Pharmacology - First Aid

Question 1

Enzyme Kinetics:

Michaelis-Menten Kinetics

Answer 1

• Km is inversely related to the affinity of the enzyme for its substrate.
• Vmax is directly proportional to the enzyme concentration.
• Most enzymatic reactions follow a hyperbolic curve (ie, Michaelis-Menten kinetics); however, enzymatic reactions that exhibit a sigmoid curve usually indicate cooperative kinetics (eg, hemoglobin).

Question 2

Enzyme Kinetics:

Lineweaver-Burk Plot

Answer 2

• ↑ y-intercept, ↓ Vmax
• The further to the right the x-intercept (ie. closer to zero), the greater the Km and the lower the affinity.
• Competitive inhibitors cross each other, whereas noncompetitive inhibitors do not.
• Kompetitive inhibitors increase Km.

Question 3

Inhibitors

Answer 3

Question 4

Inhibitors:

• resembles substrate
• overcome by ↑ [S]
• binda active site
• no effect on Vmax
• ↑ Km
• ↓ potency

Answer 4

Reversible Competitive Inhibitors

Question 5

Inhibitors:

• resembles substrate
• not overcome by ↑ [S]
• binds active site
• ↓ Vmax
• no effect on Km
• ↓ efficacy

Answer 5

Irreversible Competitive Inhibitors

Question 6

Inhibitors:

• does not resemble substrate
• not overcome by ↑ [S]
• does not bind active site
• ↓ Vmax
• no effect on Km
• ↓ efficacy

Answer 6

Noncompetitive Inhibitors

Question 7

Pharmacokinetics:

fraction of administered drug reaching systemi circulation unchanged

Answer 7

Bioavailability

Question 8

Bioavailability of IV Dose

Answer 8

F = 100%

Question 9

Bioavailability of Oral Dose

Answer 9

F typically < 100% due to incomplete absorption and first-pass metabolism

Question 10

Pharmacokinetics:

theoretical volume occupied by the total amount of drug in the body relative to its plasma concentration

Answer 10

Volume of Distribution (Vd)

• Apparent Vd of plasma protein–bound drugs can be altered by liver and kidney disease (↓ protein binding, ↑ Vd).
• Drugs may distribute in more than one compartment.

Question 11

Pharmacokinetics:

• the volume of plasma cleared of drug per unit time
• may be impaired with defects in cardiac, hepatic, or renal function

Answer 11

Clearance (CL)

Question 12

Pharmacokinetics:

the time required to change the amount of drug in the body by 1⁄2 during elimination

Answer 12

Half-Life (t1/2)

• In first-order kinetics, a drug infused at a constant rate takes 4–5 half-lives to reach steady state.
• It takes 3.3 half-lives to reach 90% of the steady-state level.

Question 13

Dosage Calculations

Answer 13

• In renal or liver disease, maintenance dose ↓ and loading dose is usually unchanged.
• Time to steady state depends primarily on t1/2 and is independent of dose and dosing frequency.

Question 14

Types of Drug Interactions:

• effect of substance A and B together is equal to the sum of their individual effects
• Aspirin
• Acetaminophen

Answer 14

Additive

Question 15

Types of Drug Interactions:

• presence of substance A is required for the full effects of substance B
• Cortisol on catecholamine responsiveness

Answer 15

Permissive

Question 16

Types of Drug Interactions:

• effect of substance A and B together is greater than the sum of their individual effects
• Clopidogrel with Aspirin

Answer 16

Synergistic

Question 17

Types of Drug Interactions:

• acute decrease in response to a drug after initial/repeated administration
• Nitrates
• Niacin
• Phenylephrine
• LSD
• MDMA

Answer 17

Tachyphylactic

Question 18

Receptor Binding

Answer 18

Question 19

Receptor Binding:

• shifts curve right (↓ potency), no change in efficacy
• can be overcome by ↑ the concentration of agonist substrate
• Diazepam (agonist) + Flumazenil (antagonist) on GABA receptor

Answer 19

Competitive Antagonist

Question 20

Receptor Binding:

• shifts curve down (↓ efficacy)
• cannot be overcome by ↑ agonist substrate concentration
• Norepinephrine (agonist) + Phenoxybenzamine (antagonist) on α-receptors

Answer 20

Noncompetitive Antagonist

Question 21

Receptor Binding:

• acts at same site as full agonist, but with lower maximal effect (↓ efficacy)
• potency is an independent variable
• Morphine (full agonist) vs. Buprenorphine (_____ agonist) at opioid μ-receptors

Answer 21

Partial Agonist

Question 22

Elimination of Drugs:

• rate of elimination is constant regardless of Cp (ie. constant amount of drug eliminated per unit time)
• Cp ↓ linearly with time
• capacity-limited elimination
• Phenytoin
• Ethanol
• Aspirin (at high or toxic concentrations)

Answer 22

Zero-Order Elimination

Question 23

Elimination of Drugs:

• rate is directly proportional to the drug concentration (ie. constant fraction of drug eliminated per unit time)
• Cp ↓ exponentially with time
• applies to most drugs
• flow-dependent elimination

Answer 23

First-Order Elimination

Question 24

Urine pH and Drug Elimination:

trapped in urine and cleared quickly

Answer 24

Ionized Species

Question 25

Urine pH and Drug Elimination: can be reabsorbed

Answer 25

Neutral Forms

Question 26

Urine pH and Drug Elimination: Weak Acids

Answer 26

* Trapped in basic environments. * Treat overdose with _sodium bicarbonate_ to alkalinize urine. * Examples: * Phenobarbital * Methotrexate * Aspirin (Salicylates)

Question 27

Urine pH and Drug Elimination: Weak Bases

Answer 27

* Trapped in acidic environments. * Treat overdose with _ammonium chloride_ to acidify urine. * TCA toxicity is generally treated with sodium bicarbonate to overcome the sodium channelblocking activity of TCAs, but not for accelerating drug elimination. * Examples: * TCAs * Amphetamines

Question 28

Drug Metabolism: * Reduction, Oxidation, Hydrolysis with cytochrome P-450 usually yield slightly polar, water-soluble metabolites (often still active). * Geriatric patients lose this phase first.

Answer 28

Phase I R-OH: * **R**eduction * **O**xidation * **H**ydrolysis

Question 29

Drug Metabolism: * Conjugation (Methylation, Glucuronidation, Acetylation, Sulfation) usually yields very polar, inactive metabolites (renally excreted). * Geriatric patients have more of this phase. * Patients who are slow acetylators have ↑ side effects from certain drugs because of ↓ rate of metabolism.

Answer 29

Phase II Geriatric patients have **M**ore **GAS** (phase II). * **M**ethylation * **G**lucuronidation * **A**cetylation * **S**ulfation

Question 30

\_\_\_\_\_ is the maximal effect a drug can produce.

