Pharmacology Flashcards
1
Q
Drugs that interfere with ethanol metabolism leading to disulfiram-like effects:
A
Metronidazole Griseofulvin Cephalosporins (some) Sulfonylureas (1st generation) Procarbazine
2
Q
Cimetidine use, mechanism of action and side effects:
A
Effects: anti-acid, H2 blocker
Side effects: decreases androgen production, inhibits P450
3
Q
What decreases the pain of an ulcer the fastest?
A
Antiacids (proton pump inhibitors as omeprazole)
4
Q
GI effect of aluminum:
A
Constipation (estreñimiento)
5
Q
GI effect of magnesium:
A
Diarrhea
6
Q
When we treat Parkinson’s disease with dopamine one side effect can be:
A
Vomiting
7
Q
Pharmacological properties and side effects of Omeprazole:
A
Irreversible effect
Long half life (we have to give 1/day)
SE: C. Difficile, pneumonia Acute interstitial nephritis B12 malabsorption ↓ Mg, Ca; fractures!
8
Q
OrdanSETRON, GraniSETRON effect and mechanism of action:
A
Antiemetics after surgery and in QT
Work very well on vomiting due to GI irritation as infections, QT and DISTENSION
Block serotonin receptors
Side effects: Prolong QT, constipation, headache and dizziness, serotonin sd
9
Q
Treatment options for motion sickness:
A
Scopolamine: muscarinic antagonist against M1 and M3
Diphenhydramine: 1st generation H1 antagonists that has both antiH1 and antimuscarinic!!!! properties
10
Q
Good preventing emesis in cancer treatment:
A
Ondansetron (5HT3 antagonist). To suppress acute vomiting
PrOCHLOrperazine (anti D2). On ❤️ problems
Aprepitant (Neurokinin 1 receptor blocker prevents substance P from binding NK1 receptors in the area postrema). To suppress delayed vomiting +- the others fail
11
Q
Increased 5HIAA (5-hydroxyindoleacetic acid) in urine +- flushing, diarrhea… indicates:
A
Carcinoid tumor/ syndrome
*We call it carcinoid syndrome when the tumor has made metastasis
12
Q
Phospholipase A2 enzymes action:
A
Release fatty acids from the second group of glycerol (cleave the 2nd carbon)
13
Q
Thromboxanes function:
A
Platelet aggregators
14
Q
NSAIDs side effects that acetaminophen does not cause:
A
Asthma exacerbation
Gastric distress
Cardiovascular risk
NSAIS treat pain fever and inflammation while acetaminophen treats pain and fever but not inflammation
15
Q
Avoid aspirin in kids except on:
A
Kawasaki disease
16
Q
Ketorolac use:
A
Moderate to severe pain in adults (NSAID)
17
Q
Sulindac (a NSAID) side effects:
A
Stevens-Johnson syndrome and hepatotoxicity
18
Q
All NSAIDs but aspirin are associated with:
A
Cardiovascular and thrombotic events (such as myocardial infarction and stroke)
19
Q
Celecoxib side effects and characteristics:
A
COX-2 selective inhibitor
Has less gastrointestinal effects than other NSAIDs
COX1: inhibited by NSAIDs, inhibition causes GI side effects
COX2: inhibited by all; makes prostacyclin in endothelium, inhibition causes hypercoagulation
Both expressed in kidney
Has less anti-platelets action (but might have prothrombotic effects as MI and stroke bc does not inhibit TXA2)
It is a sulfa drug
20
Q
Treatment for a kid with viral illness:
A
Acetaminophen, ibuprofen… no aspirin
21
Q
Buspirone effect and mechanism of action:
A
Anxiolytic
Partial agonist of 5HT 1a receptor
22
Q
Triptans, mechanism and effects:
A
Agonists of 5HT 1d, 1b receptors
Vasoconstrict and reduce acute migraine pain
SE: hypertensive crisis and prinzmetal (beta blockers are also contraindicated in Prinzmetal)
23
Q
5HT 3 receptor characteristics:
A
Related to emesis
When it activates opens ion channels
Not coupled to a G-prot as other 5HT receptors
‘Vomiting is fast’
24
Q
To treat an acute episode of gout we use:
A
NSAIDs
Corticoids
Colchicine
25
Antibiotic of choice for treatment of lung abscesses:
Clindamycin (anaerobic infections above the diaphragm, it is basically a macrolide for anaerobes)
26
Main side effects of thiazides (metolazone):
HyperGLUC:
HyperGlycemia, Lipidemia, Uricemia (acute gout) and Calcemia
Also hypokalemic metabolic alkalosis, hypothermia and acute kidney injury
27
Main side effects of ACE inhibitors:
Cough
Angioedema
Hyperkalemia
28
Main side effects of Ca channel blockers (-ipine), verapamil, diltiazem:
Ipines: flushing!!, edema, dizziness, lightheadedness
❤️ Verapamil (and diltiazem): makes CHF worse, AV block!!!, constipation, hyperprolactinemia, gingival hyperplasia
29
Main side effects of beta-blockers:
```
Bradycardia, AV block, heart failure, vasospasm
Fatigue, sedation, sleep alterations
Impotence
Bronchospasm, COPD/ asthma exacerbation
Mask hypoglycemia symptoms
Contraindicated in prinzmetal
```
30
Name 3 thiazide diuretics:
Hydrochlorothiazide
Chlorthalidone
Metolazone
31
Side effects of digoxin:
GI: nausea, vomiting, diarrhea
Blurry yellow vision
Arrhythmia
32
Name two nitrates:
Nitroglycerin
| Isosorbide dinitrate
33
Side effects of nitrates:
Hypotension, flushing and headache
34
H1 blocker examples, mechanism and effects:
1st: DiphENhydRAMINE, chlorphENiRAMINE, dimENhydrinate
2nd: Loratadine, Cetirizine, F(S)exofenadine
```
Reversible inhibitors of H1
Decrease allergy (help in motion sickness, sedation)
```
35
Dextromethorphan mechanism and effects:
NMDA antagonist
| Dry cough suppressant (decrease CNS excitation)
36
Expectorants examples, mechanism and effects:
Guaifenesin
N-acetylcysteine (sulfur donor disrupts disulfide bonds, antidote for acetaminophen)
Wet cough suppressants, mucolytics
37
Respiratory alpha-adrenergic agonists examples and effects:
PseudoEPHEDRINE, phenylEPHEDRINE (efe are alpha agonists), xylometazoline, oxymetazoline
Vasoconstriction
Decrease airway inflammation
Fast tachyphylaxis so rebound congestion after day 4. Stop them!
SE: hypertension, rebound congestion if used more than 4 days
38
Respiratory beta-adrenergic agonists examples and effects:
fAsT: AlbuTEROL, Terbutaline
Slow: SalmeTEROL and formoTEROL
Albuterol for Acute, Serial Salmeterol for long term
Bronchodilation
SE: tachycardia, arrhythmia, tremor, hypokalemia (look at electrolytes) masking of hypoglycemic symptoms
39
Methylxanthines examples, mechanism and effects:
AminoPHYLLINE
Inhibit phosphodiesterase
Bronchodilation (vasodilation, tachycardia, cardiotoxicity, neurotoxicity, block adenosine action)
40
Inhaled muscarinic blockers examples, mechanism and effects:
TioTROPIUM
Competitive blockers of Ach
Prevent bronchoconstriction and mucus secretion
41
Respiratory corticosteroids examples, mechanism and effects:
FluticaSOne, budeSOnide, fluniSOlide
| Antiinflamatories, exacerbation prevention
42
Cromoglycates examples, mechanism and effects:
CROMolyn, nedoCROMil
| Inhibit mast cell degranulation preventing acute asthma attacks
43
Antileukotrienes examples, mechanism and effects:
MonteLUKAST, zileuton
Leukotriene receptor blockers
Antiinflamatories and aspirin-induced asthma
44
Monoclonal Ab that can be used to treat asthma:
OmaliZUMAB
Ab against IgE Ab
Last resource in allergic asthma
45
Endothelial receptor antagonists examples and effects:
AmbriSENTAN, boSENTAN
Block endothelin receptors!!!
Prevents vasoconstriction in pulmonary HT
46
Mechanism of action of Gabapentin:
Prevents seizures by inhibiting presynaptic voltage-gated Ca ch.
47
Mechanism of action of Levetiracetam (keppra), valproate and topiramate:
Levetiracetam: blocks all but Na. Disrupts vesicle fusion in the presynaptic terminal
Valproate: blocks all but glutamate
Topiramate: blocks all but Ca
48
Metformin mechanism and effects:
Antidiabetic that decreases insulin resistance (renal failure and lactic acidosis -water soluble-)
49
Glitazones examples, mechanism and effects:
PiogliTAZONE
| Antidiabetic that decreases insulin resistance (hepatotoxicity, weight gain, heart failure -lipid soluble-)
50
Sulfonylureas examples, mechanism and effects:
First generation: TolbutAMIDE
Second generation: GLImepirIDE, GLYburIDE
Metglitinides very similar: repaGLIDINE
Antidiabetics that activate beta cells to secrete more insulin (renal failure, pancreatic cell death and hypoglycemia)
51
Name 3 examples of rapid acting insulin (1h):
Lispro, aspart and glulisine
52
Name 2 examples of long acting insulin (24h):
Glargine and detemir
53
Alpha-glucosidase examples, mechanism and effects:
Acarbose, miglitol
| Antidiabetics that prevent glucose absorption so decrease postpandrial hyperglycemia (diarrhea, bloating)
54
GLP-1/incretin analogs examples, mechanism and effects:
Exenatide, liraglutide
| Antidiabetic that activate insulin secretion (pancreatitis, nausea and vomiting)
55
Amylin analogs examples, mechanism and effects:
Pramlintide
| Antidiabetic that slows down glucose digestion and makes you feel full
56
DPP4-inhibitors examples, mechanism and effects:
LinaGLIPTIN
Antidiabetic that prevent incretin destruction so activate insulin secretion (GI inflammation, increase systemic infections)
57
SGLT2 inhibitors examples and effects:
CanaGLIFOZIN
| Increase urinary glucose loss (urinary mycotic infections, hypotension, avoid in renal problems)
58
Methimazole mechanism and side effects:
Inhibits thyroid peroxidase decreasing the amount of thyroid hormone
SE:
teratogenic (aplasia cutis, esophageal atresia and facial abnormalities)
ANCA+ vasculitis
agranulocytosis (presents with sore throat and fever)
59
Propylthiouracil mechanism and side effects:
Inhibits thyroid peroxidase decreasing the amount of thyroid hormone
Also inhibits 5-deiodinase decreasing conversion of T4 to T3
```
SE:
Less teratogenic but still crosses the placenta: give it on the 1st trimester but then change to methimazole to avoid maternal hepatotoxicity
Hepatotoxic!
