Pharmacology

Question 1

Which interferon ends in a instead of b?

Answer 1

Pegylated

Question 2

Which 2 classes of hepatitis drugs have dual MOA’s?

Answer 2

Interferons

Ribavirin

Question 3

What are the 2 MOA’s shared by interferons and ribavirin?

Answer 3

1- anti-viral

2- immunomodulatory (upregulate inflammation)

Question 4

Almost 100% of patients taking interferons suffer from this side effect

Answer 4

Severe myalgias and fatigue (flu-like symptoms)

Question 5

Which hepatitis drug causes dose-related side effects of bone marrow suppression and neurotoxicity?

Answer 5

Interferons

Question 6

Why is PEG-IFN preferred to IFN?

Answer 6

Only requires 1 infusion per week instead of 3

Question 7

Which drug’s anti-viral effect is based on a JAK-STAT pathway terminating in formation of an ISGF3:DNA complex?

Answer 7

Interferon

Question 8

2’5’-AAA –> Ribonuclease L: DRUG & FUNCTION

Answer 8

degrades viral RNA; interferon

Question 9

Phospho-eIF: DRUG & FUNCTION

Answer 9

inhibits protein synthesis; interferon

Question 10

Which inflammatory cell type is upregulated by interferons?

Answer 10

Th1

Question 11

Which treatment is appropriate for patients with decompensated HBV?

Answer 11

NRTI’s ONLY

Question 12

Which is better tolerated: NRTI’s or Interferons?

Answer 12

NRTI’s

Question 13

Which hepatitis drug class inhibits (viral DNA polymerase)?

Answer 13

NRTI’s – also called reverse transcriptase

Question 14

Which NRTI is appropriate to use in a patient with a history of MDRHBV? Why?

Answer 14

Tenofovir! It doesn’t require phosphorylation by host cell kinases.

Interferons are also a good choice if the patient isn’t decompensated

Question 15

What is the primary deadly side effect of Tenofovir?

Answer 15

Renal tubular acidosis

Question 16

What is the primary indication for Entecavir?

Answer 16

It is safe in renal patients

Question 17

Lamivudine is rarely used because of its high resistance profile. What mutation confers resistance to Lamivudine?

Answer 17

YMDD –> YVDD in HBV polymerase

Question 18

Which drug is less likely to work if the patient is resistant to Lamivudine?

Answer 18

Entacavir

Question 19

Which 2 HBV drugs also treat HIV?

Answer 19

Tenofovir

Lamivudine

Question 20

What are the 2 serious side effects of Ribavirin?

Answer 20

Anemia

Fetal death

Question 21

Which drug for hepatitis C is a guanosine nucleoside analog?

Answer 21

Ribavirin

Question 22

Which hepatitis drug requires monthly pregnancy testing up to 6 months after treatment has ended?

Answer 22

Ribavirin

Question 23

Simeprevir, Sofosbuvir, and Ledipasvir are HCV drugs in this class.

Answer 23

Direct acting anti-virals (DAA’s)

Question 24

Why is Simepravir used less often than Sofosbuvir and Ledipasvir?

Answer 24

It only treats HCV-I. The others treat all genotypes.

Question 25

Which DAA targets the catalytic site of the NS3/4A protease?

Answer 25

Simepravir

Question 26

Which DAA targets the NS5B dependent RNA polymerase?

Answer 26

Sofosbuvir

Question 27

Which DAA requires host cell phosphorylation?

Answer 27

Sofosbuvir

Question 28

Which DAA blocks replication and assembly at the NS5A protein?

Answer 28

Ledipasvir

Question 29

Which DAA has the highest rate of drug resistance?

Answer 29

Ledipasvir

Question 30

List as many of the 5 effects of Ribavirin as you can

Answer 30

1- inhibit IMP dehydrogenase (deplete nucleotide triphosphate pools) 2- inhibit 5' cap formation 3- inhibit viral RNA polymerase 4- induce mutagenesis (as ribavirin triphosphate) 5- potentiate Th1 effects of interferon

Question 31

Which condition predisposes a patient on Ribavirin to develop anemia?

Answer 31

Renal insufficiency

Question 32

What is the standard drug treatment in co-existant HBV/HCV?

Answer 32

Ribavirin & PEG-IFN

Question 33

Percentage range for "moderate emesis risk" chemotherapy

Answer 33

30-90%

Question 34

"-etrons" are anti-emetics that block this receptor

Answer 34

5HT3

Question 35

"-prepitants" are anti-emetics that block this receptor

Answer 35

NK1 (Substance P)

Question 36

Most H1 blockers end in "zine." Name the 2 that don't.

