Pharmacology

Question 1

What are the first and second line treatments for Generalized Anxiety Disorder?

Answer 1

1st line: CBT and/or SSRIs or SNRIs

(this is helpful because depression is often a co-morbid condition)

2nd line: benzodiazepines (diazepam, clonazepam, etc.) These are less desirable due to their risk of tolerance and dependence.

Question 2

How do sulfonylureas work in diabetes patients to release insulin?

Answer 2

Sulfonylureas bind to ATP-sensitive K channels and cause their closure independent of ATP (ATP is typically generated by glucose entering the cell and generating ATP).

K channel closure -> Ca channel open -> increased intracellular Ca -> insulin release

Question 3

What is the longterm treatment for Myasthenia Gravis?

Answer 3

Pyridostigmine (AchE inhibitor ) -> outcompetes the inactivated nicotinic receptors (by MG Abs) at the motor end plate.

Occasionally neostigmine is also used.

Question 4

What is a tensilon test? What do positive and negative test results indicate?

Answer 4

In Myasthenia Gravis patients who are showing symptoms, give them EDROPHONIUM to transiently reverse symptoms (indicating an undertreated MG patient, a POSITIVE test) OR to worsen symptoms briefly (indicating a cholingeric crisis, a NEGATIVE test).

Question 5

What are nondepolarizing neuromuscular blockers? How do they work? What can be used to overcome them?

Answer 5

Tubocurarine
Pancuronium
Cisatracurium
(CURARE)

Work by inhibiting the nicotinic (which binds Ach) receptors at the NMJ

THEREFORE: AchE inhibitors (i.e. -stigmine) drugs can be used to reverse them

Question 6

What is a depolarizing neuromuscular blocker? How does it work?

Answer 6

Succinylcholine. Actually is a nicotinic receptor agonist. The hyperstimulation in phase 1 maintains the muscle as chronically depolarized and thus unresponsive to further impulses.

Question 7

Which Acetylcholinesterase inhibitor has central (i.e. can cross CNS) effects? What is it used for?

Answer 7

Physostigmine

Used to reverse atropine/Jimson weed poisoning.

Question 8

What are organophosphates?

Answer 8

Nerve gas and insecticides (e.g. -thiols/thions) that act as acetylcholinesterase inhibitors

Question 9

What are the treatments for organophosphate/insecticide poisoning?

Answer 9

Pralidoxine for peripheral effects:

Regenerates acetylcholinesterase at muscarinic and nicotinic receptors (reversing DUMBBELLS). Does NOT reverse flaccid paralysis (i.e. Central CNS effects).

Atropine can reverse central and peripheral effects.

Question 10

What are the alpha 2 agonists? What do they do?

Answer 10

Clonidine

Act as centrally-acting sympatholytics. Useful in hypertensive emergencies, ADHD, and Tourettes

Alpha-methyldopa

Act as a centrally-acting sympatholytic
Used to treat HTN in pregnant women

Tizanidine
Centrally-acting muscle relaxant

Question 11

What are the alpha (1 and 2) antagonists?

Answer 11

Phentolamine reversible

Lowers peripheral vascular resistance via vasodilation, reduces BP

Phenoxybenzamine irreversible

Mirtazapine (2 only) - atypical depression med

Question 12

What drug is useful in treating cocaine toxicity? What drug should specifically NOT be used?

Answer 12

Phentolamine - alpha antagonist

Beta blockers should NOT be used because they would leave unopposed alpha vasoconstriction

Question 13

Prior to surgery for removal of a pheochromocytoma, patients are given ________ several days in advance and _____ intraoperatively because they are both alpha blockers and maintain vasodilation/low BP.

Answer 13

Phenoxybenzamine in advance - it is irreversible

Phentolamine intraoperatively - reversible

Question 14

Alpha 1 receptors are located ______.

Alpha 2 receptors are located ______.

Answer 14

Alpha 1 = peripherally

Alpha 2 = peripherally AND centrally

Question 15

What are the Alpha 1 selective antagonists? What are they used for?

Answer 15

-“osin” drugs:

Prazosin
Terazosin
Doxazosin
Tamsulosin

Used to treat the symptoms of BPH by relaxing smooth muscle of the urethra and prostate.

