Pharmacology Flashcards
1
Q
A common side effects of Interferon (INF) treatment is?
A
Neutropenia
2
Q
Antimicrobial prophylaxis for a history of recurrent UTIs
A
TMP-SMZ
3
Q
Antimicrobial prophylaxis for Gonorrhea
A
Ceftriaxone
4
Q
Antimicrobial prophylaxis for Meningococcal infection
A
Rifampin (DOC) — minocycline
5
Q
Antimicrobial prophylaxis for PCP
A
TMP-SMZ (DOC) — aerosolized pentamidine
6
Q
Antimicrobial prophylaxis for Syphilis
A
Benzathine penicillin G
7
Q
Are Aminoglycosides Teratogenic?
A
Yes
8
Q
Are Ampicillin and Amoxicillin penicillinase resistant?
A
No
9
Q
Are Carbenicillin — Piperacillin — and Ticarcillin penicillinase resistant?
A
No
10
Q
Are Cephalosporins resistant to penicillinase?
A
No — but they are less susceptible than the other Beta lactams
11
Q
Are Methicillin — Nafcillin — and Dicloxacillin penicillinase resistant?
A
Yes
12
Q
Clinical use of Isoniazid (INH)?
A
Mycobacterium tuberculosis — the only agent used as solo prophylaxis against TB
13
Q
Common side effects associated with Clindamycin include?
A
Pseudomembranous colitis (C. difficile) — fever — diarrhea
14
Q
Common toxicities associated with Fluoroquinolones?
A
GI upset — Superinfections — Skin rashes — Headache — Dizziness
15
Q
Common toxicities associated with Griseofulvin?
A
Teratogenic — Carcinogenic — Confusion — Headaches
16
Q
Describe the MOA of Interferons (INF)
A
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
17
Q
Do Tetracyclines penetrate the CNS?
A
Only in limited amounts
18
Q
Does Ampicillin or Amoxicillin have a greater oral bioavailability?
A
AmOxicillin has greater Oral bioavailability
19
Q
Does Amprotericin B cross the BBB?
A
No
20
Q
Does Foscarnet require activation by a viral kinase?
A
No
21
Q
Foscarnet toxicity?
A
Nephrotoxicity
22
Q
Ganciclovir associated toxicities?
A
Leukopenia — Neutropenia — Thrombocytopenia — Renal toxicity
23
Q
How are Interferons (INF) used clinically?
A
Chronic Hepatitis A and B — Kaposi’s Sarcoma
24
Q
How are Sulfonamides employed clinically?
A
Gram + — Gram - — Norcardia — Chlamydia
25
How are the HIV drugs used clinically?
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
26
How are the Latent Hypnozoite (Liver) forms of Malaria (P. vivax --- P.ovale) treated?
Primaquine
27
How can Isoniazid (INH)-induced neurotoxicity be prevented?
Pyridoxine (B6) administration
28
How can the t1/2 of INH be altered?
Fast vs. Slow Acetylators
29
How can the toxic effects of TMP be ameliorated?
With supplemental Folic Acid
30
How can Vancomycin-induced 'Red Man Syndrome' be prevented?
Pretreat with antihistamines and a slow infusion rate
31
How do Sulfonamides act on bacteria?
As PABA antimetabolites that inhibit Dihydropteroate Synthase --- Bacteriostatic
32
How do the Protease Inhibitors work?
Inhibt Assembly of new virus by Blocking Protease Enzyme
33
How does Ganciclovir's toxicity relate to that of Acyclovir?
Ganciclovir is more toxic to host enzymes
34
How does resistance to Vancomycin occur?
With an amino acid change of D-ala D-ala to D-ala D-lac
35
How is Acyclovir used clinically?
HSV --- VZV --- EBV --- Mucocutaneous and Genital Herpes Lesions --- Prophylaxis in Immunocompromised pts
36
How is Amantadine used clinically?
Prophylaxis for Influenza A --- Rubella; Parkinson's disease
37
How is Amphotericin B administered for fungal meningitis?
Intrathecally
38
How is Amphotericin B used clinically?
Wide spectrum of systemic mycoses: Cryptococcus --- Blastomyces --- Coccidioides --- Aspergillus --- Histoplasma --- Candida --- Mucor
39
How is Chloramphenical used clinically?
Meningitis (H. influenza --- N. meningitidis --- S. pneumoniae) --- Conserative treatment due to toxicities
40
How is Foscarnet used clinically?
CMV Retinitis in IC pts when Ganciclovir fails
41
How is Ganciclovir activated?
Phosphorylation by a Viral Kinase
42
How is Ganciclovir used clinically?
CMV --- esp in Immunocompromised patients
43
How is Griseofulvin used clinically?
Oral treatment of superficial infections
44
How is Leishmaniasis treated?
Pentavalent Antimony
45
How is Ribavirin used clinically?
for RSV
46
How is Rifampin used clinically?
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone when used of Leprosy 3. Used in combination with other drugs
47
How is Trimethoprim used clinically?
Used in combination therapy with SMZ to sequentially block folate synthesis
48
How is Vancomycin used clinically?
For serious --- Gram + multidrug-resistant organisms
49
How would you treat African Trypanosomiasis (sleeping sickness)?
Suramin
50
In what population does Gray Baby Syndrome occur? Why?
Premature infants --- because they lack UDP-glucuronyl transferase
51
Is Aztreonam cross-allergenic with penicillins?
No
52
Is Aztreonam resistant to penicillinase?
Yes
53
Is Aztreonam usually toxic?
No
54
Is Imipenem resistant to penicillinase?
Yes
55
Is Penicillin penicillinase resistant?
No - duh
56
IV Penicillin
Penicillin-G
57
Mnemonic for Foscarnet?
Foscarnet = pyroFosphate analog
58
MOA for Penicillin (3 answers)?
