Pharmacology Flashcards
1
Q
What is the role of raltegravir in HIV management
A
integrase inhibitor
2
Q
Which abx can precipitate Serotonin syndrome when combined with an SSRI?
A
Linezolid
3
Q
What is the pharm therapy for alzheimers?
A
cholinesterase inhibitors (donepezil) NMDA receptor antagonist (memantine)
4
Q
What is the mechanism of action of the only drug to treat influenza?
A
Zanamivir - inhibits viral neuraminidase
5
Q
What drug is used to treat Strep Pneumo Pneumonia
A
Penicillin-based (beta lactam)
6
Q
What are 3 drugs that can be used for MRSA?
A
Vancomycin
Daptomycin
Linezolid
7
Q
Which antifungal drug targets the enzyme responsible for producing a fungal wall polysaccharide
A
Echinocandins - caspofungin
8
Q
What drug has shown to improve survival in HF patients due to LV systolic dysfunction
A
Beta blockers
9
Q
Drug interaction between Lithium and what 3 drugs can precipitate Chronic lithium toxicity (confusion, ataxia, neuromuscular excitability)?
what is one of the most common fx of lithium toxicity?
A
ACE inhibitors
nonsteroidal inflammatory drugs
thiazide diuretics
TREMOR
10
Q
High dose corticosteroids can cause an increase in what immune cell?
A
Neutrophil
11
Q
What is the equation of Volume of distribution of a drug?
A
amount of drug in body/plasma drug concentration
12
Q
What is the equation of Clearance of a drug?
A
rate of elimination of drug/plasma drug concentration
= Volume of distribution * Kc(elimination constant)
13
Q
What is the equation for half-life of a drug?
A
t1/2 = (0.693 x Vd)/CL in first order elimination
14
Q
what three drugs have zero order elimination?
A
(PEA)
Phenytoin
Ethanol
Aspirin
15
Q
What can result in MAO inhibitors and ingestion of tyramine rich foods (cheese, wine)
A
Increased active presynaptic neurotransmitters, increased sympathetic stimulation = HYPERTENSIVE CRISIS
16
Q
what class of drug is Bethanechol, Carbacol, Methacholine, and Pilocarpine? What are their uses?
A
Cholinomimetic agents - Direct agonists
Bethanechol - activates bowel, bladder (post op)
Carbachol - relieves intraocular pressure in open angle glaucoma
Methacholine - challenge test for asthma dx
Pilocarpine - open/closed angle glaucoma, xerostomia (Sjogren syndrome)
17
Q
What is the receptor selectivity of:
- Norepinephrine
- Epinephrine
- Isoproterenol
A
- a > b = CO same, bradycardia, increased peripheral resistance
- a~b = increased CO, tachycardia, decreased peripheral resistance (B2>a)
- B > a = increased CO, decreased MAP, increased HR, increased pulse pressure
18
Q
What is the mechanism of Clonidine, Guanfacine
A
a2-agonists - used in Hypertensive urgency, ADHD, Tourette
19
Q
What is the preferred first-line treatment for patients with moderate-severe Rheumatoid arthritis?
What are some side fx of this drug? what is the mechanism of action?
A
Methotrexate - inhibits Dihydrofolate reductase
-inhibits growth of rapidly dividing cells:
GI ulcerations
Alopecia
Pancytopenia
Hepatotoxicity
20
Q
What is the use of Lamotrigine
What is a serious side effect to look out for?
A
Anticonvulsant for Partial/generalized seizures
–look for skin rash: (Steven-Johnson Syndrome, Toxic epidermal necrosis)
21
Q
What are the antipsychotics
- low potency (2 non-neurological)
- high potency (2 neurological)
A
- Chlorpromazine, Thioridazine
2. Haloperidol, Fluphenazine
22
Q
What are the side fx of antipsychotics
- low potency (Chlorpromazine, thioridazine)
- high potency (haloperidol, fluphenazine)
A
- Sedation, Anticholinergic, Orthostatic hypotension
2. EXTRAPYRAMIDAL Sx (Acute dystonia, Akathisia, Parkinsonism)
23
Q
What drug should be administered in the case of:
pneumonia pt administered ceftriaxone
-develops trouble breathing, abdominal cramps, lightheadedness. Hypotension, diffuse maculopapular rash
A
anaphylactic shock - give epinephrine
24
Q
What is the mechanism of action of Nedocromil and Cromolyn?