Answer 30

Efficacy * Represented by the y-value (Vmax). ↑ y-value = ↑ Vmax = ↑ efficacy. * Unrelated to potency (ie. efficacious drugs can have high or low potency). * Partial agonists have less efficacy than full agonists.

Question 31

\_\_\_\_\_ is the amount of drug needed for a given effect.

Answer 31

Potency * Represented by the x-value (EC₅₀). * Left shifting = ↓ EC₅₀ = ↑ potency = ↓ drug needed. * Unrelated to efficacy (ie. potent drugs can have high or low efficacy).

Question 32

\_\_\_\_\_ is the measurement of drug safety.

Answer 32

Therapeutic Index * **TITE**: **T**herapeutic **I**ndex = **T**D₅₀ / **E**D₅₀ * Safer drugs have higher TI values. * Drugs with lower TI values frequently require monitoring (eg. **W**arfarin, **T**heophylline, **D**igoxin, **L**ithium; **W**arning! **T**hese **D**rugs are **L**ethal!). * LD₅₀ (lethal median dose) often replaces TD₅₀ in animal studies.

Question 33

\_\_\_\_\_ is the dosage range that can safely and effectively treat disease.

Answer 33

Therapeutic Window

Question 34

Central and Peripheral Nervous System

Answer 34

* Pelvic splanchnic nerves and CNs III, VII, IX and X are part of the parasympathetic nervous system. * Adrenal medulla is directly innervated by preganglionic sympathetic fibers. * Sweat glands are part of the sympathetic pathway but are innervated by cholinergic fibers.

Question 35

Acetylcholine Receptors: ligand-gated Na+/K+ channels

Answer 35

Nicotinic * NN (found in autonomic ganglia, adrenal medulla) * NM (found in neuromuscular junction of skeletal muscle)

Question 36

Acetylcholine Receptors: G-protein–coupled receptors that usually act through 2nd messengers

Answer 36

Muscarinic * M1–5 found in heart, smooth muscle, brain, exocrine glands, and on sweat glands (cholinergic sympathetic).

Question 37

G-Protein–Linked Second Messengers: * Sympathetic * G-Protein: q * ↑ vascular smooth muscle contraction * ↑ pupillary dilator muscle contraction (mydriasis) * ↑ intestinal and bladder sphincter muscle contraction

Answer 37

α1 “After **qiss**e**s** (kisses), you get a **qiq** (kick) out of **siq** (sick) **sqs** (super qinky sex).”

Question 38

G-Protein–Linked Second Messengers: * Sympathetic * G-Protein: i * ↓ sympathetic (adrenergic) outflow * ↓ insulin release * ↓ lipolysis * ↑ platelet aggregation * ↓ aqueous humor production

Answer 38

α2 “After **qiss**e**s** (kisses), you get a **qiq** (kick) out of **siq** (sick) **sqs** (super qinky sex).”

Question 39

G-Protein–Linked Second Messengers: * Sympathetic * G-Protein: s * ↑ heart rate * ↑ contractility (one heart) * ↑ renin release * ↑ lipolysis

Answer 39

β1 “After **qiss**e**s** (kisses), you get a **qiq** (kick) out of **siq** (sick) **sqs** (super qinky sex).”

Question 40

G-Protein–Linked Second Messengers: * Sympathetic * G-Protein: s * vasodilation * bronchodilation (two lungs) * ↑ lipolysis * ↑ insulin release * ↑ glycogenolysis * ↓ uterine tone (tocolysis) * ↑ aqueous humor production * ↑ cellular K+ uptake

Answer 40

β2 “After **qiss**e**s** (kisses), you get a **qiq** (kick) out of **siq** (sick) **sqs** (super qinky sex).”

Question 41

G-Protein–Linked Second Messengers: * Sympathetic * G-Protein: s * ↑ lipolysis * ↑ thermogenesis in skeletal muscle * ↑ bladder relaxation

Answer 41

β3 “After **qiss**e**s** (kisses), you get a **qiq** (kick) out of **siq** (sick) **sqs** (super qinky sex).”

Question 42

G-Protein–Linked Second Messengers: * Parasympathetic * G-Protein: q * mediates higher cognitive functions * stimulates enteric nervous system

Answer 42

M1 “After **qiss**e**s** (kisses), you get a **qiq** (kick) out of **siq** (sick) **sqs** (super qinky sex).”

Question 43

G-Protein–Linked Second Messengers: * Parasympathetic * G-Protein: i * ↓ heart rate and contractility of atria

Answer 43

M2 “After **qiss**e**s** (kisses), you get a **qiq** (kick) out of **siq** (sick) **sqs** (super qinky sex).”

Question 44

G-Protein–Linked Second Messengers: * Parasympathetic * G-Protein: q * ↑ exocrine gland secretions (eg. lacrimal, sweat, salivary, gastric acid) * ↑ gut peristalsis * ↑ bladder contraction * bronchoconstriction * ↑ pupillary sphincter muscle contraction (miosis) * ciliary muscle contraction (accommodation) * ↑ insulin release

Answer 44

M3 “After **qiss**e**s** (kisses), you get a **qiq** (kick) out of **siq** (sick) **sqs** (super qinky sex).”

Question 45

G-Protein–Linked Second Messengers: * Dopamine * G-Protein: s * relaxes renal vascular smooth muscle * activates direct pathway of striatum

Answer 45

D1 “After **qiss**e**s** (kisses), you get a **qiq** (kick) out of **siq** (sick) **sqs** (super qinky sex).”

Question 46

G-Protein–Linked Second Messengers: * Dopamine * G-Protein: i * modulates transmitter release, especially in brain * inhibits indirect pathway of striatum

Answer 46

D2 “After **qiss**e**s** (kisses), you get a **qiq** (kick) out of **siq** (sick) **sqs** (super qinky sex).”

Question 47

G-Protein–Linked Second Messengers: * Histamine * G-Protein: q * ↑ nasal and bronchial mucus production * ↑ vascular permeability * bronchoconstriction * pruritus * pain

Answer 47

H1 “After **qiss**e**s** (kisses), you get a **qiq** (kick) out of **siq** (sick) **sqs** (super qinky sex).”

Question 48

G-Protein–Linked Second Messengers: * Histamine * G-Protein: s * ↑ gastric acid secretion

Answer 48

H2 “After **qiss**e**s** (kisses), you get a **qiq** (kick) out of **siq** (sick) **sqs** (super qinky sex).”

Question 49

G-Protein–Linked Second Messengers: * Vasopressin * G-Protein: q * ↑ vascular smooth muscle contraction

Answer 49

V1 “After **qiss**e**s** (kisses), you get a **qiq** (kick) out of **siq** (sick) **sqs** (super qinky sex).”