ANCA+ vasculitis
Agranulocytosis
```
60
Niacin (B3) mechanism and side effects:
Antagonizes VLDL cholesterol secretion!
Increases HDL a lot
Decreases FA and VLDL secretion
Decreases LDL
SE: flushing, pruritus (PGs, give NSAIDs)
Hepatotoxicity!!
Gout
Hyperglycemia
61
Fibrates examples, mechanism and side effects:
```
FenoFIBRATE, gemiFIBRozil
Activate PPAR-alpha which increases lipoprotein lipase
Decrease VLDL production!!! (~niacin)
Decrease triglycerides a lot
Increase HDL
```
SE:
Muscle toxicity
Cholesterol gallstones (inhibit 7alpha hydroxylase)
62
Statins examples, mechanism and side effects:
LovaSTATIN
Inhibit HMG-CoA reductase
Decrease LDL a lot, reduce coronary events
SE:
Hepatotoxicity!!!
Myalgias and rhabdomyolysis
63
Bile acid resins examples, mechanism and side effects:
CHOlestyramide, COlestipol
Prevent intestinal reabsorption of bile acids
Decrease LDL
SE:
Increase TG and VLDL
GI discomfort (not in diverticulosis)
Prevent absorption of fat soluble substances, ADEK, carful if giving warfarin bc increases it's effect
Cholesterol gallstones
Satins need to be given 4h apart
Also interferes with digoxin, thiazides...
64
Cholesterol absorption blockers examples and side effects:
Ezetimibe
Decrease LDL
SE:
Hepatotoxicity if + statins or niacin
Diarrhea
65
Fish oil/omega 3 FA mechanism and effects:
Decrease VLDL and ApoB production
| Decrease TG and increase HDL
66
Finasteride mechanism and effects:
Blocks 5-alpha reductase reducing DHT and treating benign prostate hyperplasia and baldness
67
Antiandrogens examples and conditions that they treat:
Finasteride (BPH and baldness)
Flutamide (prostate ca. )
Ketoconazole and spironolactone (PCOS)
68
Tamoxifen mechanism and effects:
Antagonist of the estrogen receptor in breast and help ER+ breast ca. 🙂
Partial agonist in bone 🙂 and endometrium 🙁
It is a prodrug metabolized to active endoxifen by P450
69
Spironolactone mechanism and effects:
Aldosterone antagonist, K sparing diuretic useful to treat primary hyperaldosteronism and edema due to cirrhosis or nephrotic sd. (antiandrogen)
70
Estrogen receptor modulators examples and conditions that they treat:
Clomiphene (antagonist in hypothalamus, stimulates ovulation in PCOS)
Tamoxifen (antagonist in breast, partial agonist in bone and uterus in ER+ breast ca.)
Raloxifene (antagonist in breast and uterus, agonist in bone in osteoporosis)
71
GnRH analogs examples and effects:
```
Leuprolide
Agonist pulsatile (infertility)
Antagonist continuous (prostate ca. uterine fibroids, precocious puberty)
```
72
Danazol mechanism and effects:
Partial androgen agonist
Danazol makes you Danone (hot young man)!
Treats endometriosis and hereditary angioedema due to C1 esterase inhibitor deficiency (virilization, acne, edema, decrease HDL, hepatotoxicity)
73
Alpha 1 blockers in reproductive examples and effects:
TamsulOSIN, prazOSIN
| Relax m. In bladder and prostate in BPH (hypotension)
74
Drugs that decrease insulin resistance:
Metformin (water soluble) and tazones (fat soluble)
75
Best lipid-lowering drug to reduce LDL:
Statins. They also have cardiovascular benefits
| Also ezetimibe
76
Best lipid-lowering drug to increase HDL:
Niacin (B3). But doesn’t decrease the risk of heart events
77
Best lipid-lowering drug to reduce TG:
Fibrates and exercise and weight loss
78
Which lipid-lowering drug can increase TG?
Bile acid resins
79
Adenosine mechanism and effects:
Activates Gi, increases K out of the cells hyper-polarizing
Anti-arrhythmic that cardioverts supra-ventricular tachycardia and vasodilates
Use for dx in stress test
SE:
Flushing, hypotension, chest brunt -bronchospasm- atrio-ventricular block
Antagonized by methylxanthines
80
Nesiritide and sacubitril mechanism and effects:
Nesiritide: Recombinant BNP
Sacubitril: Neprilysin inhibitor (neprilysin breaks down ANP and BNP)
Both contribute to INCREASE!!! ANP and BNP in heart failure
81
Selective arterial vasodilators examples, mechanism and effects:
Hydralazine, minoxidil
Increase cGMP in smooth arteriolar muscle
Acute severe HT, preeclampsia, CHF
SE:
Lupus-like sd. and ANGINA with hydralazine
Reflex tachycardia!!! and FLUID RETENTION!!!→ angina and coronary A disease; because they cause RAAS activation (give with sympatholytics and diuretics in long term use)
82
Beta 1 selective blockers:
Atenolol, bisprolol, esmolol, metoprolol (A to M)
Esmolol is very short acting!
83
Beta 1 and 2 non-selective blockers:
Nadolol, propranolol, timolol (N to Z)
Pindolol and acebutolol are ISA so they act as beta 1 and 2 partial agonists and therefore cause bronchodilation but are contraindicated in angina (david PINeault hACE mucho)
Labetalol and carbendiol are beta 1, beta 2 and ALPHA 1 BLOCKERS so ↓TPR and HR!!!! maintaining SV (CARmen LABa la ropa y bloquea la alpha lavadora). Labetalol for HT in pregnancy
84
Name two examples of macrolide antibiotics:
Erythromycin, azithromycin
85
Which drugs increase the surface expression of LDL receptors so increase LDL reuptake?
Statins
86
Which drugs block HMG-CoA reductase to decrease cholesterol synthesis?
Statins
87
Which drugs activate PPAR-alpha and upregulate LPL?
Fibrates
88
Which lipid-lowering agent increases TG? And why?
Bile acid resins because by blocking cholesterol reabsorption they increased the hepatic production of TG and the release of VLDL in the circulation
89
Mame examples of protease inhibitors:
RitoNAVIR, indiNAVIR, nelfiNAVIR
90
Name examples of quinolone antibiotics:
CiproFLOXACIN
NorFLOXACIN
Nalidixic acid (first generation)
91
Aromatase inhibitors examples, mechanism and effects:
AnasTROZOLE, exemestane
| Decrease estrogen production from androgen and help ER+ breast ca. in postmenopause
92
Cytochrome P450 inducers:
Barb’s funny smoker mom refuses greasy carb shakes: Phenobarbital (barbiturates), phenytoin, hydrocarbons, modafinil, rifampin, griseofulvin, carbamazepine, St. John’s wort
```
Think seizures
Alcohol (chronic)
Oral contraceptives (estrogens)
Nevirapine
Smoking (hydrocarbons)
```
You would need to increase the dose of a drug for it to work, contraceptives and warfarin might not work. Prodrugs will become more effective
93
Cytochrome P450 inhibitors:
Gee queen GRACE IS inhibit when eats PI: Gemfibrozil, QUINolones, grapefruit juice, ritoNAVIR (protease inhibitors), AZOLes (and metronidAZOle), cimetidine and omeprazole, eryTHROmycin (macrolides except azithromycin ACE), isoniazid, sulfanilamides, PPis
COKE (cimetidine, omeprazole, ketoconazole, eryTHROmycin) + Grapefruit juice + PI (PPis, isoniazid)
```
Alcohol (acute)
Amiodarone!!!
Chloramphenicol
Diltiazem
SSRIs (fluvoxamine+!!, fluoxetine-)
Cyclosporine
Metronidazole
TMP-SMX
```
Drugs (statins) will become toxic but prodrugs will become less effective
P450 inhibitors that affect methadone: AZOLes, clarithromycin, ciprofloxacin and fluvoxamine
94
Drugs metabolized by cytochrome P450:
Think about antiepileptics, theophylline, warfarin, statins (except pravastatin), methadone! benzodiazepines, oral contraceptives, cyclosporin!!! (nephrotoxic) and VITAMIN D (1α,25-dihydroxyvitamin D3)
95
Antiarrhythmics that affect phase 0 and effect:
Class I A (quinidine, procainamide) B (lidocaine) and C (flecainide)
They block fast Na ch so decrease the slope of phase 0
96
Antiarrhythmics that affect phase 2 and effect:
Class IV as verapamil and diltiazem.
Ca ch blockers
97
Antiarrhythmics that affect phase 3 and effect:
Class III as amiodarone, sotalol and dofetilide.
They block K ch
98
Synthetic version of PTH:
Teriparatide
You give it in bolus to increase osteoblasts activity and build bone (the contrary than physiological tonic fx).
99
What blocks deiodinase (that releases T3 in tissues)?
High dose propylthiuracil
Propranolol
Corticosteroids
100
How do vencurONIUM and tubocuraine work?
They are nondepolarizing m. relaxants, competitive inhibitors of Ach receptor that cause an initial fading of the m. response.
Can be reversed by AchEi
101
How does succinylcholine work?
