements
Drug induced:
DI (2)
overall MOA
- Lithium
- Demeclocycline
* inhib principle cells in collecting tubule when ADH bind V2 (via Adenyl Cyclase inhib)
Drug induced: Fanconi Syndrome(5)
- Tenofovir
- Ifosfamide (alkylizing agent that cross links DNA at Guanine N-7)
- Tetracycline (expired)
- Heavy metals/ Wilson’s disease
*# 1&2 both cause dysfunction of PCT (decrease AA, glucose, bicarb, phos)
Drug induced:
Hemorrhagic cystitis (2)
HOW TO PREVENT!!!!
- Cyclophosphamide
- Ifosfamide
*both decrease GSH (increase reactive oxygen species)
(both are alkylizing agents that cross links DNA at Guanine N-7)
Prevent with cadmic Mesna
Drug induced: Interstitial Nephritis(3)
What would be present on urinalysis?
- Methicillin (beats up too many kidneys)
- NSAIDs
- furosemide
-eosinophils
Drug induced:
SIADH (3)
“Can’t Concentrate Serum Sodium”
- Carbamazepine
- Cyclophosphamide
- SSRIs
Explain why B6 must be coadministered when giving Isoniazid.
How does this contribute to CNS effects/seizures?
Isoniazid is structurally similar to B6.
B6 is needed for conversion of Glutamate–>GABA
A decrease in GABA leads to seizures.
Drug induced:
Dry Cough(1)
MOA
How to avoid?
- ACEi
- increase bradykinins which trigger bronchoconstriction
- switch to ARB
Drug induced:
Pulmonary fibrosis(6)
Which 2 are caused by Hypersensitivy Reaction (others are caused by direct damage causing fibrosis)?
“My Nose Cannot Breathe Bad Air”
- Methotrexate
- Nitrofurantoin (hypersensitivity Response/Pneumonitis)
- Carmustine
- Bleomycin
- Busulfan
- Amiodarone (hypersensitivity Response/Pneumonitis)
Drug induced:
Antimuscarinic (4)
- Atropine
- TCAs
- H1-blockers (first gen)
- antipsych
Drug induced:
Disulfiram-like rxn (5)
How?
“‘M’argaritas ‘C’ertainly ‘C’ause ‘G’reat ‘P’uking &‘S’kin-‘F’lushing”
- Metronidazole
- certain cephalosporines
- griseofulvin
- procarbazine
- Sulfonylureas (First-gen)
*disulfiram inhib Acetaldehyde dehydrogenase–>increase acetaldehyde–>Hangover symptoms
Drug induced:
Nephrotoxicity/ Ototoxicity (4)
Which receptor for Nephrotox? Ototox?
How to treat chemo-agent induced?
- Aminoglycosides (esp. Neomycin)
- Vancomycin (via ox. stress)
- Cisplatin –>may respond to AMIFOSTINE treatment (free radical scavenger
- Loop diuretics (“Wear loop earrings”)
Nephrotox in PCT causing increase Creatinine
Ototoxicity caused by binding to NMDA-R
P450 inducers (+) (7)
“Guiness, Coronas, and PBR’S lead to Chronic Alcoholism”
- Griseofulvin
- Carbemazepine
- Phenytoin
- Barbs
- Rifampin
- St. John’s wort
- Chronic Alcoholism
P450 inhibitors (10)
“CRACK AMIGO”
- Ciprofloxicin
- Ritonavir
- Amiodarone
- Cimetidine
- Ketaconazole
- Acute Alcohol abuse
- Macrolides
- Isoniazid
- Grapefruit Juice
- Omeprazole
- Sulfonamides
P450 substrates (4)
“Always Think When Outdoors”
- Anti-epileptics
- Theophylline
- Warfarin
- OCPs
Sulfa drugs:
Name (8)
“Scary Sulfa Pharm FACTS”
- Sulfonamide abx
- Sulfasalazine
- Probenecid
- Furosemide
- Acetazolamide
- Celecoxib
- Thiazides
- Sulfonylureas
Potential reactions to Sulfa drugs (7)
Which is most common?
1= urticaria/hives
range from mild-severe
- F
- UTI
- Sevens-Johnsons (type4 hypersens via CD8+)
- hemolytic anemia (3% will have rxn via Hapten)
- Thrombocytopenia
- Agranulocytosis
- Urticaria/Hives(type1 hypersens via IgE)
Drug Name Endings, example:
Ergosterol synthesis inhibitor
-azole
Ketoconazole
Drug Name Endings, example:
Antiparasitic/antihelminthic
-bendazole
Mebendazole
Drug Name Endings, example:
peptidoglycan synthesis inhibitor
-cillin
Ampicillin
Drug Name Endings, example:
Protein synthesis inhibitor
-cycline
Tetracycline
Drug Name Endings, example:
Neuraminidase Inhibitor
-ivir
Oseltamivir
Drug Name Endings, example:
Protease inhibitor
-navir
Ritonavir
Drug Name Endings, example:
DNA polymerase inhibitor
-ovir
Acyclovir
Drug Name Endings, example:
Macrolide abx
-thromycin
Azithromycin
Drug Name Endings, example:
Inhalational general anesthetic
-ane
Halothane
Drug Name Endings, example:
Typical antipsychotic
-azine
Thioridazine
Drug Name Endings, example:
Barbituate
-barbital
Phenobarbital
Drug Name Endings, example:
Local anesthetic
-caine
Lidocaine
Drug Name Endings, example:
SSRI
-etine
Fluoxetine
Drug Name Endings, example:
TCA (2)
-ipramine, -triptyline
Imipramine, amitryptyline
Drug Name Endings, example:
5-HT 1b/1d agonists
-triptan
Sumatriptan
Drug Name Endings, example:
Benzodiaepine(2)
-zepam, -zolam
Diazepam, Alprazolam
Drug Name Endings, example:
Cholinergic agonist
-chol
Bethanechol, carbachol
Drug Name Endings, example:
Non-depolarizing paralytic (2)
-curium, -curonium
Atracurium, Vecuronium
Drug Name Endings, example:
BB
-olol
Propranolol
Drug Name Endings, example:
AchE inhibitor
-stigmine
Neostigmine
Drug Name Endings, example:
B2-agonist
-terol
Albuterol
Drug Name Endings, example:
a1-angtagonist
-zosin
Prazosin
Drug Name Endings, example:
PDE-5 inhib
-afil
Sildenafil
Drug Name Endings, example:
Dihydropyridine Ca+2 Channel blocker
-dipine
Amlodipine
Drug Name Endings, example:
ACEi
-pril
Captopril
Drug Name Endings, example:
Angiotensin-II Receptor Blocker
-sartan
Losartan
Drug Name Endings, example:
HMG-CoA reductase inhibitor
-statin
Atorvastatin
Drug Name Endings, example:
Direct factor ‘Xa’ inhibitors
-‘xa’ban
Apixaban, edoxaban, rivaroxaban
Drug Name Endings, example:
Bisphosphonate
-dronate
Alendronate
Drug Name Endings, example:
PPAR-gamma activator
-glitazone
Rosiglitazone
Drug Name Endings, example:
Proton pump inhib
-prazole
Omeprazole
Drug Name Endings, example:
Prostaglandin analog
-prost
Latanoprost
Drug Name Endings, example:
H2-antagonist
-tidine
Cimetidine
Drug Name Endings, example:
Pituitary Hormone
-tropin
Somatotropin
Drug Name Endings, example:
Chimeric monoclonal Ab
-ximab
Basiliximab
Drug Name Endings, example:
Humanized monoclonal Ab
-zumab
Daclizumab