Question 50

G-Protein–Linked Second Messengers: * Vasopressin * G-Protein: s * ↑ H2O permeability and reabsorption via upregulating aquaporin-2 in collecting twobules (tubules) of kidney

Answer 50

V2 “After **qiss**e**s** (kisses), you get a **qiq** (kick) out of **siq** (sick) **sqs** (super qinky sex).”

Question 51

G-Protein–Linked Second Messengers

Answer 51

Question 52

Autonomic Drugs

Answer 52

* Release of norepinephrine from a sympathetic nerve ending is modulated by NE itself, acting on presynaptic α2-autoreceptors → negative feedback. * Amphetamines use the NE transporter (NET) to enter the presynaptic terminal, where they utilize the vesicular monoamine transporter (VMAT) to enter neurosecretory vesicles. This displaces NE from the vesicles. * Once NE reaches a concentration threshold within the presynaptic terminal, the action of NET is reversed, and NE is expelled into the synaptic cleft, contributing to the characteristics and effects of ↑ NE observed in patients taking amphetamines.

Question 53

When using cholinomimetic agents, you should watch out for _____ in susceptible patients.

Answer 53

* exacerbation of COPD * asthma * peptic ulcers

Question 54

Cholinomimetic Agents: * direct agonist * activates bowel and bladder smooth muscle * resistant to AChE * no nicotinic activity * postoperative ileus * neurogenic ileus * urinary retention

Answer 54

Bethanechol “**Bethany**, **call** (**bethanechol**) me to activate your **b**owels and **b**ladder.”

Question 55

Cholinomimetic Agents: * direct agonist * carbon copy of acetylcholine (but resistant to AChE) * constricts pupil * relieves intraocular pressure in open-angle glaucoma

Answer 55

Carbachol **Carbachol** = **car**bon copy of **a**cetyl**chol**ine

Question 56

Cholinomimetic Agents: * direct agonist * stimulates muscarinic receptors in airway when inhaled * challenge test for diagnosis of asthma

Answer 56

Methacholine

Question 57

Cholinomimetic Agents: * direct agonist * contracts ciliary muscle of eye (open-angle glaucoma) and pupillary sphincter (closed-angle glaucoma) * resistant to AChE * can cross blood-brain barrier (tertiary amine) * potent stimulator of sweat, tears, and saliva * xerostomia (Sjögren syndrome)

Answer 57

Pilocarpine “You **cry**, **drool**, and **sweat** on your ‘**pilo**w.’ ”

Question 58

Cholinomimetic Agents: * indirect agonist (anticholinesterase) * ↑ ACh * Alzheimer disease

Answer 58

* Donepezil * Rivastigmine * Galantamine **Dona** & **Riva** dances at the **gala**.

Question 59

Cholinomimetic Agents: * indirect agonist (anticholinesterase) * ↑ ACh * historically used to diagnose myasthenia gravis * replaced by anti-AChR Ab (anti-acetylcholine receptor antibody) test

Answer 59

Edrophonium

Question 60

Cholinomimetic Agents: * indirect agonist (anticholinesterase) * ↑ ACh * postoperative and neurogenic ileus and urinary retention * myasthenia gravis * reversal of neuromuscular junction blockade (postoperative)

Answer 60

Neostigmine **Neo** CNS = **No** CNS penetration (quaternary amine).

Question 61

Cholinomimetic Agents: * indirect agonist (anticholinesterase) * ↑ ACh * antidote for anticholinergic toxicity * atropine overdose

Answer 61

Physostigmine **Ph**reely (freely) crosses blood-brain barrier → CNS (tertiary amine).

Question 62

Cholinomimetic Agents: * indirect agonist (anticholinesterase) * ↑ ACh * ↑ muscle strength * myasthenia gravis (long acting) * does not penetrate CNS (quaternary amine)

Answer 62

Pyridostigmine

Question 63

\_\_\_\_\_ is often due to organophosphates, such as parathion, that irreversibly inhibit AChE. Organophosphates are often components of insecticides; poisoning usually seen in farmers.

Answer 63

Cholinesterase Inhibitor Poisoning

Question 64

Symptoms of Cholinesterase Inhibitor Poisoning

Answer 64

**DUMBBELSS** * **D**iarrhea * **U**rination * **M**iosis * **B**ronchospasm * **B**radycardia * **E**mesis * **L**acrimation * **S**weating * **S**alivation \*may lead to respiratory failure if untreated

Question 65

\_\_\_\_\_ is the antidote for cholinesterase inhibitor poisoning.

Answer 65

Atropine (competitive inhibitor) + Pralidoxime (regenerates AChE if given early)

Question 66

Muscarinic Antagonists: * eye * mydriasis * cycloplegia

Answer 66

* Atropine * Homatropine * Tropicamide

Question 67

Muscarinic Antagonists: * CNS * Parkinson disease * acute dystonia

Answer 67

* Benztropine * Trihexyphenidyl **Park** my **Benz**.

Question 68

Muscarinic Antagonists: * GI * respiratory * Parenteral: preoperative use to reduce airway secretions * Oral: drooling, peptic ulcer

Answer 68

Glycopyrrolate

Question 69

Muscarinic Antagonists: * GI * antispasmodics for irritable bowel syndrome

Answer 69

* Hyoscyamine * Dicyclomine

Question 70

Muscarinic Antagonists: * respiratory * COPD * asthma

Answer 70

* Ipratropium * Tiotropium

Question 71

Muscarinic Antagonists: * genitourinary * reduce bladder spasms * urge urinary incontinence (overactive bladder)

Answer 71

* Oxybutynin * Solifenacin * Tolterodine

Question 72

Muscarinic Antagonists: * CNS * motion sickness

Answer 72

Scopolamine

Question 73

\_\_\_\_\_ is a muscarinic antagonist used to treat bradycardia and for ophthalmic applications. It blocks DUMBBeLSS in cholinesterase inhibitor poisoning. Does not block excitation of skeletal muscle and CNS (mediated by nicotinic receptors).

Answer 73

Atropine

Question 74

Atropine Effects: Eye

Answer 74

* ↑ pupil dilation * cycloplegia

Question 75

Atropine Effects: Airway

Answer 75

* bronchodilation * ↓ secretions

Question 76

Atropine Effects: Stomach

Answer 76

↓ acid secretion

Question 77

Atropine Effects: Gut

Answer 77

↓ motility

Question 78

Atropine Effects: Bladder

Answer 78

↓ urgency in cystitis

Question 79

Adverse Effects of Atropine

Answer 79

* *Hot** as a hare * *Dry** as a bone * *Red** as a beet * *Blind** as a bat * *Mad** as a hatter * *Full** as a flask * ↑ body temperature (due to ↓ sweating) * rapid pulse * dry mouth * dry, flushed skin * cycloplegia * constipation * disorientation * Can cause acute angle-closure glaucoma in elderly (due to mydriasis), urinary retention in men with prostatic hyperplasia, and hyperthermia in infants.

