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USMLE Step 1 flashcards > Pharmacology > Flashcards

Pharmacology Flashcards

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USMLE® Step 1 flashcards
1
Q

Which immunosupresants agents cause nephrotoxicity? Which is their mechanism of action?

A
  • Cyclosporine, Tacrolimus

- Calcineurin inhibitors – prevents IL-2 transcription

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2
Q

Why the PT and INR remain normal after two days of initiate warfarin?

A

Long half-life of factor II (prothrombin)

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3
Q

what is the reason to avoid antiacids (calcium carbonate) when use fluoroquinolones and tetracyclines?

A

Can chelate and decreased effectiveness of other drugs

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4
Q

which are the praziquantel and albendazol mechanisms of action?

A
  • Praziquantel: increases the permeability of the membranes for calcium ions—induces contraction of the parasites, resulting in paralysis.
  • Albendazol: inhibiting its polymerization or assembly into microtubules, decreased production por ATP.
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5
Q

why desmopressin is the treatment of von Willebrand disease?

A

Increases vWf release form weibel palade bodies from endothelial cells

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6
Q
  1. Drugs with low solubility in blood =
  2. Drugs with high solubility in lipids =
    Give an example
A
  1. = Rapid induction and recovery times.
  2. = high potency = 1 /MAC
    Examples: nitrous oxide (N2O) has LOW blood and lipid solubility, and thus fast induction and low
    potency.
    Halothane, in contrast, has high lipid and blood solubility, and thus high potency and slow
    induction.
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7
Q

what is Imatinib?

A

Is tyrosine kinase inhibitor of BCR-ABL (Philadelphia chromosome fusion gene in CML) and c-kit
(common in GI stromal tumors).

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8
Q

which is the use of probenecid in neurosyphilis and gonorrhea?

A

in penicillin resistance cases, because increase the serum concentraction, inhibits organic anion transporters in kidney (penicillin are secreted by this transporters)

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9
Q

Clinical manifestations of hyperestrogenemia in cirrhotic patients

A
  • Spider angiomata
  • testicular atrophy
  • dupuytren contracture
  • Ginecomastia
  • palmar erythema
  • decreased body hair
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10
Q

Which is the reason to use paclitaxel in percutaneous coronary intervention?

A

paclitaxel binding to b-tubulin and prevents breakdown microtubules—- prevents stent restenosis by preventing intimal hyperplasia

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11
Q

Entacapone

A

Inhibit COMT (cathecol O- methyl transferase): increase bioavailability of levodopa by inhibiting peripheral inhibition

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12
Q

Bumetanide

A

Loop diuretic

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13
Q

Chlorlthalidone

A

thiazide diuretics: inhibit Na/ Cl cotransporter in distal convoluted tubule

Adverse effects: Hipokalemia, Hyponatremia, descreased insuline secretion and cause hypercholesterolemia

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14
Q

6- mercaptopurine

A

Is a cytotoxic purine analog— inhibits the novo synthesis of purines
Inhibited xantine oxidase
Do not give with allopurinol because increased toxicity or decreased effects

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15
Q

Calcipotriene

A

Psoriasis
Vit D analog: bind to the receptor and activated a nuclear transcription factor———- that inhibits keratiocyte proliferation

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16
Q

repaglinide

A

Meglitinides: secretagogous, insulin secretion— by clousing K+ channels

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17
Q

Foscarnet

A

pyrophosphate analog
used in CMV resistant to ganciclovir
could chelate calcium— hypocalcemia
Induced renal wasting of Mg —– Hypomagnesemia

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18
Q

Most common side effect of SSRI´s

A

sexual dysfunction

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19
Q

Most common side effectt of ethambutol

A

blurred vision secondary to optic neuropathy

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20
Q

blood/ gas partition

A

Anesthesic solubility in blood

If it is high= slower onset of action

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21
Q

Why nondyhidropyridine calcium channel blockers do not have effect in skeletal muscle?

A

Because skeletal muscle is not dependent on extracellular calcium influx

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22
Q

Varenicline

A

partial agonist of alpha4beta2 nicotinic acetyl choline receptor, competes with nicotine
Reducing nicotine craving

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23
Q

Hydroxyurea

A

Inhibits ribonucleotide reductase

increased fetal Hb synthesis

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24
Q

Fibrates and gallstones

A

Inhibit 7 alpha hydroxylase — catalyzes bile acids synthesis

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25
Q

Omalizumab

A

Anti IgG1 monoclonal antibody— binds to IgE inhibit the action
useful in severe asthma

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26
Q

Atropine poisoning

A

Anticholinergic syndrome, Hot, dry, red, blind and mad

antidote: physostigmine

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27
Q

Clordiazepoxide

A

long acting benzodiazepines with active metabolites—- as diazepam. Treatment in alcohol withdrawal