It is a depolarizing m. relaxant, AGONIST of Ach receptors that causes an initial stable reduction of the m. response followed by a fading of the response when the receptors get desensitized.
It acts fast and is metabolized by cholinesterase fast.
Just phase 2 may be reversed by AchEi, in phase 1 they potentiate
102
Treatment of choice for paroxysmal supraventricular tachycardia:
Adenosine IV (chemical cardioversion)
103
Treatment of choice for ventricular tachyarrhythmias after MI and in digitalis-induced arrhythmias:
Lidocaine, mexiletine and phenytoin (class 1B)
104
Drugs that can induce drug induced lupus:
Hydralazine
Isoniazid (slow acetylators with ↓acetyltransferase activity are also at risk of isoniazid-induced peripheral neuropathy)
Procainamide
α-Methyldopa
```
anti TNF-α
Penicillamine
Phenytoin
Quinidine
Carbamazepine
INF-α
Diltiazem
Minocycline (tetracycline)
Chlorpromazine
Pyrazinamide
Terbinafine
Sulfasalazine
```
Presentation: anti-histone Ab, fever, myalgia, arthralgias and serositis (blood, kidney and CNS are normally ok and no butterfly rash)
105
Drugs that reduce mortality in CHF:
```
ACE inhibitors (-pril)
ARB (-sartan)
Neprilysin inhibitor+ARB (sacubitril+valsartan)
Aldo antagonists (-one)
Beta blockers (-olol)
```
106
Cause of thrombotic thrombocytopenic purpura:
ADAMTS13 deficiency (due to autoantibodies)
107
Heparin’s mechanism of action and clinical consequence of it:
Activates antithrombin 3
| In antithrombin 3 deficiency heparin doesn’t increase PTT unless is super high dose
108
Common pharmacological cause of vitamin B6 (pyridoxine) deficiency:
Isoniazid treatment for TB
109
Treatment of sickle cell anemia and how does it work?
Hydroxyurea because it increases HbF which is protective for sickle cell anemia
110
Treatment for hairy cell leukemia:
Cladribine (2-CDA), an adenosine deamimase inhibitor that makes adenosine accumulate in neoplastic B cells killing them
111
Treatment for CML:
Imatinib, a tyrosine kinase blocker
112
What do we use Edrophonium for?
For tensilon test in dx. of miastenia gravis. It is a AchE inhibitor but very short acting so we just use it for dx. (improves it but just for a little bit)
113
DA agonists examples and use:
Pramipexole, ropinirole and bromocriptine
| Early tto. in Parkinson, can postpone need for levodopa
114
COMT inhibitors examples and use:
EntaCAPONE
| Prevent levodopa break down in plasma +-DA in brain (tolcapone) in patients with fast wearing-off
115
MAO-B inhibitors examples and use:
Selegiline
| Prevent DA break down in brain
116
Amatidine mechanism and use:
Increases DA release and decreases DA reuptake
| Used in Parkinson
117
CNS anticholinergics examples and use:
BenzoTROPine, trihexyphenidyl
| In young patients improves tremor and rigidity in Parkinson but not bradykinesia
118
Name 3 examples of K sparing diuretics and their mechanisms of action:
Amiloride and Triamterene (block ENaC in the luminal collecting duct). Also trimethoprim! causing hyperkalemia!
EplerenONE, spironolactONE (block Aldo receptors so block Na/K ATPase in the basolateral collecting duct)
119
Treatment for Giardiasis:
Metronidazole
120
Name the 6 possible emesis therapies:
```
5HT3 anatagonist (graniSETRON)
DA antagonist (prOCHLOrperazine)
H1 antagonists (diphenhydramZINE)
Muscarinic antagonist (SCOPolamine)
NK1 antagonist (aprepitant)
Cannabinoids (dronaBINOL)
```
121
How do you treat a PCP and amphetamines overdose? Why?
With ammonium chloride because they are weak bases and ammonium chloride acidifies the urine
122
How do you treat an aspirin overdose? Why?
With sodium bicarb. because it is a weak acid and sodium bicarb. alkalinizes the urine
123
How do you treat hepatic encephalopathy? Why?
With lactulose that is converted to lactic acid because amonia is weak base and lactic acid acidifies the stools
124
Name 4 drugs with low therapeutic index:
```
Warning! These Drugs Are Lethal:
Warfarin
Theophylline
Digoxin
Antiepileptics
Lithium
```
125
What molecules use JAK-STAT pathway:
Prolactin
EPO, thrombopoietin, G-CSF
GH (somatotropin)
Interferons, IL, cytokines
126
Which receptors use Gs proteins?
All betas
D1
V2
H2
127
Which receptors use Gi proteins?
```
MAD2; all 2s except beta
M2 and Mu opioid receptors
Ach2; Alpha2
D2
5-HT1 (helps inhibit anxiety and migraines)
```
128
Which receptors use Gq proteins?
```
All odd numbers except beta; HAVa an MandM
H1 (lung smooth muscle Qnstrictor)
Alpha1; AT1
V1 (vasoQnstrictor)
M1 and M3 (bladder Qnstrictor)
```
Oxytocin, TRH, GnRH
GQ Qnstricts the smooth muscle! in other tissues turns on PKC
129
Name selective muscarinic agonists:
Cols and loc
| CarbaChOL, bethaneChOL, piLOCarpine and Cevimeline
130
Name muscarinic blockers:
Tropes and scopes (atropine, scopolamine, ipratropium...)
plus:
Cross BBB: Sexyhexy (trihexyphenidyl), benztropine
Selective and no cross BBB: Glycopyrrolate, Hyoscyamine, Propantheline (can be given in MG to counteract the peripheral side effects of neostigmine)
131
Which diuretics can cause ototoxicity?
Loop diuretics: furoSEMIDE, bumetanide
132
Treatment of central diabetes insipidus:
Desmopressin (ADH analog)
133
Treatment of SIAH:
Demeclocycline (tetracycline that is ADH antagonist)
| ConiVAPTAN, tolVAPTAN (block V2 receptor)
134
Where does acetazolamide act in the nephron?
At the proximal convoluted tubule
135
Where does mannitol (osmotic diuretic) act in the nephron?
At the proximal tubule and descending loop of Henle
136
Where do loop diuretics (furosemide, bumetanide) act in the nephron?
At the thick ascending loop of Henle
137
Where do thiazides (metolazone) act in the nephron?
At the distal convoluted tube
138
Where do K sparing diuretics (amiloride, triamterene, eplerenone) act in the nephron?
At the collecting duct
139
Glaucoma drugs that decrease intraocular fluid production:
β-blockers (timolol)
Carbonic anhydrase inhibitors (azetazolamide); good for close angle
α2 agonists (brimonidine)
140
Glaucoma drugs that increase fluid outflow:
Prostaglandins (latanoprost pgF2)
Muscarinic agonists (chols and loc: piLOCarpine, carbaChOL, Cevimeline)
Manitol
141
Insulin mechanism of action:
Binds insulin receptors to increase glucose uptake
142
Sulfonylureas and meglitinides mechanism of action:
Inhibit K ch on the beta cell
143
Metformin mechanism of action:
Inhibits hepatic gluconeogenesis
Decreases methilation around insulin-responsive promoters, stimulate AMPK (a prot kinase)
144
Thiazolidinediones (-tazones) mechanism of action:
Bind enhancer elements at the gene level, activate transcription regulator PPAR-gamma
145
GLP-1 agonists (-tide)
Increase glucose-dependent insulin secretion from the pancreas
146
DPP4 inhibitors (-gliptin) mechanism of action:
Increase endogenous GLP-1 and GIP that increase glucose-dependent insulin secretion
147
Alpha-glucosidase inhibitors mechanism of action:
Decrease GI sugar absorption
148
SGLT2 inhibitors (-glifozin) mechanism of action:
Increase renal glucose excretion
149
UTI treatment:
Ciprofloxacin (no if anti-acids)
TMP-SMX
Nitrofurantoin (1st line in pregnant)
Penicillins/cephalosporins (2nd line in pregnant)
150
Presentation and treatment of neuroleptic malignant syndrome:
Hypertermia, m. rigidity, mental status changes, autonomic instability, myoglobinuria, tremor, tachycardia, hyperreflexia
After exposure to antipsychotics as haloperidol and -azines
Tto: dantrolene and DA agonists
151
Presentation and treatment of malignant hyperthermia:
Hyperphosphatemia, m. rigidity, myoglobinuria, tachycardia, hypertension, hyperkalemia
After exposure to inhalation anesthesia as halothane and succinylcholine
Tto: dantrolene
152
Drugs that cause photo-toxicity:
```
SAT For Photo:
Sulfonamides
Simeprevir
Amiodarone!!!
Tetracyclines (cyclins)
5-Fluorouracil
```
153
Drugs that cause lactic acidosis:
NRTIs (didanosine, zidovudine)
| Metformine
154
What vitamin deficiency is caused by isoniazid?
Pyridoxine (B6)
155
Name 2 first generation antihistamines:
Diphenhydramine (antimuscarinic effects)
| Chlorpheniramine
156
Name 3 second generation antihistamines:
LORatadine, desloratadine
CETIrizine
FExofenadine (sexofenadine)
Less anticholinergic effects so good for BPH
Less sedation
Not good for motion sickness
157
Drugs that cause gingival hyperplasia:
Phenytoin
Non-dihydropiridines ❤️
Cyclosporine
158
What muscle relaxant should be used in hepatic and renal impairment?
