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First Aid Step 1 > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

sympathetic alpha-1 R (Gp-q): fxns

A
  • vascular sm muscle contraction
  • pupil dilation
  • intestine and bladder sphincter contraction
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2
Q

sympathetic alpha-2 R (Gp-i): fxns

A
  • decreases sympathetic outflow
  • decreases insulin release and lipolysis
  • incr plt aggregation
  • decr aqueous humor production (eye)
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3
Q

sympathetic beta-1 R (Gp-s): fxns

A
  • incr HR
  • incr heart contractility (inotropy)
  • incr renin release (to incr BP via incr ADH, thirst, and vasoconstriction)
  • incr lipolysis
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4
Q

sympathetic beta-2 R (Gp-s): fxns

A
  • vasodilation
  • bronchodilation
  • incr insulin release and lipolysis
  • decr uterine tone (tocolysis)
  • ciliary muscle relaxation (opp of accommodation), incr aqueous humor production
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5
Q

parasympathetic M1 R (Gp-q): fxns

A

Works on CNS and enteric nervous system

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6
Q

parasympathetic M2 R (Gp-i): fxns

A
  • Decreases HR

- Decr atrial contractility

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7
Q

parasympathetic M3 R (Gp-q): fxns

A
  • incr exocrine gland secretions (lacrimal, salivary, gastric acid)
  • incr gut peristalsis
  • incr bladder contraction
  • bronchoconstriction
  • pupil constriction
  • ciliary muscle contraction (Accommodation)
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8
Q

Dopamine D1 R (Gp-s): fxns

A
  • relaxes renal vascular smooth muscle
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9
Q

Dopamine D2 R (Gp-i): fxns

A
  • modulates NT release
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10
Q

Histamine H1 R (Gp-q): fxns

A
  • incr nasal and bronchial mucus production
  • incr vascular permeability
  • bronchiole contraction
  • pruritis
  • pain
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11
Q

Histamine H2 R (Gp-s): fxns

A
  • incr gastric acid secretions
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12
Q

Vasopressin V1 R (Gp-q): fxns

A
  • contracts vascular smooth muscle
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13
Q

Vasopressin V2 R (Gp-s): fxns

A
  • incr H2O permeability and reabsorption in collecting tubules
  • V”2” for H”2”O reabsorption in collecting “TU”bule
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14
Q

Gq pathway (for H1, Alpha1, V1, M1, M3 = HAVe 1 M&M)

A

R –Gq-> PLC –> breaks lipids into DAG (-> PK3) and IP3 -> increase Ca2+ –> incr smooth muscle contraction

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15
Q

Gs and Gi pathway

A

R –Gs/i-> Adenylyl cyclase –> turns ATP to cAMP –> PKA –> incr Ca in heart –> incr heart contractility

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16
Q

MOA of botulinum

A

blocks ACh release from presynaptic cholinergic neuron at NMJ

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17
Q

MOA of physostigmine, rivastigmine, galantamine, donepezil, edrophonium, neostigmine (and caffeine!)

A

AchEI

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18
Q

MOA and use of: Bethanechol

A

Cholinomimetic (Ach)

- activates bowel, bladder: for post-op or neurogenic ileus, urinary retention

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19
Q

MOA and use of: Carbachol

A

Ach copy

- constricts pupil, relieves intraocular P: for glaucoma

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20
Q

MOA and use of: Methacholine

A

Stimulates Musc Ach Rs in airway (constricts)

- challenge test for asthma dx

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21
Q

MOA and use of: pilocarpine

A

Contracts ciliary muscle of eye (for open-angle glaucoma), pupillary sphincter (for closed-angle glaucoma)
- potent stimulatory of sweat, tears, saliva (“cry, sweat, and drool on your PILOow”)

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22
Q

Use of donepezil/galantamine/rivastigmine

A

incr Ach for Alzeheimer Disease

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23
Q

Use of edrophonium

A

Old dx for MG (now test for Anti-AChR Ab)

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24
Q

Use of neostigmine

A

No CNS penetration, so use for postop/neurogenic ileus and urinary retention, postop reversal of NMJ blockade, and MG tx

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25
Q

Use of Physostigmine

A

Crosses BBB, used to “phy”x atropine OD: incr Ach for anticholinergic toxicity antidote