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28
Q

Finasteride

A

5alpha reductase inhibitor
conversion of testosterone to dihydrotestosterone
Treatment of BPH

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29
Q

fibrates

A

activating peroxisome proliferator activated receptor alpha (PPAR-alpha) —– increased synthesis of lipoprotein lipase

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30
Q

Thiazides diuretics

A

inhibits Na/Cl cotransporter in distal convoluted tubule —- decreasing reabsorption of Na and Cl—–decreased intravascular volumen– activating RAA system— increasing aldosterone—- increased K and H+ excretion— hypokalemia and metabolic alkalosis

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31
Q

Dapsone

A

mechanism of action similar to sulfonamides
useful in lepra treatment and P. jiroveci prophylaxis
adverse effects: hemolysis in G6PD deficiency

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32
Q

glipizide vs glubiride and glimepiride

A

short acting low risk of hypoglycemia (best option of elderly people)
glubiride and glimepiride long ancting more risk of hypoglycemia

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33
Q

How digoxin slows vetricular rate?

A

increasing parasympathetic tone — inhibits Na/K ATPase pump
and enhaces efferent parasympathetic ganglionic transmission—– increased vagal tone

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34
Q

Andrigenic alopecia treatment

A

5 alpha reductase inibitors: finasteride

35
Q

Interaction between nitrates and phosphodiesterase inhibitors

A

Cyclic GMP accumulation

36
Q

the arteriovennous concentration gradient in anesthesics mean?

A

tissue solubility

Large AV concentration= high solubility0 slow onset of action

37
Q

Treatment in cyanide poisoning

A
  • sodium nitrite
  • sodium thiosulfate
  • Hydroxycobalamine
38
Q

Non nucleoside reverse transcriptase inhibitor

A

efavirenz
Nevirapine
*** Do not require activation via intracellular phosphorilation

39
Q

Cocaine

A

Inhibited reuptake of monoamines: sympathetic stimulation

40
Q

Halothane hepatitis

A

halogenates inhalated anesthesics (sevofluorane, desflorane, isoflorane)—————metabolized by CYP 450 — Reactive intermediates that could cause direct hepatocellular damage

41
Q

trimethropine - methrotexate and pyrimetamine

A

inhibited dihydrofolate reductase

42
Q

Clozapine

A

in schizophrenia resistant cases and associated with suicidatility
adverse effects: agranulocytosis

43
Q

Amatoxins

A

Mushrooms poisoning

Inhibit DNA Polymerase II—— Synthesized mRNA: apoptosis

44
Q

Direct thrombin inhibitor

A

Argatroban, dabigatran, bivalirubin

45
Q

Nitrates exert their action by…..

A

vasodilation of peripheral veins and arteries (predominantly venodiltation)
decreased left ventricular wall stress (decreased preload) —- decreased end dyastolic pressure
decreased o2 demand of myocardial

46
Q

adverse effects of thiazide diuretics

A 
hypercalcemia----- decreased PTH 
hyponatremia
Hypok
Hypercholesterolemia
Hyperglycemia
hyperuricemia
47
Q

Phencyclidine intoxication

A

PCP —- hallucinogen, combative behavior, nystagmus, ataxia

Antagonist of NMDA receptor ——- excess release of excitatory neurotransmitters

48
Q

MAO inhibitors

A

phenelzine
tranylcypromine
Selegiline

49
Q

Which is the reason to avoid MAO inhibitors and SSRI´s

A

increased the risk of serotonine syndrome

50
Q

Colchicine

A

inhibits microtubules polymerization and leukotriene B4 synthesis

51
Q

Selective estrogen receptor modulators

A

tamoxifen: adjuvant therapy in breast cancer
raloxifen: postmenopausal osteoporosis
Competitive inhibitor of estrogen binding (agonist or antagonist activity)
adverse effects: hot flashes, endometrial hyperplasia (tamoxifen only) and thromboembolism

52
Q

neuraminidase inhibitors

A

inhibit viral particle release

Oseltamivir

53
Q

Jimson weed

A

it is a plant: anticholinergic toxins

54
Q

Cisplatin main adverse effect

A

ototoxicity: damaged stereocilia of hairy cells

55
Q

which are the changes in HR and SBP with nitrates?

A

HR: increase— reflex tachycardia
BP: decrease— main venodilation

56
Q

Pilocarpine

A

Contract ciliary muscle of eye
Cholicomimetic
Glaucoma and sjogren sx

57
Q

Which is the effect of leuprolide in prostate cancer?