1)Binds penicillin-binding proteins 2) Blocks transpeptidase cross- linking of cell wall 3) Activates autolytic enzymes
59
MOA: Bactericidal antibiotics
Penicillin --- Cephalosporins --- Vancomycin --- Aminoglycosides --- Fluoroquinolones --- Metronidazole
60
MOA: Block cell wall synthesis by inhib. Peptidoglycan cross-linking (7)
Penicillin --- Ampicillin --- Ticarcillin --- Pipercillin --- Imipenem --- Aztreonam --- Cephalosporins
61
MOA: Block DNA topoisomerases
Quinolones
62
MOA: Block mRNA synthesis
Rifampin
63
MOA: Block nucleotide synthesis
Sulfonamides --- Trimethoprim
64
MOA: Block peptidoglycan synthesis
Bacitracin --- Vancomycin
65
MOA: Block protein synthesis at 30s subunit
Aminoglycosides --- Tetracyclines
66
MOA: Block protein synthesis at 50s subunit
Chloramphenicol --- Erythromycin/macrolides --- Lincomycin --- Clindamycin --- Streptogramins (quinupristin --- dalfopristin)
67
MOA: Disrupt bacterial/fungal cell membranes
Polymyxins
68
MOA: Disrupt fungal cell membranes
Amphotericin B --- Nystatin --- Fluconazole/azoles
69
Name common Polymyxins
Polymyxin B --- Polymyxin E
70
Name several common Macrolides (3)
Erythromycin --- Azithromycin --- Clarithromycin
71
Name some common Sulfonamides (4)
Sulfamethoxazole (SMZ) --- Sulfisoxazole --- Triple sulfas --- Sulfadiazine
72
Name some common Tetracyclines (4)
Tetracycline --- Doxycycline --- Demeclocycline --- Minocycline
73
Name the common Aminoglycosides (5)
Gentamicin --- Neomycin --- Amikacin --- Tobramycin --- Streptomycin
74
Name the common Azoles
Fluconazole --- Ketoconazole --- Clotrimazole --- Miconazole --- Itraconazole
75
Name the common Fluoroquinolones (6)
Ciprofloxacin --- Norfloxacin --- Ofloxacin --- Grepafloxacin --- Enoxacin --- Nalidixic acid
76
Name the common Non-Nucleoside Reverse Transcriptase Inhibitors
Nevirapine --- Delavirdine
77
Name the common Nucleoside Reverse Transcriptase Inhibitors
Zidovudine (AZT) --- Didanosine (ddI) --- Zalcitabine (ddC) --- Stavudine (d4T) --- Lamivudine (3TC)
78
Name the Protease Inhibitors (4)
Saquinavir --- Ritonavir --- Indinavir --- Nelfinavir
79
Name two classes of drugs for HIV therapy
Protease Inhibitors and Reverse Transcriptase Inhibitors
80
Name two organisms Vancomycin is commonly used for?
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
81
Oral Penicillin
Penicillin-V
82
Resistance mechanisms for Aminoglycosides
Modification via Acetylation --- Adenylation --- or Phosphorylation
83
Resistance mechanisms for Cephalosporins/Penicillins
Beta-lactamase cleavage of Beta-lactam ring
84
Resistance mechanisms for Chloramphenicol
Modification via Acetylation
85
Resistance mechanisms for Macrolides
Methylation of rRNA near Erythromycin's ribosome binding site
86
Resistance mechanisms for Sulfonamides
Altered bacterial Dihydropteroate Synthetase --- Decreased uptake --- or Increased PABA synthesis
87
Resistance mechanisms for Tetracycline
Decreased uptake or Increased transport out of cell
88
Resistance mechanisms for Vancomycin
Terminal D-ala of cell wall replaced with D-lac; Decreased affinity
89
Side effects of Isoniazid (INH)?
Hemolysis (if G6PD deficient) --- Neurotoxicity --- Hepatotoxicity --- SLE-like syndrome
90
Specifically --- how does Foscarnet inhibit viral DNA pol?
Binds to the Pyrophosphate Binding Site of the enzyme
91
The MOA for Chloramphenicol is?
Inhibition of 50S peptidyl transferase --- Bacteriostatic
92
Toxic effects of TMP include?
Megaloblastic anemia --- Leukopenia --- Granulocytopenia
93
Toxic side effects of the Azoles?
Hormone synthesis inhibition (Gynecomastia) --- Liver dysfunction (Inhibits CYP450) --- Fever --- Chills
94
Toxicities associated with Acyclovir?
Delirium --- Tremor --- Nephrotoxicity
95
What additional side effects exist for Ampicillin?
Rash --- Pseudomembranous colitis
96
What antimicrobial class is Aztreonam syngergestic with?
Aminoglycosides
97
What are Amantadine-associated side effects?
Ataxia --- Dizziness --- Slurred speech
98
What are Aminoglycosides synergistic with?
Beta-lactam antibiotics
99
What are Aminoglycosides used for clinically?
Severe Gram - rod infections.
100
What are common serious side effects of Aminoglycosides and what are these associated with?
Nephrotoxicity (esp. with Cephalosporins) --- Ototoxicity (esp. with Loop Diuretics)
101
What are common side effects of Amphotericin B?
Fever/Chills --- Hypotension --- Nephrotoxicity --- Arrhythmias
102
What are common side effects of Protease Inhibitors?
GI intolerance (nausea --- diarrhea) --- Hyperglycemia --- Lipid abnormalities --- Thrombocytopenia (Indinavir)
103
What are common side effects of RT Inhibitors?
BM suppression (neutropenia --- anemia) --- Peripheral neuropathy
104
What are common toxic side effects of Sulfonamides? (5)
-Hypersensitivity reactions -Hemolysis -Nephrotoxicity (tubulointerstitial nephritis) -Kernicterus in infants Displace other drugs from albumin (e.g. --- warfarin)
105
What are common toxicities associated with Macrolides? (4)
GI discomfort --- Acute cholestatic hepatitis --- Eosinophilia --- Skin rashes
106
What are common toxicities associated with Tetracyclines?
GI distress --- Tooth discoloration and Inhibition of bone growth in children --- Fanconi's syndrome --- Photosensitivity
107
What are common toxicities related to Vancomycin therapy?
Well tolerated in general but occasionally --- Nephrotoxicity --- Ototoxicity --- Thrombophlebitis --- diffuse flushing='Red Man Syndrome'
108
What are Fluoroquinolones indicated for? (3)
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
109
What are major side effects of Methicillin --- Nafcillin --- and Dicloxacillin?
Hypersensitivity reactions
110
What are Methicillin --- Nafcillin --- and Dicloxacillin used for clinically?
Staphlococcus aureus
111
What are Polymyxins used for?
Resistant Gram - infections
112
What are the Anti-TB drugs?
Rifampin --- Ethambutol --- Streptomycin --- Pyrazinamide --- Isoniazid (INH)
113
What are the clinical indications for Azole therapy?
Systemic mycoses
114
What are the clinical uses for 1st Generation Cephalosporins?
Gram + cocci --- Proteus mirabilis --- E. coli --- Klebsiella pneumoniae (PEcK)
115
What are the clinical uses for 2nd Generation Cephalosporins?
Gram + cocci --- Haemophilus influenza --- Enterobacter aerogenes --- Neisseria species --- P. mirabilis --- E. coli --- K. pneumoniae --- Serratia marcescens ( HEN PEcKS )
116
What are the clinical uses for 3rd Generation Cephalosporins?
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
117
What are the clinical uses for Aztreonam?
Gram - rods: Klebsiella species --- Pseudomonas species --- Serratia species
118
What are the clinical uses for Imipenem/cilastatin?
Gram + cocci --- Gram - rods --- and Anerobes
119
What are the Macrolides used for clinically?
-Upper respiratory tract infections -pneumonias -STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) -Mycoplasma --- Legionella ---Chlamydia --- Neisseria
120
What are the major structural differences between Penicillin and Cephalosporin?
Cephalosporin: 1) has a 6 member ring attached to the Beta lactam instead of a 5 member ring 2)has an extra functional group ( attached to the 6 member ring)
121
What are the major toxic side effects of Imipenem/cilastatin?
GI distress --- Skin rash --- and Seizures at high plasma levels
122
What are the major toxic side effects of the Cephalosporins?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram-like reaction with ethanol (those with a methylthiotetrazole group --- e.g. --- cefamandole)
123
What are the side effects of Polymyxins?
