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USMLE Step 1 Random Facts > Pharmacology > Flashcards

Pharmacology Flashcards

drug of choice = DOC

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USMLE® Step 1 flashcards
1
Q

inhibitors of ACh synthesis, storage, release

A

hemicholinium-3, vesamicol, botulinum toxin

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2
Q

inhibitors of ACh degradation (AChE inhibitors)

A

edrophonium, neostigmine, pyridostigmine, ambenonium, physostigmine
diisopropyl flurophosphate
tacrine, donepezil, rivastigmine, galantamine

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3
Q

muscarinic receptor AGONISTS

A

methacholine (asthma challenge test)

carbachol, bethanechol, cevimeline, pilocarpine

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4
Q

nicotinic receptor AGONISTS

A

succinylcholine

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5
Q

muscarinic recept ANTAGONISTS

A

atropine
scopolamine
pirenzepine, methscopolamine, glycopyrrolate
ipratropium, tiotropium
oxybutynin, propantheline, terodiline, tolterodine, fesoterodine, trospium, darifenacin, solifenacin

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6
Q

nicotinic recept ANTAGONISTS

A

pancuronium, tubocurarine, vecuronium, rocuronium, mivacurium
trimethaphan, mecamylamine

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7
Q

sodium channel inhibitors (antiepileptics)

A

phenytoin
carbamezepine
lamotrigine
lacosamide

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8
Q

Ca channel inhibitors (antiepileptics)

A

ethosuxamide, valproic acid (inhib T-type Ca channel)

gabapentin, pregabalin (inhib HVA Ca channel)

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9
Q

GABA channel potentiators (antiepileptics)

A

Benzos (diazepam, lorazepam, midazolam, clonazepam) [increase amount of Cl influx]
barbiturates (phenobarbital) [increase duration of Cl influx]
vigabatrin (irrev inhibit GABA transaminase)

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10
Q

glutamate recept inhibitors (antiepileptics)

A

felbamate

rufinamide

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11
Q

other antiepileptic drugs under investigation

A

tiagabine
topiramate
levetiracetam
zonisamide

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12
Q

drug of choice for focal seizures

A

carbamazepine

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13
Q

drug of choice for idiopathic generalized seizures (and mixed seizures)

A

valproic acid

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14
Q

drugs of choice for absence seizures

A

ethosuxamide > valproic acid > lamotrigine > clonazepam

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15
Q

glucocorticoid receptor AGONISTS

A

prednisone (preggos), prednisolone, methylprednisolone, dexamethasone (fetal), hydrocortisone (replacement therapy)
fluticasone, beclomethasone, flunisolide, triamcinolone, budesonide [inhaled]

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16
Q

GC recept ANTAGONISTS

A

mifepristone (for ectopic ACTH synd)

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17
Q

Inhibitors of GC synthesis

A 
mitotane (DDT)
aminoglutethimide
metyrapone (dx of hypo-pit-adrenal axis)
trilostane
ketoconazole (inhib P450 enzymes)
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18
Q

Minerocorticoid receptor AGONISTS

A

fludrocortisone

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19
Q

MC recept ANTAGONISTS

A

spironolactone

eplerenone

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20
Q

Adrenal sex steroid

A

Dehydroepiandrosterone (DHEA)

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21
Q

inhibitor of fungal nucleic acid synthesis

A

flucytosine

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22
Q

inhibitor of fungal MITOSIS

A

griseofulvin

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23
Q

inhibitors of squalene epoxidase

A

terbafine, naftinfine (allylamines)

butenafine (benzylamines)

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24
Q

inhibitors of 14-alpha sterol demethylase

A

Imidazoles:
ketoconazole
butoconazole, clotrimazole, econazole, miconazole, oxiconazole, sertaconazole, sulconazole [topical]

Triazoles:
fluconazole, itraconazole (inhibit P450)
posaconazole, terconazole, voriconazole

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25
Q

inhibitors of fungal membrane stability: polyenes

A

amophotericin B

nystatin

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26
Q

inhibitors of fungal wall synthesis: echinocandins

A

caspofungin, micafungin, anidulafungin

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27
Q

tx of acute cryptococcal meningitis in HIV-positive patient

A

flucytosine + amphotericin B

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28
Q

tx of fungal inf of hair, skin, nails

A

griseofulvin

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29
Q

drug of choice for tx of candidiasis and cryptococcal meningitis

A

fluconazole

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30
Q

drug of choice for tx of invasive aspergillosis

A

voriconazole

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31
Q

only triazole whose absorption NOT affected by gastric acid

A

fluconazole

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32
Q

drug of choice for vulvovaginal candidiasis

A

terconazole

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33
Q

prophylaxis tx of invasive fungal infection

A

posaconazole

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34
Q

tx of mucocutaneous candidiasis

A

nystatin

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35
Q

tx of esophageal candidiasis

A

caspofungin, (micafungin, anidulafungin)

