Pharmacology: cardio, heme, MSK, immune

Question 1

NSAID types

Answer 1

Ibuprofen ect: reversible COX inhibition for the life of the enzyme (3 days)

Aspirin: irreversible COX inhibition (suicide inhibition). Block TX2 in platelets diminishing aggregations for the life of the platelets (8-9 days)

Acetominophen: reduces, not blocks, COX. COX must be oxidized to function. But works only in the brain, reducing pain but not inflammation. Also has endocannabinoid activity.

Naproxen: Aleve. Avoid in third trimester. Many interactions- SSRIs, lithium, methotrexate, etc

Indomethacin: serious drug, don’t use for aches & pains. Used for arthritites, HAs, to close PDA, to stop labor, to decrease amniotic fluid.

Ketorolac: injectable. Used for moderate-severe pain <5 days (can cause kidney damage with long-term use). Avoid with probenecid, pentoxyphilline, or use with chemo/radiation.

Diclofenac: for gout, PMS, arthritides, kidney stones. Topically for actinic keratosis.

Question 2

Clopidogrel

Answer 2

Anticoagulant. Blocks an ADP receptor on platelets, decreasing platelet aggregation.

Question 3

Heparin

Answer 3

Inactivates thrombin, factor Xa, and other proteases.

Half-life of an hour. Low-molecular weight heparin has a half-life of 4 hours.

IV/subQ only. IM will cause hematomas.

Question 4

Warfarin

Answer 4

Vitamin K antagonist.

Prevents synthesis of VK-dependent clotting factors (2, 7 9, 10) and protein C and protein S

Question 5

Enoxaparin

Answer 5

Blocks clotting factors Xa

Question 6

Dabigatron

Answer 6

Used post-surgery to prevents clots. Prevents DVT, strokes.

Blocks thrombin

Question 7

Rivaroxaban

Answer 7

Blocks factor Xa

Question 8

Alprostadil

Answer 8

Vasodilator for ED, injected into the penis

Question 9

Desmopressin

Answer 9

Synthetic ADH; works as an antidiuretic. Works on aquaporin channels in the kidney.

Used to treat von Willebrand, disease, hemophilia A, diabetes insipidus and bed wetting

Question 10

Epoetin alfa

Answer 10

Synthetic EPO, stimulate RBC production. Used to treat anemia from chemo.

Question 11

Pentoxyphilline

Answer 11

PDE-I, nonselective.

Used for intermittent claudication from PAD and hemorrhoids

Question 12

Clozapine vs clonazepam

Answer 12

Clozapine: atypical antipsychotic
Clonazepam: benzo for panic disorder

Question 13

Celecoxib

Answer 13

Selective COX-2 inhibiting NSAID.

Also has use in familial polyposis and possible mental illness (bipolar, schizophrenia).

Increased risk of MI and stroke; don’t use in anyone at risk.

Question 14

Tramadol

Answer 14

Opioid AND SNRI medication. Oral or injection.

Don’t use in pregnancy, small risk of miscarriage.

Goes through 3A4 and 2D6; don’t use with antidepressants, other opioids, trazodone, cyclopenzaprine, triptans or ergot, or amphetamines.

Question 15

Meloxicam

Answer 15

NSAID used to treat OA. COX-2 selectivity. Don’t use in heart disease.

Question 16

Diazepam

Answer 16

Valium. Benzo used to treat seizures, EtOH withdrawal, panic, eclampsia, and pre-surgery for sedation and to promote memory loss, IE, used before endoscopy.

Question 17

Colchicine

Answer 17

Used to treat gout and Behcet’s.

MOA: inhibits microtubules, mitosis, neutrophil migration, mast cell degranulation and ROS formation

SEs: rhabdomyolosis

Question 18

Allopurinol

Answer 18

Xanthine oxidase inhibitor. Gout.

Question 19

Prednisone uses?