Neurotoxicity --- Acute renal tubular necrosis
124
What are the side effects of Rifampin?
Minor hepatotoxicity --- Drug interactions (activates P450)
125
What are toxic side effects for Metronidazole?
Disulfiram-like reaction with EtOH --- Headache
126
What are toxicities associated with Chloramphenicol?
Aplastic anemia (dose independent) --- Gray Baby Syndrome
127
What conditions are treated with Metronidazole?
Giardiasis --- Amoebic dysentery (E. histolytica) --- Bacterial vaginitis (Gardnerella vaginalis) --- Trichomonas
128
What do Aminoglycosides require for uptake?
Oxygen
129
What do you treat Nematode/roundworm (pinworm --- whipworm) infections with?
Mebendazole/Thiabendazole --- Pyrantel Pamoate
130
What drug is given for Pneumocystis carinii prophylaxis?
Pentamidine
131
What drug is used during the pregnancy of an HIV+ mother? --- Why?
AZT --- to reduce risk of Fetal Transmission
132
What drug is used to treat Trematode/fluke (e.g. --- Schistosomes --- Paragonimus --- Clonorchis) or Cysticercosis
Praziquantel
133
What is a common drug interaction associated with Griseofulvin?
Increases coumadin metabolism
134
What is a mnemonic to remember Amantadine's function?
Blocks Influenza A and RubellA; causes problems with the cerebellA
135
What is a prerequisite for Acyclovir activation?
It must be Phosphorylated by Viral Thymidine Kinase
136
What is a Ribavirin toxicity?
Hemolytic anemia
137
What is an acronym to remember Anti-TB drugs?
RESPIre
138
What is an additional side effect of Methicillin?
Interstitial nephritis
139
What is an occasional side effect of Aztreonam?
GI upset
140
What is Clindamycin used for clinically?
Anaerobic infections (e.g. --- B. fragilis --- C. perfringens)
141
What is clinical use for Carbenicillin --- Piperacillin --- and Ticarcillin?
Pseudomonas species and Gram - rods
142
What is combination TMP-SMZ used to treat?
Recurrent UTIs --- Shigella --- Salmonella --- Pneumocystis carinii pneumonia
143
What is combined with Ampicillin --- Amoxicillin --- Carbenicillin --- Piperacillin --- and Ticarcillin to enhance their spectrum?
Clavulanic acid
144
What is Fluconazole specifically used for?
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
145
What is Imipenem always administered with?
Cilastatin
146
What is Ketoconazole specifically used for?
Blastomyces --- Coccidioides --- Histoplasma --- C. albicans; Hypercortisolism
147
What is Metronidazole combined with for 'triple therapy'? Against what organism?
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
148
What is Metronidazole used for clinically?
Antiprotozoal: Giardia --- Entamoeba --- Trichomonas --- Gardnerella vaginalis Anaerobes: Bacteroides --- Clostridium
149
What is Niclosamide used for?
Cestode/tapeworm (e.g. --- D. latum --- Taenia species Except Cysticercosis
150
What is Nifurtimox administered for?
Chagas' disease --- American Trypanosomiasis (Trypanosoma cruzi)
151
What is the chemical name for Ganciclovir?
DHPG (dihydroxy-2-propoxymethyl guanine)
152
What is the clinical use for Ampicillin and Amoxicillin?
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
153
What is the clinical use for Nystatin?
Topical and Oral --- for Oral Candidiasis (Thrush)
154
What is the clinical use for Penicillin?
Bactericidal for: Gram + rod and cocci --- Gram - cocci --- and Spirochetes
155
What is the major side effect for Ampicillin and Amoxicillin?
Hypersensitivity reactions
156
What is the major side effect for Carbenicillin --- Piperacillin --- and Ticarcillin?
Hypersensitivity reactions
157
What is the major toxic side effect of Penicillin?
Hypersensitivity reactions
158
What is the memory aid for subunit distribution of ribosomal inhibitors?
Buy AT 30 --- CELL at 50'
159
What is the memory key for Isoniazid (INH) toxicity?
INH: Injures Neurons and Hepatocytes
160
What is the memory key for Metronidazole's clinical uses?
GET on the Metro
161
What is the memory key for organisms treated with Tetracyclines?
VACUUM your Bed Room'
162
What is the memory key involving the '4 R's of Rifampin?'
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
163
What is the MOA for Acyclovir?
Inhibit viral DNA polymerase
164
What is the MOA for Amphotericin B?
Binds Ergosterol --- forms Membrane Pores that Disrupt Homeostatis
165
What is the MOA for Ampicillin and Amoxicillin?
Same as penicillin. Extended spectrum antibiotics
166
What is the MOA for Carbenicillin --- Piperacillin --- and Ticarcillin?
Same as penicillin. Extended spectrum antibiotics
167
What is the MOA for Clindamycin?
Blocks Peptide Bond formation at the 50S subunit --- Bacteriostatic
168
What is the MOA for Methicillin --- Nafcillin --- and Dicloxacillin?
Same as penicillin. Act as narrow spectrum antibiotics
169
What is the MOA for Metronidazole?
Forms toxic metabolites in the bacterial cell --- Bactericidal
170
What is the MOA for Nystatin?
Binds ergosterol --- Disrupts fungal membranes
171
What is the MOA for Rifampin?
Inhibits DNA dependent RNA polymerase
172
What is the MOA for the Aminoglycosides?
Inhibits formation of Initiation Complex --- causes misreading of mRNA --- Bactericidal
173
What is the MOA for the Azoles?
Inhibit Ergosterol synthesis
174
What is the MOA for the Cephalosporins?
Beta lactams - inhibit cell wall synthesis --- Bactericidal
175
What is the MOA for the Fluoroquinolones?
Inhibit DNA Gyrase (topoisomerase II) --- Bactericidal
176
What is the MOA for the Macrolides?
Blocks translocation --- binds to the 23S rRNA of the 50S subunit --- Bacteriostatic
177
What is the MOA for the Tetracyclines?
Binds 30S subunit and prevents attachment of aminoacyl-tRNA --- Bacteriostatic
178
What is the MOA for Trimethoprim (TMP)?
Inhibits bacterial Dihydrofolate Reductase --- Bacteriostatic
179
What is the MOA for Vancomycin?
Inhibits cell wall mucopeptide formation --- Bactericidal
180
What is the MOA of Amantadine?
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
181
What is the MOA of Aztreonam?
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
182
What is the MOA of Foscarnet?
Inhibits Viral DNA polymerase
183
What is the MOA of Ganciclovir?
Inhibits CMV DNA polymerase
184
What is the MOA of Griseofulvin?
Interferes with microtubule function --- disrupts mitosis --- inhibits growth
185
What is the MOA of Imipenem?
Acts as a wide spectrum carbapenem
186
What is the MOA of Isoniazid (INH)?
Decreases synthesis of Mycolic Acid
187
What is the MOA of Polymyxins?