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36
Q

inhib of viral attachment/entry (and mechanism)

A

maraviroc (only blocks CCR5, not CXCR4)

enfuvirtide (T-20) [inhib gp41-med fusion by binding HR1]

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37
Q

inhibitors of viral uncoating

A

block M2 channel proton
amantidine (also for Parkinson’s)
rimantidine

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38
Q

Antiherpesvirus nucleoside and nucleotide analogues (plus dz/tox if applicable)

A

phosphorylated by viral kinases:
acyclovir, valacylovir (HSV, VZV)
pencicyclovir, famcicyclovir (HSV, VZV - shingles)
ganciclovir, valganciclovir (CMV) (neutropenia)

phosphorylated by cellular kinase:
cidofovir - must be coadmin w/ probenicid (CMV retinitis in those w/ HIV) (NEPHROtox)

vidarabine, idoxuridine, trifluridine (HSV keratitis)

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39
Q

anti-HIV and -HBV nucleoside/nucleotide analogues/SE

A 
zidovudine (AZT)
stavudine (d4T)
zalcitabine (ddC)
Lamivudine (3TC) - [HBV]
emtricitabine (FTC) - 1x daily
didanosine (ddl)
Abacivir
^^all these ass. w/ neutropenia, anemia

tenofovir (HIV) (hepatotoxicity)
adefovir (HBV) (renal toxicity)
entecavir (HBV) (dose adjust in pts w/ mod renal insuff)

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40
Q

nonnucleoside DNA polymerase inhibitors/SE

A

foscarnet (renal impairment = dose-limiting)

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41
Q

NNRTIs/SE

A

efavirenz (1x daily), nevirapine, delavirdine, etravirine [rash!!]

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42
Q

inhib of viral integration - inhib HIV INTEGRASE!

A

raltegravir

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43
Q

inhib of viral integration - inhib HIV PROTEASE!/SE

A

saquinavir, ritonavir, amprenavir, fosamprenavir, indinavir, nelfinavir, lopinavir, atazanavir, tipranavir, darunavir
SE = fat distrib and metabolic abnormalities

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44
Q

inhibitors of viral release

A

inhib neuraminidase!! - Flu A, B
zanamivir
oseltamivir (prophylaxis/tx)

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45
Q

antiviral drugs w/ UNKNOWN mech of action (+ dz)

A

fomivirsen (2nd line CMV retinitis)
Ribavirin (RSV, HCV w/ IFN-alpha)
docosanol (HSV) - lacks cytotoxicity

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46
Q

antiviral drugs that modulate immune system

A

IFN-alpha
IFN-beta (tx of MS)
Imiquimod (w/ TLR-7 + 8 to boost innate immunity)

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47
Q

alpha1 receptor functions

A

Gq
increase vasc SM contraction (vasoconstriction) –> increases systolic/diastolic BP –> reflex bradycardia (DECREASED HR)
increase pupillary dilator muscle contraction (mydriasis - dilation)
increase intestinal and bladder sphincter muscle contraction

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48
Q

alpha2 receptor functions

A 
Gi
decrease sympathetic outflow (inhib NE release)
decrease insulin release
decrease lipolysis
increase platelet aggregation
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49
Q

beta1 receptor functions

A 
Gs
increase heart rate
increase contractility and conductance
increase renin release
increase lipolysis
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50
Q

beta2 receptor functions

A 
Gs
vasodilation (decrease diastolic BP)
bronchodilation
increase HR
increase contractility
increase lipolysis
increase insulin release
decrease uterine tone (tocolysis)
ciliary muscle relaxation
increase aqueous humor production
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51
Q

M1 receptor functions

A

Gq

CNS, enteric NS

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52
Q

M2 receptor functions

A

Gi

decrease HR and contractility of atria at SA node (bradycardia)

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53
Q

M3 receptor functions

A

Gq
increase exocrine gland secretions (lacrimal, gastric gland, bronchial secretions, etc.)
increase gut peristalsis
increase bladder contraction
bronchoconstriction (increase airflow resistance)
increase pupillary sphincter muscle contraction (miosis)
ciliary muscle contraction (accomodation)

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54
Q

D1 receptor functions

A

Gs

relaxes renal vasc SM

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55
Q

D2 receptor functions

A

Gi

modulates transmitter release (esp in brain)

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56
Q

H1 receptor functions

A 
Gq
increase nasal and bronchial mucus prod (allergy symptoms)
contraction of bronchioles
pruritus
pain
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57
Q

H2 receptor functions

A

Gs

increase gastric acid secretion

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58
Q

V1 receptor functions

A

Gq

increase vasc SM contraction

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59
Q

V2 receptor functions

A

Gs

increase water permeability and reabsorption in collecting tubules of kidney

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60
Q

CCB used on vasc SM

A

amlodipine, nifedipine

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61
Q

first line therapy for HTN in preg

A

hydralazine w/ methyldopa

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62
Q

can cause cyanide toxicity (releases cyanide)