Question 80

\_\_\_\_\_ causes gardener’s pupil (mydriasis due to plant alkaloids).

Answer 80

Jimson weed (*Datura*)

Question 81

Direct Sympathomimetics: * β2 \> β1 * acute asthma * COPD

Answer 81

Albuterol

Question 82

Direct Sympathomimetics: * β2 \> β1 * long-term asthma * COPD

Answer 82

Salmeterol

Question 83

Direct Sympathomimetics: * β2 \> β1 * bronchospasm in asthma * tocolysis

Answer 83

Terbutaline

Question 84

Direct Sympathomimetics: * β1 \> β2, α * heart failure * cardiogenic shock (inotropic \> chronotropic) * cardiac stress testing

Answer 84

Dobutamine

Question 85

Direct Sympathomimetics: * D1 = D2 \> β \> α * unstable bradycardia * heart failure * shock * inotropic and chronotropic effects at lower doses due to β effects * vasoconstriction at high doses due to α effects

Answer 85

Dopamine

Question 86

Direct Sympathomimetics: * β \> α * anaphylaxis * asthma * open-angle glaucoma * α effects predominate at high doses * significantly stronger effect at β2-receptor than norepinephrine

Answer 86

Epinephrine

Question 87

Direct Sympathomimetics: * D1 * postoperative hypertension * hypertensive crisis * vasodilator (coronary, peripheral, renal, and splanchnic) * promotes natriuresis * can cause hypotension and tachycardia

Answer 87

Fenoldopam

Question 88

Direct Sympathomimetics: * β1 = β2 * electrophysiologic evaluation of tachyarrhythmias * can worsen ischemia * has negligible α effect

Answer 88

Isoproterenol

Question 89

Direct Sympathomimetics: * α1 * autonomic insufficiency and postural hypotension * may exacerbate supine hypertension

Answer 89

Midodrine

Question 90

Direct Sympathomimetics: * β3 * urinary urge incontinence or overactive bladder

Answer 90

Mirabegron

Question 91

Direct Sympathomimetics: * α1 \> α2 \> β1 * hypotension * septic shock

Answer 91

Norepinephrine

Question 92

Direct Sympathomimetics: * α1 \> α2 * hypotension (vasoconstrictor) * ocular procedures (mydriatic) * rhinitis (decongestant) * ischemic priapism

Answer 92

Phenylephrine

Question 93

Indirect Sympathomimetics: * indirect general agonist * reuptake inhibitor * releases stored catecholamines

Answer 93

Amphetamine

Question 94

Indirect Sympathomimetics: * indirect general agonist * reuptake inhibitor * causes vasoconstriction and local anesthesia * caution when giving β-blockers if intoxication is suspected (can lead to unopposed α1 activation, activation → extreme hypertension, coronary vasospasm).

Answer 94

Cocaine

Question 95

Indirect Sympathomimetics: * indirect general agonist * releases stored catecholamines * nasal decongestion (pseudoephedrine) * urinary incontinence * hypotension

Answer 95

Ephedrine

Question 96

Norepinephrine vs. Isoproterenol

Answer 96

* NE ↑ systolic and diastolic pressures as a result of α1-mediated vasoconstriction → ↑ mean arterial pressure → reflex bradycardia. * Isoproterenol (rarely used) has little α effect but causes β2-mediated vasodilation, resulting in ↓mean arterial pressure and ↑ heart rate through β1 and reflex activity.

Question 97

Sympatholytics (α2-agonists): * Applications: * hypertensive urgency (limited situations) * ADHD * Tourette syndrome * symptom control in opioid withdrawal * Adverse Effects: * CNS depression * bradycardia * hypotension * respiratory depression * miosis * rebound * hypertension with abrupt cessation

Answer 97

* Clonidine * Guanfacine

Question 98

Sympatholytics (α2-agonists): * Applications: * hypertension in pregnancy * Adverse Effects: * direct Coombs ⊕ hemolysis * drug-induced lupus

Answer 98

α-methyldopa

Question 99

Sympatholytics (α2-agonists): * Applications: * relief of spasticity * Adverse Effects: * hypotension * weakness * xerostomia

Answer 99

Tizanidine

Question 100

α-Blockers: * nonselective * irreversible * Applications: * pheochromocytoma (used preoperatively) to prevent catecholamine (hypertensive) crisis * Adverse Effects: * orthostatic hypotension * reflex tachycardia

Answer 100

Phenoxybenzamine

Question 101

α-Blockers: * nonselective * reversible * Applications: * give to patients on MAO inhibitors who eat tyramine-containing foods and for severe cocaine-induced hypertension (2nd line) * Adverse Effects: * orthostatic hypotension * reflex tachycardia

Answer 101

Phentolamine

Question 102

α-Blockers: * α1 selective * Applications: * urinary symptoms of BPH * PTSD (prazosin) * hypertension (except tamsulosin) * Adverse Effects: * 1st-dose orthostatic hypotension, dizziness, headache

Answer 102

* Prazosin * Terazosin * Doxazosin * Tamsulosin

Question 103

α-Blockers: * α2 selective * Applications: * depression * Adverse Effects: * sedation * ↑ serum cholesterol * ↑ appetite

Answer 103

Mirtazapine

Question 104

Effects of α-Blocker on BP Responses to Epinephrine and Phenylephrine

Answer 104

* Epinephrine response exhibits reversal of mean arterial pressure from a net increase (the α response) to a net decrease (the β2 response). properties). * Phenylephrine response is suppressed but not reversedbecause it is a “pure” α-agonist (lacks β-agonist properties).