Answer 19

Immune suppressant obviously

Also for migraines, hormone-sensitive tumors, and blood cancers (ALL, Hodgkin’s and non-Hodgkin’s, multiple myeloma)

4x as strong as hydrocortisone

Question 20

Hydrocortisone

Answer 20

Synthetic cortisol! Treatment of choice when someone’s adrenals stop making actual cortisol (adrenocorticoid insufficiency).

It is seen as strength of 1.
Dexamethasone = 40x
Prednisone = 4x

Question 21

Methocarbamol

Answer 21

Carbamate drug, MOA not totally understood. Has GABA receptor activity and side effects similar too, but not quite as serious as, benzos and barbiturates.

Used to treat MSK pain and injury.

Question 22

Tizanidine

Answer 22

MOA unclear, used to treat MSK spasms. Probably an alpha-2-agonist (like clonidine).

QT prolongation.
CYP 1A2 inhibitor, many interactions with antibiotics, anti-arrhythmics, HTN meds and levadopa

Question 23

Triamcinolone

Answer 23

Topical steroid

Question 24

Osteoporosis medications

Answer 24

Raloxifine: SERM, prevents OP, increases T in men

Alendronate: bisphosphanate, inhibits osteoclast-mediated bone resorption, tx for OP

Calcitonin: inhibits osteoclasts. Used for hypercalcemia and OP. Work against PTH and vitamin D. Increased levels in medullary thyroid cancer (in the parafollicular cells).

Denosumab: human monoclonal antibody. Prevents OP, tx bone mets. RANKL inhibitor- blocks osteoclasts.

Question 25

Red man syndrome can be caused by which antibiotic ?

Answer 25

Vancomycin. Its thrombophlebitis and flushing. Tx: Benadryl

Glycopeptide antibiotic, its in a class all to itself. Its created by a soil bacteria called A. orientalist. Usually given by IV, Staph, MRSA.

Question 26

Which antibiotics are bactericidal vs bacteriostatic?

Answer 26

Bactericidal:
Bactrim (inhibits folate synthesis)
Flouroquinolones (inhibit DNA unwinding)
Penicillins, cephalosporins (cell wall lysis)
Metronidazole (inhibits nucleic acid synthesis)
Nitrofurantoin (builds up in the bladder, breaks DNA)
Rifaximin (binds beta-subunit of RNA polymerase)
Vancomycin

Bacteriostatic:
Tetracyclines, macrolides, lincosamides (bind 30s, inhibit protein synthesis)

Question 27

Which antibiotic increases the risk of C diff colitis by 4x?

Answer 27

Clindamycine

Also: cephalosporins, fluoroquinolones.

Tx: Metronidazole, Vancomycin, or Rifaximin

Question 28

Avoid using bactrim in patients on which drugs?

Answer 28

Anything that spares K+ (ACEI, spironolactone)

Anti-arrhthmics and anything that prolongs QT

Methotrexate

Sulfonylureas (avoid w other sulfa drugs!)

And lots others

Question 29

Nitrofurantoin

Answer 29

Builds up in the bladder and breaks DNA. Bactericidal.

Used for UTIs. Brand name: Macrobid.

Question 30

Tetracycline antibiotics

Answer 30

Doxyxyxline, Minocycline.
Bacteriostatic; binds 30s subunit
Also kills protozoans

Question 31

Macrolides

Answer 31

Azithromycin, Clarithromycin, Erythromycin
Bacteriostatic; binds 30s subunit
Use in patients with penicillin allergy

Question 32

Lincosamide antibiotics

Answer 32

Clindamycin

Bacteriostatic; binds 30s subunit
Increased risk of C diff colitis

Question 33

MOA of the following Parkinson’s drugs:
Levodopa
Carbidopa
Pramipexole

Answer 33

Levodopa: synthetic L-dopa, dopamine precursor (take 30m before meals otherwise they inhibit absorption of the drug). Avoid B6 before that encourages dopamine metabolism.

Carbidopa: inhibits peripheral breakdown of levodopa

Pramipexole: dopamine agonist