Bind cell membrane --- disrupt osmotic properties --- Are Cationc --- Basic and act as detergents
188
What is the MOA of Ribavirin?
Inhibits IMP Dehydrogenase (competitively) --- and therefore blocks Guanine Nucleotide synthesis
189
What is the MOA of the RT Inhibitors?
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
190
What is the most common cause of Pt noncompliance with Macrolides?
GI discomfort
191
What is treated with Chloroquine --- Quinine --- Mefloquine?
Malaria (P. falciparum)
192
What microorganisms are Aminoglycosides ineffective against?
Anaerobes
193
What microorganisms are clinical indications for Tetracycline therapy?
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
194
What microorganisms is Aztreonam not effective against?
Gram + and Anerobes
195
What musculo-skeletal side effects in Adults are associated with Floroquinolones?
Tendonitis and Tendon rupture
196
What neurotransmitter does Amantadine affect? How does it influence this NT?
Dopamine; causes its release from intact nerve terminals
197
What organism is Imipenem/cilastatin the Drug of Choice for?
Enterobacter
198
What organisms does Griseofulvin target?
Dermatophytes (tinea --- ringworm)
199
What parasites are treated with Pyrantel Pamoate (more specific)?
Giant Roundworm (Ascaris) --- Hookworm (Necator/Ancylostoma) --- Pinworm (Enterobius)
200
What parasitic condition is treated with Ivermectin?
Onchocerciasis ('river blindness'--rIVER-mectin)
201
What populations are Floroquinolones contraindicated in? Why?
Pregnant women --- Children; because animal studies show Damage to Cartilage
202
What should not be taken with Tetracyclines? / Why?
Milk or Antacids --- because divalent cations inhibit Tetracycline absorption in the gut
203
What Sulfonamides are used for simple UTIs?
Triple sulfas or SMZ
204
When is HIV therapy initiated?
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
205
When is Rifampin not used in combination with other drugs?
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
206
Where does Griseofulvin deposit?
Keratin containing tissues --- e.g. --- nails
207
Which Aminoglycoside is used for Bowel Surgery ?
Neomycin
208
Which antimicrobial classes inhibit protein synthesis at the 30S subunit? (2)
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
209
Which antimicrobials inhibit protein synthesis at the 50S subunit? (4)
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
210
Which individuals are predisposed to Sulfonamide-induced hemolysis?
G6PD deficient individuals
211
Which RT inhibitor causes Megaloblastic Anemia?
AZT
212
Which RT inhibitors cause a Rash?
Non-Nucleosides
213
Which RT inhibitors cause Lactic Acidosis?
Nucleosides
214
Which Tetracycline is used in patients with renal failure? / Why?
Doxycycline --- because it is fecally eliminated
215
Why are Methicillin --- Nafcillin --- and Dicloxacillin penicillinase resistant?
Due to the presence of a bulkier R group
216
Why is Cilastatin administered with Imipenem?
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
217
List the mechanism --- clinical use --- & toxicity of 5 FU.
-S-phase anti-metabolite Pyr analogue -Colon --- solid tumors --- & BCC/ -Irreversible myelosuppression
218
List the mechanism --- clinical use --- & toxicity of 6 MP.
-inhibits HGPRT (pur. Syn.) - Luk --- Lymph ---
219
List the mechanism --- clinical use --- & toxicity of Bleomycin.
-DNA intercalator -testicular & lymphomas -Pulmonary fibrosis mild myelosuppression.
220
List the mechanism --- clinical use --- & toxicity of Busulfan.
-Alkalates DNA -CML -Pulmonary fibrosis hyperpigmentation
221
List the mechanism --- clinical use --- & toxicity of Cisplatin.
-Alkalating agent -testicular ---bladder ---ovary ---& lung -Nephrotoxicity & CN VIII damage.
222
List the mechanism --- clinical use --- & toxicity of Cyclophosphamide.
-Alkalating agent -NHL --- Breast --- ovary --- & lung. - Myelosuppression --- & hemorrhagic cystitis.
223
List the mechanism --- clinical use --- & toxicity of Doxorubicin.
-DNA intercalator -Hodgkin's --- myeloma --- sarcoma --- and solid tumors -Cardiotoxicity & alopecia
224
List the mechanism --- clinical use --- & toxicity of Etoposide.
-Topo II inhibitor(GII specific) -Oat cell of Lung & prostate --- & testicular -Myelosuppression & GI irritation.
225
List the mechanism --- clinical use --- & toxicity of Methotrexate.
-S-phase anti-metabolite folate analogue -Luk --- Lymp --- sarc --- RA --- & psoriasis / -Reversible myelosuppression
226
List the mechanism --- clinical use --- & toxicity of Nitrosureas.
-Alkalate DNA -Brain tumors -CNS toxicity
227
List the mechanism --- clinical use --- & toxicity of Paclitaxel.
-MT polymerization stabilizer -Ovarian & Breast CA -Myelosupperession & hypersensitivity.
228
List the mechanism --- clinical use --- & toxicity of Prednisone.
-Triggers apoptosis -CLL --- Hodgkin's in MOPP -Cushing-like syndrome
229
List the mechanism --- clinical use --- & toxicity of Tamoxifen.
-Estrogen receptor antagonist -Breast CA -increased endometrial CA risk
230
List the mechanism --- clinical use --- & toxicity of Vincristine.
-MT polymerization inhibitor(M phase) -MOPP --- lymphoma --- Willm's & choriocarcinoma -neurotoxicity and myelosuppression
231
Which cancer drugs effect nuclear DNA (4)?
-Alkalating agents+cisplatin -Doxorubicin+Dactinomycin -Bleomycin -Etoposide
232
Which cancer drugs inhibit nucleotide synthesis(3)?
- Methotrexate - 5 FU - 6 mercaptopurine
233
Which cancer drugs work at the level of mRNA(2)?
-Steroids -Tamoxifen
234
Which cancer drugs work at the level of proteins(2)?
-Vinca alkaloids(inhibit MT) -Paclitaxel
235
ACE inhibitors- clinical use?
hypertension --- CHF --- diabetic renal disease
236
ACE inhibitors- mechanism?
reduce levels of Angiotensin II --- thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
237
ACE inhibitors- toxicity?
fetal renal damage --- hyperkalemia --- Cough --- Angioedema --- Proteinuria --- Taste changes --- hypOtension --- Pregnancy problems --- Rash --- Increased renin --- Lower Angiotensin II (CAPTOPRIL)
238
Acetazolamide- clinical uses?
glaucoma --- urinary alkalinization --- metabolic alkalosis --- altitude sickness
239
Acetazolamide- mechanism?
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self-limited sodium bicarb diuresis and reduction of total body bicarb stores.
240
acetazolamide- site of action?
proximal convoluted tubule
241
Acetazolamide- toxicity?
hyperchloremic metabolic acidosis --- neuropathy --- NH3 toxicity --- sulfa allergy
242
Acetazolamide causes?
ACIDazolamide' causes acidosis
243
Adenosine- clinical use?