Question 105

β-Blockers

Answer 105

* Acebutolol * Atenolol * Betaxolol * Bisoprolol * Carvedilol * Esmolol * Labetalol * Metoprolol * Nadolol * Nebivolol * Pindolol * Propranolol * Timolol

Question 106

β-Blocker Applications: ↓ heart rate and contractility, resulting in ↓ O₂ consumption

Answer 106

Angina Pectoris

Question 107

β-Blocker Applications: ↓ production of aqueous humor

Answer 107

Glaucoma * Timolol

Question 108

β-Blocker Applications: ↓ mortality

Answer 108

* Heart Failure * Bisoprolol * Carvedilol * Metoprolol * Myocardial Infarction

Question 109

β-Blocker Applications: * ↓ cardiac output * ↓ renin secretion (due to β1-receptor blockade on JGA cells)

Answer 109

Hypertension

Question 110

β-Blocker Applications: * symptom control (↓ heart rate, ↓ tremor), * thyroid storm

Answer 110

Hyperthyroidism * Propranolol

Question 111

β-Blocker Applications: ↓ heart rate → ↑ filling time, relieving obstruction

Answer 111

Hypertrophic Cardiomyopathy

Question 112

β-Blocker Applications: ↓ AV conduction velocity (class II antiarrhythmic)

Answer 112

Supraventricular Tachycardia * Metoprolol * Esmolol

Question 113

β-Blocker Applications: * ↓ hepatic venous pressure gradient * portal hypertension (prophylactic use)

Answer 113

Variceal Bleeding * Nadolol * Propranolol * Carvedilol

Question 114

Adverse Effects of β-Blockers

Answer 114

* erectile dysfunction * cardiovascular (bradycardia, AV block, HF) * CNS (seizures, sleep alterations) * dyslipidemia (metoprolol) * asthma/COPD exacerbations * use with caution in cocaine users due to risk of unopposed α-adrenergic receptor agonist activity

Question 115

β-Blocker Selectivity: β1-Selective Antagonists (β1 \> β2)

Answer 115

* Acebutolol (partial agonist) * Atenolol * Betaxolol * Bisoprolol * Esmolol * Metoprolol Selective antagonists mostly go from **A** to **M** (β**1** with **1**st half of alphabet)

Question 116

β-Blocker Selectivity: Nonselective Antagonists (β1 = β2)

Answer 116

* Nadolol * Pindolol (partial agonist) * Propranolol * Timolol Nonselective antagonists mostly go from **N** to **Z** (β**2** with **2**nd half of alphabet)

Question 117

β-Blocker Selectivity: Nonselective α- and β-Antagonists

Answer 117

* Carvedilol * Labetalol Nonselective α- and β-antagonists have **modified suffixes** (instead of “-olol”).

Question 118

\_\_\_\_\_ combines cardiac-selective β1‑adrenergic blockade with stimulation of β3‑receptors (activate nitric oxide synthase in the vasculature and ↓ SVR).

Answer 118

Nebivolol **N**ebiv**o**lol increases **NO**.

Question 119

Ingested Seafood Toxins

Answer 119

* **H**istamine (Scombroid poisoning)—**H**istamine release * **T**etrodotoxin—**T**otal block of Na⁺ channels * **C**iguatoxin—opening of Na⁺ channels to **C**ause depolarization

Question 120

Ingested Seafood Toxins: * spoiled dark-meat fish such as tuna, mahimahi, mackerel, and bonito * bacterial histidine decarboxylase converts histidine to histamine * frequently misdiagnosed as fish allergy * mimics anaphylaxis: acute burning sensation of mouth, flushing of face, erythema, urticaria, itching * may progress to bronchospasm, angioedema, and hypotension * treated with antihistamines, Albuterol and Epinephrine if needed

Answer 120

Histamine (Scombroid poisoning)

Question 121

Ingested Seafood Toxins: * pufferfish * highly potent toxin * binds fast voltage-gated Na⁺ channels in cardiac/nerve tissue, preventing depolarization * nausea, diarrhea, paresthesias, weakness, dizziness, loss of reflexes * supportive therapy

Answer 121

Tetrodotoxin

Question 122

Ingested Seafood Toxins: * reef fish such as barracuda, snapper, and moray eel * opens Na⁺ channels, causing depolarization * nausea, vomiting, diarrhea; perioral numbness * reversal of hot and cold sensations * bradycardia, heart block, hypotension * supportive therapy

Answer 122

Ciguatoxin

Question 123

\_\_\_\_\_ is a widely used criteria developed to reduce potentially inappropriate prescribing and harmful polypharmacy in the geriatric population. Includes \> 50 medications that should be avoided in elderly patients due to ↓ efficacy and/or ↑ risk of adverse events.

Answer 123

Beers Criteria * α-Blockers (↑ risk of hypotension) * Anticholinergics, Antidepressants, Antihistamines, Opioids (↑ risk of delirium, sedation, falls, constipation, urinary retention) * Benzodiazepines (↑ risk of delirium, sedation, falls) * NSAIDs (↑ risk of GI bleeding, especially with concomitant anticoagulation) * PPIs (↑ risk of *C. difficile* infection)

Question 124

Antidotes: Acetaminophen

Answer 124

N-acetylcysteine (replenishes glutathione)

Question 125

Antidotes: * AChE Inhibitors * Organophosphates

Answer 125

Atropine \> Pralidoxime

Question 126

Antidotes: * Antimuscarinic agents * Anticholinergic agents

Answer 126

* Physostigmine * control hyperthermia

Question 127

Antidotes: Arsenic

Answer 127

* Dimercaprol * Succimer

Question 128

Antidotes: Benzodiazepines

Answer 128

Flumazenil

Question 129

Antidotes: β-blockers

Answer 129

* Atropine * Glucagon

Question 130

Antidotes: Carbon Monoxide

Answer 130

* 100% O₂ * Hyperbaric O₂

Question 131

Antidotes: Copper

Answer 131

* Penicillamine (**copper penny**) * Trientine

Question 132

Antidotes: Cyanide

Answer 132

* Nitrite * Thiosulfate * Hydroxocobalamin

Question 133

Antidotes: Digitalis (Digoxin)

Answer 133

Anti-dig Fab fragments

Question 134

Antidotes: Heparin

Answer 134

Protamine Sulfate

Question 135

Antidotes: Iron

Answer 135

* Deferoxamine * Deferasirox * Deferiprone

Question 136

Antidotes: Lead

Answer 136

* EDTA * Dimercaprol * Succimer * Penicillamine

Question 137

Antidotes: Mercury

Answer 137

* Dimercaprol * Succimer

Question 138

Antidotes: * Methanol * Ethylene Glycol (antifreeze)

Answer 138

* Fomepizole \> Ethanol * Dialysis

Question 139

Antidotes: Methemoglobin

Answer 139

* Methylene Blue * Vitamin C (reducing agent)

Question 140

Antidotes: Opioids

Answer 140

Naloxone

Question 141

Antidotes: Salicylates

Answer 141

* NaHCO₃ (alkalinize urine) * dialysis

Question 142

Antidotes: TCAs

Answer 142

NaHCO₃ (stabilizes cardiac cell membrane)

Question 143

Antidotes: Warfarin

Answer 143

* Vitamin K (delayed effect) * fresh frozen plasma (immediate)