Atracurium (can cause seizures)
159
D2 receptor BLOCKERS names, use and side effects:
MetoCLORpramide, ProCHLORperazine
Act in the area postrema and treat chemotherapy induced vomiting and vomiting due to migraine
Prokinetics (good for post-surgical disorders and diabetic gastroparesis but do not give in obstruction)
SE: drowsiness, galactorrhea, long QT, extrapyramidal symptoms because of DA blockage (can be prevented by diphenhydramine, an anticholinergic)
Can also cause depression and neuroleptic malignant syndrome
160
Sulfa drugs:
Sulfonamide (Ab)
Sulfasalazine (Ab)
Sulfonylureas
```
Pharm FACT:
Probenecid
Furosemide
Acetazolamide
Celecobix
Thiazides
```
161
Drugs with disulfiram-like effect:
```
Metronidazole
Griseofulvin
Cephalosporins (some)
Sulfonylureas (1st generation)
Procarbazine
```
162
Name 3 direct thrombin inhibitors and their mechanism of action:
Argatroban
Dabigatran
Bivalirudin
Directly block thrombin (factor 2)
163
Heparin mechanism of action:
Activates antithrombin 3 that inhibits a lot of factors form the intrinsic pathway (11, 9, 8, 10, 5, 2)
164
Warfarin mechanism of action:
Inhibits vit K epoxide reductase so vit K cannot gamma-carboxilate factors 10, 9, 7, 2
Also COUmadin (same) and diCOUmarol
165
Drugs that can cause dyslipidemias:
B-blockers
Thiazides
Quetiapine, clozapine, olanzapine (atypical antipsychotics) fat as a QOO
166
What is the difference in the mechanism of action between zileuton and -lukasts?
Zileuton inhibits lipoxygenase (LOX) and decreases LT formation
-Lukasts block LT receptor
167
What keeps open and what closes the ductus arteriosus?
Prostaglandin E1, alprostadil, keeps it open (released by the placenta)
Indomethacin closes it
168
Which drugs absorption is affected by chelators? and by PPIs?
```
Chelation by iron or antacids (contain Ca, Mg or aluminium):
Tetracyclines (including doxi)
Quinolones (floxacines)
Levothyroxine
Digoxin
Phenytoin
```
Decrease stomach acid by PPIs:
Azoles
Warfarin
Also decreasing the stomach acid can increase chelation
169
Drugs that can cause priapism:
Trazodone
Hydralazine, prazosin
Sildenafil
Chlorpromazine
170
Therapeutic uses of prostaglandins:
Misoprostol E1: stomach ulcers
Alprostadil E1: maintain ductus/ impotence
Mia is the 1st on hEr class!
Dinoprostone E2/ carboprost F2: abortion
2 carbon dinosaurs abort (because they have high pressure in the eye and in the lung)!
Latanoprost F2: glaucoma
Epoprostenol I2/ prostacyclin I2: pulmonary HT
171
Name 3 typical antipsychotics:
Haloperidol and the Zines:
Haloperidol, FluphenaZine, Trifluperazine (+extrapyramidal: muscle rigidity)
The trio Halo Fluphe and TRIflu makes you hard because they have high potency!
ChlorpromaZine, ThioridaZine (+anti: muscarinic, his (sedation), α1 (orthostatism))
Typical have Zs, old last letter
172
Name 4 atypical antipsychotics:
Idones and APines:
```
ClozAPine
OlanzAPine
QuetiAPine
RisPeridone
AriPrazole
```
Atypical have Ps. They are D2 and 5HT2A antagonist. They make you depressed
173
Drugs that undergo 0 order kinetics:
Phenytoin
Ethanol
Aspirin
174
Drug of choice for trigeminal neuralgia:
Carbamazepine
175
Drug used on neuropathic pain (postherpetic and diabetic):
Gabapentin
176
Drugs that can cause ginecomastia:
Cimetidine
Spironolactone
Risperidone
Azoles
177
Drugs that increase gallstone risk:
Fibrates
Oral contraceptives
Ceftriaxone
Octreotide
178
Drugs that can cause ototoxicity:
Loops (bumetanide)
Cysplatin
Aminoglycosides (mycins)
Vancomycin
179
Do nitrates affect preload or afterload?
Decrease preload because they are venodilators
180
Drugs that can affect thyroid function:
Lithium
Amiodarone
Contrast
181
Treatment for heparin overdose:
```
Protamine sulfate (fast)
You cannot use FFP bc it contains antithrombin!
```
182
Treatment for warfarin overdose:
Fresh frozen plasma (fast)
| Vit K is slow
183
Drugs used for smoking cessation, mechanisms and side effects:
Bupropion: inhibits NE and DA reuptake
SE: seizures
Varenicline: nicotinic Ach partial agonist
SE: nausea, insomnia, nightmares!!!!
184
Metabolic disorder in aspirin toxicity:
Respiratory alkalosis fists
Respiratory alkalosis + metabolic acidosis (both CO2 and bicarb low)
Combined acidosis
185
Which anti-diabetic drug can cause fluid retention? What are other side effects?
Tazones
Cause exacerbation of CHF, osteoporosis and weight gain
186
TCAs examples mechanism, effects and antidote:
ClomipraMINE 🍆
AmitriptylINE
Mechanism: block 5HT and NE reuptake
Side effects: antimuscarinic (AmitriptylINE most) and alpha block (3Cs: coma, convulsions, cardiotoxicity - because they close the fast Na ch. so tachycardia and increase QT-)
ProtriptylINE is the least sedating of all
Antidote: Sodium bicarbonate
187
Illnesses treated with antimetabolites antibiotics:
Nocardia: TMP/SMX
Pneumocystis: TMP/SMX
Toxoplasma: pyrimethamine/sulfadiazine
188
Drugs that can cause SIADH:
```
Can't Concentrate Serum Sodium
Carbamazepine
Cyclophosphamide
SSRIs, TCAs, MAOIs
Amphetamines and ecstasy cause hyponatremia
Hypothyroidism causes hyponatremia
```
NSAIDs
Chlorpropamide (sulfonylurea)
Vincristine
Vinblastine
189
Drugs that can cause nephrogenic diabetes insipidus:
Lithium
Demeclocycline (tetracycline)
Fluoride
Hypercalcemia
They affect the collecting duct
190
What antiemetic do you give for a patient taking doxorubicin?
Not ondansetron because causes long QT so you give prochlorperazine (anti D2 good for QT induced nausea too)
191
Bisphosphonates (pamidronate) mechanism of action and side effects:
Inhibit osteoclasts; bind to calcium found in hydroxyapatite
```
SE:
Esophagitis (not in Barrets, achalasia...)
Jaw osteonecrosis
Femoral stress fractures
Hypocalcemia
```
192
Drugs that can cause esophagitis:
```
Bisphosphonates
NSAIDs
Tetracyclines
Ferrous sulfate
Potassium chloride
```
193
Name main muscarinic effects:
Ach makes you leaky
```
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Emesis
Lacrimation
Sweating
Salivation
```
194
Treatment of lead poisoning:
Chelation with EDTA, dimercaprol or succimer
195
Treatment for long QT sd:
MNoPQ:
| Metoprolol, Nadolol or Propranolol
196
Treatment for cryptococcus? And in meningitis?
Amphotericin B and flucytosine (flucytosine causes bone marrow suppression)
Amphotericin B and flucytosine followed by Fluconazole! in meningitis
197
Cardiac effects of digoxin:
Increase ejection fraction. Ca accumulates in sarcoplasm by inhibiting the Na/K ATPase in the muscle cell
Decrease HR and conduction thorough the AV node (Afib)! Increases vagal activity by inhibiting the Na/K ATPase in neurons
198
Antimicrobials to avoid in pregnancy and effects:
```
SAFe Children Take Really Good Care
Sulfonamides: kernicterus (bind albumin and displace bilirubin so there is more free bilirubin)
Aminoglycosides: ear
Fluoroquinolones: cartilage
Clarithromycin
Tetracyclines: teeth and bone
Ribavirin
Griseofulvin
Chloramphenicol: gray baby
```
OK in pregnancy: penicillins, cefalosporins and most macrolides
199
Drugs that can cause gout:
```
Painful Tophi and Feet Need Care:
Pyrazinamide
Thiazides
Furosemide (loop)
Niacin
Cyclosporine
NSAIDs, aspirin
```
200
Drugs that can cause Stevens-Johnson's:
```
Anti-epileptics (lamotrigine, carbamazepine, phenytoin: associated with HLA-B1502 in asians)
Allopurinol
Sulfa drugs
Sulindac (a NSAID)
Penicillin
```
201
Drugs that target the ADP or P2y12 receptor:
ClopidoGREL->Ticlopidine
PrasuGREL
TicaGRELor
202
Drugs that target the IIb/IIIa receptor:
Abciximab
EptiFIBatide
TiroFIBan
203
Drugs that directly target factor Xa; by target factor Xa which reaction so they block?
Rivaroc
FondaparinuX
They block factor Xa action therefore they block the conversion of PROTHROMBIN (II) to THROMBIN (IIa) but thrombin time is normal! (because thrombin time is measured adding thrombin to plasma and measuring the time to cloth)
204
Drugs that directly target factor 2:
Argatroban
Dabigatran
Bivalirudin
Directly block thrombin (factor 2)
205
Oral thrush treatment mechanisms:
Normal patient: topical nystatin that binds ergosterol and makes holes in the membrane (like amphotericin B)
AIDS or pharyngeal infection: azoles that inhibit the fungal cytochrome P450 dependent enzyme 14-alpha-demethylase
206
Macrolides side effects:
MACRO
Motility increase (erythromycin, no in obstruction)
Arrhythmias (prolong QT)
Cholestatic hepatitis (↑↑Alkaline Phosphatase)
Rash
eOsinophilia
Inhibit P450 (clarythromycin and erythromycin)
Resistance through Methilation of 23S rRNA
207
Mechanism of action of amphotericin B and nystatin:
Bind ergosterol and make holes in the membrane
208
Mechanism of action of flucytosine:
Cytosine deaminase converts it into 5-fluorouracil so it inhibits DNA and RNA synthesis
In cryptococcus with amphotericin B (careful in AIDS because it causes bone marrow suppression)
209
Mechanism of action of the azoles:
Inhibit the fungal Ergosterol synthesis by inhibiting cytochrome P450 dependent enzyme 14-alpha-demethylase
210
Mechanism of action of terbinafine:
Inhibits the fungal Squalene epoxidase so it inhibits Lanosterol synthesis
In dermatophytoses!!!