A
Prevent Mast cell degranulation
25
What is classification and mechanism of action of Dofetilide, Amiodarone, Sotelol?
Class III antiarrhythmic - potassium channel blocker, acts on Phase III
26
a pt is on systemic chemotherapy and develops hemorrhagic cystitis. What is the responsible agent(s) and What could have prevented these symptoms?
Cyclophosphamide, Ifosfamide - cause toxic substance acrolein to be excreted in urine
-give mesna (2-mercaptoethanesulfonate)
27
Which are the cardioselective beta blockers?
selective for B1
"A BEAM of beta-1 blockers"
```
Atenolol
Betaxolol
Esmolol
Acebutolol
Metoprolol
```
also: bisoprolol, nebivolol
28
What is the adrenergic receptor in the eye?
Alpha-1
29
What is the adrenergic receptor in the uterus? what drugs are used for stimulation and what is the result?
Beta-2
| Ritodrine, Terbutaline - uterine relaxation (TOCOLYSIS)
30
After the administration of an oral opioid, right upper quadrant pain occurs. vital signs are normal. What has happened?
Mu opioid analgesic - contraction of smooth muscle cells in Sphincter of Oddi = spasm
= Biliary Colic (increase common bile duct pressure)
31
What two drugs display competitive inhibition of Iodine transport into the thyroid?
Sodium-Iodide competitive inhibitors
Perchlorate
Pertechnetate
32
What is the mechanism of action of Ethosuximide?
Blocks T-type Ca2+ channels in thalamic neurons
33
What is the mechanism of action of Phenytoin, carbamazepine, and Valproic acid?
inhibits neuronal high-frequency firing by reducing Sodium channels ability to recover after depolarization
34
what is the mechanism and use of Mifeprostol in pregnancy?
Progesterone Antagonist
used in combo with misoprostol to terminate pregnancy
35
Identify the drug:
used to prolong QT interval
a/w lower incidence of torsades de pointes
Amiodarone
36
What is the antidote for Arsenic poisoning?
Dimercaprol, Succimer
37
What is the antidote for B-blocker toxicity?
Saline, atropine, glucagon
38
What is the antidote for copper overdose?
Penicillamine, trientine
39
What is the antidote for Heparin?
Protamine sulfate
40
What is the antidote for Warfarin?
Vitamin K, Fresh frozen plasma
41
What drugs are P450 inducers?
"Guiness, Coronas, and PBRS induce Chronic Alcoholim"
```
Griseofulvin
Carbamazepine
Phenytoin
Barbiturates
Rifampin
St. John's Wort
Chronic Alcoholism
```
42
What drugs are P450 inhibitrs
CRACK AMIGOS
```
Ciprofloxacin
Ritonavir (protease inhibitors)
Amiodarone
Cimetidine
Ketoconazole
Acute Alcohol
Macrolides (erythromycin, clarithromycin)
Isoniazid
Grapefruit juice
Omeprazole
Sulfonamides
```
43
What is the use and mechanism of Varenicline?
partial agonist of nicotinic acetylcholine receptor
-used for nicotine cravings and decreases pleasure from nicotine products (decreases dopamine release)
44
What is the mechanism and use of Theophylline?
1. Blocks Adenosine receptor (causes arrhythmia)
| 2. competitive nonselective phosphodiesterase inhib
45
What is the antidote for atropine toxicity?
Physostigmine ("Fix-o-stigmine")
46
Which antihypertensive drugs taken during pregnancy can cause the POTTER sequence? What is the mechanism of Injury?
ACE inhibitors
Angiotensin II inhibitors (-sartan)
Those drugs prevent Angiotensin II from properly helping fetal kidney development - reduced fetal diuresis = oligohydramnios
47
What is the difference between Loop Diuretics and Thiazides regarding the electrolyte abnormalities they can cause?