Answer 36

Diphenhydramine | Doxylamine

Question 37

Phenothiazines are dopamine receptor blockers that unfortunately end in "zine". Name them.

Answer 37

Chlorperomazine Perphenazine Prochlorperazine "Chlor per chlor"

Question 38

Which dopamine antagonist is classified as a butyrphenone?

Answer 38

Haloperidol

Question 39

Drugs that end in "amide" belong to this class.

Answer 39

Dopamine blockers (other)

Question 40

Which receptor does Scopolamine target?

Answer 40

M1

Question 41

Which receptor is targeted by Dronabinol and Nabilone?

Answer 41

Cannibinoid

Question 42

Which 2 drug classes should you recognize as non-specific (off-label) anti-emetics?

Answer 42

Steroids | Benzos

Question 43

Which classes of anti-emetics are contra-indicated with anti-arrhythmics because they can cause Long QT syndrome?

Answer 43

5HT3 blockers D2 blockers (because of A2 blockade effects)

Question 44

What effect do SSRI's have on 5HT3 blockers?

Answer 44

They may decrease their efficacy

Question 45

Which anti-emetic acts at vagal nerve terminals?

Answer 45

5HT3 blockers | NOTE: cannabinoids via GPCR decrease 5HT3 secretion from vagal terminals

Question 46

Which cells in the intestine secrete 5HT?

Answer 46

Enterochromaffins

Question 47

Does odansetron affect serotonin secretion in the intestine?

Answer 47

NO

Question 48

Which 2 classes of anti-emetics act directly on the CTZ?

Answer 48

NK1's (substance P) | Dopamine blockers

Question 49

Which 2 drugs are often used as nausea prophylaxis in surgery? (hint: 1 is a prodrug of the other)

Answer 49

Aprepitant | Foseprepitant

Question 50

What is the primary concern when prescribing NK/Substance P blockers?

Answer 50

CYP interactions

Question 51

Which 3 classes of anti-emetics exhibit anti-cholinergic effects?

Answer 51

M1 blockers Dopamine blockers Histamine blockers

Question 52

Which 2 classes of anti-emetics act in the vestibular system?

Answer 52

M1 blockers | H1 blockers

Question 53

Which H1 blocker has the longest half life?

Answer 53

Meclizine (dramamine)

Question 54

Which drug classes are preferentially used for motion sickness?

Answer 54

H1 blockers | M1 blockers

Question 55

Which classes of anti-emetics have the strongest anti-emetic potential?

Answer 55

5HT3 blockers | Cannabinoid stimulants

Question 56

What are the 3 non-dopamine receptor types affected by D2 blockers?

Answer 56

1- M1 (anti-muscarinic) 2- H1 3- Alpha adrenergic

Question 57

Drug class: Metoclopramide

Answer 57

D2 blocker

Question 58

Which anti-emetic causes diarrhea in healthy people, but is used to treat diabetic gastroparesis and dysmotility?

Answer 58

Metoclopramide (D2 blocker)

Question 59

What are the side effects of metoclopramide (D2)?

Answer 59

1- procholinergic --> diarrhea (only one in this class) 2- achalasia (increased LES tone) 3- weak 5HT3 inhibitor 4- no impact on GI secretions

Question 60

Which D2 blocker is renally eliminated?

Answer 60

Metoclopramide

Question 61

Which anti-emetics are contraindicated with many blood pressure drugs because they can cause severe hypotension? (2 classes)

Answer 61

D2 blockers | Cannabinoids

Question 62

Which receptor type is NOT in the VC (NTS)?

Answer 62

D2

Question 63

Which receptor types are NOT in the CTZ?

Answer 63

H1, M1

Question 64

Where are the central (CB1) and peripheral (CB2) cannabinoid receptors located?

Answer 64

CTZ/VC

Question 65

Which cannabinoid is schedule 2? Which is schedule 3?

Answer 65

2- Nabilone | 3- Dronabinol -- less potent

Question 66

Which class of anti-emetics is sympathomimetic (increases HR and BP)?

Answer 66

Cannabinoids

Question 67

Standard of treatment: mild CINV

Answer 67

Monotherapy; steroids or 5HT3, day of

Question 68

Standard of treatment: moderate CINV

Answer 68

Dual therapy: steroids and 5HT3, day of, then just the steroid for 3 days

Question 69

Standard of treatment: severe CINV

Answer 69

Triple therapy: steroids, 5HT3, and NK/SubP for day of + 3 days

Question 70

Which drug class is indicated for vertigo (1)?

Answer 70

H1 blocker

Question 71

Which drug class may be packaged with pyridoxine?

Answer 71

H1 blocker

Question 72

What is the first line treatment for morning sickness?