211
Mechanism of action of echinocandins (-fungins)
Inhibit the synthesis of beta-glucan for the cell wall
212
Mechanism of action of griseofulvin:
Interferes with microtubule function disrupting mitosis
In superficial infections, deposits in keratin
213
Sings of inhalant intoxication (glue, aerosol cans...)
Apathy, drunken appearance, headaches, parkinsonism, nasal crusting
214
Drugs that act on microtubules:
Mebendazole, bendasoles
Griseofulvin
Colchicine (also decreases leukotriene B4 formation)
Vincristine, vinblastine and paclitaxel (anti ca. phase M)
215
Treatment for a diabetic with history of heart failure and renal failure:
Glimepiride because it has hepatic clearance (second generation sulfonylureas)
216
How do you treat a walking pneumonia?
Macrolides 'throm' (block translocation, macroslides)
217
Treatment for hyperkalemia:
Mild: Na
Severe: Ca, Bicarb, Beta-agonists, Insulin+Glucose, Kayexalate, Dialysis (C BIG K Die)
218
What anticonvulsants can you give in pregnancy?
| What do you give to prevent eclamptic seizures?
Normal epilepsy, no teratogenic: gabapentin, lamotrigine and levetiracetam (GA LA para LEVEs problemas en el bebe)
Eclamptic seizures: Magnesium sulfate (blocks Ach release at the motor endplate)
219
What treatment do you need to give after TIPS?
Lactulose to increase ammonia excretion
220
How do you treat Klebsiella? How is it different from the treatment of other pneumonias?
Cefotaxime
1st line for lobar/walking pneumonia is macroslides (azithromycin/erythromycin) but if it is klebsiella you give 3rd generation cephalosporins
221
Drugs that can cause direct Coombs positive:
Alpha-methyldopa
Penicillin
Cephalosporins
222
Drugs that can cause pulmonary fibrosis:
```
My Nose Cannot Breathe Bad Air
Methotrexate!
Nitrofurantoin
Carmustine
Busulfan
Bleomycin!
Amiodarone!
```
223
How do you treat tumor lysis sd? How do you prevent it? Which drug is contraindicated?
Treatment:
Rasburicase and pegloticase; recombinant urate oxidase that convert uric acid into allantoin that is secreted in the urine (SE: G6PD hemolysis, anaphylaxis!, methemoglobinemia)
Add Ca supplementation to prevent hypocalcemia
Prevention:
Allopurinol and febuxostat; inhibit xanthine oxidase so reduce the conversion of hypoxanthine to uric acid
* they do not decrease the amount uric acid that already exists (SE: Steven-Johnson and renal stones)
Contraindicated:
Probenecib!!! uricosuric agent that blocks the reabsorption of uric acid at the PCT; it is 2nd line for gout but you cannot give it in a patient with tumor lysis sd, history of stones or decreased GFR
224
Methyldopa mechanism and effect:
It converts to alpha-methylNE that is a alpha 2 agonist to treat preexisting HT during pregnancy
SE: Coombs + warm hemolysis
225
What do we use glycopyrrolate, hyoscyamine and oxybutinynin for?
They are muscarinic antagonists;
Glycopyrrolate: reduces glandular secretions pre-surgery
Hyoscyamine: irritable bowel disease
Oxybutinynin, tolterodine: urge incontinence
226
Side effects of Lithium:
```
LiTHIUM
Low Thyroid
Heart (Ebstein)
Insipidus, nephrogenic DI and chronic kidney disease
Unwanted Movements (ataxia, temor)
```
Thiazides, NSAIDs and ACE inhibitors (-prils) reduce it's clearance
TAN! for lithium VAQ! for digoxin
227
Mechanisms of resistance to penicillins,
| vancomycin, aminoglycosides, chloramphenicol, tetracyclins, linezolid and macrolides:
```
Penicillins: beta-lactamases, mutation of PBP=transpeptidase (MRSA)
Vancomycin: D-Ala D-Lac mutation
Aminoglycosides: transferases
Chloramphenicol: acetyltransferase
Tetracyclins: pump
Linezolid: point mutation
Macrolides: methylation
```
228
Side effects of atypical antipsychotics:
All give all but the more specific side effects are:
-apines: metabolic sd
Ziprasidone: long QT
Clozapine: agranulocytosis seizures and myocarditis
Risperidone: hyperprolactinemia
229
How do you treat resistant schizophrenia or schizoaffective disorder+suicidal? which are its side effects?
Clozapine
| SE: agranulocytosis, seizures and metabolic sd
230
How do you treat deep vein thrombosis in pregnancy?
Low molecular weight heparin (dalteparin, subcutaneous) because they do not cross the placenta
231
Drugs that give you vision changes:
Ethambutol: color blindness (eyethambutol)
Digoxin: blurry yellow vision; muscarinic agonist
Sildenafil: blue vision; inhibits PDE6 in the retina. Also causes optic disk edema
232
How do you treat hypertension in pregnancy?
```
He Likes My Neonate:
Hydralazine (severe HT, preeclampsia)
Labetalol
Methyldopa
Nifedipine (for preexisting, before w. 20)
```
233
Drugs that increase survival in heart failure, decrease remodeling:
ACE inhibitors (prils)
ARAs (sartans)
Beta-blockers (Bisoprolol, Carvendiol, Metoprolol -Beta blockers Curve Mortalily-)
Sacubitril (increases ANP) + valsartan
```
Aldo antagonists (spironolactone, eplerenone) in EF less than 35%
Hydralazine + isosorbide dinitrate in African-americans
```
234
Which drug can vasodilate and decrease insulin secretion?
Diazoxide (and minoxidil); opens K channels so it will hyperpolarize the beta pancreatic cell and the arteriolar smooth muscle
Can be used to treat severe HT and hypoglycemia (hyperinsulinism)
235
How do you treat meningitis in a neonate?
Cefotaxime for group B strept and E. coli
Ampicillin for Listeria
* Listeria has PBP with low affinity for cefalosporins, ampi inactivates those PBP
236
Which Ca ch blocker is contraindicated in congestive heart failure?
Verapamil, is the one that causes the biggest reduction in contractility (the most negative inotropic)
237
Which diuretic is contraindicated in crush injury and rhabdomyolysis?
K sparing
| Crush injuries lead to rhabdomyolysis causing acute renal failure. All those lead do K overload
238
Which PGs increase uterine tone?
The 2s:
PGf2=carboprost. Bronchoconstricts (not is asthma)
FGe2=dinoprostone
Used in abortion and postpartum hemorrhage (if cannot use oxytocin that is 1st line)
239
Effects of Isoproterenol, Epi+phentolamine, Phenylephrine and Epi+propranolol in insulin release:
Isoproterenol activates Beta 2 so increases insulin
Epi+phentolamine (blocks Alpha 2) activates Beta 2 so increases insulin
Phenylephrine activates Alpha 2 so decreases insulin
Epi+propranolol (blocks Beta 2) activates Alpha 2 so decreases insulin
240
Candida treatment:
```
Thrush: topical nystatin
+ AIDS/pharyngeal involvement: azoles
Esophagitis: azole
Diaper rash: topical nystatin
Vulvovaginal: topical azole
Systemic: ampho B
```
241
Ateplase and streptokinase effect and mechanism of action:
tPa (tissue plasminogen activators), transform PLASMINOGEN into PLASMIN that breaks fibrin!
P→P
242
Opioids that can be used to treat diarrhea:
Loperamide (inhibits Ach release from myenteric plexus, also anticholinergic effects decrease secretions)
Diphenoxylate (together with hioscina/atropine to avoid abuse)
243
Ticlopidone use, mechanism of action and side effects:
Blocks the ADP P2Y12 receptor (like clopidoGREL and ticaGRELor)
Anticoagulant for stents
Neutropenia
244
Treatment of ulcerative colitis:
Mild, moderate: rectal/oral MesaLAZINE (SulfasaLAZINE has more side effects)
Severe: IV methylprednisone
245
Drugs with antimuscarinic effects:
TCAs (amitriptyline)
H1 blockers (1st generation antihistamines as diphenhydramine, chlorpheniramine)
Antipsychotics (chlorpromazine)
Meperidine (opioid)
Cyclobenzaprine (m. relaxant)
Quinidine (can increase HR and cause arrhythmia)
Amantidine
DD. stimulants (methylphenidate, amphetamines, coca, modafinil) will cause symptoms similar to antimuscarinic drugs but with diaphoresis
246
Drugs that can be used to treat urge incontinence:
```
Antimuscarinics; tropes and scopes but newer better drugs are:
Oxybutinynin
Tolterodine
Darifenacin
Solifenacin
Succinate
Trospium
Fesoterodine
```
247
How do you treat ETEC (traveller's diarrhea)?
Fluoroquinolones (floxacins) or Macrolides (thro)
248
Opioids groups and examples:
Full agonists: fentanyl, meperidine, codeine, heroin, METHADONE (LONG HALF LIFE to ↓ cravings)
PARTIAL agonists= LOWER EFFICACY: BUPRENORPHINE (suboxone is buprenorphine+naloxone withdrawal if take too much or IV for detox)
Antagonists: naloxone (for OD, increases pain, less than 1h half life), naltrexone (suppress cravings for alcohol or opiates, CAN take it if drinking, LONG half life) methylnaltrexone (for opioid-induced constipation)
249
How do you treat opioid-induced constipation?
Stoll softener
| Methylnaltrexone mu antagonists that doesn't cross the BBB so antagonizes mu just in the intestine
250
Antineoplastics that can cross the BBB:
Nitrosureas (carmustin,lomustin)
Procarbazine
Capecitadine
251
Drugs that can cause hemorrhagic cystitis:
Cyclophosphamide
Ifosfamide
Can be prevented with mesna
252
First line treatments for leukemias:
AML: cytarabine (pyrimidine). M3: all-trans retinoic acid
Hairy cell: cladridine (purine)
CLL: ibrutinib!!