A

nitroprusside

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63
Q

drugs of choice in pts w/ CAD and CHF w/ HTN

A

cardioselective beta blockers

A BEAM of beta-1 blockers

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64
Q

DOC in pts w/ isolated systolic HTN

A

CCB + thiazide diuretics (in non-diabetics)

ACE inhib or ARB (diabetics)

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65
Q

CCB used on heart

A

verapamil

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66
Q

partial beta agonists contraindicated in angina

A

pindolol, acebutolol

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67
Q

decrease GI absorption of statins

A

bile acid resins (cholestyramine, colestipol, colesevelam)

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68
Q

class IA antiarrhythmics

A

quinidine, procainamide, disopyramide
increases AP duration, ERP, QT interval

“the Queen Proclaims Diso’s Pyramid”

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69
Q

class IB antiarrhythmics

A

lidocaine, mexiletine, tocainide; (phenytoin can also fall into this class)
decreases AP duration
BEST POST-MI!! + in digitalis-induced arrhythmias

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70
Q

class IC antiarrhythmics

A

flecainide, propaferone
no change in AP duration
last-ditch drug

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71
Q

class II antiarrhythmics

A

metoprolol, propanolol, esmolol, atenolol, timolol

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72
Q

class III antiarrhythmics

A

amiodarone, ibutilde, dofetilide, sotalol

“AIDS”

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73
Q

class IV antiarrhythmics

A

verapamil, diltiazem

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74
Q

“other” antiarrhythmics

A

adenosine, Mg

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75
Q

does not presdisp to Torsades de Pointes even though prolongs QT interval

A

amiodarone (half life > 80 days)

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76
Q

DOC in dx/abolishing paroxysmal SVT

A

adenosine

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77
Q

effects blocked by theophylline and caffeine

A

adenosine

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78
Q

DM tx: no risk of hypoglycemia

A

metformin, pioglitazone, rosiglitazone, acarbose, miglitol, voglibose

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79
Q

sulfa drugs

A 
probenecid
furosemide
acetazolamide
celecoxib
thiazides
sulfonamide AB
sulfasalazine
sulfonylureas

“Sulfa Pills Frequently Cause Terrible Acute Symptoms”

pts w/ sulfa allergies –> fever, UTI, pruritic rash, Stevens-Johnson synd, hemolytic anemia, thrombocytopenia, agranulocytosis, urticaria (hives)

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80
Q

DOC for malignant hyperthermia that may be caused by use of halogenated anesthetics

A

dantrolene

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81
Q

DOC for Pneumocystis jirovecii, Toxoplasma gondii, Nocardia, Stenotrophomonas meltophilia

A

TMP-SMX

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82
Q

Vd =

A

amount of drug in body/plasma drug concentration

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83
Q

half life =

A

0.7 x Vd / CL

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84
Q

loading dose =

A

Css x Vd/F (F=1 for IV dose)

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85
Q

maintenance dose =

A

Css x CL/F

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86
Q

reduces pain by decreasing levels of substance P in PNS

A

capsaicin

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87
Q

DOC for type II DM

A

metformin

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88
Q

P450 inducers

A

Momma Bear Steals Phen-phen and Refuses Greasy Carbs Chronically

modafinil
barbiturates
St.John's wort
phenytoin
rifampin
griseofulvin
carbamezapine
chronic alcohol use
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89
Q

P450 inhibitors

A

MAGIC RACKS in GQ

macrolides
amiodarone
grapefruit juice
isoniazid
cimetidine
ritonavir
acute alcohol abuse
ciprofloxacin
ketoconazole
sulfonamides
gemfibrozil
quinidine
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90
Q

AB to avoid in preg

A 
Sulfonamides - Kernicterus
Aminoglycosides - otoxicity
Fluoroquinolones - cartilage damage
Clarithromycin - embryotoxic
Tetracyclines - discolored teeth, inhibition of bone growth
Ribavirin (antiviral) - teratogenic
Griseofulvin (antifungal) - teratogenic
Chloramphenicol - "gray baby"

“SAFe Children Take Really Good Care”

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91
Q

DOC for DVT and pulmonary thromboembolism

A

warfarin

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92
Q

DOC for Legionella

A

erythromycin

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93
Q

DOC for Treponema

A

penicillin

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94
Q

DOC for Mycoplasma

A

erythromycin or tetracyclines

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95
Q

drug infused at constant rate achieves steady state in?

A

4-5 half-lives

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96
Q

DOC for hairy cell leukemia

A

cladribine (adenosine analog that is resistant to adenosine deaminase)

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97
Q

best agent to increase HDL levels?