Answer 72

Pyridoxine

Question 73

Which antacid classes act at the basolateral membrane of the stomach? Which act on the luminal membrane?

Answer 73

Basolateral = M3, H2 Luminal = PPI's, Antacids, misoprostol, Pepto

Question 74

Which 2 OTC antacids are used as a treatment for hyperphosphatemia?

Answer 74

Aluminum | Calcium

Question 75

Which is the only OTC antacid that causes diarrhea?

Answer 75

Magnesium

Question 76

Which OTC antacid can cause ESRD?

Answer 76

Aluminum

Question 77

Which OTC antacid causes "Milk Alkali Syndrome" (nephropathy and alkalosis)

Answer 77

Calcium

Question 78

Which OTC antacid is contraindicated with a history of kidney stones?

Answer 78

Calcium

Question 79

Which OTC antacid causes "bicarb burp" (gas and flatulence)

Answer 79

Sodium

Question 80

Which 2 OTC antacids cause alkalosis?

Answer 80

Na, Cl

Question 81

Which 2 OTC antacids have the shortest onset and longest duration

Answer 81

Ca, Mg

Question 82

Which OTC antacid supplement eliminates gas by acting as a surfactant to decrease the surface tension in the gut?

Answer 82

Simethicone

Question 83

Which transporter is targeted (BUT NOT DIRECTLY DAMAGED) by OTC antacids?

Answer 83

H/K ATPase

Question 84

Which drug class can cause "rebound" acid production in GERD?

Answer 84

OTC Antacids

Question 85

Which drug class used in the treatment of GERD can cause achalasia (+ tone LES)?

Answer 85

OTC Antacids

Question 86

What warning should patients be given about taking their other medications with antacids?

Answer 86

Never take any other drugs with antacids!

Question 87

Which GERD drug can cause gynecomastia? What class does it belong to?

Answer 87

Cimetidine (H2 blocker)

Question 88

Which 2 drugs used in PUD are very strong CYP inhibitors?

Answer 88

Cimetidine, Omeprazole

Question 89

Which alternative to Cimetidine has fewer side effects but is contraindicated in pregnancy?

Answer 89

Ranitidine (dead baby in a car) | Omprazole would also be a correct answer

Question 90

Which surface-acting agent may be used preferentially in duodenal ulcers?

Answer 90

Sucralfate

Question 91

Which drug may be packaged with diclofenac in ulcer patients who need NSAIDs?

Answer 91

Misoprostol

Question 92

Omeprazole is more effective at eliminating acid than Cimetidine. Why, then, would you choose Cimetidine?

Answer 92

It has a much faster onset (1 hour versus several days)

Question 93

Which drug class for PUD can cause blood dyscrasia?

Answer 93

H2 blockers

Question 94

Which drug class for PUD causes these side effects: - increased risk of C diff - increased risk of MI - increased risk of AKI - increased risk of fracture

Answer 94

PPI's

Question 95

Most PUD drugs are contraindicated in renal failure. Which is the only one contraindicated in liver failure?

Answer 95

PPI's

Question 96

Which drug class for PUD has a cytoprotective effect -- increasing the concentration of PG's and EGF -- without affecting acid concentrations?

Answer 96

surface acting (sucralfate)

Question 97

Which is the only drug class for PUD that has no effect on acid concentration?

Answer 97

surface acting (sucralfate)

Question 98

How do PG-E1 analogs treat PUD?

Answer 98

1- increase PG's --> reduce HCl secretion | 2- increase mucosal defense --> increase bicarb and bloodflow

Question 99

Which PUD drug is contraindicated in IBD?

Answer 99

Misoprostol (causes diarrhea)

Question 100

Which PUD drug cannot be taken with anticoagulants

Answer 100

Pepto

Question 101

Which PUD drug is contraindicated with active GI bleeding?

Answer 101

Pepto

Question 102

What is triple therapy for PUD? How often do you take it?

Answer 102

PPI, Clarithromycin, Amoxicillin or Metronidazole BID

Question 103

Helidac and Pylera are quadruple therapies. What is quadruple therapy for PUD? HOw often do you take it?

Answer 103

PPI or H2, Clarithomycin, Metronidazole, Pepto

Question 104

Which 2 drug classes can cause a false negative H. pylori test, other than antibiotics? (patients need to stop taking 4 weeks prior)

Answer 104

PPI's | Pepto

Question 105

Triple and quadruple therapy for H. pylori take about 2 weeks. Then what?

Answer 105

Give PPI or H2 blocker for at least 2 more weeks

Question 106

What are the 2 first line drugs for heartburn in pregnancy?

Answer 106

OTC anatacids Sucralfate (Ranitidine and Lansoprazole are only ok if very bad)