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26
Q

Use of Pyridostigmine

A

Incr Ach and muscle strength, long acting MG tx (no CNS penetration)
“pyRIDostiGMine gets RID of MG”

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27
Q

S/E of cholinomimetic drugs

A

Exacerbation of COPD, asthma, peptic ulcers

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28
Q

Cholinergic toxicity

A 
2/2 AchEi toxicity or organophosphates (irreversibly inhibit AChE): DUMBBELSS
Diarrhea
Urination
Miosis (big pupils)
Bronchospasm
Bradycardia
Excitation of muscle and CNS
Lacrimation
Sweating
Salivation
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29
Q

cholinergic toxicity antidote (2)

A

atropine (competitively inhibits)

pralidoxime (regenerates AChE if given early)

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30
Q

MOA and use of: Atropine

A

MOA: muscarinic Ach antagonist

- dilate pupil, and antidote for cholinergic toxicity

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31
Q

MOA and use of: Benztropine

A

MOA: musc Ach antagonist (CNS)

-for PD-acute dystonia (“park my Benz”)

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32
Q

MOA and use of: Glycopyrrolate

A

MOA: musc Ach antagonist (GI, resp)

  • oral: for drooling, peptic ulcer
  • parenteral: preop to reduce airway secretions
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33
Q

MOA and use of: Ipratropium, tiotropium

A

MOA: musc Ach antag (resp)
- for COPD, asthma
“I PRAy I can breathe soon”

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34
Q

MOA and use of: Oxybutynin, tolteridone

A

MOA: Musc Ach antagonist (GU)

- reduce bladder spasms and urge incontinence

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35
Q

MOA and use of: Scopolamine

A

Musc Ach antagonist (CNS)

- for motion sickness

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36
Q

Anticholinergic toxicity

A

2/2 Atropine, Jimson weed (Datura)
“Can’t pee, can’t see, can’t spit, can’t shit”
- hyperthermia, tachycardia, dry mouth, dry/flushed skin, no sweating, mydriasis (big pupils), constipation, AMS

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37
Q

R action and use of: Albuterol, Salmeterol

A

Sympathomimetic: B2 > B1

  • Albuterol: acute asthma
  • Salmeterol: chronic asthma or COPD control
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38
Q

R action and use of: Dobutamine

A

Sympathomimetic: B1 > B2, a

- for HF (inotropic > chronotropic), cardiac stress testing

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39
Q

R action and use of: Dopamine

A

Sympathomimetic: D1 = D2 > B > a

  • for unstable bradycardia, HF, shock
  • inotropic and chronotropic (alpha effects) at high doses
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40
Q

R action and use of: Epi

A

Sympathomimetic: Beta > alpha

  • for anaphylaxis, asthma, open-angle glaucoma
  • alpha effects at high doses
  • B2 effects much stronger than NE
  • alpha blockage causes BP depression b/c of B2 action (vs phenylephrine which is only effect-suppressed)
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41
Q

R action and use of: Isoproterenol

A

Sympathomimetic: B1=B2

- EP eval of tachyarrhythmias

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42
Q

R action and use of: NE

A

Sympathomimetic: a1 > a2 > B1

- for hypotension (but will decr renal perfusion)

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43
Q

R action and use of: Phenylephrine

A

Sympatomimetic: a1 > a2

  • vasoconstriction (for hypotension)
  • dilates pupils for eye procedures
  • decongestant
  • not as susceptible to alpha blockage as Epi (get suppression of pressor effect, but no net BP depression b/c has no B2 action)
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44
Q

action of alpha-1 adrenergic receptors (NE > Epi)

A
  • smooth muscle contraction
  • pupil dilation (mydriasis)
  • skin, mucosa and GI/GU vasoconstriction/sphincter constriction
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45
Q

action of alpha-2 adrenergic receptors (Epi > NE)

A
  • smooth muscle mixed effects

- platelet activation

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46
Q

action of beta-1 adrenergic receptors (Epi=NE)

A

+ chronotropy
+ incr intropy
+ incr amylase secretion

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47
Q

action of beta-2 adrenergic receptors (Epi)

A

smooth muscle relaxation (ex bronchodilation)

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48
Q

MOA and use of: amphetamine

A

indirect sympathetic general agonist, reuptake inhibitor, releases stored catecholamines
- for: narcolepsy, obesity, ADHD