Loop Diuretics - HYPOcalcemia
| Thiazides - HYPERcalcemia
48
Statins cause an increase in what in hepatocytes as a response to decreased total cholesterol?
increased in hepatocyte LDL-receptors to increase uptake of circulating LDL
49
What is the mechanism of action of cholestyramine?
Bile-acid binder in the gut preventing reabsorption. This causes the liver to increase cholesterol use to make more bile, decreasing free cholesterol
50
What type of drug is effect in preventing chemotherapy-induced vomiting?
5-HT3 receptor antagonists (Ondansetron, granisetron, dolasetron)
51
Why do older patients received a decreased dose of digoxin?
Renal excretion impairment
52
What is the most dangerous adverse effect of amphotericin B? What are the symptoms?
Nephrotoxicity
increased membrane permeability in distal tube = Hypokalemia + Hypomagnesemia
= WEAKNESS + ARRHYTHMIAS
53
Which antihistamines has less CNS fx that first generation antihistamines??
Loratadine
| Cetirizine
54
What is the mechanism of action of Heparin?
Lowers the activity of thrombin and factor Xa
55
Which abx causes a disulfiram-like effect? (
Metronidazole
| Cefoperazone, Cefamandole (third/second gen cephalosporins)
56
What does Phase I metabolism of a drug do?
Addition of functional group (reduction, oxidation, hydrolysis)
to make it more water soluble so it can be excreted by the kidney
57
Which antimalarial drug can cause neuropsychiatric disturbances?
Mefloquine
58
Which topic musculoskeletal pain relief medication works by depleting neurons of substance P
Capsaicin
59
What is the pathogen responsible for Tinea Versicolor?
What is treatment?
Malassezia furfur - spaghettic and meatball on KOH
Selenium sulfide
60
What is a well known complication of Celecoxib (COX-2 inhibitor)?
Thromboses - stroke, MI
61
What is an adverse effect of 5-Fluorouracil?
what drug is this often administered in conjunction with?
Myelosuppression
often given with leucovorin
62
What primary action should be taken to prevent recurrence of gout?
Allopurinol - xanthine oxidase inhibitor
| --decreases production of uric acid
63
describe the pharmacologic phenomenon:
cortisol has NO DIRECT vasoactive properties
NE + cortisol causes increased vasoconstriction than NE alone
Permissiveness - one hormone allows another to exert its maximal effect
64
What is the use and mechanism of Fenoldopam?
IV used in hypertensive emergency especially in patients with renal insufficiency
- selective peripheral dopamine-1 receptor agonist
- causes arteriolar dilation, increases renal perfusion, promotes diuresis and natriuresis
65
Which medication class is used to treat supraventricular tachycardias such as those caused by atrial fibrillation by binding to sodium fast channels responsible for phase 0 depolarization
what circumstance does this drug have a higher effect? what happens?
Class 1C antiarrythmic
Flecainide
propafenone
have a increased effect at higher heart rates?
--causes a prolonged QRS as a result
66
What is the Mechanism and use of Gemfibrozil, bezafibrate, fenofibrate? What are two adverse effects?
Upregulate LDL = increased triglyceride clearance, activates PPAR-alpha to induce HDL synthesis (decrease LDL, increase HDL, greatly decreases TG)
67
What is the mechanism of Digoxin?
inhibits Na+/K+ ATPase = indirect inhibition of Na+/Ca2+ exchanger = increase intracellular Ca2+
=POSITIVE INOTROPY
-stimulates vagus nerve = DECREASE HR
68
Which antiarrhythmics are best used Post-MI? why?
Class 1B antiarrythmic:
Lidocaine
Mexiletine
-preferentially affect ischemic or depolarized Purkinje and ventricular tissue
69
Pregnant lady present with a DVT in her left calf. What is the best treatment?
Low-Molecular Weight Heparins (Enoxaparin)
70
What is the pharm that causes drug induced lupus?