CML: imatinib, dasatinib
253
Lyme disease treatment:
Doxycycline (causes teeth discoloration, bone problems, photosensitivity so do not give it in kids)
Amoxicillin: first line in younger than 8, pregnant and nursing (cefuroxime can be given because is oral)
IV Ceftriaxone if severe or disseminated (if AV block, carditis, arthritis or neuroborreliosis)
254
Main side effects of halothane:
Hepatotoxicity 2-3 days after surgery by P450 transformation to reactive intermediates
Malignant hyperthermia
Arrhythmias
255
First line treatment for pseudomembranous colitis:
Oral vancomycin (causes altered taste)
Fidaxomicin (inhibits RNA polymerase)
Metronidazol
256
Drugs that should not be prescribed to older according to Beers criteria:
```
α1 ('zosins') and α2 blockers
Anticholinergics, antidepressants, antihistaminics, opioids
Benzodiazepines, barbiturates
NSAIDs
PPIs
Antiarrhythmics 1a, 1c and 3
Estrogens
```
257
Drugs that can cause aplastic anemia, agranulocytosis and thrombocytopenia:
Aplastic anemia (no RBCs, no all leukocytes, no platelets): Cloramphenichol, Benzene, NSAIDs, Busulfan, Vinblastine, phenytoin
Agranulocytosis (no neutrophils, less than 100): Dapsone, Clozapine, Colchicine, Ganciclovir
Aplastic/agranulocytosis:
Carbamazepine, propylthiouracil, methimazole
Neutropenia (less than 500):
Ticlopidone, Aprepitant, Fosaprepitant
Thrombocytopenia (no platelets):
Heparin, abciximab, valproic acid, vancomycin, linezolid, sulfonamides, indanivir, ganciclovir, furosemide, NSAIDs, quinidine, quinine, gold
258
What are the only α1 blockers that cannot be used to treat hypertension?
TamsuloSin, silodoSin because they are selective α1A selective, α1A are just for the prostate
259
What is phenazopyridine and what is its main side effect?
Urine turns red!! (or orange!) Can look like peeing blood
Over the counter urinary analgesic for dysuria in UTIs
Red!!!-orange urine discoloration as all the -azo
Also happens with rifampin and sulfasalazine
260
DA agonists examples and use:
Pramipexole, ropinirole and bromocriptine
| Early tto. in Parkinson, can postpone need for levodopa
261
Drugs contraindicated in bowel obstruction:
Anticholinergics (metoclopramide)
Erythromycin
Ca ch blockers
Senna (bowel stimulant)
262
Drugs that prolong QT (predispose to torsades de pointes):
Some Risky Meds CAn Prolong QT:
Sotalol, dofetilide (class 3)
Risperidone, haloperidol, ziprasidone (antipsychotics)
Macrolides (thros), fluoroquinolones (floxacins)
Chloroquine
Azoles, Arsenic!
Protease inhibitors (-navir)
Quinidine, procainamide, dysopiramide (class 1a) flecainide (class 1c)
Methadone!!
Ranolazine
Thiazides, TCAs (amitriptyline), Ondansetron, Cisapride
↓K and ↓Mg
263
Cause and treatment of methemoglobinemia, cyanide and CO poisoning:
Methemoglobin (chocolate):
Cause: Nitrites (from nitrates, NO), benzocaine
Treatment: Methylene blue, vit C
Cyanide (almond):
Cause: Nitroprusside, amygdalin, fire, seeds
Treatment: Nitrites (make methemoglobin), hydroxocobalamin (binds cyanide directly), Na thiosulfate (supplies sulfur)
CO (cherry):
Cause: cars, heaters
Treatment: O2
264
Define tolerance and cross-tolerance:
Tolerance: as you keep using a drug you need more and more dose
Cross-tolerance: same as tolerance but to a different drug than the one you are using but with similar properties (alcohol and benzos, different opioids, methamphetamine and amphetamines)
265
Drugs that can cause ANCA+ vasculitis:
Hydralazine, methimazole and propylthiouracil
266
Allergic reactions caused by drugs and treatment (tto):
ACEi: angioedema; Tto: bradykinin; does not respond to antiHistaminics
Ampho B: fever; Tto: NSAIDs/antiHis
Vancomycin: red man sd; Tto: antiHis
Niacin: flushing and pruritus; Tto: NSAIDs
Aspirin, NSAIDs, OPIATES, contrast, vanco, muscle relaxants: IgE INdependent DIRECT mast cell degranulation and histamine release; causes angioedema + urticaria; Tto: Responds to antiHistaminics
Penicillin for syphilis: Jarisch Herxheimer endotoxic shock; Tto: monoclonals against IL1, IL6 and TNF-α
267
Which drug is contraindicated in inferior MI?
Nitrates (nitroglycerine)
268
First line treatment for MAC:
Macrolide + ethambutol
269
First line treatment for lepra:
Tuberculoid: dapsone + rifampin
Lepromatous: dapsone + rifampin + clofazimine
270
Which drug sudden discontinuation can cause rebound HT? and hypotension?
HT: Clonidine (α2 agonist tto for refractory hypertension), important to taper when discontinuing
Hypotension: corticoids
271
Which drugs decrease digoxin clearance?
VAQ: Verapamil, Amiodarone and Quinidine (digoxin blood levels will be high)
Loops and thiazides increase digoxin toxicity because they cause hypokalemia, hypomagnesemia also toxic (digoxin blood levels will be normal!)
TAN! for lithium VAQ! for digoxin
272
Which drugs, especially in combination, can cause 5-HT sd?
```
SSRIs
MAOIs (Selegiline)
Buspirone
Triptans
Ondansetron
Linezolid (MAOI propreties)
PROCARBAMAZINE (anti cancer with MAOI propreties)
Dextromethorphan!
Meperidine
Ecstasy
St john's wort
TRAMADOL!!
MDMA (amphetamine)
Mesna
```
273
Which % of drug concentration at the steady state do I reach after 1, 2 and 3 half lifes?
1 half life: 50%
2 half lifes: 75%
3 half lifes: 87.5%
274
Which antibiotics are contraindicated in myasthenia gravis?
Aminoglycosides ('mycins')
275
Treatment of diabetic gastroparesis:
Metoclopramide
276
How do you treat enterococcus?
Ampicillin + aminoglycosides
277
How do you treat gonorrhea?
Ceftriaxone + macrolide/doxy (because of potential resistance and possible chlamydia coinfection)
278
Mifepristone use and mechanism of action:
Progesterone antagonist used with misoprostol (PGe1 agonist) for abortion
279
How do you treat pneumocystis on an AIDS patient?
Oral TMP-SMX + increase antiretrovirals
| If TMP-SMX is contraindicated use IV pentamidine
280
Methotrexate use, mechanism of action and side effects:
Use: rheumatoid arthritis (methotrexate and other DMARD take some time to start working so give prednisone until it becomes effective)
Mechanism: inhibits dehydrofolate reductase
SE: pulmonary fibrosis!!!!! hepatotoxicity, renal insufficiency, GI ulcers, pancytopenia and alopecia
281
Treatment for rheumatoid arthritis:
Short term: intraarticular corticoids and NSAIDs
Disease modifying; take weeks to work but decrease long term deformity: methotrexate, sulfasalazine, hydroxychloroquine, minocycline, TNFα
282
Name two platelet aggregation inhibitors that ↑ cAMP:
They also act as peripheral vasodilators:
Cilostazol PDE-3 inhibitor (contraindicated in HF) used in intermittent claudication
Dipyridamole used in cardiac stress test
283
Methysergide use, mechanism of action and side effects:
Ergot alkaloid used in migraine or cluster headache prophylaxis because it vasodilates
SE: retroperitoneal/retropulmonary fibrosis
284
Pharmacological treatment of irritable bowel disease:
Loperamide
285
Name 2 weird loop diuretics and 2 weird thiazides:
Loop: bumetanide, ethacrynic acid (-mides)
Thiazide: metolazone, chlorthalidone, indapamide (-thiazide)
286
6-mercaptopurine use, mechanism of action and side effects:
Used after transplant to prevent rejection! can also be used in Chron, SLE and rheumatoid arthritis
Purine analog
SE: Hepatitis and cholestasis
287
Describe the mechanisms of action of Phenylephrine, Pseudoephedrine, Phenoxybenzamine, Phentolamine and Diphenhydramine:
Phenylephrine: α1 α2 agonist
Pseudoephedrine: α1 and β2 agonist
Phenoxybenzamine: irreversible α antagonist
Phentolamine: reversible α antagonist
Diphenhydramine: 1st generation H1 antagonist with anticholinergic properties
288
Key features of Propofol, Ketamine and Etomidate:
Propofol (GABA agonist): redistributed fast, hypotension, increases TG
Ketamine (NMDA antagonist): bronchodilator, analgesic, dissociative, increases cerebral flow, hallucinations, vivid dreams
Etomidate (GABA agonist): hemodynamically neutral, inhibits corticoids synthesis so avoid in septic shock and do not use for maintenance
289
Name 6 SSRIs:
Fluoxetine, Fluvoxamine
Sertraline
Paroxetine
Citalopram, Escitalopram
290
Name 5 SNRIs:
Venlafaxine, Desvenlafaxine
Duloxetine (DM)
Milnacipran, Levomilnacipran
291
Name 7 TCAs:
Amitriptyline, Nortriptyline
Imipramine, Desmipramine, Clomipramine
Doxepin
Amoxapine
292
Name 4 MAOIs:
TRA-PE-ZIum
TRAnylcypromine
PhEnelzine
IsocarboxaZId
Selegilide (MAO B)
293
Drugs that can cause folate deficiency:
```
Phenytoin
Carbamazepine
Alcohol
5-FU
Methotrexate
Trimethoprim
```
294
Pseudomonas treatment:
Think about a MAN dressed as BATMAN on a CAR smoking a PIPE that is driving to his PIME where his coworker is asking what? DIME? but he ends up hitting a TREE that has a FLOWER on it that needs OXIGEN!!! to live
carbaPENEms (imipemen, meropenem)
PIPEracillin, CARbenicillin, tiCARcillin +BAcTam
azTREEonan (monobactam)
cefePIME (4th generation), ceftaziDIME (3rd generation)
floxacins (fluorquinolones: ciprofloxacin, levofloxacin)
mycins!! (aminoglycosides)
295
Which second generation antipsychotic can prolong QT?