A

niacin

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98
Q

best tx for high LDL

A

statins + ezetimibe

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99
Q

best agent for hypertriglyceridemia

A

fibrates

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100
Q

SE = increases TG levels

A

cholestyramine, colestipol, colesevelam

bile acid resins

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101
Q

MOA of cromolyn

A

prevents mast cell degranulation

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102
Q

cromolyn used for?

A

PROPHYLAXIS of asthma, allergies, aspirin HST

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103
Q

anti-TB drug most effective in acidic environments + most useful against INTRAcellular organisms

A

pyrazinamide

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104
Q

pyrazinamide most effective against?

A

M.tuberculosis engulfed by macrophages

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105
Q

what is needed to convert INH to active metabolite?

A

KatG (bacterial catalase-peroxidase)

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106
Q

solo prophylaxis against TB?

A

INH

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107
Q

meningococcal prophylaxis and chemoprophylaxis in contacts of children w/ H.influenzae type B?

A

rifampin

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108
Q

toxicity = blurry yellow vision (think Van Gogh)

A

digoxin

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109
Q

thiazide diuretics cause what SE?

A
  • hypokalemic metab alkalosis (bc increased aldost secretion)
  • hyponatremia, hypomagenesemia
  • sulfa allergy
hypergGlycemia
hyperLipidemia
hypercCalcemia
hyperUricemia
("Hyper Girls Like Crushing Uppers")
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110
Q

mannitol (osmotic diuretic) can cause what SE?

A

hypernatremia, pulmonary edema

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111
Q

mannitol is CI in pts w/ what?

A

anuria, CHF

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112
Q

carbidopa decreases what SE of L-dopa?

A

nausea, vomiting

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113
Q

carbidopa increases what SE of L-dopa?

A

anxiety, agitation, insomnia, confusion, delusions, hallucinations

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114
Q

leucovorin is a?

A

tetrahydrofolate derivative that does NOT req activation by dihydrofolate before it can function as cofactor for thymidylate synthase

N5-formyl-tetrahydrofolate

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115
Q

drug whose chemo effects overcome by leucovorin

A

methotrexate

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116
Q

drug whose chemo effects potentiated by leucovorin

A

5-FU

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117
Q

bortezomib MOA and indications?

A

proteasome inhibitor

tx for multiple myeloma and Waldenstrom’s macroglobulinemia

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118
Q

tx for mod-severe allergic asthma?

A

omalizumab (anti-IgE Ab)

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119
Q

this drug has increased toxicity w/ allopurinol

A

azathioprine (6-MP, 6-TG)

bc both metab by xanthine oxidase

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120
Q

antimetabolite not S-phase specific

A

gemcitabine (pyramidine analog)

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121
Q

methotrexate inhibits

A

dihydrofolate reductase

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122
Q

5-FU complexes w/ ________ that inhibits _______?

A

w/ folic acid (THF)

inhibits thymidylate synthase

123
Q

5-FU overdose rescue =

A

thymidine

124
Q

malignant hyperthermia a SE of what drugs?

A 
inhalation anesthetics (except N2O)
succinylcholine
125
Q

chronotropic effects

A

increase RATE of contraction (HR)

126
Q

inotropic effects

A

increase FORCE of contraction

127
Q

inhibits dihydropteroate SYNTHASE

A

sulfonamides

128
Q

inhibits dihydrofolate REDUCTASE

A

trimethoprim, pyrimethamine, methotrexate

129
Q

tx for mild UTI that is safe in pregnancy?

A

nitrofurantoin (p.267 DIT)

130
Q

most common medication used for UTI prophylaxis

A

TMP-SMX

131
Q

cisplatin toxicity/prophylactic tx used to reduce toxicity?

A

nephrotoxicity;

amifostine or chloride diuresis (bc cisplatin stays in nonreactive state when in higher chloride concentration)

132
Q

1st line therapy in trigeminal neuralgia?

A

carbamazepine

133
Q

1st line tx for acute gouty arthritis?

A

NSAIDs

also Glucocorticoids in pts for whom NSAIDs are CI (ex. elderly pts w/ renal failure)

134
Q

uricosuric drugs + xanthine oxidae inhibitors (allopurinol) used for?

A

PROPHYLACTIC therapy for prevention of acute gouty attacks (used in pts w/ more than 3 episodes of acute gouty arthritis and those w/ macroscopic tophi)

135
Q

why can’t allopurinol be used in acute gouty attacks?

A

can exacerbate acute arthritis!

136
Q

antiarrhyhtmics that can cause Torsades de Pointes

A 
quinidine
procainamide
disopyramide
ibutilide
dofetilide
sotalol
137
Q

drugs that prolong PR interval

A

verapamil

metoprolol

138
Q

drugs that act on microtubules

A 
vincristine/vinblastine
griseofulvin
mebendazole/albendazole/thiabendazole
paclitaxel/docetaxel
colchicine
139
Q

DOC in cluster HA

A

inhaled 100% oxygen

140
Q

competitive inhib do what to potency/efficacy?