Question 144

Drug Reactions—Cardiovascular: coronary vasospasm

Answer 144

**CASE** * **C**ocaine * **A**mphetamines * **S**umatriptan * **E**rgot Alkaloids

Question 145

Drug Reactions—Cardiovascular: cutaneous flushing

Answer 145

Flushed from **VANCEN** (dancing): * **V**ancomycin * **A**denosine * **N**iacin * **C**a²⁺ Channel Blockers * **E**chinocandins * **N**itrates

Question 146

Drug Reactions—Cardiovascular: dilated cardiomyopathy

Answer 146

Anthracyclines * **D**oxorubicin * **D**aunorubicin \*prevented with **D**exrazoxane

Question 147

Drug Reactions—Cardiovascular: torsades de pointes

Answer 147

Prolong QT Interval (**ABCDE**): * anti**A**rrhythmics (class IA, III) * anti**B**iotics (eg. macrolides) * anti“**C**”ychotics (eg. haloperidol) * anti**D**epressants (eg. TCAs) * anti**E**metics (eg. ondansetron)

Question 148

Drug Reactions—Endocrine/Reproductive: adrenocortical insufficiency

Answer 148

HPA suppression 2° to glucocorticoid withdrawal

Question 149

Drug Reactions—Endocrine/Reproductive: diabetes insipidus

Answer 149

* Lithium * Demeclocycline

Question 150

Drug Reactions—Endocrine/Reproductive: hot flashes

Answer 150

SERMs * Tamoxifen * Clomiphene * Raloxifene

Question 151

Drug Reactions—Endocrine/Reproductive: hyperglycemia

Answer 151

**T**he **P**eople **N**eed **H**ard **C**andies: * **T**acrolimus * **P**rotease Inhibitors * **N**iacin * **H**CTZ * **C**orticosteroids

Question 152

Drug Reactions—Endocrine/Reproductive: hyperprolactinemia

Answer 152

* Typical Antipsychotics (eg. haloperidol) * Atypical Antipsychotics (eg. quetiapine) * Metoclopramide * Methyldopa \*presents with hypogonadism (eg. infertility, amenorrhea, erectile dysfunction) and galactorrhea (more common in men)

Question 153

Drug Reactions—Endocrine/Reproductive: hyperthyroidism

Answer 153

* Lithium * Amiodarone

Question 154

Drug Reactions—Endocrine/Reproductive: hypothyroidism

Answer 154

I **AM** **SU**ddenly **L**ethargic: * **AM**iodarone * **SU**lfonamides * **L**ithium

Question 155

Drug Reactions—Endocrine/Reproductive: SIADH

Answer 155

**C**an’t **C**oncentrate **S**erum **S**odium: * **C**arbamazepine * **C**yclophosphamide * **SS**RIs

Question 156

Drug Reactions—Gastrointestinal: * acute cholestatic hepatitis * jaundice

Answer 156

Macrolides (eg. Erythromycin)

Question 157

Drug Reactions—Gastrointestinal: diarrhea

Answer 157

* Acamprosate * Antidiabetic Agents (eg. Acarbose, Metformin, Pramlintide) * Colchicine * Cholinesterase Inhibitors * Lipid-Lowering Agents (eg. Ezetimibe, Orlistat) * Macrolides (eg. Erythromycin) * Quinidine * SSRIs

Question 158

Drug Reactions—Gastrointestinal: focal to massive hepatic necrosis

Answer 158

Liver “**HAVAc**” * **H**alothane * **A**manita phalloides (death cap mushroom) * **V**alproic Acid * **Ac**etaminophen

Question 159

Drug Reactions—Gastrointestinal: hepatitis

Answer 159

* Rifampin * Isoniazid * Pyrazinamide * Statins * Fibrates

Question 160

Drug Reactions—Gastrointestinal: pancreatitis

Answer 160

**D**rugs **C**ausing **A** **V**iolent **A**bdominal **D**istress: * **D**idanosine * **C**orticosteroids * **A**lcohol * **V**alproic Acid * **A**zathioprine * **D**iuretics (Furosemide, HCTZ)

Question 161

Drug Reactions—Gastrointestinal: pill-induced esophagitis

Answer 161

* Bisphosphonates * Ferrous Sulfate * NSAIDs * Potassium Chloride * Tetracyclines \*caustic effect minimized with upright posture and adequate water ingestion

Question 162

Drug Reactions—Gastrointestinal: pseudomembranous colitis

Answer 162

* Ampicillin * Cephalosporins * Clindamycin * Fluoroquinolones \*sntibiotics predispose to superinfection by resistant *C. difficile*

Question 163

Drug Reactions—Hematologic: agranulocytosis

Answer 163

**C**an **C**ause **P**retty **M**ajor **C**ollapse of **G**ranulocytes: * **C**lozapine * **C**arbamazepine * **P**ropylthiouracil * **M**ethimazole * **C**olchicine * **G**anciclovir

Question 164

Drug Reactions—Hematologic: aplastic anemia

Answer 164

**C**an’t **M**ake **N**ew **B**lood **C**ells **P**roperly: * **C**arbamazepine * **M**ethimazole * **N**SAIDs * **B**enzene * **C**hloramphenicol * **P**ropylthiouracil

Question 165

Drug Reactions—Hematologic: direct Coombs positive hemolytic anemia

Answer 165

**P**. **D**iddy **C**oombs: * **P**enicillin * Methyl**D**opa * **C**ephalosporins

Question 166

Drug Reactions—Hematologic: drug reaction with eosinophilia and systemic symptoms (DRESS)

Answer 166

* Allopurinol * Anticonvulsants * Antibiotics * Sulfa Drugs

Question 167

\_\_\_\_\_ is a potentially fatal delayed hypersensitivity reaction. Latency period (2–8 weeks) followed by fever, morbilliform skin rash, and frequent multiorgan involvement. Treatment: withdrawal of offending drug, corticosteroids.

Answer 167

DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms)

Question 168

Drug Reactions—Hematologic: gray baby syndrome

Answer 168

Chloramphenicol

Question 169

Drug Reactions—Hematologic: hemolysis in G6PD deficiency

Answer 169

Hemolysis **IS D PAIN**: * **I**soniazid * **S**ulfonamides * **D**apsone * **P**rimaquine * **A**spirin * **I**buprofen * **N**itrofurantoin

Question 170

Drug Reactions—Hematologic: megaloblastic anemia

Answer 170

You’re **h**aving a **mega** **blast** with **PMS**. * **H**ydroxyurea * **P**henytoin * **M**ethotrexate * **S**ulfa Drugs

Question 171

Drug Reactions—Hematologic: thrombocytopenia

Answer 171

**H**elp! **V**ery **L**ow platelets! * **H**eparin * **V**ancomycin * **L**inezolid

Question 172

Drug Reactions—Hematologic: thrombotic complications

Answer 172

* Combined Oral Contraceptives * Hormone Replacement Therapy * SERMs (eg. Tamoxifen, Raloxifene, Clomiphene) \*estrogen-mediated side effect