Ziprasidone
296
Which diuretic can cause folate deficiency?
Triamterene, because it inhibits dihydrofolate reductase (like methotrexate, trimethoprim and pyrimethamine)
297
Which is the only group of penicillins that is resistant to beta-lactamases?
Anti staph: nafcillin, oxacillin, methicillin (penicillinase-resistant, no need of clavulanic)
That is why MRSA resistance is through mutation of PBP
298
Which gout drug needs good renal function to work?
Probenecid, inhibits uric acid reabsorption at the PCT
299
Which illnesses are treated with TNF inhibitors (infliximab, adalimumab, etarnecept)?
Refractory psoriasis
Refractory rheumatoid arthritis
Chron with fistulas
300
Paliative tto of MM:
Take out a little marrow and give to patient: Thalidomide, lenalidomide (do a pregnancy test before!) or bortezomib (proteasome inhibitor)
Then you give the marrow back after reducing tumor load on patient
301
Toxicities associated with ethylene glycol and methanol:
```
Ethylene glycol (antifreeze) → glycolaldehyde: nephrotoxic (renal failure 72h after ingestion)
Methanol → formic acid=formaldehyde: ocular damage (blurry snowy vision)
```
302
Hep B treatment:
Tenofovir (disoproxil fumarate)
In cirrhosis livelong tto
SE: nephrotoxicity and decreased bone density
303
Drugs that can cause acne:
Androgens
Epidermal groth factor receptors
Lithium
Comedones=acne!
304
Which non-depolarizing neuromuscular-blocker can be used in patients with compromised renal function? Why?
Atracurium
| Because it is spontaneously inactivated by plasma cholinesterases (Hofmann degradation)
305
Which is the most frequent electrolyte imbalance caused by foscarnet?
Hypocalcemia (can also cause hypophosphatemia, hypomagnesemia and hypokalemia)
306
Which glucocorticoid is a prodrug?
Prednisone
| It is a prodrug of prednisolone, needs to be reduced to prednisolone by 11β hydroxysteroid dehydrogenase
307
What do we use andexanet alfa for?
Antidote for direct factor Xa inhibitors as rivaroXABAN, apiXABAN and fondaparinuX
308
What do we use idarucizumab for?
Antidote for direct thrombin inhibitors as Dabigatran, Argatroban and Bivalirudin
309
Which drugs decrease lithium clearance?
NAT: Thiazides, NSAIDs and ACE inhibitors (lithium blood levels will be high) because they decrease GFR
310
Imiquimod use and mechanism of action:
Used to treat warts (HPV), superficial basal cell and actinic keratosis (aldara)
Activates TLR7 so up regulates NFκB so activates lymphocytes induces apoptosis by inhibiting BCL2 and inhibits angiogenesis by inhibiting fibroblast GF
311
What drug class are doxorubicin and daunorubicin?
Anthracyclines; intercalating agents that also interfere with topoisomerase 2
312
Drugs sequestered by cholestyramine:
Lipid soluble: propranolol, furosemide
313
How do you treat the hemodynamic problems in shock?
DA
| Because at high doses is α1 and β1 agonist so it increases BP and CO
314
How do you adjust the dose in obese? Which parameter varies between obese and lean people?
For hydrophilic drugs (aminoglycosides, heparins, anesthetics) do NOT use the total body weight. Use the lean body weight or an adjusted body weight
For lipophilic drugs (phenytoin) use total body weight, you can use an initial loading dose to saturate the fat stores
Obese people have a higher Vd for lipophilic drugs so the same amount of drug takes longer to reach the plasma
315
Name a BCL2 inhibitor
Venetoclax
316
Mechanism of pseudoallergic response:
IgE INdependent DIRECT mast cell degranulation and histamine release secondary to low potency opioids (morphine and meperidine), aspirin, NSAIDs, vancomycin and radioiodine contrast
Same symptoms of type 1 hypersensitivity but no IgE involved, treat with antiHis
Vs foods, stings, beta-lactams and sulfonamides that will cause IgE mediated degranulation
317
Which drug can cause skin darkening as a side effects?
Ketokonazole because it blocks desmolase that is needed to make testosterone and cortisol, low cortisol increases ACTH and therefore MSH
318
Main side effects of ganciclovir?
Neutropenia
Anemia
Thrombocytopenia
Ganciclovir is bad for the marrow
319
Which measurement is the best estimate of bioavailability?
The area under the plasma concentration vs time curve
To calculate oral bioavailability you should divide the area under the curve of the oral medication by the one for an IV drug
320
What is the treatment if you see acute congestive heart failure/ lung edema?
Loops
321
What can you use to treat the anxiety and agitation of initial alcohol withdrawal?
Chlordiazepoxide, long acting Bz with low addiction potential
322
Which antidepressant is associated with some weight loss?
Fluoxetine
323
Which antidepressant can cause gynecomastia and parkinsonism?
Amoxapine that is a TCA with antidopaminergic action
324
Which antidepressants work the fastest?
SNRIs in 2-3 weeks
Venlafaxine, Desvenlafaxine, Duloxetine (DM), Milnacipran, Levomilnacipran
325
What inhibits COX1 and 2 and what effect do they have?
COX1: inhibited by NSAIDs, inhibition causes GI side effects
COX2: inhibited by NSAIDs and celecoxib; makes prostacyclin in endothelium so inhibition causes prothrombotic . Actually celecoxib might have more prothrombotic effects as MI and stroke bc does not inhibit TXA2 which is COX1 mediated while NSAIDs inhibit both prostacyclin and TXA2 so their effect is more balanced
Both are expressed in the kidney so both are associated with renal impairment
326
Which antibiotic can cause hyperkalemia?
Trimethoprim, it blocks ENaC so do not give with K sparing diuretics
327
Name 2 short acting and 3 long acting benzodiazepines:
Short: TM, you get rid of them in a TiMely manner;
TriazOlam, MidazOlam, Oxazepam 'OLAM'. More addictie, do not transform into active metabolites
Long: FLUncionan todo el DIA; DIAzepam, ChlorDIAzepoxide, FLUrazepam, transform into active metabolites
328
Mechanism of action of 3 most important contraceptives:
E+progestins:
Inhibit GnRH and LH/FSH so prevent 1) ESTROGEN SURGE during follicular phase inhibiting 2) LH SURGE and inhibiting 3) OVULATION (progestins key to block LH surge).
The decrease in LH decreases ovarian androgen production! They also increase serum hormone-binding globulin which treats the hyperandrogegism in PCOS
Progestins:
Thicken cervical mucus impairing sperm penetration
Cooper IUD:
Chronic inflammatory response impairing sperm migration
329
How do you treat angina ±TIA? How do you anticoagulate in FA with and without risk of embolic stroke RF?
Angina ±TIA and FA without risk:
Antiplatelets: Low dose aspirin is 1st line and clopidogrel if contraindicated
*In angina you normally add a statin to reduce atherosclerotic plaque formation
FA with risk of embolic stroke RF:
Antithrombotics: warfarin
330
Which autonomic drug can be used to treat PTST? what is its mechanism of action?
Which autonomic drug can be used to treat depression what is its mechanism of action?
PTST: Prazosin; α1 blocker
Depression: Mirtazapine; α2 blocker
331
Which autonomic drug can be used to treat orthostatic hypotension what is its mechanism of action?
Midodrine; α1 agonist
332
Which drug is contraindicated in inferior MI?
Nitroglycerin; because it reduces preload so it can reduce CO even more
333
Which antipsychotic is associated with retinal pigmentation? and with corneal deposits?
Chlorpromazine: corneal deposits
Thioridazine: retinal deposits
Both are low potency typical antipsychotics
334
What do you give for depression+bulimia?
Fluoxetine
335
Which SSRI is contraindicated in pregnant?
Paroxetine
336
How do you treat vomiting due to gastroenteritis?
With 5HT3 receptor antagonists (Ondansetron)
337
How do you treat vomiting due to migraine?
With dopamine antagonists (Metoclopramide)
338
Main pharmacokinetic characteristics of halothane and NO:
Halothane:
↑ potency ↓ MAC
↑ soluble = ↑blood/water coefficient = ↑AV gradient
slow
NO:
↓ potency ↑ MAC
↓ soluble = ↓blood/water coefficient = ↓AV gradient
fast
339
Key features of first and Zero order kinetics:
First:
Exponentially increasing part of the curve (first comes first)
Dose matters
Constant fraction, proportion
Zero:
Plateau, enzymes are saturated
Constant amount
340
Which 4 conditions increase thrombin time?
Fibrinogen absence
↑ fibrin degradation products because they interfere with fibrinogen formation as in DIC OR tPA treatment
Direct thrombin inhibitors (Argatroban, Dabigatran and Bivalirudin)
Heparin
341
Which type of drug is erythromycin?
A macrolide!!! THRO wins!
342
What is the function of oseltamivir?
Inhibits viral particle release
343
Which type of resistance mechanism should you think about if you see it changes with pH or Na concentration?
Pumps; they use ATP, Na gradients or proton gradients to work
344
What is the treatment of hypertensive emergency?
Nitroprusside (↑cGMP by releasing NO)
| Fenoldopam (D1 agonist Gq that vasodilates)
345
Which antiemetic promotes gastric emptying?
Metoclopramide
346
Name 2 first generation sulfonylureas, what is characteristic about them?
Clorpromadide, tolbulamide
| Disulfiram-like effect
347
What is the treatment of bartonella?
Macrolides, azithromycin
348
What do you add to the statin if the LDL is still high? and if TG are high?
LDL: Ezetimibe
TG: Fibrate
349
What is the treatment protocol of ventricular fibrilation?