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49
Q

MOA and effects of: cocaine

A

indirect sympathetic general agonist and reuptake inhibitor

  • causes: vasoconstriction and local anesthesia
  • don’t give BB w/cocaine CP b/c can cause unopposed alpha1 action -> extreme HTN
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50
Q

MOA and use of: ephedrine

A

indirect sympathetic general agonist, releases stored catecholamines
- for: nasal decongestant, urinary incontinence, hypotension

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51
Q

NE effect on BP and HR

A

NE increases SBP and DBP (from alpha1 vasoconstriction) –> incr MAP –> reflex bradycardia

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52
Q

Isoproterenol effect on BP and HR

A

Isoproterenol causes B2 vasodilation –> decr MAP –> incr HR via B1 and reflex activity

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53
Q

MOA and use of: Clonidine

A 
a2 agonist (sympatholytic)
- for HTN urgency, ADHD, Tourette syndrome
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54
Q

sympatholytic toxicity

A

Clonidine: CNS depression, bradycardia, hypotension, resp depression, miosis
alpha-methyldopa: direct coombs+ hemolysis, SLE_like syndrome

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55
Q

MOA and use of: Phenoxybenzamine

A

MOA: irreversible nonselective alpha blocker

- for pheos (to prevent catecholamine-HTN crisis)

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56
Q

MOA and use of: Phentolamine

A

MOA: reversible nonselective alpha blocker

- for pts on MAOIs who eat tyrosine foods

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57
Q

alpha blocker S/Es (2)

A 
orthostatic hypotension (w/a1 specific, only w/1st dose)
reflex tachycardia
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58
Q

MOA and use of: Prazosin, Terazosin, Doxazosin, Tamsulosin (and S/E’s)

A

MOA: alpha1-selective blockers (-osin endings)
- for BPH, PTSD (prazosin), HTN (except tamsulosin)
S/E: can get HA and orthostasis (1st use), dizziness

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59
Q

MOA and use of: Mirtazepine (and S/E’s)

A

MOA: alpha2-selective blocker

  • for: depression
  • S/E: sedation, incr appetite/wt gain (and incr chol)
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60
Q

MOA of Bb effects on: angina

A

decr heart rate and contractility –> decr O2 consumption

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61
Q

Bb effects on: MI (metoprolol, carvedilol, bisoprolol) and chronic HF

A

decrease mortality

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62
Q

MOA of Bb effects on: SVT (metop, esmolol)

A

decr AV conduction velocity (class II antiarrhythmic)

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63
Q

MOA of Bb effects on: HTN

A

decr CO, decr renin secretion (due to B1-blockade on JGA cells)

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64
Q

MOA of Bb effects on glaucoma (timolol)

A

decr secretion of aqueous humor

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65
Q

Bb toxicity

A

impotence, bradycardia, AV block, Sz, sedtion, asthma/COPD exacerbation

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66
Q

B1 selective blockers (B1 > B2): in 1st half of alphabet (A to M)

A

acebutolol (partial ag), atenolol, betaxolol, esmolol metoprolol

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67
Q

Nonselective Bbs (B1=B2): in 2nd half (N to Z)

A

nadolol, pindolol (partial ag), propranalol, timolol

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68
Q

nonselective alpha and beta antagonists (modified “olol” to -ilol or -alol)

A

carvedilol, labetalol

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69
Q

Antidote to acetaminophen toxicity

A

N-acetylcysteine (NAC) - replenishes glutathione

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70
Q

Antidote to cholinergic toxicity (2/2 AchEi toxicity or organophosphates)

A

Atropine > Pralidoxime

71
Q

Antidote to amphetamine toxicity

A

NH4Cl (ammonium chloride) to acidify urine and let the basic amphetaines be excreted

72
Q

Antidote to anticholinergic (antimuscarinic) toxicity

A

physostigmine salicylate + control hyperthermia

73
Q

Antidote to benzo toxicity

A

flumazenil

74
Q

Antidote to BB toxicity

75
Q

Antidote to CO poisoning

A

100% O2, hyperbaric O2

76
Q

Antidote to Cu, Arsenic, gold toxicity

A

Penicillamine (chelator)