A

DECREASE potency (increase Km)

141
Q

noncompetitive inhib do what to potency/efficacy?

A

DECREASE efficacy (decrease Vmax)

142
Q

the lower the Km

A

the higher the potency

143
Q

the higher the Vmax

A

the higher the efficacy

144
Q

high efficacy drugs classes?

A

analgesic
antibiotics
antihistamines
decongestants

145
Q

highly potent drug classes?

A

chemotherapeutic
antiHTN
antilipid

146
Q

drug w/ low therapeutic index

A

digoxin
lithium
theophylline
warfarin

147
Q

phase I drug metabolism?

A

reduction
oxidation
hydrolysis

can result in still active metabolite (can be more toxic)
uses CYP450!!

148
Q

phase II drug metabolism?

A

conjugation: glucuronidation, acetylation, sulfation)

renally excreted

149
Q

tx of OD of beta-blockers in arrhythmias

A

glucagon

150
Q

1st gen cephalosporins

A

cefazolin
cephalexin

“PEcK”

151
Q

2nd gen cephalosporins

A

cefoxitin
cefaclor
cefprozil
cefuroxime

“HENS PEcK”

152
Q

3rd gen cephalosporins

A

ceftriaxone
cefotaxime
cefdinir
ceftazidime

153
Q

4th gen cephalosporins

A

cefapime

154
Q

ceftriaxone treats what?

A

meningitis and gonorrhea

excreted in bile and long acting

155
Q

ceftazidime treats what?

A

Pseudomonas

156
Q

3rd gen cephalosporins cover what?

A

serious gram neg bacteria

also S.pneumo!!

157
Q

cefepime treats what?

A

Pseudomonas and gram +

158
Q

aztreonam binds to?

A

PBP3

159
Q

drug that inhibits ribonucleotide reductase

A

hydroxyurea

160
Q

drug that inhibits dihydrofolate reductase

A

trimethoprim

methotrexate

161
Q

drug that inhibits thymidylate synthase

A

5-FU

162
Q

drug that inhibits IMP dehydrogenase

A

mycophenolate

163
Q

drug that inhibits PRPP amidotransferase

A

6-MP

164
Q

drug aiding in dx of Prinzmetal’s variant angina

A

ergonovine

165
Q

low potency typical antipsychs

A

chlorpromazine

thioridazine

166
Q

high potency typical antipsychs

A

trifluperazine
fluphenazine
haloperidol

167
Q

drugs used to tx Tourette’s synd

A

fluphenazine, pimozide (high potency antipsychs)

tetrabenazine (help degrade dopamine)

168
Q

typical antipsychs block what receptor?

A

D2 receptors (which increases cAMP)

169
Q

clozapine acts on what receptors?

A

D4

170
Q

DOC for tx of psychosis induced by Parkinson meds

A

quietapine

171
Q

specific sympt of chlorpromazine

A

corneal deposits

172
Q

specific sympt of thioridazine

A

retinal deposits

173
Q

lithium MOA?

A

inhib IP3 (phosphoinositol cascade)

174
Q

buspirone facts?

A

stim 5-HT1A receptors
no addiction, tolerance or sedation!
no interaction w/ alcohol
takes 1-2 wks to take effect

175
Q

SSRIs

A

fluoxetine
paroxetine
sertraline
citalopram

176
Q

SNRIs

A

venlafaxine

duloxetine (greater effect on NE)

177
Q

SNRI MOA

A

inhib serotonin and NE reuptake

178
Q

tx for fibromyalgia?

A

milnacipran or amitriptyline

179
Q

can tx diabetic periph neuropathy

A

duloxetine

180
Q

indication for imipramine

A

bedwetting

181
Q

indication for clomipramine

A

OCD

182
Q

which TCA has most anticholinergic SE?

A

3rd gen (amitriptyline)

use nortryptilline in elderly to decrease confusion, hallucination SE

183
Q

which TCA is less sedating; but increases ________?

A

desipramine

increases seizure threshold

184
Q

TCA MOA

A

block reuptake of NE and serotonin

185
Q

TCAs

A

amitriptyine, nortriptyline
imipramine, desipramine, clomipramine
doxepin
amoxapine

186
Q

MAOIs

A

tranylcypromine
phenelzine
isocarboxazid
selegiline

187
Q

selegiline inhibits what selectively?

A

MAO-B - used for dopamine (Parkinson’s)

188
Q

MAOI MOA/use

A

increased levels of NE, serotonin and dopamine by inhibiting MAO

can be used to tx atypical depression

189
Q

ingestion of tyramine w/ MAOIs causes?

A

Hypertensive crisis

190
Q

bupropion MOA + benefit

A

inhib NE and dopamine reuptake w/ greater effect on dopamine

no sexual SE!