Defibrillation→ Epinephrine→ Amiodarone
350
Which inhaled anesthetic causes seizures?
Enflurane epileptogenic
351
Uses of colchicine:
Gout
Pericarditis
Familial Mediterranean fever
352
Which antidiabetic causes flatulence, diarrhea and elevated transaminases?
Acarbose
353
How do you treat gram + cocci infections in allergic to penicillin?
Macrolides (azithromycin)
354
What type of drug is aripiprazole?
Atypical antipsychotic; it is a D2 partial agonist while the rest are 5HT2 and D2 antagonist
355
Which antineoplastics cause hyperpigmentation? How do you differentiate them in terms of side effects?
Busulfan (cross-links DNA) and bleomycin (free radicals)
Both cause pulmonary fibrosis but busulfan causes myelosuppression and bleomycin does not
356
How do you treat endometritis and aspiration pneumonia?
Gentamicin + clindamycin: endometritis
Clindamycin: aspiration (it is basically a macrolide for anaerobes)
357
What is the mechanism of action of bacitracin?
Inhibits peptidoglycan synthesis; inhibits translocation of D-ala D-ala from inside to outside the bacterial cell wall
358
What is the treatment for TCAs overdose?
Sodium bicarbonate
359
Which type of inhibitors are the statins and methotrexate?
```
Competitive
Increase Km (=Michaelis-Menten constant)
```
360
How can you cause mydriasis but not cycloplegia?
With alpha 1 agonists (NE)
Muscarinic antagonists will cause both mydriasis and cycloplegia
361
What is the treatment for cluster headaches?
Acute: O2 or sumatriptan
Prophylaxis: verapamil
362
How long do you need to be on ahminoglycosides to get ATN?
7-10 days
363
Which drug can vasodilate and increase HR?
Milrinone; PDE-3 inhibitor that increases cAMP in cardiomyocytes and vascular smooth muscle
364
What is the mechanism of action of isoniazid?
Inhibits the synthesis of mycolic acids
365
Which beta blockers are contraindicated in agina?
Pindolol and acebutolol, they have ISA (intrinsic sympathomimetic activity) so they act as beta-1 partial agonists and will not reduce the myocardial O2 demand
366
What pharmacologic treatment should you give to a patient with ADPKD?
ACE inhibitors because they are renoprotective
367
Which Ca ch blockers is contraindicated in patients with unstable angina or MI?
Nifedipine, because it can exacerbate myocardial ischemia due to reflex tachycardia
368
Side effects of sirolimus and tacrolimus:
Sirolimus:
Pancytopenia
Insulin resistance
Hyperlipidemia
Tacrolimus:
Neurotoxicity
Nephrotoxicity (correct with diltiazem)
Increased risk of DM
369
Which beta-blockers are used to treat portal hypertension? why?
Propranolol, timolol (also in glaucoma), nadolol
| Because they also block beta-2 which decreases portal blood flow
370
Which is the only symptom of hypoglycemia not blocked by beta-blockers?
Sweating
371
What is the treatment of PCP in patients with sulfa drug allergy?
Pentamidine
Atovaquone
Dapsone can be given as prophylaxis
372
What is the difference between direct thrombin inhibitors and LMWH?
Direct thrombin inhibitors are oral and inhibit factor Xa directly while LMWH are subcutaneous and inhibit factor Xa indirectly
373
Main SE of INF-α inhibitors
Depression
| Flu-like
374
What is the difference in binding 30s between tetracyclines and aminoglycosides?
Tetracyclines bind 30s reversibly
| Aminoglycosides irreversibly
375
Which type of drug is primidone?
A barbiturate used to treat seizures and essential tremor
376
Which substrate concentration is the best to measure the amount of enzyme?
The one that leads to Vmax because Vmax is proportional to the amount of enzyme
377
Mechanism of action of Sildenafil:
NO is made in the endothelium but it acts on cGMP on the smooth muscle!
Sildenafil acts on the SMOOTH M. vasodilating the deep ARTERY to increase blood flow into the corpora cavernosa! It does not synthesize NO it just increases cGMP!
378
What should be avoided on a patient taking L-dopa/carbidopa?
Vit B6, because it promotes the conversion of L-dopa to dopa in the periphery
379
Define how MAC and fast/ slow onset correlates with solubility of inhaled anesthetics:
↑ Blood/gas = ↑ blood solubility = Slower; as halothane
↑ Oil/gas = ↑ potency = ↓ MAC; as halothane
380
Why are thiazides adjutants of loop diuretics?
They potentiate the effects of loops because they block the reabsorption of all the Na that the loops leave on the tubules, they avoid that all the work to excrete the Na gets overridden downstream
381
Which drugs can be used to treat nephrogenic diabetes insipidus? and SIADH?
Nephrogenic diabetes insipidus:
Indomethacin
Amiloride if is due to Li
Thiazides
SIADH:
Demeclocycline
Vaptams
382
Mechanism of action of praziquantel:
↑Ca influx into the sarcoplasm
383
Mechanism of action, indications and main side effects of Daptomycin:
Disrupts cell membranes by creating transmembrane channels via insertion of charged lipid tail in cell membrane → ion flux → rapid DEPOLARIZATION → K+ dependent DNA, RNA, and protein synthesis cease → cell dies
Indications: vancomycin-resistant bacterias
Do not use in pneumonia because surfactant inactivates it!
SE: rhabdomyolysis (monitor CK), peripheral neuropathy and eosinophilic pneumonia
384
Mechanism of action of carfizomib:
Decreases protein degradation by proteosomes and therefore decreases activation of CD8 T cells because less things are presented in MHC1
385
Key feature and main side effects of pyrazinamide:
AntiTB that is activated in acidic pH! therefore it works better inside phagolysosomes
SE: hepatotoxicity and gout
386
What causes tardive dyskinesia?
Upregulation of DA receptors after prolonged exposure to DA-blocking agents
387
What is the main mechanism by which dihydropyridine Ca ch blockers improve HF symptoms?
They are vasodilators selective for the ARTERIOLES so they mainly decrease afterload therefore decrease the heart's oxygen demand
388
What is the first line therapy for women with PCOS and hirsutism?
Oral contraceptives
389
Which antibiotics are specific for anaerobes? Which for gram positive?
Anaerobes:
Aminoglycosides
Clindamycin (above diaphragm; macrolides are for aerobes)
Metronidazole (below diaphragm)
Gram +:
Vancomycin
390
What is the first line treatment for lyme in younger than 8, pregnant and nursing?
Amoxicilin
391
How do you treat spontaneous bacterial peritonitis?
3rd generation cephalosporins (cefoTAXime) because it is normally due to gram negative as E.Coli and Klebsiella
392
Treatment of hypertensive emergency:
```
Fenoldopam
Nitroprusside
Labetalol (that prevents reflex tachycardia because blocks beta 1, so pick it if you see that the HR went down!)
```
FiNaL
393
What is a possible treatment for acute pulmonary edema?
IV morphine
394
Caffein mechanism of action:
Inhibits adenosine effect so releases DA/NE, the renal adenosine blockage leads to diuresis
*Contraindicated in chemical stress test
395
Why Thiazides cause hyponatremia and loops don't?
The pump that is inhibited by loops is in charge of keeping the medullary osmolarity so they generate less driving force to move water out of the urine, it is very hard to reabsorb too much water and become hyponatremic
Thiazides do not affect the medullary osmolarity so you can still reabsorb water in the collecting duct while you loose Na so you can get hyponatremic
396
Psoriasis and dermatitis herpetiformis tto:
Psoriasis:
Local: vit A, D (calcipotriene), TAR
Spread: oral steroids, methotrexate, UVB, PUVA (UVA+psoralen)
Refractory: TNF alpha blockers
Dermatitis herpetiformis:
Dapsone
397
What is the treatment for Kaposi sarcoma?
INF-alpha
398
What does INF-alpha treat?
```
Hairy cell leukemia
Kaposi
Melanoma
Condyloma accuminata
Renal cell carcinoma
```
399
Mayor SE of fluorinated inhaled anesthetics:
Increase cerebral blood flow thereby increasing intracranial pressure
But they cause a decrease in cerebral metabolic rate
400
What is the advantage of atracurium?
Neither renal or hepatic elimination, it is eliminated by enzymes
You should use it in hepatic and renal dysfunction
401
Pharmacodynamic characteristic of aminoglycosides:
Highly charged
Low Vd
Do not distribute in adipose tissue
402
Mechanism of action of oseltamivir and zanamivir:
Block neuraminidases that promote virus progeny release from host cells; neuraminidase cleave sialic acid
403
What is the preferred first-line drug for African American patients with isolated hypertension?
Chlorthalidone
404
What is the treatment for acute intermittent porphyria? And for porphyria cutanea tarda?
Acute intermittent porphyria: hemin
| Porphyria cutanea tarda: hydroxycloroquine
405
Key characteristics of Indinavir, Saquinavir, Atazanavir, Zidobudine, Lamivudine, Tenofovir, Stavudine, Emtricitabine, Efavirenz, Integravir and Enfuvirtide:
Indinavir: kidney stones
Saquinavir, Atazanavir: prolong QT
NRTIs
Zidobudine: ~pregnant, marrow suppression
Lamivudine: hep B tto, least toxic
Tenofovir: hep B tto, nucleotide, fanconi, GI upset
Stavudine: lipodystrophy
Emtricitabine: hyperpigmentation of palms and soles
NNRTIs are teratogenic and hepatotoxic:
Efavirenz: vivid dreams
Integravir: high CK
Enfuvirtide (gp41): skin reaction
Maraviroc (gp120)
406
Which anti-herpes drugs do not require phosphorylation by the viral kinase?
Cidofovir (+probenecid) and foscarnet
| Important in HIV infected with HSV, CMV or VZV because they get viruses that become resistant
407
How do you treat Ureaplasma and Mycoplasma?
Macrolides
408
Good drugs for treating DM2 and cause weight loss:
Tides (GLP1 agonists)