77
Q

Antidote to cyanide poisoning

A

Nitrite + thiosulfate, hydroxocobalamin

78
Q

Antidote to Digitalis/Digoxin toxicity

A

Anti-dig Fab fragments

79
Q

Antidote to heparin toxicity

A

protamine sulfate

80
Q

Antidote to Iron toxicity

A

Deferoxamine, Deferasirox

81
Q

Antidote to lead poisoning

A

EDTA, dimercaprol succimer (combines w/lead in the body), penicillamine

82
Q

Antidote to mercury poisoning (also works for arsenic and gold)

A

Dimercaprol (BAL), succimer

83
Q

Antidote to Methanol, Ethylene Glycol (antifreeze) poisoning

A

Fomepizole > ethanol, dialysis

84
Q

Antidote to methemoglobinemia

A

Methylene blue, Vit C

85
Q

Antidote to Opioid toxicity

A

Naloxone, Naltrexone

86
Q

Antidote to salicylate (ASA) toxicity

A

NaHCO3 (to alkalinize urine), dialysis

87
Q

Antidote to TCA toxicity

A

NaHCO3 (to alkalinize plasma)

88
Q

Reversal of tPA, streptokinase, urokinase

A

aminocaproic acid

89
Q

Antidote to warfarin toxicity

A

Vit K (delayed effect) + FFP (immediate)

90
Q

What drugs can cause coronary vasospasm (drug rxn)?

A

cocaine, sumitriptan and ergot alkaloids (for migraines)

91
Q

What drugs can cause cutaneous flushing (drug rxn)?

A

Vancomycin, Adenosine, Niacin, CCBs (“VANC”)

92
Q

What drugs can cause dilated cardiomyopathy (drug rxn)? - and how to prevent it?

A

anthracyclines (doxorubicin, daunorubicin) - prevent w/dexrazoxane

93
Q

What drugs can cause TdP (drug rxn)?

A

Class III (sotalol, amiodarone) and class IA (quinidine, procainamide) antiarrhythmics, macrolide abx (erythromycin, azithro), APs, TCAs

94
Q

What drugs can cause adrenal insufficiency (drug rxn)?

A

glucocorticoids, on withdrawal (HPA suppression)

95
Q

What drugs can cause hot flashes (drug rxn)?

A

tamoxifen, clomiphene

96
Q

What drugs can cause hyperglycemia (drug rxn)?

A

tacrolimus, protease inhibitors, niacin, HCTZ, corticosteroids

97
Q

What drugs can cause hypothyroidism (drug rxn)?

A

Li, amiodarone, sulfonamides

98
Q

What drugs can cause acute cholestatic hepatitis w/jaundice (drug rxn)?

A

erythromycin

99
Q

What drugs can cause diarrhea (drug rxn)?

- (“May Excite Colon On Accident”)

A

Metformin, Erythromycin, Colchicine, Orlistat, Acarbose

100
Q

What drugs can cause focal to massive hepatic necrosis (drug rxn)?
- (liver “HAVAc”)

A

Halothane, Amanita phalloides (death cap mushrooms), VPA, Acetaminophen

101
Q

What drugs can cause hepatitis (drug rxn)?

A

TB drugs (rifampin, isoniazid, pyrazinaminde), statins, fibrates

102
Q

What drugs can cause pancreatitis (drug rxn)?

- “Drugs Causing A Violent Abdominal Distress”

A

Didanosine (ART), Corticosteroids, Alcohol, VPA, Azathioprine, Diuretics (furosemide, HCTZ)

103
Q

What drugs predispose to C diff?

A

Clindamycin, ampicillin, cephalosporins

104
Q

What drugs can cause agranulocytosis (drug rxn)?

- “Gangs CCCrush Myeloblasts and Promyelocytes”

A

Ganciclovir, Clozapine, Carbamazepine, Colchicine, Methimazole, Propylthiouracil

105
Q

What drugs can cause aplastic anemia (drug rxn)?

- “Cant Make New Blood Cells Properly”

A

Carbamazepine, Methimazole, NSAIDs, Benzene, Chloramphenicol Propylthiouracil

106
Q

What drugs can cause direct coombs+ hemolytic anemia (drug rxn)?

A

methyldopa, PCN

107
Q

What drug causes gray baby syndrome (drug rxn)?

A

chloramphenicol

108
Q

What drugs can cause hemolysis in G6PD?