191
Q

mirtazapine MOA

A

alpha2-antag (increases release of NE and serotonin)

also potent 5-HT2 and 5-HT3 recept antag

192
Q

trazodone MOA/use/SE

A

inhibit serotonin reuptake
used primarily for insomnia
SE = priapism

193
Q

demeclocycline is used in

A

SIADH bc ADH antagonist

194
Q

Na-channel binding strength for Class I antiarrhythmics

A

IC > IA > IB

IC = increased incidence of use dependence

195
Q

class II antiarrhythmics MOA

A

decrease cAMP, Ca
decreases slope of phase 4 (slows HR)
increases PR interval

196
Q

metoprolol can cause what SE

A

dyslipidemia

197
Q

class II antiarrhythmics OD tx

A

glucagon

198
Q

beta-blocker that can exacerbate prinzmetal’s angina

A

propanolol

199
Q

used in tx of WPW

A

procainamide

amiodarone

200
Q

class III antiarrhythmics MOA

A

increases AP, ERP, QT interval

works on phase 3!!

201
Q

class I antiarrhythmics MOA (as a class!)

A

decreases slope of phase 0

202
Q

class IV antiarrhythmics MOA

A

decrease depolarization of latter part of phase IV
decreases depolarization of phase 0 –> increases ERP
decreases SA/AV nodal activity
increases PR

203
Q

class IV antiarrhythmics CI in

A

pts w/ HF exacerbation

204
Q

adenosine MOA

A

increases K+ out of cells –> hyperpolarization
decreases Ca
prolong PR interval

205
Q

adenosine effects blocked by

A

theophylline (pts w/ COPD/asthma)

caffeine

206
Q

drug CI in closed-angle glaucoma

A

epinephrine

207
Q

baclofen MOA

A

GABAb agonist

208
Q

H1 blockers - 1st gen

A

can cross BBB - sedation!

diphenydramine, dimenhydrinate, chlorpheniramine

209
Q

H1 blockers - 2nd gen

A

can’t cross BBB

loratadine, fexofenadine, desloratadine, cetirizine

210
Q

beta-2 agonists for prophylaxis of asthma

A

salmeterol

formoterol

211
Q

theophylline characteristics

A

inhib PDE –> decreases cAMP hydrolysis –> brochodil
narrow therapeutic index: cardiotox, neurotox (seizures)
blocks action of adenosine
tx OD w/ beta-blockers

212
Q

inhaled GC effects/use

A

inhib synth of cytokines (by inhib phospholipase A2)
inactivate NF-KB –> decreased TNF-alpha prod (bc it’s the TF that activates this cytokine)
1st line for CHRONIC asthma

213
Q

montelukast, zafirlukast MOA/use

A

block leukotriene recept (D4 recept antagonists)
aspirin-induced asthma!!
also chronic asthma prophylaxis

214
Q

zileuton MOA/use

A

5-LOX inhib (no leukotriene synth)

chronic asthma prophylaxis

215
Q

omalizumab MOA/use

A

Monoclonal anti-IgE Ab

used in allergic asthma resistant to other tx

216
Q

N-acetylcysteine in asthma/CF use:

A

mucolytic by cleaving disulfide bonds in mucus glycoproteins

also prevents contrast-induced nephropathy

217
Q

how does dextromethorphan cause cough suppression

A

antag NMDA glutamate receptors

218
Q

bosentan MOA/use

A

for pulmonary arterial HTN

competitively antag endothelin-1-receptors

219
Q

pseudoephedrine, phenylephrine resp uses

A

constrict dilated arterioles in nasal mucosa (via alpha-agonist properties) –> reduce nasal congestion
open obstructed Eustachian tubes
pseudoephedrine –> also a stimulant

220
Q

pseudoephedrine, phenylephrine resp SE

A

HTN, rebound nasal congestion if taken long term (all)
CNS stim/anxiety (pseudoephedrine)
tachyphylaxis - due to decreased NE from neg feedback causing vasodil + congestion (phenylephrine)

221
Q

acetazolamide used in glaucoma by

A

blocking bicarb formation –> decreases formation of aqueous humor

222
Q

acetazolamide SE

A

hyperchloremic metab acidosis, sulfa allergy, paresthesias

223
Q

loop diuretics SE

A 
Ototox
Hypokalemia/hypocalcemia
Dehydration
Allergy (sulfa)
Nephritis (acute)
Gout

“OH DANG!”