Question 173

Drug Reactions—Musculoskeletal/Skin/Connective Tissue: drug-induced lupus

Answer 173

Having lupus is **M**ega “**SHIPP**-**E**” * **M**ethyldopa * **S**ulfa Drugs * **H**ydralazine * **I**soniazid * **P**rocainamide * **P**henytoin * **E**tanercept

Question 174

Drug Reactions—Musculoskeletal/Skin/Connective Tissue: fat redistribution

Answer 174

Fat **PIG**: * **P**rotease **I**nhibitors * **G**lucocorticoids

Question 175

Drug Reactions—Musculoskeletal/Skin/Connective Tissue: gingival hyperplasia

Answer 175

**C**an **C**ause **P**uffy **G**ums * **C**yclosporine * **C**a²⁺ Channel Blockers * **P**henytoin

Question 176

Drug Reactions—Musculoskeletal/Skin/Connective Tissue: hyperuricemia (gout)

Answer 176

**P**ainful **T**ophi and **F**eet **N**eed **C**are. * **P**yrazinamide * **T**hiazides * **F**urosemide * **N**iacin * **C**yclosporine

Question 177

Drug Reactions—Musculoskeletal/Skin/Connective Tissue: myopathy

Answer 177

* Statins * Fibrates * Niacin * Colchicine * Daptomycin * Hydroxychloroquine * Interferon-α * Penicillamine * Glucocorticoids

Question 178

Drug Reactions—Musculoskeletal/Skin/Connective Tissue: osteoporosis

Answer 178

* Corticosteroids * Depot Medroxyprogesterone Acetate * GnRH Agonists * Aromatase Inhibitors * Anticonvulsants * Heparin * PPIs

Question 179

Drug Reactions—Musculoskeletal/Skin/Connective Tissue: photosensitivity

Answer 179

**SAT** **F**or **photo**: * **S**ulfonamides * **A**miodarone * **T**etracyclines * 5-**F**U

Question 180

Drug Reactions—Musculoskeletal/Skin/Connective Tissue: rash (Stevens-Johnson syndrome)

Answer 180

**Steven Johnson** has **epileptic all**ergy to **sulfa drugs** and **penicillin**. * Anti-**Epileptic** drugs (Lamotrigine) * **All**opurinol * **Sulfa Drugs** * **Penicillin**

Question 181

Drug Reactions—Musculoskeletal/Skin/Connective Tissue: teeth discoloration

Answer 181

Tetracyclines **Teeth**racyclines

Question 182

Drug Reactions—Musculoskeletal/Skin/Connective Tissue: tendon and cartilage damage

Answer 182

Fluoroquinolones

Question 183

Drug Reactions—Neurologic: cinchonism

Answer 183

* Quinidine * Quinine \*can present with tinnitus, hearing/vision loss, psychosis, and cognitive impairment

Question 184

Drug Reactions—Neurologic: Parkinson-like syndrome

Answer 184

cogwheel rigidity of **ARM**: * **A**ntipsychotics * **R**eserpine * **M**etoclopramide

Question 185

Drug Reactions—Neurologic: peripheral neuropathy

Answer 185

* Phenytoin * Vincristine

Question 186

Drug Reactions—Neurologic: pseudotumor cerebri

Answer 186

* Growth Hormones * Tetracyclines * Vitamin A

Question 187

Drug Reactions—Neurologic: seizures

Answer 187

With **seizures**, **I BITE** my tongue. * Isoniazid (vitamin B6 deficiency) * Bupropion * Imipenem/Cilastatin * Tramadol * Enflurane

Question 188

Drug Reactions—Neurologic: tardive dyskinesia

Answer 188

* Antipsychotics * Metoclopramide

Question 189

Drug Reactions—Neurologic: visual disturbance

Answer 189

**T**hese **D**rugs **I**rritate **V**ery **P**recious **E**yes: * **T**opiramate (blurred vision/diplopia, haloes) * **D**igoxin (yellow-tinged vision) * **I**soniazid (optic neuropathy/color vision changes) * **V**igabatrin (bilateral visual field defects) * **P**DE-5 inhibitors (blue-tinged vision) * **E**thambutol (color vision changes)

Question 190

Drug Reactions—Renal/Genitourinary: Fanconi syndrome

Answer 190

* Cisplatin * Ifosfamide * expired Tetracyclines * Tenofovir

Question 191

Drug Reactions—Renal/Genitourinary: hemorrhagic cystitis

Answer 191

* Cyclophosphamide * Ifosfamide \*prevent by coadministering with Mesna

Question 192

Drug Reactions—Renal/Genitourinary: interstitial nephritis

Answer 192

* Penicillins * Furosemide * NSAIDs * Proton Pump Inhibitors * Sulfa Drugs

Question 193

Drug Reactions—Respiratory: dry cough

Answer 193

ACE Inhibitors

Question 194

Drug Reactions—Respiratory: pulmonary fibrosis

Answer 194

**M**y **N**ose **C**annot **B**reathe **B**ad **A**ir. * **M**ethotrexate * **N**itrofurantoin * **C**armustine * **B**leomycin * **B**usulfan * **A**miodarone

Question 195

Drug Reactions—Multiorgan: antimuscarinic

Answer 195

* Atropine * TCAs * H1-Blockers * Antipsychotics

Question 196

Drug Reactions—Multiorgan: Disulfiram-like reaction

Answer 196

**S**orry **P**als, **C**an’t **G**o **M**ingle. * 1st-Generation **S**ulfonylureas * **P**rocarbazine * **C**ephalosporins * **G**riseofulvin * **M**etronidazole

Question 197

Drug Reactions—Multiorgan: nephrotoxicity/ototoxicity

Answer 197

**L**isten **A**nd **P**ee **V**ery **TER**ri**B**ly: * **L**oop Diuretics * **A**minoglycosides * Cis**P**latin * **V**ancomycin * Ampho**TER**icin **B** \*Cisplatin toxicity may respond to amifostine

Question 198

Drugs affecting pupil size: ↑ pupil size (mydriasis)

Answer 198

* Anticholinergics (atropine, TCA, tropicamide, scopolamine, antihistamines) * Drugs of Abuse (amphetamines, cocaine, LSD) * Sympathomimetics

Question 199

Drugs affecting pupil size: ↓ pupil size (miosis)

Answer 199

* Antipsychotics (haloperidol, risperidone, olanzapine) * Drugs of Abuse (eg. heroin/opioids) * Parasympathomimetics (pilocarpine) * Organophosphates

Question 200

Cytochrome P-450 Inducers (+)