SHIPP
```
Sulfonamides
Hydralazine
Isoniazid
Procainamide
Phenytoin
```
71
What needs to be monitored in patients on:
1. Warfarin
2. Heparin
1. PT
| 2. PTT
72
What forms are Hepatitis is there is a vaccination for ?
Hep A, B
73
What is the use/mechanism of Metoclopramide? What is a side effect to be careful of
stims the intestines - diabetic and postsurgery gastroparesis, antiemetic
D2 receptor antagonist, does not influence colon transport time
-side fx: D2 antagonist so DONT USE WITH PARKINSONS
74
What is the biochemical signalling involved with vagal activation of gastric parietal cells?
Vagal stim - ACh - binds M3 receptor
- stims Gq subunit
- activates PLC
- DAG, ITP
- increased intracellular Ca2+
75
65 year old presents with two days of melanotic stools, early satiety, abdominal bloating. Endoscopy shows a tumor in his stomach. Biopsy shows multiple spindle shaped cells.
What is most likely Dx, what is the associated gene defect?
GIST (gastrointestinal stromal tumor)
- -c-KIT
- -always spindle shaped
76
What gene defect is related to melanin spots on lips + buccal mucosa, colonscopy showing multiple hamartomatous polyps
Peutz-Jegher Syndrome
| STK11 gene
77
A pt with portal hypertension has esophageal varices. Which vein does the esophageal vein drain into intially? What other vein does the esophageal vein anastamose with?
drains into Splenic vein which drains into Superior mesenteric Vein
anastamoses with the Left gastric V
78
What other autoimmune disease is associated with Celiac sprue/dz?
Hashimotos (autoimmune thyroiditis)
79
Which two diarrheal diseases should be reported to the CDC?
Salmonella
| Shigella
80
What is the first line treatment for Parkinson's disease? what is a side effect prevented by a conjunct pharmaceutical?
Levodopa-carbidopa
carbidopa - prevents peripheral conversion of levodopa to dopamine
----prevents DIZZINESS/ORTHOSTASIS
81
What is a antiarrythmic drug that increases Digoxin toxicity? what is an antiarrythmic drug that can help with digoxin toxicity?
quinidine - increases toxicity
| lidocaine - can help dysrhythmias caused by digoxin toxicity
82
what is the mechanism of action of Metronidazole?
Forms free radicals that damage DNA
83
What is the mechanism and possible use of sirolimus?
binds to mTOR = inhibits T-cell proliferation in response to IL-2
used w cyclosporine and corticosteroids to suppress organ rejection
84
identify dz and mechanism:
33 year old italian female presents with left eye pain and blurry vision for one week. Hx: recurrent oral and genital ulcers, the most recent resolving two weeks ago. Bilateral tender, erythematous pretibial nodules
Behcet syndrome - activation of complement system by circulating antibody complexes
-recurrent oral aphthous ulcers, genital ulcers, uveitis, joint arthorpathy, panniculitis (inflamation of the subq fat layers beneath skin = erythema nodosum)
85
How do Aspirin and Naproxen differ?
both are NSAIDs
1. Aspirin IRREVERSIBLY inhibits COX
2. Naproxen REVERSIBLY inhibits COX
86
What is the most serious side effect of a TB drug that causes red/orange urine?
what is the mechanism of action?
rifampin - Hepatotoxicity
| --inhibits DNA-dependent RNA polymerase
87
Which antihypertensive should be used in pts with CREST syndrome?
ACE inhibitors - inhibits vasoconstriction - preventing further vascular damage and
"scleroderma renal crisis"
88
Which two abx have an adverse side effect of ototoxicity? which one causes it more often?
Aminoglycosides (ie Gentamicin)
Vancomycin - cause ototoxicity LESS OFTEN
89
How long does it take for a drug administered at a constant rate of infusion to reach steady state?
4-5 half lives
90
What is the equation for Maintenance Dose, Desired Plasma Concentration, Clearance, and Bioavailability?
Maintenance Dose = (CP * CL)/F
Cp - desired plasma concentration
CL - clearance
F - Bioavailability
91
HIV patient is put on anti-retroviral therapy. He now complains of fatigue and dyspnea, new systolic murmur heard on cardio ausc. Labs show anemia nad reticulocytopenia. what is the drug administered?