224
Q

2 classes of diuretics causing ACIDEMIA

A
  • acetazolamide

- K+-sparing (hyperkalemia causing –> H/K exchange in plasma)

225
Q

2 classes of diuretics causing ALKALEMIA

A

loop and thiazides

  • vol contraction (bicarb reabsorb –> Cl- secreted)
  • K+ loss
  • low K+ states (H exchanged for Na, instead of K exchanged)
226
Q

increased aldosterone can have what effect on heart

A

cardiac remodeling –> can worsen LV dysfunct in HF pts

227
Q

ACE inhib 2 unique clinical applications

A

diabetic renal disease

used Post-MI + in CHF pts (to prevent unfav heart remodeling as a result of chronic HTN)

228
Q

ACE inhib SE

A 
"CATCHH"
Cough (dry!!)
Angioedema
Teratogen
Creatinine increase (bc of decreased GFR --> decreased FF)
Hyperkalemia
Hypotension
229
Q

methotrexate indications/SE

A 
cancers
ectopic preg
hydatidiform mole
RA
psoriasis

SE: myelosuppression (reversed w/ leucovorin), macrovesicular fatty change in liver, mucositis, teratogen

230
Q

cyclophosphamide MOA/SE

A

covalently X-link DNA @ guanine N-7
bioactivated by liver
SE - hemorrhagic cystitis prevented w/ mesna (thiol groups bind acrolein)

231
Q

used against brain tumors

A

nitrosureas (carmustine, other -mustines, streptozocin)

cross BBB –> CNS!!! (therefore, CNS toxicity also)

232
Q

busulfan

A

used in CML
used to ablate pt bone marrow before BMT

SE = pulm fibrosis, hyperpigmentation!

233
Q

vinca alkaloids bind?

A

beta-tubulin in M phase + block polymerization of microtubules

234
Q

vincristine SE

A

neurotox (periph neuritis)

235
Q

vinblastine SE

A

bone marrow suppression

“vinblastine BLASTS bone”

236
Q

paclitaxel MOA/indications

A

MOA - HYPERSTABILIZE polymerized microtubules –> can’t break down spindles
**ANAPHASE can’t occur

used for: ovarian/breast carcinomas

237
Q

cisplatin SE

A

nephrotox (acute tubular injury; prevent w/ amifostine)
acoustic nerve damage
Chloride diuresis

238
Q

etoposide, teniposide MOA

A

inhib topo II

239
Q

hydroxyurea MOA/use

A

inhib ribonucleotide reductase

used in melanoma, sickle cell

240
Q

irinotecan, topotecan MOA

A

inhib topo I

241
Q

trastuzumab aka …

A

herceptin
Mab against HER2 (c-erbB2)
SE = cardiotox

242
Q

bevacizumab

A

Mab against VEGF –> inhib angiogenesis

243
Q

vemurafenib

A

inhib B-raf kinase w/ V600E mut

for metastatic melanoma

244
Q

cimetidine SE

A

inhib CYP450
antiandrogenic effects
crosses BBB (confusion, dizziness, HA)
decreases renal excretion of creatinine (also seen w/ ranitidine)

245
Q

sucralfate req?

A

acidic environment to polymerize

246
Q

misoprostol indications

A 
NSAID-induced PUD
maintains PDA
induces labor (ripens cervix)
247
Q

octreotide (somatostatin analog) indications

A

acute variceal bleeds
acromegaly
VIPoma
carcinoid tumors

248
Q

hypercalcemia can stim what?

A

G-cells to produce gastrin

249
Q

terbutaline

A

Beta2-agonist used to reduce premature uterine contractions

250
Q

tx HTN in pt w/ renal dz?

A

clonidine
methyldopa

these are alpha2-agonists

251
Q

give to pts on MAOIs who eat tyramine containing food

A

phentolamine

252
Q

vascular alpha receptors are mostly what type

A

1B

253
Q

tamsulosin blocks

A

alpha-1A, 1D receptors on prostate + does not reduce blood pressure as much

254
Q

beta agonists do what to BP?

A

DECREASE (bc of beta2 effect)

255
Q

drug class used cautiously in diabetics

A

beta-blockers (can mask hypoglycemia); use beta1-blockers instead!

256
Q

beta-blockers effects:

A

1) decrease O2 consumpt (by decreasing HR, contractility)
2) reduce mortality in MI
3) decrease AV conduction (metoprolol, esmolol)
4) decrease CO
5) decrease renin secretion
6) slow progression of HF in CHF (but make sure not to decrease HR too much!!)
7) decrease aqueous humor secretion (timolol)

257
Q

tx for pts w/ HTN and bradycardia

A

partial beta blockers!

pindolol, acebutolol

258
Q

non-selective beta blockers w/ alpha1-blocking ability too:

A

labetalol

carvedilol

259
Q

hydroxychloroquine

A

tx for SLE

SE = permanent retinal damage, myopathies

260
Q

direct cholinergic agonists

A

bethanechol
carbachol
pilocarpine
methacholine

261
Q

AChE inhibitors

A 
neostigmine
physostigmine
pyridostigmine
donepezil
edrophonium
echothiophate
diisopropyl flurophosphate
262
Q

stim alpha1, 2 + beta1, 2

A

epinephrine

263
Q

stim alpha1, 2 + SOME beta1

A

epinephrine

264
Q

beta agonist (beta1 = beta2)