DOC in diagnosing and abolishing AV nodal arrhythmias
244
ADH antagonists- site of action?
collecting ducts
245
adverse effect of Nitroprusside?
cyanide toxicity (releases CN)
246
adverse effects of beta-blockers?
impotence --- asthma --- CV effects (bradycardia --- CHF --- AV block) --- CNS effects (sedation --- sleep alterations)
247
adverse effects of Captopril?
fetal renal toxicity --- hyperkalemia --- Cough --- Angioedema --- Proteinuria --- Taste changes --- hypOtension --- Pregnancy problems --- Rash --- Increased renin --- Lower Angiotensin II (CAPTOPRIL)
248
adverse effects of Clonidine?
dry mouth --- sedation --- severe rebound hypertension
249
adverse effects of ganglionic blockers?
severe orthostatic hypotension --- blurred vision --- constipation --- sexual dysfunction
250
adverse effects of Guanethidine?
orthostatic and exercise hypotension --- sexual dysfunction --- diarrhea
251
adverse effects of Hydralazine?
nausea --- headache --- lupus-like syndrome --- reflex tachycardia --- angina --- salt retention
252
adverse effects of Hydrochlorothiazide?
hypokalemia --- slight hyperlipidemia --- hyperuricemia --- lassitude --- hypercalcemia --- hyperglycemia
253
adverse effects of Loop Diuretics?
K+ wasting --- metabolic alkalosis --- hypotension --- ototoxicity
254
adverse effects of Losartan?
fetal renal toxicity --- hyperkalemia
255
adverse effects of Methyldopa?
sedation --- positive Coombs' test
256
adverse effects of Minoxidil?
hypertrichosis --- pericardial effusion --- reflex tachycardia --- angina --- salt retention
257
adverse effects of Nifedipine --- verapamil?
dizziness --- flushing --- constipation (verapamil) --- nausea
258
adverse effects of Prazosin?
first dose orthostatic hypotension --- dizziness --- headache
259
adverse effects of Reserpine?
sedation --- depression --- nasal stuffiness --- diarrhea
260
Amiodarone- toxicity?
pulmonary fibrosis --- corneal deposits --- hepatotoxicity --- skin deposits resulting in photodermatitis --- neurologic effects --- consitpation --- CV (bradycardia --- heart block --- CHF) --- and hypo- or hyperthyroidism.
261
Beta Blockers- CNS toxicity?
sedation --- sleep alterations
262
Beta Blockers- CV toxicity?
bradycardia --- AV block --- CHF
263
Beta Blockers- site of action?
Beta adrenergic receptors and Ca2+ channels (stimulatory)
264
Beta Blockers- BP?
decrease
265
Bretyllium- toxicity?
new arrhythmias --- hypotension
266
Ca2+ channel blockers- clinical use?
hypertension --- angina --- arrhythmias
267
Ca2+ channel blockers- mechanism?
block voltage dependent L-type Ca2+ channels of cardiac and smooth muscle- decreasing contractility
268
Ca2+ channel blockers- site of action?
Cell membrane Ca2+ channels of cardiac sarcomere
269
Ca2+ channel blockers- toxicity?
cardiac depression --- peripheral edema --- flushing --- dizziness --- constipation
270
Ca2+ sensitizers'- site of action?
troponin-tropomyosin system
271
Cautions when using Amiodarone?
check PFTs --- LFTs --- and TFTs
272
Antiarrhythmic class IA effects?
increased AP duration --- increased ERP increased QT interval. Atrial and ventricular.
273
Antiarrhythmic class IB- clinical uses?
post MI and digitalis induced arrhythmias
274
Antiarrhythmic class IB- effects?
decrease AP duration --- affects ischemic or depolarized Purkinje and ventricular system
275
Antiarrhythmic class IB- toxicity?
local anesthetic. CNS stimulation or depression. CV depression.
276
Antiarrhythmic class IC- effects?
NO AP duration effect. useful in V-tach that progresses to V-fib and in intractable SVT LAST RESORT
277
Antiarrhythmic class IC- toxicity?
proarrhythmic
278
Antiarrhythmic class II- effects?
decrease the slope of phase 4 --- increase PR interval (the AV node is particularly sensitive)
279
Antiarrhythmic class II- mechanism?
blocking the beta adrenergic receptor leads to decreased cAMP --- and decreased Ca2+ flux
280
Antiarrhythmic class II- toxicity?
impotence --- exacerbation of asthma --- CV effects --- CNS effects --- may mask hypoclycemia
281
Antiarrhythmic Class III- effects?
increase AP duration --- increase ERP --- increase QT interval --- for use when other arrhythmics fail
282
Antiarrhythmic class IV- clinical use?
prevention of nodal arrhythmias (SVT)
283
Antiarrhythmic class IV- effects?
decrease conduction velocity --- increase ERP --- increase PR interval
284
Antiarrhythmic class IV- primary site of action?
AV nodal cells
285
Antiarrhythmic class IV- toxicity?
constipation --- flushing --- edema --- CV effects (CHF --- AV block --- sinus node depression) --- and torsade de pointes (Bepridil)
286
classes of antihypertensive drugs?
diuretics --- sympathoplegics --- vasodilators --- ACE inhibitors --- Angiotensin II receptor inhibitors
287
decrease Digitoxin dose in renal failure?
NO
288
decrease Digoxin dose in renal failure?
YES
289
Digitalis- site of action?
Na/K ATPase
290
Digoxin v. Digitoxin: bioavailability?
Digitoxin>95% Digoxin 75%
291
Digoxin v. Digitoxin: excretion?
Digoxin=urinary Digitoxin=biliary
292
Digoxin v. Digitoxin: half life?
Digitoxin 168hrs Digoxin 40 hrs
293
Digoxin v. Digitoxin: protein binding?
Digitoxin 70% Digoxin 20-40%
294
Esmolol- short or long acting?
very short acting
295
Ethacrynic Acid- clinical use?
Diuresis in pateints with sulfa allergy
296
Ethacrynic Acid- mechanism?
not a sulfonamide --- but action is the same as furosemide
297
Ethacrynic Acid- toxicity?
NO HYPERURICEMIA --- NO SULFA ALLERGY; same as furosemide otherwise
298
Furosemide- class and mechanism?
Sulfonamide Loop Diuretic. Inhibits ion co-transport system of thick ascending loop. Abolishes hypertonicity of the medulla --- thereby preventing concentration of the urine.
299
Furosemide- clinical use?
edematous states (CHF --- cirrhosis --- nephrotic syndrome --- pulm edema) --- HTN --- hypercalcemia
300
Furosemide- toxicity? (OH DANG)
Ototoxicity --- Hypokalemia --- Dehydration --- Allergy (sulfa) --- Nephritis (interstitial) --- Gout
301
Furosemide increases the excretion of what ion?
Ca2+ (Loops Lose calcium)
302
how do we stop angina?
decrease myocardial O2 consumption by: 1-decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4-decreasing contractility 5-decreasing ejection time
303
Hydralazine- class and mechanism?
vasodilator- increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
304
Hydralazine- clinical use?
severe hypertension --- CHF
305
Hydralazine- toxicity?
compensatory tachycardia --- fluid retention --- lupus-like syndrome
306
Hydrochlorothiazide- clinical use?