A
  • is a GnRh analog
  • continuous GnRH effect for long term leuprolide use—– supresses LH release ————– reduced production of testosterone. (similar effect of surgical orchiedectomy)
58
Q

Anti TNF allpha agents

A

Infliximab: monoclonal antibody to TNF alpha
Etanercept: recombinant TNF receptor fusion protein

59
Q

Aspirin

A

NON selective irreversible inhibiting COX-1 (and COX-2) —- inhibited the synthesis of TXA2 (potent stimulator of platelet aggregation)

60
Q

Ehylene glycol poisoning

A

High aniongap metabolic acidosis
flank pain, gross hematuria and oliguria
calcium oxalate crystals

61
Q

Drugs that are implicated in SLE drug induced

A
  • procainamide
  • hydralazine
  • isoniazide
  • minocycline
  • TNF-Alplha inhibitors (etanercept)
62
Q

Side effects of non dihydropyridine calcium channel blockers

A

dyltiazem and verapamil

constipation and AV block

63
Q

methimazole and propylthiouracile

A

inhibit thyroid peroxidase (iodine organification and coupling of iodotyrosines)

propylthiouracile also decreaseperipehral conversion T4 to active T3

64
Q

Norepinephrine

A

adrenergic agonist
alpha1: increased blood pressure (IP3 pathway) *** baroreceptor reflex (bradicardia)
and beta1 recerptors: increase cAMP (Gs) increased cardiac contractility, increased heart rate
RESULT: heart unchanged

65
Q

Erythropoiesis stimulating agents adverse effects:

A

increase risk fir thrombosis embolic events— increase blood viscosity
Also develop hypertension (activation of erythropoietin receptors on vascular endothelium and smooth muscle cells

66
Q

Ramelteon

A

melatonin agonist— suprachiasmatic nucleus (useful in insomnia en erderly patients)

67
Q

Inhalation anesthesics

A

Increased GABA, Potassium channels (hyperpolarization of neuronal membranes), nicotinic and glycine receptors

  • Myocardial depression
  • Lungs: except nitrous oxide are respiratory depressants, decrease tidal volume and minute ventilation (hypercapnia), suppresion of mucociliar clearance (athelectasis)
  • Brain: decrease vascular resistance — increase cerebral blood flow
  • kidney: decrase glomerural filtration rate
  • liver: decrease hepatic blood flow
68
Q

Which is the reason of hemin and glucosa treatment in acute intermitent porphyria?

A

Down reagulating ALA synthase

becasuse the attacks in AIP are because the acummulation of ALA and PBG

69
Q

succinylcholine adverse effects

A

hyperkalemia, hypercalcemia and malignant hyperthermia

70
Q

Cell cycle independent drugs

A
    • Cross. link DNA: interfere with replication
  • alkylating agents: nitrosoureas, cyclophosphamide, busulfan
  • platinum agents: cisplatin
71
Q

Oxybutinin/tolterodine vs bethanecol

A
  1. antagonist of muscarinic receptor (urinary urgency)

2. Agonist of muscarinic receptor (pop ileus and urinary retention)

72
Q

Renal ischemia with NSAIDS

A

PGS normally vasodilate the afferent renal arteriole

NSAIDS inhibits synthesis of PGS———– vasoconstriction of afferent arteriole

73
Q

Bile acid binding resins

A

Cholestyramine, colestipol and colesevelam
Binding bile acids in Gi tract ———-inhibiting enterohepatic circulation ——————-decrease LDL levels, uptake of LDL.
Side effects: impaired absortion in gut and increase hepatic production of TAG———–Hypertryglyceridemia

74
Q

Low distribution volume

A

3-5 L—— means high charged, the drug remains in the plasma

75
Q

Relation between antihyoertensive drugs and K

** Thiazide and ACE inhibitors

A

Thiazide: HypoK

ACE inhibitors: HyperK

76
Q

inhibitation Cox 1 and 2

A

COX 1: acetylation inhibits generation of TMX A2 in platelets
Cox 2: acetylation bloxks PGS production in inflammatory cells

77
Q

Two specific symptoms of opiod withdrawal

A

Yawning and lacrimation

78
Q

Nitrates and nitrites action mechanism

A

activate guanylyl cyclase— increased cGMP — myosin light chain dephosphorylation: relaxation

79
Q

Imatinib

A

tyrosine kinase inhibitor of BCR-ABL—- useful in Chronic myeloid leukemia

80
Q

lithium side effects

A

hypothyroidism
Nephrogenic diabetes insipidus
movements (tremor)
ebstein anomaly (cardiac, tricuspid valve)

81
Q

Ribavirin

A

treat for hep C and respiratory syncytial virus
inhibited the synthesis of nucleotides: competitively inhibited inosine monophosphate dehydrogenase —- interferes duplicate of viral genetic material

82
Q

Thiazolinedione

A

Pioglitazone and Rosiglitazone
Binds to PPAR-y nuclear transcription regulator (Decrease insuline resistance)

Side effect: Na reabsorption (be careful in heart failure)

83
Q

Reed sternberg cells

A

distinctive tumor giant cells seen in Hodgkin lymphoma

Binucleated, bilobed (mirror images)

USMLE Step 1 flashcards (10 decks)

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