A

isoproterenol

265
Q

beta1-agonist

A

dobutamine

266
Q

alpha-agonist (alpha1 > alpha2)

A

phenylephrine

267
Q

beta2-agonist for premature contractions

A

ritodrine

268
Q

ephedrine MOA

A

releases stored catechol

-used for nasal decongest, urinary incontinence

269
Q

alpha2-agonists

A

clonidine

methyldopa

270
Q

alpha-blockers

A

phenoxybenzamine

phentolamine

271
Q

alpha2-blocker

A

mirtazapine

272
Q

tx of opioid withdrawal

A

methadone, buprenorphine
suboxone (a combo of naloxone + buprenorphine; harder to abuse)
neonatal opioid withdrawal - diluted tincture of opium solution

273
Q

tx cocaine OD

A

benzos
haloperidol
NEVER BETA BLOCKERS!!

274
Q

tx nicotine withdrawal (meds)

A

bupropion

varenicline

275
Q

tx for PCP, LSD

A

benzos

276
Q

tx for heroin addiction

A

methadone (long-acting oral opiate)

naloxone + buprenorphine = partial agonist; oral naloxone not easily abused

277
Q

tx for delirium tremens w/ alcohol withdrawal

A

long-acting benzos preferred (unless pt has liver disease –> use short-acting benzos)

278
Q

tx for anxiety

A

SSRI, SNRI, buspirone

279
Q

tx for ADHD

A

methylphenidate, amphetamines

280
Q

tx for bipolar disorder

A

Lithium
valproic acid, carbamazepine
atypical antipsych

281
Q

tx for bulimia

A

SSRIs (fluoxetine esp)

282
Q

tx for depression

A

SSRI, SNRI, TCA, buspirone

mirtazapine (esp w/ insomnia)

283
Q

tx for OCD

A

SSRI, clomipramine

284
Q

tx for panic disorder

A

SSRI, venlafaxine, benzos

285
Q

tx for PTSD

A

SSRI

286
Q

tx for schizophrenia

A

antipsych

287
Q

tx for social phobias

A

SSRIs

288
Q

tx for Tourette’s synd

A

antipsych

289
Q

tx for drug-induced Parkinsonism

A

benztropine

trihexyphenidyl

290
Q

ziprasidone SE

A

prolong QT interval

291
Q

lithium excretion

A

exclusively by kidney; most reabsorbed @ PCT following Na reabsorption

292
Q

cyclosporine SE

A

nephrotox (by vasoconstriction of aff + eff arterioles), HTN, hyperlipidemia, hyperglycemia

293
Q

drug used in lupus nephritis

A

azathioprine

294
Q

alemtuzumab

A

anti-CD52 humanized Mab for tx of CLL

295
Q

beta2 > beta1 agonist

A

terbutaline

296
Q

probenecid actions

A

inhib reabsorpt of uric acid @ PCT

inhib secretion of penicillin

297
Q

TZD w/ increased risk of bladder cancer

A

pioglitazone

298
Q

adiponectin does what?

A

is released by activation of PPAR-gamma (site of action of TZDs)
decreases insulin resistance

299
Q

TZDs metabolized where?

A

liver

300
Q

sitagliptan use req monitoring of what drug?

A

digoxin

301
Q

drugs w/ anticholinergic properties

A

-ANTIHISTAMINES (H1 BLOCKERS)
chlorpheniramine, cyproheptadine, diphenhydramine, hydroxyzine

-ANTIDEPRESSANTS
amoxapine, amitriptyline, clomipramine, desipramine,
doxepin, nortriptyline, paroxetine, imipramine, protriptyline

-CARDIOVASCULAR MEDICATIONS
furosemide, digoxin, nifedipine, disopyramide

-Antidiarrheal Medications
diphenoxylate, atropine

-Antispasmodic Medications
belladonna, clidinium, chlordiazepoxide, dicyclomine, hyoscyamine, propantheline

-Antiulcer Medications
cimetidine, ranitidine

-ANTIPARKINSON MEDICATIONS
amantadine, benztropine, biperiden, trihexyphenidyl

-MUSCLE RELAXANTS
cyclobenzaprine, dantrolene, orphenadrine

-ANTIVERTIGO MEDICATIONS
meclizine, scopolamine

-ANTIPSYCHOTIC MEDICATIONS
chlorpromazine, clozapine, olanzapine, thioridazine

-URINARY INCONTINENCE
oxybutynin, probantheline, solifenacin, tolterodine, trospium

-PHENOTHIAZINE ANTIEMETICS
prochlorperazine, promethazine

302
Q

DOC for myoclonic seizures

A

vaproic acid

303
Q

DOC for simple/complex partial seizures

A

carbamazepine

USMLE Step 1 Random Facts (35 decks)

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