HTN --- CHF --- calcium stone formation --- nephrogenic DI.
307
Hydrochlorothiazide- mechanism?
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
308
Hydrochlorothiazide- toxicity? (hyperGLUC --- plus others)
Hypokalemic metabolic alkalosis --- hyponatremia --- hyperGlycemia --- hyperLipidemia --- hyperUricemia --- hyperCalcemia --- sulfa allergy.
309
Ibutilide- toxicity?
torsade de pointes
310
K+- clinical use?
depresses ectopic pacemakers --- especially in digoxin toxicity
311
K+ sparing diuretics- clinical use?
hyperaldosteronism --- K+ depletion --- CHF
312
K+ sparing diuretics- site of action?
cortical collecting tubule
313
K+ sparing diuretics- toxicity?
hyperkalemia --- endocrine effects (gynecomastia --- anti-androgen)
314
loop diuretics (furosemide)- site of action?
thick ascending limb
315
Mannitol- clinical use?
ARF --- shock --- drug overdose --- decrease intracranial/intraocular pressure
316
Mannitol- contraindications?
anuria --- CHF
317
Mannitol- mechanism?
osmotic diuretic- increase tubular fluid osmolarity --- thereby increasing urine flow
318
mannitol- site of action?
proximal convoluted tubule --- thin descending limb --- and collecting duct
319
Mannitol- toxicity?
pulmonary edema --- dehydration
320
Mg+- clinical use?
effective in torsade de pointes and digoxin toxicity
321
name five Antiarrhythmic drugs in class II?
propanolol --- esmolol --- metoprolol --- atenolol --- timolol
322
name four HMG-CoA reductase inhibitors.
Lovastatin --- Pravastatin --- Simvastatin --- Atorvastatin
323
name four Antiarrhythmic drugs in class IA.
Quinidine --- Amiodarone --- Procainamide --- Disopyramide
324
name four Antiarrhythmic drugs in class III.
Sotalol --- Ibutilide --- Bretylium --- Amiodarone
325
name three ACE inhibitors?
Captopril --- Enalapril --- Lisinopril
326
name three calcium channel blockers?
Nifedipine --- Verapamil --- Diltiazem
327
name three Antiarrhythmic drugs in class IB.
Lidocaine --- Mexiletine --- Tocainide
328
name three Antiarrhythmic drugs in class IC.
Flecainide --- Encainide --- Propafenone
329
name three Antiarrhythmic drugs in class IV.
Verapamil --- Diltiazem --- Bepridil
330
name three K+ sparing diuretics?
Spironolactone --- Triamterene --- Amiloride (the K+ STAys)
331
name two bile acid resins.
cholestyramine --- colestipol
332
name two LPL stimulators.
Gemfibrozil --- Clofibrate
333
Nifedipine has similar action to?
Nitrates
334
preferential action of the Ca2+ channel blockers at cardiac muscle?
cardiac muscle: Verapamil>Diltiazem>Nifedipine
335
preferential action of the Ca2+ channel blockers at vascular smooth muscle?
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
336
Procainamide- toxicity?
reversible SLE-like syndrome
337
Quinidine- toxicity?
cinchonism: HA --- tinnitus --- thrombocytopenia --- torsade de pointes due to increased QT interval
338
Ryanodine- site of action?
blocks SR Ca2+ channels
339
Sotalol- toxicity?
torsade de pointes --- excessive Beta block
340
Spironolactone- mechanism?
competitive inhibirot of aldosterone in the cortical collecting tubule
341
thiazides- site of action?
distal convoluted tubule (early)
342
Triamterene and amiloride- mechanism?
block Na+ channels in the cortical collecting tubule
343
Verapamil has similar action to?
Beta Blockers
344
what two vasodilators require simultaneous treatment with beta blockers to prevent reflex tachycardia and diuretics to prevent salt retention?
Hydralazine and Minoxidil
345
which diuretics cause acidosis?
carbonic anhydrase inhibitors --- K+ sparing diuretics
346
which diuretics cause alkalosis?
loop diuretics --- thiazides
347
which diuretics decrease urine Ca2+?
thiazides --- amiloride
348
which diuretics increase urine Ca2+?
loop diuretics --- spironolactone
349
which diuretics increase urine K+?
all except the K+ sparing diuretics Spironolactone --- Triamterene --- Amiloride
350
which diuretics increase urine NaCl?
all of them
351
Acetaminophen has what two clinical uses and lacks what one clinical use of the NSAIDs?
Acetaminophen has antipyretic and analgesic properties --- but lacks anti-inflammatory properties.
352
Can Heparin be used during pregnancy?
Yes --- it does not cross the placenta.
353
Can Warfarin be used during pregnancy?
No --- warfarin --- unlike heparin --- can cross the placenta.
354
Does Heparin have a long --- medium --- or short half life?
Short.
355
Does Warfarin have a long --- medium --- or short half life?
Long.
356
For Heparin what is the Structure
Large anionic polymer --- acidic
357
For Heparin what is the Route of administration
Paranteral (IV --- SC)
358
For Heparin what is the Onset of action
Rapid (seconds)
359
For Heparin what is the Mechanism of action
Activates antithrombin III
360
For Heparin what is the Duration of action
Acute (hours)
361
For Heparin what is the Ability to inhibit coagulation in vitro
Yes
362
For Heparin what is the Treatment for overdose
Protamine sulfate
363
For Heparin what is the Lab value to monitor
aPTT (intrinsic pathway)
364
For Heparin what is the Site of action
Blood
365
For Warfarin what is the Structure
Small lipid-soluble molecule
366
For Warfarin what is the Route of administration
Oral
367
For Warfarin what is the Onset of action
Slow --- limited by half lives of clotting factors
368
For Warfarin what is the Mechanism of action
Impairs the synthesis of vitamin K-dependent clotting factors
369
For Warfarin what is the Duration of action
Chronic (weeks or months)
370
For Warfarin what is the Ability to inhibit coagulation in vitro
No
371
For Warfarin what is the Treatment for overdose
IV vitamin K and fresh frozen plasma
372
For Warfarin what is the Lab value to monitor
PT
373
For Warfarin what is the Site of action
Liver
374
Is toxicity rare or common whith Cromolyn used in Asthma prevention?
Rare.
375
List five common glucocorticoids.
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
376
Secretion of what drug is inhibited by Probenacid used to treat chronic gout?
Penicillin.
377
The COX-2 inhibitors (celecoxib --- rofecoxib) have similar side effects to the NSAIDs with what one exception?
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
378
What are are the Sulfonylureas (general description) and what is their use?
Sulfonylureas are oral hypoglycemic agents --- they are used to stimulate release of endogenous insulin in NIDDM (type-2).
379
What are five advantages of Oral Contraceptives (synthetic progestins --- estrogen)?
1. Reliable (<1% failure) 2. Lowers risk of endometrial and ovarian cancer 3. Decreased incidence of ectopic pregnancy 4. Lower risk of pelvic infections 5. Regulation of menses
380
What are five disadvantages of Oral Contraceptives (synthetic progestins --- estrogen)?