- “hemolysis IS D PAIN”

A

Isoniazid, Sulfonamides, Dapsone, Primaquine, Aspirin, Ibuprifen, Nitrofurantoin

109
Q

What drugs can cause megaloblastic anemia (drug rxn)?

- “having a –blast– with PMS”

A

Phenytoin, Methotrexate, Sulfa drugs

110
Q

What drugs can cause thrombocytopenia (drug rxn)?

A

heparin (HIT)

111
Q

What drugs are pro-thrombotic (not intended effect)?

112
Q

What drugs can cause fat redistribution (drug rxn)?

A

PIs, glucocorticoids

113
Q

What drugs can cause gingival hyperplasia (drug rxn)?

A

phenytoin, CCBs, cyclosporine

114
Q

What drugs can cause gout/hyperuricemia (drug rxn)?

- “Painful Tophi and Feet Need Care”

A

Pyrazinamide, Thiazides, Furosemide, Niacin, Cyclosporine

115
Q

What drugs can cause myopathy (drug rxn)?

A

Fibrates, niacin, colchicine, hydroxychloroquine, IFN-a, penicillamine, statins, GCs

116
Q

What drugs can cause osteoporosis (drug rxn)?

A

steroids, heparin

117
Q

What drugs can cause photosensitivity (drug rxn)?

-“SAT For photo”

A

Sulfonamides, Amiodarone, Tetracyclines, 5-FU

118
Q

What drugs can cause SJS (drug rxn)?

- “Steven Johnson has EPILEPTIC ALLergy to SULFA DRUGS and PCN”

A

AEDs (lamotrigine), allopurinol, sulfa drugs, PCN

119
Q

What drugs can cause SLE-like syndrome (drug rxn)?

- “having lupus is SHIPP-E”

A

Sulfa drugs, Hydralazine, Isoniazid, Procainamide, Phenytoin, Etanercept

120
Q

What drugs can cause childhood teeth discoloration (drug rxn)?

A

tetracyclines

121
Q

What drugs can cause tendonitits/tendon rupture/cartilage damage (drug rxn)?

A

fluoroquinolones (ciprofloxacin, levo, moxi, etc.)

122
Q

What drugs can cause PDisms (drug rxn)?

- “cogwheel rigidity of ARM”

A

APs (1st gen), Reserpine, Metoclopromide (Reglan)

123
Q

What drugs can cause seizures (drug rxn)?

-“ I BItE my tongue”

A

Isoniazid (from B6 deficiency), Buproprion, Imipenem/cilastatin, Enflurane (anesthetic)

124
Q

What drugs can cause TD (drug rxn)?

A

APs, metoclopromide (Reglan)

125
Q

What drugs can cause DI (drug rxn)?

A

Li (and demeclocycine = tetracycline Abx)

126
Q

What drugs can cause Fanconi syndrome (drug rxn)?

A

Tetracyclines (expired)

NB: Fanconi syndrome is proximal tubule dysfxn causing loss of glucose, aa’s, PO4 and bicarb –> RTA and rickets

127
Q

What drugs can cause hemorrhagic cystitis (drug rxn)? and prevented by coadministering what chemo adjuvant?

A

cyclophosphamide (prevent by coadministering with mesna - organosulfur chemo adjuvant)

128
Q

What drugs can cause interstitial nephritis (drug rxn)?

A

methicillin, NSAIDs, furosemide

129
Q

What drugs can cause SIADH (drug rxn)?

-“Cant Concentrate Serum Sodium”

A

Carbamazepine, Cyclophosphamide, SSRIs

130
Q

What drugs can cause dry cough (drug rxn)?

131
Q

What drugs can cause pulmonary fibrosis (drug rxn)?

-“Breathing Air Badly from Meds”

A

Bleomycin, Amiodarone, Busulfan, MTX

132
Q

What drugs can cause anticholinergic (antimuscarinic) toxicity?

A

Atropine, TCAs, H1 blockers, APs

133
Q

What drugs can cause disulfuram-like rxn (drug rxn)?

=flushing, tachycardia, hypotension

A

metronidazole, some cephalosporins, griseofulvin, procarbazine, 1st gen sulfonylureas

134
Q

What drugs are nephro- and oto-toxic?