Prazosin - PTSD

Question 16

What are the beta 1 selective beta blockers?

Answer 16

A-M drugs

Atenolol
Betaxolol
Esmolol
Acebutolol
Metoprolol

Question 17

What are the non-selective beta antagonists that also have alpha 1 blocking ability?

Answer 17

Carvedilol

Labetalol

Question 18

_____ inhibition at the JGA reduces renin production, ultimately reducing BP.

Answer 18

Beta 1

Question 19

Acute treatment of aortic dissection includes giving IV ______s such as ______.

Answer 19

Beta blockers

Labetalol
Esmolol
Propranolol

Question 20

What cardiac drug class can be used as prophylaxis for migraines?

Answer 20

Beta blockers

Question 21

First line treatment for essential tremors is _____.

Answer 21

Beta blockers

Question 22

What is a non-selective beta blocker?

Answer 22

Propranolol

Question 23

What curious tx is given for beta blocker overdose?

Answer 23

Glucagon

Question 24

How do vincristine and vinblastine work?

Answer 24

They bind to tubulin building blocks and preventing their polymerization preventing microtubule production/mitotic spindle formation -> cell death

Question 25

What are the toxicities/side effects of vincristine (and other anti-microtubule drugs)?

Answer 25

Peripheral sensory neuropathy - stocking glove
Autonomic nervous system dysfunction -> paralytic ileus
Alopecia

Question 26

What are the toxicities/side effects of vinblastine and taxanes?

Answer 26

Myelosuppression

Question 27

How do the “taxanes/taxel” drugs work?

Answer 27

Stabilize microtubules and promote their assembly ultimately leading to cell death.

Question 28

What are the tyrosine kinase inhibitors? (suffix and examples) What is the sketchy scene?

Answer 28

-“nib”

Imatinib
Erlotinib
Sorafenib
Sunitinib
Vemurafenib

Sketchy scene = signing of the declaration of independence

Question 29

Imatinib = tx for ____ and ____.

Answer 29

Receptor tyrosine kinase inhibitor

Imatinib = Gleevec ->Tx for CLM bcr/abl t(9;22)

AND

C-kit GIST tumors (GI stromal)

Question 30

What is the mechanism of Rituximab?

Answer 30

Binds to CD20 on B cells inducing apoptosis.

Question 31

What is serum sickness?

Answer 31

A delayed (Type III) immune reaction after infusion of a chimeric monoclonal ab. Characterized by fever, rash, lymphadenopathy, proteinuria, etc. Generally occurs 7-10 days after infusion.

Occurs due to the human immune system reacting against the mouse portion of the Ab.

Tx = steroids

Question 32

Triptans (e.g. sumatriptan) are what kind of drug used to treat what?

Answer 32

Serotonin 5-HT1b/1d agonists which counter the pathophysiologic mechanisms of migraine headaches by inhibiting release of vasoactive peptides, promoting vasoconstriction and blocking pain pathways in the brainstem.

They are used for the ACUTE and ABORTIVE (i.e. not prophylactic) treatment of migraines.

Question 33

Why does propofol have such a rapid onset followed by a rapid reversal?

Answer 33

Initial onset is rapid because it is lipophilic and will quickly go to/enter organs receiving high blood flow.

It subsides quickly as blood is redistributed and thus the drug is redistributed all over the body and can sit in adipose tissue, muscle, etc.

Question 34

______, a depolarizing NMB, is used for rapid-sequence intubation.

Answer 34

Succinylcholine

Question 35

What is the difference between propranolol and metoprolol?

Answer 35

Propranolol is a non-selective beta blocker

Metoprolol is beta 1 selective

Question 36

Which classes of antiarrhythmics can cause QT prolongation/torsades de pointes?

Answer 36

Class IA (quinidine, procainamide) and Class III (amiodarone, dofetilide, sotalol)

Question 37

After administration of corticosteroids, on CBC you will see _____philia due to what?

Answer 37

Neutrophilia as neutrophils “demarginate” aka leave their posts on endothelial cells. Free circulation however means they are sub-functional and thus this is one of the factors in immunosuppression secondary to corticosteroid administration.