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression --- weight gain --- nausea --- HTN 5. Hypercoagulable state
381
What are five possible toxic effects of Aspirin therapy?
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
382
What are five toxicities associated with Tacrolimus (FK506)?
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
383
What are four advantages of newer low-molecular-weight heparins (Enoxaparin)?
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
384
What are four clinical activities of Aspirin?
1. Antipyretic 2. Analgesic 3. Anti-inflammatory 4. Antiplatelet drug.
385
What are four clinical uses of glucocorticoids?
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
386
What are four conditions in which H2 Blockers are used clinically?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger-Ellison syndrome
387
What are four H2 Blockers?
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
388
What are four Sulfonylureas?
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
389
What are four thrombolytics?
1. Streptokinase 2. Urokinase 3. tPA (alteplase) --- APSAC (anistreplase)
390
What are four unwanted effects of Clomiphene use?
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
391
What are nine findings of Iatrogenic Cushing's syndrome caused by glucocorticoid therapy?
1. Buffalo hump 2. Moon facies 3. Truncal obesity 4. Muscle wasting 5. Thin skin 6. Easy bruisability 7. Osteoporosis 8. Adrenocortical atrophy 9. Peptic ulcers
392
What are signs of Sildenafil (Viagra) toxicity?
Headache --- flushing --- dyspepsia --- blue-green color vision.
393
What are the clinical uses for Ticlopidine --- Clopidogrel?
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
394
What are the four conditions in which Omeprazole --- Lansoprazole is used?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger-Ellison syndrome
395
What are three clinical uses of the Leuprolide?
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
396
What are three clinical uses of the NSAIDs?
1. Antipyretic 2. Analgesic 3. Anti-inflammatory
397
What are three common NSAIDS other than Aspirin?
Ibuprofen --- Naproxen --- and Indomethacin
398
What are three complications of Warfarin usage?
1. Bleeding 2. Teratogenicity 3. Drug-drug interactions
399
What are three possible complications of Heparin therapy?
1. Bleeding 2. Thrombocytopenia 3. Drug-drug interactions
400
What are three possible toxicities of NSAID usage?
1. Renal damage 2. Aplastic anemia 3. GI distress
401
What are three toxicities of Leuprolied?
1. Antiandrogen 2. Nausea 3. Vomiting
402
What are three toxicities of Propylthiouracil?
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
403
What are three types of antacids and the problems that can result from their overuse?
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia --- rebound acid increase - All may cause hypokalemia
404
What are three unwanted effects of Mifepristone?
1. Heavy bleeding 2. GI effects (n/v --- anorexia) 3. Abdominal pain
405
What are two Alpha-glucosidase inhibitors?
1. Acarbose 2. Miglitol
406
What are two clinical uses of Azathioprine?
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
407
What are two conditions in which COX-2 inhibitors might be used?
Rheumatoid and osteoarthritis.
408
What are two Glitazones?
1. Pioglitazone 2. Rosiglitazone.
409
What are two mechanisms of action of Propythiouracil?
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
410
What are two processes Corticosteroids inhibit leading to decreased inflammation?
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
411
What are two toxicities associated with Cyclosporine?
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
412
What are two toxicities of the Glitazones?
1. Weight gain 2. Hepatotoxicity (troglitazone)
413
What are two toxicities of the Sulfonylureas?
1. Hypoglycemia (more common with 2nd-generation drugs: glyburide --- glipizide) 2. Disulfiram-like effects (not seen with 2nd-generation drugs).
414
What are two types of drugs that interfere with the action of Sucralfate and why?
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
415
What can result due to antacid overuse?
Can affect absorption --- bioavailability --- or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
416
What enzyme does Zileuton inhibit?
Lipoxygenase
417
What enzymes are inhibited by NSAIDs --- acetaminophen and COX II inhibitors?
Cyclooxygenases (COX I --- COX II).
418
What is a common side effect of Colchicine used to treat acute gout --- especially when given orally?
GI side effects. (Note: Indomethacin is less toxic --- more commonly used.)
419
What is a common side effect of Misoprostol?
Diarrhea
420
What is a possible result of overdose of Acetaminophen?
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
421
What is a possible toxicity of Alpha-glucosidase inhibitors used in type-2 diabetes?
GI disturbances.
422
What is a possible toxicity of Ticlopidine --- Clopidogrel usage?
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
423
What is a sign of toxicity with the use of thrombolytics?
Bleeding.
424
What is action of insulin in the liver --- in muscle --- and in adipose tissue?
1. In liver --- increases storage of glucose as glycogen. 2. In muscle --- stimulates glycogen and protein synthesis --- and K+ uptake. 3. In adipose tissue --- facilitates triglyceride storage.
425
What is are two clinical uses of Cyclosporine?
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
426
What is the category and mechanism of action of Zafirlukast in Asthma treatment?
Antileukotriene; blocks leukotriene receptors.
427
What is the category and mechanism of action of Zileuton in Asthma treatment?
Antileukotriene; blocks synthesis by lipoxygenase.
428
What is the category of drug names ending in -ane (e.g. Halothane)
Inhalational general anesthetic.
429
What is the category of drug names ending in -azepam (e.g. Diazepam)
Benzodiazepine.
430
What is the category of drug names ending in -azine (e.g. Chlorpromazine)
Phenothiazine (neuroleptic --- antiemetic).
431
What is the category of drug names ending in -azol (e.g. Ketoconazole)
Antifungal.
432
What is the category of drug names ending in -barbital (e.g. Phenobarbital)
Babiturate.
433
What is the category of drug names ending in -caine (e.g. Lidocaine)
Local anesthetic.
434
What is the category of drug names ending in -cillin (e.g. Methicillin)
Penicillin.
435
What is the category of drug names ending in -cycline (e.g. Tetracycline)
Antibiotic --- protein synthesis inhibitor.
436
What is the category of drug names ending in -ipramine (e.g. Imipramine)
Tricyclic antidepressant.
437
What is the category of drug names ending in -navir (e.g. Saquinavir)
Protease inhibitor.
438
What is the category of drug names ending in -olol (e.g. Propranolol)
Beta antagonist.
439
What is the category of drug names ending in -operidol (e.g. Haloperidol)
Butyrophenone (neuroleptic).
440
What is the category of drug names ending in -oxin (e.g. Digoxin)
Cardiac glycoside (inotropic agent).
441
What is the category of drug names ending in -phylline (e.g. Theophylline)
Methylxanthine.
442
What is the category of drug names ending in -pril (e.g. Captopril)
ACE inhibitor.
443
What is the category of drug names ending in -terol (e.g. Albuterol)
Beta-2 agonist.
444
What is the category of drug names ending in -tidine (e.g. Cimetidine)
H2 antagonist
445
What is the category of drug names ending in -triptyline (e.g. Amitriptyline)
Tricyclic antidepressant.
446
What is the category of drug names ending in -tropin (e.g. Somatotropin)
Pituitary hormone.