A

Aminoglycosides (gentamycin, streptomycin, tobramycin, amikacin), vancomycin, loop diuretics (furosemide), cisplatin (cisplatin toxicity may respond to amifostine)

135
Q

What drugs induce CYP 450?

- “chronic alcoholics St-eal Phen-Phen and Never Refuse Gr-easy Carbs”

A 
Chronic alcohol use
St. John's wort
Phenytoin
Phenobarbital
Nevirapine
Rifampin
Griseofulvin
Carbamazepine
136
Q

What drugs inhibit CYP 450?

- “AAA RACKS IN GQ Magazine”

A 
Acute Alcohol Abuse
Ritonavir
Amiodarone
Cimetidine
Ketoconazole
Sulfonamides
INh (isoniazid)
Grapefruit juice
Quinidine
Macrolides (except azithromycin)
137
Q

What 4 drugs are common substrates of CYP 450 and thus influenced by the inducers/inhibitors?
-“Always Think When Outdoors”

A

AEDs
Theophylline
Warfarin
OCPs

138
Q

What are the sulfa drugs?

- “Popular FACTSSS

A 
Probenecid
Furosemide
Acetazolamide
Celecoxib
Thiazides
Sulfa abx
Sulfasalazine
Sulfonylureas
139
Q

What can a sulfa allergy rxn look like?

A

fever, UTI, SJS, hemolytic anemia, tcp, agranulocytosis, hives

140
Q

what are -azoles?

A

antifungals: ergosterol (lipid) synthesis inhibitors

141
Q

what are -bendazoles?

A

antiparasitic/antihelminthic

142
Q

what are -cillins?

A

abx: peptidoglycan synthesis inhibitor

143
Q

what are -cyclines?

A

abx: ribosomal 30S protein synthesis inhibitors

144
Q

what are -ivir drugs?

A

anti-flu: neuraminidase inhibitors (ex. oseltamivir)

145
Q

what are -navirs?

A

HAART: PIs (ex. ritonavir)

146
Q

what are -ovirs?

A

antiviral: DNA polymerase inhibitor (Acyclovir)

147
Q

what are -thromycins?

A

macrolide abx (azithromycin, erythromycin)

148
Q

what are -anes?

A

inhaled general anesthetic

149
Q

what are -azines?

A

typical (1st gen) APs (ex thioridazine)

150
Q

what are -barbitals?

A

barbiturates (ex phenobarbital)

151
Q

what are -caines?

A

local anesthetics

152
Q

what are -etines?

A

SSRIs (ex fluoxetine)

153
Q

what are -ipramines and -triptylines?

A

TCAs (ex imipramine, amitriptyline)

154
Q

what are -triptans?

A

anti-migraine: 5-HT 1b/1d agonist

155
Q

what are -zepams and -zolams?

156
Q

what are -chols?

A

cholinergic agonist (ex bethanechoo, carbachol)

157
Q

what are -curiums and -curoniums?

A

nondepolarizing paralytics

158
Q

what are -olols?

159
Q

what are -stigmines?

A

AChE inhibitors (incr cholinergic effects)

160
Q

what are -terols?

A

B2 agonists (ex albuterol)

161
Q

what are -zosins?

A

a1 antagonists

162
Q

what are -afils?

A

PDE-5 inhibitors (ex sildenafil)

163
Q

what are -dipines?

A

dihydropyridine CCBs (ex amlodipine)

164
Q

what are -prils?

165
Q

what are -sartans?

A

ARBs (angiotensin-II R blockers)

166
Q

what are -statins?

A

Statins: HMG-CoA reductase inhibitors

167
Q

what are -dronates?

A

bisphosphonates (ex aledronate)

168
Q

what are -glitazones?

A

PPAR-gamma activators (oral DM med)

169
Q

what are -prazoles?

170
Q

what are -prosts or -prostols?

A

prostaglandin analogs (ex misoprostol - for gastric ulcers and elective abortions)

171
Q

what are -tidines?

A

H2 antagonists (ex ranitidine, cimetidine)

172
Q

what are -tropins?

A

pituitary hormines (ex somatotropin)

173
Q

what are -ximabs?

A

chimeric monoclonal Abs (ex basiliximab)

174
Q

what are -zumabs?

A

humanized monoclonal Abs (ex daclizumab)

First Aid Step 1 (1 decks)

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