Answer 200

**M**ost **chronic alcoholics** **St**eal **Phen**-**Phen** and **Nev**er **Ref**use **Greas**y **Carb**s. * **M**odafinil * **Chronic Alcohol U**se * **St**. John’s Wort * **Phen**ytoin * **Phen**obarbital * **Nev**irapine * **Rif**ampin * **Gris**eofulvin * **Carb**amazepine

Question 201

Cytochrome P-450 Substrates

Answer 201

**A**lways **T**hink **W**hen **O**utdoors: * **A**nti-Epileptics * **T**heophylline * **W**arfarin * **O**CPs

Question 202

Cytochrome P-450 Inhibitors (–)

Answer 202

**SICKFACES**.**COM** (when I **A**m drinking **grapefruit juice**): * **S**odium Valproate * **I**soniazid * **C**imetidine * **K**etoconazole * **F**luconazole * **A**cute Alcohol Abuse * **C**hloramphenicol * **E**rythromycin/Clarithromycin * **S**ulfonamides * **C**iprofloxacin * **O**meprazole * **M**etronidazole * **Am**iodarone * **Grapefruit Juice**

Question 203

Sulfa Drugs

Answer 203

**S**cary **S**ulfa **P**harm **FACTS**: * **S**ulfonamide Antibiotics * **S**ulfasalazine * **P**robenecid * **F**urosemide * **A**cetazolamide * **C**elecoxib * **T**hiazides * **S**ulfonylureas

Question 204

Patients with sulfa allergies may develop \_\_\_\_\_. Symptoms range from mild to life threatening.

Answer 204

* fever * urinary tract infection * Stevens-Johnson syndrome * hemolytic anemia * thrombocytopenia * agranulocytosis * acute interstitial nephritis * urticaria (hives)

Question 205

Antimicrobials: ergosterol synthesis inhibitor

Answer 205

-azole Ketocon**azole**

Question 206

Antimicrobials: antiparasitic/antihelminthic

Answer 206

-bendazole Me**bendazole**

Question 207

Antimicrobials: transpeptidase (penicillin-binding protein)

Answer 207

-cillin Ampi**cillin**

Question 208

Antimicrobials: protein synthesis inhibitor

Answer 208

-cycline Tetra**cycline**

Question 209

Antimicrobials: neuraminidase inhibitor

Answer 209

-ivir Oseltam**ivir**

Question 210

Antimicrobials: protease inhibitor

Answer 210

-navir Rito**navir**

Question 211

Antimicrobials: DNA polymerase inhibitor

Answer 211

-ovir Acycl**ovir**

Question 212

Antimicrobials: macrolide antibiotic

Answer 212

-thromycin Azit**hromycin**

Question 213

CNS Drugs: inhalational general anesthetic

Answer 213

-ane Haloth**ane**

Question 214

CNS Drugs: typical antipsychotic

Answer 214

-azine Thiorid**azine**

Question 215

CNS Drugs: barbiturate

Answer 215

-barbital Pheno**barbital**

Question 216

CNS Drugs: local anesthetic

Answer 216

-caine Lido**caine**

Question 217

CNS Drugs: TCA

Answer 217

* -ipramine * -triptyline Im**ipramine** Ami**triptyline**

Question 218

CNS Drugs: 5-HT_1B/1D Agonist

Answer 218

-triptan Suma**triptan**

Question 219

CNS Drugs: benzodiazepine

Answer 219

* -zepam * -zolam Dia**zepam** Alpra**zolam**

Question 220

Autonomic Drugs: cholinergic agonist

Answer 220

-chol Bethane**chol** Carba**chol**

Question 221

Autonomic Drugs: nondepolarizing paralytics

Answer 221

* -curium * -curonium Atra**curium** Ve**curonium**

Question 222

Autonomic Drugs: β-blocker

Answer 222

-olol Propran**olol**

Question 223

Autonomic Drugs: AChE inhibitor

Answer 223

-stigmine Neo**stigmine**

Question 224

Autonomic Drugs: β2-agonist

Answer 224

-terol Albu**terol**

Question 225

Autonomic Drugs: α1-antagonist

Answer 225

-zosin Pra**zosin**

Question 226

Cardiovascular Drugs: PDE-5 inhibitor

Answer 226

-afil Silden**afil**

Question 227

Cardiovascular Drugs: dihydropyridine Ca²⁺ channel blocker

Answer 227

-dipine Amlo**dipine**

Question 228

Cardiovascular Drugs: ACE inhibitor

Answer 228

-pril Capto**pril**

Question 229

Cardiovascular Drugs: angiotensin-II receptor blocker

Answer 229

-sartan Lo**sartan**

Question 230

Cardiovascular Drugs: direct factor Xa inhibitor

Answer 230

-xaban Api**xaban** Edo**xaban** Rivaro**xaban**

Question 231

Drugs: bisphosphonate

Answer 231

-dronate Alen**dronate**

Question 232

Drugs: DPP-4 inhibitors

Answer 232

-gliptin Sita**gliptin**

Question 233

Drugs: PPAR-γ activator

Answer 233

-glitazone Rosi**glitazone**

Question 234

Drugs: calcineurin inhibitor

Answer 234

-limus Evero**limus** Tacro**limus**

Question 235

Drugs: proton pump inhibitor

Answer 235

-prazole Ome**prazole**

Question 236

Drugs: prostaglandin analog

Answer 236

-prost Latano**prost**

Question 237

Drugs: endothelin receptor antagonist

Answer 237

-sentan Bo**sentan**

Question 238

Drugs: H2-antagonist

Answer 238

-tidine Cime**tidine**

Question 239

Drugs: pituitary hormone

Answer 239

-tropin Somato**tropin**

Question 240

Monoclonal Antibodies: chimeric human-mouse monoclonal Ab

Answer 240

-ximab Ritu**ximab**

Question 241

Monoclonal Antibodies: humanized mouse monoclonal Ab

Answer 241

-zumab Bevaci**zumab**

Question 242

Monoclonal Antibodies: human monoclonal Ab

Answer 242

-mumab Ipili**mumab**

Question 243

Small Molecule Inhibitors: tyrosine kinase inhibitor

Answer 243

-tinib Ima**tinib**

Question 244

Small Molecule Inhibitors: proteasome inhibitor

Answer 244

-zomib Borte**zomib**

Question 245

Small Molecule Inhibitors: cyclin-dependent kinase inhibitor

Answer 245

-ciclib Palbo**ciclib**

Question 246

Receptor Fusion Proteins: TNF-α antagonist

Answer 246

-cept Etaner**cept**

Question 247

Interleukin Receptor Modulators: IL-2 agonist/analog

Answer 247

-leukin Aldes**leukin**

Question 248

Interleukin Receptor Modulators: interleukin receptor antagonist

Answer 248

-kinra Ana**kinra**