447
What is the category of drug names ending in -zosin (e.g. Prazosin)
Alpha-1 antagonist
448
What is the category --- desired effect --- and adverse effect of Isoproterenol in the treatment of Asthma?
Nonspecific beta-agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
449
What is the category --- desired effect --- and period of use of albuterol in the treatment of Asthma?
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
450
What is the category --- desired effect --- and possible mechanism of Theophylline in treating Asthma?
Methylzanthine; desired effect is bronchodilation --- may cause bronchodilation by inhibiting phosphodiesterase --- enzyme involved in degrading cAMP (controversial).
451
What is the category --- mechanism of action --- and effect of Ipratroprium in Asthma treatment?
Muscarinic antagonist; competatively blocks muscarinic receptors --- preventing bronchoconstriction.
452
What is the category --- mechanism of action --- and particular use of beclomethasone and prednisone in Asthma treatment?
Corticosteroids; prevent production of leukotrienes from arachodonic acid by blocking phospholipase A2. Drugs of choice in a patient with status asthmaticus (in combination with albuterol.)
453
What is the category --- method of use --- and adverse effects of Salmeterol in Asthma treatment?
Beta 2 agonist; used as a long-acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
454
What is the clincial use for Misoprostol?
Prevention of NSAID-induced peptic ulcers --- maintains a PDA.
455
What is the clinical use for Clomiphene?
Treatment of infertility.
456
What is the clinical use for Heparin?
Immediate anticoagulation for PE --- stroke --- angina --- MI --- DVT.
457
What is the clinical use for Sildenafil (Viagra)?
Erectile dysfunction.
458
What is the clinical use for Sucralfate?
Peptic ulcer disease.
459
What is the clinical use for Warfarin?
Chronic anticoagulation.
460
What is the clinical use of Mifepristone (RU486)?
Abortifacient.
461
What is the clinical use of Tacrolimus (FK506)?
Potent immunosuppressive used in organ transplant recipients.
462
What is the effect of the Glitazones in diabetes treatment?
Increase target cell response to insulin.
463
What is the enzyme inhibited --- the effect of this inhibition --- and the clinical use of the antiandrogren Finasteride?
Finasteride inhibits 5 Alpha-reductase --- this decreases the conversion of testosterone to dihydrotestosterone --- useful in BPH
464
What is the lab value used to monitor the effectiveness of Heparin therapy?
The PTT.
465
What is the lab value used to monitor the effectiveness of Warfarin therapy?
The PT.
466
What is the main clinical use for the thrombolytics?
Early myocardial infarction.
467
What is the mecanism of action of Sucralfate?
Aluminum sucrose sulfate polymerizes in the acid environment of the stomach and selectively binds necrotic peptic ulcer tissue. Acts as a barrier to acid --- pepsin --- and bile.
468
What is the mecanism of action of the COX-2 inhibitors (celecoxib --- rofecoxib)?
Selectively inhibit cyclooxygenase (COX) isoform 2 --- which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 which helps maintain the gastric mucosa.
469
What is the mecanism of action --- effective period --- and ineffective period of use for Cromolyn in treating Asthma?
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
470
What is the mechanism of action and clinical use of the antiandrogen Flutamide?
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor --- used in prostate carcinoma.
471
What is the mechanism of action and clinical use of the antiandrogens Ketoconazole and Spironolactone?
Inhibit steroid synthesis --- used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
472
What is the mechanism of action of Acetaminophen?
Reversibly inhibits cyclooxygenase --- mostly in CNS. Inactivated peripherally.
473
What is the mechanism of action of Allopurinol used to treat chronic gout?
Inhibits xanthine oxidase --- decresing conversion of xanthine to uric acid.
474
What is the mechanism of action of Aspirin?
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
475
What is the mechanism of action of Clomiphene?
Clomiphene is a partial agonist at estrogen receptors in the pituitary gland. Prevents normal feedback inhibition and increses release of LH and FSHfrom the pituitary --- which stimulates ovulation.
476
What is the mechanism of action of Colchicine used to treat acute gout?
Depolymerizes microtubules --- impairing leukocyte chemotaxis and degranulation.
477
What is the mechanism of action of Cyclosporine?
Binds to cyclophilins (peptidyl proline cis-trans isomerase) --- blocking the differentiation and activation of T cells mainly by inhibiting the production of IL-2 and its receptor.
478
What is the mechanism of action of Heparin?
Heparin catalyzes the activation of antithrombin III.
479
What is the mechanism of action of Mifepristone (RU486)?
Competitive inibitor of progestins at progesterone receptors.
480
What is the mechanism of action of Misoprostol?
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
481
What is the mechanism of action of NSAIDs other than Aspirin?
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
482
What is the mechanism of action of Omeprazole --- Lansoprazole?
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
483
What is the mechanism of action of Probenacid used to treat chronic gout?
Inhibits reabsorption of uric acid.
484
What is the mechanism of action of Sildenafil (Viagra)?
Inhibits cGMP phosphodiesterase --- casuing increased cGMP --- smooth muscle relaxation in the corpus cavernosum --- increased blood flow --- and penile erection.
485
What is the mechanism of action of the Alpha-glucosidase inhibitors?
Inhibit intestinal bursh border Alpha-glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
486
What is the mechanism of action of the glucocorticoids?
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
487
What is the mechanism of action of the H2 Blockers?
Reversible block of histamine H2 receptors
488
What is the mechanism of action of the Sulfonylureas?
Close K+ channels in Beta-cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
489
What is the mechanism of action of the thrombolytics?
Directly of indirectly aid conversion of plasminogen to plasmin which cleaves thrombin and fibrin clots. (It is claimed that tPA specifically converts fibrin-bound plasminogen to plasmin.)
490
What is the mechanism of action of Ticlopidine --- Clopidogrel
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
491
What is the mechanism of action of Warfarin (Coumadin)?
Warfarin interferes with the normal synthesis and gamma-carboxylation of vitamin K-dependent clotting factors II --- VII --- IX --- and X --- Protein C and S via vitamin K antagonism.
492
What is the mechanism of Azathioprine?
Antimetabolite derivative of 6-mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
493
What is the mechanism of Leuprolide?
GnRH analog with agonist properties when used in pulsatile fashion and antagonist properties when used in continuous fashion --- causing a transient initial burst of LH and FSH
494
What is the mechanism of Tacrolimus (FK506)?
Similar to cyclosporine; binds to FK-binding protein --- inhibiting secretion of IL-2 and other cytokines.
495
What is the memory key for the action of Sildenafil (Viagra)?
Sildenafil fills the penis
496
What is the memory key for the effect of aluminum hydroxide overuse?
AluMINIMUM amount of feces.
497
What is the memory key for the effect of magnesium hydroxide overuse?
Mg = Must go to the bathroom.
498
What is the memory key to remember which pathway (extrinsic vs. intrinsic) and which lab value Warfarin affects?
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
499
What is the possible mechanism and effect of Metformin in treating diabetes?
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
500
What is the specific clinical use of Indomethacin in neonates?
Indomethacin is used to close a patent ductus arteriosus.