Zidovudine - NRTI
--causes bone marrow suppression = anemia, reticulocytopenia
(inhibits DNA synthesis in bone marrow cells)
92
What are the nonselective Beta blockers? what is a contraindication?
```
PNPT
Propanolol
Nadolol
Pindolol
Timolol
```
contraindicated in pts with asthma and COPD
93
What are the two most common side effects of Aminoglycosides (ie gentamicin)
Ototoxicity
| Nephrotoxicity
94
10 year old pt has repeated infections (Aspergillus skin infection @ 2, Staph aureus tooth abscess @5). Nitroblue tetrazolium staining test is negative. What is the likely dx?
Chonic Granulomatous Disease - lack of oxygen-dependent microbial killing
95
What is the use/mechanism of action of flumazenil
Benzodiazepine overdose antidotes
-competitive antagonish at the GABA receptor - decreases POTENCY
96
Identify Abx:
Treat necrotizing fasciitis
broad spectrum active against wide range of aerobic, anaerobic gram-positive, and gram negative bacteria
Broad spectrum Carbapenem (Meropenem)
97
Why is chlamydia trachomatis (gram negative bacterium) resistant to penicillins?
Cell wall lacks MURAMIC ACID
- --most other bacteria have this
- --beta-lactam abx need muramic acid to disrupt cell wall
98
what is the mechanism of the intramuscular injection therapy for a neisseria gonorrhea infection?
what is the oral therapy
Intramusc - Ceftriaxone
Oral (initial management of choice) = Azithromycin - Inhibition of peptide translocation on the bacterial ribosome
99
Which antifungal leads to accumulation of lanosterol in fungal cell membranes? what is a common use?
Fluconazole - treat cryptococcal meningitis (affects HIV, immunocompromised pts)
--inhibits conversion of lanosterol to ergosterol in fungal membranes
100
What are two pharm therapies (which is preferred) for bronchoalveolavage fluid contains organisms w septate hyphae Y-shaped branching pattern using a Gomori methenamine silver stain?
Asperigillus fumigatus
- -Voriconazole - Preferred
- -Amphotericin B - renal side effects
101
Pt presents w nausea, vomiting, diarrhea after being administered with high dose of Methotrexate.
what is antidote?
Leucovorin - folic acid analogue used to reverse methotrexate toxicity
102
What is the mechanism of carbidopa?
Inhibits DOPA DECARBOXYLASE
=decreases plasma dopamine levels
103
How does aspirin cause attacks of gout?
competes with uric acid for renal excretion
104
Which tuberculosis drug can cause blurred vision/loss of acuity?
what is the mechanism?
Ethambutol - inhibits Arabinosyl transferase
| -obstructs formation of cell wall = bacteriostatic
105
What is the most common initial step in lyme disease therapy? what is a common side effect?
initial Tx = Doxycycline
| ---phototoxic dermatitis
106
What is the drug/primary mechanism used in motion sickness? (ie child getting sick in the morning on the way to school on the school bus)
Scopolamine - muscarinic antagonist
107
What is the initial step in management of Raynaud's phenomenon?
Calcium channel blockade in smooth muscle cells
108
Which antiepileptic drug is the only p450 inhibitor?
Valproic acid
109
What is the mechanism of ketamine? side fx?
blocks glutamate receptors
--can cause vivid dreams and hallucinatiosn commonly post-op
110
What abx should be used in a pt bitten by a stray can that is allergic to sulfa and penicillin?
Pasteurella multocida - gram negative rod
--use Doxyycline - alternative to penicillin and sulfa if there is an allergy
111
Which sedating benzo should be used in a pt with liver cirrhosis
Lorazepam (NOT diazepam)
---lorazepam goes straight into phase II metabolism, diazepam needs phase I
112
pt with ALL is started on Allopurinol b/c of high uric acid levels. what other medication should be adjusted?
6-mercaptopurine
- --xanthine oxidase is involved in metabolism of mercaptopurines
- -allopurinol inhibits xanthine oxidase
